Doctors who operate "off the grid" have an ethical obligation to ensure that their patients understand this and to make sure their patients have, at minimum, a catastrophic-coverage policy, said Carolyn Long Engelhard, director of the Health Policy Program at the UVA School of Medicine. “Under the Affordable Care Act, which the physicians may hate and which we know has problems, poor, uninsured people who can’t get health insurance at their jobs can qualify for pretty large subsidies and get comprehensive insurance," Engelhard said.