The Republican leadership's intense opposition to the Affordable Care Act clearly baffles -- and disappoints -- one of the party's most admired figures, former Health and Human Services Secretary Dr. Louis W. Sullivan.
Speaking at the opening session of the Association of Health Care Journalists 2014 conference in Denver last Thursday, Sullivan, the former president of the Morehouse School of Medicine who served as HHS Secretary during the George H. W. Bush administration, noted that many of the major provisions of the Affordable Care Act are based on the reform proposals he and other Republicans crafted more than two decades ago.
"Many of the features of the Affordable Care Act are part of what we proposed back in 1991," he said, mentioning in particular the individual mandate. That provision -- the requirement that Americans enroll in a private health insurance plan if they are not eligible for a government program like Medicare or Medicaid -- is among the most vilified by today's GOP.
"If they were supportive of it then, why are they so opposed to it now?" he asked.
This was not the first time Sullivan has expressed support for the concepts behind the reform law.
"If implemented the way it should be, (the law) will result in more people having access to health insurance, and improve the health status of our citizens," Sullivan told the Montgomery (Ala.) Advertiser last September.
In another interview with the Anniston (Ala.) Star in November he stated unequivocally, "I'm for the Affordable Care Act." He added, "It's an imperfect bill and has a number of things that need to be addressed, but rather than working to try to dismantle it, we should work to improve it."
He went on to say that the plan he developed in 1991 with help and support from other Republicans -- including those who are leading the charge against Obamacare today -- "had the similar concept of the health insurance exchange." That plan also would have provided subsidies to help low-income individuals and families afford coverage, just as the Affordable Care Act does.
"But now the Republican Party is attacking the same concept," he said. "I'm not for that kind of political one-upmanship."
Sullivan is especially dismayed that so many Republican governors, including Gov. Nathan Deal of Georgia, where Sullivan was born and still lives, have refused to expand the Medicaid program to bring more low-incomes individuals and families into coverage, as the Affordable Care Act makes possible.
Deal has said expanding Medicaid "is something our state cannot afford," even with the federal government paying 100 percent of the cost of expansion during the first three years and 90 percent after that.
"I think it is probably unrealistic to expect that promise to be fulfilled in the long term, simply because of the financial status that the federal government is in," Deal said during the Republican National Convention in Tampa in 2012.
Sullivan told the journalists Thursday that, in his view, Georgia can't afford not to expand Medicaid.
Not only would the expansion bring hundreds of thousands of Georgians into coverage, the millions of dollars the federal government would send to the Peach State "would be in circulation" in the state, he said. That money, he added, would help pay the salaries of nurses and other health care providers and help keep the doors open at big public hospitals like Atlanta's Grady Memorial.
Since Sullivan's tenure as Secretary of Health and Human Services ended in 1993, he has remained active in efforts to improve the health of Americans and reduce health care disparities among people of color. Honored by the Republican National Committee in February -- Black History Month -- as one of three GOP "trailblazers" (along with former Assistant Secretary of Labor William Brooks and former Ohio Supreme Court Judge Sara J. Harper), he now heads the Sullivan Alliance to Transform the Health Professions.
The goal of the Alliance, according to its website, is to "provide the focused leadership, deep commitment, and sustainable efforts that will result in the addition to our nation's workforce of more well-trained health professionals from racially and ethnically diverse backgrounds."
Among the areas most in need of an expanded workforce, Sullivan says, is oral health. In an op-ed in the New York Times in April 2012, Sullivan called on more states to follow Alaska and Minnesota's lead in passing legislation to allow mid-level dental professionals to treat patients, especially in areas where few dentists practice.
Sullivan, who turned 80 last November, is showing no signs of slowing down. The country would be well served if politicians on both sides of the aisle would follow behind the trail he continues to blaze to improve the health of all Americans.