Editor’s Note: Welcome to Medical Economics’ blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Lori E. Rousche, MD, a family physician in Souderton, Pennsylvania. She is also the hospice medical director for Grand View Health in Sellersville, Pennsylvania. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


Lori Rousche, MDThe repeal and replace of The Affordable Care Act, or Obamacare, has failed. The current White House’s push to rewrite healthcare is on hold. As per our president, he is waiting for Obamacare to explode, and then maybe change will happen. Obamacare certainly has its flaws. Premiums are increasing at an untenable pace and several million United States citizens remain uncovered.


Further reading: What AHCA’s failure means for physicians


 Although I am no great fan, there is a very favorable element of the ACA that I would be loath to see disappear. That is the program’s expansion of Medicaid. Medicaid is a joint federal and state program that covers millions of low income Americans, including families and children, pregnant women, many nursing home residents and some people with disabilities. If the Medicaid expansion was repealed and federal spending on Medicaid was decreased as planned, many patients who are currently covered would lose that coverage. That leaves some of our most needy patients in a potential healthcare crisis.

Let’s consider Mr. K.’s situation: He is the stereotype of the vulnerable elderly. This is a 94-year-old widower who lives with his cat. He has multiple medical problems including heart disease, heart failure, hypertension and venous stasis. His biggest issue, however, is mobility.


In case you missed it: Fight not over to preserve ideal patient care, says ACP


Due to spinal stenosis, he has an extremely difficult time ambulating. At some point in the near future, he will be forced to leave his home and reside in a nursing facility. Mr. K. should have been in an assisted living community years ago, truth be told. He reports he just doesn’t have the money for admission anywhere, especially somewhere that would allow him to keep his cat. Because property taxes in our part of Pennsylvania are so high, he has had to take a loan out just to cover the taxes for the last three years. His income is fixed, with just his social security money available.  

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Medicaid expansion must remain safe in healthcare reform