Tuesday we heard the president say, “Tonight, I am also calling on this Congress to repeal and replace Obamacare with reforms that expand choice, increase access, lower costs and, at the same time, provide better health care,” in his first address to Congress. The coalition of congressional Republicans, President Trump and Health and Human Services Secretary Tom Price face the task of making this happen.

They may be trying to reinvent the wheel.

Since the Affordable Care Act was implemented, mounting evidence shows there are more people who have access to a doctor and more who are healthier as a result. Many beneficiaries are those who voted for Trump and helped sustain his party’s congressional majority.

Let’s start with access. All data point to more people with health care. The Congressional Budget Office showed that 10 million more people are now insured than were in 2010; the Centers for Disease Control and Prevention counts 17.8 million more insured in the same amount of time; the Census Bureau shows that 12.8 million have been insured since 2013. In California, the vigorous implementation of the act has enabled more than 90 percent of the state’s residents to have access to a doctor.

New data, published in January’s Health Affairs, build on these numbers in several new ways. A study of 2014 Affordable Care Act enrollees revealed that more than half were those who joined the ranks of the insured had previously gone without insurance for more than three years. These are people who were unable to see a doctor for their high blood pressure, diabetes or other chronic problem; ones who racked up unaffordable charges from the emergency room because they had no choice but to go there because of a sudden and unexpected illness; or a mother whose child went without a pediatrician to vaccinate her against life-threatening infections.

If that doesn’t give us pause, then how about this? The same study also shows a great benefit from the act to Americans with lower incomes, many of whom voted for Trump because of his promise to protect their job, income and retirement security: The decline in uninsured was highest in people with incomes below 139 percent of the poverty line. This was true both in states that did and did not expand Medicaid coverage. Kentucky and West Virginia, states Trump won in November, have seen their rates of uninsured drop more than any others in the nation.

Trump World will also have to face that the Affordable Care Act has improved people’s health as well. A second study in the same issue of that same journal reveals that in states that expanded Medicare, patients at federally funded health clinics had better outcomes on four of eight measures: asthma treatment, testing for cervical cancer, body-mass-index assessment and hypertension control, versus those in non-expansion states who received care in the same settings. Finally, a third Heath Affairs study shows that people are alive today because the Affordable Care Act’s preventive care provisions resulted in their doctors discovering colon cancer at an early and treatable state.

Certainly Obamacare isn’t perfect. Premium hikes, at least for last year, were portrayed as excessive and untenable during the election cycle and during the president’s speech. Many insurers, faced with price transparency and the need to compete side-by-side with one another, like airlines on Expedia, are not happy with their profit margins. The state-run health exchanges could simply collapse because insurers decide to exit, as Humana did. It remains to be seen if either of these will affect the health gains seen as a result of the act.

But better access and quality — two Holy Grails of American health care — will prove stubborn facts for Secretary Price and his boss to confront with anything they can confabulate to repeal and replace the Affordable Care Act. That makes it a more perfect solution than anything that has come before it.

Rahul Parikh is a physician in the East Bay www.rahulparikh.com

 

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