House sets stage to gut health law; big­ger hur­dle of re­plac­ing it looms

Woman cred­its ACA for grant­ing her life-sav­ing heart trans­plant

Houston Chronicle - - FRONT PAGE - By Mike Hix­en­baugh

Anne Bunt­ing’s heart failed a week be­fore Barack Obama was elected pres­i­dent in 2008.

Eight years later, she wrote him a let­ter:

“Dear Mr. Pres­i­dent,” it be­gan. “Thank you for sav­ing my life.”

Bunt­ing isn’t an in­sur­ance ex­pert and doesn’t know if the Af­ford­able Care Act was the best way to re­form health care cov­er­age.

She only knew it came along at the right time for her.

On the night Obama gave his first vic­tory speech a lit­tle more than eight years ago at Grant Park in Chicago, Bunt­ing was at home in Hous­ton, get­ting used to life with a pace­maker.

A tem­po­rary fix, her doc­tors had said.

The 58-year-old voted for Obama but had never con­sid­ered her­self very po­lit­i­cal. She hadn’t paid much at­ten­tion to his cam­paign prom­ises to over­haul the health care sys­tem. She was self-em­ployed and had al­ways been able to af­ford de­cent in­sur­ance.

Her view of the in­dus­try changed four years later when, af­ter weeks of feel­ing short of breath, she sat with a car­di­ol­o­gist at Bay­lor St. Luke’s Med­i­cal

Cen­ter in Hous­ton. “Ms. Bunt­ing, you can’t go home,” the doc­tor said. “You need a heart trans­plant.”

Dr. Stephanie Coul­ter and her col­leagues be­gan the work of adding Bunt­ing to the na­tional trans­plant wait­ing list. The next day, the physi­cians got an up­set­ting mes­sage from Bunt­ing’s in­sur­ance com­pany, Blue Cross Blue Shield: The com­pany wouldn’t be pay­ing for a heart trans­plant, a rep­re­sen­ta­tive said, be­cause the pa­tient’s heart fail­ure was con­sid­ered a pre-ex­ist­ing con­di­tion.

“They told me, ‘You can’t give her a heart trans­plant,’ which is what she needed,” said Coul­ter, the head of women’s health at Texas Heart In­sti­tute. “They said we could give her this other de­vice in­stead, a pump that’s im­planted in the left ven­tri­cle to help the heart con­tinue beat­ing. The in­sur­ance com­pany was lit­er­ally telling us, the physi­cians, how to pro­ceed with her treat­ment. It was crazy.”

And, for the time be­ing, it was le­gal.

Bunt­ing barely sur­vived the op­er­a­tion.

Just as Coul­ter had feared, the bat­tery-pow­ered pump im­planted in her left ven­tri­cle put an im­me­di­ate strain on the right side of her heart. To save her, doc­tors had no choice but to add a se­cond pump to that ven­tri­cle.

Coul­ter felt ter­ri­ble, she said. No pa­tient of hers had ever sur­vived with a dual pump. Bunt­ing was dif­fer­ent. “She was the most amaz­ing fighter woman,” Coul­ter said. “She re­cov­ered, which is a mir­a­cle, and then she ac­tu­ally left the hospi­tal. She was walk­ing around with two pumps.”

By then, Obama was a few months into his se­cond term. He’d sur­vived a cam­paign in which his op­po­nent vowed to undo his sig­na­ture pol­icy achieve­ment, the Af­ford­able Care Act, with most of its big­gest changes set to go into ef­fect at the start of 2014.

Crit­ics and sup­port­ers alike had taken to call­ing it “Oba­macare,” an ac­knowl­edg­ment that the di­vi­sive law wouldn’t have hap­pened with­out the pres­i­dent who cham­pi­oned it.

For bet­ter or worse, he was uniquely re­spon­si­ble for its con­se­quences.

By that spring, doc­tors were wor­ried her heart wouldn’t work much longer, even with the me­chan­i­cal pumps.

An in­sur­ance agent helped Bunt­ing find a new Blue Cross Blue Shield plan on the mar­ket­place ex­change cre­ated by Oba­macare. This time, un­der the new law, the in­surer was barred from deny­ing pay­ment for spe­cific treat­ments based on pre­ex­ist­ing con­di­tions.

Bunt­ing’s new plan went into ef­fect on April 1, 2014. The next day, her doc­tors added her to the wait­ing list for a new heart. Ten days later, she had a life­sav­ing trans­plant.

Mem­bers of her care team, amazed by all that she’d en­dured, clapped and cheered in the op­er­at­ing room as her new heart be­gan to beat in­side her chest.

“Sud­denly, af­ter that, it was like I was back to nor­mal,” Bunt­ing re­called. “Fi­nally I could breathe. I could go hik­ing and work out and travel. I was alive again.”

She had the thought then, but didn’t voice it:

Thanks, Obama.

She got the idea to write to him in the fall, in the midst of a bit­ter pres­i­den­tial cam­paign that seemed as much about his legacy as any­thing.

Hil­lary Clin­ton promised to build on Oba­macare, de­spite pre­mium spikes, the rise of high-de­ductible plans and a grow­ing cho­rus of crit­ics who’d said the law had been a fail­ure. Don­ald Trump promised to kill it and re­place it with some­thing dif­fer­ent.

A few days af­ter Trump’s vic­tory, she sat at her com­puter and typed a note. Four para­graphs, 286 words:

“My name is Anne Record Bunt­ing … I was told I needed a heart trans­plant … in 2014, the Af­ford­able Care Act came into be­ing … 10 days later, I re­ceived the gift of life … thank you.”

She didn’t ex­pect to get a re­sponse. It came a few weeks later, printed on White House sta­tionery:

“Dear Anne … Thank you for your kind words … I am glad that the Af­ford­able Care Act helped you … It is why I worked so hard … Michelle and I send our love.”

Bunt­ing read and reread the let­ter, trac­ing her fin­ger over the loop­ing let­ters of his sig­na­ture. Then she put it in a frame.

On Fri­day, as mem­bers of the U.S. House voted to be­gin the process of re­peal­ing the health care law — ex­actly a week be­fore Trump’s in­au­gu­ra­tion — Bunt­ing car­ried her let­ter from the pres­i­dent to Texas Heart In­sti­tute and showed it to some of the physi­cians who’d helped save her, wip­ing away tears as they re­called to­gether how close she’d been to death.

“This woman is one of the bravest peo­ple I have ever met,” said Dr. Leo Simp­son, one of her car­di­ol­o­gists, be­fore pulling her into a hug.

A few weeks ago, an Obama aide had asked if the pres­i­dent could share her story with re­porters to high­light ways the law has been suc­cess­ful, a last­ditch ef­fort to sway the pub­lic as Congress be­gins to craft a re­place­ment plan.

If peo­ple want to use her let­ter for po­lit­i­cal means, that’s fine, she said. But it’s not why she wrote it.

She just wanted the pres­i­dent to know that he’d had a ma­jor im­pact on her life.

“When some­one does that,” Bunt­ing said, “I think you should tell them.”

An­nie Mul­li­gan

Dr. Leo Simp­son hugs a tear­ful Anne Bunt­ing on Fri­day at the Texas Heart In­sti­tute. Bunt­ing re­ceived a heart trans­plant in 2014, soon af­ter the ACA went into ef­fect.

An­nie Mul­li­gan

Anne Bunt­ing re­ceived a per­sonal re­ply from Pres­i­dent Obama: “I am glad that the Af­ford­able Care Act helped you . ... It is why I worked so hard.”

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