When I walked into the clinic exam room, Sarah greeted me with a beatific smile. Despite her relative youth and a diagnosis of widely metastatic breast cancer, she clearly had the happy gene. As her physician, I had a harder time with the cards that life had dealt her. From her chart, I learned that she had had a good job with health insurance until the economic downturn. In short order, she noticed a lump in her breast, lost her job, then her health insurance. Since North Carolina has not fully implemented the Affordable Care Act, she was trapped. By the time she found our clinic, her breast cancer had spread to her bones. Despite the grim prognosis and the constant bone pain, she was still smiling.
With nearly three years of data, the benefits of the Affordable Care Act are clear. No longer does a diagnosis of diabetes, cancer or heart disease, so-called pre-existing conditions, prevent you from buying health insurance. No longer will you lose your insurance if you change your job. No longer will you have to forgo preventive health care for want of money including cancer screening and free contraception. Mental health and substance abuse treatment has expanded.
If you are diagnosed with a catastrophic, expensive-to-treat illness, there will not be an insurance cap on benefits. More than 20 million Americans now have health insurance under the ACA. Among these millions are 6 million young adults under the age of 26 who gained insurance by the provision in the ACA allowing them to remain on their parents’ insurance.
Despite these benefits, our Republican U.S. Congressional delegation, including Sens. Richard Burr and Thom Tillis and Reps. Renee Ellmers and David Rouzer, has voted over and over again to throw out the Affordable Care Act. While they enjoy excellent health insurance paid for by the taxpayers, they have cynically voted to deny the same health insurance to thousands of North Carolinians whom they represent. This is a reverse Robin Hood scenario: rob the working poor, the sick and the middle class, while enriching themselves.
Thirty-two states have expanded Medicaid to cover the working poor using federal funds. In those expansion states, the death rate has decreased, the rate of rise in cost of health care premiums has decreased, thousands of new jobs have been created, fewer rural hospitals have closed and millions of dollars have flowed into the states. Beyond these concrete, measurable benefits, people with insurance just feel better, secure that they are not one medical illness away from financial ruin.
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Not so in North Carolina. Due to the cold-hearted intransigence of Gov. Pat McCrory and our legislature, North Carolina said no to federal funding to expand Medicaid. The consequences of that decision have been very real. Several hundred North Carolinians die each year for want of prevention and treatment. Insurance premiums for those with private insurance are 10 percent higher or more, and our overall health care costs are rising faster than those states that expanded Medicaid.
Is the Affordable Care Act perfect? Of course not. All new legislation has problems including the Social Security and Medicare acts when they were each passed. With each of these previous laws, the members of Congress worked together in a bipartisan manner to pass follow-up laws to fix them. That can happen again.
Early voting has begun. When you go to the polls, think of my patient Sarah and all the other Sarahs in North Carolina who are faced with early deaths. Send a message to those who want to restrict the expansion of the Affordable Care Act or, worse, take away your insurance.
Charles van der Horst, M.D., is an emeritus professor of medicine at UNC-Chapel Hill