For seven years, congressional Republicans have documented their insatiable desire to scratch the itch that is the Affordable Care Act. They have inundated Americans with the hue and cry of their obligation to “repeal and replace.”
There is little debate that certain parts of the ACA are flawed and in need of review — a few being individual market problems, rapid beneficiary growth and increasing costs. Currently, however, there is significant debate concerning the Senate’s version of “repeal and replace,” the Better Care Reconciliation Act. The controversy regarding the BCRA is much more than senators getting comfortable with a bill that is making most Americans uncomfortable: the blunt reality is this is a partisan political, financial and health care demographic battle.
There is overwhelming evidence that the BCRA will target the eldest, youngest, poorest, sickest, disabled, addicted and pregnant. Panicked concerns abound from senators, physicians, insurance and hospital executives, and patient advocacy groups.
One consistent and notable exception is the current executive branch, where the president has stated, “I am very supportive of the Senate health care bill. Looking forward to making it really special. Remember, Obamacare is dead.”
This contrasts with the eventual reality of fewer people with health care coverage under Medicaid, with funding limits starting in 2021 and proposed Medicaid spending decreasing 26 percent by 2026. In 2016, Medicaid insured 48 percent of American children, 46 percent in Washington. And children only account for just under 20 percent of total Medicaid costs. (Total Medicaid costs increased 4.3 percent in 2016 to $576 billion of which the federal share is $363 billion). Let’s not forget that Medicaid accounted for almost 60 percent of the newly insured under the ACA. Abandoning the oldest, youngest and most vulnerable of our citizens is not going to replace care, it is going to worsen it. Sacrificing even some of the current 74 million Medicaid recipients at the altar of tax savings is going to leave states with a future incalculable Sophie’s choice, especially to the 31 states that expanded Medicaid coverage with the ACA: do they restrict eligibility, eliminate or decrease services, reduce reimbursements for medical care or hospitals, increase patient out-of-pocket costs, opt out of requiring essential benefits guaranteed by the ACA, or vote to spend more?
The consistent and key message is that Congress is now abrogating the federal government’s responsibility to provide health care to our most vulnerable citizens and is legislating kicking the fiscal can down the road to states that are even now struggling with their yearly budgets. Their single-minded purpose cannot be deterred by public polls, state governors, insurance and health care executives, physicians or patient advocacy groups. It is an itch they cannot ignore, even though in scratching it is producing an infection spreading rapidly from Washington D.C. throughout the country.
Repeal and replace is about real people with real health problems, granted health care consumes 2.6 percent of our gross domestic product. But if our legislators can vote to allocate billions to safeguard our citizens from terrorist attacks, can they not devote similar sums to safeguard the welfare of all Americans? Is the only answer senators are proposing as to the who gets health care, what and how much they get, and where they get it, truly a bill such as the BCRA? Do our senators really believe that creating a workable alternative to achieve real health care reform that could provide cost-effective care, bend the cost curve, eliminate waste, apply more appropriate medical choices for diagnosis and treatments and focus on population health would spring forth from a secret Senate committee? How else can we explain this suspect bill occurring with no input from the previously mentioned health care ecosystem?
I would respectfully suggest that if the president could fulfill a promise to the American people by creating a bipartisan commission “to review ways to strengthen the integrity of elections and study vulnerabilities in voting systems,” he could certainly create a commission to study and recommend more positive solutions to the apparent flaws noted within the BCRA.
Real solutions and health care reform do not begin with the prospects of 22 million future Americans uninsured and reducing the federal deficit over 10 years by $321 billion, with an estimate of 15 million fewer Medicaid enrollees. Potential solutions cannot begin with creating opportunities for insurers to increase costs and cost-sharing for Americans with pre-existing conditions.
As a practicing pediatrician for almost 40 years, I am acutely aware of how wellness allows children to thrive in school and in life. And how neglected or ill-health affects not only their families, but their future as productive citizens. Ensuring their health is the highest form of caring and love we can demonstrate. Every pediatrician is familiar with the sound bite that 0 percent of children vote but 100 percent need compassionate health care. The impending cruel reality is that the BCRA’s cuts and caps will definitively limit children’s access and care. Every time I look in the eyes of parents with sick children I see fear: fear that their child will get sicker, that they will not recover or that they will have an uncertain future. Every physician is entrusted to relieve, not worsen that fear. Unless Congress can recalibrate and revise instead of repeal and replace, that fear will remain, and worsen.
For seven years, the Republicans have maintained it is their American responsibility to act and replace the ACA. My hope is that understanding that responsibility to act will imply they also understand their obligation to act responsibly.
Mercer Island resident Don Shifrin, MD, is a pediatrician and a member of the American Academy of Pediatrics.
