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A Piece of My Mind
December 12, 2012

Enough, Already

Author Affiliations

A Piece of My Mind Section Editor: Roxanne K. Young, Associate Senior Editor.

Author Affiliation: Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Kentucky (michael.stillman1972@gmail.com).

JAMA. 2012;308(22):2347-2348. doi:10.1001/jama.2012.14475

In May 2012, I left Boston University School of Medicine for a faculty position at University of Louisville in Kentucky. My new job entails both administration and research, but I also precept in a resident clinic that serves a largely indigent population.

Since 2006 when then-governor Mitt Romney signed into law a virtual twin of the Affordable Care Act, only around 5% of Massachusetts' population lacks health insurance. In my Louisville clinic, however, 60% of the patients are uninsured, and they represent the full spectrum of ethnicity, age, wellness, and employment status. While our hospital offers uninsured patients reduced-cost office visits, access to inexpensive generic prescriptions, and sliding-scale charges for laboratory testing, they pay full price for imaging studies, certain preventive vaccinations, and diagnostic tests, including cardiac stress tests and sleep studies. They receive only the care they are able to pay for themselves and lack reassurance that their next minor illness won't destroy them financially.

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