During a brutal winter in December 1776, exhausted American soldiers who had suffered military defeats were facing an uncertain future for their cause of freedom and independence. Knowing the weariness of his troops and the skepticism of the Continental Congress, General George Washington ordered officers to read Thomas Paine's inspiring "American Crisis" aloud to their companies. The first pamphlet starts, "These are the times that try men's souls: The summer soldier and the sunshine patriot will, in this crisis, shrink from the service of their country; but he that stands it now, deserves the love and thanks of man and woman." Since then, American political rhetoric has often referred to "winter soldiers" as those Americans who stand up for their fellow countrymen through adversity. As our country implements the Affordable Care Act as part of a long journey towards the basic goal of universal health care, many of my colleagues in medicine urge leaders in federal and state governments to be those winter soldiers and stand up for our patients and families.
Despite the successful enrollment of over 7 million Americans into private health insurance; and despite over 4 million Americans being enrolled in Medicaid where states opted for expansion of the program, there are political advisors telling politicians to downplay Obamacare. Their recommendation is to describe the law as "flawed from the beginning," despite the fact that since 2010, when the Affordable Care Act was signed into law, no child with a pre-existing condition can be denied health insurance, and around 3 million young adults have been protected under their parents' health plans. There were 105 million Americans with limits on their lifetime benefits, and because of Obamacare provisions enacted between 2010 and 2014, those limits are now banned, meaning families will not suffer financial ruin because loved ones fall sick. In 2012, due to the ACA, 34 million senior citizens benefited from free preventive services and 70,000 patients who left the hospital were not readmitted. Flawed from the beginning? Really?
Before making any apologies for the ACA and reinforcing the deluge of misinformation, all of us (and maybe especially politicians) need to celebrate the very real benefits the law has provided to millions of patients and families. There have been legitimate problems and grievances along this journey, and those are being addressed, but to reduce the conversations about the ACA's worth to website glitches and misinformed soundbites is a terrible disservice. Polls show that while "Obamacare" is still not widely popular, many of its provisions (like the ones mentioned above) continue to be strongly favored across the political spectrum. In fact, 62 percent of Republicans across the country favor the expansion of Medicaid so families making between $23,000 and $31,000 per year can get coverage.
In addition to pushing for more states to opt for Medicaid expansion, politicians should lead a discussion with their constituents on basic steps to improve experiences with the ACA's exchanges. A few days ago, FamiliesUSA published an excellent report, "Accelerating the Affordable Care Act's Enrollment Momentum: 10 Recommendations for Future Enrollment Periods." Among their recommendations are commonsense ideas like equipping navigators (the people who help you choose a health plan and sign up) with up-to-date information, streamlining Medicaid enrollments, and excluding health plans with exorbitant premiums, just to name a few. Each of these ideas can be the start of conversations on the ACA based on fact, not fiction.
Congressman Paul Ryan, the supposed "ideas man" of the Republican Party has once again proposed a budget that repeals the Affordable Care Act, privatizes Medicare, and slashes Medicaid into block grants, leaving millions of Americans without health insurance and ruining our already threadbare social safety net. If this budget bill is brought to the floor of the House of Representatives, and if it passes, it will be the the House's 51st vote to repeal the ACA. If there's anything that has been "flawed from the beginning," it is members of Congress repeatedly trying to pass legislation rooted in contempt for the poor and the sick.
Election years may feel like "the times that try men's souls" to politicians, but they should know that their tribulations are minor in comparison to the challenges our patients and families were regularly facing prior to passage of the Affordable Care Act. Being denied health insurance for pre-existing conditions, facing financial ruin because of illness, and vague unreliable health plans are slowly becoming things of the past, thanks to Obamacare. But challenges still abound: 5 million Americans are stuck in the coverage gap, missing out on health insurance coverage because they earn low incomes in states where politicians decide political reputations are worth more than expanding Medicaid.
Where would America be if members of Congress, governors, and state legislatures abandoned policies of social justice because of baseless attacks? Bills and legislation to abolish slavery, extend voting rights to women and minorities, and to uphold civil rights were not greeted with open arms and big hearts. Even Medicare, one of the most popular health programs in American history, suffered attacks. Nevertheless, each of these causes had their champions who were willing to risk far more than any politician is being asked to risk today. I, like many physicians across the country, strongly urge our political leaders to buck up their courage, speak truth to people and power, and be winter soldiers for the Affordable Care Act and Medicaid in our journey towards universal health care.