Comment To Sen. Rob Portman

Dear Senator Rob,

As your constituent, I'm so glad to read that you oppose the Ryan/Trump House health "deform" plan, a.k.a. the ACHA.  It's a hideous and cruel joke, which would reward the wealthy and the healthy while punishing the poor and the sick.  Yesterday's CBO scoring confirms just how awful the ACHA would really be.

It's worth noting that I've been covered by a subsidized plan under the ACA/Obamacare for some time, and, at age 62, I recently received a surprise Stage 4 cancer diagnosis.  The ACA is keeping me alive.  The ACHA might very well kill me if enacted into law.

Happily, it's clear that it won't become law.  What's unclear is just what you GOP Senators are going to come up with, if anything.  Here is what you should do:

Keep the ACA/Obamacare and strengthen it to expand coverage, instead of shrink it.  There are still millions of Americans who lack health coverage.  As a nation, this fact should be an embarrassment to us and to you as an elected official who can do something about it.  Take care of everyone.

Reject the bogus idea that substandard, loophole-ridden, cheap policies are a valid means of expanding coverage.  Retain the ACA's required essential medical benefits.

Exert strong federal control over individual plans offered on the exchanges.  The current state-controlled system doesn't work well.  By leaving it up to 50 different insurance departments in 50 different states, you potentially create 50 different sets of rates and rules for the same hypothetical person.  Require a sufficient minimum number of private insurers to participate in the exchanges.  The idea that huge (and hugely profitable) carriers like Aetna and United Health "can't afford" to offer competitive plans is absurd.  Impose federal premium/price controls when necessary.

Adhere to the group coverage philosophy.  Embrace the concept of strength in numbers, and keep the individual mandate.  The more people we have on the exchanges, in the "risk pool," the better we spread the risk and control/reduce costs for everyone.  Isolating the old, the sick, and those with pre-existing conditions does the exact opposite.

Maintain income-based premium subsidies at their current levels.  The ACHA's age-based tax credit scheme would drastically cut premium support to millions, including me.  It's a really stupid idea -- people pay premiums with their income, not their age.

Resist the pressure from your far-right brethren to defund the ACA/Obamacare with unnecessary and unwise tax cuts for wealthy individuals and corporations.

Lastly -- and this is the biggie -- offer a properly funded, government-run, Medicare-for-all public option on the exchanges, as a competitive alternative to the individual plans offered by private carriers.  It's an idea whose time has come, and you know it.  If such a public option would be the first step toward a genuine universal single-payer system (as exists in the rest of the world), then so be it.