The Holes in the Safety Net

 Lina presents to our medical office with a complex medical history. A 40-year-old Asian female, she found out a week ago that she is pregnant, even though she has been using birth control regularly for several years. This is only the latest turn in an ongoing medical saga she has been navigating. When I introduced myself as a medical student working with the Women of Means staff, she eagerly agreed to sit down and talk with me at length – “I want you to do well on your report!”, she insisted. Throughout the ensuing conversation, I was struck by her upbeat demeanor in the face of a daunting host of obstacles. Her story is a vivid snapshot of some of the successes and frustrations that arise when healthcare reform and cultural traditions meet.

Currently homeless in Boston, Lina is unemployed and receives a small income through Social Security disability benefits. Kidney disease, high blood pressure, and schizophrenia top her list of chronic medical conditions. Per the state requirement for all residents to carry health insurance coverage, she is enrolled in a program through MassHealth in which both Medicare and Medicaid fund her health care. Her prescription medications are covered under a prescription drug plan that can provide her with medications on a pre-designated list of qualifying drugs.  Depending on the prescription, she may pay as little as one dollar as a copay for covered drugs. Her numerous doctors’ office visits and most of her prescribed medications thus pose little to no financial burden to Lina; she pays no yearly premium and no copay for primary care or specialists visits, or for hospitalization.

With this background, one might expect the financial stress on Lina for her health care to be negligible. On the contrary, her medical problems still strain her budget. She is ethnically Chinese and a firm believer in alternative herbal medications. Her kidney problems, she tells me, have no effective medical treatment under the Western medical system, so she relies heavily on herbal supplements and acupuncture. Not covered by her health insurance, the herbal medicines cost her up to $250 per month, not an insignificant portion of her monthly Social Security income. Furthermore, some prescriptions she has received for topical analgesics for joint pain or recommended over-the-counter fiber supplements are not covered through her insurance and are difficult for her to afford.

The Women of Means office at Women’s Lunch Place affords her relief in a few ways. She is here today to arrange for a volunteer to accompany to her upcoming ob/gyn appointment. She also regularly attends the weekly medical acupuncture clinic held by one of the Women of Means doctors. She expresses to me her gratefulness that since discovering this program, she has been able to receive acupuncture free of charge, which she feels helps her physically and eases some of the psychological burden she bears.

Lina’s case provides a frank view of the often harsh reality of living in poverty with multiple medical conditions, even under a system considered in some ways to be a model in providing affordable health insurance for all its citizens.  Her cultural background and reliance on alternative medicine complicates her situation, simultaneously providing her some relief that she is told Western medicine cannot afford, while further straining her already limited financial resources. Compared to many, she has increased motivation to seek medical care after seeing her father die of renal failure and an unsuccessful kidney transplant back in China many years ago. As her unexpected pregnancy brings the latest chapter of her medical story, this complex encounter with the medical system will not likely be her last.