About 1 week ago, CD-1 citizens held a rally in front of Rep. Zeldin’s Patchogue offices.  “Shame on Zeldin” was the battle cry referring to LZ’s vote for Trumpcare (AHCA).  By my estimate 150 people attended. There were 4 speakers: 2 physicians, one hospital administrator and one nurse. In striking contrast to Zeldin, these were people with hands on and life long experience in health care delivery.  A transcript of their speeches follows below.

D Posnett MD:

AHCA can be summed up as follows:

1. Preexisting Conditions. We have them and the AHCA will make it possible for insurance companies to refuse to cover people with preexisting conditions.
2. AHCA weakens Medicare by reducing it’s solvency to 2025 from 2028
3. The Affordable Care Act has the Medicare Part D “donut hole” on schedule to close in 2020. Repealing the Affordable Care Act could force Medicare participants to cover much of the prescription medication needs out of their own pockets.
4. The AHCA is bad for women in ways too numerous to name. The Kaiser Family Foundation does an excellent job of spelling out the problem in Ten Ways That the House American Health Care Act Could Affect Women:
   • decreased Medicaid Eligibility
   • Capping Federal Medicaid Spending
   • no more Medicaid funds for Planned Parenthood
   • no Abortion Coverage
   • Tax Credits, Premium and Cost-Sharing Subsidies based on age not income
   • Insurance Reforms: permit insurers to charge higher premiums to individuals with health problems if they have a lapse in coverage.
   • Essential Health Benefits waivers for states (automaticallyt approved)
   • Preventive Services Medicaid and Medicaid expansion patients at risk
   • Contraceptive Coverage gone
   • Pregnancy-Related Care potentially gone via state waivers

Mike Anthony (Hospital Administrator, North Brooklyn Health Network):

• What About the effects of AHCA on Long Island’s Safety Net Hospitals?
• Per America’s Essential Hospitals (a group that represents safety net hospitals), “Our hospitals could not sustain such reductions without scaling back services or eliminating jobs.”
• Ken Raske from GYNHA: 27 hospitals in NYS are already designated “institutions under fiscal stress.”
  
• By one estimate 250,000 might lose coverage, another estimate says 334,000 on LI
  
• The ACA has resulted in 25,000 more health care workers on LI. What happens to those jobs after ACA is repealed?
  
• Per Stony Brook Univ. Health economist Debra Dwyer:
  “We have some hospitals that are going to be hit pretty hard…Stony Brook University Hospital and Brookhaven Memorial Medical Center in particular because they serve Suffolk County’s more vulnerable population and made investments in response to incentives from the Affordable Care Act.”
  
• Per Dr. Victor Politi, president and chief executive officer of the Nassau Health Care Corporation says that, “repeal of Obamacare could ultimately result in his hospital receiving less federal reimbursement for patient care – and they already operate annually on a deficit.”
• Per Janine Logan, senior director of communications and population health  at the Nassau-Suffolk Hospital Council: “This is bad news for New York.
• Congressman Zeldin is intellectually dishonest. He constantly attacks Obamacare’s high premiums, deductibles and co-pays, but Obamacare had three features that enhanced insurance market stability: (1) Risk Adjustment (redistribute funds to plans with higher risk employees); (2) Reinsurance (Provider payment to plans that enroll higher-cost individuals); (3) Risk Corridors (limits losses and gains beyond certain corridors.)
• ACA architects understood that risk exposure would be difficult to measure. Even with mandated insurance and community rating, experts were uncertain about the possibility of negative impacts brought by adverse selection (sicker patients signing up faster than healthy persons). Thus, the 3-part risk smoothing. These features were expected to last a few years until markets adjusted to the new reality.

Jeanne Spier RN

As a nurse , mom, wife, daughter, consumer and family health care provider I have had decades to participate in and observe American Health Insurance. It’s a hot mess. While The Obamacare/ Affordable Care Act (and even Bush’s Medicare D ) were a very good start, the ACA was over-diluted in the legislative process, followed by what I can only describe as partisan hatred.

I am adamant we should be pushing our legislative representatives to a Single Payer/ Universal Health care plan. NOW.  It is a perfect time to do so. With every American enrolled, just like Medicare, you needn’t sign up, therefore there are no tax penalties, no lapse of coverage penalties, no worry about a pre-existing condition. Premiums, deductables, and copays are REPLACED with a “Medicare” tax deduction. No one makes money off your health. It goes with you, if you move out of state, change jobs, or lose your job, you still have insurance.

It’s cost effective to manage and administer, like our Social Security System. Pharmaceuticals are far cheaper when bartered through a national purchaser. Ask the VA. Ask those that buy meds from Canada on the internet. Ask every other industrialized country.

I hope to debunk some of the hysteria regarding the recalcitrant insurance companies. What they are doing now is no different than what they’ve been doing for decades.

• WHAT IS Insurance?- A thing providing protection against a POSSIBLE eventuality. (Derived from Middle Eng and French-) A SENSE OF ASSURANCE: A GUARANTEE
• Not one of us knows if we or our loved ones will contract a terrible disease, have a stroke, get cancer, go blind, get addicted, develop mental illness, need emergency surgery.  So insurance is our “assurance” that we can remain solvent and cared for. The current legislation is certainly a step backwards. As President Trump said, “It’s complicated.”
• We need to realize that health insurance and pharmaceuticals are for profit industries. Shareholders reap a reward from profits on your cancer, your diabetes, your bad heart, your addiction treatment, your end of life care.
• Before the ACA most of the lay public never realized how much of the money-iceberg was lying below the water line, (unless we were unlucky enough to need it to pay medical costs. You would be shocked. Before the ACA insurers could and did DROP YOU like a hot potato if you exceeded their “lifetime maximums.” Then followed Medicaid and personal bankruptcy.
• In the early 1990’s,  during an emergency hospitalization, I got stuck paying a $5000 out of pocket bill to a surgeon’ group because they were “out of network”.  We have learned how limited our options are.
• In the late 1990’s, Oxford’s “managed care” Medicare HMO, dropped their senior citizen’s coverage like hot potatoes. I had never seen so many older folks in a true panic. SO THIS ISN’T NEW.  And Oxford, Cigna, and Aetna are still here, aren’t they? So the only ones hurt were the consumers.
• During the 10 years I worked for NYHQueens 2003-2013, the cost of insurance premiums SKYROCKETED- starting YEARS BEFORE OBAMACARE.  What do insurance companies think of you?  From a very reliable source:  A United Health Care executive was overheard telling a fellow employee, “Patients are not our customers. Shareholders are our customers.”
• Personal bankruptcies are often initiated by overwhelming Health Care Costs, in some studies up to 50%.
• Planned Parenthood: 88%-97% of their services do not include abortion. They are the only source of health care for millions of women.
• Hundreds if not thousands of Zeldin’s constituents have been forced into MediCAID, the insurance for poor people. (Not MediCARE which works very well.)

Commercial insurance, commercial addiction facilities and commercial end-of-life facilities are troubling.

Repeal Obamacare’s individual and employer mandates. Fine. Replace it with a single payer program!

Viral Patek MD

Recounted stories of several patients that had been saved by ACA or suffered because of lack of health care insurance.