Herbert C. Smitherman Jr, MD, MPH, FACP

As a physician we take an oath to do no harm. Police officers promise to protect and serve. Legislators are selected by the people to defend our rights, oversee our policies and work in our best interest. However, it seems those we have trusted to govern our nation have forgotten about the people who depend on them the most.

Recently, the American Health Care Act (AHCA) was presented before Congress and voted on in the blink of an eye. A bill that represents one fifth of our economy, impacts everyone in our country rich or poor, insured or not, was put into an 1800 page document and voted on 24-hours after being filed.  The vote was held with no debate, no hearings, no Congressional Budget Office analysis, and with many congressional members admitting not to have read the bill at all. This bill, both in substance and process, was a disturbing approach to governance and a willful neglect and disservice to the American people.

Let’s take a look at the facts of the AHCA Bill voted out of the House:

  • Under the American Health Care Act (AHCA) health insurance would be cut to as many as 24 million people, and large companies will no longer have to provide health Insurance coverage to their employees, undermining where most families in the U.S. receive their health Insurance coverage.


  • This new bill cuts Medicaid in a big way. Medicaid insures 70 million people in the US with 66% of its spending going toward care for poor seniors and the disabled. Under this new bill, Medicaid gets cut by $880 billion, cutting care and hurting many of the most vulnerable Americans in the country.


  • Hospitals got more insured patients with the ACA so the government reduced what hospitals got paid from Medicare. The new bill cuts 24 million people who received new health insurance but keeps the cuts in Medicare. Even with millions of people cut from insurance this new bill keeps the Medicare cuts to hospitals in place which would disproportionately hurt rural and urban hospitals, causing cuts to hospital services that could lead to hospital closures across the country.


  • While this bill robs the deserving, it is working overtime to help big business.

The AHCA gives states access to waivers that can enable insurers to charge more for people with pre-existing illnesses and can charge seniors up to five times as much as younger people for the same amount of health insurance coverage. So even though President Trump’s key campaign promise was, “No one would lose coverage for pre-existing conditions,”, this is one of the main features ripped from the bill.

  • The Bill’s waivers serve as a free pass allowing health insurance companies to opt out of covering any basic services they so choose, such as hospitalization, pregnancy, emergency room care, gynecological services, Cancer care, behavioral health and drug treatment coverage, which includes mental health and addiction treatment; a mandatory provision that was built into the Affordable Care Act.


  • This AHCA eliminates funding for the Prevention and Public Health Fund after 2018, which provides for investment in prevention, wellness and public health programs to improve health and restrain the rate of growth in health care costs. After this provision phases out, there will be no programming to help keep individuals well.


  • The $808 billion in Exchange subsidies currently provided to middle class families to subsidize the purchase of their health insurance on an ACA Exchange are radically cut in this bill and these monies are shifted to the wealthiest 1% and corporations in the form of an $800 billion tax cut.

This bill decreases health insurance coverage to millions of Americans, raises premiums, eliminates protections for pre-existing illnesses, and raises deductibles. This is not a healthcare bill it is a “wealthcare bill”. The real purpose of this bill is to take money out of healthcare to pay for a GOP tax cut bill. That’s why the healthcare bill had to come first in order to find the revenue to pay for the GOP tax cuts. This bill is the largest redistribution from the poor to the rich in a single bill in U.S. history, and hurts the elderly, the sick, the poor and the middle class. So the poor and middle class pay twice. First in the loss of healthcare coverage for their families and second, no benefit from the tax breaks generated by the revenue theft from healthcare. Any bill that does this much damage to the well-being of the American people is unbecoming of the U.S. Congressional members who voted for it, and unworthy of our great nation’s history in protecting the most vulnerable among us.

Herbert C. Smitherman Jr, MD, MPH, FACP is Vice Dean, Diversity and Community Affairs, Associate Professor, Department of Medicine and Karmanos Cancer Institute, Wayne State University School of Medicine/ Detroit Medical Center, President and CEO, Health Centers Detroit Foundation, Inc. and Board Chairman, Detroit Wayne Mental Health Authority.

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