Doctors and patient advocates sound louder warnings as Trump and GOP push Obamacare repeal

Reporting from Washington —  As House Republicans move toward a vote to roll back the Affordable Care Act, nearly every major organization representing patients and doctors now opposes the legislation.

The American Cancer Society’s advocacy arm warned in a letter to lawmakers this week that the House bill threatens patients’ ability “to afford insurance that covers the healthcare services they need to treat a cancer diagnosis.”

The National Alliance on Mental Illness, another leading patient advocate, called the legislation “life threatening,” cautioning that it would “destroy countless hopes for recovery.”

And a coalition of 87 patient and physician groups — including the American Academy of Pediatrics, the March of Dimes and the American Lung Assn. — told GOP congressional leaders in another letter that the House bill “could be devastating to people with serious diseases.”

Also on record against the legislation are the American Medical Assn., the American College of Physicians and the American Nurses Assn.

The outpouring of opposition from dozens of organizations, many of whom for decades have advocated for patients’ health, has not deterred the GOP push to repeal the 2010 law, often called Obamacare.

But it underscores how out of step the plan put forth by President Trump and his congressional allies is with the widely held views of doctor and patient advocacy groups about what works best for patients, particularly the sickest and most needy.

“The bottom of my stomach falls out when I look at some of what is being proposed,” said Barbara Jones, who for 14 years has been helping patients, many uninsured, who phone the American Cancer Society’s call center in Austin, Texas, seeking help.

“Do these politicians really know what happens when someone is diagnosed with a catastrophic cancer?”

The House GOP bill, which would cut more than $1 trillion in federal aid that helps low- and moderate-income Americans get health insurance, is projected to nearly double the number of people without health coverage over the next decade, increasing the ranks of uninsured by 24 million.

Millions of consumers also would see skimpier health coverage and higher deductibles under the GOP plan, the nonpartisan Congressional Budget Office estimates.

Hardest hit in the long run would be lower-income Americans and those nearing retirement, according to the budget office.

Republican leaders dismiss those dire predictions and say they are clearing away government regulations to reduce costs and create what House Speaker Paul D. Ryan (R-Wis.) often calls a more “patient-centered” system.

Health and Human Services Secretary Tom Price said recently the House bill would “restore, protect and preserve the doctor-patient relationship, the trusting partnership that is fundamental to quality healthcare.”

Trump and other Republicans note that, in contrast, the current law is pushing up premiums for some consumers and leaving fewer insurance choices in some parts of the country.

The GOP push has picked up support from several influential groups, including the U.S. Chamber of Commerce and the National Retail Federation. And some supporters of the repeal push are doctors, including Price, a former orthopedic surgeon.

Most patient advocates and leading physicians agree that Obamacare has shortcomings.

But across the country — in community clinics and hospitals, doctor’s offices and healthcare call centers like the one in Texas — many of the people who work closest with sick patients say they don’t understand how stripping away health coverage and scaling back what insurers must cover will improve patients’ lives.

“The fact is, people are not going to go to the doctor if they don’t have insurance,” said Dr. Mary Newman, a primary care physician in suburban Baltimore, adding that even wealthier patients are reluctant to seek routine care for something like a suspicious skin mole or a breast lump if they’re uninsured.

“It is really scary,” Newman said. “We help them any way we can, but they are ashamed or in denial about asking for help without insurance coverage.”

The obstacles for doctors and nurses who care for poor patients often are even larger.

At HealthLinc, a network of health clinics in northwestern Indiana that historically served large numbers of uninsured patients, doctors and nurses were routinely forced to skip recommended tests or treatments because patients couldn’t afford them, said Beth Wrobel, the clinic’s chief executive.

“I’d have to get on the phone and beg the local hospital for an MRI or something like that,” Wrobel said. “We want to be able to send our patients on their way to wellness, but our options were very limited.”

The expansion of Medicaid coverage in Indiana through Obamacare has begun to change that, she said, as patients now can go see specialists they need, or get MRIs and other tests the clinic can’t provide.

The healthcare law has extended coverage to more than 20 million previously uninsured Americans and is driving the nation’s uninsured rate to the lowest levels recorded, data show.

A growing body of research shows that is dramatically improving patients’ access to care.

The share of adults who skipped medical care because of costs dropped by nearly one-fifth between 2013 and 2015, according to a recent report from the Commonwealth Fund. The gains were even more dramatic in the states that have most expanded coverage through the federal healthcare law.

The improved access is leading to better results, other studies indicate, including helping poor patients better control diseases such as asthma and high blood pressure.

And still other research suggests that the coverage expansions made possible by Obamacare ultimately may save lives.

That is what researchers found occurred in Massachusetts after that state enacted its trailblazing coverage expansion in 2006, a model that was replicated in the federal law that President Obama signed in 2010.

At the cancer call center in Texas, Jones worries all that progress may now be reversed.

“I’m afraid we’ll be back to hearing people ask us, ‘You mean they are going to let me die?’ ” she said. “And we won’t have many answers.”

A side-by-side comparison of Obamacare and the GOP’s replacement plan »

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