Email #115, Subject: “repeal” or “build”?

Following the defeat of the American Health Care Act, you wrote in your e-newsletter: “Congress must continue working to come to a consensus on legislation to repeal and replace Obamacare.” You said this is necessary because of “unaffordable premiums, higher deductibles, and lack of choice and access that far too many folks in the Sixth District and across the country have experienced firsthand.”

While your statements might seem to oppose President Obama, he expressed some of the same concerns following the defeat of the AHCA too: “I’ve always said we should build on this law, just as Americans of both parties worked to improve Social Security, Medicare, and Medicaid over the years. So if Republicans are serious about lowering costs while expanding coverage to those who need it, and if they’re prepared to work with Democrats and objective evaluators in finding solutions that accomplish those goals — that’s something we all should welcome.”

Though your core difference is obvious—you want to “repeal and replace Obamacare” and he wants to “build on” it—your shared goals are obvious too. You just state them in negative terms: “unaffordable premiums, higher deductibles, and lack of choice and access,” while he states them in positive terms: “lowering costs and expanding coverage.” You and President Obama also seem to agree on a path forward. You say Congress must “come to consensus,” and he says Republicans should “work with Democrats.” The result would be the same.

When I called your office to ask you to oppose the flawed ACHA, your intern asked me if I supported the ACA. I told him I was neutral toward it. If the choice is between the ACHA and the ACA, or the ACA and nothing, I prefer the ACA. But I would much rather have a new health care bill that improved on the ACA. I don’t care if that means “repeal” or “build on.” I don’t support the ACA because it’s been branded as Obama’s legacy. I support the ACA because I believe in its goals.

You said you are “interested in any health care proposal that lowers health care costs for all Americans.” The AHCA failed to pass because it would have failed to achieve those goals.  As you have argued so forcefully in the past, the status quo is not good enough. Because the Republican party controls both houses of Congress and the White House, it remains the Republican party’s responsibility to find a path forward.

What steps are you taking to build bipartisan legislation that will correct the flaws of the ACA?

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 #100, Subject: “broken promises”?

The President stated in a mass email last week:

“Americans were promised that Obamacare would bring down healthcare costs — that promise was broken. Americans were promised they could keep their healthcare plans under Obamacare – that promise was broken. Americans were promised that Obamacare would not raise taxes on the middle-class – that promise was broken.”

I am startled then that the new American Health Care Act breaks so many of President Trump’s own promises.

He promised that the new health care plan would get “insurance for everybody” and with “much lower deductibles.”

He promised: “The way to make health insurance available to everyone is to lower the cost of health insurance, and that is what we are going to do.”

He promised: “And I’m not going to cut Medicare or Medicaid.”

He promised he would give governors “the resources and flexibility they need with Medicaid to make sure no one is left out.”

He promised: “Everybody’s got to be covered. This is an un-Republican thing for me to say … I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now. … The government’s gonna pay for it.”

But the American Health Care Act doesn’t cover everyone. It doesn’t even cover everyone who currently has insurance under the ACA. The Congressional Budget Office says 14 million people will lose their insurance next year if the ACA is replaced by this bill. 24 million will lose their insurance over the next ten years.

The American Health Care Act doesn’t include enough funding for those forced into its high risk pools and so the government isn’t “gonna pay for it.”

The American Health Care Act cuts Medicaid by eliminating the entire ACA expansion. States will have fewer “resources” and so far less “flexibility.”

The American Health Care Act raises deductibles on the sick and elderly, patients who under the ACA can’t be charged more than three times more than other patients. But new the bill allows insurance companies to charge five times more.

Given these broken promises, how can you continue to criticize Obamacare but ignore all of the flaws and broken promises contained in your own party’s replacement bill?

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.

Email #74, Subject: “Better Way”?

Thank you so much for your recent letter in response to my concerns regarding your intended ACA repeal. However, because your letter once again failed to address the specific details I raised, your continuing pattern of avoidance and contradiction increases my overall concern.

While you state that nothing “can resuscitate Obamacare from its failures,” your “Better Way” 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.” These are three signature elements of the ACA. Since your plan recreates them, in what sense is the ACA a failure? Is this political battle just about naming rights?

You also once again state that there needs to be “a stable transition period between repealing Obamacare and the new health care solution.” This is in direct opposition to the President’s promise. President Trump assured the country that the new health care program would be signed into law the same day or even the same hour that the ACA would be repealed. Why are you instead insisting that “it’s important that we have a transition period”? How long do you intend this period to last? In what sense will it be “stable” for those families who will lose their ACA coverage and have no other means of getting insurance during your transition? You state that you “want the families who are hurting under Obamacare to feel relief as quickly as possible,” but your “transition period” would accomplish the opposite. Why exactly is this period “important”? Is it, like naming rights, designed to bolster the appearance of the eventual replacement bill? The longer the period between plans, the more desperate and willing Americans will be for anything — no matter how inferior it may be to the ACA.

I commend your stated goal to “improves access to affordable health care for all Americans.” But if, as you also state, the replacement does not involve what you term “big government mandates,” it is unclear how you will pay for it. Since you have built your career as a deficit hawk, I can’t believe you will endorse radically unbalanced budgets. And yet without an ACA-like mandate, how can you provide health care “for all Americans.” Because your professed goals are so contradictory, could you please clarify to your constituents what exactly you intend to do?

Chris Gavaler

Bob Goodlatte replies about Obamacare

Dear Mr. Gavaler:

Thank you for contacting me regarding the high cost of health care and your thoughts regarding the Patient Protection and Affordable Care Act, commonly referred to as Obamacare.  It is valuable for me to hear what parts of Obamacare have been beneficial to you, and I will be sure to share that information with my colleagues who sit on committees with jurisdiction over health care reform. To be clear, the 115th Congress has not yet voted to repeal Obamacare, but instead has begun a legislative process to craft a new health care policy that is fair and improves access to affordable health care for all Americans.

I know Americans are frustrated by rising health care costs, and I share in this frustration.  I have talked with folks all across the 6th District, those under employer-sponsored health insurance plans, those providing employer-sponsored insurance, those self-insured, and even those uninsured. Their message remains the same: health care is becoming unaffordable.  In just 30 years, from 1980 to 2014, health expenditures in the United States saw a tenfold increase, rising from $256 billion to $3.03 trillion.  We can all agree that something must be done.

Unaffordable premiums, deductibles through the roof, losing a doctor you’ve had for years, being dropped from the coverage you need – these are just some of the ways Obamacare isn’t working for Virginians. The calls, letters, and emails I’ve received about what families, seniors, and businesses have experienced only emphasize this fact. Since the implementation of this law, Americans have seen their insurance premiums increase and their access to care decrease.  No amount of patches or delays can resuscitate Obamacare from its failures. That is exactly why Congress is getting to work on the process to repeal and replace this law.

Before Congress can implement a new health care system that truly works for the American people, Congress must review and repeal law that is not working today. To achieve this first step, the House and Senate passed a resolution to initiate a procedure called reconciliation, the means by which committees can draft legislation to evaluate and repeal portions of Obamacare within their jurisdiction. In the House, once legislation is approved by the relevant committees, it will be put together into one, straightforward bill. Once the House and Senate pass the bill resulting from reconciliation, it would then go to the President for his signature. Reconciliation is simply a step in the process of reforming our health care system, and Congress has not yet voted on a final repeal of Obamacare. Rest assured, an important part of this process is ensuring that there is a stable transition period between repealing Obamacare and the new health care solution. While I want the families who are hurting under Obamacare to feel relief as quickly as possible, it’s important that we have a transition period.

Many are asking what a new health care system will look like. Crafting a new system that works for Americans is of the utmost importance and something Congress is taking very seriously. House Republicans have shared numerous ideas over the past several years that would create a health care system focused on patients, not the government. The “Better Way” agenda, developed last fall, is our starting point for a replacement system that promotes more choices and lower costs. 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. Committees are already hard at work on plans and taking input from lawmakers and constituents from across the country. You may read more about the “Better Way” agenda by visiting better.gop.

As the United States welcomes a new Administration, now is the time to reverse the flawed policies of Obamacare and implement real, patient-centered health care reforms. In the coming months, I look forward to advancing the health care reforms the American people have demanded. Never before has Congress had a better opportunity to act and clear a path for health care reforms that put patients first, not big government mandates.

Again, thank you for the benefit of your comments. Please feel free to contact me whenever I may be of assistance.

With kind regards.

Sincerely,

Bob Goodlatte
Member of Congress

Email #46, Subject: balanced budget or Obamacare repeal?

Thank you for your letter declaring your support for a balanced budget amendment. I am especially pleased to see that your position on this issue did not change because a Republican is entering the White House tomorrow. You supported this amendment under Obama, and you continue to support it under Trump. I commend that principled consistency.

I am, however, confused then why you undermined the Budget Office by barring them from calculating and reporting the cost of repealing the Affordable Care Act. If you wish to “put an end to deficit spending” as you state, this information is vital. The last estimate was $350 billion. Repealing the ACA will not only prevent Congress from balancing the budget, it will add greatly to the long-term deficit, two problems you claim are your top concerns.

I don’t understand how to interpret this extreme inconsistency. Do you believe the costs of the ACA repeal somehow don’t count? I understand you want both, but, as you say: “Families all across our nation understand what it means to make tough decisions each day about what they can and cannot afford and government officials should be required to exercise similar restraint when spending the hard-earned dollars of our nation’s citizens.”

Your contradictory positions suggest you are not living up to your own standard. Instead of ranking the repeal against its costs and making the tough decision of which matters more, you appear to be showing no restraint and pretending that you can have both. You can’t. Please acknowledge that financial fact and change one of your positions accordingly.

Email #42, Subject: repeal but replace later?

You recently criticized Obamacare for: 1) “unaffordable premiums,” 2) “deductibles through the roof,” 3) “losing a doctor you’ve had for years,” and 4) “being dropped from the coverage you need.” May I assume these are also your top priorities for any health care bill that would replace Obamacare? If so, I strongly agree.

You also state that you “want the families who are hurting under Obamacare to feel relief as quickly possible,” but that it’s more “important that we have a transition.” Why is that exactly? What does this “stable transition period” do for those families? How does it answer your four criticisms? In what sense is it “stable” at all? Isn’t it further destabilizing the health care market?

You also state that “Before Congress can implement a new health care system that truly works for the American people, we have to get rid of what is not working today.” But getting rid of Obamacare “today” without simultaneously replacing it with something better would increase all four of the top concerns you named.

Without either Obamacare or a stronger replacement bill replacing it immediately, families who are already hurting now would face: 1) even more unaffordable premiums, 2) even higher deductibles, 3) losing even more doctors, and 4) being dropped from even more coverage plans.

The process you outlined will create a bill to “dismantle” Obamacare, but not replace it. You say you will then work on another, separate bill that will provide better health care. But how does that help the people who needed Obamacare in the first place? 

If the only thing keeping people from drowning is a half-inflated life preserver, they cling to it. You want to rip that life preserver out of Americans’ hands as you shout from the safety of the shore: “We’ll be back later with a better one.”

I understand you hate Obamacare. That’s why you call it “Obamacare” instead of the Affordable Care Act. I don’t care what it’s called. It’s all many Americans have right now. Don’t put partisan fighting ahead of the health care needs of the people you are supposed to be serving.

Chris Gavaler