Repealing the Affordable Care Act – Be Afraid

Gentle Readers – this was published this morning in the Daily Item, the paper for this area of Pennsylvania. I grant that it is not measured and without passion. But then, if you have read anything I have written, you will know that the facts are correct, but there is always passion.


Today the Republicans and their President presented the “idea” they have to repeal and replace the Affordable Care Act (ACA), also known to many as ObamaCare.

To be perfectly transparent, I must point out that while I read the actual legislation and generally supported it, I found too many insurance company give-aways were included. The single-payer option, which would have driven costs down in a major way while focusing our quality efforts, was not allowed to see the light of day. Obama and his collaborators made the calculation that if they tried to have a single-payer option – that is, one among many – the entire plan would fail. So, they chose, instead, a complex system of Exchanges, Subsidies, Medicaid expansion and regulation to get where they wanted to go.

And it more or less worked.  There are, today, as I write, about 20 million Americans who have access to health care that did not prior to President Obama’s ACA, health costs as a percent of our country’s Gross Domestic Product flattened out and then rose at a much lower level than had been seen on the past. Regulations were implemented that DROVE innovation and cost savings by improving quality and safety; this was NEVER done by the private, for-profit insurance companies. Or, better said, it was done by the insurance companies to the extent that it would shave dollars spent on care so that these dollars could be re-directed into the pockets of over-paid executives and their shareholders. To the detriment of the American people.

Were there problems ? Of course. Could they be corrected by rational legislation ? Absolutely ! This was, however, prevented. Prevented by an obstructionist Republican Party, led by a group of well-heeled men and women happy to see Mr. and Mrs. America suffer so that these Party hacks can give their “owners” the tax breaks they want, so that they can drive our country back to the 1950s.

What the Republicans are rushing to pass – this so-called fiscally conservative group doesn’t even know the cost of what they are doing; they don’t know how many people this will hurt – is legislation that:

  1. Eliminates the Medicaid expansion, responsible for increasing health care access to tens of millions of Americans. Twenty to thirty million of us are at risk of losing health coverage. By the way, most of these are working people.
  1. Replacing the Medicaid Expansion with Block Grants capped at what each state was spending in 2016. While this may sound acceptable, it will drive down services year after year. And if there is another HIV epidemic, influenza epidemic, measles epidemic, there will be limited money to care for our people.
  1. Eliminates Federal Standards guiding the plans insurance companies offer. No standards mean that the insurance companies do what they want, offer what they want. And if you choose the wrong plan, or can’t read their unreadable prose, too bad for you. The Republicans do not care.
  1. While the Republicans say that they want to keep the rule that insurance companies can’t cap how much is paid out to a person for their disease. And they say they want no limitations based upon pre-existing conditions. The ONLY way this works is if EVERYONE is obliged to buy insurance, the mandate. They want to do away with this; this is the stupidest idea ever. Of course, we prefer not to have the mandate, but it is the glue that makes everything else stick. Without it, there is no way the Republicans can demand no caps on coverage, or no limitations of coverage based upon pre-existing conditions. These so-called fiscal conservatives are know-nothings when it comes to finance. I learned more about finance working in my mom and dad’s liquor store as a child.
  1. Subsidies are removed and tax-credits are offered which can be used to buy an insurance policy. This will not, and cannot, work. The policies will be too expensive. People will go uncovered or will buy catastrophe-only policies. Health maintenance will fall by the wayside and our health will take a dive. Except, that is, for the rich. They will be sitting pretty.


There are other issues to be discussed, but space is limited. One of the beauties of the ACA was that it untied health insurance from employment. If you wanted to try your hand at starting a business or a farm, you didn’t have to go uncovered; your family did not have to suffer. With this plan – even if it is changed somewhat – the men and women governing our country will have pushed working America back into the position of limited upward mobility.

Trump and the Republicans, great if you can afford them. We can’t.

About AJ Layon

AJ Layon was, for 28 years, at the University of Florida College of Medicine, in the Division of Critical Care Medicine, in Gainesville, FL. For the approximately 10 years until September 2011, he was Professor and Chief of Critical Care Medicine at UF; In September of 2011 he became System Director and Co-Chairman of Critical Care Medicine in PA; this ended in 2017. He served as a Physician in the Surgical Group with Médecins sans Frontières (MSF, Doctors without Borders) through 2018 and is presently an intensivist in Florida, struggling through the SARS-CoV-2 crisis. While his interests are primarily related to health care, health care reform, and ethical issues, as a citizen of our United States and our world, he will occasionally opine on issues of our "time and destiny". Follow on Twitter @ajlayon
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