Thank you for your work in support of an effective Veterans Administration, ensuring that Americans who have served their country can receive a high quality of care. I am writing because I have read news reports that you are among a group of senators developing a health care bill based on the one recently passed by the House. I have also read that Republican leaders hope to pass the Senate bill before the July 4th recess. I have concerns about both the process and the rumored substance of this bill.
America’s health care system needs improvement. Americans spend more on health care per capita than any other country, yet our life expectancy and other quality of life measures trail many of our peers in the G20 (https://ourworldindata.org/the-link-between-life-expectancy-and-health-spending-us-focus). This imbalance puts America at a competitive disadvantage. Higher health care costs lead to less discretionary spending, weakening domestic demand for American products and services. Worse overall health leads American workers to be less productive as they must take time away to care for their own health or for sick family members. The imbalance between coverage offered in the group market and individual market also makes it harder for entrepreneurial Americans to leave a large employer and start a new business. By increasing access to care and reducing its overall cost, America can become stronger, more productive and innovative, and more resilient as a nation.
The message that the House sent with the AHCA was that insurance premium costs are the biggest challenge facing the American health system. Premium costs are an important issue, but they pale in comparison to both the overall cost of care and the ability of many Americans to access quality care at all. Many of the premium savings offered by the AHCA are driven by changes which allow insurers to offer less coverage or to offer cheaper policies to younger and healthier people while older and at-risk Americans’ premiums will rise. These changes will not bring about a healthier or more resilient America. Rather, they will lead us to abandon the Americans who need help the most: the CBO estimates that the AHCA would cause 23 million Americans and 280,000 Coloradans to lose health coverage by 2026 (https://www.cbo.gov/publication/52752 and http://acasignups.net/ahca-coverage-loss).
2016 was a challenging year for my wife and I, navigating several medical crises. We were able to survive the financial aspect not because of low premiums or our ability to save about $2000 through a HSA but because of a reasonable out-of-pocket maximum and because in many cases our insurance-negotiated rates were half of the provider-billed amounts. My biggest worry as I faced months of illness was that I would lose my job and therefore my insurance. Under the AHCA plan and with my newly discovered pre-existing condition, I worry that if I lose my job that the high cost of American health care would lead to either bankruptcy or death. This is a prospect that Americans need not face: our nation is strong and innovative enough that we can find a way to ensure that every citizen can receive quality health care at a reasonable cost.
Finally, I am concerned that you and other Republican senators are developing this bill in private and are hurrying to pass it before the American people can come to understand the proposal and provide our input. America’s health care system needs significant improvements, but the situation is not so urgent that we cannot take six months to have a national conversation about how we can best ensure that Americans have access to the care we need. The United States Senate has a proud history as a deliberative body, carefully considering the impact of legislation not just on the current political cycle but on the effect it has on the lives of hundreds of millions of Americans for generations to come. The House version of the AHCA bill was prepared in such a rush that the CBO has not yet had time to estimate the macroeconomic effects and share that data with the American people. I hope that the Senate takes a more careful approach and listens closely to the people of Colorado and America. I encourage you to include success metrics for cost, coverage, and overall health in the Senate bill; if these metrics do not improve under the bill, its provisions should sunset.
Come 2020, the resilience of the American health care system will play a significant role in my voting choices. I will be swayed not by how low my monthly premium prices are but by whether I and the people I care about receive better or worse medical and mental health care than we could in 2016. I am blessed to have a good job and modest investments; I happily paid $221 for the Net Income Investment Tax knowing that it helps provide health care to those less fortunate than I. And I would gladly pay more in income tax to achieve a healthier and more resilient America.
Thank you for your consideration and hard work on this matter,