MEMO to Speaker Ryan: #PayMoreForLess Bill 'fails children…bad for working families'


To:    Speaker Ryan
Fr:     Democratic Leader’s Press Office
Dt:     March 8, 2017
Re:    #PayMoreForLess Bill “fails children…bad for working families”

We know you have been painfully trying to calm the raging, internal Republican dysfunction inside your Conference that you probably haven’t had a chance to check the mail.  For your edification, we’ve summarized statements and letters from health care, consumer, civil rights and labor groups about your #PayMoreForLess bill.  Sit down.  It’s not pretty.


We write today to express our opposition to the American Health Care Act.  This bill would weaken Medicare’s fiscal sustainability, dramatically increase health care costs for Americans aged 50-64, and put at risk the health care of millions of children and adults with disabilities, and poor seniors who depend on the Medicaid program for long-term services and supports and other benefits. 

American Medical Association:

…we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations.  As you consider this legislation over the coming days and weeks, we hope that you will keep upmost in your mind the potentially life altering impact your decisions will have on millions of Americans who may see their public, individual or even employer-provided health care coverage changed or eliminated. 

American Hospital Association:

Any ability to evaluate The American Health Care Act, however, is severely hampered by the lack of coverage estimates by the Congressional Budget Office (CBO).  Lacking that level of analysis and needed transparency, we urge that Congress should wait until an estimate is available before proceeding with formal consideration.


Federation of American Hospitals:

Based on our review of the American Health Care Act (AHCA) as currently drafted, and in the absence of a Congressional Budget Office analysis and estimate of the cost and coverage impacts that might allay our concerns, we have significant issues with this legislation.


American Diabetes Association:

On behalf of the nearly 30 million Americans living with diabetes and the 86 million more with prediabetes, the American Diabetes Association (Association) is writing to express our serious concerns with the American Health Care Act…we have serious reservations about many of the proposals in this bill. Our initial areas of concern include the tax credit proposal, proposed changes to Medicaid, potential disruption of coverage and repealing the prevention and public health fund.


American Cancer Society Cancer Action Network:

…reduced federal funding combined with state-specific eligibility and enrollment restrictions will likely result in fewer cancer patients accessing needed health care.  For low-income individuals these changes could be the difference between an early diagnosis when outcomes are better and costs are less or a late diagnosis where costs are higher and survival less likely.


American Health Care Association (AHCA)/National Center for Assisted Living (NCAL):

The residents in long term care centers are uniquely vulnerable.  More than one million individuals call nursing centers their home and most rely on Medicaid for their care.  This bill will cut Medicaid funding for seniors and individuals with disabilities, jeopardizing access to the care they need.  We strongly encourage Congress to protect Medicaid access for seniors and people with disabilities in the Obamacare repeal and replace effort.


America’s Essential Hospitals:

We are particularly disappointed lawmakers seem willing to consider this bill in committee without a Congressional Budget Office score and an estimate of how the bill might impact healthcare coverage.  A score is crucial, as this legislation could place a heavy burden on the safety net by reducing federal support for Medicaid expansion over time and imposing per-capita caps on the program.


America’s Hospitals and Health Systems:

We are very concerned that the draft legislative proposal being considered by the House committees could lead to tremendous instability for those seeking affordable coverage.  Furthermore, we are deeply concerned that the proposed Medicaid program restructuring will result in both the loss of coverage for current enrollees as well as cuts to a program that provides health care services for our most vulnerable populations, including children, the elderly and disabled.


American Public Health Association:

This proposal would jeopardize the health and lives of many millions of Americans…American lives are on the line…It is particularly troubling that legislators plan to consider this proposal without a score from the Congressional Budget Office.  We urge House members to oppose this plan and instead strengthen our nation’s commitment to improving the health and safety of all Americans.


National Disability Rights Network:

The legislation revealed by House Republicans last night is a giant step backwards in the treatment and care of individuals with disabilities…It permits discrimination against people with disabilities in the insurance market for their pre-existing conditions…The National Disability Rights Network urges the House not to send people with disabilities back to a time when it was nearly impossible for us to obtain health insurance, live in the home of our choice or participate in community life.  We will never go back to those days.  Never.


Consortium For Citizens with Disabilities:

While many of the policy points are troubling, it is simply unconscionable to use the Medicaid program to pay for the repeal of the ACA, the repeal of corporate and provider taxes, and to provide new tax benefits for individuals.  Medicaid provides services and supports that maintain the health, function, independence, and well-being of 10 million enrollees living with disabilities.



Easterseals is greatly concerned that AHCA removes the federal funding guarantee that currently exists in Medicaid.  People with disabilities rely on Medicaid-funded services such as attendant care, adult day and home health services to remain in their homes and communities and live productive lives.


National Family Planning & Reproductive Health Association (NFPRHA):

When people do not have access to the family planning care and education they need, they are more vulnerable to sexually transmitted disease and at a greater risk of unintended pregnancy and poor birth outcomes, all of which have high personal costs and translate into increased expense across the entire health care system. Lawmakers should block this dangerous measure and return to thoughtful, bipartisan deliberation on improving access to affordable, high-quality health care in this country.  There is too much at stake.


National Partnership Women and Families:

The Republican repeal bill is an affront to women and families. It reflects its authors’ determination to deny women access to quality, affordable health care, including the comprehensive reproductive health care and abortion services that are essential to their health, equality and economic security… This bill takes us back to the days when there were few benefit standards or consumer protections in place – to a time when insurers were the ones who decided what and who they would cover, what doctors we could see, and where we could get care.


National Physicians Alliance:

The National Physicians Alliance opposes the draft Republican House bill revealed last night. We believe the drastic cuts it proposes to Medicaid, coupled with the substantial reductions in subsidies that helped millions afford healthcare would be extremely detrimental to our patients… All the while, the proposed legislation hands millionaires, billionaires and health insurance CEOs a massive new tax break.


Trust for America’s Health (TFAH):

We are strongly opposed to the House Obamacare Replacement bill, which would repeal significant portions of the Affordable Care Act (ACA), including the Prevention and Public Health Fund.  Under this plan, millions of people could lose health insurance—a devastating blow to the health of many of our nation’s most vulnerable individuals and families.  Without affordable insurance coverage we will see increased levels of preventable illnesses, injuries and deaths.  



The reality is, this isn’t a healthcare plan at all.  It’s a massive transfer of wealth from working people to Wall Street.  For more than a century, the labor movement has fought to make health care a right for every American.  The Republican plan contradicts this very idea by making care less affordable and accessible.  It’s bad for healthcare, it’s bad for working families, it’s bad for our economy and we will fully oppose it.


American Federation of State, County, and Municipal Employees:

The replacement plan put forward by congressional leadership is no replacement at all for the tens of millions of Americans who rely on the Affordable Care Act to keep their families healthy without fear of bankruptcy.  It is simply a tax cut for corporations and the wealthy, funded by gutting Medicaid and shifting health care costs onto states and working families.


National Council of La Raza (NCLR):

This bill is a threat to America’s well-being and represents a step back to the days when health insurance was financially out of reach for too many working Americans.  Our nation’s future depends on healthy and hard-working families.  The changes to Medicaid will devastate a program that is a lifeline for 74 million vulnerable Americans, including children, people with disabilities, and 18 million Latinos.  This effort to radically change the financing structure of Medicaid will jeopardize their lives.


Asian & Pacific Islander American Health Forum:

Many things are clear from the bill, yet many unknowns remain. What we know is that millions of Americans, including Asian Americans, Native Hawaiians and Pacific Islanders (AAs and NHPIs) relying on coverage under the ACA will be worse off. Under the guise of flexibility, this plan would end Medicaid as we know it by phasing in per-capita caps.


National Council on Aging (NCOA)

We are also troubled that the legislation gradually eliminates the important Medicaid expansion, which extended health insurance coverage to 11 million adults, including about 1.5 million people aged 55-64, and that it repeals incentives to improve access to Medicaid home and community-based services under the Community First Choice program.


National Committee to Preserve Social Security & Medicare:

The ACA is a highly complex piece of legislation that includes many benefit increases for seniors on Medicare, contains many program improvements that help to drive the cost of health care down and extends the solvency of the Part A trust fund.  For these reasons, we strongly believe that any replacement legislation should do no less than the ACA for our senior population.


Center for Medicare Advocacy:

The Affordable Care Act expanded health insurance coverage for tens of millions of Americans.  We cannot accept the AHCA plan, which would strip away existing health care and jeopardize Medicare, Medicaid and the states.  The AHCA repeal plan would take us back to the time when families all over the country lacked insurance.


Medicare Rights Center:

AHCA creates a tax windfall for the wealthiest Americans at Medicare’s expense.  The law repeals a modest tax increase on only the highest earners that helped put Medicare on strong financial footing, thereby manufacturing a Medicare funding crisis that could be used later in the name of cutting earned Medicare benefits.


National Center for Transgender Equality:

Under this bill, millions would lose coverage and millions more would pay more for their health care…President Trump and leaders in Congress don’t seem to understand that this is not a political exercise—they are playing with millions of Americans’ lives.


PICO National Network:

Even worse, the poorest among us – those on Medicaid –  will likely suffer the most.  The proposed changes will cut Medicaid expansion, impacting some 70 million people covered by the program.  These are the very people they should be working to protect first, instead the administration and this Congress are lining the pockets of the already wealthy.  This new bill will fail to the elderly.  It will fail our children, and it will fail all those who are poor and struggling.


United Methodist Church:

This bill has been promoted as a “fix” to the health care system in the United States but will do nothing to improve access and affordability. Instead, it will harm many in the congregations and communities in which we live and serve.  People will die because of efforts like this to roll back health care.


The Episcopal Church:

This current proposal falls woefully short of our spiritual calling to care for the ‘least of these,' as well as the noble values upon which our great nation was founded.


Catholic Health Association of the United States:

We strongly encourage the full House to reject this ‘replacement’ bill and work to craft legislation that addresses the real issues without creating unneeded chaos in the system and coverage loss for those who need health care.


American Federation of Teachers (AFT):

That Republicans are now trying to ram something through after keeping it under lock and key makes it clear that they want to hide the details and cost from the American people.  If something sounds too good to be true, it is.  They know that if their true intent were exposed, Americans would soundly reject their efforts.


National Education Association:

It’s time for the Republican leadership to come clean with the American people. Repealing the ACA will harm our students and their families by forcing cuts to critical programs, reducing financial support for lower-income Americans, and taxing the middle class. Bottom line, working Americans will pay more for less coverage while insurance executives and the wealthy get handouts.


American Federation for Suicide Prevention:

We must ensure the gains we have made in mental health and substance use disorder coverage remain in place so every American has a path to a more healthy and productive life.


Americans for Tax Fairness Executive:

The House Republicans disastrous plan to dismantle the Affordable Care Act puts at risk the health coverage of millions while handing $465 billion in tax breaks to the wealthiest Americans and the biggest health insurance and prescription drug corporations.  Quite simply, ACA repeal means the rich will get richer and millions will lose their health care.


Coalition for Human Needs:

The impact of these plans is not just heartbreaking – we should be outraged that the drafters care more about whopping tax cuts for high-income stock market traders, and health insurance and drug companies than they do about maintaining and strengthening coverage for many millions of people.  The drafters were content to drop coverage for low-wage workers, but they took the time to end a tax on tanning salons.


National Women’s Law Center:

The House Republican ACA repeal bill would be devastating for women.  Rather than protecting access to care and coverage, this bill undermines the infrastructure of our nation’s health system, targets low-income individuals, and restructures the system in favor of wealthier individuals. All of this comes at the expense of women, who will be particularly harmed by the repeal bill.


Center for Law and Social Policy (CLASP):

The Center for Law and Social Policy (CLASP) writes today to raise serious concerns about the American Health Care Act and the impact this bill will have on low-income individuals.  CLASP advocates for public policies and programs at the federal, state, and local levels that reduce poverty, help low-income people become economically self-sufficient, and create ladders to opportunity for all.


Cystic Fibrosis Foundation:

The bills released by the two House committees this week fail to adequately protect people living with cystic fibrosis and place the lives of millions of Americans living with serious and chronic diseases at risk.


HIV Medicine Association:

These proposals will not only harm individuals with HIV but will compromise our nation’s public health by leaving fewer with access to the antiretroviral treatment that keeps patients healthy and reduces their risk of transmitting HIV to near zero. We strongly urge the committees to reconsider the bill and the accelerated and non-transparent process with which these proposals have been advanced.


Federal AIDS Policy Partnership:

This is likely to result in a loss of coverage and services for individuals with HIV and millions of other low income individuals with chronic illnesses and diseases whose access to healthcare and lives depend on this vital program.  Formal analysis and comment by the Congressional Budget Office, the Medicaid and CHIP Payment Access Commission and the Government Accountability Office is critical to evaluate how the 70 million Americans who rely on this program stand to be affected by the proposed changes.


Leadership Conference on Civil and Human Rights:

This proposal is truly disheartening.  It doesn’t ensure that all Americans will continue to have health coverage, as its supporters claim.  Rather, it drastically cuts financial assistance for low-income people living at or below the poverty line, undermines and places severe limitations on the Medicaid expansion, and proposes to defund Planned Parenthood centers from the Medicaid program.


Women’s Community:

We are deeply troubled by Congressional efforts to repeal this groundbreaking and essential law. Any vote to repeal the law – or significant portions of it – puts the health, well-being and economic security of women in jeopardy. Repealing the ACA risks going back to a time when women struggled to find affordable health coverage in the individual market, were routinely charged more than men for the same health insurance, and often found that health coverage did not cover their essential health care needs.


Women of Color:

We strongly urge you to oppose all efforts to repeal the ACA and instead support amendments that protect our communities’ ability to create families with dignity and respect and without government intrusion.



The American Health Care Act makes a mockery of every campaign promise Donald Trump made about health care. It sets the stage for deep, punitive, permanent cuts to Medicaid in just a few years, which would cause grave harm resulting in rationing care for some of the most vulnerable people in our country: low-income families, pregnant women, people with disabilities and the elderly. The Republican plan would allow insurance companies to raise premiums and out-of-pocket costs, especially for seniors.  The only winners would be the wealthy.


Access Living:

…be clear, it could PULL THE RUG OUT from under community-based supports.  The AHCA is a giant budget cut to Medicaid! It makes Medicaid pay for benefits for wealthier people!


Children’s Defense Fund:

The American Health Care Act would reverse progress and make children worse off by depriving them of the comprehensive and affordable child-appropriate coverage they are guaranteed today, jeopardizing their futures and also the nation’s future economic and national security.


Unite Here!:

…what was unveiled by House Republicans is a plan that slashes healthcare coverage for millions of Americans, includes ridiculous giveaways—like a tax break for healthcare corporations that pay executives more than $500,000 a year—and imposes a huge tax increase on middle-class health benefits to pay for tax cuts for the rich.


Families USA:

The GOP health care proposal would be laughable if its consequences weren’t so devastating.  This bill would strip coverage from millions of people and drive up consumer costs.  It shreds the Medicaid social safety net that serves more than 72 million people, including many children, senior citizens and people with disabilities.  And it once again leaves millions of people in America with chronic illness and disease at the mercy of insurance companies.


First Focus:

The American Health Care Act would…be a major step backwards for our nation’s children. [It] would seriously threaten the health and well-being of millions of children.  These provisions also violate a campaign promise by President Donald Trump to not cut the Medicaid program and to ensure that no one would lose health coverage under the bill.


Consumers Union:

The American Health Care Act would, as currently written, be a major step backwards for our nation’s children…marking up a bill that will impact millions of lives without a CBO score and without providing transparency and allowing for fair review is irresponsible and unfair to consumers.


Washington Interreligious Staff Community (WISC):

The scriptures of the Abrahamic traditions of Christians, Jews, and Muslims, as well as the sacred teachings of other faiths, understand that addressing the general welfare of the nation includes giving particular attention to people experiencing poverty or sickness.  For their sake and for the common good, we must continue to make progress toward a U.S. healthcare system that is inclusive, equitable, affordable, accountable, and accessible for all.…the millions of people who could be affected deserve proof of a comprehensive replacement plan that would protect their access to coverage.  Changes to the ACA or Medicaid will impact the health of millions of Americans.


Sister Simone Campbell, NETWORK Advocates for Catholic Social Justice:

Our test for any ACA replacement bill is simple: Does the bill protect access to quality, affordable, equitable healthcare for vulnerable communities? After reviewing the House GOP replacement bill, the answer is a resounding no.  Instead of providing greater health security, the bill increases costs for older and sicker patients and drastically cuts the Medicaid program, all while providing huge tax cuts to wealthy corporations and individuals. This is not the faithful way forward and must be rejected.


Community Catalyst:

The proposals in this long-delayed bill are terrible for consumers.  They would substantially decrease financial assistance for low- and middle-income consumers, making coverage less affordable.  The GOP bill undermines the financial stability of the Medicare program and it reneges on longstanding federal commitments to states and to low-income children and families, seniors and people with disabilities.  It makes these harmful changes to our health care system in order to finance tax breaks that overwhelmingly benefit the wealthy and big drug and insurance corporations.  It’s no wonder the bill’s drafters kept the content a secret as long as possible.  It flies in the face of what the American people want.


Young Invincibles:

House Republicans introduced a bill to repeal and replace the ACA, which would have devastating effects on millions of young adults, a group which has seen the greatest health care gains under the ACA: in the past six years, Millennial uninsurance rates have dropped from 29 percent to 16 percent.


Planned Parenthood:

One in five women in America has relied on Planned Parenthood, and their health care shouldn't get caught up in congressional Republicans' extreme agenda. This proposal would deny millions of women access to cancer screenings, birth control, and STD testing and treatment.

The GOP plan will create a manufactured health care crisis in America and throw millions off their health care.  It is shameful, wrong, and more than anything else dangerous.


California Hospitals Association:

The proposed Affordable Care Act (ACA) partial repeal and replace plan released last night by House Republicans could have negative impacts on California hospitals and the patients they serve.  In particular, CHA is concerned about the likelihood of a reduction in coverage that would result from this proposal. 


California’s Health Consumer Advocacy Coalition:

The House leadership’s proposal would undermine the way millions of Californians get coverage, public and private.  The plan goes beyond repealing the Affordable Care Act and the loss of coverage for millions Californians by also capping Medi-Cal, which covers a third of our state.  This isn’t repeal and replace, but repeal and destroy coverage for millions of Californians