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Doctors Are Terrified for Their Patients Under Trumpcare

"Modern medicine will allow her to see her 70th birthday. But if this Senate bill becomes a reality, she might not live to see her 30th."

by Dhruv Khullar
Jun 29 2017, 2:00pm

The Washington Post / Getty

Republicans in Congress are considering legislation to repeal the Affordable Care Act and replace it with their own health reform. The Congressional Budget Office (CBO) estimates that under the Senate's version of the bill, 22 million fewer Americans will have health insurance. The insurance people do have would be skimpier—covering fewer medical services—and patients would face higher copays and deductibles.

Insurers would no longer have to cover many "essential" health benefits, including birth control or pregnancy; in some cases, they could opt out of providing chemotherapy for cancer patients. Many sicker, older, and poorer Americans would be priced out of the market altogether.

What, one might ask, is the purpose of such an ostensibly disastrous POL (Piece of Legislation)? Well, while it takes health care away from poor Americans, sick Americans, disabled Americans, and older Americans, wealthy people get a big tax cut—which, as we all know, is the goal of good health policy.

On a moral level, it seems unconscionable that the richest country in the history of the world cannot—and will not—secure access to basic, affordable health care for its citizens. But it's even more unconscionable to take care away from those who already have it, as the Republican health bill threatens to do.

On a medical level, it's clear that having health insurance improves people's financial, mental, and physical health. People who have health coverage are less likely to have trouble paying their bills or suffer medical bankruptcy. They have better mental health and wellbeing. And they're more likely to get the preventive care and treatment they need. Kicking 22 million people off health insurance, as the GOP health bill does, would lead to more than 24,000 additional American deaths each year. I asked doctors from around the country how they think losing health insurance would affect the patients they care for.

Aaron Quarles, Emergency Medicine, McGaw Medical Center, Northwestern University, Chicago, IL

I treat the CEO and the homeless the same—as citizens who have the right to great medical care. There are countless patients I've seen with some small ache or strange tingling, or who were just in the wrong place at the wrong time, and their lives changed forever: a new cancer diagnosis, a stroke, a terrible car accident. Jobs lost. College plans put on hold. Houses sold to become poor enough to get on Medicaid because Grandma's nursing home needs would bankrupt the family.

If my patients lose their insurance, many will wait until it's too late. Others will come in for minor complaints better managed by primary care doctors. In the emergency department, the patient mix will simultaneously be more sick and less sick. Which means longer wait times and worse outcomes because staff and resources are stretched thin. The human body doesn't care which party you vote for or which tax bracket you fall in. Neither do I.

Lucy Schulson, Primary Care, Beth Israel Deaconess Medical Center, Boston, MA

What will it mean for my patients to lose health insurance? It will mean choosing between getting their blood pressure medicine to prevent a stroke and feeding their kids. It will mean weighing seeing me—their doctor—about a new breast lump, against fixing their car so they can get to work. It means ignoring that escalating chest pain because they're scared of the emergency room bill. Health is a human right, and insurance is the first step in accessing healthcare. I don't want my patients to have to choose between their health and other life essentials.

I would be failing in my duty as a physician if I didn't speak out against the changes to health care the Senate is proposing. I have an ethical obligation to help my patients, and when a piece of legislation threatens their lives, I have no choice but to speak out.


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Atul Nakhasi, Internal Medicine, UCLA Ronald Reagan Hospital, Los Angeles, CA

I'm afraid they'll get sick more often and die sooner. I'm particularly worried for my Medicaid patients. One of my HIV patients is functionally cured right now because of Medicaid. Her doctor's visits are covered by Medicaid. The blood work she needs every three months is covered by Medicaid. The $2700 per month medication her life depends on is covered by Medicaid. Modern medicine will allow her to live her full potential and see her 70th birthday. But if this Senate bill becomes a reality, she might not live to see her 30th.

Michael Clery, Emergency Medicine, University of Michigan Health System, Ann Arbor, MI

I can't even count the number of patients who come through my Emergency Department with a severe chronic disease—COPD, heart failure, diabetes—who hadn't been able to get treatment after a job loss or a job change. But once they got insurance through Obamacare, they finally allowed themselves to be cared for. They finally acknowledged the shortness of breath, the chest pains, the swollen legs they'd been ignoring out of necessity.

If my patients lose insurance, they'll no longer be telling me how long they've been minimizing their chest pain. They won't be telling me how much they appreciate finally getting the care they need, so they can keep working and caring for their families. They'll come in when it's too late.

Theresa Williamson, Neurosurgery, Duke University Hospital, Durham, NC

In neurosurgery, we deal with life-threatening emergencies, life-changing diagnoses, and other diseases that significantly impact people's quality of life—and I fear that the healthcare repeal legislation being considered will make my patients suffer more in every one of those areas.

I worry about patients putting off getting medical care because I've seen the devastating consequences of people presenting to the emergency room too late—fearing high bills because they don't have health insurance. I worry that patients won't have adequate access to experts and that they won't be able to get the complex surgeries they need. I fear that patients won't be able to get the medications and the rehabilitation services they need after surgery, which are ultimately so important for them to live healthy and full lives.

Braveen Ragunanthan, Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA

As a pediatrician, I'm constantly thinking about the impact on children. Deep cuts to Medicaid will be devastating to the millions of kids who depend on it. So many of my patients depend on Medicaid for basic health care, starting from the newborn nursery through their pediatric primary care visits. Right now, I'm thinking about the kids whose lives are already filled with chaos—chaos that most people couldn't even comprehend. Losing access to their health provider could be a death sentence for children already coping with trauma, hunger, violence, abuse, and unstable housing.

Jacob Izenberg, Psychiatry, UCSF Medical Center, San Francisco, CA

I take care of patients with mental illness. This means that many of my patients rely on Medicaid, particularly those with severe mental illness, who often can't get steady work. Their needs are unique: They often require comprehensive community-based treatment, case management, and other social services. In California, Medicaid is set up to pay for these services, while private insurers are not.

As a result, my most severely mentally ill patients stand to lose access to the quality, comprehensive community mental health services designed to care for them. It's hard to overstate how devastating these cuts would be to my patients. If this bill passes, I expect to see fewer patients in the outpatient clinic and more of them in the emergency room.

Shakira Bandolin, Emergency Medicine, UC Davis Medical Center, Sacramento, CA

For many of my patients, the emergency department is their lifeline, since we see patients despite their insurance status. I see so many patients on a daily basis who are struggling to work, provide for their families and afford the increasingly expensive cost of basic health care. When patients lose insurance, they first lose the ability to seek preventative care, and often having to choose between their next meal and getting appropriate antibiotics for their children. This has been an extremely humbling and frustrating part of my practice, but the situation has improved drastically since the ACA.

I worry that the emergency department will again become the only point of care for my patients. These are hardworking individuals who contribute to society, yet their right to basic health care may be taken away.

Dhruv Khullar is a physician at NewYork-Presbyterian Hospital and a researcher at the Weill Cornell Department of Healthcare Policy and Research.

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