President Donald J. Trump
The White House
1600 Pennsylvania Avenue, NW
Washington, D.C. 20500
Dear Mr. President:
The end of the Affordable Care Act (ACA) would be a great benefit to Americans. The best outcome in Texas v. Azar would be for the Court to dismiss the appeal for lack of standing by the Appellants who support ACA. The Executive Branch should not continue to enforce this unconstitutional law, and Congress should not rush to reenact a modified version.
The sky would not fall.
Proponents of the law threaten that “millions would lose health coverage.” First, “coverage” should not be used as the metric. What people need is care. There is no evidence that people were getting less care before ACA; in fact, they are probably getting less care now. Consider that:
- Under ACA, life expectancy in the U.S. has dropped for the third year in a row.
- At least 21,904 patients died on Medicaid waiting lists according to a 2018 report, as Medicaid expansion to childless, able-bodied adults reduced services to the sickest patients.
- Nearly 6 million people lost their coverage when it was regulated out of existence by ACA. The available replacement plans were much more costly, had very high deductibles, and often restricted care to very narrow networks.
- Between 2014, the year coverage became mandatory, and 2016, the net increase in private coverage was a mere 1.7 million people, at a shocking cost of $341 billion or $200,000 per newly insured person.
The continued existence of the law has hampered the Administration’s efforts to allow people to buy affordable coverage that meets their needs, as through short-term, limited-duration plans and association plans. ACA outlaws coverage for catastrophic costs only for persons over age 30, and the expansion of physician-owned hospitals, which offer less costly, higher quality choices.
The issue of pre-existing conditions is not a problem for employer plans, only for the small individual market, where it was made worse by ACA, which forced the cancellation of long-standing policies. Federal tax policy that ties health coverage to employment should be changed so that most people can own their own policies. Employers should be able to help without loss of a tax advantage. Congress should also consider Rep. Chip Roy’s solutions to restore patient autonomy, through Health Freedom Accounts, and proposals to devolve responsibility to states, where it constitutionally belongs.
The Administration’s recent rule allowing use of employer-funded HRAs for the purchase of certain individual plans is a welcome step, but further flexibility is needed.
In the meantime, there are measures such as state high-risk pools, which were obliterated by ACA. Pre-existings are generally not a bar to membership in health-sharing ministries, though members do not agree to share expenses related to such conditions. (Many times, voluntary extra contributions do help.) Aiding persons with uninsurable needs should be done without destroying the insurance market for all.
The replacement for ACA command-and-control is freedom. AAPS has presented a 10-point plan for immediately restoring patient freedom and choice plus a white paper that proposes longer-term solutions. Congress should also consider Rep. Chip Roy’s solutions to restore patient autonomy, through Health Freedom Accounts, and proposals to devolve responsibility to states, where it constitutionally belongs.
It is not the proper role of the judiciary to craft some reasoning to confer constitutionality on an unconstitutional act rammed through Congress. Nor is it the responsibility of the executive to enforce an Act it holds to be unconstitutional. It is the duty of Congress to abide by the Constitution, the Law of the Land, and not to cobble together a grand plan to achieve some lofty, politically popular goal and hope the courts can devise a constitutional rationale for it.
Intervenor states like California (which projects a $21 billion surplus in its proposed budget) can enact an ACA-like plan for their own states and could offer medical care to anyone who loses coverage due to the unconstitutionality of ACA. It is not their right under the Constitution to force other states such as Texas to live under such a plan. As proponents of ACA claim it should reduce costs and improve quality, states should not object to reaping these claimed benefits at the state level.
Americans should have the right to choose their medical treatment and their means of arranging payment. Thank you for your work to protect this right.
Jane M. Orient. M.D.
CC Sen. Mitch McConnell, Rep. Kevin McCarthy