National reform will not upend the way North Carolinians obtain insurance or health care. Most people will still receive coverage through work or purchase a policy from a private insurer on the individual market. Seniors will still get their guaranteed Medicare benefits. Nevertheless, reform is a revolutionary shift in how we think about health care. No longer will we focus on whether or not a particular person qualifies for a public program or is eligible for private insurance. Instead, we will work to find where different individuals fit into the system. It will be assumed that every one qualifies for coverage.

This is important because right now our health care system has too many holes and not enough nets. Over the next three years, health reform reverses this trend by building broader and stronger safety nets while narrowing the cracks through which too many families fall.

After reform is fully implemented in 2014, health care will be more accessible than at any other time in our state's history. That is why North Carolina health advocates and analysts are elated by the passage of comprehensive national reform. Reform will inevitably help millions of people across our nation, but the true test of this legislation is how it unfolds on the ground. How will it help the people caught in the whirlwind of everyday experiences?

Over the past year, the North Carolina Justice Center's Health Access Coalition has traveled the state talking to people of every political stripe about their health care experiences. Here are a few stories that demonstrate the problems people face everyday in our current system. None of the problems are simple. Just as our health system is complicated, so too are the struggles families face in accessing care. But if health reform can extend relief to these people, then this historic bill will qualify as a success.

• Michael Byrus is a 23-year-old man living in Apex. He is a college student with a painful chronic ailment called Crohn's disease. His inflammations are serious and difficult to control, although he is careful with his diet and self-administers his regular injections. During a recent extended stay in the hospital while he recovered from major surgery, Michael's insurance company threatened to drop his coverage. Because Michael's condition makes him virtually uninsurable, this was a serious threat.

  How was the insurance company able to withdraw Michael's coverage just when he needed it most? He is insured by his mother's policy, but to stay on that plan he must maintain his status as a full-time student. But Michael's surgery and subsequent recovery would keep him out of school for most of the semester. The insurance company questioned his student status and said he was no longer eligible to remain on his mother's plan.

  Despite his illness, Michael worked with his college and with individual instructors to conduct class work, remain a student, and maintain coverage.

• Susan Smith in Hickory has labored over the last several years, helping her 25-year-old daughter Rachael afford the care she requires. Rachael Smith has systemic lupus. Lupus makes it difficult for her to work, which means that a group policy is unobtainable and Rachael's condition makes purchasing insurance on the individual market impossible.

  After one particularly frightful bout in the hospital, Rachael was left with a $30,000 bill. Neither Susan nor her daughter had the money to pay. Collection agents hounded them. Susan was only able to cover the debt with her husband's small life insurance policy after he passed away.

  They finally had a brief respite before Rachael was hospitalized again. Susan says a 48-hour stay stuck them with another $30,000 bill. They were devastated.

  This time Susan thought to ask about a charity care policy at the nonprofit hospital. She was never told about financial assistance by anyone at the hospital. Susan is now applying for charity care, hopeful for help but nervous that another episode will result in bankruptcy.

To read the full article as it appears in the North Carolina Medical Journal, please click here.