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 #133: “war against the Constitution”?

You wrote in 2014:

“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 by passing the Preventing Executive Overreach on Immigration Act.”

That bill, which you enthusiastically voted for, stated that it would:

“prohibit the executive branch from exempting from removal categories of aliens considered under the immigration laws to be unlawfully present in the United States.”

The issue, you argued, wasn’t just about immigration, but the Constitution itself:

“it is the role of Congress to make all laws, the Judiciary to interpret the laws, and the President to enforce the laws. This system was wisely set into place by our country’s framers over 200 years ago because they knew first hand that the concentration of power in the same hands was a threat to individual liberty and the rule of law. President Obama’s decision to ignore the limitations placed on his authority and claim legislative power threatens to undo our system of government.”

The principle, you insisted, was preventing “the President from changing our laws unilaterally.” But where is that principle now that a Republican President is waging a new “war against the Constitution”?

On January 20, President Trump signed an executive order requiring agencies to “exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the [Affordable Care] Act that would impose a fiscal burden …” If the meaning of the order was unclear, Trump spokesperson Kellyanne Conway clarified it two days later when she said the President would “stop enforcing the individual mandate,” the tax penalty that is part of the ACA law and that was ruled constitutional by the Supreme Court.

As a result of the executive order, the IRS is no longer enforcing the penalty. Although all Americans are still legally obligated to have health insurance or pay a tax penalty administered by the IRS, the IRS is ignoring the law. Taxpayers can simply leave blank the line on their return requiring them to disclose whether they have insurance.

According to the Constitution, it’s the President’s job to “take care that the laws be faithfully executed.” President Trump is doing the opposite. His executive order prevents provisions of the ACA from being executed.

When you objected to President Obama’s selective implementation of immigration laws, you called it “war against the Constitution.” But because you personally agree with President Trump’s selective implementation of the Affordable Care law, you say nothing.

If Obama’s actions threatened to “undo our system of government,” then so do Trump’s. This would be obvious to you if the U.S. Constitution were more to you than a political prop and if your own actions were guided by principle rather than convenience.

Email #104, Subject: “Mandate all households to obtain adequate insurance”?

The health care replacement bill eliminates the ACA’s tax penalty for anyone who doesn’t sign up for insurance. That mandate is by far Obamacare’s most controversial and unpopular element, and you and the GOP have been fighting it for years.

But for not decades. In the 90s, you supported the individual mandate. “In 1993, in fighting ‘Hillarycare,’” explained former Speaker of the House Newt Gingrich in 2012, “virtually every conservative saw the mandate as a less dangerous future than what Hillary was trying to do.” 1993 is also the year you first took office, and GOP opposition to President Clinton’s health care plan was your first big Congressional fight. And you won it. Congress blocked the Clinton plan.

But you did it by proposing what now is called Obamacare. Its centerpiece—that tax penalty—was proposed by the conservative Heritage Foundation. They explained in 1989: “If a young man wrecks his Porsche and has not had the foresight to obtain insurance, we may commiserate, but society feels no obligation to repair his car. But health care is different. If a man is struck down by a heart attack in the street, Americans will care for him whether or not he has insurance.”

And so, the Heritage Foundation concluded, there’s only one solution: “Mandate all households to obtain adequate insurance.”

That’s the origin of the Obamacare “mandate.” Republican Governor and former Presidential candidate Mitt Romney enacted it successfully in Massachusetts, and President Obama, abandoning Clinton’s 1993 approach, adopted it for the ACA. You won. The Republican health care plan is law.

Which is why it’s so perverse to see you and the rest of the GOP so adamantly opposed to the ACA now. Your replacement bill, the American Health Care Act, strikes the mandated tax and so as a result can’t pay for itself. That’s why fiscal conservatives originally invented the mandate, and why so many fiscal conservatives are opposing the replacement bill right now.

The AHCA both does less and costs more. It’s the worst of both worlds.

Email #103, Subject: “headed where it needs to head”?

Three of your fellow seven Virginia Representatives have come out against the American Health Care Act. But you have not stated a position, despite direct media and constituent requests to do so. You did, however, say you “think” it will bring down costs. I would like to think it would too, but all evidence suggests otherwise.

You’ve been promising a health care plan that will cost Virginians less than the ACA, but if you pass the AHCA, we will pay more. The Wall Street Journal says: “GOP Health Plan Would Hit Rural Areas Hard.” That’s the majority of your home district. In Rockbridge county where I live:

a 40-year-old making $20,000 will pay $890 more.

a 27-year-old making $20,000 will pay $1,020 more.

a family of four making $50,000 will pay $2,220 more.

a family of four making $40,000 will pay $3,650 more.

a 60-year-old couple making $50,000 will pay $7,550.

a 60-year-old couple making $25,000 will pay $11,550 more.

When you were interviewed on Harrisonburg TV last week, you said 38,000 people in our district use the ACA. That’s a higher percentage than nationally because, you explained, we “don’t have the Medicaid expansion in Virginia.” That’s because you and the Republican-controlled state assembly blocked that expansion. As a result, the ACA is even more vital here, a state where, as you also acknowledged, costs are not rising like they are elsewhere.

Though the ACA is working here, I understand that its strategy for keeping costs down hasn’t been working across the country. But the AHCA’s plan to divide people into two insurance groups, “low risk” and “high risk,” won’t keep costs down either. It will do the opposite. It intentionally raises costs for the “high risk,” the people who most need health care.

My family of four won’t be directly affected because my wife and I get our insurance through our employer. But the AHCA will hurt us too. Since it repeals the ACA’s individual mandate, fewer healthy people will sign-up for insurance, which will raise premiums for everyone else. Worse, those same people, when they get sick or injured, can then sign up, further raising our premiums.

You said the AHCA is “headed where it needs to head.” At the moment that’s toward higher premiums, a higher deficit, and less health care for your own constituents. Would you please explain then how you justify your wishful thinking?

Email #99, Subject: “not trying to leave anyone in the lurch”?

I don’t understand why the GOP has put forward a health care plan that is more flawed than Obamacare.

As you know, the Affordable Care Act combines all recipients into a single, cost-balancing pool. But the American Health Care Act divides recipients into two pools: low risk and high risk. Because the high risk recipients can be charged five times more, keeping them on insurance will cost the government $178 billion. That’s far more than is currently being spent on the same people now enrolled under the ACA.

The Republican bill would cost all taxpayers more because it eliminates the ACA tax penalty for those who don’t sign up for any insurance and because those in low-risk pools would contribute less and so raise prices for high-risk people. alternatively, Secretary Tom Price, the bill’s primary author, has proposed radically underfunding the high-risk pools. At one point he suggested as low as $1 billion. The current proposal is $100 billion—leaving $78 billion unpaid.

You said “We’re not trying to leave anyone in the lurch” and that “There should be more options, not fewer.” But the millions of people who end up in your high-risk pools will be left in the lurch. Instead of more options, they’ll end up with far fewer or none at all. And that’s not because the new plan is merely “flawed” like the ACA. It’s because the plan is designed to fail.

The Republican Congress would intentionally underfund the high-risk pools. You said of high-risk patients currently getting their health insurance through the ACA Medicaid expansion: “We can’t afford this when we have $20 trillion in national debt.” So rather than adding an annual $78 billion to the debt, do you intend to cut off insurance to those who need it most?

If you prioritize the debt over life-saving health care for millions of Americans, then state that fact. Stop pretending the American Health Care Act improves Obamacare. The ACA has one core goal: to provide more health care. Your plan has one goal too: to provide less health care.

I consider that immoral. And a majority of voters across the District 6 do too.

Email #97, Subject: pre-existing conditions and lifetime limits?

When you wrote to me last month about the new ACA replacement bill, you said: “This plan notably includes proposals to protect access to coverage for individuals with pre-existing conditions, allows dependents under the age of 26 to stay on their parents’ plans, and removes lifetime limits on coverage.”

But now I read that the bill would allow insurers to raises their prices for people with pre-existing conditions. In what sense does that “protect access”? The ACA eliminated the whole concept of pre-existing conditions, but the GOP bill would bring it back so that companies can charge 30% higher premiums.

Worse, the new bill would allow insurers to set lifetime limits—even though you said before it would not. Under the ACA, insurers can’t set arbitrary caps and so abandon the people who most need health care, those with terrible, long-term diseases.  The new bill would reinstate that immoral practice.

When I called your office to ask about this last Friday, your staffer told me that you had not taken a position on the new health care bill yet and were still reviewing it. Since it violates two of your stated priorities, may I assume that you will not be voting for it? Otherwise your letter highlighting the importance of pre-existing conditions and lifetime caps was meaningless.

Since it was a form letter, I assume you sent copies to all of your constituents who contacted your office about Obamacare in the last several weeks. Given the historic surge in calls and letters to Congress this year, I can only imagine how may people that is. It would be especially disturbing then if you contradicted your own letter now that we can all see the deep shortcomings of the GOP replacement bill.

Since the weekend must have given you ample time to complete your review of the American Health Care Act, I look forward to your next press release announcing your disapproval. All of your constituents trust you to stand by your words and permanently eliminate pre-existing conditions and lifetime limits.