Affordable health care should be available to everyone. Yet congressional leaders propose to dismantle the network of federal programs that defray health care costs for millions of families, including some of the most vulnerable people in our communities.

Congress needs to hear strong and sustained constituent voices supporting U.S. efforts to ensure access to affordable, quality health care.

The U.S. Government’s Role

Since 1965, when Congress created Medicaid and Medicare, government health care programs have made a huge difference in the health and incomes of people who qualify for them.

Yet programs crafted around narrow eligibility requirements aren’t sufficient to ensure access to care for everyone. As one example, states have enormous flexibility over their Medicaid programs. In Texas, a family with two children can get Medicaid coverage only if they earn less than $4,326 a year. In some states, most adults without children can’t get help through Medicaid, no matter what their income. The federal government needs to play a role in establishing a consistent baseline of coverage and access to care.

By the 2000s, many people in the U.S. faced barriers to health care coverage. Growing health care costs made coverage unaffordable to many. More employers chose not to offer health insurance to their workers. Many health insurance companies denied coverage to people with “pre-existing conditions”—leaving the very people who most needed care without affordable coverage. Younger and healthier people chose bare-bones coverage or opted out entirely, further driving up costs for everyone else.

Where We Are Now

The 2010 Affordable Care Act has helped address these issues. Today, more people are able to get coverage through Medicaid, it is less expensive for many to buy insurance, and insurance companies can’t denying coverage based on pre-existing conditions.

Fewer people today are living without health insurance than at any time in our country’s history. More than 16 million people who were previously uninsured now have coverage. The ACA’s emphasis on comprehensive and preventive care has slowed the growth of health care costs to the lowest rate in 50 years.

While the U.S. health care system is far from perfect, federal programs are critical to help tens of millions of people receive necessary medical care. Proposals to repeal the ACA without an adequate replacement would unravel this progress.

Repeal of the ACA could cause as many as 30 million people to lose health insurance. It is dangerous and irresponsible to repeal this legislation without an alternative in place to ensure the benefits of the legislation aren’t lost.

Yet many of the alternatives touted by congressional leaders would have the opposite effect, making coverage less accessible for vulnerable individuals and essentially creating a two-tiered health care system.

• Expanding health savings accounts would allow people to save and invest money, tax free, to pay for medical care. These accounts would not help low-income families who cannot afford to set money aside or who don’t pay federal taxes in the first place.
• Reinstituting and expanding high risk pools. Before the ACA, states created “high risk pools” to offer insurance to people denied private coverage due to illness or pre-existing conditions. These plans were very expensive, both for states and individuals, and in practice led to long wait lists, meager benefits, and high premiums.
• Allowing insurers to sell plans across state lines could lead to a “race to the bottom” as insurers congregated in states with weaker regulations. Giving younger, healthier people more options for low-cost, bare-bones plans could price sicker individuals out of the market.
• Changing Medicaid funding. See more about these proposals.

The stakes in the health care debate are high. Congress is considering changes that would affect millions of people. These changes would also weakens the fabric of our society as a whole.

Ensuring access to affordable, quality health care is the very definition of a public good—a service that can’t be adequately provided by private interests but that is necessary to benefit everyone. Today, the U.S. government’s role in providing these public goods is under question.

Members of Congress need to hear your support for health care access, but they also need to know that you believe the U.S. government should be providing services to ensure that everyone can meet their basic needs.

Already, constituent pressure has delayed action on repeal of the ACA. We need to keep up that advocacy in the months ahead, to protect access to affordable health care for all.