Baltimore City Health Commissioner Leana Wen has some serious concerns with Republican lawmakers’ proposed replacement for the Affordable Care Act.

Republican representatives in Washington yesterday unveiled the 123-page American Health Care Act. The bill aims to replace President Obama’s landmark legislation that required most Americans to get health insurance, at risk of a financial penalty, with a system of tax credits that pushes Americans to buy insurance from private companies, rather than a federal marketplace.

President Obama’s law, passed in 2010, enabled an estimated 20 million uninsured Americans to get health insurance via government-run marketplaces and vastly expanded Medicaid coverage for the poor. Republicans and insurance companies have pledged for years that they would scrap the law in favor of a system centered around the private sector.

Under the proposed new bill, which has already received pushback from key Republican senators who wanted something stronger, the government would replace government subsidies for insurance companies with tax credits to individuals based upon their income or age. It would also eliminate the penalty imposed by Obamacare for those who live uninsured, but instead allow insurance companies to charge people extra if they have coverage lapses before they do sign up for plans.

Today, Baltimore City Health Commissioner Dr. Leana Wen issued a statement listing six provisions of the bill that she says would have “drastic consequences” on public health. Chief among them is the subsidy-based system, which she said “punishes those with lower wages by eliminating subsidies to help pay for insurance coverage based on a person’s income.”

Presently, insurance companies receive subsidies to cover individuals who make a relatively low amount of money. Dr. Wen argues the proposed tax credit method, which would pay them at one point in the year, would push them to delay getting necessary medicine and treatment and drive more individuals to use emergency rooms only when they are “very ill and their care becomes unnecessarily expensive.”

Wen also says a provision that caps Medicaid spending will create large drops in coverage that “hurt those who are the most vulnerable—including seniors, women, children, people with low incomes and individuals with disabilities.”

This is particularly valuable for Baltimore, which has an estimated 25,000 people addicted to drugs, because Medicaid has improved access to treatment for those addicted individuals, Wen said. Our health commissioner has been recognized for targeting addiction as a disease, championing the overdose-reversing drug naloxone and expanding access to drug addiction treatment.

The other components of the American Health Care Act she highlights as bad are:

  • Replace the penalty for lack of insurance with surcharges from companies, which she said would retroactivity hurt the ill when they do get coverage;
  • Revoking funding for Planned Parenthood (due in part to its provision of abortions, which in reality account for a small share of the organization’s services), which will reduce availability of other reproductive health services, cancer screenings and preventative exams;
  • Eliminating an Obamacare requirement that health plans cover hospitalization, maternity care, mental health services and other “essential benefits”;
  • And cutting the Public Health Prevention Fund, which Wen said provides nearly a sixth of the Centers for Disease Control and Prevention’s budget and would in turn reduce preventative care for diseases like hypertension, cancer, and diabetes, and also make the country less ready to fight off epidemics and infectious diseases.

“I urge for our elected officials to consider the impact of this ‘replacement’ plan on the health and well-being of our nation,” Wen said.

Maryland Rep. Andy Harris, a trained doctor who was at one point considered to run the National Institutes of Health under President Trump, praised his fellow Republicans’ bill today on WBAL’s C4 Show, saying it “winds down” Obamacare without leaving too many out to dry. He also said it will transfer Medicaid funding from the federal government back to states and cut down on “fraud and abuse.”

“We’ll get away from the heavy-handed government mandates of Obamacare that, for the vast majority of Americans, caused increases in their premiums,” he said.

Harris also said the notion that 20 million Americans would lose coverage is “ridiculous” and that many of those with existing plans already have egregiously high deductibles that could be lowered under the new law.

The Congressional Budget Office still needs to analyze the potential costs of a massive overhaul of the nation’s health care system, though The Washington Post reports House committees want to move the bill forward to the floor before they determine exactly what those costs would be.

Ethan McLeod is a freelance reporter in Baltimore. He previously worked as an editor for the Baltimore Business Journal and Baltimore Fishbowl. His work has appeared in Bloomberg CityLab, Next City and...