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Get Well Senator McCain, But Take Your Time


With Senator John McCain (R-Arizona) recovering from a medical procedure and unable to make it to Washington, DC for a vote on the Better Care Reconciliation Act, the Senate has been forced to delay proceeding on this piece of legislation for the time being. This pause in the rush to repeal and replace the Affordable Care Act should Americans the opportunity to express our wishes to our Senators. For me that’s Ted Cruz and John Cornyn who both play pivotal roles in the health reform debate.


As a physician, I agree with most other health care provider and patient advocacy groups that this bill – in its current form – is toxic to patients. There are, however, a few ways our Senators could limit the toxicity of this bill. The revised version released on July 13th pumped $225 billion back into system by keeping taxes on wealthy Americans like me and my fellow physicians. As a doctor who is glad to pay those taxes, I’d like to see them used where they could best help my patients.

First, the Senate proposal decreases the rate of growth of Medicaid by converting it from an open-ended entitlement to a program with a set amount of money per enrollee. While this stabilizes and improves predictability in costs from the federal government’s point of view, the formula used to calculate growth is faulty. Instead of increasing the per capita cap for Medicaid at the general rate of inflation, our Senators should make sure that the Medicaid growth formula is pegged to the higher rate of medical inflation. Otherwise, over 1.8 million Texans could lose Medicaid coverage.

Secondly, the Senate proposal negatively impacts the marketplace for individual health insurance. Hundreds of billions of dollars that went to help fund people’s insurance on disappears, as well as extra dollars called cost-sharing reductions which helped people earning under $30,000 afford their copays and deductibles. These funds ought to be restored. If not, another half a million Texans could lose private insurance.

Lastly, the Senate bill isn’t completely awful. The proposal provides some subsidies to people under the federal poverty line to pay for private health insurance premiums instead of relying on Medicaid. This is a terrific fix for the Affordable Care Act. As it is constructed now, people in states like Texas that did not expand Medicaid and live below the poverty line are unable to receive any financial assistance when buying health insurance on However, with high deductibles estimated to be nearly $6,000, few people would choose private insurance. How could someone earning under $11,000 per year afford that? The Senate proposal should be modified to extend these so-called cost-sharing reductions to poor Texans who want to buy private health insurance instead of using Medicaid.

I work in the county health system. I primarily treat people who are either uninsured, have Medicaid, or are on an Obamacare plan. I cannot help my patients without the generosity of the taxpayers funding their care. So in a way, every one of you that reads this and pays your taxes is just as responsible for saving lives as I am. So please, help us – the doctors, nurses, techs, and all the others who care for the least fortunate – by asking your senators to consider these three improvements to the Senate proposal before John McCain heals up from his surgery and flies back to Washington DC to cast a vote.

Cedric Dark, MD, MPH, FACEP
About Cedric Dark, MD, MPH, FACEP

Cedric Dark, MD, MPH, FACEP is Founder and Executive Editor of Policy Prescriptions®. A summa cum laude graduate of Morehouse College, Dr. Dark earned his medical degree from New York University School of Medicine. He holds a master’s degree from the Mailman School of Public Health at Columbia University. He completed his residency training at George Washington University. Currently, Dr. Dark is an Assistant Professor in the Department of Emergency Medicine and a Health Policy Scholar in the Center for Medical Ethics & Health Policy at Baylor College of Medicine. He produces a health policy podcast for the American Academy of Emergency Medicine. Dr. Dark’s commentary and opinions on this website are his own and do not represent the views of Baylor College of Medicine or the American Academy of Emergency Medicine. Contact: Website | Facebook | Twitter | Google+ | YouTube | More Posts