I received this from Derek Kilmer, the U.S. Congressman from my district.
Bonnie Sherrell
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Dear Mrs. Sherrell,
Thank you for contacting me about the American Health Care Act. I appreciate you
taking the time to write and share your thoughts with me.
Too often, the discussions regarding the healthcare are portrayed as distant
policy conversations in Washington, D.C. The reality, however, is that these
issues have real consequences for folks in our neck of the woods.  This is
about people.
This is about the mom I met in Tacoma whose 24-year-old daughter has bipolar
disorder. Her daughter is now able to have insurance because the Affordable Care
Act (ACA) enables her to stay on her parents insurance until her
26th birthday. And that insurance policy now treats mental illnesses the
same as physical ailments because the law now establishes mental health parity.
This is about the cancer survivor I met who said she never thought she would be
able to have health insurance because of her pre-existing conditions. She told
me that she now has insurance as part of the Medicaid expansion and is getting
the treatments that she needs. She said, This is about life or death for me.
This is about every woman I represent who no longer has to pay more for
insurance simply because she is a woman. And its about every person whose life
may be saved because they now have access to free preventive services like
annual check-ups, mammograms, and cancer screenings.
This is about every staff member at Franciscan, Multicare, Olympic Medical
Center, Mason General, Summit Pacific, Grays Harbor Hospital, Harrison Hospital,
Jefferson Healthcare, and every other health provider in our region. These
health care providers have saved millions of dollars – and are able to
continue to be significant employers in our region – because they are now
more financially viable because they have seen a dramatic reduction in the
number of uninsured patients walking through their doors.
And its about the more than 20 million people who now have insurance coverage
– including roughly half a million Washingtonians who did not before
– because of this law.
I wasnt in Congress when the Affordable Care Act was passed. There are parts of
the law that undeniably represent real progress for the folks I represent. That
said, there are also improvements that I believe ought to be made. In fact, Ive
sponsored several bills to try to reduce health care costs for small businesses,
improve access to primary care, and strengthen care in rural areas. Ive said
that if there are reasonable proposals to improve the law, Id be open to
supporting such improvements.
Unfortunately, what weve seen proposed in Congress would send American
healthcare in the wrong direction. The bill passed by Republicans in
Congress on May 4th will effectively dismantle some of the progress made under
the Affordable Care Act. Their plan, known as the American Health Care Act (or
the AHCA for short) doesnt pass the test of improving the system. As it was
written, it will cover fewer people and cost those purchasing insurance –
particularly seniors – substantially more. 
First, the Republican plan would leave millions of Americans without healthcare
coverage. The non-partisan Congressional Budget Office estimates that 14 million
fewer people would be covered under the AHCA during the first year alone. This
number jumps to 24 million in ten years. This would not only hurt the folks who
lose coverage. It would hurt local healthcare providers who will see a spike in
uncompensated care. Thats why the American Hospital Association and the
American Medical Association have come out in opposition to this bill.
Second, the Republican plan would do real damage to the Medicaid system.
Medicaid provides healthcare to lower-income Americans and their families,
people with disabilities, nursing home residents, children, and others. In our
state, two-thirds of Medicaid recipients are seniors and people with
disabilities. Its a difference-maker. In Washington state alone 20,000 people
got cancer treatment because of the healthcare they received through the
Medicaid expansion. Unfortunately, the AHCA proposal would cut off funds for
states to add new enrollees, reduce the amount of Medicaid dollars states
receive for current enrollees, and would lock out those who have a gap in
coverage.
Third, the AHCA would negatively impact womens health services. Millions of
women rely on Planned Parenthood for primary care visits, cancer screenings and
other health services. Despite the fact that federal law currently prohibits tax
dollars being used to fund abortions, the Republican proposal included a
provision prohibiting Planned Parenthood from receiving Medicaid reimbursements
for any of the care it provides – including mammograms, cervical cancer
screenings, family planning assistance, and other care. This would impact a lot
of people, especially lower-income women. One in five women in our country have
visited Planned Parenthood, with over three-fourths having incomes of 150
percent or less of the federal poverty level.
Fourth, this bill would eliminate the Affordable Care Acts Prevention and
Public Health Fund. This important fund supports approximately 12 percent of the
CDCs entire budget and helps ensure that Americans are protected from
communicable diseases such as Ebola, Zika, measles, and mumps. We all know the
CDC is at the frontlines of stopping epidemics before they spread. Whats more,
our state gets $14 million from this fund, with those dollars covering roughly
50 percent of our states immunization program. The Republican plan would zero
this prevention fund out entirely.
Fifth, this bill would allow states to waive the requirements that insurance
companies cover preexisting conditions. Further, it would allow states to remove
requirements that insurance companies provide coverage for essential health
benefits, such as mental health and substance abuse treatment, hospitalization,
prescription drugs, maternity and newborn care. This is a bad policy that will
likely leave millions of people uninsured or under-insured. Thats why
organizations like the American Cancer Society oppose this bill.
Sixth, this bill would impede the progress weve been making in the fight
against the opioid epidemic and mental health challenges. Currently, as a result
of the Medicaid expansion, nearly 1.3 million people receive treatment for
mental-health and substance abuse disorders, including 30,000 people in
Washington state who got treatment for substance abuse disorders through the
Medicaid expansion. Unfortunately, as mentioned, the bill pulls the plug on the
Medicaid expansion. Beyond that, though, the bill proposes eliminating the
requirement that Medicaid cover basic mental health and addiction services.
Thats why the American Psychiatric Association and mental health advocates have
raised concerns about the bill.
Seventh, the bill would cut health care for working people and those living
paycheck to paycheck in order to give nearly $600 billion in tax breaks to
special interests and the super-wealthy. The AHCA proposes two tax cuts
specifically for the wealthiest Americans. These proposed changes would not save
$1 – not $1 – for folks earning less than $200,000 per year. In
contrast, if youre a millionaire, youll get – on average – a
$50,000 tax cut. In fact, according to the Center for Budget and Policy
Priorities, our nations 400 highest income taxpayers (who earn, on average,
over $300 million/year) would see an annual tax cut of roughly $7 million. If
that wasnt enough, the Republican plan would allow insurance companies to get a
tax deduction for pay and bonuses they provide to their executives over
$500,000. For the life of me, I cant figure out the problem that provision is
trying to solve.
And finally, this bill would hurt seniors. Changes in the bill would shorten the
solvency of the Medicare program, hastening the exhaustion of the Medicare trust
fund by four years. In addition, the Republican proposal changes the law to
allow insurance companies to charge seniors five times more than young
people for healthcare coverage. Thats why groups like the AARP have come out
against it.
Ive heard from literally thousands of constituents who have opposed this
proposal. Thank you for adding your voice.
While the bill has been passed by the House, I am hopeful that it will not move
forward in the Senate. In the meantime, I believe Democrats and Republicans
should be working together to promote accessible and affordable health insurance
that works for every family and employer. Whats more, the effort to
strengthen our health care system goes beyond the Affordable Care Act. Our
nation still spends too much money paying for unnecessary procedures. We need to
focus on rewarding value and wellness over volume – not just paying
providers for how much care they provide, but for actually helping to improve
the patients health.
Congress has real work to do to improve our health care system for doctors,
hospitals, rural providers, and patients. Rather than playing politics, that
should be the focus. Please know that, as your representative, Ill keep at it!
I will be sure to keep your thoughts in mind as Congress debates this issue in
the future. I encourage you to continue to share your views with me on this
topic or any other issue. Thank you for reaching out. It is an honor to serve as
your representative.
Sincerely,
Derek Kilmer
Member of Congress
