Here & Now

Closer Look: Madison Physician On Proposed Obamacare Repeal

Frederica Freyberg:

In tonight’s closer look, how some medical doctors are eyeing the repeal of the Affordable Care Act? This week, Wisconsin Physicians for a National Health Program spoke out about their concerns. Dr. Melissa Stiles is a member of that group. Doctor, thanks very much for being here.

Melissa Stiles:

You're very welcome.

Frederica Freyberg:

Well, you say that you have concerns about the rapid repeal of the Affordable Care Act without a proven plan in place. What are those concerns?

Melissa Stiles:

Yeah. Significant concerns. My main concern is that we don’t go backwards. We did make some tremendous strides with the Affordable Care Act in terms of expanding coverage, and I think fixing some of the inadequacies of our health care system. And my fear is we go backwards in terms of coverage and potentially losing coverage for 20 million Americans in the first year of the repeal and up to 30 million in the second is not the right direction.

Frederica Freyberg:

Now, Obamacare, as we’ve come to call it, was not a proven plan when it was put in place either. So why this call, you know, for this new plan, whatever it might be, that it be proven?

Melissa Stiles:

Sure. Obamacare had some proof because it was — a lot of the major tenets of the plan were based on the Massachusetts plan. So there was some evidence that it did work. So there was a demonstration. When we look at what’s being put forth, and, as you know, we don’t have a plan put forth yet, but we could predict that ones put forth by Ryan and also Price in the past, of high deductible plans coupled with health savings accounts, there is no demonstration project for that, not even in a city, in a region, state or any other nation that has done that.

Frederica Freyberg:

Now, when you note Price, you mean the incoming DHSS Secretary nominee, Dr. Tom Price, and he has a plan that really closely mirrors — Speaker Paul Ryan's plan with some of those prongs of which you speak. So how would the repeal, getting closer to the ground, of the Affordable Care Act affect your patients?

Melissa Stiles:

Potentially the major — the people that were most affected by this were people that had small businesses — and I practiced in a small community, Bellville, for 25 years, had a number of dairy farmers. A lot of those couples had to have a second job for health insurance. I gave an in-service on the Affordable Care Act one evening in Bellville. It was packed. People finally saw the light that they could have health insurance without being tied to a job. There were people there with pre-existing conditions that now could get insurance. So those are the main people affected. I think when we also look at the 20 million people that potentially will lose insurance, those people were the most vulnerable. They couldn’t — they didn’t qualify for Medicaid and they were in this gap. And so now they had subsidies that they were able now to get insurance.

Frederica Freyberg:

And there’s a certain number of those people in Wisconsin as well.

Melissa Stiles:

There is. And the estimate is about 225,000.

Frederica Freyberg:

So what about the uncertainty of all of this for people who just got kind of used to the Affordable Care Act, for physicians and hospitals and, again, patients?

Melissa Stiles:

And a lot of organizations are calling for caution. The Wisconsin Hospital Association on their blog, on their website, calls for caution as we move forward. And the concern is not so much if we do repeal, not so much what we repeal it with. The concern is as much as how we do it. When you look at how everything is intricately involved, all now the pillars of what I consider our health care currently, Medicare, Medicaid, the Affordable Care Act, and employer-based insurance, are all affected by any repeal of the ACA. When we look at the assurances that the ACA gave in terms of — you wouldn’t be denied for pre-existing conditions. You would not have your insurance cut off if you developed an illness. You had to wait up to 12 months if you had a job with a pre-existing condition to get insurance. Those same assurances are also for employer-based plans, along with no out-of-pocket costs for preventive services. So this affects not just people that are getting insurance, but the subsidies, it affects all of us. For Medicare, there are tremendous research going on in terms of how we really should look at value-based care. Also, close the loophole, what we call the doughnut hole for Medicare prescriptions, which is so vital for our patients.

Frederica Freyberg:

Also very important and very changeable right now. Dr. Melissa Stiles, thanks very much.

Melissa Stiles:

Thank you.