Lives in the Balance

Part IV: Where the Public’s Health is at Stake, First, Do No Harm

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For nearly a decade, Democrats, as well as some Republicans and many Independents, have been defending the healthcare reforms contained in the Affordable Care Act (the “ACA” or “Obamacare”), while many Republicans and some Independents have been clamoring for repeal.

Now, under Republican control of both the White House and the Congress, our national debate about how best to assure affordable healthcare for all Americans has intensified.

In this context, we, who serve in government, would do well to follow that ancient first maxim of the medical professions:  Primum non nocere.

“First, do no harm.”

Congressman Elijah Cummings

This was the core advice Maryland’s Democratic congressional delegation gave to Governor Larry Hogan back in February.  We urged him to join other Republican Governors in protecting the people of our states by forcefully demanding a viable replacement for the Affordable Care Act in any Republican legislation to “repeal” Obamacare.

If we are to do no harm, we argued, we must protect the more than 400,000 Marylanders who have gained insurance coverage as a result of the ACA – reforms that substantially reduced Maryland’s uninsured rate from 10.2 percent in 2013 to 6.6 percent in 2015.

We cannot meet the test of doing no harm, we continued, if we allow reactionary elements in the Congress and White House to strip the ACA’s protections against predatory insurance practices from millions of Marylanders.

Maryland’s families are depending upon us, we noted, to strongly defend the “Patient’s Bill of Rights.” These ACA provisions require insurance companies to cover emergency services, protect those with preexisting conditions, mandate coverage of preventive services with no cost-sharing, eliminate annual and lifetime coverage limits, and allow young people to remain on their parents’ plans until reaching the age of 26.

Finally, we advised Governor Hogan that we must protect our State’s budget and economy against the devastating economic impacts of any callous ACA “repeal.”

According to the Center on Budget and Policy Priorities, repeal of the ACA and its Medicaid expansion and premium tax credits would endanger 52,000 Maryland jobs in 2019.  It also would cause Maryland’s state budget to lose $23.4 billion in federal Medicaid funding between 2019 and 2028.

To his credit, Governor Hogan recently indicated (through his spokesman) that the current Republican repeal proposals “do not work for Maryland.”

I fully agree.

Analysts with the Robert Wood Johnson Foundation have determined that, by 2022, 528,000 more Marylanders would be uninsured under the Senate Republicans’ “repeal and replace” bill than under the ACA.  By the end of that same five year period, Maryland would lose $3.7 billion (45 percent) of our federal Medicaid and ACA funding.

Moreover, according to the Kaiser Family Foundation, the human and financial damage would not be limited to those who depend upon Medicaid for their health and survival.

Rather than reducing premiums in the individual private market for health insurance (a primary concern driving public sentiment for reform), the average monthly premium for a Maryland “Silver Plan” under the Senate bill would increase to $333 – 74 percent higher than under the ACA.

A premium increase of that magnitude, when added to less help with deductibles and co-pays, would mean that many Maryland families with modest incomes could not afford health insurance.  As a result, they would not receive the care that they need and deserve until a crisis forced them into our emergency rooms at even higher cost to us all.

This was the context last week when Republican Senate leaders proposed amendments to their “repeal and replace” proposal that did little to mitigate the harm that this proposed legislation would impose on the people of Maryland and, in fact, made that potential harm even worse.

In whatever form, the Republican proposals to “repeal and replace Obamacare” do not work for Maryland or America.

I also agree with Governor Hogan’s suggestion that “Congress should go back to the drawing board in an open and bipartisan fashion to craft a bill that works for all Americans.”

As a first step, we must live up to our duty to “do no harm” by defeating the current Republican “repeal and replace” proposals.  We need Maryland’s Governor to join other Republican state leaders who have been more forceful and outspoken in challenging the practical and moral implications of these bills.

Next, the Congress must act promptly and on a bipartisan basis to reduce the harm that many Americans in some individual insurance markets are currently experiencing.

We must immediately take thoughtful, non-partisan and evidence-based action to stabilize the individual insurance markets that are struggling and make their premiums more affordable – and we must challenge the Trump Administration to stop its efforts to sabotage those markets.

The American people are sending us a clear message.  Their lives are in the balance, and they have had enough of political partisanship where the health and safety of their families is concerned.

Federal initiatives to protect our families against injury and serious illness are just as important as defending our nation against foreign military attack.  We who serve in Washington must listen to the people we serve and act accordingly

Congressman Elijah Cummings represents Maryland’s 7th Congressional District in the United States House of Representatives.