May 4, 2017

United States House of Representatives
Washington, DC  20515

Dear Representative:

On behalf of the millions of members and supporters of the National Committee to Preserve Social Security and Medicare, I write to urge you to vote against Representatives Tom MacArthur and Mark Meadows’s and Representative Fred Upton’s respective amendments to H.R. 1628, the American Health Care Act (AHCA), and to oppose the underlying bill to repeal the Affordable Care Act (ACA). 

We opposed the AHCA when it was first scheduled for consideration in the House of Representatives in March and, unfortunately, the MacArthur/Meadows amendment only makes the bill more objectionable because it would further increase premiums and decrease coverage for millions of Americans.

Under the amendment, states could apply for waivers that would enable them to allow insurance carriers to charge certain enrollees with pre-existing conditions thousands of dollars more than healthier individuals.  This proposal would be particularly harmful to the 40 percent of enrollees age 50 to 64 who have one or more pre-existing condition.

The MacArthur/Meadows amendment would require states receiving this waiver to set up high-risk pools, where people with pre-existing conditions could buy health insurance.  However, most high-risk pools have failed because they did not have enough money to cover sicker enrollees and the AHCA has the same problem.  While the Upton amendment would add $8 billion over five years to fund high-risk pools, it is a miserly amount, still far less than what is needed to mitigate the desperate situation being created for sick people by the MacArthur/Meadows amendment. 

States could also receive a waiver to allow insurance carriers not to offer essential health benefits like prescription drugs, chronic disease management and maternity care.  In waiver states, that means insurance plans may not cover chemotherapy for cancer patients or insulin for diabetics.

In addition, the MacArthur/Meadows amendment does nothing to address several provisions in the underlying bill that would undermine the health security of seniors and people with disabilities, including:

  • Reducing the Medicare Part A Hospital Insurance trust fund’s solvency by repealing the ACA’s 0.9 percent Hospital Insurance trust fund payroll tax on wages above $200,000 per individual or $250,000 per couple.  Accelerating the exhaustion of the Part A trust fund would likely lead to cuts in Medicare, including privatizing the program, that would be detrimental to current and future beneficiaries.  
  • Allowing insurers to charge older enrollees five times more than younger ones.  The Congressional Budget Office predicts that by 2026 this provision will substantially raise premiums for older people, e.g., 20 percent to 25 percent higher for a 64-year-old.
  • Jeopardizing long-term care and other services by restructuring Medicaid into per capita caps or block grants.  Middle class Americans often rely on Medicaid for long-term services and supports when they exhaust their savings.  Nearly two-thirds of all nursing home residents’ care is financed in part by Medicaid.  In addition, Medicaid provides home and community-based services that allow seniors to stay in their homes.  
  • Phasing out the Medicaid expansion will take away health coverage for low-income seniors under the age of 65.
  • Making services more difficult to access by eliminating retroactive and hospital presumptive eligibility of Medicaid beneficiaries. Many people do not enroll in Medicaid, often because they aren’t aware they are eligible.  Under current rules, when they come to a hospital for care and are eligible for Medicaid, they can be enrolled temporarily.  Under current law, individuals can be retroactively enrolled for a 90-day period.  The AHCA would reduce the retroactive enrollment period to a month.  These changes will make it harder for seniors to get prompt care and for doctors and hospitals to be reimbursed. 
  • Driving up seniors’ out-of-pocket costs by repealing the ACA’s subsidies, based on income and the cost of health insurance, that help defray the cost of premiums.  The AHCA would provide refundable tax credits ranging from $2,000 to $4,000, based solely on age.  For many people age 60 and older, a $4,000 tax credit would fail to make comprehensive coverage affordable.
  • Imposing an onerous premium surcharge of 30 percent for individuals who reenter the insurance market after a lapse in coverage of over 63 days.  Although this penalty applies to all individuals, it could be particularly burdensome for older, sicker individuals who rely more heavily on health insurance than younger and healthier individuals.  Breaks in coverage are often due to honest mistakes or misinformation, but the AHCA does not include any exemptions to help in such cases.   

The National Committee urges you to vote against the American Health Care Act.  It weakens Medicare’s solvency leaving it vulnerable to benefit cuts and privatization, threatens access to Medicaid’s long-term care benefits, and requires seniors to pay more for less health care coverage.  We also ask that you oppose the MacArthur/Meadows and Upton amendments because they would allow insurance carriers to charge very high premiums to people with pre-existing conditions and not cover the lifesaving treatments and services prescribed for the people who need them the most. 


Max Richtman
President and CEO