Moderated by Tom Sabulis
Medicaid expansion under the Affordable Care Act is all over the map. The Texas legislature just passed a bill to stop it. Arizona Gov. Jan Brewer is trying to force state lawmakers to expand access to it. In Georgia, Gov. Nathan Deal says we can’t afford it. Today, a health care executive and two physicians debate the pros and cons of this controversial component of Obamacare.
Commenting is open below.
By Jack Bernard and Neil Shulman
In a fruitless effort, the radical Republicans in the U.S. House of Representatives have once again pushed through a repeal of “socialist” Obamacare — for the 37th time. This is partisan politics at its finest, since Obamacare is simply an update of Romneycare, a thoroughly Republican concept based on private insurance first introduced by former Republican presidential candidate Bob Dole in more reasonable times.
As health care professionals with many decades of experience, we do not believe that Obamacare (the Affordable Care Act or ACA) is the best solution for our ills. Although it will not provide insurance for all Americans, it is at least a move in the right direction regarding access — especially if Republican governors like ours stop playing politics and accept the federal money to expand Medicaid.
We cannot just let our fellow citizens suffer, expecting the free market to miraculously change and take care of the problem of the uninsured, as has been proposed by Reps. Paul Ryan, Paul Broun and others. The percentage of uninsured has risen drastically in the U.S. and even faster in Georgia, where 22 percent of the population is uninsured.
Here are two examples of how the current system simultaneously mistreats patients while wasting money — problems that can be alleviated by immediate Medicaid expansion:
• A woman graduates with huge college debt, getting a job as a waitress with no health insurance. A pimple on her skin turns dark. She goes to an ER, where the doctor tells her to see a dermatologist. Because she’s broke, she applies to Medicaid, which sends her a letter stating that she is ineligible; she has to be even poorer or disabled from her disease. The cancer spreads and, six months later, she is admitted to a hospital on Medicaid. After $100,000 of health care, she is sent to hospice to die. She is 29 years old.
• A 47-year-old security guard is admitted to a hospital with severe shortness of breath and elevated high blood pressure. Within three days, he is discharged, with $68,000 in medical bills. His doctors know that his blood pressure will zoom back up without the needed blood pressure meds. However, he has no money, and the hospital is not required to give him meds, so he doesn’t get any. He is sick, exhausted and alone. His blood pressure zooms back up, and he bleeds in his eyes, becoming blind. Now, he is disabled and eligible for Medicaid.
In the words of the civil rights leader Philip Randolph: “A community is democratic only when the humblest and weakest person can enjoy the highest civil, economic and social rights that the biggest and most powerful possess.”
We must choose what sort of a nation we will be: a country of compassion, or a Darwinian society in which the strong ruthlessly trample the weak. If we Americans view ourselves as the moral beacon of the world, then we must take care of the less fortunate here at home. In the short term, we must fully implement Obamacare, including expanding Medicaid. Longer term, the most effective solution is Medicare for all, not just those over 65.
Jack Bernard, a Republican from Jasper County, is a retired senior health care executive and was Georgia’s first director of health planning. Neil Shulman is associate professor of medicine at Emory University Medical School.
By Tom Price
It has been three years since President Barack Obama led a partisan effort by Washington Democrats to pass an overhaul of America’s health care system. As the government begins to implement more and more facets of the law, it is becoming clearer to even its most ardent supporters the disaster awaiting doctors, patients, medical innovators and the economy at large.
One of the Senate’s chief architects of the law has said he fears a “huge train wreck” is approaching. Another has said the law is so complex, it is “just beyond comprehension.” Even labor unions that stood with Democrats as they went about passing the legislation are now turning against it — the United Union of Roofers, Waterproofers and Allied Workers going as far as to call for its repeal.
The reasons to scrap the law are numerous. Health care premiums are rising, not falling. Full-time job opportunities will be shifted to part-time in response to the law’s new rules and regulations. The IRS, the enforcement arm, is gearing up to impose mandates and new taxes on individuals, families, employers and even innovative medical technologies. Many states realize there is a serious logistical and financial gamble that comes with setting up the law’s insurance exchanges or expanding the Medicaid program.
Advocates of patient-centered health reforms have long predicted these and other harmful consequences of the president’s health care law. It is why the House of Representatives voted once again earlier this month to repeal it in full so we can protect the principles of health care we hold dear: accessibility, affordability, choices, innovation, responsiveness and quality.
That vote, and other repeal efforts, have drawn criticism from the law’s defenders. These are the same folks who, in large part, believe the American people ought to sit down, keep quiet and be resigned to a world where the federal government controls their health care decisions. They’d rather spend time figuring out how to manage the train wreck than pulling the emergency brake and avoiding it!
For our part, House Republicans are not interested in giving up on the fight for patient-centered reforms or abandoning the American people to a declining health care system. We see no virtue in degrading access to quality, affordable health care choices so that Washington can dictate the what, when and how of health care delivery. It makes no sense to incentivize businesses to create fewer jobs or physicians to see fewer patients — all of which will occur under the president’s health care law.
Those who are continuing to defend and implement the law are doing so despite mounting evidence that the American people, our health care system, and our economy are going to suffer the consequences. Instead of criticizing efforts to repeal the law, they ought to respond to its failings by joining our efforts to pursue patient-centered solutions that put patients, families and doctors in charge, not Washington.
Republican Rep. Tom Price, a physician, represents Georgia’s 6th Congressional District.