By Barbara R. Casper, M.D.
The Courier-Journal (Louisville, Ky.), Jan. 13, 2017
I am a physician who has cared for uninsured and underinsured patients for my entire 31 years of practice. In the past I have written editorials in support of the Affordable Care Act and with the likelihood of its repeal without a viable replacement I feel that I need to provide a voice for my patients who will be adversely affected by this change.
People need to understand that not having insurance kills people. I have seen this in my own practice prior to the ACA. I cared for a patient who refused to come to the doctor in spite of an obvious cancer until it was so advanced that there was little we could offer her but comfort care. She was too young for medicare, had to quit her job to care for an ailing husband and was concerned that they might lose their house if she incurred medical bills. She may have lost her house but sadly she did lose her life.
My personal experience with the implementation of the ACA is that patients can now afford their medications and their preventive care. This has resulted in many of my patients now having their chronic illnesses such as diabetes and hypertension under control. This has significant economic benefits to our communities in that the cost of catastrophic care for the consequences of these diseases left unchecked are much more expensive, not only in dollars spent but in suffering. My experience has been verified by a study published in JAMA Internal Medicine where a comparison of health care in Kentucky, Arkansas and Texas was completed. Kentucky and Arkansas both expanded medicaid while Texas did not. The results indicate that in Kentucky and Arkansas the number of emergency room visits decreased, the visits to primary care physicians increased as did compliance with medications. This was in contrast to Texas where patients are still obtaining their health care through the emergency department. This is what the law was intended to do.
This is not a perfect law – some folks did not benefit from the expansion of Medicaid or the subsidies and now have higher deductibles and limited options for plans. The law could be improved but the Republicans have focused so much on the repeal that nothing has been accomplished. It is interesting that now that they have the votes to actually repeal the law, no viable replacement has been discussed. They have had seven years to develop their own plan. My own personal opinion is that a single-payer system – Medicare for all would be the best possible replacement.
A recent poll indicated that only 20 percent of the public is in support of the repeal of the ACA. For me, this is NOT a political issue – it is an issue of caring for my patients. I have had many discussions with patients in my office recently who are concerned about losing their insurance and I have difficulty reassuring them. I will continue to care for them – it seems to me that our elected officials do not.
Barbara R. Casper, M.D., is a professor of medicine at the University of Louisville.