Our fine congresswoman should vote NO on the House bill that would repeal and replace the Affordable Care Act. Ms. Stefanik is a smart and rising star in the Republican Party, and I am hoping she is smart enough to see that the currently proposed bill, as advocated by Speaker Ryan, is a dog, which will sink like a stone in New York state. Ms. Stefanik often cites her independence from just toeing the Republican Party line. The Ryan health care plan should be one of those occasions in which our congresswoman exercises her independence, steps away from the party and votes no on the plan.

Here is why the current Republican bill is bad for the North Country, bad for New York state and bad for the nation.

The two House committees debated for less than 24 hours on the entire repeal and replace. (The ACA took two years. The House alone held 79 hearings over the course of a year, heard from 181 witnesses and accepted 121 amendments, many of which were Republican.) This time the Republican-controlled committees heard from no stakeholder witnesses (not even the new secretary of Health and Human Services), they saw no budget impact figures, and they had no data on how many individuals would be covered (or not covered) under the new law. They might as well have voted the bill out of their committees with blindfolds on. This is bad public policy and a shameful way to handle our heath care system, which contributes to about one-sixth of the U.S. economy. We now know how devastating the Ryan plan will likely be for the country:

¯ 14 million people would lose coverage next year.

¯ 24 million would lose coverage over 10 years.

¯ 2 million would be deterred from buying insurance annually after 2018.

¯ $880 billion would be cut from Medicaid over 10 years.

¯ $100 billion would be spent on grants to state governments, used “mostly” to reimburse insurers.

For the North Country, the Ryan plan is not affordable for lower-income workers. The tax credits that replace the ACA subsidies are adjusted based on age rather than ability to pay, as in the ACA. The legislation would eliminate the subsidies that reduce deductibles and co-pays for moderate-income policyholders on the individual market, and replace them with inadequate tax credits. The tax credits do not go as far as Obamacare’s subsidies. According to a Kaiser Family Foundation study, a 27-year-old would get only about $2,000 instead of $3,225 under Obamacare, on average, while a 40-year-old would get $3,000 versus nearly $4,150. Worse yet, a 60-year-old would receive only $4,000 instead of nearly $9,900 under Obamacare. This plan will leave many low-income, working North Country residents with an inability to purchase affordable health care, and many of these residents will lose the health coverage they now have.

As this plays out, it will be important that Ms. Stefanik can distance herself from this bill by recording a NO vote when it hits the House floor.

For those North Country residents living just above the federal poverty line, the Medicaid expansion will begin to evaporate in just two-and-a-half years, with no replacement plan offered. This will also leave thousands of North Country residents without coverage. Under the Ryan plan, New York state will be forced to choose between reducing covered services, reducing rates to providers or reducing the number of residents eligible for coverage. Elimination of the individual mandate will force premium increases for the rest of the population as those who are insured will be older and sicker. Individuals who miss just one premium payment but then come back on will be either denied coverage or forced to pay the insurance companies a 30 percent penalty. This at the same time the insurance company executives making over $500,000 will receive a huge tax break under the Republican plan. Keep in mind, the newly uninsured or under-insured will still use the health care system, as they should. Hospitals and other providers still need to pay for staff, plant and equipment, insurance, etc., even when patients cannot or will not pay. These costs will have to be spread to the insured population and/or again drive thousands into health care bankruptcy.

This bill is a huge step in the wrong direction, providing tax breaks for the most wealthy while eliminating access to coverage for the middle-class working families. Elise, if you represented Westchester County or Long Island, maybe supporting this bill could make some sense, but you do not. Your represent the North Country, where we are proud to have a strong working class that deserves to have access to affordable health care insurance and where the provision of health care services is a huge economic driver. This bill is a political hot potato and does not fulfill President Trump’s promise that his plan will cover all Americans. Madam Congresswoman, I hope you will vote NO on Speaker Ryan’s repeal and replacement bill. We can do better than this.

—

Barry Brogan lives in Saranac Lake and is a health policy analyst, registered nurse and CEO of North Country Behavioral Healthcare Network. He recently completed an eight-year term as a trustee of Adirondack Health.