Repealing without replacing the ACA will weaken national security
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President-elect Donald TrumpDonald John TrumpCould Donald Trump and Boris Johnson be this generation's Reagan-Thatcher? Merkel backs Democratic congresswomen over Trump How China's currency manipulation cheats America on trade MORE is correct in advocating for an immediate replacement for the Affordable Care Act (ACA) if it is repealed. It is also reassuring that Speaker Ryan appears to agree that if the ACA is repealed it should be immediately replaced. 

The ACA has led to 20 million additional people gaining health insurance coverage, and a reduction of the overall uninsured rate from 16 percent to under 9 percent.

The repeal without placement of the ACA could leave these individuals and families uninsured and forced to seek uncompensated care, with unmet medical needs.


While the legal, political and moral arguments play out in this debate, there are national security impacts that should also be considered. There are real implications for disaster resilience when people have, or don’t have, secure access to healthcare.

At an individual level, people who have medical coverage are better positioned to seek treatment earlier in a disease process. A wealth of medical research tells us that early detection usually means that it is more likely that the individual will recover, and that treatment can be less invasive.

People are also more empowered to manage their health in the absence of disease, and are thus more resilient and better able to help others in a disaster situation.

For infectious diseases such as Zika, SARS, and Ebola, early detection and diagnosis reduces the opportunity for the spread of the disease to others. Early detection by healthcare providers is also key to alerting public health officials to the emergence of an infectious disease in the community before it is widespread. 

Access to healthcare for those who could not otherwise access it increases the response capacity of our healthcare system. With a greater percentage of the population appropriately utilizing this infrastructure, physicians and healthcare organizations can build their operations around more comprehensive care that is better able to surge to the needs of a disaster.

Other public health indicators like vaccination rates and access to emergency care reflect the resilience of our nation to the health impacts of disasters, and the functioning of the systems that will be leveraged in a disaster.

The linkage of healthcare access to national security is not theoretical. The National Health Security Preparedness Index quantifies our readiness for the health impacts of disasters through a process that includes “access to high-quality medical services across the continuum of care during and after disasters”. It also includes measures on the ability to detect and respond to health threats, which are often times first reported by a patient visiting their physician.

The Trust for America’s Health Report, Ready or Not: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism further quantifies preparedness and rates states on their readiness to respond to a health threat. This includes data from the National Health Security Preparedness Index, as well as data on vaccination rates and other components that require high-functioning healthcare and public health systems.

Comprehensive healthcare reform does not come easy. The number of interrelated parts from public and private stakeholders creates a myriad of constituents with competing agendas. If the ACA is repealed and not replaced, it should not be assumed that an agreement will be reached in a year, two years, or after the midterm elections.

The prospect of putting an expiration date on the ACA with an intent to replace it later is reminiscent of the broken promises that led to budget sequestration, a promise backed with the threat of unthinkable budget cuts that became a reality.

Our national security benefits from a robust healthcare system where patients and their diagnosis are managed early and competently. Increasing access to the full continuum of healthcare for Americans leads to more resilient people as well as public health and healthcare systems. Reducing access to healthcare not only has direct consequences to the health of those who will lose access, it weakens the health and security of our nation.

Jeff Schlegelmilch, MPH, MBA (@jeffschlegel) is the Deputy Director of the National Center for Disaster Preparedness at Columbia University’s Earth Institute. He has over a decade of experience in developing programs for community resilience and public health preparedness. Over that period he has advised numerous local, state and federal officials on preparedness policies and programs.

Irwin Redlener, MD (@IrwinRedlenerMD) is the Director of the National Center for Disaster Preparedness at Columbia University’s Earth Institute, and Professor of Health Policy and Management and Pediatrics at the Mailman School of Public Health at Columbia University. He is the author of Americans At Risk: Why We Are Not Prepared For Megadisasters and What We Can Do Now, published in 2006 by Alfred A. Knopf, Inc.


The views expressed by contributors are their own and not the views of The Hill.