Preexisting From the Start

As the American Health Care Act made it through the House, I felt great concern for my patients. Working as a Neonatology Fellow in the Neonatal Intensive Care Unit (NICU), I take care of many premature and critically-ill babies. I work with an amazing team that includes neonatal nurse practitioners, neonatal nurses, respiratory therapists, nutritionists, pharmacists, social workers and so many more. On any given day, one little baby can have between three to ten physicians, nurses, and other NICU team members providing care for the baby and support for their family.

Despite the constant intensive care these infants receive, the likelihood that any given neonate will leave the NICU with a chronic medical condition and/or an increased risk of developmental delay is, unfortunately, high. While technology has advanced greatly in recent years, a baby born prematurely will not grow and develop as well as he or she would have inside the womb.

Take, for example, a baby born at the earliest of viability. This baby would have only spent between 23 to 24 weeks in the womb (instead of 40) and weigh barely over 1 lb. A baby born at this gestational age has an incredibly underdeveloped brain, lungs that are not ready to be breathing in oxygen, kidneys that cannot effectively regulate water and salt, and intestines that aren’t prepared for breast milk or formula. Their skin is so thin that using even the smallest tape to attach cardiorespiratory monitors can cause significant tearing and bleeding. This baby will stay in the NICU for three to six months and need to receive intravenous access for medicines and nutrition. The baby is at an incredibly high risk for serious infections, significant bleeding in the brain, kidney failure, and many significant organ problems. If the baby survives, they may need continued respiratory and feeding support when he or she is ready to leave the NICU. They will, definitely, need developmental support. Upon discharge, this baby will need follow-ups from their primary pediatrician, developmental pediatrician, physical therapist, speech therapist, and occupational therapist.

Without making a single choice in his or her life, this baby will already have been diagnosed with multiple diseases, thereby having multiple pre-existing conditions. While the Affordable Care Act expanded Medicaid and protections to individuals with pre-existing conditions, TrumpCare stands to make it easier for insurers to raise premiums or deny insurance to those same individuals. This stands to cause even more harm to families already on a tight budget, who now have higher deductibles to cover when their baby has to follow-up with multiple specialists.

Because of this, the American Academy of Pediatrics (AAP) was strongly against TrumpCare. The AAP covers nearly 66,000 healthcare providers associated with the Pediatrics profession, including myself. Despite the AAP’s and most other healthcare organization’s strong opposition to the AHCA, most Republicans in the House completely ignored those of us who’ve seen the benefit of health insurance to our patients.

That leaves me with significant concern. As a Pediatrician and Neonatology Fellow it is part of my job to advocate for babies and children who are unable to do so for themselves. The American Health Care Act pushed by President Trump and his Republican colleagues will harm children and their families if passed in its current state. My patients’ families will find affordable health insurance more difficult to come by, and that is unacceptable. I stand with the AAP in strong opposition to TrumpCare and will continue to advocate for the babies and their families who will be negatively affected by this legislation. As the AHCA heads to the Senate, I strongly encourage all individuals who feel that health care should not be prohibitively expensive or denied to individuals based upon pre-existing conditions to call their Senators and voice opposition to TrumpCare.