A Philly ER doc on the GOP health bill and what his patients really need

Emergency room doctors and nurses can do a lot for patients in crisis. But ongoing care? Not so much.

A young woman using a wheelchair came into the emergency room at the Hospital of the University of Pennsylvania recently, complaining of terrible back pain.

I asked her how bad it was.

“If it were not for my two young boys, I would no longer be here,” she told me.

Erik J. Blutinger, M.D.

Without insurance, she couldn’t get the physical therapy that might have helped her manage the pain. “I am confined to my bed, praying for insurance so that I can finally treat my back and live again,” she said.

My heart sank. How can the richest country on earth fail to help people like this young mom?

In Pennsylvania, more than 52 percent of residents have reported difficulty affording health care, 10 points higher than the national average, a recent study found.

Emergency rooms such as mine are on the front lines. We stabilize the sick and work to arrange follow-up care, regardless of patients’ ability to pay. We aren’t always successful. But now, we are on the cusp of changes that could make things far worse than they already are.

The Congressional Budget Office (CBO) estimates that the Better Care Reconciliation Act (BCRA) – Senate Republicans’ plan to cut back on Obamacare — will leave 22 million more people uninsured by 2026 with a 26 percent reduction in federal spending for Medicaid. This plan, like a similar one advanced by House Republicans, threatens to overturn the successful expansion that increased the number of Medicaid enrollees by 15 percent in just three years. Yet our airwaves stay inundated with polarizing debate.

The BCRA should continue to raise red flags across the political spectrum even though Senate Majority Leader Mitch McConnell has chosen to delay voting on the bill until after the July 4th recess. Eliminating cost-sharing subsidies for patients who cannot afford out-of-pocket costs for doctors or health services is dangerous. Allowing insurers to charge older people up to five times the amount paid by younger individuals is discriminatory. Drastically cutting federal funding for Medicaid and expecting states to pick up the slack would only harm those who already are underserved. While scoring political points may win in the short term, poorly crafted policy will take years to fix.

The emergency room is often mislabeled as a Band-Aid for the wounds left by our health system, especially with higher spending and poorer outcomes than all other wealthy countries.

Too often, I hear people say, “Oh, you can always go to the ER and they’ll take care of you even if you don’t have insurance.”

Here’s the truth: We can stabilize you, but that’s not the same as taking care of you.

For instance, we can briefly stop a patient’s severe intestinal bleeding. But we cannot provide weeks of follow-up care with a gastroenterologist to avoid having the same thing happen all over again.

Health insurance is critical for access to the kind of continuing care that leads to better health.

It is time we realize that we all should be equal when it comes to getting the health care we need. The BCRA will have devastating consequences for patients, their families, and for Pennsylvania.

And it will strain and even break the backs of many more of our patients. 

Erik J. Blutinger, M.D. is a resident in emergency medicine at the Hospital of the University of Pennsylvania.