‘Obamacare,’ the GOP and the road ahead

GOP complaints about the Affordable Care Act (aka “Obamacare”) begin with a really, really big lie.

That is, Republicans claim that the ACA hasn’t worked. Wrong. It’s been a huge success, bringing health care coverage to more than 20 million Americans who previously did not have real access. In particular, it has helped those in poverty, those with pre-existing conditions and those with women’s health issues. It vastly expanded Medicaid coverage. In New Mexico alone since 2013, an additional 309,054 adults and children have been added to the rolls. Currently 358,107 children and 89,107 elderly and disabled now have care, with a total of 766,732 Medicaidcovered lives.

So what does the GOP have in its draft plan to replace Obamacare? An offer of fig leaf coverage with high deductibles and lots of exclusions, or high-cost upgrades for those with “pre-existing conditions,” one of which might be being a woman in need of contraception. They propose health savings accounts or tax credits. These are nice options for those of us with disposable income at the end of the month but are useless for those living paycheck to paycheck.

They suggest “high risk pools” that have never worked due to their astronomical costs. They also want to end the individual mandate and subsidies for those in poverty. This allows the healthy to drop out and forces others out of the pool, precipitating a “death spiral” of adverse selection so that no insurance company can afford to stay in the market, effectively killing the whole program. They recommend block grants for Medicaid. I submit that each year the payments will be lowered (“fiscal responsibility” requires it, you know), starving the program. This will leave the poor at the mercy of visits in extremis to the nearest emergency department.

The predicable outcome of all this in New Mexico alone will be thousands of preventable deaths and untold suffering. For a party that is dedicated to the right to life, I see only political cowardice and consider their proposals a shameful scam.

Amend the ACA is my suggestion; it is not yet perfect. Repealing it with the GOP “fixes” is, in my opinion, immoral, unethical and should be considered illegal.

James Webster, M.D., is the Michael Gertz Professor of Medicine emeritus, Feinberg School of Medicine of Northwestern University, and past president of the Chicago Board of Health. He lives in Santa Fe.

The predicable outcome of all this in New Mexico alone will be thousands of preventable deaths and untold suffering.