Donna Torrisi is scared to death about Republican plans to repeal Obamacare.
Torrisi is a nurse practitioner who heads Philly-based Family Practice & Counseling Network (FPCN, for short). Through six gleaming nurse-managed health centers, FPCN provides primary healthcare for 23,000 low-income patients, most of them the working poor.
"My stomach is in knots," says Torrisi. "I don't know what we'll do if we have to go back to the way it was."
Neither do her patients.
Ervin Perkins, Elise Cannon and Debra Shanks are three of them. They were all uninsured until they enrolled in Obamacare and now receive care at FPCN's big, cheerful East Falls campus.
Cannon, 60, had a heart attack after a lifetime of taking better care of others than of herself. Shanks, 62, who retired early to look after her mom, who later died of Alzheimer's, landed in the ICU for a month when her gall bladder ruptured. Perkins, 60, had been in an accident that ruined his knee and left him in such bad pain he had spiraled into despair.
All needed not just urgent care and rehab for their bodies but follow-up therapies to dial back the stressors that had contributed to their medical catastrophes.
Because lower stress promotes better health, which results in fewer ER visits, hospitalizations and unpaid bills. Which - see how sweet this is? - lowers stress.
I'd call them clinics, but that would give a wrong and forlorn impression of the compassionate, high-quality, dignified care that Torrisi and her staff provide.
The network, a program of the national nonprofit Resources for Human Development, has won reams of local and national best-practice awards for its model of care, and Torrisi is regularly lauded and honored for her leadership and vision.
Before the Affordable Care Act, known as Obamacare, was passed, 25 percent of FPCN's patients were uninsured. Because the network treats everyone regardless of ability to pay (it offers a sliding-fee scale), it had to eat a lot of the cost of providing primary, behavioral, dental and preventive care.
"It was a constant struggle to break even," says Torrisi.
But thanks to Obamacare, the number of uninsured network patients has plunged to just 9 percent. So the network is actually getting paid for more of the services it used to provide for next to nothing.
Torrisi has used the new income to expand behavioral health services, like stress and pain management, smoking cessation, individual and group counseling and mind/body classes.
These have been absolute game-changers for her patients' health. Many have a history of childhood trauma, which, research shows, makes them more likely to suffer as adults from heart disease, obesity, diabetes, tobacco use, substance abuse and chronic pain.
"The consequences of trauma are really complicated," says Torrisi.
Because of the broader services, though, more of FPCN's patients aren't just getting better. They're getting well.
As FPCN behavioral health consultant Susan Bash likes to say, "We help patients cope and hope."
And, wonder of wonders, thrive.
"I feel great," says Cannon emphatically. "This place has taught me how to take care of myself."
Says Shanks, who can now afford the medications that are keeping her well, "My quality of life is so much better than it was before."
Perkins, who will soon undergo a knee replacement, gets emotional when he talks about the FPCN staffers who patiently got him through the worst 18 months of his life.
"I'm actually happy these days," he says in wonder. "Look at me - I'm smiling."
Cannon, Shanks and Perkins are among the 695,000-plus lower-income Pennsylvanians who have enrolled in Obamacare since Gov. Wolf's 2015 expansion of Medicaid, which has kept their premiums affordable. Nationally, 88 percent of enrollees in a Medicaid plan are satisfied with their plans, according to a survey by the nonprofit Commonwealth Fund.
So far, their satisfaction is nowhere on the radar of House Republicans, who seem focused solely on middle-income Obamacare users who are rightfully horrified that their premiums and deductibles have skyrocketed so high that they can't even afford to use the plan.
But, Torrisi does not know what repeal will mean for the patients she and her staff have watched get better and better.
"The law isn't working, its failing," House Speaker Paul Ryan said of Obamacare last week. "It's nothing but a string of broken promises."
That's why his Mr. Tough Guy talk about repealing the plan is scaring the holy hell out of Torrisi. The woman is a godsend, and her staffers are angels. It would be immoral to strip away the current plan that has been a lifesaver for so many, with no clear plan for satisfying anyone in the years to come.
The truth is that before Obamacare, America always had a national healthcare plan. It was called luck and it was lethal if you ran out of it.
Obamacare sought to make healthcare an American right, not a privilege for those lucky enough to enjoy good health or to have a job that offered awesome insurance.
Middle-income users shouldn't need luck to be able to afford Obamacare, just as low-income users shouldn't need luck to keep it.
Because for some people, luck always runs out.
It's time we took it out of the healthcare equation.