I am writing this letter is in response to statements made by
Senator Marco Rubio (R-FL) regarding the Senate’s discussion of the
American Health Care Act (AHCA). This is a bill that was rightly called
“mean” by President Trump. As a hospitalist physician in Jacksonville,
I’d like to set the record straight.
1) Individual exchange markets are destabilizing right now due to uncertainty regarding Trump’s threats to withhold the ACA’s cost-sharing reduction (CSR) payments. House Rep Kevin Brady (R-TX) has called to fund these payments to stabilize the markets. Senator Rubio should stand up to stabilize these markets by following the law and making the CSR payments.
2) Senator Rubio stated he wants “managed Medicaid,” but the House bill and Trump’s budget don’t do anything to support Medicaid health management. Instead, they cut $800 billion out of Medicaid. These cuts go beyond removing the Medicaid expansion, representing a dramatic restructuring of the program. Though Florida will not lose out on Medicaid expansion, we will still lose coverage under the per-capita-cap scheme. One estimate shows 378,000 people in Florida losing Medicaid coverage by 2028. Of those, 227,100 are children, 36,400 are people with disabilities, and 51,200 are elderly who need long-term care services. Senator Rubio should stand up for Floridians who receive health insurance through Medicaid.
3) Senator Rubio said Florida has state mandates that “go beyond” the ten “essential health benefits” in the Affordable Care Act (ACA). A Medicare (CMS) report shows that prior to the ACA, there was no requirement in Florida for individual plans to cover mental health, nor for individual or small group plans to cover substance abuse. In 2015, 3,900 Floridians died of opioid overdose, causing Governor Scott to declare a state of emergency. Senator Rubio should not take Florida back to a time when substance abuse treatment was not required insurance coverage by repealing the ACA’s essential health benefits.
4) While Senator Rubio represents Florida, the US Senate makes decisions for all 50 states. For example, Alabama had no law prior to ACA requiring maternity coverage. Florida only required autism services to be covered by large-group plans. While individual states may be better-suited to decide how to regulate health insurance than the federal government, the federal system should appropriately set a minimum standard of protection across all 50 states. Senator Rubio should not let our neighbors in Alabama lose protections like maternity coverage by repealing the ACA’s essential health benefits.
5) Senator Rubio said we weren’t talking about employer-based coverage, which is about 50% of the market. But the AHCA removes the employer mandate, which allows employers to choose not to offer health insurance to employees. An estimated 150,500 Floridians will lose employer-sponsored health insurance under this plan. Senator Rubio should stand for strengthening employer-sponsored insurance.
6) Senator Rubio says he wants “big robust tax credits,” but the AHCA increases premium costs and lowers tax credits/subsidies for elderly sick patients. In some cases, this could increase premiums up to 800%. The current bill is estimated to knock 700,900 Floridians off individual-market health insurance within 10 years. Senator Rubio should stand up for those patients who are too young for Medicare, who have pre-existing conditions, and who would be priced out of the individual market under the Upton-MacArthur amendment to the House bill.
Senator Rubio says he wants to lower premiums. He says he wants to improve health management under Medicaid. He wants people in Florida to have certain benefits which are mandated by Florida law. To do that, he should STOP treating this healthcare bill as a vehicle to cut taxes for the wealthy. Fix the ACA, don’t gut it. Reform Medicaid, don’t cap it. Protect pre-existing conditions and essential health benefits, don’t waiver them. Allowing some states to gut pre-existing conditions hurts us all. America needs a healthy population in order to have a healthy economy. As a physician, I take care of sick people in Jacksonville every day. I expect my local, state, and federal elected representatives to do the same, including Senator Rubio.
Jennifer Cowart, MD
Indivisible St. Johns
1) Individual exchange markets are destabilizing right now due to uncertainty regarding Trump’s threats to withhold the ACA’s cost-sharing reduction (CSR) payments. House Rep Kevin Brady (R-TX) has called to fund these payments to stabilize the markets. Senator Rubio should stand up to stabilize these markets by following the law and making the CSR payments.
2) Senator Rubio stated he wants “managed Medicaid,” but the House bill and Trump’s budget don’t do anything to support Medicaid health management. Instead, they cut $800 billion out of Medicaid. These cuts go beyond removing the Medicaid expansion, representing a dramatic restructuring of the program. Though Florida will not lose out on Medicaid expansion, we will still lose coverage under the per-capita-cap scheme. One estimate shows 378,000 people in Florida losing Medicaid coverage by 2028. Of those, 227,100 are children, 36,400 are people with disabilities, and 51,200 are elderly who need long-term care services. Senator Rubio should stand up for Floridians who receive health insurance through Medicaid.
3) Senator Rubio said Florida has state mandates that “go beyond” the ten “essential health benefits” in the Affordable Care Act (ACA). A Medicare (CMS) report shows that prior to the ACA, there was no requirement in Florida for individual plans to cover mental health, nor for individual or small group plans to cover substance abuse. In 2015, 3,900 Floridians died of opioid overdose, causing Governor Scott to declare a state of emergency. Senator Rubio should not take Florida back to a time when substance abuse treatment was not required insurance coverage by repealing the ACA’s essential health benefits.
4) While Senator Rubio represents Florida, the US Senate makes decisions for all 50 states. For example, Alabama had no law prior to ACA requiring maternity coverage. Florida only required autism services to be covered by large-group plans. While individual states may be better-suited to decide how to regulate health insurance than the federal government, the federal system should appropriately set a minimum standard of protection across all 50 states. Senator Rubio should not let our neighbors in Alabama lose protections like maternity coverage by repealing the ACA’s essential health benefits.
5) Senator Rubio said we weren’t talking about employer-based coverage, which is about 50% of the market. But the AHCA removes the employer mandate, which allows employers to choose not to offer health insurance to employees. An estimated 150,500 Floridians will lose employer-sponsored health insurance under this plan. Senator Rubio should stand for strengthening employer-sponsored insurance.
6) Senator Rubio says he wants “big robust tax credits,” but the AHCA increases premium costs and lowers tax credits/subsidies for elderly sick patients. In some cases, this could increase premiums up to 800%. The current bill is estimated to knock 700,900 Floridians off individual-market health insurance within 10 years. Senator Rubio should stand up for those patients who are too young for Medicare, who have pre-existing conditions, and who would be priced out of the individual market under the Upton-MacArthur amendment to the House bill.
Senator Rubio says he wants to lower premiums. He says he wants to improve health management under Medicaid. He wants people in Florida to have certain benefits which are mandated by Florida law. To do that, he should STOP treating this healthcare bill as a vehicle to cut taxes for the wealthy. Fix the ACA, don’t gut it. Reform Medicaid, don’t cap it. Protect pre-existing conditions and essential health benefits, don’t waiver them. Allowing some states to gut pre-existing conditions hurts us all. America needs a healthy population in order to have a healthy economy. As a physician, I take care of sick people in Jacksonville every day. I expect my local, state, and federal elected representatives to do the same, including Senator Rubio.
Jennifer Cowart, MD
Indivisible St. Johns
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