Primary Physicians React to Affordable Care Act Repeal

Just two weeks ago, I posted a story on this blog about public rallies against repeal of the Affordable Care Act, aka Obamacare, including one I attended and observed here in Chicago that day. That article discussed patients’ reactions to the prospect of ACA repeal under the Trump administration, noting that just 26 percent of Americans currently favor wholesale repeal—far from a majority—while substantial majorities favored almost all the major provisions of the current law. But what about the primary care physicians who treat those patients and serve on the front lines of medical care? How do they feel?

Well, the New England Journal of Medicine apparently decided to find out. It turns out that an even smaller minority, just 15 percent favor wholesale repeal, including just 38 percent of those who voted for Donald Trump. The journal notes that the adjusted response rate to its survey was 45.1 percent, and that the views of primary physicians are not necessarily the same as other physicians. It also notes that about three-quarters favor making changes to the law, but that option is not at all inconsistent with favoring its continued operation. Many such laws are amended over time as a result of experience with their strengths and weaknesses. One potential change favored by those surveyed is that of providing a public option, such as Medicare, in competition with private coverage. Creating such an option for consumers runs counter to current Republican dogma on the issue.

That said, 95.1 percent favored the prohibition on denying coverage based on pre-existing conditions, and majority support for other key provisions of the current law, with the exception of the tax penalty for noncompliance, although even that support was higher than for the general public, at 49.5 percent, almost half. However, the prohibition on denying coverage depends on the mandate for individual coverage. One makes the other possible.

Jim Schwab

“For God’s Sake, Don’t Repeal It”

Overflow crowd attends health rally at SEIU-HCII hall.

Overflow crowd attends health rally at SEIU hall.

“Six weeks ago,” said Sen. Dick Durbin, the Illinois Democrat who is assistant minority leader in the U.S. Senate, “I got a call from Burlington, Vermont.” It was Sen. Bernie Sanders, who told him “we need to rally in cities across the U.S.” to preserve health care for Americans. Sanders, though falling short of the Democratic nomination last year against Hillary Clinton, showed a noteworthy capacity as a prescient organizer. He clearly anticipated the assault that the new administration and congressional Republicans have now launched against the Patient Protection and Affordable Care Act (ACA), popularly known as Obamacare. And so today, five days before Donald Trump will be inaugurated the 45th President of the United States, rallies to preserve the ACA took place. Durbin spoke in Chicago at the overflowing hall of the Service Employees International Union (SEIU), Health Care Indiana-Illinois (HCII) unit.

Line forms at the back of the building. It got much longer.

Line forms at the back of the building. It got much longer.

My wife and I arrived about 15 minutes before noon, parked our car in the lot behind the building, and joined a long and rapidly growing line of people seeking to attend the 1:00 p.m. rally. Limited by fire code, the SEIU staff had to cut off the number of people entering, directing the rest of the crowd to a Jumbotron behind the building. We were lucky, among the last 25 people allowed inside, and the line behind us stretched around the corner. Clearly, the Republican attack on health care had stirred a hornet’s nest, at least here in Chicago.
Durbin was the leadoff speaker following an opening by Greg Kelley, executive vice-president of SEIU-HCII. With

U.S. Rep. Jan Schakowsky posing with followers.

U.S. Rep. Jan Schakowsky posing with followers.

him were several Chicago area Congressmen—Reps. Mike Quigley, Jan Schakowsky, Brad Schneider, and Raja Krishnamoorthi, all Democrats, along with Cook County board president Toni Preckwinkle. Durbin cited the statistics that reveal the origin of the angst driving the overflow crowd. He noted that some 1.2 million people in Illinois stood to lose their health insurance coverage if the ACA is repealed, roughly 10 percent of the population. The ACA saves seniors in Illinois an average of $1,000 per year on prescription drugs. People stood to lose the ACA’s protection against lifetime limits on coverage, which in the past often led to bankruptcy for people with catastrophic illnesses like cancer.

“The Affordable Care Act was the most important vote I have ever cast as a member of Congress,” Durbin concluded. “If the Republicans can’t replace it with something as good or better, for God’s sake, don’t repeal it.”

A true citizen uprising needs more than politicians at the podium, and union leaders, such as SEIU president Mary Kay Henry, health care consumers, representatives of Planned Parenthood and a small business alliance, and others, including the Rev. Jesse Jackson, kept the standing-room-only crowd revved up. Tracy Savado, introduced as a health care consumer with a story to tell about lifetime coverage caps, shared that her husband had been diagnosed with an acute form of leukemia. Fearful of lacking enough insurance, she inquired of her insurance company representative about this point, and, she said, was told that President Obama’s health care law had done away with such limits. Prior to the ACA, she noted, about half of all insurance policies had lifetime caps on coverage. She added that she had recently attended a farewell for outgoing Health and Human Services Secretary Sylvia Burwell. Asked what might happen in the new administration, Savado said, Burwell paused and noted that the biggest obstacle to the GOP plan for repeal is “people sharing their stories” about the benefits they have enjoyed from the new law. “When people understand what’s at stake, they aren’t going to want repeal,” she concluded.

Many of the other speakers essentially made many of the same points in different ways for almost an hour and a half, until William McNary, co-director of Citizen Action Illinois, ended the rally on a boisterous note with a rousing speech in which he declared that “the only pre-existing condition the Republicans want you to have is amnesia.”

His comment is a powerful point that is worth remembering in considering how matters came to this pass. More than a few Americans who voted for Trump in the recent election are also benefiting from Obamacare. While people clearly can and do vote on issues other than health care, it remains undeniable that this constitutes some form of contradiction that requires explanation. Even amid the 2010 debate that ended with the passage of the ACA, Tea Party rallies often featured protesters with signs that read, “Keep your government hands off my Medicare.” What sort of stunning ignorance is required to fail to understand that Medicare was and is a creation of the federal government by a vote of Congress in the 1960s and that, absent the “government hands,” it would never have come to be in the first place?

Recent polls have shown overwhelmingly that voters favor virtually all the key features of the Affordable Care Act even as many nonetheless oppose whatever they perceive as “Obamacare.” A post-election Kaiser Health Tracking Poll found public support at 80 percent oDSCF3283r above for ACA provisions allowing young adults to stay on their parents’ insurance plans, eliminating most out-of-pocket costs for preventive services, subsidies for low-income insurance purchasers, and state  options for expanding Medicaid, as well as 69 percent for prohibition of denial of insurance because of pre-existing conditions. Only 26 percent want the law repealed. What we have faced since 2010, and must confront now, is not a real plan to replace Obamacare with something better, but an incredibly slick campaign of propaganda to associate the word Obamacare with something evil.

People who come to terms with the origins of such contradictions may find themselves in a better position to understand the remarkable political gall required for the Republican majority in the U.S. House of Representatives to pass repeal in recent days without offering a clue as to what will replace Obamacare. “Repeal and replace” was Trump’s campaign mantra, yet even he has offered no details of consequence about what that will mean even as he insists Congress will somehow do both within the next few weeks. Anyone who believes that can be done by a party that has failed to define an alternative for the last six years is truly prepared to believe in political miracles.

It would be more realistic to look closely at Trump’s nominee for Secretary of Health and Human Services, Rep. Tom Price of Georgia, a man who advocates replacing much of current Medicare coverage with a voucher system and is devoted to dismantling Obamacare. Read his intentions closely, get angry, and organize.

Jim Schwab