Bob Goodlattes replies about health care

Dear Mr. Gavaler:

Thank you for contacting me with your concerns regarding Medicaid and the impact of H.R. 1628, the American Health Care Act (AHCA), on Medicaid. Medicaid is an important program for many Americans with limited income and resources, but it is facing collapse if we don’t act to fix it now.

Seven years ago, the Patient Protection and Affordable Care Act, commonly known as Obamacare, became law. With it came unaffordable premiums, higher deductibles, and a lack of choice and access to insurance for far too many folks in the Sixth District of Virginia and across the country. The Department of Health and Human Services found that the health insurance premiums paid by Virginians increased an average of 77% between 2013 and 2017. Additionally, in April of this year, Aetna announced that it will exit Virginia’s Obamacare insurance marketplace, leaving an estimated 27 counties with only a single insurer to pick from in 2018. It’s easy to see why this mess of big-government mandates and red tape has not provided the health care solutions so many families need.

As you may know, optional state expansion of Medicaid under Obamacare has significantly increased federal spending on the Medicaid program. Under Obamacare, the federal government share is higher for individuals in the newly eligible expansion population (defined as non-elderly adults with family income at or below 133 percent of federal poverty level) than for individuals in traditional Medicaid. This program currently supports over 72 million recipients, more than those currently enrolled in Medicare. In fact, the program now accounts for more than 15 percent of all federal health care spending and represents one in four dollars of a state’s average budget.

As you may know, Medicaid is both federally and state-funded, but states do not currently have enough control over the program. They are required to follow a “one-size-fits-all” program that is mandated by the federal government – a program that is not getting the job done.  Low reimbursements to health care providers and greater regulatory burdens have led to fewer and fewer physicians accepting Medicaid. Sadly, Medicaid patients are roughly twice as likely to visit the emergency department (ED) as those with private insurance. Medicaid beneficiaries shouldn’t be forced to visit an ED to get primary care.  It is clear reforms are needed to improve Medicaid- reforms that incentivize states to align their own Medicaid programs to their individual needs, as opposed to promoting unrestrained growth and spending.

In the 115th Congress, a proposed alternative to repeal Obamacare and replace it with patient centered reforms is H.R. 1628, the American Health Care Act (AHCA). At its most basic, the AHCA would take steps to ensure health care remains affordable and accessible. Under the AHCA, individuals who do not have access to health insurance through their employer or a program like Medicaid or Medicare would receive an age and income-adjusted tax credit that is both advanceable, and refundable. This credit can be used to choose state-approved health insurance coverage, as well as unsubsidized COBRA coverage.  The bill strengthens consumer-driven health care choices by increasing maximum contributions to tax-advantaged Health Savings Accounts by nearly 100 percent, and repeals a number of Obamacare taxes, including a tax on the medical devices many Americans rely on for daily care.

Under the AHCA, Medicaid financing would be converted to a per capita model. The per capita allotment would be based on a state’s average medical assistance and non-benefit expenditures in four beneficiary categories: aged, blind and disabled, children, and adults. Under the AHCA, states would no longer be able to choose to expand their Medicaid programs to cover the “newly eligible” population, and states that have already expanded would have their enrollment at the enhanced match rate frozen as of 2018. States, like Virginia, that have not expanded their Medicaid program under Obamacare, would have access to a safety-net fund established under the AHCA that is specifically for non-expansion states. Additionally, Medicaid cuts that were established under Obamacare would be restored to non-expansion states earlier than for states that chose to expand their Medicaid programs.

H.R. 1628 was passed by the House of Representatives, with my support, on May 4, 2017. It now awaits further action by the United States Senate.

The status quo cannot continue. We know that our nation can do better. I firmly believe that the American Health Care Act is a better way forward. As the Senate begins consideration of this bill, I urge them to keep the process moving. Passing the AHCA is a major step in repealing Obamacare and ensuring Americans have access to affordable health care. As long as Obamacare continues to fail, I will continue to work in the House to maintain my commitment to the people of the Sixth District to repeal Obamacare and support patient-centered health care reform. Obamacare must not remain the law of the land.

I appreciate you taking the time to share your views with me and hope you will stay in touch as the 115th Congress continues to debate important issues to our country. I believe it is vital to keep an open line of communication so I can best serve the interests of Virginia’s 6th District. Please feel free to contact me whenever I may be of assistance to you and your family.

With kind regards.


Bob Goodlatte
Member of Congress

Author: Chris Gavaler

Chris Gavaler is an associate professor at W&L University, comics editor of Shenandoah, and series editor of Bloomsbury Critical Guides in Comics Studies. He has published two novels: School for Tricksters (SMU 2011) and Pretend I’m Not Here (HarperCollins 2002); and six books of scholarship: On the Origin of Superheroes (Iowa 2015), Superhero Comics (Bloomsbury 2017), Superhero Thought Experiments (with Nathaniel Goldberg, Iowa 2019), Revising Fiction, Fact, and Faith (with Nathaniel Goldberg, Routledge 2020), Creating Comics (with Leigh Ann Beavers, Bloomsbury 2021), and The Comics Form (Bloomsbury forthcoming). His visual work appears in Ilanot Review, North American Review, Aquifer, and other journals.

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