In 2015, I returned to these communities to learn how the people I had originally interviewed were faring in the wake of the Affordable Care Act as well as the broad social and economic changes of the past decade. Altogether, I looked for 145 people and was able to re-interview 82. While some of the people were now insured and far healthier than they had been a decade earlier (see “Faces of the Newly Insured”), at least 10 people were dead and 36 people had disappeared without a trace from the homes and communities in which they’d been living when I first met them.
I have no doubt that if Shanice had turned 18 in the era of the Affordable Care Act, her experiences would have been quite different. She either would have been able to stay on her parents’ health insurance or she would have been eligible for Medicaid (Illinois has expanded Medicaid under the ACA). Not only would she have avoided medical debt and ensuing bankruptcy, but she may even have been able to access treatment that could have averted the expensive surgery to begin with.
The ACA would not, however, have saved her from the consequences of housing challenges.
At a community health center in Decatur, nurse administrators Karen Schneller and Tanya Andricks explain that it is impossible to provide follow-up care for patients who can’t be reached – whose phones are turned off and mail is returned “addressee unknown.” Even if they are able to access care in the next place they land, people like Shanice find different facilities and providers prefer different medication and treatment protocols. This results in a range of problems resulting from stopping and starting diagnostic and medication regimes with each move.