We are the physicians of the Cincinnati Medical Association representing “the collective voice of African American physicians and the leading force for parity and justice in medicine and the elimination of disparities in health”.

We are writing this letter to alert ALL individuals that your VOTE counts as far as maintaining your pre-existing healthcare coverage which is currently mandated by the Patient Protection and Affordable Care Act (commonly referred to as Obamacare or the ACA). This single protection is of benefit to every American, no matter who pays for your insurance coverage.

Let us restate the other manners in which every citizen of our country benefits from the ACA. Because of the law, 37% more nonelderly adults are insured. Insurance companies’ ability to implement price discrimination because of age or gender has been eliminated. The “lifetime limit” on the amount an insurance company would have to pay for a beneficiary has been eliminated, thus lessening the potential for financial ruin from medical bills. The preventive services mandates of the ACA require coverage, with no copay, for 15 preventive services for adults; 22 preventive services for women; and 26 preventive services for children. The ACA allowed for adult children under the age of 26 to be covered by their parents’ insurance. So, the constantly articulated goal of repealing the ACA, by the President and his Congressional allies, would eliminate all of these protections which benefit every American.

Another major provision of the ACA is the Medicaid expansion provision chosen by 27 states. The uninsured rates in small towns and rural areas of these states dropped from 35% to 16% compared to a decline from 38% to 32% in the non-expansion states. Ohio accepted Medicaid expansion and experienced a decline in its low income insured rate from 35% to 18%. This benefit to the small towns and rural areas is especially realized by our Kentucky neighbors. The Kentucky Medicaid expansion resulted in a decrease in the uninsured rate from 43% in 2008-2009, to just 13% in 2015-2016, according to a 2018 Georgetown University study. Across the country, when Medicaid expansion has been implemented, the uninsured rates drop and the gap between the higher uninsured rates in the rural areas compared to the urban areas has narrowed. Note that every policy that increases access to healthcare is beneficial for patient continuity of care, lessens the burden on our emergency rooms, decreases human suffering, and decreases costs.

So, let us now address the elephant in the room, pre-existing medical conditions coverage. The ACA eliminated the insurance companies’ pre-existing conditions exclusion policy that had made 52 million adults under the age of 65 uninsurable. A Kaiser Foundation report from Summer, 2018 reveals that 75% of Americans say that it is very important and another 15% say that it is somewhat important that the “ACA’s provisions protecting those with pre-existing conditions remain law”. Additionally, 90% of Americans say that insurance companies should not be allowed to charge the unfortunate citizens with illness more for health insurance coverage. The following local legislators have voted against and/or voted to repeal parts or all of the ACA which would eliminate the pre-existing conditions protection; Senators Portman (R-OH), McConnell (R-KY), Paul (R-KY), Young (R-IN) and Representatives Chabot (R-OH1), Wenstrup (R-OH2), Davidson (R-OH8), Massie (R-KY4), and Messer (R-IN6). The Trump administration, being unable to repeal this legislation, which has so greatly benefited ALL Americans, has slowed or eliminated subsidies payments, diminished website access and support, eliminated navigators, slashed the advertising activities and budget, and shortened the open enrollment period. Here we provide an important reminder that the Open Enrollment Period for 2019 coverage runs from Thursday, November 1, 2018 until Saturday, December 15, 2018. Go to the HealthCare.Gov website or call (800) 318-2596 for specifics.

The President and Congress continue to chip away at ACA benefits by passing the Tax Cut and Reform Bill of 2017 which contains a provision eliminating the individual mandate of the ACA. Contrary to the President’s statements, this does not repeal the ACA. The mandate repeal in the Tax Bill is not in effect until 2019 and the other protections of the ACA will still be in place as long as the ACA remains the law of the land. Nevertheless, 13 million fewer Americans will be insured by 2027 and premium increases of 10% are expected due to this repeal of the individual mandate alone, according to the non-partisan Congressional Budget Office (CBO). Another result of the Tax Bill of 2017, which adds a projected $1.5 trillion dollars to our National Debt, is that mandatory budget driven cuts in Medicare will also need to be addressed. Despite all of these destabilization measures there is still insurance company coverage on the ACA exchange in every state in the United States.

As our government stands now, both the Executive and Legislative branches are pushing to implement healthcare policy that is opposed by a majority of Americans. The next phase of this fight will be waged in the courts. The Trump administration has decided to not defend the ACA in a suit brought by Texas and 19 other states. These states are contending that Congress’ elimination of the individual mandate in the 2017 Tax Bill should render the ACA null and void in its entirety. The majority of Americans, 17 state governments, the American Medical Association, the American Hospital Association, the AARP, and a number of other organizations are opposed to the Texas argument. This case will eventually go to the Supreme Court of the United States (SCOTUS). Unfortunately, SCOTUS is trending toward a partisan third branch of government. We can only hope that these and all federal judges, who have lifetime appointments, will judge for the majority of the people and not for the partisans who selected them. If you are concerned about these judges, then you should VOTE for individuals for the US Senate who reflect your healthcare needs and values.

So, we as committed citizens, who are privileged to be able to provide healthcare to our patients, are encouraging you to vote before or on November 6, 2018. It is clear, that the repeal of the ACA will eliminate the protections currently assured and every American citizen will be adversely affected. When you vote ask yourself if the voting record of the person on the ballot indicates proper action, not convenient words, regarding your healthcare coverage. Vague or broad descriptions of policy positions on the campaign trail cannot be allowed to mask or overshadow the candidate’s positions on pre-existing conditions, documented by a previous vote. If a candidate voted against or wants to repeal the ACA, then that person has voted against the only law that assures the preservation of pre-existing conditions coverage as well as all other benefits of the ACA. In addition, it is clear that small towns and rural areas have the most to lose if the Medicaid expansion afforded by the ACA is eliminated. We need a House of Representatives and Senate in place that will listen and vote the healthcare needs of the majority. Why vote for someone who has voted against you maintaining your pre-existing conditions exclusion or against your having insurance coverage?

Clyde Henderson, MD
Cincinnati Medical Association