Originally printed in The Hill newspaper.
The Rev. Martin Luther King Jr. once admonished, "Of all the forms of inequality, injustice in health care is the most shocking and inhumane."
If President Donald J. Trump and the Republican leadership in Congress have their way and are able to repeal the Patient Protection and Affordable Care Act, they should know that the direct result of their proposed action would be to refuel this "shocking and inhumane" injustice.
We are already shamefully behind most industrialized countries, and even some developing ones, in several important health indicators. With repeal, there will be no hope to remedy this national embarrassment, which is largely due to the disparities in health care suffered by people of color but also by Americans living in rural areas and the U.S. territories. Exacerbating this travesty is no way to "make America great again."
These are disparities that impair the quality of life and shorten the lifespans of those affected. They result in an estimated 90,000 excess preventable deaths annually, but also cost hundreds of millions of dollars in this country every year.
The end of Medicaid expansion, and even the other proposed replacements for subsidized exchanges which are likely to come with less benefits, higher deductibles, or inadequate tax credits or deductions, will once again lead to reduced access to preventive care, delays in care that will result in more catastrophic, more costly care and an increase in premature preventable deaths – inequities that the ACA was on its way to eliminating.
The Republican leadership in Congress has already placed all Americans at higher risk by refusing to fund many important provisions of the ACA, such as those aimed at reducing opiate addiction, which might have helped to prevent the enormity of the epidemic some communities are facing today, and those that would have strengthened our public health infrastructure so that more communities would be better prepared to deal with emerging infectious diseases like Zika or even Ebola – to name just two.
But it is important to call attention to several other provisions of the law that are important to poor communities and communities of color.
We in the Congressional TriCaucus – a coalition of the Black, Hispanic and Asian- Pacific Islander House Caucuses – have always insisted that ensuring the right to quality health care and improved health status in communities like ours, that have long been left out of the health care mainstream, requires more than just providing insurance.
In the early days, when health care reform was still just a discussion piece, we developed benchmarks that we would work together to have included in any legislation that was developed. The work was hard enough in the House of Representatives, where we were about 85 percent successful, but the larger battle began anew after the U.S. Senate and White House proposed to drop most of what we won. But we were unrelenting in our efforts and had all fully, or in some cases partially, restored.
We fought for them because they are critical to the wellbeing of the communities we represent. So beyond losing health insurance coverage, which is also vitally important, we are also very concerned about the threats to the health equity provisions we got included, but that are never talked about.
Some of these are: the anti-discrimination language (which actually needs to be strengthened); the comparative effectiveness research done by the patient centered outcome research institute, which we insisted be an independent entity, free of political influence; the additional support for training minorities who are grossly underrepresented in the health professions; the improvements in the Indian Health Service; the inclusion of pediatric dental health care; the funding of community health worker grants; the creation of an Institute for Minority and Health Disparity Research at NIH; the strengthening of existing offices of minority health and creation of new ones at several DHHS agencies; and the commitment to eliminating health disparities as a core component of the law.
The new president and the Republican Congress can either continue campaigning or they can begin to govern, and do so for ALL AMERICANS. When they decide to govern, they need to begin by stopping their spreading of misinformation about the ACA and instead get to work with Democrats, who have always wanted to amend areas of the law that would improve and strengthen the ACA.
Their goal cannot be honoring some false campaign rhetoric. It must be to ensure that all people in our country have access to quality, comprehensive, culturally concordant health care. It must be to ensure that health care is a right for all.