For months, I have received questions from concerned residents about how repeal of the Affordable Care Act (ACA) would impact their health. My patients were worried about whether they could still get medications to treat their heart disease and diabetes, whether they would they lose coverage for mental health and addiction services, and whether they would continue to get basic preventive services such as mammogram, pap smears and blood pressure screenings.
This week, House Republicans issued their proposed replacement. There are six particularly concerning provisions with drastic consequences to Baltimore's health:
First, the bill punishes those with lower wages by eliminating subsidies to help pay for insurance coverage based on a person's income. As a physician who has practiced medicine before and after the ACA, I have seen patients forced to make the impossible choice between basic needs, including food and housing, and critical medications. I have seen patients forgo paying for insurance coverage because it is too expensive. I have seen the consequences when people are forced to pay for this "choice" with their lives.
The policy also drives more people to use emergency departments as a source of primary care. As an emergency physician, I am proud to deliver excellent care when people need it — but this is an inappropriate safety. Studies have shown that patients without health insurance put off their medical needs until they become so severe that they can no longer be pushed aside. At that point, when patients are very ill, their care becomes unnecessarily expensive.
Second, the bill places a cap on Medicaid spending, which limits the amount states can pay per person. This leads to inevitable cuts in coverage and will hurt those who are the most vulnerable — including seniors, women, children, people with low incomes and individuals with disabilities. These are already populations who face a disproportionate share of health disparities, which will worsen if the Medicaid safety net is weakened.
In Maryland and across the country, Medicaid expansion has also improved access to treatment for those with the disease of addiction. Even still, only one in 10 people with an addiction is able to get the help that they need. Amid a public health epidemic where over 2,000 Marylanders are dying of overdose in a year, the last thing we should do is to take away life-saving treatment. For a patient with the disease of addiction, there is no margin of error. Losing coverage today could mean overdosing and dying tomorrow.
Third, the bill replaces the individual mandate with one effectively requiring continuous coverage, penalizing those whose coverage lapses. Simultaneously, the bill would remove penalties if companies did not provide affordable insurance options. This moves the burden away from businesses and insurance companies and places it instead on individuals and their families. With fewer affordable options, this proposal would increase the likelihood of a person's coverage lapsing, and thus their risk of financial consequences. It would punish people retroactively who are already ill, rather than proactively rewarding people who invest in prevention.
Fourth, it strips important community resources, such as Planned Parenthood, of federal funding. These organizations offer critical reproductive health services such as mammograms, pap smears and annual exams. Blocking access to them would harm women, families and children.
Fifth, the proposal eliminates the requirement that health plans provide essential health benefits. These include hospitalization, maternity care and mental health services. As a pregnant woman, I cannot imagine having an insurance plan that does not cover this need, and having to pay out-of-pocket for every ultrasound, blood test, doctor's visit and hospital stay. Women and families will be forced to ration their own care, resulting in higher pre-term births requiring expensive, intensive care. Whatever savings are incurred by insurance companies short-term will harm the health of mothers and children in the long-term.
Finally, the bill cuts the Prevention and Public Health Fund, which constitutes nearly one-seventh of the Centers for Disease Control and Prevention's budget. These funds are used to prevent diseases such as hypertension, cancer and diabetes, which are drivers of the major causes of death in the United States. They also help ensure that our nation is prepared against emerging threats such as bioterrorism and Ebola and other infectious diseases. Cutting these funds will hurt patients' health and compromise our country's ability to protect residents.
My patients are right to be concerned. This ACA replacement plan will roll back gains for millions of Americans and be detrimental to health and well-being of our nation. It is fiscally irresponsible and a national security risk. We must do everything we can to safeguard life for Baltimore's residents, and for our generations to come.
Dr. Leana Wen is the commissioner of health in Baltimore City. Twitter: @DrLeanaWen and @BMore_Healthy.