Progress Notes features doctors and medical students across the country on the frontlines of our health care system. Our views and experiences are diverse, but we share common goals and values. We speak up to move toward a future where everyone can have access to affordable, high-quality health care. Please share our posts, and follow us on Facebook and Twitter!
We know the work to protect our patients does not stop. In the wake of our tremendous victory to defeat efforts to repeal the ACA, join us in taking some important steps during this August recess to hold members of Congress accountable for their votes on ACA repeal and to urge congress to move forward in a bipartisan manner to improve health care.
View this map or list of events in key states to find rallies, protests, forums, and visits planned to members of congress in key states. You can also check townhallproject.com for information about public events where Members of Congress will be present.
- Write a letter to the editor of your local newspaper.
Following the failure to pass three different bills last week, Senate Republicans have temporarily halted efforts to repeal-and-replace the Affordable Care Act, though the White House is still seeking a path forward for repeal. The Administration is pushing for the Senate to continue working on health care legislation, but it seems that Senate leadership is now focusing on bipartisan efforts to stabilize the health insurance market. Meanwhile, the fate of the cost-sharing reduction payments (CSR) to health insurers is still uncertain, as the Administration cast doubt on whether the federal government would continue funding those subsidies. Members of the Senate Health Committee are planning to hold bipartisan session hearings, beginning the week of September 4, to "stabilize and strengthen the individual health markets," while urging the The Administration to continue paying the cost-sharing subsidies until then. Republican and Democratic governors have also reiterated their desire for funding that stabilizes the market, putting forth proposals to bolster policies which help their constituents afford health insurance. And as the administration continues to mull its decision regarding CSR payments, a federal appeals court has ruled that state attorneys general can defend the subsidies given that terminating them would "directly and imminently" cause an insurance premium hike and lead to more uninsured.
Amidst the uncertainty, insurers are still expected to make final adjustments to their proposed 2018 premiums by August 16 and must make final decisions about whether to sell Obamacare plans in 2018 by September 27. Molina Healthcare is one among some other insurers that have been exiting the exchanges, recently announcing its exit in Utah and Wisconsin, citing hefty second quarter losses in those markets. Anthem Blue Cross has also reduced individual health plan coverage for some 150,000 Californians, exiting from 16 of the 19 California regions it covers. Following its pullback from the exchanges, Aetna reported a 52% jump in second-quarter profits and raised its 2017 forecast. And at least six states with GOP governors— Arkansas, Kentucky, Arizona, Maine, Wisconsin and Indiana— have already drafted plans that would change eligibility guidelines for Medicaid. This is likely to impact low-income Americans and those with certain disabilities, if states add work requirements, introduce drug testing for recipients or raise premium prices.
This past week the Senate also passed a key funding bill, which renews the FDA's authority to collect feesfrom the prescription drug and medical device industries. The bipartisan legislation will account for $8-9 billion over five years and represents over a quarter of all FDA funding. The bill passed after the Senate passed a separate bill which expanded access to experimental treatments for people with terminal illnesses. The "Right to Try Act," championed by Senator Ron Johnson (R-Wis.) allows patients to request access to experimental drugs directly from drug companies without having to go through the FDA; but, does not require drugmakers to make the experimental treatments available.
And on the last day before leaving for the August recess, the Senate confirmed Dr. Jerome Adams to be the 20th Surgeon General of the United States. Adams served as Indiana's state health commissioner and stated in his hearing that his main priorities would be the opioid epidemic, wellness and community and employer engagement.
MEMBERS IN ACTION
With the threat of coverage for millions on the line, doctors and medical students from Washington, DC to California took to the streets to make their voices heard and successfully beat back the latest attempts to repeal the ACA.
In addition to rallying to save coverage, DFA’s Drug Pricing, Value, and Affordability Campaign, led by Bruce Rector and Justin Lowenthal, organized national stakeholders for a conversation on the pressing issue of rising drug prices.
Tell us about what you are up to! Email your updates and photos to DFAHQ@drsforamerica.org.
Board Member Dr. Kyle Ragins joined with Congressman Jimmy Gomez (CA-34) to speak about the importance of preserving the ACA at the “Our Lives On The Line” bus tour kick-off in Los Angeles. The bus will be traveling across the country this summer.
As the ACA repeal voted loomed, Board Member Shalini Pammal organized doctors and health advocates for a vigil on the steps of the Massachusetts State House to urge Senators to put patients over politics.
After the vote, State Leader Dr. Umbereen Nehal attended a rally in Cambridge to thank members of Congress who stood with patients and voted against ACA repeal. She was mentioned in a Boston Globe article covering the event.
Dr. Katherine Scheirman shares the DFA NY, together with a coalition of state physicians, participated in a “die in” to continue to raise awareness for the deadly consequences of taking away coverage. The team also conducted meetings and outreach to Senators Gillibrand and Schumer.
Medical students at Mount Sinai also participated in several phone banking efforts to defend the ACA and Medicaid. Students were able to provide unique perspectives due to their broad exposure to the healthcare system and the fact that some are on Medicaid themselves.
William Coe, a medical student at the Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health, penned a powerful op-ed in his hometown paper in Raleigh, North Carolina. In the piece he discussed the opioid epidemic and the necessity of expanding and maintaining Medicaid in NC to support efforts to save lives.
“Individuals suffering from mental health and addiction stand to benefit the most from Medicaid expansion. Across the country, Medicaid accounts for 25 percent of all spending for mental health disorders and 21 percent of all spending for substance use disorders, making it the largest source of financial support for such services, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).”
State Leader Dr. Donald Nguyen recently joined health advocates for “Our Lives On The Line” rally in Dayton, Ohio to urge Congress to put an end to repeal efforts and focus on bipartisan action to improve and strengthen the ACA. The event was part of a national day of action across the country.
State Leader Dr. Arthur Lavin, joined by colleagues from Cleveland, meet with Senator Rob Portman and Senator Sherrod Brown’s office to underscore the disaster repeal would spell for patients across Ohio.
Dr. Benjamin Abella participated in a Facebook panel discussion with Congressman Raul Ruiz MD and Dr. Don Berwick (former director of CMS) about the consequences of repealing the ACA.
Board Member Dr. Meghana Rao spoke at the “Our Lives On The Line” rally in the nation’s Capitol about the life changing impact the ACA has had on her patients in Baltimore. After the rally she marched with hundreds of advocates, patients, and health providers to the White House.
DRUG PRICING, VALUE, AND AFFORDABILITY CAMPAIGN
Dr. Bruce Rector and medical student Justin Lowenthal, leaders of DFA’s Drug Pricing, Value, and Affordability Campaign, convened a meeting with dozens of organizations working on prescription drug pricing and affordability. Attendees included major physician, labor and patient groups to discuss strategy on state and national efforts to reduce the cost of prescription drugs.
Don’t forget to tell us about what you are up to. Email DFAHQ@drsforamerica.org with your updates and photos.
We did it!
Last night, Senators Collins (ME), Murkowski (AK) and McCain (AZ) came together with all Democrats and Independents to kill the Senate bill to repeal the Affordable Care Act and protect the coverage of millions of patients.
This great victory would not have been possible without you.
Together, we have spent the last seven months tirelessly fighting off repeal attempts. We flooded congressional offices with calls, held countless meetings with members of Congress, wrote opinion pieces, spoke at local events and gathered in great numbers in Washington, DC at a White Coat Fly-in to make our voices heard with Congressional leaders.
From the bottom of my heart, thank you. Your voices, and those of patients benefiting from the health law, made the difference.
As we breathe a sigh of relief, we also know the fight to protect our patients' access to care continues. Congressional leaders still support repeal. The Administration remains committed to destabilizing the marketplace and making it harder for consumers to get the coverage they need. We also know that there will be opportunities ahead to build on the progress for our nation’s health.
Take this moment to rest and rejuvenate yourself for the battles to come. Then let’s get back to work fighting the misguided efforts to take away coverage and making health care what it should be; a right for everyone in America.
Scott Poppen, MD MPA
The last seven years have come down to this moment.
You have given much of your time, money and leant your voices to fight for every patient's right to quality, affordable care. Now, we need you to rally for our patients again.
Tens of millions of people are counting on us to do everything we can in the next 36 hours to stop them from losing life-saving health coverage.
Our efforts are working. Both the Better Care Reconciliation Act, with the Cruz Amendment, and the repeal and delay bills have already been voted down in the Senate.
The Senate will soon enter “vote-a-rama” which is when both parties quickly offer numerous amendments. At the end of this process, Senator Mitch McConnell will introduce another version of ACA repeal that is being called "skinny repeal." That version would repeal the individual and employer mandates and the medical device tax. We expect this vote to take place before the end of the week.
What You Can Do
This is not over. Senators Susan Collins (R-ME) and Lisa Murkowski (R-AK) voted no on the motion to proceed and have expressed deep concerns about the impact of repeal on their state. We need to use this opening to put as much pressure as possible on all Senators, but especially those in target states.
- Call and urge these Senators to #VoteNo on ACA repeal. Make sure to thank Sens. Murkowski and Collins and urge them to stand strong.
- Help reach even more people in key states by phone banking with Indivisible.
- Find an event near you.
Yours in service,
Scott Poppen MD MPA
A vote is expected on the Senate floor later this week. The Senate has just begun debate on repeal. Senators Susan Collins (R-ME) and Lisa Murkowski (R-AK) voted no today and with other moderate Senators deeply concerned about the impact of repeal on their states, we have an opportune window to make an impact.
We need to put as much pressure as possible on Senators to vote no on this bill, and that is especially important if you are from one of the following target states.
Capitol Switchboard: 202-224-3121
Sen. Capito (WV): 202-224-6472
Sen. Portman (OH): 202-224-3353
Sen. Murkowski (AK): 202-224-6665 Tell her thank you for voting no and urge her to stand strong.
This is a crucial week for the future of the Affordable Care Act and the health care of millions of patients.
The Senate is expected to vote within the next 36 hours on a bill to repeal the ACA. The procedural vote, called a Motion to Proceed, will determine whether a repeal bill goes to the Senate floor later this week. We must make Senators' phones ring off the hook to ensure this does not happen.
The Administration and Senate leadership are pulling out all of the stops to pressure Senators to vote yes, and these efforts may be working. Among their top targets are Senators Capito (WV), Murkowski (AK) and Heller (NV). These Senators need to hear from us TODAY.
Take 2 minutes today to call your Senator and urge them to vote NO on the Motion to Proceed - (202) 224-3121. This is especially important if you live in West Virginia, Alaska or Nevada.
Below is a simple message you can leave your Senator
Senator <INSERT NAME>, I am a <DOCTOR OR MED STUDENT> and, as the Senate considers a bill to repeal the ACA, I am calling to urge you to do no harm. (Feel free to share a short patient story or why this matters to you).
ACA repeal would be a disaster of epic proportions for patients. I urge you to vote NO the Motion to Proceed. Senators must not support any bill that repeals the ACA, destroys Medicaid, ends Medicaid expansion, rolls back coverage or undermines consumer protections.
My zip code is <INSERT HERE>.
Thank you for your time.
Meghana Rao, MD
There have been major developments in the last 36 hours around ACA repeal.
Thanks to your hard work, efforts to repeal the ACA have hit a road block in the Senate.
On Monday, two additional Senators announced their opposition to the Better Care Reconciliation Act, effectively killing the legislation for now.
Yesterday, Senate leadership announced they will move forward, next week, with a vote to repeal the ACA WITHOUT a replacement. This bill would cause 32 million Americans to lose coverage, premiums to double and end the Medicaid expansion. That is why Senators Collins, Capito and Murkowski have announced they will vote no on the motion to proceed. If they vote no, they would successfully prevent the bill from advancing to the floor. But, until the vote happens, we cannot let up.
|Call Senators at (202) 224-3121 and tell them to vote NO on the motion to proceed on ACA repeal.|
As a reminder, the following are they key Senators to contact:
Sen. Capito (WV), Sen. Collins (ME), Sen. Murkowski (AK), Sen. Heller (NV), Sen. Flake (AZ), Sen. McCain (AZ), Sen. Portman (OH), Sen. Cassidy (LA). When calling Senators Capito, Collins and Murkowski make sure to urge them to stand strong and thank them for putting patients over politics by voting no.
ACA repeal would be a tragedy of epic proportions for patients. It is clear our outreach is making a big impact. Let's aim to defeat these efforts for good so Congress can begin working in a bipartisan way to strengthen and improve upon the health law.
Scott Poppen, MD MPA
A Senate vote to repeal the ACA is expected NEXT WEEK. We are one vote away from killing this bad bill that harms millions of patients. We can't let up now!
- CALL, CALLS, CALLS! Call Senators and urge them to oppose any bill that strips coverage from millions of Americans, ends vital consumer protections and phases out Medicaid: (202) 224-3121. Visit this toolkit for additional resources. Key Senate targets are: Heller (NV), Murkowski (AK), Capito (WV), Flake (AZ), McCain (AZ), Portman (OH), Cassidy (LA), Collins (ME).
- Our partners are hosting a People’s Filibuster in Washington, DC on Monday and Tuesday of next week. RSVP here to attend.
- Can't make it to DC? Our partners are also hosting events across the country. Fine one near you here, here and here.
Senate Republican leaders released a revised versionof the Better Care Reconciliation Act (BRCA) yesterday, attempting to move forward with their plan to repeal and replace much of the Affordable Care Act. There have been concessions made to both moderates and conservatives in an attempt to reach the needed 50 votes; however, as unity proves elusive, there are few signs of substantial progress. The revised bill includes an amendment from Senators Ted Cruz (R-TX) and Mike Lee (R-UT) that would allow insurers to sell less comprehensive plans if they also offer at least one option that complied with federal standards. Insurers have already spoken out against this two-tier market proposal, citing that this would threaten access to coverage for individuals with costly medical conditions.
Moderates continue to express concern that the revised bill does not include enough protections for poorer or older Americans, particularly given rollbacks in Medicaid funding and subsidies to purchase insurance, and some Republican senators are considering a possible bipartisan solution that would shore up the Obamacare markets. On Wednesday, the New Democrat Coalition's Affordable and Accessible Health Care Task Force released a proposal to stabilize the individual markets and reduce premiums. The House Democrats 'Solutions over Politics' plan would create an annual $15B reinsurance fund to provide payments to insurers that enroll higher-cost, sicker individuals, continue Obamacare's insurer payments, allow a buy-in option for Medicare for people nearing retirement age, expand tax credits to help people buy insurance and expand the availability of catastrophic health plans that include essential health benefits and coverage for primary care for younger enrollees. Further, health care is expected to be a top discussion point at the National Governors Association meetingswhich began yesterday—particularly, major changes to Medicaid and states' health insurance marketplaces.
First quarter results have suggested that insurers are on a path to profitability, despite rhetoric that Obamacare markets were failing. While there are still issues with the marketplace and uncertainty remains regarding the future of repeal-and-replace efforts, insurers spent 75% of premiums on medical claims in this year's first quarter, in comparison to the prior two years during which insurers spent more than 85% of premiums on medical costs, translating into huge losses.
And lastly, the House subcommittee controlling the National Institutes of Health (NIH) also proposed a $1.1B boost for the agency this past week, defying an initial push from the Trump administration to cut funding.
MEMBERS IN ACTION
It's the last day of our fundraising drive and I have some exciting news to share.
Dr. Murali Sivarajan of Seattle, Washington has generously agreed to help us reach our goal tonight by matching your donation, dollar-for-dollar, up to $10,000 by midnight.
I know you may have given in the past but today’s contribution will go twice as far. That means if you give $100 your donation will count for $200.
Given the pressing threats facing our patients, Doctors for America is readying to bring on an additional staffer to help ensure the voices of doctors, medical students and patients are heard. Your contribution will help fund this important addition at a crucial moment.
Yours in service,
Scott Poppen, MD MPA
Doctors, of all people, know first-hand how critical Medicaid coverage can be to our patients.
Behind closed doors, lawmakers in Washington, DC are scheming to pull the rug out from under our patients and chokehold their access to quality health care. Repealing the ACA would rob Medicaid of $800 billion over the next decade; claw back coverage for 22 million, including the 11 million previously-uninsured working poor who gained access through the ACA; and make cash-strapped states responsible for an ever-increasing share of the bill. Simply put, the Senate bill would decimate coverage for our most vulnerable patients.
Please join me in standing up on our patients' behalf. Doctors For America empowers physicians to collectively advocate on issues that are of life-and-death importance to their patients, such as access to care. The financial support of concerned physicians is crucial to this effort.
In my home state of Louisiana we expanded Medicaid coverage nearly a year ago, and over 436,000 hard-working residents now have access to quality health care as a result. I remember well the frustrations of caring for low-income patients prior to Medicaid expansion: prescribing medications too expensive to be filled, referrals for specialty care I knew were unobtainable, a parade of endless emergency department visits. I am not willing to go back to this. If you practice in a Medicaid expansion state, you know this is a program worth fighting for. If your state has yet to expand Medicaid, the Senate repeal bill would erase any opportunity to do so in the future.
Passage of this disastrous bill could be mere days away. Our most vulnerable patients are depending on us to speak up on their behalf. Help Doctors for America empower physicians and medical students across America to do just this. Your financial contributions will fuel the effort.
Yours in service,
Joe Kanter, MD, MPH
New Orleans, Louisiana
"Doctor, no one should die like she died. We couldn't do anything for her even though there were ways to treat her."
Prior to the passage of the Affordable Care Act (ACA), I had a patient whose story has motivated me to action ever since.
My patient, who I will call Sarah to preserve her identity, was in her late forties. Sarah was married with kids. She had a new job after being out of work for a couple years, but was in the first six months of that job and on “probation,” which meant her health insurance did not kick-in until her probation was up. So, though she was employed, she was still uninsured.
A couple months into the job, she noticed she began losing weight. That bothered her but she didn't seek medical help because she wanted to make it through her six month probation without any problems. As time went on she started feeling worse. Finally, one week before her six month probationary period was up, she was so sick she couldn’t go to work. That’s when she finally came to see me.
I examined her and immediately felt a large mass in her abdomen. The way that a cancer feels make your heart sink as a physician. Cancer feels hard, not firm or soft - you know it right away. She never went back to work. She never got insurance coverage.
We worked with specialists to provide discounted care to determine her cancer type, metastatic kidney cancer, and identified a new treatment available for advanced kidney cancer that might extend her life, but it was more than $30,000 per month. We worked hard with the drug company to get the medication free for her and, after many phone calls and much paperwork, it arrived on her doorstep three months after I first saw her.
After she died, I ran into her husband at the grocery story. We greeted each other and with tears in his eyes he said to me, “Doctor, no one should die like she died. We couldn't do anything for her even though there were ways to treat her. Everyone should be able to get medical care when they need it and should not be afraid that they'll be denied care just because they're sick. That makes no sense - that's when people need help. Please, please tell her story to others. She cannot have died in vain."
Remembering how things were nearly a decade ago still brings tears to my eyes. As a new doctor, I felt like I had taken an oath to heal, but too often had both hands tied behind my back because people lacked the coverage they needed. I will not go back to that time.
For Sarah, and the millions of patients currently benefiting from coverage thanks to the ACA, I donate my time and money to Doctors for America. I urge you to join me in giving what you can in this critical moment.
Evan Saulino, MD PhD