The December ruling by Texas District Judge Reed O’ Conner that the entire Affordable Care Act (ACA) was unconstitutional followed by the Department of Justice's ruling in agreement to strike down the entire ACA this week has the potential to intensify efforts to repeal the ACA.
The Trump administration supports repealing the entire historic health reform law and is determined to do so. Even before the final vote to make this the law of the land in 2010, Republicans vowed to do away with the health law adopting the phrase repeal and replace.
The health-care crisis in America is real and has been an issue for decades, but Republicans have been focused on repealing the Affordable Care Act. And while it may take a while before a final court decision strikes down the entire law, even the impact of these attempts is far reaching and quite disturbing to the millions of people who are in dire need of affordable health care.
As a nurse, I know this to be true after four decades taking care of hundreds of uninsured patients in emergency rooms and community based-settings. Personally, I also vividly remember my childhood when my family did not have any health-care coverage and had to rely on our public hospital for services.
Although we used it sparingly, I dreaded having to travel far and wait hours in an overcrowded space to see a doctor for my asthma condition. Although the care was good, the system was clearly overburdened causing many people to leave without being seen by a health-care provider. Today, I envision an even more pronounced scenario if the ACA is totally repealed.
Evidence reveals the growing number of people who will be adversely impacted if we experience a total repeal of the ACA and millions more are denied affordable health care.
According to the New York Times, approximately 21 million Americans would be at risk for loss of health-care coverage; more than 12 million low income adults who have struggled to get coverage through the Medicaid program would be at risk for loss of coverage.
The dangers of a repeal of the ACA is not limited to health-care coverage. An estimated 133 million Americans thought to have a preexisting condition would lose their protections against possible discrimination and higher health-care cost imposed by insurers.
The provisions to protect those with pre-existing conditions have been one of the most popular components outlined in the ACA, a provision that protects the poor and the affluent alike. In addition, according to the Economic Policy Institute (EPI), the repeal of the ACA would result in the loss of 1.2 million jobs across numerous work industries not limited to the health-care industry.
And while not perfect, any gains resulting from the passage of the ACA would be lost leaving a wider gap in coverage to address. The findings from a recent Commonwealth Fund report assert that fewer people are uninsured today compared to 2010 when the ACA first became law. People are also experiencing less coverage gaps. While this represents some positive change in numbers, 45 percent of U.S. adults are still inadequately insured comparable to the rates of 2010.
The House Democrats have moved quickly to draft legislation to make health care more affordable and to insure protection for those with preexisting conditions. However, this too will take time and perhaps years of debate.
As a nurse, I believe the time to solve America’s health-care crisis is way overdue. The constant back and forth debates and ongoing efforts to repeal the ACA does little to ease the minds or the health status of those most in need.
I have seen too many patients, families and communities experience the worst of all health outcomes due to the lack of affordable health care. Increasingly, members of the public are coming forth to share personal testimonies on how they have to decide between health care or other necessities of life due to their inability to afford co-payments and deductibles.
A recent Gallup poll revealed that three in ten Americans forgo or deter treatment due to the high cost of care. The continual delays in seeking medical services carries real consequences that for many can involve higher health-care costs and a higher probability of poorer health outcomes. While some health systems provide some form of charity care, they barely scratch the surface of caring for all those in need nor in providing the wide range of services needed across the health-care continuum from prevention to tertiary care.
Daniel Dawes details in his book “150 Years of ObamaCare” the long arduous journey to achieving health reform in the United States. For the first time in our history, the United States has been able to enact a comprehensive roadmap for realizing health-care reform.
I believe it is more prudent to build on this existing reconstructed infrastructure instead of repealing the entire ACA. While there are fixes that are needed to the ACA, Americans cannot afford to start all over again building consensus among a wide array of stakeholders and creating a newly configured infrastructure.
This will take far too much time as history has already demonstrated in our previous attempts to achieve health reform. Time spent on starting from scratch would further jeopardize the health and wellbeing of those most in need of health care leaving our health care system in further chaos.
Access to affordable health-care will no doubt be of high priority during the next presidential campaign. However, we cannot afford to wait for years of debates or a total destruction of existing policies that are designed to help address the issue. There is an urgent need to find solutions to our health-care crisis; but this will not happen until our nation realizes that prolonged debates and bickering will further drive up health-care costs and poorer health outcomes.
Janice Phillips RN Ph.D. is an associate professor at Rush University College of Nursing and the director of nursing research and Health Equity at the Rush University Medical Center in Chicago. This column is written in association with the Public Voices Fellowship.