Bronx hospital doc fears what will happen to patients, urgent care access with ACA repeal

Ira Kirschenbaum.
 Ira Kirschenbaum

Although it’s still unclear what a repeal and replacement of the Affordable Care Act will look like, one New York orthopedic surgeon said it will be a disaster if it’s anything like President Donald Trump’s dramatic and immediate immigration ban.

In an exclusive interview with FierceHealthcare, Ira Kirschenbaum, M.D., chairman, Department of Orthopaedic Surgery and director of Surgical Operations at Bronx-Lebanon Hospital Center, says the health reform law was flawed, but that doesn’t mean he thinks it’s a good idea to return to a pre-ACA world.

"If we see a sizable decrease in the number of people who are insured again, from a physician’s point of view, we will see problems with uninsured patients getting access to coordination of care," he said.

The replacement plan must be carefully considered and rolled out to avoid the trauma that occurred last week when the White House administration ordered an immigration ban, which created a chaos across the globe, according to Kirschenbaum.

"We don’t really know what the word repeal of ACA means, so right off the bat, if the repeal was like Trump’s ban on immigration and all of a sudden 18 million people didn’t have healthcare, it would be an absolute disaster," he says.

Replacement plan must ‘do no harm’

Most physicians, Kirschenbaum says, think about the individual human life and don’t believe in acceptable losses. So while some may not think a few million people losing insurance is that big compared to the 324 million people who live in the United States, it matters very much to the medical community.

“The rule in medicine is, first do no harm. So whatever you do with 18 million people potentially uninsured, you need to do no harm,” Kirschenbaum says.

Consider, he says, an uninsured patient who goes to an urgent care center for a wrist sprain. That patient may not seek follow-up medical attention and that wrist injury will likely turn into a long-term chronic disability. Multiply that scenario by the millions who could lose their insurance and you have a setup for a catastrophe.

“If you have a 27-year-old adult who is no longer on his parent’s health plan now walking the planet and twists his ankle, he may have to pay $40,000 to fix it. No one could afford to fix a simple broken ankle. Just imagine if he had a chronic disease,” he says.

Critical need for preventive care, early screenings

Kirschenbaum also foresees a public health problem if these uninsured patients don’t get care and therefore don’t get early diagnoses. If patients don’t catch those conditions early, that early problem becomes a complex problem. The Affordable Care Act provided for preventive care and screenings. The public health implications could be great if women don’t get cervical screenings, men don’t get prostate screenings, and patients aren’t diagnosed early with diabetes or hypertension.

Patient worries differ depending on the age group, according to Kirschenbaum. Younger patients are more concerned about urgent situations, such as an injury after playing sports, and older patients are worried about general access to care.

Replacement must consider high-risk pools

As for a potential replacement plan, Kirschenbaum says it must address costly, high-risk patients. “Everyone has a solution for a healthy patient who is 26 years old. That’s easy. But what about high-risk pools? Those patients who already have hepatitis, HIV or diabetes—what’s going on for these people? They must allocate resources for them.”

Kirschenbaum believes access to healthcare is something a civilized society offers its citizens. That means a health plan that assures them access to care for acute issues and prevents them from becoming bankrupt if they have a chronic disease. He would like to see options that allow patients to buy Medicaid and Medicare insurances at a reasonable price.

But a replacement plan also requires a solution that doesn’t burden hospital emergency departments. If millions lose their health insurance, those uninsured patients will often seek care at their local emergency room and that’s not a place to receive well care, preventive care and general medicine care. “I’m fearful as a physician that the decrease in the number of insured puts pressure on ERs and urgent care centers, and that care will be temporary,” Kirschenbaum says.