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Failures Of Affordable Care Act Push Patients To Rely On Urgent Care Centers

In the United States, where health care costs are bankrupting Americans more than any other type of debt, urgent care centers (UCC) are on the rise, and more Americans are leaving their primary care physicians behind in favor of them.

At John Peter Smith Hospital (JPS) in Fort Worth, Texas, there’s a program for low income residents called JPS Connections, which intends to act as a kind of “service of last resort” for those unable to access health care via state, federal, or pharmaceutical assistance.

JPS Connections currently serves around 50,000 Tarrant County residents each year, all of whom are forced to reapply annually or else face being bumped off of the program.

Norma, who asked to use only her first name to discuss private information about her family’s medical care, said that while Obamacare helped a number of those in her neighborhood in Fort Worth, she and her family struggled with deductibles and high premiums. JPS Connections was a lifesaver.

“When we first heard of Obamacare, a lot of us over here thought it would be easier, and that things would get better. But for my family it was really difficult because the premiums were just too high. I lost my job, my husband got sick, and then things just kept getting worse,” Norma shared.

But joining JPS Connections is not easy. An avalanche of paperwork, long waits, and piling medical debt make it difficult to handle.

“I don’t understand why basic medical stuff costs so much, and why we even have to pay for it. My family didn’t choose to be sick,” Norma lamented.

The thought of being pushed off JPS Connections gave Norma intense anxiety, and she started to look towards urgent care centers because maybe it would be “easier, instead of going through JPS and worrying about when they’ll deny us care.”

Norma continued, “I feel like the only way to make ends meet is to do work under the table or else, if our income goes over the [maximum income level], then we can’t use it anymore. But for my family, with the debts we have, and the cost of living out here, it doesn’t give us any breathing room.”

Another caveat is that one must first sign up for insurance if they’re eligible under the Affordable Care Act in order to access the JPS Connections program.

The urgent health care market is profitable and on the rise. According to a report from Business Insider, “patient volume will continue to expand through 2021 to about 300 patients per week, with revenue per UCC increasing to almost $1.7 million.”

Some 10,000 urgent care centers have expanded across the U.S., which provide everything from intermittent health services to full service speciality care. Instead of driving to a medical center headed by a general practitioner, one can find these clinics inside office buildings and shopping malls.

U.S. health insurance companies, including Cigna, and UnitedHealthCare, advertise these facilities as the most reasonable and accessible options for those in need of non-emergency care when compared to an emergency room visit. What this means for patients is affordable care is possible, to some extent (although truly humane health care remains remote).

Speaking to urgent care center patients, it became evident most have good experiences with the rate of service and the overall costs.

Matt McGowen, a 27-year-old software developer in San Francisco and student at the City College of San Francisco, said urgent care facilities were a substitute when he was  unable to see a doctor.

“I’ve gone in for a minor sports injury and a stomach bug while on a trip out of the Bay Area. I made sure that the urgent care facility was in my insurance network and the bill was on par with a doctor’s office co-pay plus treatment,” McGowen added.

For McGowen, health care in the U.S. is horrific “for just about everyone except insurance executives, hospital owners, and specialists”.

McGowen—echoing the sentiment of many other Americans struggling with medical programs—described the industry as “an overpriced, over-complicated mess that most people don’t know how to access effectively, or are simply priced out of good care.”

“I don’t think health care will get better in America,” he said. “[Not] without a universal program like Medicare for All. As long as health care remains a commodity, people with less money will get worse care and people will suffer across the board. It will continue to look like it does now, basically, with the caveat that it can absolutely get more cruel and more unjust.”

Twenty-six year-old Pete Volk, a Washington, D.C., resident and editor at Vox Media, used urgent care centers because of their location, how relatively inexpensive they are, and the fact that they do not require an appointment. He does not have a primary care practitioner and found that these facilities have short wait times. The staff is also friendly and knowledgeable.

“I’ve gone in for cold/flu symptoms and an issue where mucus was building up in my throat (that time I went to urgent care in part to get a referral to an ENT [ear, nose, and throat doctor]). My bill has been $35 each time, with no cost for prescriptions. I chose to go to urgent care instead of a conventional doctor route to avoid the weeks-long wait to be seen,” Volk shared.

While Volk has experienced little trouble with these centers, he joined others in calling for a revolution in the health care industry. “Single-payer or bust.”

Mackenzie Newhouse, a 20 year-old full-time barista and student from Chicago, Illinois, used urgent care facilities in part to avoid long wait times at emergency rooms.

She added, “I also have a lot of medical anxiety that is worse in the ER/hospital setting so that is usually a last resort for me. I do not currently (and have not in 5+ years) have a general practitioner as insurance coverage is spotty and unreliable for me.”

Newhouse’s experience with urgent care facilities was always pleasant and quick until she was taken back to see a practitioner.

“One particularly negative experience was when I had fallen on ice and twisted my ankle pretty badly,” Newhouse said. “I was in a lot of pain so they did an x-ray. It came back as not broken, and I was immediately discounted as overreacting and offered an OTC Extra Strength Tylenol.”

“This recommended route of treatment was continued despite my obvious pain and persistent request of stronger relief. I left with no relief or treatment besides a recommendation to “ice and stretch” the injured ankle. The bill for this was over $200. I have no experience with seeking out any other kind of treatment as an adult so this usually feels like my only option.”

Newhouse is “honestly terrified” about the future of health care.

“My unreliable insurance coverage relies entirely on [Obamacare] and Medicaid, and with the current administration’s stance on both, I am unsure of my health care future. I feel as though we were potentially close to being on the right track, but I definitely don’t feel that way anymore. I think the future of health care is precariously perched on a cliff, surrounded by politicians just waiting to shove it off into the abyss.”

Lili, a 49 year-old resident of Houston, Texas, who is a corner store cashier, went to an urgent care facility after dealing with crippling lower back pain. She asked to use only her first name to speak about private health matters.

“I was scared that the emergency room would be too expensive even with insurance. It wasn’t a life-threatening problem so I didn’t think it was worth it,” Lili said.

She is one of the few people who found urgent care to be a waste of time. “It made me realize how necessary having a primary care provider is because I felt that the people in the urgent care center did not see me as a priority. I am not sure if they were just limited in the care that they can provide or they were just unwilling to provide better care.”

Lili hoped the U.S. would adopt a universal health care program “so people wouldn’t have to worry about having insurance, wondering if their insurance is enough, or if their insurance will cover them.” She said that the current system “makes health care very confusing, and when you are sick, the last thing anyone should be thinking about is whether or not they will be able to pay to get there or whether or not their insurance will be accepted.”

Like many Americans, Lili’s health care premiums continue to surge. “It’s not fair to have to pay expensive premiums on top of co-pays for each visit.”

Should health care programs in the U.S. stay married to insurance company earnings, and should the health care industry remain a for-profit business model, millions will continue to suffer from not only crippling illnesses but also debilitating debt.

Urgent care facilities, though they have their benefits, do not rectify the failings of the government to take care of people. In the words of Pete Volk, it is “single-payer or bust.”

Roqayah Chamseddine

Roqayah Chamseddine

Roqayah Chamseddine is a Lebanese-American writer, published poet, and journalist, whose work can be found at