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Thursday, 25 October 2018 06:49

This November, I'm Voting for My Patients

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One of the many great parts of Saturday Night Live's recent skit about the Brett Kavanaugh hearing on the series' season premier was the cardboard image of Alyssa Milano floating in the background. Although a very a funny image in the skit, Milano's actual presence at the hearings holding up an "I Believe Survivors " sign was a reminder of the passion fueling American politics right now. Our current state of politics is pulling unlikely activists into the limelight like Milano, who has spoken about her presence at the Kavanaugh hearings to support Dr. Ford and the #MeToo movement.

While I am glad that Milano and others have used their celebrity to affect political change, Milano's presence at the Kavanaugh hearings reminded me that political passion is not reserved for celebrity. With the mid-term elections coming, we can all step out to speak and share our truth.

As a Nurse Practitioner, I will be voting for my patients.

I will be voting for my patient with diabetes who builds motorcycles and loves to ride. After many years without access to care, he has developed numbness in his feet from his diabetes, making his rides harder and less frequent. The implementation of the Affordable Care Act (ACA) in 2014 expanded health care coverage to millions in the United States including my patient. But the repeal of the individual mandate is set for January 2019 and will severely cripple this step forward. Millions, like my patient, will once again be uninsured.

I will be voting for my uninsured patient newly diagnosed with cancer waiting for an oncology appointment at our large county hospital. Overwhelmed with uninsured patients, hospital wait times can be high. But at least I was able obtain an early diagnosis for her and refer her to quality care. Many without insurance are not so lucky. According to the Institute of Medicine, uninsured adults are more likely than insured to be diagnosed at an advanced stage of cancer.

I will be voting for my patient with ulcerative colitis. When she was first diagnosed, she had health insurance. When she switched insurance plans, she lost coverage as a pre-existing condition. She was not alone; 52 million under 65 have a pre-existing condition. The ACA barred health insurers from excluding people because of pre-existing conditions, giving my patient hope. In February, a federal law suit in Texas seeks to strike down the entire ACA, taking this vital protection with it.

I will be voting for my low-income patient who wants to avoid an unwanted pregnancy. Proposed changes to Title X funding could shrink the number of clinics and family planning resources. It will also elevate the priority of natural family planning and abstinence counseling above clinical standards of care and limit the provision of the full range of contraceptive methods. President Trump's commitment to the appointment of "pro-life" justices, including Judge Kavanaugh, to the Supreme Court may also negatively impact the legacy of Roe v. Wade and reproductive rights.

And I will be voting for my immigrant patients who, based on a proposed rule from the Department of Homeland Security, may have to choose between health care, food and housing, and the opportunity to obtain a green card. This proposed rule could cause 5.5 million to either dis-enroll in Medicaid or fail to sign up. Potential consequences could include worse health outcomes, increased use of emergency rooms for primary care, and increased communicable diseases.

Just like many object to celebrity involvement in politics, many may challenge the role of politics in health care. Yet as a provider at a large free medical clinic in Chicago, I cannot turn my thoughts away from the millions that remain uninsured across the country and the challenges that my patients face.  About 50% of all US health care is funded by federal and state governments. But Republicans want 2018 to be a year for further attempts to repeal and replace the ACA. And Senate Republican leader Mitch McConnell has stated disappointment in their failure last year to overturn the signature healthcare law.

The ACA brought my patients hope for access to health insurance, coverage of pre-existing conditions, and accessible contraception. But rather than repealing the protections that were gained, could we vote for candidates who will build on the progress made in the ACA?

November is coming. My patients and I may not be as high profile as Alyssa Milano. Nevertheless, my passion runs high. If things don't turn differently this November, that may be me you see holding a "Healthcare is a Human Right" sign during the next Senate hearing.

Margaret Perlia Bavis is a Family Nurse Practitioner and an assistant professor at Rush University College of Nursing and a Public Voices Fellow with the OpEd Project.