Dr Brown is F. Bayard Carter Professor and Chair Emeritus, Department of Obstetrics and Gynecology, Duke University, President-Elect of the American College of Obstetricians and Gynecologists, and a past member of the Contemporary OB/GYN editorial board.
Ms DiVenere is Officer, Government and Political Affairs, the American College of Obstetricians and Gynecologists.
Recent statements by US policy makers show a shallow understanding of the issues facing low-income individuals in America. One freshman congressman, an obstetrician, said “Just like Jesus said, ‘The poor will always be with us’ … There is a group of people that just don’t want healthcare and aren’t going to take care of themselves”1 as a rationale for repeal and replacement of the Patient Protection and Affordable Care Act (ACA or “Obamacare”). Another more senior member of Congress said, “Americans have choices, and they’ve got to make a choice. So rather than getting that new iPhone that they just love and … spend[ing] hundreds of dollars on that, maybe they should invest in their own healthcare.”2
These statements are very disturbing in general but particularly when coming from a physician who has taken the Hippocratic Oath. They suggest that the poor and most vulnerable children and adults in this country deserve neither healthcare nor coverage for preventative health services.
Perhaps both these legislators and many of their colleagues believe that an individual’s current medical condition is a referendum on being poor.
ACA and Medicaid: lifelines for the poor
It’s worth noting, and too many people don’t remember, that before the ACA, nearly one-third of pregnant women had no health insurance, and 20% of women of childbearing age (15–44 years) were uninsured.3,4
Uninsured women with breast cancer were up to 50% more likely to die from the disease, and faced a 60% greater risk of late-stage cervical cancer diagnosis.5,6
The ACA put in place landmark protections for women’s health, including maternity coverage for all women in all plans, mandatory no-cost coverage of evidence-based preventive services—including all FDA-approved contraceptives—and important insurance protections.
Unfortunately, too many state and federal politicians are insensitive to the fact that Medicaid is a lifeline for the many of our elderly in nursing homes, the disabled, and the mentally ill. It’s a lifeline too for millions of low-income individuals, including the working poor and their families. The truth is that Medicaid is a US success story, improving the lives and health of those covered, especially women and children, and proving that indeed, low-income individuals do want healthcare. The Health Insurance Association of America describes Medicaid as a “government insurance program for persons of all ages whose income and resources are insufficient to pay for health care.” Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States. All states have participated in Medicaid since 1982 for individuals.