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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!


DFA Round Up - August 4, 2017


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TAKE ACTION

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. 

WEEK-AT-A-GLANCE

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.

CALIFORNIA

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.



MASSACHUSETTS 

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.


NEW YORK

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.



NORTH CAROLINA

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).”

OHIO

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.



PENNSYLVANIA 

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.



WASHINGTON, DC

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.

 

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A major win for patients

By Scott Poppen, MD MPA
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Dear Robert,

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.

 

In solidarity,

Scott Poppen, MD MPA

 

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Senate to vote on repeal

By Scott Poppen, MD MPA
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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.

What’s Next

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.

Yours in service, 

Scott Poppen MD MPA

Chair

 

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This isn't over

By Shalini Pammal
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In a move that violated the sacred oath that doctors take to "first do no harm”, Senators just voted to advance a bill to the floor, that repeals the Affordable Care Act, thus stripping life-saving coverage from millions of Americans. While this is disappointing news, we know the fight to protect patients' lives has only just begun.

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 

Target states:
Sen. McCain (AZ): 202-224-2235
Sen. Heller (NV): 202-224-6244
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.
Sen. Collins (ME): 202-224-2523 Tell her thank you for voting no and urge her to stand strong.
 
Let’s tell Senators to end this rush to repeal and work in a bipartisan manner to improve the health law. Your voice matters for the millions of patient lives at stake. This is not over.
 
In solidarity,
 
Shalini Pammal
Board Member

 

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URGENT: ACA vote expected within 36hrs

By Meghana Rao, MD
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Dear Brannon,

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

SAMPLE SCRIPT:

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.

 

In solidarity,

Meghana Rao, MD

Board Member

 

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UPDATE: Senate repeal efforts

By Scott Poppen, MD MPA
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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. 

 

In solidarity,

Scott Poppen, MD MPA

Chair

 

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DFA Round Up - July 14, 2017

By Shalini Pammal
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TAKE ACTION

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 weekRSVP 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.
WEEK-AT-A-GLANCE

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

Tell us about what you are up to! Email your updates and photos to DFAHQ@drsforamerica.org.

Illinois

Dr. Ram Krishnamoorthi shares that he and Drs. Laura Craig, Mara Davis and others in Chicago teamed up with Indivisible Chicago for a rally. Mara, a family physician, and Laura, a graduating psychiatry resident, both spoke and told stories of their patients. The Chicago Tribune ran the story on their front page on Friday and CNN.com used some photos as well!



Maine

Dr. Cathleen London penned an op ed in the Portland Press Herald urging Sens. Collins and King along with Rep. Pingree and Poliquin not to rollback coverage, especially for the state’s most vulnerable.

"The proposed cuts both in the Senate health care legislation and in a budget proposal soon to be brought forward in the Republican-controlled House are a direct attack on the interests of the people of Maine. We must ask our members of Congress, Sens. Susan Collins and Angus King, and Reps. Chellie Pingree and Bruce Poliquin, to defend Maine’s most vulnerable people."

Med student Margaret Hayden also penned an op edin the Portland Press Herald urging Sen. Collins to support the ACA and cautioning that a vote against the ACA be devastating for Maine.

“As a future doctor, I know what will happen if the Affordable Care Act is repealed. Mainers will get sicker. Many will go bankrupt. Some will die.”

Maryland

Dr. Matthew Molloy a pediatrician at Hopkins and former DFA Maryland State Director wrote an op-ed in the Baltimore Sun pointing out the devastating impact the President’s budget would have on children.

“The budget seeks to dismantle the foundational programs that make America great and keep Americans safe and healthy with deep cuts proposed to Medicaid, anti-poverty programs, education support and biomedical research. As a pediatrician, I am appalled that these cuts disproportionately impact children.”

Massachusetts

Drs. Umbereen Nehal, Jeffrey Schnipper and Diana Wasserman, along with Dr. Wasserman’s granddaughter Ellaria Vecsey, met with Senator Markey’s office. DFA MA was invited to provide testimony and examples of the impact of gains made through the ACA on patients. They discussed strategies to protect health reform and to continue to improve healthcare.



New York

Dr. Kamini Doobay recently spoke at the "Violence is a Health Issue” summit which was co-hosted by The NYC Health Department’s Center for Health Equity and the NYC Coalition to Dismantle Racism in the Health System. Public health leaders, health professionals, medical school leadership and community activists addressed topics such as structural violence and the racial inequities that contribute to poorer health outcomes in communities of color. Video of her remarks here.

 

North Carolina

DFA Board Member Dr. Lori Heim and Dr. Naveed Aziz spoke at the Moore County Indivisible meeting where 100 people showed up. The doctors presented on what the ACA was and how that contrasts with what the AHCA/BCRA proposes.

 

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It’s the last day

By Scott Poppen, MD MPA
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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.

Will you donate $50, $100 or $1,000 right now to make certain we have the funds we need in the future?

 

Yours in service,

Scott Poppen, MD MPA

Chair

 

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Medicaid is in jeopardy

By Joe Kanter, MD, MPH
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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.

Give whatever you can today to help protect our 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.

Stand with Doctors for America by donating today. 

 

Yours in service,


Joe Kanter, MD, MPH

Board Member

New Orleans, Louisiana

 

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For Sarah

By Dr. Evan Saulino
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"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.

The medicine arrived in a brown box on her doorstep just one week before she died. Simply too late. 

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.

Dr. Boyd Shook, an internal medicine physician in Oklahoma, is joining me in donating to DFA. He has offered to match the first $1,000 donated today. This will double your impact if you donate now. 

In solidarity,

Evan Saulino, MD PhD

Board Member

 

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