Bich-May Nguyen, MD, MPH
Houston ( Houston Chronicle, March 9,2017): As a family physician, I have seen how patients have benefited from the Affordable Care Act, also known as “Obamacare.” After seeing the Republican proposal this week, I am worried that Republicans are going to violate the first line of the Hippocratic oath: First, do no harm.
While they have spent years unsuccessfully trying to repeal the ACA, Republicans had not developed a detailed plan to replace it until now. Early evaluations suggest this scheme could have a devastating effect on millions of people and add millions of dollars to the national debt.
First, the Republican program would replace ACA subsidies based on income with less generous tax credits based on age. Their proposal would make it harder for young and diseased Americans to pay for health insurance and get the health care they need.
Recently, I cared for a graduate student. She has a chronic illness that requires regular specialty appointments and is controlled with an expensive medication. When her insurance plan changed, she could not get the medication for two months. She had difficulty focusing on her studies due to her disease worsening. She now has insurance coverage through an ACA subsidy and exchange. She will not be able to afford the care she needs through the Republican plan.
While older adults seem to get more money to pay for health insurance through this Republican strategy, the tax credits would be smaller than the current ACA subsidies. Also, Republicans would allow insurance companies to charge older adults fives time what they charge younger adults. Currently, the ACA limits insurers to charge older adults to only three times the younger adults.
These changes for older adults concern me, too. I took take care of an older man with a rare medical condition as well as multiple chronic diseases. He did not qualify for Medicare yet, but he was able to purchase insurance through the ACA exchange. However, he would not be able to afford higher premiums, co-pays, and deductibles through the Republican bill.
Additionally, Republican legislators want to alter Medicaid by changing the federal funding for states to a per-capita payment and stopping support after 2020. States would receive money based on the number of Medicaid patients enrolled and nothing extra after 2020.
If the state faced a recession or a new, expensive disease or treatment emerged, the state would have to make up the difference. States would be more likely to cut benefits or push costs to patients.
I have treated a number of patients who have been cured of hepatitis C, thanks to new drugs. One of the drugs costs almost $95,000 for the full course of treatment. Without insurance coverage, none of my patients would have been able to afford these medicines. They would have remained infected and risked developing liver failure or liver cancer.
Finally, Republicans are moving to defund Planned Parenthood. This would cut services for screening for sexually transmitted infections and cancers as well as contraception. This change disproportionately affects low-income women and women of color.
National leaders may not know what happened in Texas after Planned Parenthood was removed from the women’s health program in 2013. The New England Journal of Medicine published a report that found fewer women had access to birth control. Subsequently, Medicaid covered more childbirths. Another study from the journal Obstetrics & Gynecology found that women’s deaths related to pregnancy decreased worldwide, but doubled for Texas from 2010 to 2014.
Republicans say they want to provide Americans with more choices. Yet, they are removing an essential provider of women’s health care.
For now, Republicans have written a plan that only addresses funding mechanisms that can be passed with a simple majority instead of a two-thirds vote. Still, millions of Americans could become uninsured. The GOP proposal does not live up to President Donald Trump’s promise that he would make health care cheaper and better for everybody.
The budget-neutral ACA helped millions of people get health insurance, but it was not perfect.
If the Republicans were brave, they would tackle narrow networks, rising prescription drug costs and affordability. Instead, they’re giving benefits to the wealthy, adding to the national debt, and playing politics with millions of people’s lives.
About Bich-May Nguyen, MD, MPH
Bich-May Nguyen cares for patients at a community health center and teaches medical students, residents, and faculty development fellows. Dr. Nguyen received her MD in the Underserved Track from Baylor College of Medicine and an MPH from Harvard School of Public Health. She completed her residency training in Family Medicine at Boston University. Dr. Nguyen is involved with the National Physicians Alliance and serves on the Executive Board of the New Leaders Council Houston