We emergency doctors are moderates by nature. In fact, a report last year found we are the most politically centrist of any medical specialty: Of those giving party affiliations, 51 percent of emergency doctors identify as Republican.
Why is this? I like to say that it’s because emergency doctors touch all segments of society on a daily basis. Literally. In some states, ER doctors are perhaps the only people—not just in medicine but in any profession—who make enough money to be in the 1 percent but still have regular and direct interactions with the homeless. It’s not unusual for an emergency physician who makes $325,000 per year to be seen hand-delivering a heroin addict a cup of water. Or naloxone. Or CPR. We treat the rich and poor alike. We see the government programs that save the lives of the needy and the ones that are completely useless and feed into the very problems they purport to address.
The politics of my specialty’s governing body, the American College of Emergency Physicians, reflects our centrism. Before the Affordable Care Act was passed in 2010, the ACEP affirmed certain core values, but it neither endorsed nor rejected any version of the bill. The same was true of Medicare Part D and for many other controversial pieces of health care legislation. It was also true of the American Health Care Act.
In a break from tradition, ACEP stated that it would “have to oppose the bill” if it erodes coverage for emergency care. At issue is the ACA’s provision that certain “essential health benefits” be included in any legal marketplace health care insurance plan. Emergency care is an essential health benefit. (Does one even have to say this? So far, no sane person has argued otherwise.) The question now is: Who gets to decide what is and what is not an essential health benefit? The Freedom Caucus of the Republican Party is asking that the states should get to. Why? The simplest answer is that this would free the states of the tyranny of being told by Washington what minimal coverage must include. Of course, the only thing states might do with this newfound power, if they end up with it, is cut things from the required care list. They’re currently allowed to add essential health benefits as they see fit.
In addition to emergency services, the ACA currently requires all plans to cover nine other essential health benefits, including outpatient care, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services (and chronic disease management), and pediatric services. So, if the Freedom Caucus gets this in, all of that is on the chopping block, depending on the state you live in.
During the past election cycle, the Republicans found an effective rally cry in the notion that “coverage does not equal access.” It was a reasonable concern, and a politically savvy rejoinder to the Obama administration’s unforced error of promising that no one would have to change plans or doctors under the ACA. The AHCA proposal, however, does not solve the problem surfaced in this quip. Indeed, to remove the essential health benefits requirement from the national law is to admit that the game being played has nothing to do with health or care and everything to do with political ideology and cold-hearted macroeconomics.
It’s not an exaggeration to say that if emergency services are not covered by all health care plans, this could bring about a world in which a poor person would have to think twice before calling 911 if he thinks he is having a heart attack. Is that worth it? I don’t think requiring such basic services to be covered in our health plans makes me, or any other reasonable person, some sort of apologist for big government.
That’s why I am proud that ACEP has stated that it will oppose a bill that “erodes the protection that patients currently have to access to emergency medical care.”
We emergency doctors believe in moderation in all things—and that includes moderation. If there were ever a time for us to break with our tradition of not picking a side in a contentious political fight over health care, the battle to save the essential health benefits coverage requirement is certainly the appropriate time.
Disclaimer: The opinions expressed in this article are solely those of the author and do not reflect the views and opinions of Brigham and Women’s Hospital.