• The Congressional Budget Office estimates that 15 million people will lose their Medicaid coverage under the American Health Care Act (AHCA). That includes 638,900 people in our state. Kids with disabilities and the elderly rely on Medicaid—it’s not just low-income people but the working poor who are struggling to live the American Dream. It’s true that Medicaid funding increases in raw dollar terms, but by so little that millions will lose their coverage. All of this so you can give $700 billion in tax breaks to the wealthy. How do Congress justify adding this additional burden to the American people in the face of huge tax breaks for the wealthy while the plan was being discussed?

• According to a report published June 14, 2017 by researchers at George Washington University’s Milken Institute School of Public Health and The Commonwealth Fund, if it becomes law, the AHCA, as passed by the U.S. House of Representatives, could cause an estimated 924,000 jobs to disappear by 2026 and trigger an economic downturn in nearly every state,. How do you justify adding this additional burden to the American people in the face of huge tax breaks for the wealthy? How does that square with the administration’s goal to reduce unemployment?

• I have family and friends getting treatment for opioid abuse. Ending the Medicaid expansion and letting states opt out of patient protections means that many people who need treatment for opioid abuse will lose the care they need. The American Health Care Act you drove to passage would sunset funding for treating opioid addiction. The AHCA earmarked an additional $15 billion to the Patient and State Stability Fund for maternity, mental-health, and substance-abuse coverage. $1.9 Billion is the estimated cost in North Carolina for opioid treatment by 2026, a number that dwarfs the Stability Fund. Where is the evidence you are committed to helping your constituents fight opioid addiction and if you are, how do you propose the funding gap be addressed? In the end, do you value tax breaks to pharmaceutical companies more important than the health of your constituents?

• The AHCA would result in significantly higher medical costs for many Americans, especially the elderly, many of whom will develop health issues. It’s true that CBO estimates premiums will go down after seeing them spike in the first few years. But deductibles and out of pocket costs go up more as insurance plans cover less resulting in net higher costs. The elderly will be priced out of the health insurance market increasing deaths from illnesses that could have been treated or prevented but were unaffordable. In short, costs go up for us while taxes for the wealthy go down. This seems to reflect a value structure that puts wealth of a few before the health of the many. How do you answer that charge?

• I’m concerned about people with pre-existing conditions. The Affordable Care Act (‘Obamacare’) protected them successfully. It’s technically true that the AHCA maintains the requirement that people with pre-existing conditions have access to coverage. But the bill also has a waiver that allows insurance companies get around this if states opt out of patient protections. Sure, people with pre-existing conditions have access to coverage—but they may not be able to find any plans that cover their pre-existing condition or that is not priced out of reach. The bottom line is, people with pre-existing conditions will be much worse off under this bill than they are under current law. Are you going to put people with pre-existing conditions at risk so you can fulfill a political promise? What does that say about your priorities?

• In April, the Brookings Institute published a report on an amendment to the AHCA emerging from the House-Whitehouse negotiations. The amendment would allow states to waive the “community rating” requirements that bar insurers from setting premiums based on health status. This would mean more expensive coverage for pre-existing conditions. Before the ACA the following were considered preexisting conditions by the industry: sexual assault, domestic violence, postpartum depression, pregnancy, and Caesarean sections as preexisting conditions and justified charging women who have experienced them more or denying coverage entirely. This provision makes every woman of reproductive age a pending pre-existing condition and will potentially result in increased expense for coverage. How is this not an assault on women’s health?

• Regardless of all else, the AHCA hurts the people: it destroys Medicaid as we know it, it takes away treatment for opioid addiction, it puts people with pre-existing conditions at risk, it raises costs for patients, and it shifts huge costs to already-strapped state budgets putting state government in the position of having to decide what they value more: the health of all, or the tax benefit to a few. Do you see this choice as one of morality or economics?