Repeal of Affordable Care Act is Politics Playing with the Wellbeing of Americans
Why anti-choice activists seem to care so much about the well being of theoretical children in the form of embryos and fetuses, but don’t acknowledge the well being of all the children subject to abuse and neglect in this world continues to baffle me.
3) Increased Access to Health Insurance
This largely took the form of the optional Medicaid Expansion and anytime Medicaid is expanded, rich people get concerned about giving poor people free handouts. Enter: the perennial (and boring) debate about the appropriate size of government.
We forget about the people that these policies impact. We don’t hear the story of the 42-year-old patient that I met who works two jobs to contribute to the family (his wife works as well) and is having the first doctor’s visit of his adult life thanks to the ACA. And they’ve come in droves.
What’s forgotten is that health insurance was actually invented to help maintain labor production. The UK’s National Insurance Act of 1911 recognized that illness was often unpredictable and so if every member contributed to a healthcare system it could provide aid to injured workers with the idea that they would then be able to return to the labor force faster.
One of the most incredible impacts of the ACA in my practice has been access to addiction treatment. Addiction to prescription opiates and heroin is at epidemic levels in this country. Interestingly, the most recent surge is attributed to heavy prescribing by doctors in previous years causing addiction in patients (in part because corruption and in part because the makers of these drugs didn't honestly report how addictive they were). We’re not talking about whatever stereotype people have in their head about “addicts.” One of my patients got addicted after she was given opiate pain medication after having her first child.
The most effective treatment is opiate replacement therapy. Most people know these as Methadone clinics and Suboxone prescriptions. Without them, some experts estimate the lifetime relapse rate as 95%. With them relapse is reduced by 34%. Few modern medications have such a large individual impact.
The problem is that before the ACA the wait lists to get into a methadone clinic were really long. Many of the patients that are admitted to the hospital for opiate dependence-related complications are interested in recovery. We would treat them, get them engaged in treatment, and even get them stabilized on methadone but upon discharge, there was no way for them to continue the treatment. They couldn't afford it. No one was surprised when they then relapsed shortly after discharge.
If you discharged a patient with asthma and told them to get on a waitlist for their daily preventative asthma medications, of course they would end up getting worse again.
With the ACA, wait lists dropped dramatically as virtually all patients with substance dependence now qualified for Medicaid. In fact, our hospital setup a system with the local methadone clinic where, upon discharge, the patient would have an appointment with them the next day.
Treating patients with opiate substance dependence is one of the most rewarding things that I do as a physician. You watch people transform from homelessness and estrangement from friends and family, to steady employment and stabilized relationships.