On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA) — historic legislation designed to transform our health care...
Dr Harry Heiman

Dr. Harry Heiman

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA) — historic legislation designed to transform our health care system.

Unfortunately, the health care reform debate, both before and after the legislation’s passage, has been hostage to a highly partisan political process that has had little to do with health and health care. Now two years later, most Americans remain uninformed about the legislation. Lack of knowledge, however, has not precluded strong and passionate feelings on both sides of the political and ideological divide.

It is time to repeal and replace — time to repeal and replace the rhetoric. It’s time to take an honest look at why we embarked on health reform in the first place and how the ACA addresses the underlying problems in our health care system.

Our current health care system, by any measure, is broken and unsustainable. The U.S. has the most expensive health care system in the world, yet our outcomes are no better. We pay much more, but don’t get more in return.

We are the only developed country in the world that doesn’t provide universal access to care. We have the greatest disparities in health and health care of any developed country in the world. Quality of care and life expectancy vary based on your income, where you live, the color of your skin, and whether you have health insurance.

Otis Brawley, chief medical officer at the American Cancer Society, in his recent book “How We Do Harm,” describes our health care system as one that combines famine and gluttony, depending on your ability to pay. Famine for those who are uninsured or underinsured and suffer for lack of access to basic medical care, and gluttony, for those who are well off and insured, but who, in fact, may suffer as a result of overtreatment and unnecessary treatment.

Almost 50 million Americans are uninsured. The rate in Georgia is even higher, with more than 20 percent, or one in five Georgians, not having health insurance.

A recent CDC study reported that those without health insurance are seven times more likely to go without needed health care because of cost.

Physicians see these patients every day — suffering complications from what are often preventable problems. These are the patients we see putting off refills of their essential medications for high blood pressure and diabetes, delaying important cancer screening tests like mammograms and colonoscopies, and often ending up in the emergency department or being admitted to the hospital for preventable illnesses and complications. They suffer and we collectively pay the costs. We share the costs in dollars, while uninsured people pay with their lives.

The ACA is designed to achieve goals most Americans agree are necessary. It expands access to health care for an estimated 32 million Americans who are currently uninsured. It eliminates pre-existing exclusions for those with chronic medical problems or a history of a serious illness. It eliminates rescissions of insurance policies and annual or lifetime caps on coverage and extends dependent coverage to age 26.

Already, as a result of the ACA, children with diseases like diabetes, autism, or asthma cannot be denied coverage. More than 50,000 adults previously denied coverage have obtained health insurance. Almost 2 million young adults are now covered through their family’s insurance plan. For the first time, co-pays and deductibles for preventive services are eliminated, removing barriers to lifesaving tests like mammograms and colonoscopy, PAP smears and immunizations.

Some have argued that this is an unnecessary expansion of government.  I challenge them to show me how the free market has created opportunities for those who are poor — especially the working poor, and those with chronic medical problems, who need access to care the most, but are unable to purchase health insurance.

Health care providers understand how the current system is failing the most vulnerable in our communities. This is why the ACA has been supported by the American Medical Association, with more than 200,000 members, the American Academy of Family Physicians, with more than 100,000 members, the American Academy of Pediatrics, with more than 60,000 members, and the American College of Physicians, with almost 130,000 members. The ACA is about the government providing a framework and support for many of the most vulnerable in our society when market systems have failed.

The “mandate” being challenged in the Supreme Court requires that each person take responsibility for their health care by having health insurance. To suggest that we all won’t require health care services at some point in our lives is ludicrous.

From birth to death, we are all subject to the unpredictability of life. Who hasn’t had a friend or family member with a sudden, unanticipated injury or illness requiring medical treatment?  If personal and community responsibility is a value we support, then shouldn’t everyone be held accountable?

The Affordable Care Act is not perfect. Legislation rarely is. But it goes a long way toward improving our current system by expanding access, improving quality, controlling costs, and creating value; goals that most Americans agree will move us in the right direction.

Physicians are professionally bound by the Hippocratic Oath of “do no harm.” To perpetuate a health system that denies basic access to care for 50 million Americans is both harmful and unconscionable. It is time to repeal and replace the rhetoric of division and distraction. The ACA takes a major step forward in assuring that all Americans have access to affordable, high-quality health care.


Harry J. Heiman, MD, MPH, is director of health policy for the Satcher Health Leadership Institute at the Morehouse School of Medicine. He is active in Georgians for a Healthy Future and the Georgia Academy of Family Physicians.

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