An opinion piece published in Annals of Internal Medicine says that the GOP's plans to dismantle the Patient Protection and Affordable Care Act (ACA), without a replacement law, will have a "potentially dangerous impact".

While the ACA is far from perfect, its repeal would mean stripping coverage from poorer patients and those with pre-existing conditions, which could result in an unprecedented public health crisis. Article author Susan Dentzer, BA, President and CEO of The Network for Excellence in Health Innovation in Cambridge, Mass. urges physicians to resist repeal and demand to see a full-blown replacement plan first with the same “cold-eyed rigour they would apply to any claim that the latest snake oil offering on the market was a better cure for patients.”

The ACA was designed not to provide universal health insurance coverage but to take a major step towards it through the expansion of both private health insurance and Medicaid for low-income populations. Following its implementation, about 20 million people have gained coverage through the law's various aspects; in turn, the nation's overall rate of uninsurance has fallen to around 8.9 percent, a historic low. "Although gaining health coverage does not guarantee access to care, without coverage, access is almost certainly compromised," the author notes.

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A 2003 report from the Institute of Medicine calculated that 18,000 Americans died each year due to lack of health coverage alone. Those who have gained coverage under the ACA include millions who were already sick but either were denied coverage or could not afford it in the pre-reform insurance market. Once insured, they also received significantly more medical services than those previously enrolled in individual plans. "Whatever the ACA's imperfections, it assembled a complex interrelationship of provisions to make health coverage comprehensive and meaningful," says Dentzer, citing these key benefits: coverage for people with pre-existing health conditions through a “guaranteed issue” requirement; provisions for 10 categories of health benefits deemed “essential,” including mental health coverage; and scrapping of limits on lifetime payouts on health insurance policies.

In contrast, no extant Republican plan has assembled a suite of insurance provisions, subsidies, Medicaid coverage, and other assistance that would offer as much protection as the ACA, according to the article. "Now, amid the drive not to amend the law, but to repeal it — and absent a definitive replacement plan — physicians, as stewards of the nation's healthcare, should be up in arms about the potentially dangerous impact," the author writes.

Source: Annals of Internal Medicine
Image Credit: ACA

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