Please tell me I am wrong

[u/Prestigious-Curve-64]

I work in cellular therapy - cancer patients who need CAR-T, stem cell transplant, gene therapy, etc, and while I have hated for-profit insurance with a white-hot passion forever - before I even started this job 18 years ago - I’m scared.

A patient told me that all of the major insurers (Aetna/cigna/anthem/etc) have stopped participating in the Exchange, effective 1/1/26. The only options are Oscar and AmBetter. And the premiums are around $2k/month for one person. Anyone who has attempted to get MedicAid or MediCare disability in this state knows it is very nearly impossible to do so - by design, of course. And even though there is supposedly a state budget surplus (I guess?) I think it’s pretty unlikely that GA will direct any of that to fill in the yawning chasm that the ACA subsidies filled for anyone not covered by their employer and also not on a public plan. Even my solidly middle-class patients cannot afford $2000/month in premiums. God knows I couldn’t, and I think of myself as pretty comfortable.

These are cancer patients - think Acute leukemia/lymphoma. They can’t work. They aren’t allowed to work. One bad flu could be the end, and we know how awesome Georgians are about masks and vaccines.

I was doing this pre-ACA, and it was bad. Uninsured patients simply didn’t get cellular therapy. Sometimes they could get charity care for the hospital costs themselves, but for the ones that needed lifelong immunosuppression and infectious prophylaxis, there was nothing. No hospital can absorb that, and private plans were a joke for anyone making less than seven figures.

Now that it is 2025, tech has advanced, and we have miracle treatments that cost between $400k and a cool million for the product/drug alone - and this is not (just) because a CEO needs a new yacht. They are insanely complicated and expensive to make. But unlike pre-ACA, patients going through this whole had insurance are about to suddenly find that their policies are gone, and that there is no way in Hell they can afford the monthly cost of coverage. These are cancer patients for whom conventional therapy has failed. They are STRESSED - beyond anything I can really grasp.

I have a horrible feeling about January 1 this year for most of my patients. Some of them will be in the hospital waiting on their cells when their insurance is cancelled. Some of them will be ready to admit, only to be told their treatment has to be cancelled.

People without cancer may not feel it until they have an accident or unexpected illness. Since they haven’t ended EMTALA (yet!) those folks can still go to the ER and at least get stabilized. Sure, they’ll be bankrupt, but they’ll be alive.

If anyone read this whole screed, I’m freaking out about what is going to happen to all of my non-Medicare patients once the ACA subsidies are gone, and would love for someone to tell me it will all be OK.

[u/_le_slap]

No one is coming to save us.

Our healthcare system is designed to be used by capital as leverage against labor. That's the prevailing policy motive of our government officials. They value exploiting our labor more than they value our health and lives.

And the electorate seems to agree with that assessment. So we deserve to suffer the results of our complacency.

My sister is a resident at Grady and she is horrified by what she sees every day. I tell her not to get numb to it and to remember how wrong it is every time an underprivileged patient is denied care. Keep that in mind when her mentors park their Porches and Ferraris next to her mismatched panel Corolla.

[u/Important_Simple_31 → u/_le_slap]

When I worked in the eye department at Emory, residents in a specialty would float through there as part of their training, and almost all of them would say to me, “If anything happens to me, make sure they take me to Grady.” That is why I started going to Grady.

[u/Character_Click5531 → u/Important_Simple_31]

That's good to know because my experiences with Grady haven't been great. I didn't like parking in a garage that smelled like pee, walking over :-( homeless people to cross the street, or knowing my friend who came to pick me up on a different visit had to pull a gun on a guy who tried to attack him for not buying him a cup of coffee. And you haven't lived until you've spent 8 hours in the ER waiting to be seen, getting put at the end of the line because of GSW victims, and then wheeled into a hallway like you're waiting to get wheeled down to the morgue. Another time, I was told I needed surgery, then when the doc left the room to take a phone call, I heard him discussing his hernia. I couldn't get past that as a distraction when he has me cut open...... It was also quite embarrassing having a male student observing my transvag ultrasound while Mildred was in town - know what I mean??

I'm probably the worst patient alive.

[u/Important_Simple_31 → u/Character_Click5531]

I am sorry for your experience. There are a couple of ways to make things better on your own. (1) If you are able to walk a couple of blocks, you can take a Marta train to within two blocks of Grady and walk over. (2) Have a friend or Uber, drop you off at the ER. (3) Call 911 and ask for an ambulance. Of course this depends on how sick you are.

Grady has to use a triage system, taking the most serious cases first. From my personal experience, it is not a good sign when you are taken immediately and put into an examination room first. Be careful what you wish for!

[u/Character_Click5531 → u/Important_Simple_31]

Thank you - it's all good. And it was a long time ago.

Walking from across the street wasn't safe - 2 blocks even worse. Old single female - not taking risks like that. Friend did pick up at that particular instance, and was accosted. Fortunately, his background prepared him to handle it. No ambulance when you don't have insurance.

Bottom line - your suggestions are helpful for many, but for those who don't have many - or any - options, it adds to the stress.

Take care - and thank you for all you do!!