The day President Donald Trump was sworn into office, I was closing out the end of a 100-hour work week at UC Davis Medical Center. My Inauguration Day started at 7 a.m. and, with the exception of an hour and a half to drive home and eat, ran nonstop until I finished the last of my notes at 11 p.m.
In those 100 hours, I got to know and care for dozens of members of my community. They included a retiree who had a bicycle accident and ended up with a blood clot in his lungs. Another was a paraplegic who had broken his neck in a car accident, and was now hospitalized with a multi-drug resistant infection.
I met an elderly woman, brought to our ER after screaming and throwing objects at people, who turned out to be suffering from a flare-up of her bipolar disorder.
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Three individuals who passed out or fell at home and needed to be treated in the hospital. Another woman whose husband gave her HIV before they separated, and who had just been evicted from her recently deceased parents’ home. And a young man who developed kidney failure in his 20s from undiagnosed high blood pressure, and was now on dialysis three days a week.
Two things united all of these patients:All suffered from an unpredictable chain of events that led them to the hospital, and all had health insurance.
Say what you will about the Affordable Care Act – it is by no means perfect and does not cover everyone – but it has drastically increased the number of Americans with health insurance. Which means that I can at least get my patients on treatment for their diseases, and their families won’t be bankrupted by a trip to the emergency room.
In fact, of the dozens upon dozens of patients I saw that week, every single person was insured or able to be referred to a qualifying health insurance plan by the time they left the hospital.
So the irony was not lost on me when, after finishing work that night, I finally saw the headlines about Trump ending the era of “American carnage.”
By nearly all accounts, what the Trump administration and Republicans in Congress are now proposing would result in a new form of carnage on a wide scale.
The repeal of the individual mandate will allow more healthy individuals to drop their health plans, while the Republicans’ new Continuous Coverage provision makes it more expensive to get back into a health plan again. As some analysts have noted, this will keep more healthy people out of the individual market, make the insured population sicker and ultimately make health insurance more expensive for everyone.
While health insurance is set to become more costly, the Republican plan will make it harder for patients to afford those plans in the first place. They eliminate ACA provisions that provide more support for more expensive plans and for Americans who make less money. Their proposal also allows health insurers to charge older patients even more for the same level of coverage, pushing the total cost of insurance even further out of reach for patients who often need it the most.
Meanwhile, the Republican proposal to place spending caps on Medicaid will turn it into a zero-sum game, where states will have to choose between funding medicines for one kind of patient and surgeries for another group of patients. For all the false talk about “death panels” with the ACA, Republicans are poised to institutionalize something eerily similar for Medicaid.
The result of all these changes will be health insurance that is more expensive, with fewer people able to afford the medical care they need.
Before Obamacare, I once took care of a woman in her 50s who had just been diagnosed with breast cancer. Her family made too little to afford health insurance, but too much to qualify for Medicaid.
The last time I spoke with her, we talked about what she was going to do. She was about to be discharged from the hospital, and I wanted to see what we could do to get her follow-up care. I still remember her hospital room, the dark tan walls, the wistful smile on her face.
She told me she was going to go home and die.
She knew that she couldn’t get insurance, and her family would never be able to pay out of pocket to treat her cancer. It would bankrupt them. It would make them homeless, require them to sell everything they owned and more. So she chose to pay for her family’s home with her life.
The carnage from repealing the ACA won’t be seen on the 5 o’clock news, or in newspaper headlines. It will happen quietly, in living rooms and hospital rooms for millions of Americans across the country. And patients, their families and their providers and caregivers will be the ones to bear witness to it.
Dr. Anthony Bhe specializes in internal medicine at UC Davis Medical Center. He can be contacted at firstname.lastname@example.org.