We can’t miss the daily digest of confusion over how our healthcare system is – once again – being overhauled to fit the agenda of the ruling political party in the US. Proposed revisions to the Affordable Care Act are certain to slash coverage for millions, and for some people, that’s okay.
For the rest of us on the bottom rung of the socio-economic ladder, however, we are once again left to fend for ourselves. But this is nothing new, and this debate will likely continue into the next century. In the meantime, real people are experiencing lapses in coverage, cancellation, and rising rates. All this has a direct impact on the overall health of this country:
According to the Washington Post:
A study of the aftermath of insurance expansion due to health care reform in Massachusetts found that among people between 20 and 64 years of age, there was a significant drop in mortality: 8 fewer deaths per 100,000 adults. Another Massachusetts study found that after health care reform, residents got more preventive care and reported better health.
Research examining the expansion of Medicaid to pregnant women in the 1980s and 90s found that insurance coverage was associated with less infant and child mortality.
And USA Today, in their report on the healthiest countries in the world, found:
The quality of a nation’s infrastructure and health system are closely related to a low prevalence of disease. Doctors were far more available in the healthiest countries than in the least healthy ones, for example. The prevalence of physicians in seven of the healthiest countries was at least double the global ratio of 1.52 physicians per 1,000 people. In all of the least healthy countries, on the other hand, there was less than one doctor per 1,000 people.
Wow. One doctor for every 1,000 people? I live in a rural area spanning over 50 miles of scenic byway in the Colorado Rockies from Central City to Allenspark. Calculating estimated population for this region based on data from 2014, that area is home to at least 10,000 people.
Wow. Ten-thousand people…and ONE doctor? Yup.
It is true that a handful of residents will commute to Boulder, Estes Park or Idaho Springs for a physician. We had a clinic in Black Hawk (right next to Central City in Gilpin County) for over 30 years, which closed it’s doors permanently in 2014. They are now building a casino where Mountain Family Clinic served residents of the rural mountain communities in Gilpin County.
The one doctor on the mountain, Dr. Michael Camarata, was given a few days notice at the end of February that his Medicaid contract was terminated. As of March 1st, he no longer is reimbursed for seeing Medicaid patients. This happened before, according to the Nederland paper The Mountain Ear, in 2012, when Dr. Camarata was put on probation for prescribing too many Medical Marijuana Cards:
If a doctor reaches a certain number of medical marijuana cards, it is reported to the Colorado Medical Board by the Colorado ¬†Department of Public Health and Environment. They looked at the charts of some patients. There were two complaints about narcotic prescriptions; of improper prescribing of narcotic drugs that triggered a hearing with the Colorado Medical Board on August 17, 2012.
“I was scared to death,” says Camarata, “I thought I was going to lose
my license. After the hearing, we entered an agreement that I was not
to prescribe marijuana cards or narcotics, but I could do everything
else. I was put on probation and allowed to continue my practice.”
At that time, United Health Care pulled their coverage of Dr. Camarata and Columbine Family Clinic, affecting nearly 300 patients. It was not until late in 2016 when United Health Care coverage was finally reinstated.
Losing Medicaid coverage, however, affects over 1500 patients (myself included). Many of these patients do not have transportation to get “down the mountain” to a city clinic, and with such short notice, the Boulder Clinica has a waiting list of several weeks. The revocation of coverage is based on a Federal Law saying that any MD whose license is in question is not allowed to serve Medicaid patients. However, the application of this law is an “unprecedented interpretation” according to Dr. Camarata’s lawyer.
Since taking over the town clinic in 2010, Dr. Camarata’s practice has grown, and he has garnered a reputation as a quality, and caring physician. Why wasn’t this law applied back in 2012? Apparently it was a bureaucratic oversight. Now that the paperwork has caught up with Camarata, once again, it’s the patients who are paying the price – not just with their pocketbooks, but with their health.
This article is part of an ongoing series covering rural health care and health care accessibility in Colorado. We encourage you to contact your local representatives to voice your concerns over the potential loss of coverage, and the threat of cutting health care funding to rural clinics – and the everyday people they serve.