As a family doctor, I’m privileged to get to take care of all types and ages of people. When it became apparent that the mom of one of my newborn patients was struggling with postpartum depression and that she didn’t have a primary care provider of her own, I asked if she’d like to see me as a patient so we could talk more about treatment options. She seemed grateful for the chance, and we made an appointment for a few weeks later to talk exclusively about her, and not just in the context of her baby.

She missed the appointment, didn’t return my phone calls to check up on her and make sure things were okay, and I didn’t see her again until she brought her baby in again for a well-child visit. I asked how things were going, how was her mood and was she doing okay? She explained that she really wasn’t; her husband was doing the bulk of the work to care for the baby, and the rest of their lives, because some days she couldn’t make herself get out of bed.

She admitted she was afraid to seek care for a medical condition like depression. She knew what was going on in Congress with a possible repeal of the Affordable Care Act (ACA), and she didn’t want a pre-existing condition like postpartum depression on her medical record. She explained very rationally that the family’s insurance situation was bound to change soon—they are lucky enough to get insurance through her husband’s employer, but he would likely be looking for a new position within a few years—and she knows that prior to the ACA, medical conditions like this could make insurance so much more expensive that it would be unaffordable, or could be denied flat-out. Rather than seeking care for a serious medical condition, one that can become life-threatening if not treated, this young woman who currently has health insurance chose to forgo care because the future is so uncertain. Just the threat of ACA repeal is having a real impact on patients; I hope we don’t have to find out what happens if it really is repealed.