Doctor knows best

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Indian-American physicians discuss changes to Affordable Care Act

Since its inception in 2013, the Affordable Care Act has been attacked and defended mainly on a partisan basis. However, for more than a year, critics and supporters as well as consumers, have picked holes in the implementation of this novel system that brought an unprecedented number of Americans under the health insurance umbrella.

The strongest critics of the system were Republicans who now control Congress and the White House, calling for repealing and replacing Obamacare. It was also then presidential candidate Donald Trump’s war cry as well.

Within the general public however, the line between supporters and critics has thinned, and that is reflected in the views of physicians of Indian origin who make up a significant proportion of healthcare givers in this country. Some estimate that at least one in seven patients nationwide is treated by an Indian-American physician. Those interviewed by News India Times, including supporters, agree some aspects need preserving and others done away with.

For decades, Indian-origin physicians have worked in rural and underserved areas as part of their training, developing bedside skills and an undeniable pride in their ability to deal with multicultural America. Many see President Trump as a pragmatist who will not be deaf to voices of experience that say, keep the best and change the rest. Former Obama supporters, while not praising Trump, want to engage in bringing about change for the most vulnerable, as discussions proceed at the national level.

Interviews with older Indian-American physicians and younger practitioners reveal those on both sides of the aisle, expect their voices heard about where taxpayer dollars should go in the existing healthcare system, and what should be the priorities going forward as Obamacare comes under the anvil.

There is universal agreement among physicians about the plus-points of Obamacare – health insurance for some 22 million people especially the more economically vulnerable, coverage of kids under their parents’ insurance until age 26, coverage of pre-existing conditions, and continued coverage under new illnesses, as well as women’s coverage. All those interviewed wanted these to continue. Predictably, supporters credit Obamacare with many more accomplishments, especially those working in inner city areas, but critics abound.

“Obamacare has pluses and minuses,” says Dr. Seema Jain, former president of the American Association of Physicians of Indian Origin (AAPI). Her views on the pluses and minuses echoed those of some others News India Times spoke to.

Physicians (and patients) are experiencing longer wait-times for patients; sicker patients by the time they are seen by a physician; too much paperwork; rising problems with homecare because patients come in to see doctors when they are already quite sick; high deductibles and rising deductibles keep patients from seeing doctors on time which means interaction between doctor and patient. For patients, access to care takes longer; premiums are very high for some, especially small business owners among which are Indian-American physicians and healthcare personnel, penalties for not insuring, what to do if generic medicines are not available for some illnesses and the high cost of non-generic meds.

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“Very high deductibles are very impractical for those covered by Obamacare,” said Dr. Sudhir Parikh, an allergist with several clinics in the New York tri-state area, and publisher of News India Times. “In reality that ends up having a worse health outcome,” said Parikh who is also a recipient of India’s Padma Shri award. He also criticized the inability of insurance companies to operate across borders, resulting in one or other company dominating coverage. The government could offer tax relief for those paying a high deductible for care, Parikh suggests.

“It has to be a hybrid between Obamacare and Trumpcare,” Parikh opines.

Dr. Manan Trivedi, president of the National Physicians Alliance, is a staunch Obamacare supporter and apart from the usual plus points in the ACA, he says, as a physician he is all for the preventative care benefits which are mandatory for insurance companies to provide free of cost. “This is critical for patients.” An Iraq War veteran, Trivedi has tried repeatedly to get elected to the U.S. Congress to make a difference, and lost from Pennsylvania’s District 6.

“I welcome the discussion on how to make ACA more affordable,” he says. “But repealing without a better replacement would be devastating,” Trivedi contends. “We are willing to discuss changes,” he says about the National Physicians Alliance. But he contends, any alternative to the complaint of “high deductibles” would make costs even higher. On the issue of allowing insurance companies to cross borders, he says, “That’s a race to the bottom. Every state would become like Louisiana for example, where the regulations are much looser.”

At the same time, he concedes, “I get that businesses need to make money. But we want our patients to be covered.” As for the complaint about more paperwork, he says, “That has nothing to do with Obamacare. It has to do with insurance companies.”

“We need to figure out how doctors can be talking more to patients and documenting less and there are pilots going on for testing that model,” Trivedi said. Primary care and reproductive health are extremely important, he said. “If everyone could sit down and discuss rather than politicize healthcare, it could work,” he emphasizes.

Dr. Vinod Shah of Maryland, a former president of AAPI said, “We spend $3.4 trillion on healthcare and half of that cost is on less than ten percent or less of the population.”

An aging population needing more care needed to be managed, as did the rising need for mental health services and the “extraordinarily” high cost of hospital care, the Indian-American physicians agreed.

“We need to shift some of that hospital care to outpatient settings,” Shah suggested.

The emphasis on “procedure” rather than clinical care was a concern expressed by those News India Times spoke to. More doctors prefer joining an institution rather than opening clinics.

“There’s no real desire to go to smaller communities and set up clinics like we did 40 years ago,” Shah said. Perhaps a solution could be providing incentives to do that through federal programs, he suggests.

Several of those interviewed credited Indian-American physicians with having greater patient empathy, better bedside manner, and clinical care qualities of family physicians, not least because foreign medical graduates served in rural areas and inner cities as part of their first years of service.

Dr. Manik Chhabra, 35, who did internal medicine and his residency at Yale, would not work anywhere else but in an inner city area.”I view it as my obligation to serve in areas with the highest needs and where I can use my skill set,” he told News India Times. For his patients, Obamacare is a boon and he warns those wanting change to keep in mind the consequences.

“I see the changes being proposed (in ACA) as really a direct threat to my patients in inner Philadelphia,” Chhabra said.

“My patients belong to vulnerable groups – the impoverished, veterans, etc. and I strongly believe the Affordable Care Act has provided many protections and increased access.”

Among the multiple benefits, he counts increased coverage for substance use disorders, i.e. addictions, increased access and numerous payment options.
“Given the amount of attention to the opioid crisis in rural and urban areas, defunding Obamacare would take away billions of dollars from this area,” he feared. Where he practices, issues of rising costs of insurance or increased paperwork, does not apply.

“But I do think premiums are increasing but not as fast or as high as they would without Obamacare, he contends. And patient wait time may be increasing because more people are able to access healthcare services and get help.

“If we have to make changes to deductibles or insurance plans, we have to be really careful,” he warned.

“When the dust settles, the good parts of Obamacare will be kept,” according to Dr. Shah.