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If you have a chronic illness and you don't have enough money to see a doctor, you usually get sicker and sicker until you lose your job, at least in the USA. Here are some ideas for what poor people can do to access medical care in the United States.

If you don't have health insurance but you have at least a little money, you can always go to walk in clinics. Even your regular doctor may be glad to accept cash rather than go through the hassle of filing with an insurance plan. It can be very hard to get medical care in the USA if you don't have money.

If you work at all in the states that didn't expand Medicaid eligibility, you may earn too much for Medicaid coverage, but not enough for "Obamacare" coverage. What can you do?
 

1. During the next open enrollment season, take an optimistic look at your next year's earnings.

Never lie on a federal form. However, the next time you can enroll in Obamacare, see if you can't possibility earn enough to meet the minimum income to qualify for insurance subsidies (a little over $12,000 a year for individuals). If you can, claim that amount, and get your subsidy so you can afford insurance. If you don't earn the requisite income the next year, you will owe either nothing or a small penalty for not qualifying for the insurance you have received. Congress could change this law, but you will at least have had coverage, which can get you the medical attention and drugs you need to stay healthy, or just to stay alive.

2. Enroll in your city or county's healthcare system.

Many cities and counties have medical schools attached to teaching hospitals that offer care to the working poor. The application process may not be dignified, but the care may be superb. Typically, city or county healthcare systems charge only token fees for doctor visits or medications, and offer hospitalizations or even surgery for free. However, you may be used as a teaching case for medical students and residents, seeing as many as a dozen doctors instead of one.

Some cities and some rural areas have free clinics or sliding-scale clinics. A few of these clinics will see anyone who comes in the door. If you have access to such a clinic, be nice, and offer them any kind of help you can. 

3. If (or when) you do get bills you can't pay, don't ignore them.

It's never a good idea to ignore a huge bill from an emergency room or a hospital, even if you can't possibly pay it. Often hospitals and clinics have access to charitable foundation funds, or they get reimbursed by the federal government for charity cases. You usually won't get help from those funds if someone in the hospital administration isn't helping you with your case. Stay in touch with the clinic or hospital's financial office until your bill is resolved.

4. When you have to get treatment in the ER, ask the doctor to make sure any prescriptions are for generics.

Many pharmacies sell medications on a list of about 500 products for as little as $4 a month. When you doctor gives you a prescription, ask for a generic. Sometimes you have to have a more expensive product, but many chronic conditions are managed with inexpensive medications. Even if you have insurance, you are likely to get these inexpensive medications whenever applicable.

5. Don't delay healthcare just because you don't have money.

Chronic problems can get worse if you don't get help for them. It's better to go the ER when you are just a "little sick" than it is to wait until you need a full-blown hospitalization. It can be scary, or a major hassle, to deal with the billing office, but it is better to deal with a financial hassle while you are relatively healthy than to wait until you are seriously sick.

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