By Betsy Ryan

I have been thinking a lot about John F. Kennedy’s book Profiles in Courage, which outlined difficult political decisions made by U.S. senators over our nation’s history. Often the decision was a balance between what was right versus intense political pressure. Our N.J. Congressional Delegation faces a difficult vote this Thursday, when Paul Ryan’s American Health Care Act is up for a vote in the House of Representatives. 

Here are 10 reasons why I urge every member of our delegation to vote no:

1. The nonpartisan Congressional Budget Office says that the AHCA will force 14 million Americans off the insurance rolls next year, and 24 million Americans will lose their coverage over the next decade.
2. The vote will jeopardize the healthcare coverage for millions of New Jersey residents. About 800,000 New Jerseyans currently are insured under the Affordable Care Act. And 1.8 million state residents will be affected under a major change to the Medicaid program, namely the implementation of Medicaid per capita caps. Those affected by this change in coverage will include senior citizens, the disabled and children and families.
3. N.J. taxpayers will also feel the impact. The switch to Medicaid per capita caps reduces federal funding to the states by $880 billion, according to the Congressional Budget Office. The states, their residents and their healthcare providers will be left to absorb those federal funding cuts.
4. The funding cuts to our state won’t end there. New Jersey Policy Perspective estimates that New Jersey stands to lose $4.2 billion in federal matching funds if the ACA is rolled back. This will create a huge fiscal crisis in New Jersey.
5. This bill WILL cause many people to lose their health insurance in New Jersey. That means we will see the charity care obligation spike – on the heels of significant state cuts to charity care funding in the last three years. Current funding stands at just $252 million for this important safety-net program. Before the Affordable Care Act, N.J. hospitals provided about $1.3 billion in charity care services annually. If the AHCA passes, our state will have to increase charity care funding to cover the costs of caring for the newly uninsured. Without it, the hospitals that care for us will face severe fiscal pressures – not to mention greater numbers of people in their emergency rooms that will strain the system for all. 
6. The ACA is more popular now than it ever has been. That is reflected in polling by the Kaiser Family Foundation and in town hall meetings all over America. No doubt, the ACA needs some repair work, but people are scared of losing the coverage that is provided under the ACA.
7. Healthcare is responsible for 17 percent of our nation’s gross domestic product. It also represents the second largest employment sector in New Jersey. Be cautious when making seismic changes to this important part of our economy.
8. President Trump has promised coverage for all. This bill does the opposite; it erodes coverage. It is a step in the wrong direction. Millions of people could lose their health insurance, including access to preventative and primary care. Healthcare costs would increase for all as the burden of charity care is added to their premiums. And emergency rooms will return to the days when they served as the doctor’s office for those without insurance.
9. The Trump Administration promises that there will be two more parts of a three-part plan for health reform. But parts 2 and 3 have not been shared with you in our congressional delegation, nor with the American people. There are too many unanswered questions.
10. And a final thought: Some people say this bill is “dead on arrival” in the Senate. Moderate Republicans are expressing concern about the substance of the bill, especially in states like New Jersey that have expanded Medicaid. Governors in both red and blue states have expressed serious concerns about the bills’ cost shift to the states and its lack of flexibility in administering state Medicaid programs. Healthcare advocates have expressed grave worries about the bill’s impact on individuals’ health – as well as the fiscal health of our healthcare delivery system. Meanwhile, constituents are passionately urging their representatives in town hall meetings to preserve their healthcare coverage. Clearly, this is not the right bill for a better healthcare system for the future.

This is too important to get wrong. Let’s slow down, bring in the impacted stakeholders including the patients and other individuals who have the most at stake – their health – and have an open and informed discussion before moving forward.  Our healthcare provider community pledges to work with you on this important matter.  Please vote ‘no’ this Thursday on the AHCA.