As an ER doc for 20 years I thought I'd seen it all: outbreaks, death, you name it. But this #pandemic is the worst. Due to mass layoffs, millions will now lose insurance & not get treatment, causing them to die and/or spread it.
Here's what @realdonaldtrump is missing... (1/13)

As layoffs continue, even more will lose their health insurance. What happens to them? After you lose your job, you get 60 days to enroll in plans on the exchanges. But many of them have high deductible & high co-pays, making them unaffordable to many who just lost a job. (2/13)

With #COVID19 we're seeing many patients with serious respiratory symptoms requiring hospitalization & even life support. There will undoubtedly be many without insurance who won't seek treatment even though they need it. Therefore, there are a few things we must do ASAP. (3/13)

First: Given the lack of early widespread testing, the only way hospitals can avoid a crippling influx of patents is a nationwide shelter-in-place to decrease the transmission of this novel virus that is twice as contagious as influenza, and for which there is no vaccine. (4/13)

Meanwhile, many businesses have temporarily closed their doors, leaving millions of Americans without a paycheck. In a “good economy” we've still had 30 million uninsured in this country. With millions more added to the rolls, it means more people will inevitably die. (5/13)

The math gets really bad. A huge increase in the uninsured, combined with a #pandemic with a 15% hospitalization rate where 5% go to ICU...  equals huge, un-payable medical bills for a ton of people (even with a plan from the exchange, which could have a $5k deductible). (6/13)

The only reasonable solution for this uninsured crisis is a government-funded payment system for healthcare. But the president's idea to pay hospitals for #COVID19 treatment only, doesn't work: many with symptoms won't get checked, in case it ends up being something else. (7/13)

Because of the continued lack of tests, many with symptoms won’t get tested. They will be discharged with a diagnosis of “Presumed COVID19.” Will the President pay the medical bills of these people, or will he act like for-profit insurance companies and deny payment? (8/13)

The president's plan doesn't address our uninsured issue because these Americans will get sick in other ways. Their chronic illnesses will go untreated putting them at higher risk of complications if they get infected. Fortunately, there's a better way to do this... (9/13)

We should extend Medicaid to the unemployed. It currently covers those with income below the poverty line, and "Medicaid expansion" covers those from 100-138% of the poverty line. This expansion group is funded by the federal government at 90% of expenses. We must do more.(10/13)

Congress should expand Medicaid to all unemployed individuals with a 90-100% reimbursement to states from the feds. The insurance industry won't like this, but it's best for America. And means we wouldn't need emergency payments to hospitals from the federal government. (11/13)

By using the existing Medicaid system, we can avoid delays in coverage that will inevitably occur with exchange-based purchasing of plans. In addition, many individuals will simply not buy insurance when faced with unaffordable cost-sharing associated with seeking care. (12/13)

This is the most straightforward approach to dealing with the impending increase of uninsured individuals lacking care in the face of a health emergency.

The status quo -- and the president's "plan" -- are wholly inadequate. We must get Americans the healthcare they need. /END.