As the Government Shutdown Looms…

I’ve been wondering about what are the most constructive things to do as an Iowa physician as the government seems to grind to a shrieking halt, Government shutdown: What you need to know –

Even though there is a lot of opposition to the Affordable Care Act (ACA, Obamacare), it’s the law and I see patients every day in the hospital who either don’t have insurance at all or who have IowaCare–which is going away. In my role as a psychiatric consultant, when my colleagues call me to help a patient they’re treating for medical illness who also suffers from mental illness, I have to think about what resources the patient has for accessing mental health care.

If the patient doesn’t have insurance, they don’t have access to medical or mental health care. Never mind the debate about how much mental health care they can get under the ACA–the bottom line is “no insurance–no access.” I can’t make practical recommendations for effective mental health care to patients and families who don’t have insurance coverage.

I’m aware that coverage is not the same thing as care. I’m aware that there will be questions about whether there’ll be enough physicians (including psychiatrists) to meet the needs of those who have coverage.

But if you don’t have coverage at all, you don’t get care without taking on the burden of out-of-pocket costs, such as emergency room visits. And for the vast majority of the patients I see, emergency room visits with a psychiatrist should be the beginning  of a comprehensive mental health care plan for recovery, not a stopgap assessment and a temporary fix.

I’m a foot soldier in the war on mental illness. I don’t have time for politicians who would rather shut down the government by playing pointless games aimed at delaying the ACA. I’m reminded of that every time I see someone who desperately needs mental health care and whose mental illness makes treatment of medical illness problematic if not impossible.

Maybe the congressmen who are trying to kill the ACA can give me a script I can read to the patients I see who have no access to health care, and who can’t heal and move forward without effective psychiatric treatment. Let the congressmen try to explain to my patients how they can access medical and mental health care without insurance.

I’m not waiting for congress and the president to hash this out. I have to use what tools and little time I have to do something constructive. So I’m spreading the word to Iowans about the Iowa Health and Wellness Plan and the Health Insurance Exchange.

See the September 25, 2013 update to the Iowa Health and Wellness Plan.

Learn how to enroll at:

Health Insurance Marketplace, Affordable Care Act |

Because my leaders refuse to lead, this foot soldier is an army of one.



  1. I can see why you want everyone to have coverage. It’s different in the hospital where I trained. Patients who came to the ED were treated, regardless of insurance, or lack thereof. If they were uninsured and admitted, they were put on emergency medicaid, so the hospital got paid. If they were sent to the outpatient clinic, the clinic would work with them to get medicaid. The clinic also supplied them with two subway fares at each visit-one for the trip home, and one for the return trip to the clinic.
    So I guess I don’t see coverage as the barrier to care that it is in your area. Granted, it wasn’t the best care around, but it was a pretty solid clinic, and no worse than what most people will get with coverage.


    • Every day I see patients in the hospital who barely know that IowaCare is finished; and they barely know that there is an alternative. I think I’m going to have to make a new boilerplate recommendation in my consultation notes:

      “Please have the unit social worker help the patient learn how to enroll in the Health Insurance Exchange.”



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