United States Senate

Washington, DC   20510

Dear Senator:

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 the Motion to Proceed to the consideration of legislation to repeal and/or replace the Affordable Care Act (ACA) and to oppose the underlying bills to repeal the health care reform law.

Regardless of whether the Senate considers the House-passed American Health Care Act, the Senate’s Better Care Reconciliation Act or the Obamacare Repeal Reconciliation Act; each version leaves millions of Americans uninsured and would be particularly harmful to mature, older and disabled Americans.

Provisions in some or all of these bills are particularly objectionable because they would:

  • Reduce 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.
  • Allow insurers to charge older enrollees five times or more than younger ones.
  • Jeopardize 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.
  • Phase out the Medicaid expansion, which will take away health coverage for low-income older adults under the age of 65.
  • Drive 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.  None of the repeal bills come close to offsetting the loss of the ACA subsidies.
  • Allow insurance carriers to:
    • Charge certain enrollees with pre-existing conditions thousands of dollars more than healthier individuals.
    • Pick and choose which essential health benefits – like prescription drugs, chronic disease management and maternity care – their plans will cover.  Without the essential benefits requirement, health plans may not cover chemotherapy for cancer patients or insulin for diabetics. In a health insurance market without risk sharing, comprehensive coverage would be unaffordable because most plan enrollees would have pre-existing conditions.
  • Impose 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 legislation being considered does not include any exemptions to help in such cases.

The National Committee believes this legislation is so deeply flawed that Congress must start from scratch to achieve a bipartisan solution that strengthens the ACA’s landmark improvements made to the individual health insurance market, lowers costs for all Americans regardless of health status and age, and protects existing programs like Medicaid and Medicare.

But first, we urge you to vote against the Motion to Proceed and against the underlying legislation that would put seniors and people with disabilities at significant risk of ending up uninsured and losing access to needed care.



Max Richtman
President and CEO