What is ACT?
The University of Texas Health Science Center at San Antonio (UTHSCSA) “ACT Together for Health: Access Care, Texas” project is a new community-based initiative, dedicated to providing resources and guidance for the over 300,000 uninsured in Bexar County residents, some of whom may be eligible for coverage through the Health Insurance Marketplace under the Affordable Care Act (ACA) in Bexar County, TX. This community service learning project is a collaborative effort of the UTHSCSA Center for Medical Humanities & Ethics (CMHE), the UTHSCSA Student Government Association, the San Antonio Metropolitan Health District, and the Fiesta® San Antonio Charitable Corporation. It seeks to offer an orientation to the ACA and the Health Insurance Marketplace, delivered by the U.S. Center for Medicare and Medicaid Services (CMS), for approximately 200 volunteer students and faculty as they prepare to serve the community as “Champions for Coverage.” The Project is housed at the UTHSCSA CMHE at 7703 Floyd Curl Dr., San Antonio, TX 78229. Its activities are primarily planned and executed by students, with faculty mentorship and oversight. The primary faculty mentor for the project is Dr. Ruth Berggren, Director of the CMHE. Read entire Executive Summary here.
Letter of Invitation from Community Partners
Q&A with Dr. Ruth Berggren: "On Ethics and the ACA"
Why should the Center for Medical Humanities & Ethics (CMHE) sponsor a student organization devoted to educating the public about affordable health care options?
Since its inception our Center has consistently focused on the importance of the Doctor-Patient relationship; there can be no doctor-patient relationship if the patient cannot get in the door.
Education, and facilitation of enrollment in affordable health insurance is the moral equivalent of providing care in our student-run free clinics.
Is it ethical for the government to mandate that all individuals have health insurance?
I will approach this question from the physician’s perspective. Ethics codes from the American Medical Association (AMA) and the American College of Physicians (ACP) stipulate a physician’s duty to facilitate medical care for all persons.
AMA Ethics principle IX states “A physician shall support access to medical care for all people”, while principle VII asserts “A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health”.
Facilitating medical care means someone must pay for it; if the uninsured patient cannot pay for himself, then the responsibility for the bill falls to the taxpayer. We already pay for un-insurance with property taxes here in Bexar County. By calling it a “tax”, the Supreme Court has shown that the individual mandate merely re-directs some of the responsibility for paying those health care costs to the actual consumers, using a sliding scale.
This is not only ethical, it is also in keeping with the American value of self-reliance. Instead of relying on public assistance in the very expensive Emergency Room when ill, health care consumers with incomes will need to pay at least a portion of their own freight.
While the individual mandate increases the number of uninsured people who should get health care coverage (32 million people by some calculations), it still leaves some 20 million out of care. Moreover, those that are covered are not necessarily guaranteed access. A study of vulnerable populations here in San Antonio makes plain that people with coverage still experience barriers to accessing health care (e.g., language, transportation, and health literacy). Thus, affirming the individual mandate is a positive but incomplete step toward the physician’s obligation to support access to care for all.
Read the full interview here.
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