When I first met Paul, a 51 year old with a resistant infection of the bones in his left foot, he had already been in the hospital for weeks getting antibiotics. Paul lived in low-income housing, and had spent the past year in and out of emergency rooms. His story ended well. After a 47-day hospital stay, Paul’s infection was treated, he was walking around with his foot in a boot, and my hospital ultimately paid for a flight home to North Dakota where his niece would care for him.
The Affordable Care Act (ACA) is the reason why patients like Paul are still alive. Paul has Medicaid, an insurance plan for poor Americans that was expanded and better-funded because of the ACA. Prior to the ACA, Paul would not have qualified for Medicaid as state Medicaid programs were not required to cover childless, low-income, non-disabled adults. When Paul reached North Dakota, he would have a primary care doctor who was better-compensated to care for him, as the expansion in Medicaid coverage helped primary care physicians maintain financially viable practices. Every aspect of Paul’s care and his eventual improvement can be linked to the ACA.
Take another patient of mine, Angel, a 22 year old who came to my office in February to discuss contraceptive options. Angel was on injectable birth control that was causing her to gain weight and she wanted to try something different. Angel ultimately chose to get an IUD, which was approved by her insurance. I placed her IUD one week later. It will allow her to fully focus on her career by preventing pregnancy for up to seven years, or until Angel is ready to begin her family.
Angel’s ease of access to reproductive care was protected because of the ACA. For one, the ACA mandates that the full range of contraceptive coverage be covered by most insurance plans, and Angel did not have to fight with her insurance company to get the IUD covered. The ACA also requires that dependents be covered until age 26, so Angel was guaranteed insurance coverage by her parents’ plan.
The Trump administration has started chipping away at reproductive health coverage, with new regulations in 2018 that expanded the number of employers who can opt out of covering reproductive services. For Angel, the cost of an IUD without insurance would be as much as $1,000 — an unreasonable sum for most Americans.
The largest beneficiaries of the ACA are older Americans with pre-existing conditions. Take my father-in-law, for example, who has employer-subsidized insurance. He has Type 2 diabetes and takes metformin and a statin. The ACA prevents most insurers from discriminating against individuals with pre-existing conditions like diabetes or cancer. In the event of a job loss, the ACA protects my father-in-law and many Americans’ access to an affordable health care plan.
When my father-in-law reaches Medicare eligibility age in a few years, he will continue to benefit from the ACA. If he exceeds the amount that Medicare covers in prescription drug costs, he can count on paying no more than 25 percent of the price for any brand-name drugs. The ACA provides a commitment to older Americans that they can retire in a financially secure manner while knowing they will have comprehensive insurance coverage.
Despite the overwhelming good done by the ACA, the Trump administration is bent on gutting the law. If the current ACA repeal ruling from Forth Worth, Texas ends up before the Supreme Court, the Trump administration may have its way. The effects of such a repeal would be disastrous for my patients and my community. Poor patients and single parents would lose Medicaid. Out-of-pocket costs would increase dramatically for basic needs such as reproductive health and senior citizens would be left to fend for themselves for vital medicines.
The ACA touches the lives of nearly every American, and a repeal would be political suicide for those championing it. More important, an ACA repeal would cause immense suffering for millions of Americans whose access to health care and quality of life have improved dramatically because of the ACA.
Devesh Madhav Vashishtha is a family medicine resident physician at Swedish Cherry Hill in Seattle and a member of the American Academy of Family Physicians’ Commission on Quality and Practice.
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