Some health care questions for Sen. Toomey
To the Times: The following is an open letter to U.S.. Sen. Patrick Toomey, R-Pa.:
Before you cast your vote on the Better Care Reconciliation Act (BCRA), there are some questions that I, and I imagine many Pennsylvanians, have regarding this piece of legislation and your outspoken support for it. I would greatly appreciate answers to the following questions, and the typical politicalboilerplate response will not suffice. Please note that I want direct and honest answers to these questions — not majestically general answers to questions I did not ask. You owe the citizens of this great commonwealth at least that much.
My first question is procedural. Why do you think it is appropriate to craft momentous legislation — in this case, legislation that will affect roughly one-sixth of the economy — behind closed doors without any input from Democrats? In short, why did you use a decidedly partisan, secretive procedure? It is one thing to make an attempt at bipartisanship and fail; it is quite another never to make an attempt in the first place. And while it is certainly true that Obamacare is a partisan bill, in terms of procedure there was both transparency and a serious effort to engage the other side. In fact, the Senate’s attempt at crafting a bipartisan health care bill — an attempt spearheaded by Democrat Max Baucus — considerably extended the timeline for passing Obamacare; beginning in the spring of 2009, a group of three Democrats and three Republicans, the so-called “gang-of-six,” endeavored to reach a bipartisan agreement within the Senate Finance Committee. These negotiations eventually broke down, but the words and actions of President Obama and many members of Congress rightly conveyed the belief that legislation of this magnitude required our representatives at least to make a good-faith effort at bipartisanship. Without bipartisan legislation, how will we achieve longterm stability in insurance markets? Democrats say they are willing to negotiate. Why not ask for their input?
Second, and perhaps most importantly, in the universe of potential Obamacare fixes, why is this particular solution the best? No one thinks Obamacare is beyond reproach; it needs fixing. However, this is not the only viable fix. So why this approach? Answering this question requires a public justification. You need to explain to your constituents why, for example, the best Obamacare fix is one that puts some of the most vulnerable segments of our population at greater risk than they would be under current law.
To be more specific, why does the best fix allow insurers to charge non-Medicare seniors five times as much as young persons (currently insurers can charge them only three times as much)? According to the CBO, a 64-year-old earning $58,000 would experience an annual premium increase of $13,700 on the benchmark silver plan.
Why does the best fix reduce federal funding for the Medicaid expansion — something which will undoubtedly hurt the working poor? Beginning in 2021, the federal share of funding for the Medicaid expansion will begin to decrease, and in states with “trigger laws” — laws which terminate the Medicaid expansion if federal funding is reduced below Obamacare levels — coverage will be dropped. You have argued that no one will lose coverage under this plan, but this blatantly ignores the fact that several states have “trigger laws” that will automatically rescind the Medicaid expansion upon a decrease in federal funding (by one estimate 3.3 million will lose coverage due to “trigger laws”). On top of this, the CBO projected that some states without “trigger laws” would likely drop the expansion as a result of funding decreases.
Why does the best fix change the funding structure for Medicaid? This change will reduce federal Medicaid outlays and could place elderly persons dependent on nursing and inhome care at risk, as well as people with disabilities. What is more, the CBO concluded that this reduction in Medicaid spending, coupled with less generous subsidies in the individual, non-group market, will further reduce the number of insured persons in the United States. More broadly, Sen. Toomey, why does the best fix result in 22 million fewer persons being insured (as compared to current law)?
Third, why does the best fix include a tax cut that will disproportionately help the wealthy while simultaneously decreasing coverage and benefits for some of the most vulnerable among us? How do these tax cuts improve healthcare for most people and serve the greater good? A skeptic would think that the health and welfare of the many are being sacrificed for the benefit of the few.
Lastly, why has the best fix been so roundly rejected by groups such as the American Medical Association, the American Heart Association, the American Academy of Pediatrics, The New England Journal of Medicine, the American Association of Retired Persons, and the Conference of Catholic Bishops? And why does the best fix have such abysmal support from the American public? A recent opinion poll found that only 17 percent of Americans support this bill. What do you know that these people and groups do not? Please share your wisdom with us, Sen. Toomey.
Perhaps you can reflect on and respond to these questions over the July Fourth recess. I eagerly await your response.