Note From The Commissioner: The Cost of Sabotaging the ACA

Last week, Baltimore City filed suit against the Trump Administration for intentionally and unlawfully sabotaging the Affordable Care Act (ACA). Under the leadership of Mayor Catherine Pugh and Solicitor Andre Davis, we joined colleagues from across the country to express our deep concern about the consequences of undermining the ACA.

Here in Baltimore City, more than 10,000 of our residents are enrolled in plans purchased through the health insurance marketplace. Destabilizing the ACA could mean that 10,000 people will become uninsured. This directly affects the demand on our Health Department’s services. We operate clinics that are a safety net for uninsured and underinsured Baltimoreans. We already operate on a shoestring budget, and further increases in the uninsured rate will place an even greater burden on programs already short on resources. It will make us either incur additional costs, or force us to reduce our ability to care for the most vulnerable.

But what services do we cut? Do we cut reproductive healthcare – which is already being threatened as a result of the Trump Administration’s proposed Title X changes? Do we cut opioid addiction treatment – in the middle of a public health emergency? Or do we cut our core services, including HIV/AIDS treatment, dental and oral care, hypertension detection, or even cancer screenings?

There is also a human cost. I’m an emergency physician, and I have seen what happens when people delay care because they simply can’t afford it. I had a patient who lacked insurance and wasn’t able to have a lump in her breast examined when she found it – she died a year later and left behind three children. This mother, and countless others, could be here today if she was able to seek treatment earlier. When we talk about the Trump administration sabotaging the ACA, we are talking about people’s health and their families' futures. 

Our core services are as important as ever. Last week was World Breastfeeding Week, and our Health Department’s WIC clinic staff have been hard at work promoting the health benefits of breastfeeding for both babies and mothers. We are glad to be working with incredible partners across the City. On Monday, Councilwoman Shannon Sneed introduced a bill< that would require employers to provide appropriate lactation accommodations for employees who breastfeed. I commend Councilwoman Sneed and the Baltimore City Council for introducing this bill and for recognizing that a woman should never have to choose between working and feeding her child.

As I discussed on WYPR’s Healthwatch this week, for us in Baltimore, we will never waver in our commitment to provide care to our most vulnerable residents. We strongly believe that health is a fundamental right that should be provided to all, regardless of economic circumstances, immigration status, or any other factors. 

Leana Wen, M.D., M.Sc.

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