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Invited Commentary
February 2016

Health Policy and Medical TrainingBreaking Down Barriers Between the Wards and the World

Author Affiliations
  • 1Internal Medicine Residency, University of California–San Francisco, San Francisco
JAMA Intern Med. 2016;176(2):256-257. doi:10.1001/jamainternmed.2015.6848

During a recent emergency department shift, I cared for 2 unrelated 26-year-olds with life-threatening complications of poorly controlled type 1 diabetes mellitus. The shift was so busy that it did not register until later why both left the hospital against medical advice. On their 26th birthdays, they had lost their parents’ health insurance coverage under the Affordable Care Act (ACA). Both explained that they were out of insulin, had lost access to their regular physicians, and could not afford inpatient hospitalization.

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