Email #313: “Americans will be hurt”

Last Friday, the attorney generals of 18 states filed a joint suit requesting a temporary restraining order and later permanent injunction preventing the Trump administration from halting ACA subsidy payments.

Those attorney generals have the support of their governors, Republicans included. Republican Gov. Sandoval says the President’s stopping payment is “going to hurt kids. It’s going to hurt families. It’s going to hurt individuals. It’s going to hurt people with mental health issues. It’s going to hurt veterans. It’s going to hurt everybody.” The bipartisan National Governors Association agrees: “We are deeply concerned that the administration has declined to continue these payments, further increasing uncertainty for state marketplaces.”

Doctors oppose the President too. The American Medical Association says: “Our patients will ultimately pay the price. We urge Congress to accelerate its efforts to reinstate these payments before further damage is done.” The American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, the American Congress of Obstetricians and Gynecologists, the American Osteopathic Association, and the American Psychiatric Association are all urging the subsidies to continue too, saying in a group statement: “This action will make it harder for patients to access the care they need. Costs will go up and choices will be restricted.”

Even many Republican law-makers agree. Republican Rep. Reed, co-chair of the bipartisan Problem Solvers Caucus, says: “It’s only going to get worse as this marketplace continues to destabilize. If we stay where we are and do nothing, I think this is going to be a pox on all of our houses.” Republican Senator Alexander said in August: “Without payment of these cost-sharing reductions, Americans will be hurt.”

You, however, have said nothing. I know many Republicans have argued that the subsidies are unconstitutional because Congress never appropriated money. A lower court agreed, but the appeal has not been settled, and until it is, the ACA and its subsidies remain the law. The Supreme Court has heard three different ACA challenges in the past, and three times it ruled in favor of the ACA. Even Bush-appointed Chief Justice Roberts declared: “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible we must interpret the Act in a way that is consistent with the former, and avoids the latter.”

If the Court rules that the ACA subsidies are unconstitutional, so be it. But until then, they are the law, and the Trump administration has the Constitutional and moral responsibility of continuing them. You and all of Congress have the moral responsibility of passing legislation that stabilizes healthcare for millions of Americans. Since all of the GOP’s attempts to repeal and replace the ACA failed, that means working within the framework of the ACA. It means crossing the aisle and compromising. Cutting off subsidies only harms Americans who need them.

Email #312: “the very core of our system of government”?

You praised President Trump’s elimination of Deferred Action for Childhood Arrivals because you said it was an “unlawfully-contrived program.” You said President Obama had “used his ‘pen and phone’ to overstep his authority and unilaterally rewrite our nation’s laws” in a manner that was “wholly unconstitutional” and compromised “the rule of law.”

Obama created DACA in 2012 after the nearly identical DREAM Act failed to pass in the Senate. The administration stopped deporting illegal immigrants who matched the proposed DREAM Act criteria anyway. You responded with the Preventing Executive Overreach on Immigration Act, saying: “President Obama declared war against the Constitution by changing our immigration laws on his own and Congress today began its fight against this unprecedented power grab.”

When the courts blocked Obama’s immigration order, you applauded: “The case of United States v. Texas is fundamentally about preserving the separation of powers and its outcome will have drastic implications for our Republic… I am hopeful that the Supreme Court will stop President Obama’s lawlessness so that we protect the Constitution and the intent of the Founding Fathers that the legislative branch, which reflects the will of and is accountable to the American people, makes the laws, not the President.” Due to the death of Justice Scalia, the Court deadlocked in a 4-4 decision.

But you demonstrated your continuing commitment to this issue by creating the House Judiciary Committee’s Task Force on Executive Overreach last January, correctly noting that “presidents of both parties have aggrandized their power and usurped Congress to legislate from the Oval Office. This is not a Republican or Democratic issue; it’s an American issue and touches the very core of our system of government.” You said the Task Force “will study this troubling trend and also look for solutions to prevent the executive branch from exceeding its constitutional authority. The separation of powers and its checks and balances are designed to protect individual liberty and we must ensure that it is preserved for future generations.”

And now President Trump has given the Task Force a lot more to study.

The President tweeted last week: “Since Congress can’t get its act together on HealthCare, I will be using the power of the pen to give great HealthCare to many people – FAST.” He then used that power to issue executive orders that violate provisions of the Affordable Care Act. He said during the signing: “I just keep hearing repeal-replace, repeal-replace. Well, we’re starting that process.”

But as you have so forcefully argued in the past, no President has the power to create legislation and no President has the power to alter or repeal legislation once it’s been created by Congress–including in this case the Affordable Care Act. By the standards you applied to President Obama, President Trump’s “lawlessness” and “power grab” is usurping Congress too.

Fox News reported: “President Donald Trump is taking his first steps to fulfill his vow to dismantle Obamacare on Thursday, signing an executive order that … would allow consumers to buy short-term policies, which don’t have to comply with Obamacare’s protections for those with pre-existing conditions.”

The Wall Street Journal says the executive orders “initiate the unwinding of the Affordable Care Act, paving the way for sweeping changes to health-insurance regulations by instructing agencies to allow the sale of less-comprehensive health plans to expand.” The newspaper also said the President was “using his authority to accomplish some of what Republicans failed to achieve with their stalled congressional health-care overhaul.”

President Trump’s “Obamacare relief” orders follow the same steps and executive abuses that you so vigilantly opposed under President Obama. After his party failed to pass the legislation he wanted, the President is using his pen to overstep his authority and unilaterally rewrite our nation’s healthcare laws. According to you past arguments, President Trump’s directives to bypass ACA provisions and create unlawfully-contrived healthcare associations are wholly unconstitutional and compromise the rule of law.

The only difference is political. You opposed the DREAM Act, and so it was simple for you to oppose DACA. But you supported ACA repeal bills, and so you agree with the goals of the President’s executive orders. While I empathize with the difficulty and irony of your position, anything short of a condemnation of President Trump with the same vigilance and vigour that you condemned President Obama’s “war against the Constitution” will expose you as an unprincipled hypocrite.

As much as I have disagreed with so many of your past actions, I am sincerely hopeful that you will rise to this situation and place the Constitution before your political party. As you said, the very core of our system of government is at stake.

Email #306: “a great HealthCare Bill”?

President Trump tweeted Saturday:

“I called Chuck Schumer yesterday to see if the Dems want to do a great HealthCare Bill. ObamaCare is badly broken, big premiums. Who knows!”

Schumer responded:

“The president wanted to make another run at repeal and replace and I told the president that’s off the table. If he wants to work together to improve the existing health care system, we Democrats are open to his suggestions. A good place to start might be the Alexander-Murray negotiations that would stabilize the system and lower costs.”

I wrote to you about the Alexander-Murray bill last month, predicting that if it passes:

“the President will describe it as ‘essentially’ a repeal of the ACA anyway and so claim to have accomplished a campaign promise.”

His phone call to Senator Schumer on Friday is the first tangible step to that increasingly likely outcome. If the President makes a deal with Democrat leaders, moderate Republicans will join, and the country will get a law that will “increase access to care and deliver affordable health insurance options.” Those are the two goals you emphasized in July, and so I assume you still prioritize them.

You also said last December that you were “working towards a bi-partisan solution to solve the problem of unaffordable health care.” So you must be pleased that the President is now working towards a bi-partisan solution too. Since a majority of your constituents will applaud any legislation that President Trump calls “a great HealthCare Bill,” are you prepared to cross the aisle and pass a Trump-ObamaCare bill that improves but does not repeal the ACA?

Since partisan repeals have proven impossible, the only other alternative is a permanent but increasingly ineffective ACA. The Congressional Budget Office’s original projections were based on the assumption that over 20 million people would enter the ACA market, but less than half as many actually did. As long as enrolments remain low, the ACA will remain affordable only for those receiving subsidies. But those subsidies will also prevent a complete collapse, locking the system in permanent dysfunction.

Despite this, the Trump administration is cutting the next ACA sign-up period from twelve weeks to only six, and the sign-up website will be shut down on all but one of those Sundays, even though Sunday is one of the most popular sign-up days. The administration has also cut funding to enrollment assistance groups by 40% and the advertising budget by 90%, even though many Americans are unaware that the ACA is still available or that they need to re-up to maintain their coverage. The end result will be even fewer enrollees and so even higher premiums.

If President Trump has a strategy it must be to further weaken the ACA so greatly that a bipartisan repair bill will so drastically improve the system that the result will “essentially” be a repeal and replacement. If that’s the President idea of “a great HealthCare Bill,” I’ll grudgingly support it. Will you?

Email #298: “bi-partisan solution”?

You said last December: “I am working towards a bi-partisan solution to solve the problem of unaffordable health care.” That was ten months ago. Have you made any progress on that solution? For it to be bi-partisan, you must have been working with at least one Democrat. Could you name who that was?

After the Senate failed to pass the AHCA in July, you said: “I will keep working towards a solution to increase access to care and deliver affordable health insurance options.” What happened to the “bi-partisan” part? Did you abandon what you had been working on before supporting the highly partisan AHCA?

Now the GOP has again failed to pass a partisan healthcare bill. Despite controlling 52 seats in the Senate, they could not reach even a 50-vote majority, let alone the 60 votes needed without the procedural manipulation of so-called reconciliation. According to the Congressional Budget Office, that latest partisan bill would have cut Medicaid by a $1 trillion, raised the number of uninsured Americans by millions, and eliminated federal protections for pre-existing conditions by turning over all control to the states. Little wonder it didn’t attract a single non-GOP vote and even lost at least three key Republican senators.

Now that the September 30 reconciliation deadline passed yesterday, will the GOP move to a centrist position on healthcare? If so, this would be a great moment to reprise that “bi-partisan solution” you were “working towards” last fall. Can you describe anything about that bill? Or, if it was only something still in its earliest stage, can you describe some of the process? What specific steps had you taken? Who else was involved that made the process “bi-partisan”? Or what aspects of the bill were designed to attract Democrats?

If you can’t answer any of these questions, then there’s no sense in which the solution could be called “bi-partisan.” Except perhaps in a Orwellian sense. George Orwell defines his 1984 term “doublethink” as telling “deliberate lies while genuinely believing in them.” Were you aware that you were lying when you claimed to be “working towards” a “bi-partisan solution” on healthcare or is your rhetoric so empty that you don’t register your own fabrications?

Email #291: “the indignity of it all”?

Some think that the majority party in Congress should be required to involve the minority party before taking any major legislative action. One Congressman expressed particular outrage when a bill was rushed to a vote without hearings or minority input simply because the party in charge was facing a deadline:

“Now, the indignity of it all is that here in the closing days of the Congress, when this bill has been brought forward in this urgent manner, we are not even given the opportunity, as the minority is always given, to offer a motion to recommit, no opportunity to amend this bill in any way, shape or form, as though this was perfectly drawn and perfectly brought here, and that anybody who was not in the small room where the final version of this, totally without the inspection of the American people, totally without the opportunity for anybody to participate, brought here in some perfect manner; and now, of course, we are going to pass it without even the opportunity for the minority to offer changes to the bill.”

That was in 2010. The bill was the DREAM Act, which became the blueprint for President Obama’s DACA program. The majority party was the Democrats, and the outraged Republican Congressman was you.

Now the GOP-controlled Congress is facing its own deadline. After September 30th, the so-called “reconciliation” process can no longer be used to avoid the Senate requirement that legislation have 60 votes to pass. Since the GOP only controls 52 seats, that means compromise will be the only path forward. But instead of embracing bipartisanship, the GOP is attempting to hurry through an ACA repeal bill.

Given the “indignity” you felt in 2010, I would expect you to oppose the Senate bill out of principle. The Graham-Cassidy repeal has been brought forward in a far more urgent manner than the DREAM Act was seven years ago, and, since not even the CBO has had a chance to calculate its repercussions, it is being pushed through totally without the inspection of the American people and totally without the opportunity for anybody but a handful of Republican Senators to participate.

But not all Republican Senators are accepting this process. Three have rejected it, including Senator McCain who said on Friday:

“I believe we could do better working together, Republicans and Democrats, and have not yet really tried. Nor could I support it without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it. We should not be content to pass health care legislation on a party-line basis, as Democrats did when they rammed Obamacare through Congress in 2009. If we do so, our success could be as short-lived as theirs when the political winds shift, as they regularly do.’’

When the first ACA repeal bill failed last summer, McCain said:

“Let’s return to regular order. We’ve been spinning our wheels on too many important issues because we keep trying to find a way to win without help from across the aisle. That’s an approach that’s been employed by both sides, mandating legislation from the top down, without any support from the other side, with all the parliamentary maneuvers that requires.”

This sounds like you in 2010. Except you were in the minority then, and McCain is in the majority now. Was your “indignity” sincere? Was your appeal for a fair process based on principle? Or were your complaints only political posturing that you ignore now out of hypocritical convenience?

Email #289: “working towards a solution”?

The latest version of an ACA repeal, the Senate’s Graham-Cassidy bill, would eliminate the individual mandate, eliminate essential health benefits, convert ACA market and Medicaid funds into state block grants, cap and reduce those funds over ten years, and eliminate those funds completely by 2027.

A group of eleven governors–five Republicans, five Democrats, and one Independent—condemned the bill. The Blue Cross Blue Shield Association, America’s Health Insurance Plans, the American Medical Association, the American Hospital Association, AARP, and the American Cancer Society are condemning it too.

The CEO of Blue Cross Blue Shield said:

“The bill contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions. The legislation reduces funding for many states significantly and would increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans’ choice of health plans.”

The CEO of Alaska State Hospital and Nursing Home Association said:

“The cuts could be devastating to our health care system, including rural and frontier hospitals that operate on razor-thin margins. These hospitals are often accessible only by airplane or ferry, so the loss of a hospital means an expensive and disruptive medical evacuation out of the community. Ultimately, patients will bear the consequences, through reduced access to health care and lost insurance coverage.”

The Congressional Budget Office has estimated that the previous, similar repeal bills would have resulted in 15 to 18 million fewer people having healthcare the following year, a fact that doomed those bills in the Senate. The CBO does not have enough time to score the Graham-Cassidy bill before the September 30th deadline for a “reconciliation” vote, but preliminary calculations suggest a decrease of at least 15 million and as many as 30 million people.

You said in July: “I will keep working towards a solution to increase access to care and deliver affordable health insurance options.” But Graham-Cassidy and its predecessors would decrease access and decrease affordable options. Even if you’re right that “Obamacare does not work,” these repeals are not solutions. When will you start working for a bill that, like the ACA, is at least trying to achieve the goals you claim to support?

The AHCA, like Graham-Cassidy, would decrease access to care, but you voted for it because you said the AHCA would increase access to care. How can your constituents understand your position as anything other than Orwellian doublethink?

Email #286: “health insurance in 2018”?

Last month, Anthem announced it would be leaving the Virginia ACA market because the President would not guarantee the federal subsidies that let poor enrollees afford deductibles. As a result, 70,000 Virginians were going to lose their health insurance next year, over 30,000 in your own district.

Fortunately, Anthem changed its mind, announcing last week: “Since learning that 63 counties and cities would not have access to individual health plans, Anthem has been engaged in further evaluation and discussion with regulators to ensure that no bare counties or cities exist in Virginia.”

Your Republican colleague Rep. Griffith expressed thanks: “I am appreciative that Anthem re-entered the market, ensuring that Southwest Virginians will have an option to purchase health insurance in 2018.” Griffith’s congressional district borders yours, and so you share the 40,000 residents of Roanoke and New River valleys who would have lost their insurance.

You, however, did not express thanks. Would you prefer that Anthem not provide healthcare for your neediest constituents? Do you want the ACA market to collapse regardless of the human price?

Last week the Senate Health Committee held its fourth and final hearing on a bipartisan bill to stabilize the ACA insurance markets. Republican Committee chair Senator Alexander and Democrat Committee member Senator Murray hope to introduce a new healthcare bill for a vote this month. It would fund the subsidies that Anthem needs to remain in Virginia. It would create a catastrophe-only coverage option for enrollees. And it would give states more freedom to control rates and plans.

Personally, I think catastrophe-only coverage is a terrible idea, but I understand that many conservatives feel it’s essential for any bipartisan deal. I therefore support it. I also fear that states will have the “freedom” to strip away protections for pre-existing conditions and other essential needs. Still, if the measure brings Democrats and Republicans together, I support it. I assume many conservatives will dislike the cost of subsidies. But that’s the nature of compromise. Both sides must move to the center.

Unfortunately, these bipartisan efforts are being halted by the GOP’s latest and last attempt to repeal the ACA before September 30th, the deadline for the filibuster-preventing reconciliation process. Senator Murray said yesterday: “Republican leaders have decided to freeze this bipartisan approach and are trying to jam through a partisan Trumpcare bill.”

I know you would prefer to repeal the ACA. But if the repeal fails and the Senate passes the Health Committee’s bipartisan bill instead, will you vote for it? I predict the President will describe it as “essentially” a repeal of the ACA anyway and so claim to have accomplished a campaign promise. As long as it gets insurance to the people who need it, I don’t care who takes credit. Do you?

Email #281: “insurance for everybody”?

While the President has vacillated on many positions, his pledge for universal healthcare is one of his few consistencies. He said in 1999: “If you can’t take care of your sick in the country, forget it, it’s all over. … I believe in universal healthcare.”

He repeated the point the following year in his book The America We Deserve: “I’m a conservative on his most issues but a liberal on health. It is an unacceptable but accurate fact that the number of uninsured Americans has risen to 42 million. Working out detailed plans will take time. But the goal should be clear: Our people are our greatest asset. We must take care of our own. We must have universal healthcare.”

When asked as a candidate in an April 2015 debate, “Now, 15 years ago, you called yourself a liberal on health care. You were for a single-payer system, a Canadian-style system. Why were you for that then and why aren’t you for it now?” he answered: “As far as single payer, it works in Canada. It works incredibly well in Scotland. It could have worked in a different age, which is the age you’re talking about here.”

When Sean Hannity asked him a similar question later in 2015, he answered: “As far as single-payer and all — there’s so many different things you could have. Honestly, Sean, to do, to have great health insurance. The one thing I do tell people, we’re going to have something great.”

And he said as President-elect in January: “We’re going to have insurance for everybody. There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us…. It will be in a much simplified form. Much less expensive and much better.”

Senator Sanders has now introduced a bill for near-universal healthcare. It would expand Medicare into single-payer system for nearly every American. Despite the President’s long-standing commitment to universal healthcare and his open admiration for other countries’ single-payer systems, Press Secretary Sanders said: “I think that the president as well as the majority of the country knows that the single payer system that the Democrats are proposing is a horrible idea.”

I don’t know enough about the complexities of healthcare systems to know whether expanding Medicare would be “horrible” or not. I do know that the President has been open to similar single-payer approaches, despite his press secretary’s claim.

I personally don’t care how universal coverage is accomplished. If you have a better way to achieve the President’s goal, I would very much like to hear it. And if you reject Sanders’ approach, then it is your responsibility to propose a better path to universal healthcare.

I know you oppose the Affordable Care Act. I don’t personally care if the ACA is repealed or not—as long as it’s replaced by something that moves us closer to the President’s commitment. Is that your goal too? Or do you oppose “insurance for everybody”?

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

Email #224: “door to bipartisanship”?

Thank you for your form letter regarding the American Health Care Act. Though it mostly repeats your earlier statements, I do appreciate one tiny revision. You first refer to the ACA as “the Patient Protection and Affordable Care Act, commonly known as Obamacare,” instead of simply calling it “Obamacare,” a pejorative term coined by Republicans to attack the law. Although I hope this is a step toward a more reasonable common ground, it also coincides with “Obamacare” no longer being an easy target. A recent poll reported that the ACA has a 50% approval rating, making it a little more than twice as popular as either of the GOP replacement bills, which are polling at only 24%.

Now that two more Republican Senators have refused to support the Senate version of the AHCA, I have heard renewed talk of repealing but not replacing the ACA. President Trump tweeted earlier this week: “Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!”

But prospects for a repeal-only bill are even worse. Republican Senator Capito has already rejected the possibility and on good grounds: “Repealing without a replacement would create great uncertainty for individuals who rely on the ACA and cause further turmoil in the insurance markets. We can’t just hope that we will pass a replacement within the next two years. I will only vote to proceed to repeal legislation if I am confident there is a replacement plan that addresses my concerns.”

But the President is right about starting over and working with Democrats this time. Senate Minority Leader Schumer is saying the same thing: “Rather than repeating this same, failed partisan process again, Republicans should work with Democrats on a bill that lowers premiums, provides long-term stability to the insurance markets and improves our health-care system. The door to bipartisanship is open now.” Senator Manchin has already begun that process, contacting eleven other Senators who have served as governors like him and inviting them to “sit down and start bipartisan talking.”

I hope you will help to lead the same process in the House. Congress has been in session for six months and is no closer to passing a new health care bill. It’s time for a bipartisan, centrist approach. This is what our country needs right now.