As you are aware, the current health care system has major flaws. Despite having one of the highest spending rates per capita on health care, Americans rank poorly in many health-related measures, including suicide rates, life expectancy, chronic disease burden, obesity, doctor visits, physician population, preventable hospitalizations, and avoidable deaths. 

​

One of the best ways to combat these statistics is by moving towards affordable, universal coverage. Studies have shown that better coverage lowers mortality rates, and the American College of Physicians cites it as “a crucial component to ensuring quality health care for all without financial burden that causes delay or avoidance of necessary medical care.”  The Patient Protection and Affordable Care Act (ACA) has increased coverage in the United States by and estimated 20 million people, with 13 million poorer Americans enrolling in Medicaid after the Act was passed.

​

On your website, you advocate a repeal of the ACA (or, as it is colloquially known, “Obamacare”), saying it has “crippled the health insurance industry.” However, a Kaiser Family Foundation report indicates that the individual health insurance market is stable, and was in fact “highly profitable” in 2018. The New York Times reported that “companies, which were once spending nearly every cent of each dollar they collected in premiums on medical claims, were now taking in enough money to have 25 cents left over in the most recent period of 2019.” Seeing as I have not completed comprehensive research on this issue specifically, I am interested in looking into some of your data on the effects of the ACA on the health insurance industry.

​

I understand that part of the concern is likely related to some of the ACA regulations that can increase costs for insurers. While repealing the Act is one way to handle these price increases, it would also remove the protections for low-income individuals and people with pre-existing conditions. In fact, Trump Administration proposals that remove or limit the ACA are predicted to increase premiums for sicker patients, increased the number of uninsured, and lead to a variety of changes to Medicaid, including reductions in eligibility, covered services, and payment for providers, according to the Brookings Institute. Instead of a repeal, would you support measures to provide relief for insurance companies and families by re-instating cost-sharing reduction payments as a permanent mandatory appropriation?

​

Another concern you mention is choice and affordability for citizens. To the point of choice—I agree that increasing options can be beneficial, as areas with a greater multitude of insurance plans have slower premium increases than areas with a single insurer. Why is repealing the ACA the best way to increase choice? From what I understand, the federal marketplace established by the ACA helps consumers without employer-based coverage evaluate options and purchase insurance. However, choice must also be accompanied by universal coverage in order to promote public health. The American College of Physicians report “Envisioning a Better U.S. Health Care System for All: Coverage and Cost of Care” gives two options that lead to universal coverage: single-payer health care and a public option. In considering choice as a factor, it is clear that the public option is ideal. Creating a public option with essential benefits, reasonable payment rates for providers, and the opportunity for employers to offer the plan would raise the standard for private health insurance plans as well, expanding consumer choice in a way dictated by the government, rather than for-profit companies. It would give and affordable choice to the 2.5 million people who qualify for expanded Medicaid coverage but live in states that chose not to expand. Despite this, most Republican proposals oppose the public option in favor of deregulation and repealing the ACA. How does repealing the ACA increase choice while protecting patient benefits and affordability in a manner comparable to a public option?

​

It is true that the Affordable Care Act’s failure to place meaningful limits on deductibles has created a burden for people, especially those who previously benefitted from uninsured discounts on services. An alternative method for relieving this burden is to create an income-based subsidy for cost-sharing. Similar systems are employed in Germany and Switzerland, which both have better health statistics than the United States. While this would require increased federal spending, it is also an important way to improve the health and well-being of the American people. I am sure there are other ways to achieve this goal, and so I am interested in hearing how you would address high costs for low-income citizens in the event of an ACA repeal.

​

A less costly way of increasing affordable coverage is to make full use of the systems already in place. The Bipartisan Policy Center and the American College of Physicians both recommend auto-enrollment into marketplace plans for people who are eligible for marketplace subsidies. If this was combined with a restoration of the enrollment advertising budget, it would increase public awareness of the plans available to them.

​

Another way to lower costs is to consider the price of services, rather than the insurance plans that cover costs. With this in mind, what are your views on supporting all-payer claims databases through federal legislation in order to promote transparency in the industry and limiting “surprise bills” by requiring out-of-network providers to accept a the median in-network payment from insurers?