MCMS Physician Winter 2017 - 16

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Repealing the ACA: Women's Health May Suffer
Continued from page 15

Five years ago, a woman with premature rupture of membranes
(PROM) at 19 weeks went to a religiously-affiliated hospital.
They would not induce labor even though they knew that the
fetus would die and there was a significant chance the mother
would also die, leaving behind her other children. Luckily, her
husband took her to another hospital where her life was saved.
I will never forget doing a C-section on a 10-year-old girl.
Should she have been responsible enough to use contraception
when she was sexually abused by her stepfather?
Who will take responsibility for care of a microcephalic
child born to a woman who was infected with Zika? What
responsibility does society have to that child?
Until you are in the "trenches," there are many things you
may not understand. Those of us practicing obstetrics and
gynecology have been there. The government should not be the
one making decisions about very complex, ethical and moral
decisions.
Fallout From ACA Repeal
Enforcement of the ACA is in two jurisdictions. The
president can remove the funding for subsidies for insurance
premiums and Medicaid expansion. Congress would have to
vote to change the other provisions. The mandate for coverage
of contraception may no longer stand. We may no longer be
able to keep our children on our insurance plans until age 26,
although the president-elect recently claimed he would consider
maintaining this provision and that of insuring citizens with
pre-existing conditions. From an economic point of view, this
is very complex. Women may be charged more than men for
insurance. The mandate to cover contraception, including its
most effective forms, and maternity care may be eliminated. Up
to 20 million people may no longer have health insurance.

Since the Senate does not have 60 Republican votes, a
filibuster cannot be prevented. The fate of the ACA therefore,
remains uncertain. Hospitals fear repeal of the ACA because
they anticipate fewer beds filled. Insurance and pharmaceutical
companies are concerned about loss of the advantages they
gained by more people being covered and the government
providing subsidies. Insurance companies complained that their
profits were down, but it is hard for physicians to be sympathetic
to them since they continue to cut our reimbursements.
Most physicians are very unhappy with the ACA for good
reasons. But repealing it will not fix the medical liability
problem, make insurance companies or the government
reimburse us more fairly, or get rid of MIPS and MACRA (our
trade for getting rid of the SGA). We already spent a fortune
setting up EMR, and may no longer be able to get any money
back for meeting "meaningful care" requirements, as bad as
they are.
Our Patients Need Us Now More than Ever
In summary, medicine (physicians) and healthcare for
patients, especially women, may suffer. Can we, in medicine,
help push for a solution? I believe we can stand for our ability
to practice medicine with fair reimbursement for our hard work,
preserve the parts of the ACA that work for the majority, and
not return to the dark ages for women's health. The caveat is that
we have to unite to work for the common benefit of healthcare
by participating in our medical societies and being in engaged
relationships with our elected officials to try to shape policy.
If we accept the results of this election on healthcare, then we
deserve what we get. But our patients do not, although many of
them had no idea what the actual consequences of their votes
might be.
I am glad to be retired, but I do not feel I can abandon
the patients for whom I cared, or my colleagues. Our work to
maintain our principles continues. It is our responsibility to
participate in any changes to the ACA so that our patients do
not suffer and so that we can maintain our ability to practice
medicine.

M C M S P H Y S I C I A N 16 W I N T E R 2 0 1 7
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