My letter to the Senate Finance Committee about ACA repeal legislaton

Topher Spiro, veep for health policy at the Center for American Progress and a forceful ACA advocate on Twitter (@topherspiro), got hold of a letter from Senate Finance Committee Chair Orrin Hatch to healthcare "stakeholders," inviting their input by May 23 on Republican senators' efforts to write an ACA repeal bill. Hatch asked that letters be sent to HealthReform@Finance.Senate.gov.

Since the Republican senators' bill-writing process is as secretive and rushed as the House's, Spiro seized the opportunity to encourage non-privileged "stakeholders" -- all of us -- to send their two cents to the email address provided. He has offered to tweet any letters tweeted at him, with a screenshot.

Here's mine:

Dear Members of the Senate Finance Committee:

As a constituent, husband and father of two adult children, son and son-in-law of four aged parents, member of a community and citizen of a nation with many people who lack affordable, reliable access to health insurance or are at risk of losing newly obtained insurance, I urge you

• not to eviscerate Medicaid by imposing per capita caps on federal funding or imposing a block grant formula; 
• not to phase out the ACA Medicaid expansion or reduce the enhanced federal funding that enables it;
• not to end income-based subsidies for premiums and out-of-pocket medical expenses that render individual market coverage and actual healthcare affordable to millions of low-and moderate-income Americans; 
• not to compromise the ACA's ban on medical underwriting or mandating of guaranteed issue or requirement that health plans provide Essential Health Benefits; and 
• not to repeal the ACA taxes that have enabled some 20 million Americans thus far to gain insurance coverage.

More broadly, you should not cut hundreds of billions of dollars in federal spending devoted to extending healthcare access in order to fund repeal of the ACA's taxes on the wealthy and on healthcare industries well able to afford them. You should not reduce federal funding that enables Medicaid to provide vital services to 75 million Americans, including the elderly (e.g., 2/3 of nursing home residents), the disabled, 40% of the nation's children, and low income adults. Medicaid is the most cost-efficient segment of the U.S. healthcare system. You should not impose funding formulas that, in the name of efficiency and flexibility, will inevitably lead to cuts in services and eligibility.  

My two sons have both made use of subsidized coverage in the ACA marketplace during gaps in employer- or university-sponsored coverage. My parents and in-laws may ultimately rely on Medicaid if they spend down their assets to pay for assisted living. My wife and I may need to rely on an affordable individual market for comprehensive health insurance should we lose access to employer-sponsored insurance before reaching Medicare age, regardless of an pre-existing conditions we may develop. All of these essential resources are under threat as you deliberate ACA repeal without adequately funding or designing a replacement.

Your legislative efforts should focus on strengthening the ACA marketplace by funding reinsurance programs, improving subsidies for the middle class, providing public option fallbacks in areas with limited private insurer participation, and otherwise showing the same commitment to making the market work that you have accorded to Medicare Advantage and Medicare Part D. 

The nation is watching. Promises to improve access to healthcare while cutting benefits to fund tax cuts will not fool anyone.  Serve your constituents, not powerful monied interests.

As a stakeholder in the U.S. healthcare system, I expect this letter to become part of the public record in your deliberations. Thank you for taking note of it.

Sincerely,

Andrew Sprung

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Note: Having Medicaid on the brain, I wrote "Medicaid" when I meant "Medicare" in the sentence anticipating my wife and my possible needs for the indiv market -- corrected above. Yow.