TMC PULSE

t m c » p u l s e | m a r c h 2 0 1 7 10 TWO STORIES IN ONE ACT Into the Coverage Gap F or the past year, Natalia Fuentes, 67, has been riding a health care roller coaster. Caught in a "coverage gap," she is part of a group of unin- sured, low-income adults living just above the federal poverty line. Fuentes, who needs regular treatment for cataracts and glaucoma, has been unable to benefit from the Affordable Care Act (ACA). Until last March, she received high-quality care at an affordable rate through Harris Health System. "I could see all of my regular doc- tors at Vallbona clinic and I could go to Ben Taub if I needed to see another doctor or to Sunnyside if I needed an MRI," Fuentes explained. "I used to pay $10 for a doctor consultation and $8 for medicine. If I needed an MRI, I only paid $10; if I needed an EKG, I only paid $10. It was a big help for me." But in a roundabout way, the ACA intervened. Passed in 2010, and put into effect in 2014, the ACA included coverage expansion that extended Medicaid eligibility to greater numbers of low-income residents across the coun- try. Individual states had the option to expand Medicaid coverage; those that opted in received additional federal funds. But Texas, home to more unin- sured Americans than any other state, opted out of expanding Medicaid. As a result, many Texans were deprived of health care coverage, which led to higher costs and lower revenues for health care providers. Last year, Harris Health System was forced to scale back coverage to its patients. Under the new program, households that exceed 150 percent of the federal poverty line no longer Caring for a Compromised Heart L ong-distance runner Rebecca Trahan was the embodiment of health. At 5'2" and 108 pounds, she was in peak physical shape. The self-employed graphic designer and small business owner exercised religiously, maintained a clean diet, didn't smoke and rarely drank alcohol. In August 2011, just a few days after her 49th birthday, Trahan visited Denver, Colorado, where she spent a week at a horse camp. While she was driving to the Denver airport for her return flight to Houston, her vision suddenly blurred and she became overwhelmed with sweat and nausea. But she dismissed the symp- toms, assuming they were precursors of a migraine. "I pulled over to the side of the road to take my vascular inhibitor when a hippopotamus flew into the car and sat on my chest," Trahan said, describing the crushing pressure she suddenly felt on her heart. "My jaw was numb, and my arms were numb, and just huge sweating, all of that. Classic symptoms of a heart problem, but I denied it all." The symptoms persisted for 45 minutes. "I convinced myself, even though I didn't believe it really happened, that it was a panic attack, because I had just run 15 miles with no problems," Trahan said. What Trahan experienced was neither a migraine nor a panic attack. It was a spontaneous dissection of the left main coronary artery, a rare and occasionally fatal condition. Trahan's heart was collapsing. Spontaneous coronary artery dissection—also referred to as SCAD—occurs when the inner lining of a coronary artery becomes loose, allowing blood to flow underneath and form a bubble. This obstructs blood flow to the heart, which can cause a heart attack, abnormal heart rhythm, or even sudden death. The exact causes of SCAD are unknown, but research indicates that patients are often healthy women with little to no risk factors for heart disease. Instead of calling 911 or going to the hospital, Trahan continued down the freeway. She dropped off her rental car, caught her flight back home and continued with her usual workout regimen of running, boxing and lifting weights. But at 3 a.m. the following Tuesday, Aug. 30, Trahan awoke in another fit of agony. With blurry vision and severe chest pain, she dragged herself to the bathroom, took some aspirin and went back to bed, counting her breaths and waiting for the pain to pass. Later that afternoon she went to see her doctor. After her internist ran a few tests, the medical team told her she needed to be transported to St. Luke's Hospital by ambulance. "An ambulance? Are you kidding me? I can drive," Trahan said, running the numbers in her head. "It's going to cost a fortune." Trahan paid for her own insurance and was concerned about mounting medical costs. "Rebecca, you fail to see the grav- ity of the situation," her cardiologist The only thing that saved me was that there was a non-pre-existing clause.

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