My Turn: A scary week for New Hampshire’s health care

For the Monitor
Published: 7/12/2019 11:04:01 AM
Modified: 7/12/2019 11:03:50 AM

This week, a coalition of Republican states and the Trump administration are arguing in court that we need to end the American health care system as we know it. This group wants to destroy the Affordable Care Act, which could kick tens of thousands of Granite Staters off their health insurance.

If they are successful, they could end protections for the 572,000 New Hampshire patients with pre-existing conditions, raise out-of-pocket costs by eliminating the mandate that health insurance companies cover prescription drugs, end Medicaid expansion, which covers 57,000 people in New Hampshire, and stop essential health benefits like substance use disorder treatment.

It’s an alarming effort that would hurt New Hampshire, which is why I have been so disappointed in Gov. Chris Sununu for refusing to join the bipartisan lawsuit to defend the Affordable Care Act against this group trying to dismantle it. Our congressional delegation, led by Sen. Jeanne Shaheen, has pushed for legislation that bolsters the ACA while lowering health care costs. On a state level, the most important thing we could do to save Medicaid expansion and coverage for pre-existing conditions would be to join the bipartisan lawsuit led by 21 states, including five with Republican governors, to save the Affordable Care Act.

Unfortunately, Sununu won’t join. Even worse, I recently learned that the individuals challenging Sen. Shaheen in 2020 said they support Trump’s callous health care agenda, too. Bill O’Brien, Donald Bolduc and likely any other candidate who seeks the Republican nomination for U.S. Senate would vote to end the ACA and take away coverage for patients with pre-existing conditions.

There is a lot of discussion about the potential end of the ACA and what it would mean. As an OB/GYN, I know that when people discuss pre-existing conditions, what they’re often talking about is deeply personal. Imagining a future where insurance companies hold all the cards, and can deny you care, is simply heartbreaking.

If your boyfriend beats you up, and you go to the emergency room for care, it could now be seen as a pre-existing condition. Yes, if Donald Trump and congressional Republicans are successful, a health insurer could deny you coverage because of abuse you suffered in your home. If you suffer a chronic injury because of domestic abuse, and you have to change insurance plans for whatever reason, suddenly you could be in a position where you are forced to pay for care out of pocket.

The same goes for our children and families. Pregnancy? That’s a pre-existing condition. A previous cesarean delivery? A pre-existing condition. Asthma? A pre-existing condition. If your child has trouble breathing, it would not be a problem for an insurance company to therefore deny him or her insurance.

Trump, Sununu and congressional Republicans consistently talk about combating the opioid epidemic, but ending the ACA would strip coverage for essential health benefits that include substance use disorder treatment. Moreover, thousands of Granite Staters who get their insurance through Medicaid expansion and are in recovery could lose access to that care if they are successful in ending Medicaid expansion. That cannot be our health insurance system in 2019 in America.

I know our system is not perfect. It’s far from perfect, which is why the legislation that Sen. Shaheen is leading to reform and improve the ACA while cutting costs for families is so important. But the Republican approach to overturn this law completely would be devastating for New Hampshire, and it would take us back to a dark time in American health care.

In my practice, patients would start to decline routine care – deciding not to get an ultrasound to check in on the health of their pregnancy because they are concerned their insurance will not pay for it. These are the kind of essential health benefits that are covered by the Affordable Care Act. That’s what happened before the ACA. My patients would say they don’t want to have blood tests because of the cost, even though that blood work is important for their health, and the health of their pregnancy.

One of the most common refrains from my patients would be: “Can’t that wait until my insurance kicks in?”

I remember those days, and I don’t want to go back. It was a scary time for patients, and it pained me as a doctor to see so many families and individuals forgoing the care that they needed. Yet, somehow, President Trump, with the tacit support of Sununu and the encouragement of Senate candidates like Bill O’Brien and Donald Bolduc, is trying to take us back to that time.

There’s not much we can do as individuals to challenge these decisions, but what we can do is hold our elected officials accountable. If Sununu won’t fight to protect my patients, I will vote for someone else who will. And I will be proud to re-elect a health care champion like Sen. Shaheen over these candidates pledging to end our care.

(E. Rebecca Pschirrer is a maternal-fetal medicine doctor at Dartmouth-Hitchcock Medical Center in Lebanon.)


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