Congressman Lewis,
Thank you for your letter of March 29, 2017, in response to my concerns about the American Health Care Act (H.R. 1628). I was a bit surprised to receive your letter 5 days after Speaker Paul Ryan pulled the legislation from consideration, but it's good to know where you stand.
You state your belief that "The Affordable Care Act is collapsing under its own weight," and while I agree that it has its warts, none of your suggestions appear to improve upon it.
Let's start with your mention of Health Savings Accounts (HSAs), which of course are in wide use today. While HSAs are better than nothing, they amount to nothing more than a tax break, and a fairly modest one at that. For families facing a severe health crisis, such as cancer, an HSA amounts to setting aside pre-tax dollars you don't have to pay for health care you can't afford --- even for middle-income families.
Unfortunately, this appears to be the best of your suggestions. Your promise of tax credits "that anyone can use to purchase insurance anywhere in the country" seems to strongly indicate that you support the policy which Republicans call "selling insurance across state lines", but which in reality would mean a race to the bottom. Insurers would operate from the states with minimal requirements for coverage, thus cherry-picking the healthiest consumers from around the country and causing insurance rates to skyrocket for everyone else.
Of course, under the ACA, that can't happen, thanks to the ACA mandate that all insurance plans cover 10 Essential Health Benefits --- but you also say you want to strip that mandate in the name of "choice", thus guaranteeing a race to the bottom. Presumably your principle of "choice" means you would also eliminate the ACA's mandate requiring that individuals buy insurance. As you must know, eliminating this mandate would result in a mass exodus of young, healthy consumers from the individual market, meaning that insurers would maintain their profits by jacking up premiums on the older, sicker consumers who remain --- or they would exit the individual insurance market completely. How do either of these outcomes result in greater "choice"?
Considering your support for these flawed policies, which seem to benefit no one but the insurance industry, it's hard to take seriously your commitment to "ensuring that the most vulnerable among us do not slip through cracks as we work to reform the health care system." This statement seems to be at odds with your support for the AHCA, which would roll back the Medicaid expansion of the ACA. In fact, of the 26 million people projected to lose health coverage --- by the Trump White House's own estimates! --- 17 million would be Medicaid recipients. Your dogged support for this legislation in the face of 17% popular support, and even as the Republican caucus imposed their version of "martial law" to get it passed before members had a chance to read it, strongly indicates that your primary concern is to toe the party line and support your president, rather than the well-being of the most vulnerable among us.
As for problems with the ACA, it's worth noting that 2017 is the first year that premium prices rose above those projected by the CBO back in 2009, and that a substantial portion of the price increase was offset by subsidies. And as noted above, your suggestions for fixing this problem only promise to drastically worsen the problem. An obvious and simple solution is to increase the subsidies available under ACA. But I suggest that we think big.
The United States already has an established and tremendously successful program of single-payer health care, called Medicare. In the coming weeks, Senator Bernie Sanders and Rep. Peter Welch plan to introduce legislation to Congress which will expand Medicare to cover all Americans. This bill would address all of your concerns (no premiums to pay, available to everyone in the country, protects the most vulnerable) and mine (universal coverage, no race to the bottom). The key sticking point, of course, is the cost --- but surely the cost to the taxpayer in the form of a tax increase would be cancelled out somewhat by the complete elimination of a health care premium.
As this legislation has yet to be introduced, it's impossible to know all the details. But it does seem like a promising way forward, and I hope you will join with me in supporting it.
