Here's to Health!

I AM A FAMILY PHYSICIAN in Cleveland. For more than two decades, I have cared for lower-income families whose health struggles were made worse by their inability to afford private health insurance or to qualify for publicly funded health insurance through Medicaid or Medicare. Very few of their employers offer health insurance. This results in unaffordable medications and treatments, poor control of chronic illnesses, and avoidable complications from these illnesses.

The Affordable Care Act (ACA) of 2010 represented a sea change in the lives of my patients. They benefitted from two major health-insurance expansions: individual health-insurance exchanges, with subsidies to help middle-income families buy private insurance, and an expansion of Medicaid.

More than 20 million previously uninsured Americans—including many of my patients—now have health insurance under the ACA, and the nation’s uninsured rate is at a historic low.

Because of the ACA, my previously uninsured patients can afford medications and treatments, get their chronic illnesses under control, return to work, and become more engaged in their families and communities. Many of them referred to the insurance they now are able to access as a lifesaver.

For example, my patient Mary is diabetic and lost her job. As a result, she became uninsured, and she could no longer afford her diabetes medications and testing supplies. She made repeated trips to the emergency room when diabetic crises arose. Then she became eligible for Ohio’s Medicaid expansion, which began in 2014. After working with my medical team and having access to needed medications, Mary now has her diabetes under control, she is back at work, and she says she’s never felt better.

My patient Joe went to the emergency room one day with a cough. A chest X-ray showed a spot on his lung. Uninsured, Joe went without medical care for months until Ohio’s Medicaid expansion provided coverage. After seeing me and getting the appropriate testing, Joe was diagnosed with early-stage lung cancer, which thankfully was treated while it was still curable. Joe is now back at work.

The health-care act passed by the House of Representatives this spring would have removed $1 trillion from Medicaid and the individual insurance market, denying Medicaid to millions of Americans and making private insurance unaffordable to millions more, while at the same time providing hundreds of millions of tax-cut dollars to very wealthy Americans. (The Senate version would have been even worse.) “I have never seen members of Congress vote to so deeply hurt so many of their own constituents,” wrote Robert Greenstein of the Center on Budget and Policy Priorities. Greenstein called the GOP bills “the biggest assault on ordinary Americans—and the largest Robin-Hood-in-reverse transfer of income up the income scale, from low- and middle-income families to those at the top—in our country’s modern history.”

The United States is the only high-income country without nearly universal health-care coverage. There are several policies that could bring our country more in line with other industrialized nations while keeping the major structures of our health insurance system in place: continue funding Medicaid as a responsive entitlement; continue Medicaid expansion; continue to stabilize the individual health-insurance exchanges through a combination of tax credits and cost-sharing subsidies to middle-income families that are tied to the actual cost of insurance; allow individuals in the private market to purchase Medicaid in regions where private insurers do not offer coverage; and lower the age of Medicare eligibility from 65 to 60.

Responsible health-care coverage is not a matter of right and left; it’s a matter of right and wrong.