Tag Archives: uninsured

The Textured Reality of Care: From Equity to the Whole Person

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The narrative of healthcare is often flattened into convenient stereotypes, but the reality I have witnessed over decades of practice is far more textured. Today, as I reflect on National Minority Health Month—which we just concluded in April—I am struck by how many still hold a narrow mental image of health disparities, one defined strictly by specific zip codes or Medicaid status.

To truly understand why we observe this month, we must look back to its origins in 1915, when Booker T. Washington established National Negro Health Week. He understood that health was the bedrock of all progress, stating:

“No race can be 100% efficient that is 50% well. Without health, and until we reduce the high death rate, it will be impossible for us to have permanent success in any other line of endeavor.”

What began as a local effort evolved into a national mandate following the landmark 1985 Heckler Report. This report was the federal government’s first comprehensive “wake-up call” regarding health inequality. It mathematically proved a devastating reality: nearly 60,000 “excess deaths” were occurring annually among minority populations—deaths that would not have happened if these groups had the same mortality rates as white Americans. It identified six key killers, including cancer and heart disease, and laid the groundwork for the Office of Minority Health, prioritizing research and access to care as national imperatives.

The Face of the Underserved

Looking back across my journey from the Eastern Shore to Tennessee, and eventually back to New Jersey, I see that these disparities have not always worn the face we expect. My career has been spent caring for patients of diverse racial, ethnic, gender, and linguistic backgrounds, but they all shared one painful commonality: they had been dismissed.

Whether it was a small business owner in Maryland or a Black professional in New Jersey; a working single mother making ends meet or a father supporting a family; a mother holding things together after a spouse was laid off, or an elderly person caught in the “gap” of having too much income for aid but too little to survive—they have all experienced the distress of not being heard. I found that I couldn’t’ simply listen; I had to find the answers while still being their doctor.

The Geography of Disparity

The reality is that being under-insured or uninsured creates health disparities for everyone. Many people do not see themselves as a “minority,” so they fail to realize that they, too, are victims of these systemic gaps. In 1990, after finishing residency, I moved to the Eastern Shore of Maryland and practiced there for six years. My patient population was a majority of white patients—watermen, crabbers, oyster shuckers, and small business owners. These were the breadwinners of their families, often working for themselves or small companies, cobbling together care through pharmacy assistance programs because they made just enough to be ineligible for state support. I still recall the relief of finally helping an inpatient qualify for Medicaid—a moment where the system finally caught a man before he fell.

The Power of Trust and Cultural Awareness

When I moved to Chattanooga, Tennessee, in 1996, the lens shifted. My private practice became a cornerstone for insured Black professionals—business owners, church leaders, and even the local funeral home owner—who represented a standard of success that the “minority” label rarely captures yet they were my patients because of the care I provided by always listening and not dismissing them.

Since returning to New Jersey in 2002, I have continued to see “two worlds” simultaneously. As an educator, I witness the struggles of those navigating high-deductible plans; yet, in my own practice, I serve a vibrant mix of Black professionals whose health journeys were backed by stable employment. In these environments, shared identity and trust, combined with the ability to afford care, allow for a health security that transcends common assumptions.

However, we must be honest: affordability is only half the battle. True security requires cultural awareness and culturally sensitive care. Even among the insured and the professional, the “dismissal” remains a lethal threat. This is most glaringly evident in maternal health, where Black women continue to face significantly higher complication rates regardless of income or education. When the barriers of cost are removed and the bridge of cultural understanding is built, the “disparity” begins to dissolve—but only if we commit to a system that listens.

A Fragile Progress: Looking to 2027

The real sea change came with the Affordable Care Act (ACA). I watched small business owners gain the freedom to stop worrying about the cost of life-sustaining medication. For many, it was the first time they were eligible for a safety net that allowed them to focus on their health rather than the bill.

Moving Toward the Whole Person

But as we transition into May 2026, I recognize that this progress is incredibly fragile. With the expiration of the ACA’s enhanced premium tax credits at the end of 2025, the outlook for the remainder of 2026 and 2027 is increasingly grim. We are looking at nearly 5 million Americans losing coverage this year. For those who manage to keep their plans, the reality is one of soaring costs. Premiums are doubling or even tripling for many, coinciding with a cooling economy where loss of employment is beginning to strip away the “stable coverage” my professional patients once relied upon. For the breadwinners supporting families, these rising costs mean a return to the “dismissal” of the system—not because they aren’t sick, but because they can no longer afford to be heard.

As April ends, we move into May: Whole Person Health Awareness Month. This shift is a natural evolution of my philosophy. To truly dissolve disparities, we must move toward an integrated model that honors the “whole person”—seeing beyond the diagnosis to the social drivers, the behavioral health, and the economic pressures we face in 2026 and beyond.

To achieve true health equity and high-reliability care, we must look past labels and protect the systems that provide security to this diverse mosaic of people. We cannot allow the progress of the last century—built on the back of the Heckler Report and the ACA—to be undone by a return to the era of the “uninsured majority.” Listening is the first step, but ensuring the system supports what we hear is the mission that remains.

As Dr. Martin Luther King Jr. reminded us:

“Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane because it often results in physical death.”

Caring for Uninsured Patients: Help is on the Way

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When I launched my private practice, it was on the Eastern Shore of Maryland in a small town.  I joined a physician who had been in practice for several years.  I managed to keep my schedule light for a few weeks so I could study for my Board Examination.  I had just finished my residency training but I was no stranger to outpatient practice.  After my return from the exam which I opted to take in Orlando, I never saw fewer than 20 patients a session.  The busiest days saw us seeing 30 or more patients.  I admit that many walked in but most were scheduled.  This was in early 90’s which was the beginning of the rise of HMO’s.  My practice was hospitable- sponsored.  In less than 1 year, I had repaid the hospital the loan and started to make a profit.  Many of my patients were uninsured but a significant number were Medicaid, Medicare and HMO. I welcomed the Clinton Health Plan and even was interviewed by local newspapers.  Sadly, for my community, it never happened.

The Affordable Care Act (ACA) will change the number of uninsured patients in the US.  While I was on the Eastern Shore in the 90’s, it was apparent that many of the residents had no way out of the cycle of poverty and the health problems neglected from being uninsured.  The reality played out in the Emergency Room of the local hospital day and night.  Being uninsured affected every family. Our community had business owners who were farmers, fisherman, mechanics, contractors and shop owners.  Many made too much money for Medicaid but they could not afford the cost of private insurance.  Many of them landed in the ER with serious medical conditions they had ignored.  Some even called my office and were seen as emergency visits.  One particular case was a bit scary.  One of my staff called and brought her brother in.  He was complaining of chest pain and would not go to the ER. They came to the office and I did an EKG.  To my surprise the brother was having an acute myocardial infarction.  He was uninsured and was still refusing to go to the ER even as the ambulance arrived.  We did get him there.  He and I had a tense ambulance ride together to the tertiary care hospital and I handed him off to the cardiologist who greeted us both and whisked him off to the Cardiac Intensive Care Unit.  Weeks later, the community came together for a fund-raiser.  I attended and was to my surprise honored by everyone for my excellent care.  Unfortunately, I had to leave to go to the ER to care for a patient that was not so fortunate.

I had hoped that the HMO’s would make healthcare affordable but that did not happen.  The reality for patients then and now is that if you lack insurance, you end up in the ER.  I worked with the local health department.  My office was ground-zero for many programs.  We saw patients enrolled in the Breast and Cervical Cancer Screening Program, Vaccines for Children and participated in every pharmaceutical company sponsored free medication program. We saw patient from the Mental Health programs, Drug treatment programs, and Adult Daycare.  My practice had so many patients enrolled in Pharmaceutical Company Patient Assistance Programs; one company invited me to give a presentation to a group of providers.

I was a member of the steering committee and a board member of the new Federally Qualified Community Health Center (FQHC) in our town. It was our answer to tacking the rate of uninsured patients.  It was hard work to get the grant written, not by me thankfully but I did read it and had to give input on the clinical operation.  I also had to pledge my service which meant clinical sessions, on call coverage and hospital admissions.  I was also involved in recruiting the first full-time provider.  We were fortunate to be designated a National Health Service Corp (NHSC) site.  This allowed us to recruit a NHSC scholar who could use our site and a 3-year commitment to repay medical school loans. The good news is that built into the Affordable Care Act is increased funding for the NHSC.  The program is now expanded and will allow an increase in primary care providers in areas where they are needed.  We were fortunate to get a brilliant young Family Physician in our community. The CHC is still there but it is now part of a bigger network. Across the US, FQCHC are providing care to uninsured and under-insured patients.

Medicine for me has always been about helping my patients. The Affordable Care Act is going to change the delivery of medical care in the US.  I am gearing up for all the excitement.  I work now as a Medical Director for Student Health Services at a major university.  All fulltime students are required to have insurance either through their parents or a plan that is sponsored by the school. The plan is also available to part-time students.  It is very affordable for students.  My task is to help students be informed about what is covered and how to access care using the insurance plan. The Affordable Care Act requires that the policy meets all the same criteria as plans to be provided by other plans.  It must provide preventive services, emergency care and coverage of medications.  There is no restriction for preexisting conditions.   The next dilemma will be if there is the capacity to care for all of the patients.