February 2017
Saying Goodbye to Obamacare
and Hello to... What? 

The Patient Protection and Affordable Care Act became law on March 23, 2010. The term "Obamacare" was originally coined by opponents of the law and has been used in a derogatory fashion by opponents ever since. The rally cry of the opponents has long been "Kill Obamacare!"

Well, now the opponents of the law are in charge. With the seating of the new Republican-led Congress and the inauguration of Mr. Trump, the health care policies of this nation need a new name. What remains of the old law, and what is introduced as new, what is lost and what is gained, are now under the control of this new government - they now own it! From this point forward it is no longer under President Obama's control. The albatross is now around their necks.

The tendency of some of us might be to sit back and see what happens. And, if one doesn't like the new law, to attach a catchy, derogatory name to it such as "Not-So-Great-Care" or "The Republican Health Care Plan." But I think we as physicians have a moral obligation to be actively engaged in the debate and to stand up for our patients and our profession. We as physicians realize that the issues surrounding health care policy in the United States are extremely complex and demand the input of our nation's best minds. We physicians are some of those best minds. Most, if not all of us, recognize that outright repeal of the current law, without an alternate program in place, is folly and will lead to chaos and suffering. 

I offer the following SWOT analysis of the current situation in which we find ourselves:

S trengths: More U.S. citizens are now covered by health insurance than ever before. The percentage of people without insurance fell from 16 to nine percent in the past six years. In terms of access to health care, people are no longer discriminated against because of gender or pre-existing illness. Young adults, struggling to attain the education they need to succeed in life, can stay on their parents' health care policy until the age of 26. According to the Kaiser Foundation, health care premium costs for employers increased only three percent in 2015 compared to over 30 percent per year prior to the Affordable Care Act. 

W eaknesses: The Affordable Care Act is costly and some say not affordable. Insurance companies have left the market place in some states, including Kentucky, claiming they could not make a profit, thereby creating voids in health care access and preventing competitive pricing. The health care debate issue has been highly partisan, making civil conversations difficult. The mandate to purchase insurance is unpopular especially among young, generally healthy persons. Without healthy people in the risk pool, it is difficult to imagine how any form of expanded health care coverage could be paid for, short of increasing taxes.

O pportunities: Re-opening this can of worms to have a mature discussion about the health care policies of this nation presents the opportunity to address the broadest array of health policy issues. Topics could include, in addition to access and affordability of health care for the maximum number of citizens, tort reform, the finance of medical school education, the funding of graduate medical education and the creation of additional residency positions, the maldistribution of physicians and access to health care in rural and inner city communities, the high cost of medicines, the variability of value, costs and safety among hospitals, and the supply of and appropriate reimbursement for primary care physicians.

T hreats: Our country is deeply in debt. The prevailing sentiment among the Republican-controlled legislature is to curb the debt and cut taxes. The Congressional Budget Office in June of 2015 forecasted that repeal of the Affordable Care Act would increase the deficit up to $353 billion over the next decade and the number of people with insurance would fall by 24 million. The Rand Corporation independently predicted that in 2018 alone, Mr. Trump's campaign's health plan would add an additional $6 billion to the deficit and decrease the number of insured by about 20 million people. The uncertain and potentially tumultuous future poses the greatest threat to our economy and health care.

We need to recall what Charles Mayo, a founder of the Mayo Clinic, said in 1919, "It is a poor government that does not realize that the prolonged life, health and happiness of its people are its greatest asset." We need to protect that asset at all cost.

I call upon you to get engaged. Call our senators and representatives. Contribute to the conversation. Join the AMA, the KMA and GLMS and contribute to their Political Action Committees. The outcome of this debate will affect your practice and determine your patients' access to affordable health care. The health care policies created by this new government will affect the lives of you, your sons and daughters, and your grandsons and granddaughters.

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  • Protect the integrity of the patient-physician relationship
  • Advocate for the health and well-being of the community
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