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Should US doctors mourn for Obamacare?

BMJ 2017; 356 doi: (Published 24 March 2017) Cite this as: BMJ 2017;356:j1441
  1. Adam Gaffney, instructor1 2,
  2. Zackary D Berger, associate professor3 4,
  3. Saurabh Jha, associate professor of radiology5
  1. 1Harvard Medical School, Boston, MA, USA
  2. 2Cambridge Health Alliance, Cambridge, MA, USA
  3. 3Johns Hopkins University School of Medicine, Baltimore, MD, USA
  4. 4Johns Hopkins Berman Institute of Bioethics, Baltimore
  5. 5Hospital of the University of Pennsylvania, Philadelphia, PA, USA
  1. Correspondence to Z D Berger Zberger1{at}, S Jha Saurabh.Jha{at}

Any changes to the Affordable Care Act are likely to result in fewer people being insured, worry Adam Gaffney and Zackary D Berger, but Saurabh Jha thinks reform could prioritise market forces and really make care affordable

Yes—Adam Gaffney, Zackary D Berger

The Affordable Care Act (ACA), otherwise known as Obamacare, is in the crosshairs of Donald Trump’s rightwing government. The president and congressional Republicans have made clear that they want to repeal the law. And on 6 March the House Republicans released a bill (the American Health Care Act) designed to do so, but it doesn’t have the party’s full support. Trump has threatened lawmakers that he will abandon healthcare reform altogether if they fail to pass the bill, but surely Obamacare cannot escape unscathed for long.

The Republican agenda should be resisted. This is not because the ACA is perfect: in truth, it leaves much to be desired, a fact that contributed to many voters’ dissatisfaction with the healthcare status quo. Yet the Republicans’ proposals would only make things worse, risking the ACA’s most useful—and lifesaving—provisions, to the detriment of healthcare in the United States. They would, however, benefit the rich through generous tax cuts.

Millions more people insured

The ACA reduced the ranks of America’s uninsured by 20 million people.1 It also banned insurers from discriminating against people with pre-existing conditions, from charging women higher premiums, and from setting lifetime or annual insurance caps on coverage, among other provisions. These are all long overdue reforms that the Republican plan would keep.

The ACA’s funding also included a new progressive tax on high income investors, which the Republican plan eliminates (together with various taxes on the healthcare industry).

Nevertheless, the new bill could result in an …

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