In May the House of Representatives narrowly passed the American Health Care Act. Now, a few members of the Senate are secretly constructing their own bill, and there are disturbing rumors it shares considerable overlap with the House’s AHCA bill. Now is the time to remind members of Congress and the Trump regime that the majority of the American people did not vote for Trump. The majority of the American people did not vote for attacking the health care of millions of our fellow Americans. Not a single reputable medical association or public health group supports schemes in Congress to repeal the Affordable Care Act. Here’s why:
5. Secrecy is unhealthy for democracy.
Perhaps the one thing everyone can agree upon, including Trump, is that American health care is complicated. When faced with complexity, physicians and patients know the value of open and honest conversations. For the past several weeks a small select cadre of Senators have been working in secret on a bill that supposedly has much in common with the disastrous AHCA. No hearings have been scheduled in the relevant Senate committees to discuss the consequences of repealing the Affordable Care Act. The American people have not been given a chance to review drafts of Senate legislation that could impact the health care of millions. Doctors, nurses, and patients strongly urge Senators to conduct open hearings before any action is taken to repeal the Affordable Care Act. All of us can contribute our knowledge and experience to improve American health care.
4. Millions of children will lose coverage.
For me and thousands of my colleagues in pediatrics, it is unacceptable that provisions in the AHCA will cause 3 million children to lose coverage, increasing the uninsured rate for children by 50 percent. The efforts to phase out Medicaid’s expansion and turn the program over to a system of per capita caps or block grants will severely impact the health of millions, including 37 million children. Our patients with birth defects and other pre-existing conditions have prevailed over many challenges in their young lives. We refuse to let their future prospects be jeopardized by Medicaid caps or by insurance companies imposing “continuous coverage” or lifetime limits.
3. Being a woman will be a pre-existing condition. Again.
Prior to passage of the Affordable Care Act, insurance companies charged women significantly higher rates than men. Over 70 percent of individual health plans sold by insurance companies did not cover maternity care. The ACA stopped these discriminatory practices and made life-saving preventive health services free of charge. However, all that progress may be undone by Senators looking to AHCA provisions to allow insurance companies to up-charge our patients with pre-existing conditions and to sell low quality insurance plans with no essential benefits (like maternity care, reproductive health services, cancer screenings, etc). Additionally, funding for Planned Parenthood could be in jeopardy as Senators haggle over this vital source of health care for millions of women.
2. Racial disparities in health will worsen.
Among the many achievements of the Affordable Care Act were the steps taken to reduce minority health disparities. In large part thanks to 31 states expanding Medicaid, African-American and Latino-American communities experienced improved health coverage and greater access to care. The AHCA and the Senate’s possible ideas will take us in the wrong direction. The devastating changes to Medicaid in the AHCA are particularly dangerous to the health of minority communities because Medicaid covers over half of all children of color as well as 1 in 5 non-white adults. My colleagues and I urge the Senate to stop repeal of the Affordable Care Act and instead work towards extending health justice to all.
1. Medicaid will be decimated by per capita caps.
As physicians, what we find particularly alarming are dangerous attacks on Medicaid being comfortably discussed in secret by members of Congress. The AHCA would convert the program’s funding into per capita caps, resulting in $800 billion slashed from Medicaid. Senate aides have said the Senate’s schemes would be worse. Per capita caps in Medicaid mean the federal government would give each state a very small, fixed amount of money to run that state’s Medicaid program based on certain patient populations. Because AHCA ends the federal government’s open commitment to Medicaid, a state will be left with no further support if more people suddenly need the help of Medicaid because of a natural disaster, recession, disease outbreak, or other hardships. Under the drastically low funding of a per capita cap system, a state trying to maintain their Medicaid program will be left with difficult budget decisions that will hurt our patients no matter what. In order to pay for in-home long term care services, a state may cut its education or transportation funding. Children with special health needs will see their care diminish in quality because states can not afford to perform at high standards when funding is low. The Congressional Budget Office’s analysis of the AHCA estimates that of the 23 million people who will lose health care coverage, 14 million will lose it because of AHCA’s drastic changes to Medicaid.
Rather than heed these warnings, many senators are enthusiastic to wreck Medicaid with per capita caps as passed by the House of Representatives. One of the disagreements between Senators and their House colleagues is when to stop the expansion of Medicaid under the Affordable Care Act. Despite the fact that 31 states successfully expanded Medicaid under the ACA (and thus covered 15 million Americans who report high levels of satisfaction with their new care), the House’s AHCA freezes patients out of Medicaid as early as 2019. Some “moderate” Senators want to delay kicking people off their Medicaid coverage by 3 to 7 years. Such a delay is cold comfort to our patients, many of whom will not be able to afford health care elsewhere.
Medicaid is a cornerstone of America’s health care. Medicaid contributes to the education and training of every doctor, nurse, and allied health care provider in this country. Our patients who are not directly covered by Medicaid for their health care still benefit from the program because Medicaid helps hospitals hire staff and expand services. Every American should appreciate Medicaid’s role as a first responder during natural disasters and disease outbreaks. The program covers over half of all births and 60 percent of all nursing home care. Though we may not be thrilled about the low reimbursements from Medicaid, the overwhelming majority of health care providers participate in the program and care for patients.
As physicians, we are calling on Congress to stop its plans to repeal or undermine the Affordable Care Act. We have not journeyed with our patients through illnesses, injuries, and other hardships only to watch them suffer from cruel policies passed by members of Congress and the Trump regime in order to score cheap political points. Our patients need protections from discrimination by the insurance industry. They need support with affording high quality, reliable coverage. Medicaid is critical to ALL of our health care, and can not withstand the damage from per capita caps or phasing out the expansions under the ACA. Now is the time to end secrecy in creating legislation that could impact the healthcare of millions. We look forward to joining our patients and our elected officials in open, honest conversations in public hearings, town hall meetings, and other venues of democracy. Together, we can make health justice a reality for all.
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