While lawmakers in Washington are still bickering over the Patient Protection and Affordable Care Act, the Maine State Nurses Association is fed up. The group is calling for universal state coverage, to be funded through a payroll tax.
Meet Tommy Davis, a self-described "dead man walking."
This uninsured man visited the ED after his intense abdominal pain and obstipation became unbearable. After spending his life savings on $10,000 worth of tests in the ED, he learned he had metastatic colon cancer.
"The year before, he'd had similar symptoms and visited a primary care physician, who had taken a cursory history, told Mr. Davis he'd need insurance to be adequately evaluated, and billed him $200 for the appointment," University of Louisville physicians, Michael Stillman, M.D., and Monalisa Tailor, M.D., wrote in a perspective article in the New England Journal of Medicine.
"Since Mr. Davis [an alias] was poor and ineligible for Kentucky Medicaid, however, he'd simply used enemas until he was unable to defecate. By the time of his emergency department evaluation, he had a fully obstructed colon and widespread disease and chose to forgo treatment."
This man will die because he lacked insurance.
Although Stillman and Tailor call Mr. Davis's situation appalling (and it is), it shouldn't come as a surprise. The uninsured Mr. Davis is certainly not alone in his inability to pay for healthcare, despite having a full-time job.
As nurses know, it's nothing new at all.
"As nurses we see it all the time… people waiting too long to have something minor taken care of," Cokie Giles, BSN RN, president of the Maine State Nurses Association and a nurse at Eastern Maine Medical Center in Bangor, tells me.
Although cancer isn't minor, the authors of the NEJM piece write that, "[had] Mr. Davis been insured, he might well have been offered timely and appropriate screening for colorectal cancer, and his abdominal pain and obstipation would surely have been urgently evaluated."
Giles herself remembers caring for a young, uninsured man with diabetes who couldn't afford the supplies to manage his condition, despite working full-time. Leaving his diabetes unchecked resulted in nearly losing his foot from a bad infection and spending six weeks on IV antibiotics.
While lawmakers in Washington are still bickering over the Patient Protection Affordable Care Act, nurses in Maine are fed up. In their eyes, healthcare isn't a political issue. It's a human right.
"I think there is no other question than of course it is a human right," Giles says. That's why the Maine State Nurses Association has been working on the "Health Care as a Human Right Campaign," which aims to "change the broken way healthcare is delivered in the state." The group believes the Patient Protection and Affordable Care Act doesn't go far enough in providing health insurance to all.
"In this most industrialized country and the wealthiest country, healthcare should not be only for people who can afford it," Giles says. "We would like to see everyone to be covered." They propose paying for universal coverage in Maine through a payroll tax.
"That, to us, is the only answer," she says.
Giles says it was "very disheartening" when Maine refused federal healthcare money. In fact, the Portland Press Herald wrote in July that Maine has the "dubious distinction" of being "the only state in the nation where the people's representatives have approved health care expansion under the Affordable Care Act but it will not become law because of a governor's veto. In fact, Gov. Paul LePage has now vetoed it twice."
Giles says Maine nurses are still fighting for universal coverage. They've been spreading the word by hosting free health screening events and town hall meetings throughout the state. And they're trying to get the public and lawmakers onboard by telling stories of real patients like the "dead man walking" in the NEJM article.
"We're trying to do this through stories," Giles says. Mainers, she says, sometimes have to travel for hours through the rural state to receive healthcare that they can barely afford. "It's a tough place for some of these people who are barely getting by. They're living day-to-day."
Is health insurance a nursing issue? Giles has only one answer: An unequivocal "yes."
"It's clearly a nursing issue," she says. "Because we're the ones that take of these people that come in."
Alexandra Wilson Pecci is an editor for HealthLeaders.
