Michigan cancer survivor fears health care implications of a second Trump term

Marcie Paul survived late-stage ovarian cancer with coverage from the Affordable Care Act. Republican threats to the ACA and other health care programs, she fears, could cost future patients their lives.

Michigander Marcie Paul credits the Affordable Care Act (ACA) with saving her life. When she was diagnosed with ovarian cancer in 2009, Paul said, her condition made her “uninsurable.”

“There’s a big red mark on my health record,” she explained. “My husband went out on his own a few years after I was diagnosed and we started a new business. We could not have done that without the ACA.”

‘These things directly impact our lives’

Thanks to the ACA’s coverage for pre-existing conditions, Paul was able to receive the care she needed—including heavy monitoring and frequent CAT scans—without fear of skyrocketing costs or refused assistance from insurance companies.

“Like most ovarian cancer, it was late-stage. Unlike most ovarian cancer, I’m still here,” she said. “There’s not a lot of us diagnosed, and there’s certainly not a lot of us that have survived.”

The overall five-year survival rate for patients diagnosed with stage III ovarian cancer is 41%, while the stage IV rate is just 20%. Paul’s doctors have monitored her closely for recurrence in the years since her diagnosis. She’s only recently “graduated” to a single annual scan.

Paul, a West Bloomfield resident who works in advertising and has a background in fine arts, says her cancer experience propelled her into health care advocacy work.

“Our treatment outcomes are quite poor. And so there’s just not a lot of us to do the advocacy. There’s not a lot of us to be screaming about more research funding and better access to care and have a say in how those research funds are used,” she said. “So I feel compelled to do that inasmuch as I’m well enough to be able to.”

Paul’s staunch defense of the ACA only grew in 2017, when the health care plan narrowly avoided a Donald Trump-backed repeal in the Senate thanks to a last-minute ‘no’ vote from late Republican Senator John McCain.

“I remember the hearings and that last vote, and I was really holding my breath,” Paul said. “And so for people that say that these things don’t matter to them, or what happens in Lansing, ‘What does that have to do with me?’ These things directly impact our lives.”

Trump threats to health care would harm Michigan cancer patients

Paul worries about the future of the ACA and the potential implications of a second Trump term for American health care as a whole. Trump has made no secret of his qualms with the ACA, which he has promised to chip away at and replace if reelected.

Trump has also suggested that he’d be open to cutting other critical health programs, including Medicare. During his first term, Trump’s budget proposals included significant slashes to provider payments for Medicare. 

And a recent report from Georgetown University explains that Project 2025, the far-right agenda considered a “blueprint” for a second Trump term, would present “draconian” threats to Medicaid via elimination of beneficiary protections, new obstacles for would-be enrollees, and reduced federal oversight of state Medicaid programs. 

Paul sees clear and direct threats to cancer patients in Michigan should Medicare or Medicaid experience cuts. In her work on the Patient Advisory Council at Karmanos Cancer Institute, she’s witnessed firsthand benefits for patients enrolled through the Healthy Michigan Plan, a state Medicaid program. 

“We have a very high Medicaid patient population [at Karmanos], and these people would not have been able to access treatment,” she said. As of May 2024, more than 1.8 million Michiganders were enrolled in some form of Medicaid. 

Paul also credits the Biden-Harris administration’s Inflation Reduction Act for allowing Medicare to negotiate drug prices with pharmaceutical companies. 

“Just the fact that they started to negotiate Medicare is really a revelation,” she said. 

‘Women are terrified to go to an OBGYN’

Beyond her general advocacy for protecting the ACA, Paul echoes the sentiments of many reproductive rights advocates in her concern about the future of women’s health care. 

In the wake of the Supreme Court’s 2022 Dobbs decision that overturned the federal right to an abortion guaranteed by Roe v. Wade, right-wing lawmakers have espoused limitations on in-vitro fertilization (IVF) treatment, challenged birth control access, and even promoted criminal consequences for patients seeking abortion care. 

Trump himself has taken credit for Dobbs and implied he would support further restrictions on reproductive health care.  

This culture of fear and uncertainty, Paul worries, has dissuaded many women from pursuing gynecological care altogether and could contribute to higher rates of cancer like her own. 

“The impact of the Dobbs decision on women seeking gynecologic care has really hurt cancer screening, cancer care, ovarian cancer—all gynecological cancer,” she said. “Women are terrified to go to an OBGYN and OBGYNs are terrified to do anything. And if you have cancer while you get pregnant… I’ve never seen gynecologic oncologists become so politically active as they have in the last two years.”

Paul’s fears aren’t unfounded. In the case of gynecological cancers detected during pregnancy, treatment might include pregnancy termination. 

A 2023 report from KFF shows that more than 40% of surveyed OBGYNs have felt “very or somewhat concerned about their own legal risk when making decisions about patient care and the necessity of abortion” since the passage of Dobbs, while one in five office-based OBGYNs reported feeling “personal constraints” on their ability to provide care for pregnancy-related medical emergencies. 

Personal connections remain at heart of health care advocacy

When it comes to reaching other Michiganders, Paul leans on her personal health story as a point of connection. If skeptical voters complain about ACA coverage being “too expensive,” Paul is quick to share her cancer experience. 

“I would say, ‘It’s not more expensive than me paying out of pocket for a CAT scan. It’s not more expensive than you paying for every medical bill that you might get,’” she said. “So it’s not more expensive that way, and it is a relatable example, and people really listen to it.”

Protecting the ACA and other health care programs should matter to all Michiganders and Americans, Paul said—especially because her story isn’t quite as rare as it might seem. 

“40% will get cancer in their lifetime. You’re talking about extremely large numbers, and then add in other chronic diseases. So pre-existing conditions affect everyone, and a lot of people want to keep their kids on insurance,” she said. “There’s a lot of work to do.”