The ACA: Clinicians weigh in on whether to repeal or preserve

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Three health care clinicians discuss the advantages and disadvantages of repealing the Affordable Care Act and how the change would impact their practice.
Three health care clinicians discuss the advantages and disadvantages of repealing the Affordable Care Act and how the change would impact their practice.
Editor's note: The following comments regarding the Affordable Care Act were received before House Speaker Paul Ryan withdrew an initial attempt of legislation to repeal it on March 24, 2017. 

My concern is that while Dr Tom Price has stated that he wants to strengthen the “doctor/patient” relationship, he has shown himself to be less than supportive of including nurse practitioners (NPs) with their/our full range of practice. He is for balance billing to allow an MD to charge patients beyond the amount allowed by the insurer and to enable the provider to collect his/her chosen fee. My understanding is that Obama's concession to the GOP members of Congress was to retain the insurance companies (whose interest is NOT in our health, but in the health of their individual bottom lines), so there will be inevitable increases in the deductibles, co-pays, and premiums while reducing the amount of the service that they cover.

Unless we have a single-payer healthcare system that would allow one large entity to standardize costs across the healthcare delivery system, costs will continue to increase, and without some sort of mandate to bring more healthy persons into the insurance panels, the increased illnesses of aging baby boomers will overwhelm the system. Likewise, Dr Price's preference for giving states “block grants” to manage their Medicaid patients would be sending us back decades and hurting our most vulnerable members of the population.

All in all, Dr Price's proposal strikes me as a rather self-serving, “let them eat cake” response.—Bette Kisner, RNCS, Boston

Our President is not taking anything away from the poor or needy. He sincerely wants better coverage and better prices. As an NP, I have laughed at those who tell me that 20 million more persons were covered by ACA. First, most of them are getting Medicaid, which has limited coverage and limited providers that will take it. Second, many of those forced to pay premiums never get to use their actual insurance, as they never meet the large deductibles. So what they have is an insurance card, not health coverage. The ACA was slapped together in haste and by those who had a narrow focus on only those it would help, not on those who would be hurt.—Robert Eisenbart, RN, MSN, FNP, Union Grove, Wisc.

I wish there were a healthcare plan that truly focused on preventive medicine to reduce healthcare costs. I don't know what that looks like in terms of implementation, but I try my best as a provider to discuss this at every patient visit in some way. We spend so much in ER visits and tertiary care, and we live in a culture in which many people cannot afford basic health needs, let alone have the money or means to eat a healthful meal each day. I have a love/hate relationship with the ACA, and I'm willing to listen to what the proposed healthcare plan is now. But I hope it will benefit the patients, because so far it sounds like it may not be what America needs.—Amira Evans, FNP-C, Indianapolis


These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.

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