Dear Mr. Paul Ryan,

I am writing you about the proposed repeal of the Affordable Care Act. I write to you as a mom, wife, daughter and friend of those whose lives have been helped in many crucial —several life-saving– ways by the ACA, and who stand a lot to lose by its repeal, whether or not they even know it.

I also write as a former health insurance professional who has worked on thousands of proposals for both government and corporate plans over the course of several years, before, during and after ACA laws went into effect. I am writing as a registered Independent from a Republican family, complete with family members who served as representatives in the Republican Party.

Mr. Ryan, I need to be clear that this is not about politics, or Republican vs. Democrat, Liberal vs. Conservative. I can tell you many, if not most, of my former insurance colleagues (aside from those at the tippy top who arguably have some conflicts of interest, to put it respectfully) are against repeal. These are people on both sides of the aisle, Republicans and Democrats, alike.

As I know you must be aware, there are a lot of misconceptions about the ACA. Because I worked on so many health plans, I know many things that many people do not seem to know, yet.

For example, I know that prior to the ACA many people died waiting for their appeals to be processed. My husband was almost one of them. When he was only 31 we found out he had a very large aortic aneurysm from a previously undiagnosed heart defect. The culmination of an aneurysm is dissection — how we lost John Ritter, and more recently, Alan Thicke.  I could’ve lost my husband at any minute, according to both his cardiologist and heart surgeon. We also had a newborn son. I was on unpaid maternity leave and my husband was facing life-threatening open heart surgery, which was even more complicated because it would be his second one (he had a defect repaired as a child).

Our insurer denied the MRI that the doctor needed prior to being able to perform the surgery. Because the portion of the ACA that reduced appeal processing time frames was passed only a few months prior, by law, our insurer had days rather than months to process our appeal for the test he needed to save his life.

Again, I was home with a newborn on unpaid maternity. We wouldn’t have been able to pay for the test on our own. His surgeon was very clear: He did not have months to wait. I realized immediately that the ACA saved my husband’s life, and I am thankful for it nearly every day of my life. Note, I am not someone sucking off the system looking for a handout, as so often has been portrayed in certain media; in fact, I worked for the system at the time.

My husband survived. We went on to have another child who had an airway defect, and a few other issues that caused sleep apnea and interfered with his development. By this time, I needed to leave my job to focus on my family and other health issues. We did not have a lot of money, but because of the ACA, and its role in expanding the Children’s Health Insurance Program (CHIP), we were able to obtain subsidized coverage for our children through our state’s Husky plan. This allowed us to get surgery my baby boy needed when he was only 1 year old— surgery he needed to effectively breathe.

So, as you see, Mr. Ryan, the ACA saved both my husband and my child’s lives. I was in tears when I read that the senate voted AGAINST continued funding for CHIP.

But that’s not all. In my early 20s, I had an individual plan. I was kicked off of said plan for having the unfortunate tick bite that led to Lyme Disease while covered under the plan, and subsequently forced to pay back tens of thousands of dollars in claims for intravenous antibiotics and hospital care. As you know, the ACA has made that practice illegal.

Because I have Lyme Disease on my health records, I was not able to secure insurance from any other individual plan. And I had a chronic illness that made it too difficult to work full time to obtain coverage that way. I was 23, and therefore, too old to go on my parent’s plan. I am lucky that my parents were in a position to help me, and that I survived that experience, but many don’t.

I now live in fear that if my husband ever lost his job, with his heart condition, my Lyme Disease, my children’s asthma and airway issues, no insurer would ever touch us, and ONE hospital claim would bankrupt us.

The ACA gave me peace of mind. In fact, it saved us a third time. When my husband had a three month benefit waiting period before his new job, we were able to obtain affordable coverage through our state exchange. Again, no individual insurer would touch us otherwise, and we paid approximately $500 per month vs. the $1,200 COBRA premium, with a lower deductible than what we had. I am thankful for that all of the time, as well. We couldn’t afford COBRA on one income.

As I said earlier, because of my career background, I know things that perhaps most Americans don’t know.

For example:
· I know prior to the ACA many people with serious illnesses, including children, would hit their annual and lifetime plan maximums, and then no longer be covered for life-saving medications and procedures—for the year and/or forever. What do you suppose would happen if they and their families weren’t independently wealthy and couldn’t afford million dollar treatments? Let’s not sugar coat this: They would die. Many have. I’ve been in meetings that reviewed such high dollar claimants, discussed their relative diagnoses, and proposed such limits. The ACA made this illegal, as it should be.

· I know that my parents will be paying more for their prescriptions through Medicare if ACA is repealed, because it helped to close the doughnut hole.

· I know that women will once again be charged higher premiums, for simply being female.

· I know that while rates and premiums did rise, they ALWAYS do because healthcare costs are rising exponentially, and in fact, premium rises trended lower than prior to ACA.

· I know that part of the reason healthcare costs, particularly for hospitals, rise so strongly is the large number of uninsureds who visit hospital emergency rooms for minor illnesses, which they subsequently cannot pay for, and that drives up the costs for the rest of us as taxpayers and insureds who must pay more to keep the hospital solvent.

· I know that ACA imposed out of pocket maximums, thus limiting the expense shifted to the consumer.

· I know that when President Trump says “I like those HSAs,” he is talking about high deductible health plans (legally one cannot have an HSA WITHOUT a high deductible plan).

· I know that such high deductible plans shift more costs to consumers— so that the end goal is the American people pay more WITHOUT the consumer protections and out of pocket cost and premium limits included in the ACA. This effectively leaves them with the part most tend to associate with Obamacare somehow —that their deductible went up—without the associated protections and better coverage provided.

· I know that the industry trend was shifting to high deductible plans and HSAs, since President Bush signed them into law in 2005, anyway. Many people erroneously believe if “Obamacare” (that is ACA, one and the same, for laypeople who may read this) goes away, so do their deductibles. Most government and corporate plans were moving to these plans because many were drowning under their own healthcare costs, and wanted to save money. It was never a question of if high deductible plans would be most prevalent, but when.

· I know the reason we don’t allow insurance to be bought across state lines is because it’ll be a rush to the lower common denominator of coverage, especially without the consumer protections laws formerly part of the ACA to protect American people.

· I know that mental health coverage, birth control coverage, maternity care and preventative care will no longer be a requirement.

·  I know young men and women who cannot find full time work will very likely see bankruptcy, as soon as their early 20s, and possibly more than once, if they happen to have any kind of health issue.

·  I know plans will once again be able to refuse care to pregnant women under an employer-based plan as a “pre-existing condition.”

·   I know that the ACA reduced appeal processing timeframes for people who need urgent and life-saving care. I know that this means some will die.

·  I know the ACA provided an External Review process (a review from an un-biased third party) for all claim and appeal issues. And this means some will die, or become bankrupt from paying claims that should have been covered.

·  I know there are millions of people, like my friend’s mom, who are on the exchange with cancer and who have to now also not only fear dying, but fear losing their coverage, and dying sooner.

Mr. Ryan, I am also writing as a shareholder in my former health insurance company, one of the nation’s largest. I understand companies need profit (whether healthcare should ethically be for-profit is another discussion). However, Mr. Ryan, my parents taught me right from wrong, and profiting from people’s deaths is clearly wrong.

Most people don’t know these things, but they’re catching on.  And I pray they remember when it comes time to vote.

I know the ACA needs adjustments to make it work better. I know that it was a starting point, and it was always expected there would be reiterations as we learn what works and what doesn’t.  Isn’t that how most laws work? Or do you always simply quit and start from scratch?

I also know that to repeal it completely, along with all of the consumer protections it supplies, especially with no replacement planned, is grossly negligent. I pray that you do the right thing and vote against ACA repeal and have the heart and mind to convince your colleagues of the same.

Jill Negro is a Wallingford stay-at-home mom of two, writer and adjunct professor.

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