From the desk of the EMD: Obamacare, Trumpcare, who cares?

May 8, 2017

Dr. Blaiss

With members of your College, the Academy and the Allergy and Asthma Network, I was lobbying on Capitol Hill during Allergy and Asthma Awareness Month. It just so happened that the vote in the House for the American Health Care Act (AHCA) took place on one of the days we were there. As you know, the House Republicans got a bill passed. If at first you don’t succeed, try, try again. At the Latin and South American Allergy Meeting in Cancun shortly afterward, an allergist from Venezuela and another from Argentina were asking me about the passage of the bill.  As I explained, that’s just the first step and nowhere near a finished product. The Senate must pass a health care bill that will probably be very different from the House’s and then it goes to committee in both chambers to work out a compromise before a final vote. If passed by both the Senate and House, it still has to be signed by the President. As I gave the foreign allergists a U.S. civics lesson, they just looked at me in bewilderment. Not sure I can blame them.

Many medical organizations, hospitals and others in the health care arena came out against the House plan. It appears that it would reduce the number of people with insurance and therefore bring down access to needed health services. No doubt that is an issue. But with Obamacare, many patients on the Exchanges had such high deductibles with their “insurance” that all they really had was catastrophic care, not preventive care, which would include allergy care. Also, the House plan would reduce Medicaid, which is the lifeline for many of the poor population, yet how much effect it would have is unclear. The House bill will allow insurance companies to raise prices for those with pre-existing conditions and to not guarantee that treatments are covered. This has to be a major concern to us as allergists treating patients with asthma and other chronic conditions. Will they get priced out of insurance and not receive the care they need? I have read what I can on the House bill and to be honest, there is much I just don’t understand. I’ll bet most of the House of Representatives did not understand what they were voting for or against either.

What should we tell our patients if asked about all the health care chaos going on in D.C.? Should the College follow the AMA and come out against the House health care bill? Gee, I don’t know. I have mixed feelings about this. There are definite problems with Obamacare that must be remedied. We see this in many of our office practices daily. Increasingly, insurance companies are pulling out of the Exchanges. The House bill may improve some of those problems, but it may make other areas of health care much worse for many of our patients.

So what’s an allergist to do? Whenever I ask myself that question, it comes back to what is best for my patient. And in that regard, for some patients Obamacare has worked, but for others the new House bill may be better. There is no clear black and white answer. I guess if I were smart enough, when I was lobbying, I would have walked over to the Health and Human Services offices, taken the elevator to Secretary Price’s office and told him this is how to fix the healthcare mess in the US.  

What I do know is that we as allergists must be aware of what happens in Washington D.C.  We must be more vocal on behalf of our patients. We can’t be silent and we need to let our legislators know how we feel whether you believe we need a single payer system, which I think will happen in the future, or a removal of government controls with a competitive health care market place or something in between. The College’s Advocacy Council is keeping their eyes and ears open, making sure that we are informed and can take action on Capitol Hill as needed. Health care is a moving target. There is no simple, easy fix. How do you control rising costs yet make sure no person lacks basic preventive care? Maybe I am being a Pollyanna, but hopefully the Senate will craft a health care bill that truly puts the patient first. We should demand it. It’s a matter of life and death.

Michael Blaiss, MD, FACAAI, Executive Medical Director