“Together, we’re going to deliver real change that once again puts Americans first,” Trump said to the roaring crowd at a campaign rally in October 2016. “You’re going to have such great health care, at a tiny fraction of the cost — and it’s going to be so easy.”

And yet the national debate on healthcare has erupted as costs skyrocket and more and more people grow weary of the bills from the doctor’s office. As Democratic primary campaigns rage on, progressive candidates have endorsed the idea of a single-payer national insurance plan, with moderates supporting a public option plan. President Trump has suggested cuts to Medicare to lower the federal deficit, should he win a second term, according to the New York Times.

As the topic becomes partisan and takes the main stage, potential solutions flung about, there seems to be only one thing people agree on — medical care is expensive.

After he took his place as the 45th president of the United States, Trump perhaps began to think otherwise to his proclamation of “easy.”

“Now, I have to tell you, it’s an unbelievably complex subject,” he said at a meeting in early 2017 with governors from across the country. “Nobody knew health care could be so complicated.”

On a personal level

Thomas Gillis, a sophomore at the University of Wisconsin, has been plagued with medical troubles since later years in high school.

Gillis described his first serious injury, in 2017, which required surgery and additional care.

“I was on a spring baseball trip in high school. I ended up getting in a collision during a play, and broke my leg straight through in a compound fracture,” Gillis said. “I had to get picked up by an ambulance, got a ton of x-rays, and I had trauma surgery to get it fixed and have a rod put in my leg. I stayed in the hospital for multiple days, and was flown specially back to Milwaukee.”

Gillis said he was grateful to have not been initially concerned about cost. 

“I knew the whole time, we had insurance,” he said. 

As Gillis healed, though, it slowly dawned on him just how expensive the entire process was. While he had been in surgery, money hadn’t been at the forefront of his mind — his health was. But as time passed, and bills started coming in, he was shocked to see just how much this one incident cost.

“I remember one of the nights my mom was getting the bills, she got one where medical costs before insurance kicked in was 140 thousand dollars. Just for the specific surgery, and just for this bill,” Gillis said. “Being only 17, I’d never been exposed to much … but that was one of the first times I actually thought, ‘well, if we weren’t well off, and really, if we didn’t have insurance, what would we have done?’ … to someone who might not have insurance, what are you supposed to do? You’re stranded.”

Unfortunately, Gillis’ health woes were not yet over. As time passed, more issues developed, this time with his brain. During the summer of 2017, he started getting headaches that he initially thought were migraines. They kept him up at night.

While he knew this wasn’t normal, and likely not healthy, he refrained from going to see medical professionals for financial reasons.

“The whole time, I was thinking I should get it checked out,” he said. “But there was always something holding me back — MRIs are expensive, medicine is expensive. You never want to be the boy who cried wolf, and crying wolf cost you thousands of dollars. I had already just cost thousands of dollars for something else.” 

Gillis said he put up with it until the pain became so unbearable he broke down to his family, and went to see a doctor. After getting back from the appointment, he said his mother immediately called him downstairs — someone had looked at the scan. That specialist became so concerned that Gillis needed to go to the emergency room immediately.

So that night, he headed back to the hospital. As it turned out, it was fortunate that he did.

“I don’t know how close I came to just dealing with it and dying, because I was worried about the medical care,” Gillis said. “I actually had to have emergency brain surgery to relieve pressure in my brain right away.”

And, of course, the bills followed once more.

“My mom wouldn’t even show me the medical bills for that one. And I didn’t even want to think about it,” Gillis said.

Following this latest incident, Gillis was diagnosed with an autoimmune condition. He said it requires him to take daily medication to keep his health in check, which came at a price. 

“Since then, I buy pills that I literally need every single day or else I’ll wind up back in the hospital. It’s not cheap, and we reached our deductible on the insurance in the first few months,” Gillis said.

Gillis noted there’s other upkeep — his specialist, who he had been seeing for his case from the start, had relocated to Madison from Milwaukee. While it worked out for Gillis because he happened to relocate at the same time, to be a student at UW, he said it would’ve cost even more to commute back and forth.

Let alone the price of each appointment, he added, or the extra time it would’ve taken.

Gillis said it was important to note both serious surgeries occurred within months of each other — in the same year — and the unpredictable way medical problems can happen makes preparing for them hard.

“What are you supposed to say, that someone should have planned for this? Two expensive surgeries in six months is not something anyone expects,” he said. “There’s no fairness or process for how these things happen, and nobody should be forced to be scared of going to the doctor because they’re worried they can’t pay.”

Behind the facts

Assistant Professor in the Department of Population Health Sciences at UW-Madison Rebecca Myerson, discussed the Affordable Care Act, also known as Obamacare.

“It was designed to increase access to coverage and increase affordability of care for those covered, through a large number of mechanisms,” Myerson said. “Some of these mechanisms were particularly targeted to specific populations including people aged 25 and younger, the Medicare population, people with diagnosed chronic conditions, people without employer-sponsored insurance and low-income adults.”

She noted some facets of the ACA were designed for those 25 years of age and under, citing a provision that allowed those who fell in that age group to stay longer on their parents’ health insurance plans. This policy, she said, was an earlier impact of the ACA, as it kicked in before later coverage expansions.

Myerson added college-aged students could be notably affected by certain sects of the ACA and expansions to healthcare access.

“There are also some policies that were not age-specific but may disproportionately affect or just be relevant for college-aged people,” Myerson said. “These include Medicaid eligibility expansions [as] students may have low income and be eligible for coverage in states that implemented this policy, and coverage for birth control without cost sharing for all qualified health plans as an essential health benefit. Mental health services were also required to be covered.”

Myerson’s work on the subject has involved a paper published with professors from the University of Southern California. Published in the Journal of Policy Analysis and Management, the abstract states the study “provides the first evidence to our knowledge that near-universal access to Medicare at age 65 is associated with improvements in population-level cancer mortality.” The study notes cancer as the second leading cause of death nationwide in the US.

In a review paper she published with professors from USC and the University of Chicago, the abstract stated expansions in insurance coverage for low-income adults accelerated diabetes diagnosis and then, in turn, boosted doctor visits for diabetes management.

“The findings from my research on cancer and Medicare insurance suggests that nearly-universal health insurance coverage can improve health equity – reducing death from treatable causes among under-served patient populations,” Myerson said.

Government approach

In Wisconsin, Governor Tony Evers received praise from those supporting the ACA when in June 2019, he pulled Wisconsin from a multistate lawsuit that sought the nullification of the federal health care law, according to the AP. Entrance into the lawsuit was spearheaded by former Gov. Scott Walker, who approved Wisconsin joining the suit.

In his State of the State address in January 2019, Evers cemented his support of federal level healthcare plans.

“The people of Wisconsin voted for a change [in the 2018 gubernatorial election] and asked us to stop playing politics with their health care,” Evers said. “I’ve said all along that I believe the best way to maintain protections for healthcare here in Wisconsin is to stop trying to dismantle those protections at the federal level.”

Jennifer Miller, a spokesperson for the Wisconsin Department of Health Services, discussed ACA enrollment in Wisconsin.

“Governor Evers and the Wisconsin Department of Health Services (DHS) believe every person should have access to quality, affordable healthcare, and that starts by making sure folks know there are options,” Miller said in a statement to the Badger Herald. “However, the open enrollment period for 2020 ran from November 1 to December 15, 2019. Those who want to obtain health coverage through [the ACA] will have to wait until the next enrollment period later this year to have coverage in 2021.”

Miller added that people could also try to find out if they are eligible for BadgerCare Plus, “a health care coverage program for low-income Wisconsin residents.” 

According to data provided by Marlena Holden, Director of Marketing and Strategic Communications at UW University Health Services, 24.18% of respondents in a survey said that, while students at UW, they decided not to use healthcare services because of cost. 36.7% of respondents said they waited to obtain healthcare until they were able to travel somewhere their insurance covered.

Of respondents who said they did not have health insurance, 50% said it was due to cost. 

In a statement to the Badger Herald, Holden said some services at UHS were no-cost for students.

“Most healthcare services — including medical services, mental health counseling, radiology, laboratory tests, victim advocacy and free flu shots — are available to UW-Madison students at no-cost beyond what a student already paid as part of the student segregated health fee,” Holden said.

Campus-wide effects

Alex, a UW student who requested to go by first name only, talked about how, like Gillis, he and his friends weren’t really thinking seriously about healthcare costs. 

“When I was a freshman, some of my friends had made a jar where you put in money whenever you did something ‘wrong,’ like if you lost your keys on a night out, puked because you drank too much [alcohol], stuff like that. It was a joke that we’d put the money in the jar towards anyone who wound up in detox, because everyone talks about how expensive it is,” Alex said. “I probably put a couple bucks in [the jar], and at the end of the [academic] year we went out and spent it all on booze.”

He said as he had friends actually go to “detox” or the emergency room in later years, he realized the joke wasn’t nearly as funny. “Detox” is slang for hospital admission, typically through the emergency room, for alcohol detoxification when consumption has reached dangerously high levels.

“My friend actually wound up in the ER once because she had been puking and passed out after drinking, and everyone there was really scared that it was becoming dangerous and not just a hard night out,” he said. “We were seriously worried about her. I’d never seen someone in that bad shape before.”

Alex said that while she wound up being okay, and was released after being cleared to go home by medical professionals, she wound up bringing up financial concerns after she sobered up.

“She got really, really upset the next day, after she sobered up and realized what [had] happened. At the time, we were thinking about her, maybe what her parents would think, and cost wasn’t even brought up,” he said. “But some of the first words out [of] her mouth were ‘This is gonna be so f*cking expensive.’ And she told us months afterwards that she owed almost a thousand dollars on the bills that her insurance didn’t end up covering.”

Her parents were furious, Alex said, perhaps unsurprisingly so. But despite their knowledge of the incident, financial concerns at home meant she was required to pay for the bill herself. He added that while he had been told she’d managed it, he had no idea how.

“Figuring out how you’re gonna pay that kind of money is not a casual thing for broke college kids,” he said. “I don’t think — to be honest, I know I couldn’t have paid that.”

He said while some responsibility falls to students to keep themselves safe, the implications of the incident were dangerous. While he said he understood it might be hard for adults to sympathize, given that they admittedly drank to excess and she wound up fine, there was still more to the story.

“We were trying to do what so many college kids do, have a good time, and it got out of hand. We tried to be responsible after, do the right thing, and she was fine. But now she has to pay a lot of money because we decided to get professional help,” he said. “I know we were doing something stupid, to land ourselves in that type of situation. But it’s something else entirely to say that people should be going broke just to get to a doctor in an emergency.”

He added that the long-lasting effects were something to be concerned about.

“Something I’m taking from [the situation] is that next time, it’ll take a lot more for me to want to risk anyone’s paycheck, just in case they end up fine, too. And [my friend] was already looking the worst I’d ever seen somebody, at that point,” he said. “People will have to stop breathing or something to get people to take them to doctors, for people to think its worth that kind of money, and that’s way too late.”