Low-income patients with chronic pain often face hurdles accessing the care they need despite Affordable Care Act (ACA) reforms, health care experts say.

Meanwhile, people living in poverty are more likely to experience pain, along with the stress, worry, and anger that worsen, or even cause, the discomfort, according to the Brookings Institution. The correlation between poverty and pain is especially strong, with about 38% of poor people reporting physical pain compared to about 16% of wealthy people.

The costs of treating the 100 million patients with chronic pain are sky-high—about $600 billion annually for treatment and lost productivity, according to the Institute of Medicine (IOM).

Alejandra Estrin Dashe, director for Northwestern’s Office of Diversity and Inclusion, says the costs are so high partially because providers tend to opt for the most expensive treatments first. She says:

“Patients in chronic pain face all sorts of barriers to getting the best care…[Maybe] they work so much that they just don’t take care of themselves. Others may not even be aware of their options. For instance, someone with pain from shingles doesn’t know they might be given just one acupuncture treatment and bam!—it’s gone.”

Low-income patients also don’t have access to specialists like nutritionists or physical therapists who could teach them how to eat healthy food on a budget or exercise. These simple steps could potentially offer patients significant relief.

With limited resources to care, many live with untreated pain.

Medical system needs better approach to treat chronic pain, report says.

The IOM report offered a blueprint for approaching chronic pain in a different way, recommending a “cultural transformation.” Stanford University Dr. Phillip Pizzo tells WebMD:

“We see that for many patients chronic pain becomes a disease in its own right… We need to address this in a more comprehensive and interdisciplinary way and include prevention as a very important goal.”

Despite health care reform, low-income patients with chronic pain continue facing barriers to effective care.

The ACA expanded health care coverage, but did little to change the system itself, which continues to focus on treating sickness instead of promoting wellness.

The U.S. medical system also has a dearth of pain specialists, reports WebMD. Family doctors fill in the gap by treating those patients who are lucky enough to afford treatment. However, family doctors often lack the time and needed expertise to offer patients true hope for healing. Instead, they often prescribe opioids, which are dangerous and ineffective against chronic pain. The pills are, however, likely to be paid for by insurance.

Pain specialists, on the other hand, are more likely to offer effective, affordable treatments family doctors may not know about. They’re also more likely to connect patients to alternative therapies like acupuncture and massage, which are often more effective than traditional medical interventions, reports Minnesota’s StarTribune.

Minnesota resident and licensed acupuncturist Barbara Gosse recalled to the StarTribune the differences in recovery she experienced after two bone surgeries. After the first, Gosse underwent traditional treatments and lay, suffering and miserable, in bed for a week. With the second surgery, she had acupuncture before and immediately after. The difference was astounding; Gosse says:

“I was up and moving in 48 hours. It was a tremendous difference.”

Unfortunately, patients living in poverty often can’t afford these alternative treatments. They’re expensive and typically not covered by health insurance. And even though health coverage often does pay for more expensive, traditional treatments, low-income people tend to have difficultly paying for premiums, let alone out-of-pocket costs like co-pays and deductibles.

How did health care reform help people in poverty?

One of the biggest changes the ACA made was to require all people in the U.S. to have health insurance. It also helped low-income citizens pay for it with tax credits.

Before health care reform, many people with pre-existing conditions found it difficult to find affordable coverage, if they could find it at all.

ACA ordered insurance companies to accept everyone, but many people still can’t afford coverage, even with financial aid, according to the Kaiser Family Foundation. According to Kaiser, 21% of uninsured adults who applied for health care after ACA said they didn’t buy a plan because they believed it cost too much.

Before the ACA, about 18% of all U.S. residents—more than 47 million people—lacked health insurance. Today, about four million people remain uninsured, according to Kaiser.

While increasing access to coverage is a step in the right direction, Kaiser says it doesn’t solve the very real challenges many low-income people face when trying to pay for health care.

Although more people have health care coverage, low-income patients still face difficulty paying for medical treatment.

Other obstacles people living in poverty face when signing up for health care coverage include practical barriers like limited access to the Internet, which is required to search the online health care insurance market place, apply for coverage, and pay for it once they sign up, reports Kaiser. About 19% of low-income people surveyed by Kaiser reported limited access to the Internet.

And while many plans accept direct withdrawal from a checking account, many people in poverty or with low incomes don’t have checking or savings accounts.

A large portion of low-income people also said they weren’t aware of the many changes happening to state Medicaid programs, which exist to serve those in poverty. Although the news media widely reported these changes, the message often didn’t reach into the very communities it affected.

Kaiser says a greater, more strategic effort is needed to address these issues. One possibility is distributing information through social service agencies, health clinics, and even hospital outpatient facilities that often treat the uninsured.

What reforms do you believe would expand access to care for those in poverty?

Image by 401(k) 2012 via Flickr


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