Repealing the PPACA Could Harm Vulnerable Communities

I have already posted some observations that, in my opinion, the calls to repeal the Patient Protection and Affordable Care Act (PPACA) are politically motivated, and that the public does not agree with the call for wholesale repeal.  I thought it would be interesting to look at how the proposed repeal could impact vulnerable communities, as outlined in this article.

The article notes that African-Americans are more likely to live under the poverty line (26%) and are uninsured a higher rate than the overall U.S population (21%, as opposed to 14-15% overall).  Those calling for repealing the PPACA have not put forward any measures that would address this lack of access to health insurance, they have not proposed any process to address the lack of primary care physicians working in medically-underserved communities, and have no plan to promote preventive care--all of which are addressed in the PPACA.  In essence, the call for repealing the PPACA would entrench the status quo that already results in significant health care disparities in minority and poor communities.

As an aside, I think it is interesting that the call for repeal embodied in the Republican "Pledge to America" states it will ensure that insurance companies cannot refuse care to those with pre-existing conditions.  This is interesting because the Republicans oppose the main mechanism for reaching this goal (the individual mandate that everyone would need to purchase health insurance) and because this requirement would involved significant government regulation (something the Republicans claim to oppose).

As it stands, then, the Republicans aim to repeal the PPACA's reforms that actually protect patients and that could improve access to care for marginalized communities while having no mechanism in place to fix the problems that already exist--even as evidence increases that the public does not support the call for repeal. 

I think the Republican's insistence in pushing for this unpopular proposal for repeal will end up changing nothing and serving as nothing more than an opportunity for political grandstanding.  As a result, the House will waste time engaging in showmanship when they could be working to effect fixes in the bill that would strengthen it and that could address areas of concern.  In that case, we all lose.

AMA Guidelines on Physicians and Social Media

Just posted about the newly-released AMA guidelines addressing physician use of social media.  I'm not sure that these guidelines will help very much right now, but I hope they might lead to further discussion heading forward.

How Popular Is Repealing Health Care Reform?

Now that the fallout from this week's elections are evident, we are already hearing calls from the new Republican majority in the House that they will start actively pushing for repeal of the Patient Protection and Affordable Care Act (PPACA).  This made me wonder: how popular is the notion of repeal among the American public?

The Kaiser Family Foundation published a poll recently that seeks to answer that question.  My reading of the situation is that the polling is fairly hard to interpret, with somewhere between 26% and 51% reporting they would like to see the law repealed.  However, the highest %s that are in favor of repeal were reported when the only choice was repeal/don't repeal.  If the poll offered additional questions, including making small changes, or giving the law a chance to work and adjusting as things move forward, the % supporting straight-out repeal was much lower.

Finally, one poll asked respondents which of the reforms enacted by the PPACA they would like to see repealed.  When analyzed at this level of detail, more than 50% supported keeping 6 of the 8 reforms discussed.  Only 2/8 reforms had 50% in favor of repealing them: the individual mandate that everyone must purchase health insurance (51% favored repeal), and the new taxes and fees on "cadillac" (high cost) health insurance plans.  The reforms that more than 50% wanted to keep included allowing children stay on parents' plans up to age 26, eliminating lifetime benefit caps, making insurance available to people with major preexisting conditions, improving the Medicare part D drug benefit for seniors, and setting up health insurance exchanges to make health insurance available for those who cannot afford it now.

Sounds as though most Americans who disapprove of the PPACA overall still like many of its key reforms, and prefer that the law be adapted/modified, not repealed.  I hope the new Republican House majority is paying attention.