Health Insurance Reform Could Lead to Patient Abandonment: Why the Silence?

Richard E. Anderson, MD, FACP

Will Washington cancel coverage for millions of patients and unleash a tidal wave of litigation on the U.S. healthcare system? I challenge leaders in healthcare and government to address this question.

Not a day goes by that we don’t read something about the effort to repeal and/or replace the Affordable Care Act. The House of Representatives passed their version of the American Health Care Act in May and the Senate so far has not been able to gather enough votes to repeal or replace. Whether they could reconcile the differences and get a bill to the President remains an open question.

Politics aside, what matters most to me is what I am not hearing—details about a specific, well-thought policy that would preserve access to care and protect the healthcare system from what could become a litigation nightmare.

Any replacement legislation must address the potential for patient abandonment. If the Congressional Budget Office is correct and millions of patients lose their health insurance, many patients won’t be able to pay for continued care. For those who are actively receiving treatment (think diabetes, pregnancy, cancer, coronary artery disease, stroke) physicians would be faced with an impossible choice: to continue treatment in a setting where medications, imaging studies, hospitalization, and consultant care are not available, or face a legal and ethical quagmire of patient abandonment. The predicates for this charge are well established:

  1. The doctor patient relationship is established.
  2. The patient still needs medical attention but is unable to find a suitable alternative.
  3. Injury or worse, results.

Litigation is almost certain to ensue. And “the patient could not pay” is rarely, if ever, a successful defense strategy.

If tens of millions of people lose coverage, it is not difficult to imagine that tens of thousands of them will find themselves in this situation. We could see then that tidal wave of malpractice litigation visited upon America’s physicians. It makes me wonder: Is that what the Congress and the President want?

I hope not. But that begs a set of follow-on questions: Why is this issue not being openly discussed? Where is the voice of organized medicine? Why aren’t the AMA and the national specialties societies not drawing attention to this problem? This isn’t a political issue; it is a far more serious matter with grave personal and legal consequences. In the extreme, it is a matter of life and death that doctors must think about every day.

No physician wants to contemplate the abrupt termination of a patient who desperately needs care. And whether or not the estimate by the Congressional Budget Office is correct, physicians simply cannot tolerate uncertainty with such serious consequences.

Thoughtful physicians—and their patients—need to see that this issue is addressed. The question is the same to members of Congress and the leaders of organized medicine: “What is being done to prevent patient abandonment in any reform, repeal, or replace program?” It is an issue that cannot be left to chance.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.