As April begins, change is in the air. Spring has finally graced Milwaukee with multiple days of sunshine, we finally started our vegetable garden, and the city is buzzing with people emerging from hibernation.
Amidst the newness of this spring is the new reality of health care. April 1st marked the beginning of full Medicaid coverage under the Affordable Care Act in Wisconsin. This means many things to our clinic and patients. Most of our patients are now insured. This reality didn't really hit me until I started the goodbyes last week. I had been pushing people to sign up since October and repeated the speech about how they couldn't come back to the clinic hundreds of times. We can no longer care for our patients who are covered by BadgerCare (Medicaid) because we don't receive any federal payout. And, more importantly, they are now eligible for many services that we could not provide. As this process was beginning in October, I was excited and hopeful for the future of American medicine. As I hug some of my favorite patients goodbye, I feel conflicted and sad and also a little skeptical about the future.
Many patients say to me: "but Miss Abbey, my doctor is here, and you are here. I don't want to leave. Even if I do have insurance, those people don't treat me with the respect that you do here. And they don't know my story like you do."
This is one side of the coin. I can't argue with the fact that we are asking people to leave behind a familiar place they enjoy, and starting over somewhere new. And in reality, having insurance in no way guarantees you find a doctor you like or that you will be treated with respect. Like many government funded safety nets, Medicaid has it's many hoops to jump through, overused help-lines, and long waits. I still hold the belief that this will be a good change in health care policy, and that it creates necessary safety nets for the poorest people in our country. But, I still find it hard to say goodbye.
As I was falling asleep this week, I discovered another side of this coin. I struggled with how upset I was that I won't see some of my patients again. I began to explore this emotion further and realized an interesting reality about myself. On paper, I should really be happy to see them go! People I care so much about can now receive G4OVG3 surgeries, important prenatal care, dental and eye coverage, and the list goes on and on. I had spent months advocating for some of these services for people, but as I became consumed in my own emotion, I have been unable to prioritize the realities of the people I claim to serve.
I think this is an interesting reality of non-profit work. What do we do when the system we want to change actually starts to do so? We spend our days trying to give people the tools to care for themselves and advocate for themselves, but are we actually rooting for them to succeed? As I hug people goodbye, I struggle with this. I have become defined this year by my work as a nurse for people without insurance. Now they are insured. How do I fit in now? It would be naive to say that all need has been abolished by the ACA. In fact, it has created new holes and new margins that push people out. But I still struggle to define myself amidst the change.
This week is going to bring many hard goodbyes and conflicting emotions. I feel sad, but also so lucky to be able to engage with people in this period of change. My prayers turn towards the clinics that will be absorbing thousands of new patients this month. I know many people whose lives will be changed, and I am grateful for the doors that are now opened to them.
