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.

Email #208: “conversation and collaboration”?

Republican Senator Collins tweeted on Wednesday: “I want to work w/ my GOP & Dem colleagues to fix the flaws in ACA. CBO analysis shows Senate bill won’t do it.”

Democratic Senator Carper also said he’s “reaching out to Republicans who would like to find a principled compromise to fix what needs to be fixed in the Affordable Care Act.” He wants to “foster an environment in which conversation and collaboration could begin in earnest and continue over the Fourth of July recess.”

This is exactly the bipartisan approach our country desperately needs right now. It’s also the approach you have repeatedly claimed to prefer, and yet you have done little to foster it yourself. When it looked like the AHCA wasn’t going to pass in the House, you wrote in one of your newsletters:

“As the health care debate continues, let’s take a look at one aspect of the health care system that has the support of many in both parties. Community Health Centers (CHCs) have long been recognized as a proven and nonpartisan solution to primary care access…. While Community Health Centers existed long before Obamacare, when this law was passed in 2010 it recognized the value of these facilities and made a substantial investment in them. The good work done by CHCs continues to be recognized now. As we work on a new health care solution to replace Obamacare, it is important that CHCs receive support for their work to expand services and access.”

While you continued to insist that the ACA be replaced, you did so without vilifying it or its supporters. This is exactly the approach the GOP should have taken from the start. Yet a month later when the amended AHCA moved to the divided Senate, you returned to your divisive rhetoric about the “death spiral” of “Obamacare.”

The ACHA/BCRA is now finally moving in a centrist direction. Republican Senator Corker said: “The initial draft bill really didn’t provide an opportunity for low-income citizens to buy healthcare that actually covered them, so that equation is going to change.”

That likely means an amendment preserving the ACA’s tax on high-income earners. If that happens, the bill is going to lose support from the far right in both the Senate and the House. But those lost votes can be offset by centrist Democrats—unless the GOP’s relentless partisan attacks on the ACA continue to push both sides away from that middle ground.

If the Senate abandons the BCRA in its current form and instead begins to work on a centrist solution to our country’s healthcare needs, will you pledge to support their efforts?

Email #201: “I promised wrong”

“As one conservative let me say any person in the United States who requires medical attention and cannot provide it for himself should have it provided for him.” Ronald Reagan said that in 1961, and it’s as true now as it was then.

The Affordable Care Act attempted to achieve Reagan’s goal. The American Health Care Act that you voted for and the Better Care Reconciliation Act before the Senate now abandon it by eliminating health care for millions and instead cutting taxes on corporations and the highest income earners by $592 billion. USA Today, the most centrist major news source in our country, called the Senate’s BCRA a “tax cut masquerading as a health care plan.”

Centrist Republicans agree. Ohio Republican Governor Kasich said last week: “I have deep concerns with details in the U.S. Senate’s plan to fix America’s healthcare system and the resources needed to help our most vulnerable, including those who are dealing with drug addiction, mental illness and chronic health problems and have nowhere else to turn.”

Nevada Republican Governor Sandoval said: “While the current healthcare system needs improvement, it remains my priority to protect Nevada’s expansion population to ensure our most vulnerable, especially individuals with mental illness, the drug addicted, chronically ill, and our children, will always have access to healthcare.”

Massachusetts Republican Governor Baker said: “this version falls short and will result in significant funding losses for our state.”

Maryland Republican Governor Hogan said: “Congress should go back to the drawing board in an open, transparent and bipartisan fashion to craft a bill that works for all Americans.”

Centrist Republicans in the Senate agree. Republican Senator Heller said: “I cannot support a piece of legislation that takes insurance away from tens of millions of Americans.” Republican Senators Collins, Murkowski, Portman and Capito expressed similar criticisms.

If Ronald Reagan were alive, he would stand with them and the vast majority of Americans who oppose these “Trumpcare” bills.

In May, NBC and the Wall Street Journal found that only 23% of Americans thought the AHCA was a “good idea.” Last week that number dropped to 16%. But according to the Kaiser Family Foundation, 74% have a “favorable opinion” of Medicaid, which the GOP bills would deeply cut. The same survey also found that 70% oppose the new bills’ waivers allowing insurers to charge people with pre-existing condition more, while 66% want to keep the ACA’s essential benefits protection.

The only good thing about the GOP bills is entirely partisan: they would fulfill the GOP promise to repeal “Obamacare.” But what good is keeping that promise if the replacement fails? Governor Kasich said it best: “I don’t think campaign promises that leave millions of people without the help they need are any excuse. Sometimes you make a promise, and you have to be big enough to say maybe I promised wrong.”

“Trumpcare” is wrong. Should the Senate, like the House, defy the wishes of the vast majority of Americans and pass their bill, reconciling the AHCA and BCRA into a single version will be Congress’s last chance to get health care right. If that happens, I ask that you please look back to President Reagan’s original vision and pass a plan that will help the Americans who need it most.

Email #196: “generous, kind, with heart”?

The President said in April: “in business, you don’t necessarily need heart, whereas here, almost everything affects people… You’re providing health… You have to love people. And if you love people, such a big responsibility.”

He reiterated that point last week when addressing Senate Republicans working on a new health care bill: “I really appreciate what you’re doing to come out with a bill that’s going to be a phenomenal bill to the people of our country: generous, kind, with heart.”

But I’m confused in what sense the Senate bill is any of these things, since it still cuts millions from Medicaid—it just does so over a slightly longer period of time. It also does so while lowering taxes for high income earners, the opposite group of Americans most in need of generosity and kindness.

According to White House budget director Mulvaney: “you have to have compassion for folks who are receiving the federal funds, but also you have to have compassion for the folks who are paying it.” Do the highest income earners—people making at least hundreds of thousands a year—do they need the same compassion as families at and below the poverty line, the people who actually receive Medicaid? Is this what the President meant when he described the big responsibility of loving people and providing them health?

Although no Democratic Representatives were included in the drafting, amending, and passing of the American Health Care Act, and no Democratic Senators are currently included the drafting of the Senate health care bill, the Democratic governors of Pennsylvania, Colorado, and Montana and the Republican governors of Ohio, Nevada, Massachusetts and Louisiana wrote to the Senate leaders of both parties requesting a bipartisan approach to health care:

“as Governors from both sides of the political aisle, we feel that true and lasting reforms are best approached by finding common ground in a bipartisan fashion. To that end, we remain hopeful that there is an opportunity to craft solutions to these challenges that can find support across party lines, delivering improvements to result in a system that is available and affordable for every American.”

Like the President, who recently called the House’s bill “mean,” the governors criticized the AHCA:

“Improvements should be based on a set of guiding principles … which include controlling costs and stabilizing the market, that will positively impact the coverage and care of millions of Americans, including many who are dealing with mental illness, chronic health problems, and drug addiction. Unfortunately, H.R. 1628, as passed by the House, does not meet these challenges. It calls into question coverage for the vulnerable and fails to provide the necessary resources to ensure that no one is left out, while shifting significant costs to the states. Medicaid provisions included in this bill are particularly problematic.”

Despite this bipartisan appeal from governors who will have to implement the next health care law, the Senate appears to be readying to pass a bill that, like the House bill, falls significantly short of meeting the nation’s needs.

Although I know that you voted for the AHCA,  I ask that you reconsider your decision and not vote for the new Senate version when it comes before the House, unless it meets the bipartisan principles identified by the governors. They “stand ready to work with you and your colleagues to develop a proposal that is fiscally sound and provides quality, affordable coverage for our most vulnerable citizens.” That offer and attitude are exactly what our nation needs right now. You have expressed a desire for “bipartisan solutions” in the past too. But now I ask that you move past rhetoric, set aside party skirmishes, and deliver on that goal.

Email #189: “mean”?

The American Health Care Act is facing major opposition in the Senate. Republican Senator Burr said: “It’s not a good plan,” and that it was “dead on arrival.” The President reportedly called it “mean” yesterday.

That was true even before the addition of the MacArthur amendment allowed states to waive the essential benefits currently guaranteed under the Affordable Care Act. This is why Republican Senator Collins opposes the bill:

“while I would welcome some changes to improve the flexibility of plans that could be sold, we need to remember that the essential health benefits include substance abuse and mental-health treatment, which are critical to retain for my state given the opioid crisis. Preventative care, vaccinations for children save money in addition to saving lives.”

It’s hard to vilify a law that requires health insurance companies to cover such basic things as pregnancy, hospitalization, and prescriptions drugs, but Speaker Ryan has done his best, calling the ACA’s benefit list “arrogant and paternalistic mandates.” Under the AHCA, states would be free to allow insurance companies to underinsure patients by selling them cheaper, riskier packages that may or may not cover their actual needs.

This will attract young, healthy people, who are literally banking on not getting sick or injured. According to the nonpartisan Kaiser Family Foundation:

“The people who liked their pre-ACA plans were mostly healthy people who wanted cheap limited plans (and see no obligation for risk-sharing). Those folks will like this. Everyone else: no.”

Everyone else includes those who don’t want to gamble their physical well-being and financial future on the blind hope that they won’t really need serious health care. Worse, researchers at the Center on Health Insurance Reforms at Georgetown University explain how the underinsured will actually harm others:

“The losers would generally be people who want to buy a comprehensive insurance policy. Because once you give carriers flexibility to design the benefit package, they will do so to attract healthy people. No chump insurance company is going to be out there offering a comprehensive package, because then they’ll be stuck with higher-risk enrollees.”

ConsumersUnion.org sees an even bigger problem:

“eliminating Essential Health Benefits would allow insurance companies to reinstate annual and lifetime limits on plans. Currently, plans cannot limit care that is part of the EHBs on an annual or lifetime basis. Such limits would be devastating for consumers with serious illnesses, like cancer.”

Timothy Jost, a health care expert at my school and your alma mater, Washington and Lee University School of Law, agrees:

“Since the ACA’s prohibitions of lifetime and annual limits and cap on out-of-pocket expenditures also only apply to essential health benefits, states granted a waiver would be able to define these protections as well. The changes to the lifetime and annual limits and to the out-of-pocket caps could potentially apply as well to large group and self-insured employer plans.”

Why then did you support the MacArthur amendment and vote for a health care bill that weakens health care? Were you so focused on partisan hatred of “Obamacare” that you sincerely did not recognize that the hastily assembled “Trumpcare” is worse?

The ACA, as you have repeatedly argued, is not getting the job done. The country needs a bipartisan solution. That’s only possible if leading Republicans like you explore options that ignore party lines and prioritize the needs of the uninsured and the over-charged. That’s an American problem. It needs a unifying answer.

Email #171: “do better”?

Thank you for your form letter regarding the Affordable Care Act and the American Health Care Act. I am pleased that you too are concerned with “how Congress can better reform our health care system.”

I agree with you that the “status quo cannot continue” and that “our nation can do better.” According to this week’s Department of Health and Human Service’s report “Individual Market Premium Changes: 2013 – 2017,” premiums for people in the ACA’s individual markets roughly doubled in its four-year period. That’s evidence that the ACA either needs to be fixed or to be replaced with something better.

But the AHCA does neither. You said: “I firmly believe that the American Health Care Act is a better way forward.” You are firmly mistaken.

According to the Congressional Budget Office’s March report, the AHCA would increase premiums 15-20% in the next two years. And according to this week’s CBO report, the poor and elderly—those in so-called high-risk pools—would see their premiums rise an extraordinary 750%. That actually makes the flaws of ACA look good. And if the ACA remains through 2026, the CBO estimates that the number of uninsured people will rise from 27 mission to 28 million. But if the AHCA replaces it, that number rises to 52 million. That’s 23 million more uninsured.

Instead of keeping people insured and their premiums down, the AHCA cuts about $1 trillion in taxes, mostly for insurance companies and wealthy individuals. No wonder only 21% of voters approve of the AHCA. And that was before the new CBO report. Compare that to the ACA’s 50% approval rate.

You said: “As the Senate begins consideration of this bill, I urge them to keep the process moving.” But you knew that even before the new CBO report Senate Republicans were dismissing the bill. Senator Collins said: “The House bill is not going to come before us. The Senate is starting from scratch…. My goal is to actually expand coverage for those 28 million Americans who still lack coverage today despite the ACA.”

Collins acknowledges that the ACA is at least attempting to expand affordable coverage. You also say that ensuring “access to affordable health care” is important—and yet your rhetoric repeatedly shows that repealing “Obamacare” is your real goal. You say that “Obamacare must not remain the law of the land” as if repealing it will in itself achieve anything for health care. It won’t. You know that, and yet you continue to rely on pointlessly vilifying rhetoric: “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.”

It’s even easier to see why the mess of the AHCA won’t either. You said you supported the bill because it “would take steps to ensure health care remains affordable and accessible.” Will you now acknowledge that your statement is verifiably wrong? Will you admit that you made an error by voting for the AHCA before the CBO completed its analysis? Will you stop obsessing about repealing the ACA and start sincerely working on ways to achieve its vital goals?

Would you please “do better”?

Bob Goodlatte replies about health care

Dear Mr. Gavaler:

Thank you for contacting me with your thoughts on health care reform and the American Health Care Act (AHCA).  It is valuable for me to hear how Congress can better reform our health care system, and I will be sure to share that information with my colleagues who sit on committees with jurisdiction over health care reform.

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. 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.

This is exactly why I supported the American Health Care Act. 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.

Throughout the evolution of this proposal, members of our community have raised many thoughtful concerns regarding the coverage of essential health benefits. Any patient protections created by the Affordable Care Act will continue under the AHCA.

Insurance companies will be prohibited from denying coverage, rescinding coverage, or excluding benefits due to a patient’s pre-existing condition. The AHCA would only allow insurance companies to consider health status when assessing premiums if that person has not maintained continuous coverage. In addition, the AHCA includes $138 billion to assist states in establishing high-risk pools, lower out-of-pockets costs for patients, ensure coverage for special conditions such as maternity care, and for other risk-sharing measures. The AHCA will also continue allowing dependents up to age 26 to remain on their parents’ health insurance plans and prohibits lifetime limits on coverage. More information regarding provisions included in the AHCA can be found on the House Energy and Commerce Committee’s website at: https://energycommerce.house.gov/healthcarecentral.

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.

Again, thank you for taking the time to share your thoughts on this important issue. As consideration of health care reforms continue, I will be keeping your thoughts in mind. Please feel free to contact me whenever I may be of assistance to you and your family.

With kind regards.

Sincerely,

Bob Goodlatte
Member of Congress

Email #158: “no cuts to the Medicaid program”?

Why did you vote for a bill that breaks President Trump’s promise not to cut Medicaid? Donald Trump said at the start of his campaign:

“I’m not going to cut Medicare or Medicaid.”

He later tweeted:

“I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid.”

But if the Senate passes the House’s American Health Care Act, there will be major cuts to Medicaid as the Affordable Care Act’s Medicaid expansion is repealed in the 31 states that adopted it. The Congressional Budget Office estimated the AHCA would cut $880 billion from Medicaid. Ohio Governor Kasich said of the 14 million people who will lose their Medicaid:

“They are going to be living in the emergency rooms again, potentially driving up health care costs.”

Republican senators Portman, Capito, Gardner, and Murkowski have all come out against the cuts too, and yet, Secretary Price, one of the originators of the bill, said last weekend:

“There are no cuts to the Medicaid program.”

This claim is verifiably and overwhelmingly false. Price added:

“What we’re trying to do is to improve the Medicaid system, make it more responsive to patients so that there are more resources to be able to be utilized for the disabled and the aged. That makes a whole lot of sense.”

In what possible sense does cutting $880 mean “more resources”?

You, however, argued for supporting the AHCA specifically because it did cut the ACA’s Medicaid expansion. You said:

“We can’t afford this when we have $20 trillion in national debt.”

You stated that in January, the same month as the President was renewing his promise:

“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.”

Although you didn’t know you were being recorded, I presume that what you say behind closed doors to your fellow GOP Representatives still applies when you communicate with your constituents back home. So could you please acknowledge that the AHCA does cut Medicaid? And could you please explain why this is something anyone should support?

Email #157: “charged more because of a pre-existing condition”?

According to a Quinnipiac University poll released yesterday, 64% of respondents approve of the ACA’s protections for people with pre-existing conditions, and 75% think it’s a “bad idea” to allow states to opt out of them. That includes a majority of Republicans–59%.

But despite this overwhelming support, I keep reading contradictory claims about whether “Trumpcare” would cover pre-existing conditions.

The President tweeted in April:

“New healthcare plan is on its way. Will have much lower premiums & deductibles while at the same time taking care of pre-existing conditions!”

He added on TV:

“Pre-existing conditions are in the bill. And I mandate it. I said, ‘Has to be.'”

Your form letters to me have also emphasized the importance of maintaining the ACA’s ban on pre-existing conditions, highlighting its inclusion in an early version of the American Health Care Act. But after that version did not have enough Republican support to make it to the House floor for a vote, the MacArthur amendment allowed states to waive protections. Under the amended AHCA that you voted for, insurers can charge much higher premiums for people with pre-existing conditions—but only if they’ve gone uninsured for two months. The House GOP website states this clearly:

“The MacArthur amendment to the AHCA does allow states to seek a limited waiver to allow the insurance companies to charge higher premiums for a person with a health condition only if they do not maintain continuous coverage.”

However, the GOP website also states:

“Americans should never be denied coverage or charged more because of a pre-existing condition.”

Or at least the website used to say that. The New York Times referenced that statement on April 26, and NBC referenced it on May 4. But when I went to the website myself over the weekend, I couldn’t find it. I presume it was deleted—and for good reason: it’s not true of the AHCA.

Unfortunately for those who voted for the bill, it does remain true morally. It shouldn’t matter if someone has no insurance for two months, or for any period of time. So-called pre-existing conditions shouldn’t be used against any American. Before the ACA, pregnancy was a pre-existing condition. Under the AHCA waiver, it can be again. So if an uninsured women gets pregnant and tries to sign up for insurance, she can be automatically overcharged.

The term “pre-existing condition” was invented by insurance companies for the purpose of limiting coverage for people who most need it. “Obamacare” struck the concept entirely. Now “Trumpcare” is resurrecting it.

Voters–both Democrats and Republicans–will remember that in 2018.

Email #155: “the Republican Party will be rewarded”?

President Trump’s budget director Mick Mulvaney thinks you should hold a town meeting this week. He was asked on Sunday about the passage of the American Health Care Act:

“Should House members who passed it go home, and have town halls, and campaign on it?”

Mulvaney answered:

“Absolutely. Without reservation. In fact, I would be surprised if that’s not exactly what they’re doing. That’s what I would do…. I’d be ecstatic about going back and saying, ‘Look, here is what we did.’”

According to your December press release about his White House appointment, you “applaud” and “look forward to working with Mulvaney.” So then why are you now “surprising” him by not holding a town hall as he is urging? Why are you not “ecstatic” to meet with your constituents and hear their applause?

White House chief of staff Reince Priebus agrees with Mulvaney about the positive reception House Republicans will receive for their AHCA vote:

“I think that the Republican Party will be rewarded.”

Speaker Ryan does too. He says the vote will save House Republicans in the 2018 mid-term elections:

“People expect their elected leaders, if they run and campaign on doing something, they expect them to do that. And that’s what we’re doing. We’re keeping our word… I would argue that we would spell disaster for ourselves, politically, if we go back on our word.”

So why aren’t you holding a town hall to be rewarded for keeping your word? You don’t have the worries of your fellow Virginia Representative Dave Brat who is one of 24 Republicans being target by the health advocacy group Save My Care in a six-figure ad campaign criticizing them for their support of the AHCA. Our district is so overwhelmingly Republican, no national organizations are going to waste their money challenging you. And yet Brat said in a town hall last night:

“It’s very clear there’s a disproportionate number of Democrats in the room. And that’s good. You’re all my constituents, and I want to represent all of you.”

Do you feel differently? Do you only represent Republicans voters? Is that why you refuse to hold town halls?

If you’re worried about outside agitators, you could follow Iowa Republican Rod Blum’s model and require participants to prove they live in the district before being allowed to enter the town hall auditorium. He also made sure they weren’t carrying signs or noise-makers. Blum wasn’t “ecstatic”—he stormed out of a televised interview earlier in the day—but he still faced his constituents on Monday night.

So why won’t you? Blum was already facing difficult re-election prospects before he voted for the AHCA, but your seat is still considered extremely safe. The Cook Political Report gives our district a +13 Republican score, while Blum’s Iowa district is +1 Democrat. If one of you should be too afraid to stand in front of a crowd of voters, it’s Blum. And yet he did and you won’t. Why?

Even Tom MacArthur, the Representative responsible for the highly criticized amendment that allows states to strip down benefits and penalize people with pre-existing conditions, plans to hold a town hall this week. MacArthur, Blum, Brat, Ryan, Priebus, Mulvaney–they all think you should too.

You announced the day before the AHCA vote:

“I told my constituents that I would stand for them to repeal Obamacare, and I intend to keep that promise.”

So now stand before us and keep your promise to hold a town hall meeting.