Without ‘Obamacare,’ I see my patients headed for the edge of a cliff

The passage of the American Health Care Act in the House of Representatives has been hailed by some a success. As for me, I envision millions of Americans perilously at the edge of the cliff.

I am a second-year family-medicine resident at one of the major health-care centers in Phoenix. I find the AHCA to be very concerning — in particular the Congressional Budget Office’s estimates in March that under the initial version of AHCA, 24 million people — roughly the population of Florida — would become uninsured.

The latest version of the American Health Care Act was passed with such haste that the CBO wasn’t even able to update its estimate of uninsured if the ACHA were to pass. The CBO on Wednesday put that new figure at 23 million.

Now that some insurance-coverage responsibility may rest in the hands of individual states, it makes me worried about Arizonans.

I think about the patient population in our residency clinic. A majority of our patients are on the Arizona Health Care Cost Containment System plan or other Medicaid insurance plans.

Mr. L, who must come up with a $2 bus ticket for a two-hour ride to make his diabetes follow-up appointments. His blood sugar is uncontrolled, but we’re making progress. He has been compliant with our medical plan.

Mrs. M, who will return for a postpartum visit. Her baby will also be seen for a newborn checkup. She had an unremarkable delivery and received high quality prenatal care in our clinic. Her delivery was unremarkable for complications. She is interested in an intrauterine device for contraception during the postPatient partum period.

Mr. S, who has a pre-existing condition and is depressed. Given the severity of his depression, he is receiving both medications and counseling.

What do these people have in common? They are all receiving high-quality comprehensive, continuous and coordinated medical care which is a for primary-care physicians.

Their delivery of care has been possible through the Affordable Care Act (popularly known as “Obamacare.”) With the advent of the AHCA, I worry my patients are on the edge of a cliff.

If their access to insurance is repealed and replaced, Patient L cannot receive the life-saving diabetic treatment that could prevent his death. My pregnant patients would not be able to receive their prenatal care, without which it is well-known that birth and pregnancy outcomes are far worse. I worry about S, who without his insurance would have uncontrolled depression that could lead to suicidal thoughts.

Medicine teaches us to think empirically and to practice with evidence-based care, but this issue for me is visceral. I became a physician to serve the community in which I live.

If legislation passes that repeals and replaces the ACA, I will be bereft of ability to serve the indigent. While health care is very complicated and the ACA is not perfect, I think it makes more sense to not reinvent the wheel, but rather to improve the ACA.

I plead with legislators to uphold the same oath as doctors: Do no harm.

Joanna Campodonico, a native of Indiana, has lived in Phoenix for the past three years to complete her family-medicine residency. Email her at jojocampodo @gmail.com.