I am very concerned about the early actions taken by the House of Representatives in this young 115th Congress. They attempted to remove independent ethical oversight of their actions and they have broken from years of fiscal responsibility rules by considering transfers of federal lands to local governments as “no cost to the federal government.” (They are not – the American people will lose federal revenue from grazing and mining rights, for example.) Their statements regarding the promised repeal of the Affordable Care Act and the defunding of Planned Parenthood suggest that they will take these steps in a way that will cut health care options to tens of millions of Americans, most of them women and children.
I understand that Republicans, if they hope to win their next elections, have no choice but to repeal the Affordable Care Act (ACA) after promising to do so for seven years, but it appears that their “repeal and replace” rhetoric is just lip service. They are moving at full speed toward defunding the ACA using budget rules without having more than a few sketchy ideas for a replacement. Unlike what was promised by President-elect Trump in Wednesday’s news conference, it seems unlikely that a replacement will occur on the same day as the repeal.
The likely scenario is that the House and Senate will use budget reconciliation rules to strip the Affordable Care Act of funding and the authority to spend money on insurance premium subsidies and Medicaid expansion payments to states. They will still require health insurance companies to cover those with pre-existing conditions and allow children up to age 26 to stay on their parents’ plans, however, because that can’t be changed using budget reconciliation rules. That makes the individual market (not employer-based insurance) very unprofitable for insurance companies and most will drop out. Consequently, in most of the country there will not be a reasonable option for health insurance that is not employer-based. Consider these numbers from the Kaiser Family Foundation:
In the U.S., 49% get their health insurance through their employers, 7% buy through the individual market, 20% are on Medicaid, 14% are on Medicare, 2% have a different public insurance program, and 9% are uninsured.
For health insurance companies, 12.5% of clients purchase through individual markets and the ACA funding repeal means that the insurance companies will lose a lot of money on those plans. It makes good business sense to leave the individual market completely. Many who are currently covered by Medicaid will also lose their insurance when the federal government stops sending Medicaid Expansion funds to the states.
When that happens, the Republicans in Congress and President Trump will try to pass the blame. They will say that they had a replacement plan and the Democrats blocked it so that’s why tens of millions of Americans have lost access to health care. In light of the way Americans lapped up fake news during last year’s presidential campaign, that may work. Mr. Trump will also scold the insurance companies for dropping out of the market, but they will respond with solid financial arguments about why they had to get out of the money-losing business.
Only a very small percentage of Americans (6%) believe that the ACA should continue in its current state, but more Americans would like to see it strengthened or expanded (38%) than repealed and replaced (31%). My concern is that the House is full of safe conservative districts due to gerrymandering and those representatives will work hard to repeal and not replace. Thirty-eight percent of the country’s republicans and independents want that option and I suspect that the more conservative or libertarian a lawmaker’s district, the more popular is the “no replace” option.
So that’s why I have come up with this call to action. Senators have to appeal to the entire state, not just those in gerrymandered districts. That means that senators have to be at least a bit more centrist and consider the needs of all people in their states. It is in the Senate that the hope for a timely replacement is strongest.
Write to your senators. Tell them what you feel. Tell them what you need. And to make it easier, I have come up with some tools.
You’ll notice some documents in the black bar under the photo at the top of the AOneManThinkTank.me page. The “U.S. Senators Contacts with Links” document is a Microsoft Excel spreadsheet listing the names, addresses, phone and fax numbers, email links, and twitter links for all 100 senators in the 115th Congress. I have also included a proposed letter which can be mailed or faxed and a proposed tweet. Copy and paste as you wish.
Of course, feel free to write your own messages to your senators – perhaps shorter and more to the point than mine; my wife tells me I can be a bit wordy.
Let’s make this a movement. We need the Senate’s protection from rather worrisome House proposals. Please send this to everyone you can. Thank you.