Response: Letter to The Editor

This is a response to Adam’s letter to the editor (LTE) regarding my column posted on June 28th where I laid out the Republican’s plans to repeal the Affordable Care Act once again. I want to begin by thanking Adam for taking the time to write into Your Take Politics and for demonstrating the importance of a substantive dialogue.

To start off, I am glad the LTE brought the Health Policy Consensus Group’s (HPCG) proposal into the conversation because it is correct in stating it “will likely become the backbone of new Republican legislation to repeal Obamacare”. Also, I echo his recommendation to read the proposal. It is a seven page report filled with ambiguity and vagueness that could be the plan to restructure one-sixth of our economy. 

This particular proposal is, as I stated in my previous article, rooted in the plans of the Graham-Cassidy bill. The New England Journal of Medicine titled their study of the GC bill “The Most Harmful ACA-Repeal Bill Yet” and in summary stated “The Graham–Cassidy proposal excludes most of the tax cuts that were central to previous “repeal and replace” efforts. But in many ways, it would go further than earlier bills in reducing health insurance coverage and affordability.”

After reading the letter, a significant basis of our disagreements are rooted in our perception of the intent of the Republican plan. He quotes the HPCG proposal and states:

“This proposal would negate the Obamacare benefit mandates, minimum loss ratio requirement, single risk pools, and the 3:1 age rating requirement. Albeit these policies had good intentions, but they are responsible for much of the downward spiral of the ACA.”

This is the very portion of the proposal—if passed as legislation--that would allow for insurance companies to negate risk pools and the requirements that protect pre-existing conditions. Protect as in ensure that they have access to coverage, or ensure they are placed in the risk pools that keep health care costs from being insurmountable. These are the very protections he later proposes in his letter, “Any future legislation should prohibit insurance companies from canceling your coverage if diagnosed with a serious illness; there should be limits on how high insurance premiums can be increased if diagnosed with a serious illness”. 

So, we agree pre-existing conditions should be protected, but we disagree that the current proposed plan is successfully communicating a plan to achieve protections. We’ll know for certain if Republicans are sincere when legislation is on the floor and says specifically that pre-existing conditions must be covered and protected from discrimination and a series of hearings are had by the Republicans that allow for stakeholders and health care experts to validate that policy. However, I highly doubt based on previous behavior from the Republicans, we’ll witness either let alone the former. 

I’ll reiterate why the Republicans cannot be trusted with our health care. President Trump is supporting a lawsuit that is suing his own administration that will repeal pre-existing conditions. His administration is cutting outreach programs, which are intended to increase coverage, lower risk and costs. Trump’s own Health and Human Services showed data of how premiums would “sky-rocket” under Graham Cassidy. The bipartisan Congressional Budget Office released a report that showed that the repeal of the individual mandate would reduce coverage by 13 million over time and the American Academy of Actuaries, the statisticians charged to ensure insurance companies can make money, told McConnell the same thing and they passed it in their tax bill anyway. To continue, The House Ways and Means committee has passed plans for the GOP’s budget that include gutting Medicaid and Medicare funding and repealing the ACA. Insurers in Texas and Florida have asked for premium increases citing GOP policy changes as the source for the increases. The list for reasons why the Republicans are not concerned with helping everyday Americans afford health insurance is evident and nearly endless. Obamacare is no longer Obamacare. The law has been in the hands of Republicans for a year and half with policy changes made and only despair in sight, this is now Trumpcare.

Last, to address our disagreement on the use of Health Care Savings accounts. I don’t disapprove of the use of HSA’s, but I do not approve doubling the limits as a means of solving health care costs for everyday Americans. The author’s perception of savings by the typical American may be misinformed as studies have shown that Americans simply can’t save and therefore certainly don’t have enough to put aside into health care savings accounts. 

According to the U.S. Census Bureau, the average household income is only 59,039 and a quarter of Americans are saving only 6 to 10 percent of their income. Moreover the study “found nearly 60 percent of respondents have less than $1,000 in their savings accounts, while another survey found only 39 percent of Americans have enough savings to cover a $1,000 emergency”. To summarize, at best only a quarter of American households can put aside—at the high end of the spectrum—$5900 in a given year and that likely split up across retirement, emergency, or even college savings if they’re helping their kids. 

The letter cites 22 million policy holders were helped by HSA’s, but that is of the total 178 million that have coverage. This statistic, now put in perspective, correlates well with the data we’ve seen pertaining to the percentage of Americans that are able to save. The LTE misrepresented my argument as a “millionaire stow-away scheme” but my intent was to show that they’re 1. A tax shelter, which the author validates writing “you …can contribute pre-taxed dollars to the account…if you don’t use all the funds that year, it serves as an interest-bearing” savings. And, 2. Is only realistically affordable by affluent individuals, which he validates when showing only 12% of all policies have HSA’s and additional data supports that argument

I am glad the author was open to the idea of the Medicaid buy in option for the marketplaces. This would promote coverage in states that are only offering one private plan and also increase competition against private plans in all marketplaces. The author is hesitant though and cites the “lower quality of care”. However, I believe he is forgetting that the ACA marketplaces and, a chance to buy a more affordable Medicaid buy-in option, is an opportunity made available by the law who would otherwise never have access to health care at all. I believe it’s a safe argument to state individuals in need of health care will take health care over no health care at all.

Joe MelisiComment