The Waiting Room
If you've sat in an Alabama emergency room lately, you've probably noticed the waiting room is packed. You came because something was truly wrong, and you look around and wonder why it's so full.
Look a little closer at the people in those chairs. A mother holding a feverish child. A man in work boots with a cough he's carried for three weeks. A woman who has been rationing her blood pressure pills because the refill costs more than she has this month. Many of them aren't having emergencies. They have a bad cold, an infection, a sickness that should have been handled in a doctor's office days ago.
It is easy to be annoyed by them. I have been. But the question worth asking is not why they are in my way. The question is why they are there at all.
The Only Open Door
For a lot of them, the ER is the only door open. Alabama is one of the few states that turned down federal funding to expand Medicaid, and that decision left hundreds of thousands of working people without coverage. One estimate puts the number who would gain coverage at about 204,000 adults, nearly half of Alabama's uninsured adults.
These are not people who refuse to work. They cook our food, clean our offices, care for our parents, and frame our houses. Many of them work for small businesses that cannot afford to offer insurance, or they earn too little to get help buying insurance, yet Alabama's Medicaid program leaves them out.
Without insurance, a regular doctor's visit means a large fee up front, and the follow-up visit, the lab work, and the prescription all come after it. The emergency room is different. By law, it has to see you. So when the cough gets worse or the fever won't break, that is where people go.
The Kindness of Strangers
Many communities have free clinics, and the people who staff them deserve our deepest thanks. Doctors, nurses, and volunteers give up their evenings and Saturdays to care for people who have nowhere else to go. Churches open their fellowship halls. Retired physicians come back to work for nothing.
But kindness has limits. Many of these clinics are open only once or twice a month, because they run on volunteers giving what they can. They are a gift, but they cannot be a system.
You can't schedule when you get sick. An infection doesn't wait for the second Tuesday of the month. So people wait as long as they can, and then they go to the one place that is always open.
Seeing the Person in the Chair
I spent almost ten years working in homeless shelters, much of it at the Downtown Rescue Mission in Huntsville. I learned there that a crisis rarely arrives all at once. It usually starts small: a missed appointment, a prescription left unfilled, a tooth that hurts but can wait. Then one day it can't wait anymore.
I think of one man I knew during those years. He had a bone spur at the base of his spine, and he started having trouble walking. He went to doctor after doctor, but without insurance, no one would take the next step. So he kept walking on it, as best he could, until one day he couldn't walk at all.
Only then did he get a scan. It showed the bone spur was cutting into a nerve. Now it was an emergency, and the emergency was this: if no one operated, he might never walk again.
By the grace of God, a surgeon agreed to do the operation for free, and he walked again. I am grateful for that doctor every time I think of it. But I also think about how close it came, and how many months he suffered for something that could have been caught early. His recovery depended on one person's generosity. Most people in his situation are not that fortunate.
Jesus said, "I was sick and you visited me." He did not say, "I was sick, and you made sure I had a good enough reason to be." The people in that waiting room bear the image of God. They are not a drain on the system. They are our neighbors, and they are telling us something about how we have chosen to care for one another.
When I look at a crowded ER now, I try to see it the way I learned to see a shelter dining room. Not as a problem of too many people, but as a room full of persons, each with a story about how they got here.
Can We Afford It?
Some will say Alabama can't afford it, and that's a fair question to ask about any program. I run a business. I understand that money doesn't appear from nowhere, and promises made today have to be paid for tomorrow.
But the federal government pays 90 percent of the cost of expansion. Meanwhile, we're already paying for the uninsured. When someone can't pay their ER bill, the hospital absorbs it, and much of that cost gets passed along to the rest of us through higher prices and premiums. Some of our rural hospitals have closed, partly under that weight.
A Families USA analysis estimates that staying out of expansion will cost Alabama about $181.6 million in lost income and extra expenses this year alone. We are paying either way. The only question is whether we pay for people to get care or pay for them to go without it.
It Doesn't Have to Be This Way
I won't pretend that expansion would empty our waiting rooms. In states that accepted the funding, people still go to the ER. But fewer of them walk out with a bill they can never pay, and more of them have somewhere to go for the follow-up.
Here in Alabama, our uninsured working families are being buried in medical debt. Or they simply stop going to the doctor at all, until a small problem becomes a large one, and a treatable illness becomes a funeral.
The next time you sit in a crowded ER, look around the room. Those are our neighbors. We have a choice about how we care for them, and we are making it every year we wait.
