Coronavirus doctor: I was a preemie. I could be uninsurable if Trump ‘terminates’ the ACA.

COVID-19 is expected to last at least one to two more years. It's exactly the wrong time to gut a law that helps people get and keep health insurance.

“We want to terminate health care under Obamacare.” As a physician caring for hospitalized patients during the COVID-19 pandemic, I read President Donald Trump’s words last week with astonishment. Astonishment not only at what this could mean for my patients, but at what it could mean for me and the many millions of health care workers with preexisting conditions.

I was born prematurely in the summer of 1983 at 27 weeks’ gestation, which gave me preexisting conditions right from the start. I spent several weeks in the neonatal intensive care unit where, through blood transfusions, I contracted hepatitis C virus. I went on to develop chronic hepatitis C infection and ultimately needed treatment for it some 27 years later. My prematurity led to the development of asthma, which has contributed to recurrent respiratory infections throughout childhood and now into adulthood.

Prior to 2010 and the passage of the Affordable Care Act or Obamacare, health insurance companies could legally charge me more, or even deny coverage to me, because of these preexisting conditions. Unfortunately, I am not alone.

Gutting law now would be tragic

In the United States, nearly 54 million people or one quarter of adults under 65 have a preexisting condition that could have resulted in denial of coverage before the ACA. Almost 25% of health care workers, or nearly 3.5 million people, are estimated to have at least one preexisting condition.As the country has been gripped by the devastating impacts of COVID-19, it is those with preexisting conditions and adults over age 60 who face the highest risk from this coronavirus and its aftermath. The health care workers at highest risk of all are those who fall into this category and work in a critical care unit, emergency room or (like me) in an inpatient unit.

Last Wednesday, Trump was asked about his administration’s stance in the federal lawsuit brought by Republican attorneys general seeking to overturn the the ACA. It was the last day the administration could change its position before the case moved to the Supreme Court. Despite the ongoing pandemic and even some dissension within his own administration, Trump reiterated his support for gutting the entire law.

Dr. Navin Vij in 2013 when he was a Chief Resident at Case Western Reserve.

Although he has mentioned preserving some of the more popular aspects of the law, such as guaranteed coverage for preexisting conditions, Trump has not put forth a coherent plan to do so. And over more than three years in office, he has consistently supported efforts to eliminate the ACA.

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Although it will be months before the Supreme Court will hear the case and even longer until the case is decided, COVID-19 is expected to last into the next one to two years or more. As millions of Americans lose their jobs, and with them their access to health insurance, the economic stressors that cause many patients to delay seeking routine health care will grow.

What would happen if ACA vanishes?

The economic stress caused by loss of coverage, which could be mitigated by protections in the ACA (especially the ability to buy insurance on the ACA marketplace, with subsidies available to lower income people) will further exacerbate chronic health conditions. That includes long-term complications from COVID-19 infection itself, such as lung and kidney damage or blood clots.

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The health care system, which is currently facing significant financial pressures on top of the pandemic, will also be negatively impacted. People without insurance will increasingly use the emergency department for routine care or preventable issues, which increases costs and strains resources.

Over 1.3 million Americans have been diagnosed with COVID-19 and, sadly, about 80,000 have already died. As our country continues to face rising cases and deaths, what will happen if we terminate health care as we know it? Will those with preexisting conditions who care for others be cared for themselves?

Dr. Navin Vij is an academic internal medicine hospitalist and a physician scientist in Delaware. The views expressed here are solely his own. Follow him on Twitter: @VoiceofVij


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