OPINION: Suggested fixes to the ACA By Hermann Vogelstein

© Kathy Libby | Dreamstime Stock Photos

Thursday, Senate Majority Leader Mitch McConnell released the newest version of the Affordable Care Act repeal plan, called the “Better Care Reconciliation Act,” which, if passed, would reportedly leave millions without health coverage.

According to the New York Times, the bill would make deep cuts to Medicaid while allowing states to drop ACA-required benefits such as maternity care and mental health treatment. Additionally, the NYT reported that corporations and the richest families in the country would benefit by the nearly $1 trillion in tax cuts imposed by the new bill.

While many would agree that the Affordable Care Act isn’t perfect, millions have benefitted from having health insurance coverage. In a statement today, former President Barack Obama condemned the senate bill: “We didn’t fight for the Affordable Care Act for more than a year in the public square for any personal or political gain—we fought for it because we knew it would save lives, prevent financial misery, and ultimately set this country we love on a better, healthier course.” [Full statement: here]

Hermann Vogelstein, a member of Action Together Rochester’s Public Health Committee, weighed in on changes that could be made to the existing Affordable Care Act instead of an all out repeal:

1) Fix the so-called “family glitch.” Currently, family members of employees with coverage available from their employers are not allowed to receive subsidies on plans bought through the marketplace if the premium of the employer’s plan for the employee alone is deemed affordable, even if covering the entire family under the plan would be unaffordable. If the premium for the entire family under an employer-sponsored plan is unaffordable, an employee’s dependents should be eligible for subsidies if they buy coverage on the marketplace.

2) A public option should be added in every state. This would create more choices and competition, thus exerting downward pressure on premiums. It would also solve the problem of some states having only one insurer on their health insurance marketplace or none at all in some counties.

3) A way should be found to motivate all states to implement the Medicaid expansion. (Perhaps the number of years that the Federal government pays 100 percent of the cost could be extended).

4) It might also be advisable to consider increasing subsidies to those who are currently struggling to pay their premiums and out-of-pocket costs. Perhaps, the income limit for eligibility for the premium tax credit should be raised so as to provide relief from premium increases to those just above the cut off.

5) In those states that have not expanded Medicaid, the minimum income amount for eligibility for subsidies should be lowered or eliminated, so that those who need help the most don’t fall through the cracks.

6) Restore the funding that has been cut or never fully funded for certain elements of the ACA that were designed to stabilize the health insurance market. This includes reinsurance and the supplementation of the “risk corridor,” which funnels money from the government to insurance plans that have experienced losses because they ended up with an excessively high percentage of very sick patients in their insurance pool. This should obviate the need for insurers to increase premiums more than necessary in order to guard against being stuck with a losing pool of subscribers. It would also likely make them more willing to take the risk of participating in the individual market on the healthcare exchanges.

7) Extend funding for certain aspects of the ACA that are set to expire this year or next.

8) Reverse Trump’s executive orders relaxing enforcement of the penalty for failing to obtain insurance coverage, and consider increasing the penalty so as to reduce the temptation for healthy people to forgo health insurance.

9) Make care coordination a billable service for primary care physicians in order to help shift the emphasis in our health care system from expensive procedures and surgeries to preventive care.

10) Address the high cost of pharmaceuticals by increased regulation, by empowering the Center for Medicare and Medicaid Services to negotiate prices with drug companies, by allowing more medications to be imported, by creating transparency in drug pricing, by providing for easier drug comparisons, and by implementing value-based pricing of medications, taking into account their effectiveness.

11) Write into law the low-income cost-sharing subsidies for out-of-pocket costs (currently the subject of litigation), which allow those who qualify to have lower deductibles, out-of-pocket maximums, and co-pays if they buy a Silver plan.

12) States could offer preferential treatment to companies bidding on lucrative Medicaid contracts if they commit to selling plans on the ACA marketplaces (Nevada is already doing this; NY is considering allowing only companies that offer plans on its marketplace to bid on Medicaid contracts). 

Hermann Vogelstein is a member of the ATR Public Health Committee. 

Weekly Action Items

•Don’t miss this handy pocket guide of actions this week: http://bit.ly/2sOIxRK
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•Tell your senators a healthcare bill shouldn’t be cooked up behind closed doors and urge them not to vote for any healthcare bill that ends Medicaid expansion or institutes a per capita federal funding structure. Moreover, urge them to block a final AHCA vote by introducing thousands of amendments during the reconciliation process, an approach known as filibustering by amendment.

CALL:
Senator Schumer: 585.263-5866/202.224.6542
Senator Gillibrand: 585.263.6250/202.224.4451
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•Sign up to volunteer for voter registration events. The most immediate ones coming up are:

Thursday, June 22: 12-4:30 p.m. @ Flamboyanes (2-3 volunteers needed)

Saturday, June 24: 8:30 a.m.-12 p.m. @PR Festival 5K Race Seneca Park (2-3 volunteers needed)

Friday, June 30 or Saturday, July 1: @ Keeler Park (2-3 volunteers needed)

Saturday, July 8: 2 p.m. @ Puerto Rico Pageant, St. John Fisher College (2-3 volunteers needed)

To volunteer, please contact: actiontogetherroc@gmail.com and we’ll direct you to the correct person.
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•Demand all Trump-Russia findings be made public.

CALL:
Call: Senator Schumer: 585.263-5866/202.224.6542
Senator Gillibrand: 585.263.6250/202.224.4451
Rep: http://www.house.gov/representatives/find

SCRIPT:

Hi, my name is [NAME] and I’m a constituent from [TOWN].

I’m calling to ask that REP/SEN NAME support the creation of an independent commission on the Trump-Russia matters. Neither special counselor Mueller nor the congressional committee investigations are leading to public, unclassified answers about any possible wrongdoings that may have occurred, and the American people deserve to know what really happened.

Thank you for your time and attention.

[IF LEAVING A VOICEMAIL: please leave your full street address to ensure your call is tallied]
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•Support equal rights for your LGBTQ+ friends and family.

CALL:
Senator Schumer (585) 263-5866 / (202) 224-6542
Senator Gillibrand (585) 263-6250 / (202) 224-4451
Rep: http://www.house.gov/representatives/find

SCRIPT: Hi. I’m from _ZIP_ calling to express my support for equal rights for the LGBTQ community. Can you tell me if _NAME_ plans to support The Equality Act of 2017? (Senate: S.1006 / House: H.R. 2282)
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•Let’s help get John Ossoff elected and flip the Georgia sixth! Phone bank for him and keep turning it blue!

https://electjon.com/volunteer
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•Tell Senators: Protect the Hudson from Oil Barges and vote in favor of S5197.
More info and script: http://bit.ly/2tF7jR9

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•Oppose opening national monuments to energy development.

Visit: http://bit.ly/2sP31Kb

SCRIPT: I am writing in response to executive order 13792. (Share how you use or enjoy national monuments, and why you want these spaces to be preserved.)
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•Check out our Actions & Causes page for ongoing ways to get involved as well as info on progressive organizations in the Rochester area: http://bit.ly/2rIktii
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•To sign up for our weekly newsletter, event notifications, weekly action item blast, and general announcements, please visit: http://bit.ly/2rV9IdB

Weekly Action Items

Don’t miss out on this handy pocket guide of actions: http://bit.ly/2sW0F9t
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Advocate for healthcare. A senate vote is imminent.

CALL
Senator Schumer: 585.263.5866/202.224.6542
Senator Gillibrand: 585.263.6250/202.224.4451

SCRIPT: Hi. I’m from _ZIP_ calling to ask _SEN. NAME_ to fight for my right to affordable, quality healthcare coverage. Specifically, (list what you want). Ideas:
1. No gender discrimination and no lifetime caps.
2. Access to reproductive medicine without cost.
3. Coverage for all pre-existing conditions.
4. Cost less than $X per month per person.
5. Comprehensive Medicare and Medicaid.

Most importantly, share why this is personally significant to you.

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Insist on an open hearing of the senate healthcare bill.
CALL OR FAX:
Sen. Orrin Hatch, SFC office
Ph: 202.224.4515
Fax 202.228.0554

SCRIPT: I am calling Sen. Hatch in his capacity as the chair of the Senate Finance Committee. The Senate’s current approach to the healthcare issue appears secretive, manipulative, and undemocratic. Democracy thrives with discussion, cooperation, and compromise. As a consumer of healthcare services, I’m asking Sen. Hatch to conduct open, public hearings on the Senate healthcare bill.

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Click to tweet and call senators that could decide whether we lose healthcare https://www.trumpcaretoolkit.org/

You can also sign the letter to tell Senate Republicans to #LetUsTestify before they vote on their bill.
http://act.savemycare.org/page/s/let-us-testify

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Oppose the repeal of important protections from Obama’s 2nd term
CALL:
Senator Schumer: 585.263-5866/202.224.6542
Senator Gillibrand: 585.263.6250/202.224.4451

SCRIPT: Hi. I’m from _ZIP_ calling to express my concern about the Midnight Rules Relief Act. It’s unethical for regulations enacted at the end of a president’s term to be subject to different rules for repeal. Congress must be separate from the executive branch. Please ask _SEN. NAME_ to vote against S. 34.

Read more here: https://govtrackinsider.com/midnight-rules-relief-act-would…
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Support equal rights for your LGBTQ+ friends and family

CALL:
Senator Schumer 585.263.5866/202.224.6542
Senator Gillibrand: 585.263.6250/202.224.4451
Rep: http://www.house.gov/representatives/find

SCRIPT: Hi. I’m from _ZIP_ calling to express my support for equal rights for the LGBTQ community. Can you tell me if _NAME_ plans to support The Equality Act of 2017? (Senate: S.1006 / House: H.R. 2282)

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•Stop the rollback of birth control coverage.
CALL:
Office of Budget and Management, Mick Mulvaney: 202.395.3080
Department of Health and Human Services, Tom Price: 202.205.5445

For Script, visit: 5calls.org

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•Oppose the detention and persecution of gay men in Chechnya.

CALL: Rep: http://www.house.gov/representatives/find

SCRIPT: Hi. I’m from _ZIP_ and deeply concerned about the welfare of gay men in Chechnya. As I’m sure you know, the government is imprisoning and torturing them and has killed at least three. A resolution moved to the House floor to assert their human rights. Will _NAME_ please sign H. Res. 351?

Petition US companies to pressure Chechnya economically: http://iglhrc.nonprofitsoapbox.com/demand-stop-to-detention…

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•Thank Gov. Andrew Cuomo for forming the United States Climate Alliance and tell him that you appreciate his leadership, creativity, and priorities for a liveable planet.

CALL OR FAX Gov. Andrew Cuomo
Ph: 518.474.8390
Fax: 518.474.1513

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Oppose opening national monuments to energy development.

Visit: https://www.regulations.gov/document?D=DOI-2017-0002-0001, click dark blue Comment Now! button, upper right.

SCRIPT: I am writing in response to executive order 13792. (Share how you use or enjoy national monuments, and why you want these spaces to be preserved.)

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Check out our Actions & Causes page for ongoing ways to get involved as well as info on progressive organizations in the Rochester area: http://bit.ly/2rIktii

To sign up for our weekly newsletter, event notifications, weekly action item blast, and general announcements, please visit: http://bit.ly/2rV9IdB

Weekly Action Items

Don’t miss this handy Pocket Guide of Actions! http://bit.ly/2rUEmUh
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Support our Muslim community on June 10! http://bit.ly/2rIe6L
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Sign up to text for Jon Ossoff in GA-06:
http://bit.ly/2rObwEH
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Express outrage over withdrawal from Paris agreement.

Rep: http://www.house.gov/representatives/find
Schumer: 202.224.6542
Gillibrand: 202.224.4451

Go to 5calls.org for a script: https://5calls.org
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Thank Gov. Andrew Cuomo for forming the United States Climate Alliance and urge him to keep fighting against climate change!
CALL: Andrew Cuomo @ 518.474.8390
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Tell your senators to vote against anything like the House health care bill.

Schumer: 202.224.6542
Gillibrand: 202.224.4451
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Continue our fight for an independent commission (HR 356).

CALL:
Rep: http://www.house.gov/representatives/find

Go to 5calls.org for a script: https://5calls.org
**************************************************
Check out our Actions & Causes page for ongoing ways to get involved as well as info on progressive organizations in the Rochester area: http://bit.ly/2rIktii
**************************************************
To sign up for our weekly newsletter, event notifications, weekly action item blast, and general announcements, please visit: http://bit.ly/2rV9IdB

Weekly Action Items

 

•POCKET GUIDE OF ACTIONS: http://bit.ly/2qHzhNk

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Turn it blue! Help phone bank and join the campaign to rebuild a progressive majority. https://www.codeblue.team
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Tell Congress and the Department of Health and Human Services that our healthcare is not a political bargaining chip. Script and phone numbers available at: 5calls.org
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Although we got the special prosecutor we asked for, we still need a Watergate-style special committee. Keep up the pressure on our senators and reps!
http://bit.ly/2rtFq0X
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Easy Tweeting action! Tweet Trump and DeVos about their bad budget! http://bit.ly/2rL9Zvg
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Jordan Edwards was tragically shot and killed leaving a party with friends. Please support his family by contributing to his memorial fund. http://bit.ly/2pCQ1TM
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Save the primates and sign the petition: http://bit.ly/2rtFjSU
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The ACLU has created a platform called People Power to counter the worst policies and legislation coming out of the Trump administration. People Power uses relay texting to get the word out about upcoming actions, rallies, and meetings. Sign up here: http://bit.ly/2oKcD7A
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Additional Action Items:

•Join your local code blue and rebuild a progressive voting majority: https://www.codeblue.team

•Join Swing Left and help swing districts turn blue: https://swingleft.org/

•Go to 5calls.org for more action items

Weekly Action Items

POCKET GUIDE OF ACTIONS: http://bit.ly/2pr5xBl
*********************************************************************************
•Turn it blue! Help phone bank and join the campaign to rebuild a progressive majority. https://www.codeblue.team
*********************************************************************************
•Continue to express your outrage over passage of the AHCA in the House.

CALL:
Schumer; 202.224.6542
Gillibrand: 202.224.4451
Rep: http://www.house.gov/representatives/find/

SCRIPT:
Hi, my name is [NAME] and I’m a constituent from [Town/City}.
I’m calling today because I am outraged that House Republicans rammed through the American Health Care Act without a Congressional Budget Office review and without fixing the issues in the plan that would leave millions uninsured and drive up premiums for millions more. The majority of Americans want the Affordable Care Act to be repaired, not replaced, and this tone-deaf bill endangers the lives and economic stability of millions.

[IF CALLING SENATOR, ADD: I urge [SEN NAME] to vote against the AHCA and ensure the ACA’s expansion of Medicaid and protections for people with preexisting conditions remain in place.]

[IF LEAVING A VOICEMAIL: please leave your full street address to ensure your call is tallied]
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•Use the hashtag and make it trend.

#IAMAPREEXISTINGCONDITION
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•For Mother’s Day, to honor our mothers, consider a donation to Mother Earth. Here are some options to donate to. Feel free to choose one of these or something else that tugs at your heart (or donate directly to a local group). Happy Mother’s Day to all of the wonderful moms out there and to our Mother Earth!

Sierra Club (local chapter): http://bit.ly/2pnbxKx

Citizens Climate Lobby: http://bit.ly/2pcBrpf

Mothers Out Front: http://bit.ly/2qSECP6

World Wildlife Fund: http://bit.ly/2pmYtF0

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•Keep our Elections Fair and Free

CALL: Rep: http://www.house.gov/representatives/find

SCRIPT:
Hi, my name is [NAME] and I’m a constituent from Farmington.

I’m calling today because I’m in opposed to H.R.2090, the so-called Election Integrity Act of 2017. I ask that Rep. Chris Collins vote against this bill, and that they advocate for voting reforms that protect the security of our elections without discriminating against poor and minority voters.

Thank you for your hard work answering the phones.

[IF LEAVING A VOICEMAIL: please leave your full street address to ensure your call is tallied]

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•Jordan Edwards was tragically shot and killed leaving a party with friends. Please support his family by contributing to his memorial fund. http://bit.ly/2pCQ1TM

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•Religious Liberty Executive Order: The ACLU has pledged to take legal action if this executive order triggers any government action, so send them a donation to support their fight. http://bit.ly/2p4n5qR
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•Support the EPA! They are looking for people to call in on comment sessions or send a comment in writing saying you support the EPA regulations that protect us from pollution, toxic chemicals, and climate change! This is ongoing until May 15. http://bit.ly/2qlyoKT #environment
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•Keep up the pressure and focus on Trump’s Russian ties and demand an independent investigation into Russia!

-CALL, EMAIL, TWEET ALL MAJOR MEDIA OUTLETS and demand coverage on Russia and put pressure on them to investigate: http://bit.ly/2prdKVY

-CALL CHAFFETZ 801.851.8500
CUMMINGS 202.225.4471

-Demand a subpoena for white house Flynn papers (security clearances, documents of Flynn’s foreign contacts and payments received by Flynn from foreign sources)

-Call all House of Intelligence Committee Members and demand an investigation now: http://bit.ly/2pr5xBl

*********************************************************************************
•The ACLU has created a platform called People Power to counter the worst policies and legislation coming out of the Trump administration. People Power uses relay texting to get the word out about upcoming actions, rallies, and meetings.
Sign up here: http://bit.ly/2oKcD7A
*********************************************************************************
Additional Actions
•Join your local code blue and rebuild a progressive voting majority:https://www.codeblue.team
•Join Swing Left and help swing districts turn blue: https://swingleft.org/|
•Go to 5calls.org for more action items