As governor of Indiana, Mike Pence slashed state health spending, eliminating Scott County Planned Parenthood — the only place for residents of that rural area to get tested for HIV.
Shortly afterwards, HIV began to spread throughout this community, in large part due to an injection drug use epidemic.
As the crisis spiraled out of control with 20 new cases of HIV being diagnosed each week, Pence turned to Obamacare’s expanded Medicaid program to help Scott County residents get medical care, HIV tests, and substance abuse treatment, which worked to curb the outbreak and eventually brought the number of new infections down to zero.
Last month marked a victory in preserving the Affordable Care Act (ACA) and Medicaid expansion, which has been a life-saver for millions of Americans. If the GOP had succeeded in replacing the ACA with the American Health Care Act, 24 million people would have lost their health insurance, according to the Congressional Budget Office estimate.
People across the political spectrum mobilized to oppose this ill-conceived plan that would have taken away coverage or made it harder for people to get it.
Why should we consider a proposal where even one person could lose their insurance?
Why should Americans who work hard and struggle to make ends meet have to worry about a need as basic as access to health care?
In the battle to preserve this fundamental human right — a right, not a privilege — we must remain vigilant. Many components of the American Health Care Act are bound to resurface. They will affect every American — and they will be particularly catastrophic for people living with chronic conditions.
About half of all US adults have one or more chronic condition, including diabetes, HIV/ AIDS, arthritis, and heart disease. Everyone knows someone living with a chronic condition and how crucial it is for their health to maintain regular, comprehensive care.
Without it, people living with chronic conditions are hospitalized and visit the emergency room more frequently, require costly nursing homes, rack up high bills, and get pushed into poverty. Those burdensome costs are ultimately passed on to the government, insurers, and taxpayers.
At Amida Care, New York’s largest Special Needs Health Plan (SNP) for people with chronic conditions such as HIV, we’ve seen first-hand how maintaining health care leads to dramatic cost savings to the government and taxpayers.
We’ve achieved a 75 percent viral suppression rate among our HIV-positive members, saving more than $110 million from 2008 through 2015 from in-patient cost-savings and other averted health care costs to New York State. Preventing just one HIV infection can save between $400,000 and $500,000 in estimated lifetime medical costs, usually borne by state Medicaid and federal programs.
Clearly, when people lack adequate coverage and access to preventive care, we all pay for it. If the ACA had been repealed, topline estimates include a loss of $140 billion in federal health care funding for 2019 and the loss of 2.6 million jobs. States that haven’t expanded Medicaid will also be affected by the national market: collectively, the 19 states that haven’t expanded Medicaid are estimated to lose about 338,000 jobs in 2019, even though they do not receive the direct federal matching funds for Medicaid expansion.
The president promised a replacement plan that would cost less and cover more. But lowering federal spending shifts cost to state and local government. This is not solving the problem; it’s pushing the problem downstream. We need a plan that will confront the real reasons for increased cost in health care — for instance, the high cost of prescription drugs. In New York State, Governor Andrew Cuomo introduced a proposal to protect New Yorkers from soaring prescription drug prices. Similar measures should be advanced nationwide.
Limiting Medicaid or changing Medicaid funding via block grants or a per capita cap would severely undermine states’ ability to respond to a crisis. Natural disasters and recessions leave many unemployed, and Medicaid would no longer be able to scale up quickly to meet demand and help those affected.
Likewise, it is important to maintain standards for the essential health benefits that comprehensive health care should cover so that insurers don’t exclude much-needed services and people don’t bear the burden of gaps in coverage that leave them vulnerable when illness strikes.
When winning at any cost is the goal, all of us lose. We are not living up to our nation’s potential to uphold one of our most dearly held values — equal opportunity, the bedrock of the American Dream. In the wealthiest country in the world, having a chronic condition or simply aging shouldn’t bankrupt you.
Hard-working Americans shouldn’t be forced into poverty because they are unable to afford care. Taking insurance away from millions of people will not make America great.
In my Wisconsin home, with a banker father and a mother whose parents were union organizers, I witnessed how the right and left can work together to find solutions. We’ve made huge progress with the ACA. It is not broken; it can and must be improved to maximize what it achieves for the American people.
We need smart, collaborative leaders to design a health care system that works for us all — leaders who recognize that access to healthcare for all is a win-win for everyone.
Doug Wirth is the president and CEO of Amida Care (amidacareny.org), a private nonprofit community health plan that specializes in providing comprehensive health coverage and coordinated care to Medicaid members with chronic conditions.