My Patients Cannot Survive the Senate “Health Care” Bill

[avatar user=”dponieman” size=”thumbnail” align=”left” link=””]By: Diego Ponieman, M.D. M.P.H.[/avatar]On the heels of the U.S. Senate’s reveal of a bill that would dismantle the Affordable Care Act (ACA), former president Barack Obama wrote, “The Senate Bill, unveiled today, is not a health care bill. It’s a massive transfer of wealth from middle-class and poor families to the richest people in America.”

Those ‘middle-class and poor families’ are my patients. They are probably like you; they are your neighbors, your friends, the kids on the playground down the block. More than six million New Yorkers – more than one in five residents of this state – rely on free or low-cost state-based federal health insurance to survive. As a community physician and provider of health care to Medicaid recipients, I depend on stable federal funding of the program to deliver comprehensive care for my patients.

Although a vote on the Senate health care bill has been delayed, there is little doubt that access to health care for people across the U.S. remains severely endangered. The proposed legislation would have a devastating impact on the lives of millions of New Yorkers. If the bill passes in its current form:

  • Some of the most vulnerable residents of our great city will no longer be eligible for the quality, affordable health care they deserve.
  • Almost 2.2 million New Yorkers who have enrolled in Medicaid since the state accepted Medicaid expansion funds through the ACA in 2014 would be phased out of the program over a number of years.
  • Funding of future iterations of initiatives like the Delivery System Reform Incentive Payment (DSRIP) program, a statewide effort to improve quality and lower the cost of care for the Medicaid population, would be in extreme jeopardy.

Just 13 U.S. Senators, none from New York, were involved in crafting a bill that has the potential to impact tens of millions of Americans. My sense is that they have never set foot in a clinic in Upper Manhattan, Central Brooklyn, or the South Bronx. The entire process was conducted behind closed doors. The fate of so many of Americans – young and old, people with disabilities, recent immigrants, and first-generation Americans – is in the hands of a few Senators who could cast the deciding votes.

As New Yorkers, we know how hard it can be to make ends meet in this city – and we also know that our commitment to welcoming and supporting all people is what makes our city the diverse, vibrant metropolis that it is.

In our state, the positive impact of federal Medicaid funds goes far beyond insuring those in need. The DSRIP program, created in 2014 with funds allocated by the Centers for Medicaid and Medicaid Services, is transforming the way we deliver health care in New York. I serve as Chief Medical Officer of a network of more than 2,000 independent physicians who provide culturally sensitive, quality health care in underserved neighborhoods to those who have been shut out of the mainstream health care delivery system, until now.

Adequate access to care – or a lack thereof – drastically affects families and communities. In a recent report, the New York City Health Department found that residents in high poverty neighborhoods are more likely to be diagnosed with at least 21 infectious diseases including malaria and HIV/AIDS. Our communities are burdened with a disproportionate prevalence of asthma, obesity, diabetes, and smoking, which are exacerbated by factors such as pollution, food and housing insecurity.

Medicaid is a lifeline for our patients. If the federal government decides to take it away, these grandparents, parents, children – your neighbors and friends – will have nowhere else to turn. No elected official should be comfortable with that. Our representatives have a responsibility to ensure access to high quality, compassionate health care for all Americans. As the Senate discusses possible changes to, or even a new iteration of, the health care bill, our representatives in Washington must consider the implications of their actions.

At least seven of New York’s U.S. Representatives voted for the House’s replacement of the ACA, the American Health Care Act (AHCA). If an iteration of the bill passes in the Senate, the decision whether or not to protect our state’s 2.2 million Medicaid recipients would return to the House – putting my patients’ lives in the hands of New York Congress members who are not from our communities and who appear to have either minimal appreciation of the health challenges we face, or who simply prioritize politics over people.

My patients cannot survive cuts to Medicaid. The individuals who visit my practice, and similar practices and clinics all over the city, cannot afford these cuts. As New Yorkers, living in this melting pot of diversity, we have a duty to lift up our own and provide the very best care to those who need it. One of our greatest mandates as health care providers is to make our communities stronger and healthier by transforming the mindset to preventive care and practices. We are working day in and day out to ensure that the emergency room is only for emergencies, knowing that relying on the ER for basic care is an ineffective, reactive health management strategy that costs the city and the state billions each year. We know from experience that uninsured patients mean full emergency rooms and sicker communities across the city. Doctors and patients can’t afford that risk.