Suing the Trump administration to protect the ACA, health and the economy

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Today, Baltimore City filed suit against the Trump administration for intentionally and unlawfully sabotaging the Affordable Care Act (ACA). President Trump has been systematically attacking the health law, causing the cost of health coverage and the number of uninsured Americans to increase. He is violating his constitutional duty to “take care that the laws be faithfully executed.”

Following the failed attempts by Congress to repeal the ACA, the administration has worked to discourage enrollment, raise prices, instill uncertainty in insurance markets, and eliminate choices for quality health insurance. President Trump has made clear his goal to dismantle the ACA by executive action alone, until “Obamacare is finished.” By attempting to undermine the duly enacted Affordable Care Act, the Administration’s actions violate both the Administrative Procedure Act and the Take Care Clause of the Constitution.

{mosads}We in Baltimore join Columbus, Ohio, Cincinnati, Ohio, Chicago, Illinois, and citizens in Charlottesville, Virginia, to express our deep concern about the consequences of sabotaging the ACA. In Baltimore, more than 10,000 residents are enrolled in plans purchased through the health insurance marketplace. Destabilizing the ACA could mean that 10,000 people in our city alone could become uninsured.


This will directly affect the demand on the Baltimore City Health Department’s services. We operate clinics that are a safety net for uninsured Baltimoreans. We are already operating on a shoestring budget, and further increases in the uninsured rate will place an even greater burden on programs already short on resources. It will make us either incur additional costs, or force us to reduce our ability to care for the most vulnerable.

We will find ourselves asking: What services do we cut? Should we cut reproductive health care, which is already being threatened as a result of the Trump administration’s proposed Title X changes?

Should we cut opioid addiction treatment? We are in the midst of an epidemic of opioid overdose deaths. The number of people dying from fentanyl in Baltimore has climbed from 12 in 2013 to 573 in 2017 — a 5000 percent increase in four years. We see this same trend across the country. As individuals find themselves without insurance, they will turn to us for help treating their disease of addiction. What sense does it make to take away people’s ability to get treatment for the disease of addiction in the middle of a public health emergency?

Or should we look to cut HIV/AIDS treatment, dental and oral care, hypertension detection, or cancer screenings?

We also provide and subsidize other health services for our uninsured and underinsured residents. This includes a visiting nurse program with house calls for patients with chronic medical conditions and programs focused on reducing asthma and childhood lead poisoning. We assist with a Men’s Health Center, and run programs for pregnant women and children. An increase in the uninsured rate will impose burdens on each of these programs, and require more city funding.

But there’s not just an economic cost to consider. There is a human cost.

I’m an emergency physician, and I have seen what happens when people delay care because they simply cannot afford it.

I’ve treated a 48-year old teacher’s aide who waited a year before having her breast lump examined. Her cancer could have been detected earlier, and even prevented, if she had insurance. Instead, she died soon after I saw her, leaving behind three children.

I’ve treated a 32-year old construction worker who waited a week before having a leg wound looked at. What could have been cured with oral antibiotics resulted in a leg amputation, and the end of his livelihood.

We are talking about people’s health and economic futures.

We are talking about the community’s health. Let’s consider infectious illnesses — tuberculosis, HIV/AIDS, chlamydia, syphilis, and the flu. All of these rates could climb if the number of uninsured increases and people stop receiving timely, affordable, and accessible care.

For us in Baltimore and for all of us health professionals, we will never waver in our commitment to provide care to our most vulnerable residents. We strongly believe that health is a fundamental human right.

Access to quality, comprehensive, and affordable health care should not be a privilege reserved for only the wealthy. The action by the Trump administration to undermine the ACA and to willfully increase the number of uninsured people is bad for health and bad for the economy, and it is immoral and unlawful.

Leana S. Wen M.D. is the health commissioner of Baltimore City. Follow her on Twitter @DrLeanaWen @BMore_Healthy.

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