1. Why Gunshot Victims Have Reason to Like the Affordable Care Act
By SARAH VARNEY
New York Times
NOV. 28, 2016

2. Care for Gunshot Wounds
Kenneth Berry can feel the bullets in his body move. One jiggles down his leg toward his ankle; another presses on his sciatic nerve; a third has migrated to his hip.
The three bullets have been inside Mr. Berry, 41, for more than two decades, pumped into him when he was a teenager near St. Louis.
Now, after years without health coverage, besieged by untreated nerve pain and hunched over a cane, he finally has the golden ticket to get the medical procedures that will bring relief: a Medicaid card.
This is a surprising effect of the Affordable Care Act, the landmark health care law that now faces an uncertain future given the Republican Party’s victory in the presidential election and its control of both houses of Congress.

3. Expansion of Medicaid
By funding the expansion of state Medicaid programs beyond the traditional populations of poor mothers and children, the law has brought coverage to tens of thousands of previously uninsured shooting victims, often young African-American men, who, once stabilized in emergency rooms, missed out on crucial follow-up care and have endured unremitting effects of nerve injuries, fractured bones, intestinal damage and post-traumatic stress disorder.
The same states that have opted to expand Medicaid, including California, Arizona, Illinois, Michigan, Maryland and Pennsylvania, suffer high numbers of firearm injuries.

4. Changing the healing
The law is profoundly changing how gunshot victims in these states heal from grievous injuries by guaranteeing access to:
specialists
physical therapy
nursing home care
antibiotics
wound supplies and
wheelchairs,
according to dozens of interviews with trauma surgeons, rehabilitation specialists, anti-violence groups and shooting victims.

5. Incomplete Treatment
“Some of my patients would be missing their skulls three months after the injury and have to wear helmets,” said Dr. Michael Ajluni, a traumatic brain injury specialist at the Rehabilitation Institute of Michigan in Detroit. “Now they can get their skulls back in place.”
Officials at urban hospitals across the country estimated that before the health law, more than half of their gunshot patients were uninsured. Obligated under federal law, hospitals provided hundreds of millions of dollars in un-reimbursed services. Trauma surgeons called in favors for scarce charity openings with specialists, but more often grudgingly sent uninsured patients home, knowing they were unlikely to receive essential follow-up care.
Patients needing bowel diversion surgery, for example, a common necessity for those shot in the abdomen that should be surgically reversed after the intestines heal, instead walked around for months or even years with temporary colostomy bags because many hospitals would not treat them without health insurance.

6. Economics – Pretty Simple$
MB, MC
Suppose “true” MB curve is blue curve.
Suppose that without insurance benefits, effective MB is red curve.
Insurance in this case acts as an income transfer that helps people buy the care that they need. MB MC
MBe
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