Mary’s wounds seemingly come out of nowhere. A pleasant 44-year-old woman with a quiet, calm voice and optimistic attitude, Mary returns to our clinic every four to six weeks to be seen for a bright red, hot, painful patch that appears on her left thigh. Her only means of preventing infection is by periodically coming in for a new antibiotic prescription. Prior to the Affordable Care Act (ACA), Mary could not afford to receive care for her chronic skin infections. Now, she has access to appointments and medications that can prevent life-threatening blood infections if left untreated. However, Mary’s coverage ends in just a few months. As her care providers, we share her fears that soon she may no longer be able to see her doctors and buy her medications. Given this uncertainty, our team prescribed Mary large supplies of antibiotics that we hope will last her several months in case she loses her insurance. If her coverage ends, and she does not get these drugs, there is nothing she or her doctors can do to prevent her from becoming critically ill and possibly dying.
Stories like Mary’s are part of a larger debate being held in Washington right now. America is in the middle of a divisive political battle between maintaining the Affordable Care Act (ACA) and replacing it with its most recent replacement bill, the Better Care Reconciliation Act (BCRA). A few months ago, the fate of the ACA seemed to be sealed: Republicans who promised to overturn the law won control of the Senate, House, and presidency. Over the last few months, however, the conversation about health care in America has fundamentally changed.
As future physicians trained to advocate for our patients and, above all, do no harm, the AHCA and BCRA are deeply troubling
As even conservative commentators will admit, Americans increasingly perceive health care as a right, rather than a luxury for those who can afford it. The change in Republican rhetoric from “repeal” to “replace” to, mostly recently, “repair” underlies this change in public attitude towards health care coverage. Just as Republicans find themselves in a position of power to repeal Obamacare, the ACA has attained record popularity. A recent Gallup poll found that 55 percent of Americans supported the law, up from 42 percent immediately after the election. Even traditionally Republican-leaning states such as Florida and Kentucky have embraced establishing major components of the ACA.
Conversely, the BCRA, like its House predecessor, the American Health Care Act (AHCA), is hugely unpopular, with a 17 percent approval rating. Across all 50 states more people opposed than supported the AHCA. Medical groups with drastically different priorities representing medical students, doctors, insurance companies, and hospitals almost unanimously oppose the law. Even President Trump has called the House alternative to the ACA “mean.”
It is not hard to understand why the BCRA is so disliked by Americans. The nonpartisan Congressional Budget Office projects that compared to the current law, 22 million more Americans will lose insurance by 2026 under the Senate bill. Popular provisions of the ACA, such as essential health benefits and guaranteed coverage for people with disabilities and mental illness will be cut under the new Senate draft bill. As the president of America’s Essential Hospitals, a coalition of about 300 hospitals that treat a large share of low-income patients pointed out, “There has never been a rollback of basic services to Americans like this ever in U.S. history… Let’s not mince words. This bill will close hospitals. It will hammer rural hospitals, it will close nursing homes. It will lead to disabled children not getting services… People will die.”
While publicly many Republicans have adopted some of the vocabulary of the left, claiming that their goal is to provide affordable health insurance for everyone, this rhetoric is belied by their actions behind closed doors. Their strategy has been to make health care affordable to just a few select groups, such as the young, the able, the healthy, and the wealthy. Paul Starr, a Princeton University professor of sociology and public affairs who has written extensively about the history of U.S. health care policy states: “This is bringing us back to where we were before 1965… there is no longer the federal commitment to back up the states in terms of health care for the poor.”
As future physicians trained to advocate for our patients and, above all, do no harm, the AHCA and BCRA are deeply troubling, particularly for our patients like Mary. Leaders in health care, such as the AMA, agree that the ACA is an imperfect law, and should be improved with an open, public discussion about how to stabilize markets, stem the rise in premiums, and guarantee quality coverage. Unfortunately, the future of the ACA may instead come down to just a few Republican votes in the Senate. The recently announced postponement of the Senate vote on the bill is by no means an indication that the fight over health care is over and won. As Republicans privately tinker with legislation that will cut coverage for tens of millions of Americans, we must not become complacent. The last few months have demonstrated that speaking out against irresponsible and cruel legislation can profoundly influence the trajectory of our nation’s commitment to health. If we decide that protecting health care in America is a priority, we must all fight for it.