When I began PA school, I faced an unexpected financial hurdle: I no longer qualified for employer-sponsored health insurance, and although at the time, I didn’t meet the requirements for Medicaid, I did qualify for subsidized health coverage through the marketplace. However, even with subsidies, the monthly premiums and out-of-pocket costs were still a financial strain. To afford health care and cover basic living expenses, I had to continue working part-time while enrolled full-time in an intensive program. Balancing the rigorous academic demands of PA school with part-time employment was extremely challenging, but it also reinforced my resilience and deepened my commitment to this profession. It was a difficult period, but one that strengthened my empathy and gave me a firsthand understanding of the complex decisions patients often face when navigating health care access and affordability.
That experience made me reflect on the many individuals who fall through the cracks of our health care system, those who earn just enough to disqualify for Medicaid or Medicare, yet still can’t afford private health insurance. Living above the poverty line doesn’t always equate to financial stability, especially in high-cost areas like Long Island, New York, where people often struggle to afford not only health coverage, but also basic needs like food and housing. My own challenges navigating the system gave me a clearer understanding of just how flawed and exclusionary our current structure can be. That’s why I strongly believe in the expansion of public health care programs to include individuals who live above the traditional poverty threshold. No one should have to choose between staying healthy and staying afloat.
As an older and single physician assistant student, I currently rely on Medicaid for my own health insurance. I agree a lot with what Heidi Allen has to say about the program, in her TEDMED talk, “The cost of being uninsured in America,” particularly the myth that no provider will see you if you have it. I have been able to switch seamlessly from private health care insurance to Medicaid while retaining 90 percent of my health care providers. I am able to receive the same quality of care with Medicaid as with private insurance. At this point in time, without Medicaid, I wouldn’t be able to afford private health insurance, which would be a detriment to my health at this stage in my life. Therefore, I believe in the expansion of Medicaid as an aid to caring for our citizens. I also believe that, as one of the wealthiest nations, no one should be uninsured in the U.S.
Economically, it doesn’t make sense not to provide expanded health care insurance. According to Heidi Allen, increased coverage has led to greater PCP visits. It is important for the clinician-patient interaction to initially identify risky behaviors, potentially cutting off chronic disease in the future, which can be expensive to care for. Overall, expanded coverage could lead to a healthier nation and drive down health care costs. But health care costs can only decrease if unnecessary tests aren’t ordered. As I learned on rotations in the emergency department of a hospital, when ordering bloodwork or a specific exam, you must be able to justify that workup when asked. Each part of the workup must be valid in ruling out something specific in your differential diagnosis. What if all providers were held to that standard? There would be fewer exams “just because” they are available.
Mona Bascetta is a physician assistant student.
