Dear fellow Pennsylvanians:

We write to you as five Pennsylvania physicians – a pediatrician, an emergency room physician, two primary care physicians and a psychiatrist.

And we write with a sense of urgency – because we are worried about you, we are worried about our ability to care for you, and we are seriously worried about the plan unveiled in Washington last week that claims to solve problems with American health care.

And you need to be able to afford that care – to afford a premium, if there is one, and/or or a co-pay. "Afford" does not mean 20% of your income. It means you can go to the doctor while feeding your family and paying your mortgage.

Critics of the Affordable Care Act have noted that high deductibles for visits and medications stop you, our patients, from getting care. They are correct.  But the health plan proposed last week, which Republicans are trying to rush through Congress, makes that problem worse, not better. Simply put, the only people who will be better off are those who are healthy and well off financially. If you are middle income or below, and are sick or might someday get sick, you will be in a world of hurt. That doesn't make sense to us as doctors.

  1. We always leave our crystal balls at home. Predicting the future is not a medical school course.  We can't see you today and know you will be in an accident tomorrow, or have a hidden tumor found, or become depressed, or develop diabetes.  So we can't tell you what kind of health insurance you will need in the future.

  2. We doctors know that the healthy have to help pay for the sick. Congress has missed that lesson. Those who are already sick, or struggling financially, will never ever be able to pay their own way.  Never, no matter how much you might want to, or others might want you to.

Here is our simple message to you.

The Affordable Care Act was far from perfect. But in Pennsylvania, 600,000 people received expanded coverage under Medical Assistance (a.k.a. Medicaid). That might be you.  And over 400,000 people bought coverage through the Obamacare marketplace, or exchange, 75% of them with help from the government.  That might also be you. Because of this, we have been able to care for you.

The seriously flawed plan of the new administration will take this away.  It will ask the legislature in Harrisburg —and in Trenton, Dover, and many other state capitals — to decide whether we want to use this program to care for our elders, for our pregnant women, or for health care for our rural citizens in low-paying jobs. It will not give us enough money to take care of everyone.    Even with its problems, the Affordable Care Act ("Obamacare") allows Pennsylvania to care for its citizens, and us to care for you.

We don't want the Federal government, or the Pennsylvania legislature rationing care. We want to care for you.

We hope to keep working, with you, for lower premiums, lower deductibles, and maintenance of Medicaid expansion.

Please help us do that. During the election campaign, many politicians promised that repealing and replacing Obamacare would mean improved coverage. Health care is indeed complicated. Maybe that was hard to understand last November, during the election.  But we want to make it easier to understand now.

This bill will not improve coverage; in fact, millions of Americans will lose health care coverage, perhaps including you or your neighbors.  Now that you know, let your Pennsylvania and Washington legislators know that this is not what you want.  Please help us care for you.

Gene Bishop is an internist in Philadelphia; Esther Chung, pediatrician, Philadelphia; Theodore Corbin, emergency medicine physician, Philadelphia; Kenneth Thompson, psychiatrist, Pittsburgh; Robert Winn,  family physician, Philadelphia.

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