The e-mail was 138 words of frustration.
Alan Brooks' wife Cherylann, a diabetic with high blood pressure and chronic obstructive pulmonary disease (COPD), needed health insurance she couldn't afford. And now a charity clinic, her last lifeline to care, was being forced to close, purportedly because of the Affordable Care Act.
For the last four years, Brooks' family has been surviving on his Social Security disability check. While his health care is covered by Medicare, Cherylann has had to rely on the charity clinic doctors at St. Luke's South Side Medical Center in Bethlehem to monitor and treat her conditions. The fee was $10 a visit. She loved her doctors and the care she received.
But in December, word started spreading like a cold in day care that the center was going to close due to the ACA.
Talk about adding insult to illness.
"Now what?" Brooks pleadingly wrote in an April e-mail.
Their fears would turn out to be unfounded, but the Bethlehem couple didn't know that then. They first tried finding insurance on the ACA marketplace. But Cherylann, a stay-at-home mom most of her life, had no income. So she wasn't eligible for tax-credit or cost-sharing-reduction subsidies embedded in the ACA. And Brooks' disability check was already popping seams to make ends meet. There was no way the family could pay a full premium, even just $250 a month.
The couple explored Medicaid. Cherylann would have qualified if Pennsylvania had expanded the program. But it hasn't so far, and the state's controversial Healthy Pennsylvania plan remains in limbo waiting for the Department of Health and Human Services to act on a waiver request.
Gov. Corbett's plan would give federal subsidies to uninsured, low-income residents to buy private insurance in the ACA marketplace. Recipients also have to pay premiums and cost-sharing and show that they are actively seeking a job. So even if the plan were in place, Cherylann likely wouldn't qualify.
"I know Cherylann definitely couldn't get a job," said Brooks, 62. "So her putting money toward it would not be possible."
Scrambling to pay bills and find affordable health insurance wasn't always a concern in the Brooks household. Alan Brooks once pulled down a handsome salary with good health insurance as a respiratory therapist. That ended in 2008 when, he said, he was hurt on the job. He couldn't return to work and was let go, he said.
That same year, Cherylann, then 53, was diagnosed with diabetes.
At first Brooks could scrape together enough money from his unemployment checks to pay the doctors. But as the family's funds were pinched ever tighter, the couple had to find an alternative. They turned to St. Luke's South Side Center for care. In 2010 Brooks went on disability and Medicare. Cherylann kept visiting the clinic.
"I sing their praises every day," Brooks says of the clinic.
St. Luke's is a six-hospital nonprofit network with 150 outpatient sites in eight Pennsylvania counties - including Bucks and Montgomery Counties - and Warren County in New Jersey. Its charity clinics can serve between 5,000 and 8,000 different patients a year.
"We see about one-third of our patients who are uninsured," said Cheryl Quesnel, practice administrator of St. Luke's South Side Medical Center. "They are people who either don't qualify or can't afford ACA insurance, or they have an exemption from the ACA because of the Medicaid gap."
The clinic hosts 14 specialty practices every month, including pulmonologists. Most people who visit the clinic and don't have health insurance receive charity care - a $10 payment - regardless of the practice they are seeing. Other services, such as medical labs, may also bill a patient.
"We really do provide comprehensive health care for patients regardless of their insurance or their ability to pay because that is St. Luke's mission," Quesnel said. "And we live that mission here. We touch a lot of patients every day."
As for the rumor that the clinic was closing because of the ACA? It was just idle gossip.
"I think there was a lot of confusion by patients when the ACA kicked in as to whether they would still be seen without insurance," Quesnel said "But we always planned to see uninsured patients regardless. We never talked about closing."
In June, Brooks called the hospital's financial office asking for help finding his wife health insurance, since he thought the clinic was closing. The hospital worker assured him that the hospital fully intends to keep offering care at the charity clinic. Cherylann, now 59, had her annual checkup last month.
"Fortunately," Brooks said, "everything is fine."
Did you buy insurance under the Affordable Care Act through Healthcare.gov? How is it going? We would like to hear about your personal experiences with the ACA, including the expanded Medicaid program in New Jersey. E-mail us at email@example.comEndText
215-836-0101 This article was written in partnership with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.