Support the Affordable Care Act

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Dear Congressman Reed, 

We write to urge you not to repeal the Affordable Care Act (ACA), and to vote 'NO' on the American Health Care Act (AHCA). Though the original legislation is far from perfect, it has had an extraordinary impact since its implementation, ensuring that nearly 20 million more Americans have access to high-quality healthcare today than in 2010. Impressive as these numbers are, the legislation's most significant contribution to the wellbeing of the American people is yet to come. This is because, in addition to covering treatment for acute and serious sudden-onset disease, the ACA also grants wider access to quality preventive health care, which is instrumental in keeping long-term health costs down nationally, not just in New York. This is because without preventive care, diseases are spread more readily, travel farther, and are more costly in terms of care and lost productivity. Since 2017 will bring new challenges in the form of both infectious illnesses (antibiotic-resistant bacteria, influenza, and zika) and epidemics of chronic ones (diabetes, asthma, and obesity), preventive care for as many people as possible is more important than ever. Since these diseases know no state boundaries, the best way to keep New Yorkers healthy is to protect the health of the U.S. population as a whole. Simply put, preventive care is the cheapest and most effective means of doing so.

If you vote to repeal the ACA, which will end the individual mandate, severely cut Medicaid and the existing subsidies, 14 million Americans will lose their insurance this year, and 10 million more will follow by 2026.  If this many people lose their care, all of us will become sicker. This is because acute and chronic illnesses affect us as a population, not as individuals or groups. If we truly want to a healthier society, we have to protect the wellbeing of most vulnerable members of the population: the self-employed entrepreneurs, service industry workers, winemakers, farmers, and artists who add so much to the economic diversity and cultural vibrancy of our communities. High premiums are indeed a problem that has dogged the ACA of late—but repealing the act or its central provisions won’t help to lower them. Rather, our representatives in Congress need to improve the ACA by implementing two commonsense measures: nationalizing network adequacy standards and instituting prescription price controls. This way we can stop premium rate increases without risking the health care of all Americans.

First, let’s take a look the importance of the individual mandate. Recent history has shown us that health exchanges simply do not work without some means of retaining healthy customers. Consider Washington state, which set up a health care marketplace similar to the ACA exchanges in the 1990s. After the Republican legislature voted to repeal the individual mandate, insurance companies began losing money and left the state. This was because the only people buying health insurance were those who foresaw having high medical costs, which drove health insurance premiums skyward. As premiums went up, insurance became less affordable and enrollment decreased significantly. Between 1993 and 1998, seventeen health insurance carriers had left the state’s individual market. The two insurers who did remain stopped writing policies by 1999. Washington state’s individual market was essentially dead, and its legislature has been in Democratic control ever since. Additionally, replacing the mandate with a surcharge for any lapse in insurance coverage is a disastrous idea. Rather than being a tax penalty paid to the government, the surcharges will go directly into insurer's pockets. It will reflect poorly on you if insurers get richer while your constituents--all of them--collectively sicken. 

Second, consider the Medicaid expansion. Extending eligibility to 133% of the poverty level has allowed us to include over 1.1 million more people on the health exchanges in New York State alone. The costs avoided by having more than a million more people regularly seeing a primary care physician for preventive care are staggering. Unpaid emergency room bills have dropped drastically, lowering the costs that local hospitals must pass on to local taxpayers. Acute and chronic illness are treated more efficiently and effectively, which saves us the taxpayers money: in lower property taxes and in productivity that would have been lost to sick days. Additionally, the Federal government is now giving states money to fund this expansion. In the past, New York State expanded Medicaid on its own, without federal reimbursement, and some of those costs were passed onto local taxpayers by our state and local lawmakers. As a result property taxes grew swiftly in the early 2000s. But now that the Medicaid expansion has been federally funded, New York receives about $440 million dollars in for NYC and $163 million for the rest of the state. The federally funded expansion is what has kept our property taxes below the 2% gap these last four years. Moreover, property taxes are a state issue. Repealing the ACA to lower our local taxes is like treating the symptom, but not the underlying cause, of a disease. It may bring the patient some relief in the short term, but it won’t fix the underlying structural problems that made us vulnerable in the first place. Tying our state and local budgetary issues to national health reform is a shortsighted and “penny-wise, pound-foolish” way to solve a small part of much more complicated state tax issue. The health of the American people is far too important to hold hostage over property taxes.

Finally, the AHCA's plan to repeal the payroll tax on high earners and to slash the subsidies of our older citizens is unconscionable. Drastically cutting the subsidies and shifting them to an age basis will drive millions of older American out of the marketplaces—causing them to lose coverage precisely when they need it most. The Brookings Institute calculates that without the payroll tax, Medicare Fund A will become insolvent by 2024. Are we to chastise and punish older Americans for needing more care at the end of lives, after they have given all of us so much? A lack of coverage negatively impacts their wellbeing and that of their families as well. This latter point has been demonstrated in a recent study by David Slusky, an economist at the University of Kansas. Slusky’s work has found that in states that opted not to take Federal money for Medicaid expansion, divorce rates among older Americans has skyrocketed. This is because, without the expansion and facing vast medical debt, lower middle class spouses will divorce to protect one half of the family’s money from bankruptcy proceedings the sicker spouse faces. Clearly, quality affordable health care protects our communities physically as well as spiritually. So, not only is this new legislation opposed by the majority of the medical community (over 7 different national medical research associations and over 4 different hospital associations), it will harm our local entrepreneurs, lower income citizens, and our cherished elders—but in addition to all this it will attack the nuclear family unit, the bedrock of American society. There can be no other interpretation of the AHCA but that it is an un-Christian, un-American, and inhuman piece of legislation. You must vote against it. 

Rather than repealing the ACA, wouldn’t you rather be one of the pioneering representatives who worked on a bi-partisan basis to fix it? The only way to keep insurance for 20 million Americans AND to make premiums affordable would be to remedy, not repeal, the existing Affordable Care Act. First, we should keep what works: protections for people with pre-existing conditions, the individual mandate, and the expansion of Medicaid. Next, create a national review board that can negotiate the prices of prescription drugs, the way Canada does, which is a proven means of keeping drug costs low. Recall that a recent Senate bill trying to institute this practice had the support of many members of your party, such as Ted Cruz, Susan Collins, Jeff Flake, John Kennedy, Mike Lee, and John Thune. Finally, implement national network adequacy standards. These would fix the ‘narrow network’ problems that bedevil the existing system by requiring insurers to work with a certain number of providers in the areas they serve, and regulate the maximum distances patients travel for care while ensuring minimum provider to enrollee ratios and hours of operation at health care centers. 

If you maintain the portions of the ACA that work and remedy what’s flawed, you and the other members of our 115th Congress will be able to implement a health care system that faithfully provides quality care to all Americans. Supporting the Affordable Care Act is the best medical, financial, and moral decision for this country, because willfully ignoring the suffering of marginalized Americans both literally and figuratively sickens the American body politic. The United States will be valued not for its labyrinthine tax codes, the size of its GDP, or the dazzling array of beautiful, clever things that endlessly divert and distract its populace. Rather, posterity will judge us by how well we cared for the most fragile and frail amongst us, by how jealously we guarded—not our own comfort and wellbeing—but that of our fellow citizens. Health care is a universal human right. Support the Affordable Care Act and you will protect us from corporeal ailments as well as far more devastating disease of apathy, and the death of human kindness.


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