The Congressional Budget Office estimates that 24 million people will be left uninsured with the repeal of the Affordable Care Act. While it hard to conceptualize a number that vast, to make it real you need only to condense that statistic into 24 million realities, 24 million individuals at kitchen tables across America, 24 million private worries and mental spreadsheets and silent prayers.

How big is 24 million? Big enough that even if you don’t personally feel an immediate impact, you’ll probably know someone who will. It means one of your family members, friends or neighbors will be one catastrophic event from personal bankruptcy. It means that a cancer diagnosis, a daughter with lupus, a brother with schizophrenia, a parent with Alzheimer’s, or a son with juvenile diabetes is just the beginning of a nightmare. Suffering with the illness is compounded by the agony of not being able to afford the treatment.

It means forgoing preventive care and counselling so that when patients do fall ill, their disease is often too advanced to cure. It means presenting for non-emergent care at emergency rooms – the most expensive, least effective way to receive treatment. It means missed opportunities for doctors and physician groups to intervene to reduce overall expenditures with population health initiatives instituted under the auspices of the Affordable Care Act.

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Arguably, the replacement of the Affordable Care Act with Trumpcare has the positive effect of reducing the federal deficit. Obviously, that’s a laudable goal. But Trumpcare also rewards the wealthiest amongst us by providing billions back in tax breaks to our wealthiest citizens and companies, which means that we could have simply lowered the deficit and maintained the Affordable Care Act simply by preserving the current level of taxation on these corporations and the stratospherically rich. History has shown that trickle-down economics is a fallacy perpetuated by those from whom the trickle is expected. Instead, the income gap grows increasingly wider. 

At the crux of the Trumpcare policy is the repeal of the individual mandate. The mandate is nothing more than the expectation that each citizen protect themselves as they balance out the risk pool. It is the same as collision insurance mandated to drive a vehicle; the difference is that while you may never have a car accident, it is a virtual certainty that you will fall ill. Younger, healthier people need to protect themselves as they help balance the insurance risk pool, making the insurance companies more willing to keep premiums lower and encourage more insurance participation and competition. These are Republican ideals; increasing participation and competition in a free market by ensuring an attractive population of consumers who then comparison shop for their best option. An intelligent strategy would be to enhance this, not replace it.

In his very own “Let them eat cake” moment, Jason Chaffetz suggested that the solution to lower income families trying to pay for health care was simply forgoing phone upgrades. This speaks volumes to the lack of understanding of what American families face.  Most families can’t afford the option of health savings accounts when there are other, more pressing issues. And the most generous health savings account balance is woefully insufficient to pay for one day of a hospitalization. He and his fellow party members clearly lack the insight and compassion to understand how millions of Americans live in fear of an unforeseeable adverse health event, not just because of the impact on their well-being but because of the devastation on their finances.  

Numbers such as “24 million” are abstract in theory. These are 24 million people – children without health coverage, women with no prenatal care, men without the means to seek medical attention when they aren’t sure if that pain in their chest is reflux or their first heart attack. Twenty-four million families hoping choosing not to change jobs or worse, lose their jobs, as to not create a break in coverage continuity.  Twenty-four million people lying awake at night wondering how to afford all that needs to be afforded and how to prioritize. Fifty states battling a growing opioid epidemic with a shrinking budget.

In short, 24 million is not the tally at the bottom of a spread sheet. Twenty-four million is not an incidental causality of an imperfect system that is being manipulated for political fodder of the majority party. These are 24 million human lives.  If health care is to be determined by politicians instead of physicians, then they need to adopt the oath each doctor recites at the inception of their career – first, do no harm.