BALTIMORE. Six reasons to fight the ACA replacement plan (Baltimore Sun)

By Dr. Leana Wen

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. Read more.