Health Care Reform: Keep What’s Working and Fix What’s Wrong

On July 25, the U.S. Senate voted to begin debate on a bill that most had not yet read. Since then, they’ve voted on and rejected two amendments, both of which are bad for patients, bad for caregivers and bad for America.

As a nurse, I know a different side of health care than the one being debated. Cutting access to health care for tens of millions of Americans doesn’t eliminate the uninsured patients’ need for care. They just delay seeking care, many times until it is too late. A delay in diagnosis and treatment can impact recovery, quality of life and often the ability to remain employed.

The replacement proposals we’ve heard so far are untested, whereas the ACA took some of its major provisions from existing federal or state government health care programs.

  • Federal matching funds: The Children’s Health Insurance Program (CHIP), signed into law in 1997, provided federal matching funds to states to provide health care for children whose parents couldn’t afford a private policy.
  • Health care exchanges and Medicaid expansion: In 2006, Massachusetts enacted what was later known as RomneyCare, which ensured every state resident had access to health care that they could afford.

Far easier than repealing the ACA, the Senate and conservatives in Congress could keep what works in the Affordable Care Act and fix what’s wrong. In America, every single American should have access to affordable, high quality health care that improves health outcomes and provides a good quality of life.

Affordable, High Quality Health Care

The Affordable Care Act (ACA) made preventive care a reality for nineteen million Americans who gained health insurance under the law. It reduced the risk of ruinous medical debt, leading to a 50% drop in the number of personal bankruptcies. A 2008 Harvard study found half of all foreclosures were due to medical debt. While it cannot be directly measured, access to health insurance likely shrank the risk of foreclosure.

Despite the decreased threat of medical debt, we haven’t solved the affordability issue yet in health care. Sen. Ted Cruz’s consumer freedom option amendment offered the “freedom” to choose a cheaper, bare bones health insurance plan with a high deductible. Not only does this fail the affordability test—the average deductible in 2016 for a single worker covered by an employer-sponsored health plan was $1,478—but it often amounts to low quality, junk insurance that doesn’t cover basics like hospitalization and prescription drugs.

Patients don’t choose to have cancer, diabetes, heart disease, a stroke or high blood pressure. Imagine a cancer diagnosis with a junk insurance policy that only covered $2,000 per year of outpatient services such as chemotherapy.

The President is right—health care is complicated. If we want to improve health care outcomes for Americans, and lower costs, elected officials need to carefully study the matter out in the open. Sen. John McCain opened the door to a bipartisan approach in his Senate floor speech on Tuesday, suggesting reform could be hashed out in the Senate Health, Employment, Labor and Pensions committee with contributions from both sides. Those of us who have worked to increase access to health care for decades know there are no easy solutions. While we’d like to see the discussion start with how we provide health care for all, such a proposition doesn’t have the votes in this Congress.

Finally, reform that includes any weakening or elimination of protections for pre-existing conditions—or the caps on premium mark-up for those who have these conditions—is a step back for America. For those who have fought cancer or continue to fight a chronic condition like diabetes, allowing insurers to price them out of the insurance market could literally be a death sentence.

I urge senators to keep what works in the Affordable Care Act and to fix what’s wrong. Patients and those who care for them deserve better than what’s on the table now.

Denise Duncan, RN, is a registered nurse and president of the United Nurses Associations of California/Union of Health Care Professionals (UNAC/UHCP).