As the second enrollment period for insurance exchanges under the ACA opened in November, many people are feeling the squeeze of the financial burdens being placed on them. While the ACA (Obamacare, as it is commonly known) is pushing to eliminate the uninsured, it is doing so at the financial well-being of many Americans. The middle-class is especially bearing the brunt of this healthcare law.

American citizens are now faced with tax penalties if they do not have medical coverage. While these penalties are currently minimal, they will increase over the next several years. Many people are purchasing insurance plans that they are not satisfied with just to avoid these penalties. I have seen many patients in my practice who simply cannot afford the premiums. With the economy in poor shape, many people don’t have extra cash to pay for a new added expense. Many are choosing to go without it and face the penalty. Others have purchased plans but are struggling to meet their monthly expenses. More people may be insured now, but many people are being burdened by this mandate.

And it is not just the cost of the premiums that are assailing patients—many of the current plans have large deductibles. One of my patients canceled her appointment because her son got sick, and she could not afford to pay the deductible for herself and her son. I am seeing more and more of these high-deductible plans and patients self-rationing. It isn’t clear to many people until they are hit with a medical bill. And then they are left trying to get out from under this debt. In fact, it has been estimated that 1.7 million people will file for bankruptcy this year because of medical expenses, according to NerdWallet Health, a division of the price-comparison website who analyzed data from the CDC, the U.S. Census, the federal court system, and the Commonwealth Fund. They have also estimated that another 15 million will deplete their entire savings to cover medical expenses. These statistics are quite alarming and are going to get worse.

“It has not shown to be a true reform because it is putting the strains on an already strained population.”


Another area where patients are expected to pay more is at the pharmacy. Insurance companies are greatly narrowing down their formularies, and copays are rising here as well. Under many plans, prescription medications are not covered until the deductible is met. Patients are forced to pay more out of pocket or go without needed medications because they cannot afford them. I have seen patients who have had to make a decision between what medications they could pay for, all needed medications. I am also seeing generic medications going uncovered. Several of my asthmatic patients are unable to get their generic inhalers—life-saving medications—covered by their prescription coverage. Some insurance companies ask for prior authorization, which can take days to process. When an asthmatic is wheezing, they don’t have days to wait. They end up paying the cost, which they may have trouble affording, or they end up in a critical medical condition in the emergency room. It is clearly not only about cost, but quality of medical care.

While the ACA is promoting the goal of getting all Americans enrolled in health insurance plans, it has done this by pushing the financial responsibility and obligations onto people who may disagree with it—and many who simply cannot afford it. It has not shown to be a true reform because it is putting the strains on an already strained population. Sure, patients should take an increased responsibility for their own health. But, is forcing these plans on them the way do that? Real reform needs to come to the American healthcare system. People should not use up their life savings or go bankrupt in order to receive the medical care that is warranted. The government has proven its ineffectiveness in the task many times over, just look at the Medicare system as an example. And private insurance companies are raking in the profits with these new mandates. Does anyone really want a healthcare system run by the government or, possibly worse, one run for corporate profits? Clearly, a new answer is needed.


Dr. Linda Girgis MD, FAAFP, is a family physician in South River, New Jersey. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University and she was recognized as intern of the year. Over the course of her practice, Dr. Girgis has continued to earn awards and recognition from her peers and a variety of industry bodies, including: Patients’ Choice Award, 2011-2012, Compassionate Doctor Recognition, 2011-2012. Dr. Girgis’ primary goal as a physician remains ensuring that each of her patients receives the highest available standard of medical care.

Follow Dr. Linda Girgis, MD, FAAFP: Website | Twitter |