Recently, I treated a patient in clinic, a woman in her early 40s. Just two years prior, she was experiencing homelessness and frequented emergency rooms every few weeks. Through the Affordable Care Act, she was able to get health insurance, which in turn helped her get her blood pressure managed and diabetes treated. It also enabled her to obtain treatment for depression and alcoholism.

As a result, she now had a job and a home. She regained custody of her children. Thanks to health insurance, which she called "her rock," she had her life back.

For my patient, like so many of our residents, the national uncertainty we face is deeply personal. In 2010, 81,000 adults in Baltimore City were without health insurance. That number has been cut in half — meaning that more than 40,000 now have access to life-saving care. Will their coverage now be at risk? Will our neighbors and family members be priced out of the basic right to health?

WEST BALTIMORE — At the sidewalk’s edge in a vacant lot, the crowd gathered around the card table, to learn how to bring someone back from the dead.

On the table rested a vial of naloxone — the drug that reverses overdoses from heroin and other opioid drugs — screwed into a nostril-shaped inhaler. Daryl Mack of the Baltimore City Health Department had assembled the kit in about 30 seconds in front of the crowd.

The watchers, older black men and women from Baltimore’s Sandtown neighborhood, nodded at Mack’s description of a black person turning ashy gray during an overdose as their breathing stops, and how the drug on the table will call them back from the edge of death.

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It's late August and Dr. Leana Wen is standing underneath the soaring dome of City Hall, a bank of cameras pointed at her as she leads a news conference to mark National Overdose Awareness Day.

As Baltimore’s health commissioner, substance abuse and addiction are among her top priorities, not to mention issues of national importance. Last year, more Baltimoreans died from overdoses (393) than from homicides (344). So she’s here—flanked by Senator Ben Cardin, Congressman John Sarbanes, Police Commissioner Kevin Davis, Fire Chief Niles Ford, and others—to sound the alarm about the nation’s opioid overdose epidemic and tout the city’s innovative response to the crisis.

There’s much to tout. In October 2015, Wen became the first health commissioner in Maryland to issue a blanket prescription allowing all Baltimoreans to obtain naloxone, a medication that can reverse an in-progress opioid overdose. The bold move attracted national attention and helped earn her a spot on a panel with President Barack Obama at the National Rx Drug Abuse and Heroin Summit in March.

It is a cold, wet, dreary Saturday morning on the first day of October. It's the kind of morning most people would rather spend stretched out in bed, or maybe sipping a cup of coffee and daydreaming about nothing much in particular. But at 9 a.m., inside the Baltimore War Memorial, Baltimore City Health Commissioner Leana Wen is addressing a crowd of about 50 people at something called "Solutions Summit: Behavioral Health Forum." Organized by the nonprofit Open Society Institute, the event is a way for citizens to come together and work toward solutions to the city's lingering structural problems.

This morning, she's talking about addiction deaths, and how they have increased in part due to fentanyl, an opioid that can be added to any number of drugs. According to the Drug Enforcement Administration, fentanyl is up to 100 times more powerful than morphine and 30 to 50 times more powerful than heroin.

Wen speaks with passion and authority, and the room is silent as she makes her case about the urgency of this situation.

"The number of people dying…has increased by tenfold—not 10 percent—10 times in the last two years because this medication fentanyl has gotten mixed with heroin, with cocaine, and people don't know that it's there," Wen says. "There is so much work ahead of us but now we have to focus on saving lives."