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Indiana's impending health care crisis calls for action throughout the entire U.S.

Rob Stone, M.D. of Bloomington, Indiana has provided us with the following background information on the effort by twenty state attorneys general to invalidate the remaining elements of the Affordable Care Act (ACA). That is followed by an op-ed he wrote for the Bloomington Herald-Times on this topic and then by a Bloomington Herald-Times editorial in support of Rob Stone's position.

Background Information

February 26, 2018: Indiana Attorney General Curtis Hill Jr. announced that Indiana had joined 19 other states* in a suit filed in Federal court in Texas to invalidate the remaining elements of the Affordable Care Act (ACA).  In his statement Hill said “The whole house of the Affordable Care Act must come crumbling down."

The ACA helped over 340,000 Hoosiers obtain healthcare.  According to the nonpartisan Kaiser Family Foundation [kff.org] 1.1 million Hoosiers under 65 have pre-existing conditions that would have made them uninsurable before the ACA’s reforms were enacted.

June 6, 2018: US Attorney General Jeff Sessions announced the Justice Department would not defend against the suit from the 20 states and the provisions of the ACA that protect consumers with pre-existing medical conditions, meaning that insurance companies could again deny coverage or charge higher rates to Hoosiers with pre-existing illnesses like diabetes, cancer, or high blood pressure.

* The other 19 states [tell friends from those states]: Alabama, Arkansas, Arizona, Florida, Georgia, Kansas, Louisiana, Maine, Mississippi, Missouri, Nebraska, North Dakota, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, Wisconsin.

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Lawsuit will hurt health of Hoosiers

By Rob Stone, M.D.
The Herald-Times (Bloomington, Ind.), June 19, 2018

This guest column was submitted by Rob Stone, M.D., of Bloomington, a practicing physician and director of Hoosiers for a Commonsense Health Plan.
 
Did anyone see the news release from the Indiana Attorney General’s office on Feb. 27 this year? The one where AG Curtis Hill announced that Indiana “has joined a 20-state coalition urging a federal district court in Texas to hold the Affordable Care Act’s individual mandate is unconstitutional.” In a speech at the Heritage Foundation in Washington, D.C., Mr. Hill went on to crow, “The whole house of the Affordable Care Act must come crumbling down.”
 
I admit I was not paying attention, either, until June 7 when the nation’s top lawyer, Jeff Sessions, announced that the Justice Department would not defend this lawsuit that Indiana is pursuing. The lawsuit aims to void the Affordable Care Act and crucial provisions in it that protect consumers with pre-existing medical conditions.
 
To be clear, anyone with a pre-existing health condition, whether it be a disability they were born with, cancer, heart disease, diabetes, high blood pressure, you name it, is in grave danger of losing their health insurance as a result of this action by Indiana’s attorney general.

We know that when people lose their health insurance it makes it difficult and expensive to receive testing and treatment, difficult to even find a doctor who will see you. We know that their health will deteriorate and people will die as a result. We know this will lead to disability, suffering and to medical bankruptcy.
 
I have practiced medicine in Indiana since 1983. For 28 years, I was an emergency physician, dealing daily with people who had no health insurance. They waited until they were desperate and in dire straights before coming into the ER for care, waited until their heart attack or their stroke was complete and no treatment would be able to reverse the damage.
 
I saw people die from delaying care because they couldn’t afford it. I saw the situation in our state get better after Obamacare. Indiana has seen a small but significant improvement in our state health rankings over the past few years. We are beginning to make progress on our infant mortality and opioid crises. All that progress could be lost if Mr. Hill is successful in his efforts as more Hoosiers lose coverage and access to care.
 
To make matters worse, Medicaid stands to be cut as well, and with Medicaid cuts, we will see rural hospitals close, which will even further aggravate problems like infant mortality and the shortage of addiction treatment options. Many rural hospitals are the largest employers in their communities.
 
Why did he feel this is something so important to pursue? How does taking health insurance away from Hoosiers come under the purview of the AG? Was he acting on his own, or at the behest of the governor?
 
I think Mr. Hill’s actions in this case are fundamentally inconsistent with the role of the attorney general and can be seen as a serious dereliction of his duty to protect the people of this state.

Either Mr. Hill should act to withdraw Indiana from this lawsuit, or else he should resign his position.

https://www.heraldtimesonline.com...

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Editorial: Indiana AG shouldn't be cheering decision that could hurt Hoosiers

The Herald-Times (Bloomington, Ind.), June 22, 2018

Indiana Attorney General Curtis Hill has claimed victory for the state based on an action that could cost 1 million Hoosiers health insurance.

As covered in a guest column by Dr. Rob Stone in the Tuesday H-T, the issue in play here is the recent announcement that the Department of Justice will stop defending core provisions of the Affordable Care Act, otherwise known as Obamacare.

One provision is the guarantee that those with pre-existing medical conditions could get insurance coverage without paying exorbitant premiums.

Hill was one of 20 Republican attorneys general who filed a lawsuit that argues the ACA is unconstitutional since Congress got rid of the individual mandate, a tax penalty for people who did not buy health insurance.

In announcing it would no longer fight challenges to the ACA, which remains the law of the land, the Justice Department said it agreed with the lawsuit Hill is part of.

That’s terrific, says Indiana’s top lawyer.

The effect on real Hoosiers and tens of millions other Americans could be devastating.

The Kaiser Family Foundation, which focuses on national health care issues, estimates that 27 percent of adult Americans under age 65 have health conditions that the ACA guaranteed would be covered. That math adds up to the more than 1 million Hoosiers referenced above. Some of those Hoosiers will continue to be covered under employer plans or other government plans, but others could be considered uninsurable on the open market, as they were before the ACA protection.

As an aside, the Kaiser Foundation notes pre-existing conditions affect far more women than men.

The attorney general, in a news release, praised the Justice Department’s decision and suggested “Congress should allow Indiana and all the other states to exercise freedom in the ways they deal with the issue of health care for their own citizens.”

The fact is, Indiana has dealt with the issue of health care fairly well in recent years with the Healthy Indiana Plan and HIP 2.0. How did then Gov. Mike Pence come up with such a successful program?

Credit for that should go to the Affordable Care Act so widely disparaged by Hill and others in his party. The reason Indiana moved to develop a plan to cover 350,000 uninsured Hoosiers rather than the 40,000 it was covering was because the ACA provided funding to expand Medicaid or a similar program. State lawmakers never would have done that on their own.

Those in the state who want to continue to bash the ACA or Obamacare ignore the fact that hundreds of thousands of Indiana’s citizens have better access to quality health care because of it.

Hill and his GOP colleagues should not have added Indiana into this lawsuit — at least not if the health of Hoosiers matters to them.

https://www.heraldtimesonline.com...

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Rob Stone has initiated a petition at change.org directed to Indiana Attorney General Curtis Hill Jr. Individuals in the other nineteen states involved may want to consider initiating similar petitions:

https://www.change.org...

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Comment:

By Don McCanne, M.D.

Our number one imperative is to enact and implement a health care financing system that will bring health care justice to every single person in the nation - a well designed, single payer, improved Medicare for all - and we should not allow anything to distract us from that goal... with one major caveat.

Because of obvious political barriers, enactment of an improved Medicare for all does not seem to be imminent, though our efforts in support should continue at a level as if it is imminent. We cannot relax in the least in our advocacy for single payer reform. That said, in the interim it is important that we do what we can on a state level to protect and improve what we do have. As Rob Stone's op-ed and the Herald-Times editorial indicate, this cruel lawsuit by the twenty attorneys general, if successful, will cause physical suffering and financial hardship and even result in death for far too many innocent residents of the United States, since an adverse outcome would apply to the entire nation and not just to the twenty states.

We must take up (virtual) arms against these attorneys general to ensure that their sick effort is defeated, this while we continue our march forward to win health care justice for all through the enactment of a single payer, improved Medicare for all.

Also keep in mind the utmost importance of casting your vote, even for the down-ballot offices such as attorney general.

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