Dear Congressman Zeldin,
When we spoke last week, you told me you weren’t ready to commit your support to the American Health Care Act because you wanted to see changes you believed were imminent. I reached out to your communications director this week, after the House leadership’s changes were released, to ask what you’d concluded. Jen told me you’d be reviewing the changes with your staff late yesterday and she’d get back to me last night or this morning. I haven’t heard from her yet — maybe you’re still not sure.
I’m taking this unusual step to reach out to you as a constituent rather than as a reporter seeking an interview.
There may be a host of issues about which we disagree, but I know you to be an intelligent, thoughtful and compassionate person and I respect you. I hope you feel the same way about me.
I know we agree that our health care system is broken. We may have a different understanding of why it’s broken and how we should go about fixing it, but we agree it’s broken.
Honestly, it’s been broken for almost as long as I can remember — certainly all of my adult life. I’ve spent some of my adult life without health insurance coverage. My husband and I have been small business owners off and on over the past 25 years and there were periods during which we couldn’t afford the premiums. One such time, we’d already had children. We earned too much to qualify for the subsidized health care for our kids that was available through the state, but not enough to afford health care premiums. That was scary, knowing that if some illness visited, especially one requiring hospitalization, we faced financial ruin. My husband was a contractor then and a lot of tradesmen were without coverage. We personally know two people who were bankrupted by medical bills.
Health insurance premiums are ridiculously expensive. Our current plan presently costs us just under $1,600 per month. That’s more than our mortgage payment.
But this isn’t a new phenomenon. It was happening long before the Affordable Care Act was passed. Our premiums have increased since the ACA because the plan we had before did not cover prescription drugs — that was our option, to save $200 a month at the time, since we needed no prescription drugs. So our old plan was not “ACA compliant.” The ACA-compliant plan cost us more, but gave us drug coverage — which, as it would turn out, we’d need before long when our daughter got sick.
Health insurance premiums were going up before the ACA, they continued to rise after the ACA and, while I’m not a betting person, I daresay they will continue on the same trajectory under the proposed AHCA. “Competition across state lines” is a red herring. Insurance companies set rates based on their claim experience and actuarial analysis. If a company in Texas manages to put together a network of providers on Long Island, you can be sure they’re not going to charge Texas rates on Long Island.
The reality is, there’s no real competition in this market sector. These monolithic and very profitable private businesses essentially have a monopoly. They need to be regulated accordingly. Subsidies, tax credits, health savings accounts, interstate “competition”— none of this is really going to do anything to reduce or even stabilize premiums (and deductibles).
As long as these for-profit insurance providers can operate virtually unfettered and without meaningful rate regulation, they will continue to maximize profits by raising premiums and cutting back on coverage, while reducing reimbursements to health care providers and hospitals — squeezing doctors and hospitals to the breaking point. Their concern is not the patient’s health so much as it is the corporate bottom line — which has been very, very healthy, by the way. These are multi-billion dollar businesses, whose executives enjoy multimillion dollar annual compensation.
That’s what the free market buys Americans when it comes to health care. It’s naive to think leaving it to the free market — as we hear some people say — will have any different result.
I personally think that the ACA was doomed when the single-payer option was negotiated out of the bill prior to its adoption seven years ago.
The new health cooperatives, including New York’s Health Republic, were torpedoed by a Congress that withheld risk corridor funding — which was one of the ACA’s three essential elements needed to make sure that the new plans would survive their infancy, when they were insuring a pool of subscribers they had no experience with in a brand new market. Of course the cooperatives failed. That was the intention.
The bottom line for all of us is a philosophical decision, really. Do we really want all Americans to have access to health care — effective, affordable health care? When people can’t afford to buy it on their own, should the rest of us pay? Is health care a right? Or is it privilege?
Should healthy people help underwrite the cost of care for people who are chronically ill or disabled — when their care can run into many millions of dollars over the cost of their lifetimes?
I don’t think your answers to these questions would be much different, if at all, from mine.
So why support a bill that relies on an imaginary “free market” to cure what’s ailing our health care system?
Why support a bill that gives health insurance giants a tax deduction for bonuses paid to their exorbitantly compensated executives?
Why support a bill that replaces subsidies with flat-rate tax credits and health savings accounts? How will these help people who are living paycheck-to-paycheck, like thousands of your constituents? The flat-rate tax credits will not grow at the same pace as premiums, which have risen faster than the cost of living for decades.
Why support a bill that’s going to leave tens of millions of people without insurance over the next decade?
I’m scared. I really am. I’m worried about what will happen to my children’s ability to maintain meaningful insurance coverage. I’m worried about my ability as a business owner to continue to provide health insurance coverage for my full-time employees.
I’m worried about what will happen when some members of Congress, who have long been interested in eliminating “entitlements,” next train their sights on Medicare. I’ll be 60 on my next birthday. Will the Medicare program I’ve paid into my entire working life be there when I turn 65? Or will I be given a voucher and best wishes for “good luck” in the private market. Keep in mind why Medicare exists in the first place. Seniors could not buy coverage and get the care they needed when they needed it most.
Is that the world we want to return to? I hope not. And while I know there are members of your caucus who, in the name of budget cutting and the almighty dollar, are eager to turn back the hands of time. I can’t imagine you’d stand with them.
Let’s fix what’s broken — not break what’s not.
Note: This letter was emailed to Congressman Zeldin earlier today.
Denise Civiletti is an owner of East End Local Media Corp., publishers of SoutholdLOCAL and RiverheadLOCAL. An award-winning reporter, including a “Writer of the Year” award from the N.Y. Press Association in 2015, she is an attorney, former Riverhead Town councilwoman (1988-1991) and former co-publisher and executive editor of The Suffolk Times. The views expressed in this column are hers alone.