Top Story: ACA Remains the Law of the Land

Today’s Top Story: At 1:30 am on July 28, 2017, something amazing happened. The clerk called the roll of yay votes, and there was a notable name missing: Senator John McCain (R-AZ). Then the clerk called the nays, and again, amazement: McCain’s name appeared! The final vote was 49 yay to 51 nay. Perhaps the most momentous and consequential vote since TARP and the ACA… and it did not carry. The other two no votes, Collins (R-ME) and Murkowski(R-AK) have been consistently criticized the bill and its process and held to firm no votes throughout.

This vote was for the so called “skinny repeal” of the ACA. The provisions would have resulted in 16 million people losing their health insurance. That’s about 1 in 20 adults in the United States. It would have cut $235 billion (with a ‘b’) from Medicaid over 10 years. There would have been annual premium increases of approximately 20%. All to save $184 million (with an ‘m’) over 10 years. To put that in perspective, that’s about 35% of this year’s defense budget. In short, the bill was disastrous.

Through the process of trying different (but equally destructive) repeals through a series of procedural games, many a Senator’s hypocrisy was on full display. In particular Senator McCain, who gave a speech Wednesday decrying the loss of regular order while voting to proceed. McConnell and his Senators did their best to keep going, ignoring hearings and stifling debate and shunning anything resembling regular order. The latest plan was to vote for something awful–a new version of “skinny repeal”–while telling caucus members that the bill was a placeholder that would be fixed in committee (although signs pointed to the House potentially circumnavigating that process by immediately passing the “placeholder” bill for subsequent signing by President Trump and certain, massive harm to the country). That a bill affecting 1/6th of the American economy and tens of millions of Americans came close to being passed in a matter of hours in the dead of night is, frankly, a terrifying sign of the fragility of our democracy in its current state of crisis.

McCain was not the only Republican Senator to decry the process while still participating in it. A group of Republican Senators–McCain (R-AZ), Graham (R-SC), Johnson (R-WI), and Cassiday (R-LA) also spoke out during a press conference on the morning of the 27th, deploring the secrecy, the lack of regular order, the lack of hearings and debate, and so on. Just as McCain’s speech did not prevent him from voting yes on the motion to proceed Wednesday, these sensible objections did not prevent Graham, Johnson, and Cassiday from ultimately supporting the “skinny repeal” vote after midnight that night.

In the end, however, Senator McCain partially redeemed himself for enabling the repeal and replace process, because his vote is the one that killed this version of the bill. Now, the bill was returned to the calendar, so it’s not completely dead, but at least for now, the ACA is relatively safe. McConnell has another two months before he loses his slot for a health care reconciliation bill, and the executive branch continues to sabotaging the exchanges, so uncertainty remains and the fight is not over. But for now, those rooting against repeal can rest easy.


Top Story: GOP Health Care Repeal Efforts Proceed in Senate

Today’s Top Story: 50 Republican Senators and tie-breaker Vice President Pence voted Tuesday afternoon to open debate on a nebulous Senate version of the AHCA tax cut/Medicaid cut/ACA repeal effort. The process consists of 20 hours of debate and proposed amendments, likely comprising wildly different versions of the bill, followed by a final vote to pass or not pass the legislation out of the Senate. From there, the Senate bill will either be taken up directly by the House or pass to conference committee along with the House AHCA so that one compromise bill can emerge for a final vote in both houses.

Presumably multiple versions of the several Senate bills under the BCRA name will be put up for a vote during the amendment process, but it is not known which version will ultimately be put to a final vote. That decision rests with Senate Majority Leader Mitch McConnell.

Tuesday’s vote was notable for several reasons. First, it featured a number of Republican Senators changing previous “No” votes to “Aye” on the motion to proceed for a variety of reasons, some apparent (Senator Rand Paul voting yes in exchange for consideration of a straight ACA repeal), some less so (Senator Dean Heller had been wavering for some time before voting yes).

Second, the vote to proceed with debate is notable simply for being the next step in a legislative process whose undemocratic nature is unprecedented in living memory. Not content to merely write the bill in secret, without input from Democrats or even female Republicans, McConnell put forth the motion to proceed without any understanding among the public or his fellow Senators as to what, exactly, they would be voting on. Any version of the bill or its amendments to be briefly discussed and then voted up or down during the remainder of the 20 hour process will not be scored by the CBO, may contain provisions that (as per rulings from the parliamentarian) cannot be passed in a reconciliation bill, and may not be adjusted for any of this before ultimately being voted on in the expected conclusion this Thursday or Friday. In short, an enormously unpopular bill which will almost certainly result in tens of millions of additional uninsured Americans and thousands of deaths is being rushed through in secrecy and confusion in the hopes of hiding the bill from the voters and the voters from the Senators. It remains to be seen whether Republican Senators can agree on a version of this bill, but it is certain that a significant hurdle before the ultimate passage of some Republican health care bill into law has been crossed.

Finally, the last yes vote on the motion to proceed was cast today by Senator John McCain, who recently underwent surgery for a blood clot above his eye and was subsequently diagnosed with a brain tumor. Despite the health risks involved, McCain unexpectedly returned to DC in time to cast a vote in favor of stripping the very health care from which he so recently benefited from tens of millions of Americans. In an ostensibly rousing speech, the Senator followed his party line vote by calling for bipartisan compromise. Late Tuesday night McCain voted in favor of a version of the bill he called a “shell” and swore he would not vote for just hours earlier, proving that even serious illness could not hamper his facility with hypocrisy and lies.


AHCA Stories: It Could Be You

Torchlight continues to speak with individuals whose life would be deeply impacted if GOP proposals for changing the Affordable Care Act become law. The following transcript has been lightly edited for clarity.

 

Q: What’s your name, where are you from, what do you do? Tell us about yourself and your family.

Tony:  My name is Tony, I’m from New York, and I work with my family running a restaurant supply business. I’m 32 years old, I have an older sister, and my parents are both alive and feisty.

Q: What can you tell us about your experiences with the medical system and health insurance before the Affordable Care Act?

Tony: Before the ACA, my experience with the medical system was, I think, fairly typical of a relatively healthy young person. I had assorted run ins where I tore ligaments, and had to fight with the insurance company to pay for MRIs and rehab, but mostly, I was able to ignore it. I was either on my parents’ health insurance, or very quickly on my own insurance, as part of my job. However, I’ve dated numerous folk who have had non-job provided insurance, and before the ACA, this was generally “hope you don’t get sick” insurance. I think like most healthy young adults from affluent areas, I honestly just didn’t really think all that much about the specifics of health care. Mostly complained about co-pays and referrals.

Q: What did you think of the ACA when it was first being debated and passed?

Tony: When the ACA was being debated, I felt like it was a good first step. My mom had been diagnosed with breast cancer when I was in middle school, so I knew about pre-existing conditions, and how insurance companies would try to drop you if and when they could. But just in general, I felt like health care in the US was broken, and the ACA represented step 1. I never really felt like the ACA was perfect, even before things like the public option or waivers for medicaid got put in, but in my mind, almost anything would have represented a net improvement over the status quo.

I felt like when you weren’t talking about the ACA, or tying things to a political party, almost everyone agreed that healthcare was completely effed. But suddenly, when you tried to talk about actually fixing the problem, all these crazy arguments broke out. I’m definitely further to the left of the ACA, but in a political climate like we have right now, I didn’t then, and don’t now, know how you make real changes to such a complicated problem.

Q:  How did things change for you regarding health care access and affordability after the ACA?

Tony:  I had job-provided insurance, so I didn’t use the marketplace. However, provisions that affected all plans, that benefited me, were that no insurance plan could drop you because of a pre-existing condition, and no insurance plan could set a lifetime or yearly limit on treatment dollars.

 

Q:  At some point those aspects became critical, right?

 

Tony:  So, fun fact, the median age of diagnosis for leukemia, the type of cancer I got, is 67. It’s not genetic, so I had no way of screening. It’s not environmental, either, so it’s not due to something I did or ate, or how / where I lived. It’s legitimately the most random thing. I was training for a triathlon, was getting light headed, and when I got checked out a month before my race, they told me it was cancer.
So the ACA’s provisions immediately became important for me, because my bills were very quickly insane. I don’t think people understand quite how much cancer can cost, particularly the type of cancer I got (bone cancer generally, leukemia specifically). When most people think of cancer, they think of tumor cancers, and I think most people think that means a few sessions of chemo and an operation to remove the tumor.

If only it were that simple in reality. Bone cancers require a lot of treatment. After being diagnosed on a Friday, I was admitted to Cornell hospital in NYC on Monday. I then spent 28 days straight in the hospital. The bill for that was several hundred thousand dollars, just in hospital charges. The pharmaceutical bill was ~$68,000. All in 28 days. I was diagnosed Friday, and by Thursday, when chemo started, I had already hit my maximum yearly out of pocket for my insurance (~$8,000). After my initial discharge, I was free for about 2 weeks. Little did I know, I had just entered a new billing cycle for my insurance, and literally day 1 of the new year (~31 days after initial diagnosis) I hit my maximum out of pocket again. So, in summary, 32 days after diagnosis, I was at $16,000 out of pocket, and the total bill from the hospital was around $330,000.

I can go into more detail about what these costs related to, or about my treatment in specific, but the timeline: Diagnosed July 1st, 2012. From July -> December, a total of ~128 days were spent admitted in a hospital. Stem cell transplant November 7th, 2012, at Memorial Sloan. Released from the hospital December 18th. Total billing from the hospitals at this point: roughly $1.8M. Overall, I was in heavy treatment for roughly 18 months. To date, total billing is about $2.25 million. Total out of pocket expenses ~$24,000 solely in insurance payments. Probably a couple thousand or so in incidental stuff (random prescriptions not covered, Oxford trying to get away with not covering anesthesiologists that were incidental to procedures I had done, Oxford trying to charge extra for doctors that covered me on rounds that weren’t part of their plan, the usual sort of bullshit insurance companies try to get away with).


Additionally, the ACA made it so that during my recovery, I wasn’t worried as much about losing my job. I knew that I could get insurance from the marketplace, and if my parents needed to drop me from the payroll, they could have. I was only marginally capable of working (even disregarding the fact that 70% of the time I was in the hospital, and of the remaining 30%, I spent the majority extremely immunosuppressed and couldn’t be around people). It also made me comfortable knowing that if/after I recovered, I would be able to move states, change jobs, change insurance plans, and not pay any penalty simply for being diagnosed with leukemia.

Q: How will Republican proposals in Congress to change the ACA impact you if they pass?

Tony:  The real truth of this is that I don’t know, specifically, how it will impact me. Most of that is because the bill keeps changing forms, and all of them are bad for me personally. Just some of the things that could impact me:

Lifetime limits: I can’t imagine a provision that allows an insurance company to put lifetime limits on a person that wouldn’t include me in those limits. If they get implemented, I almost assuredly will no longer have insurance. Due to some of my treatments, I have increased risk of: early onset glaucoma, mild to moderate skin cancers, mild to moderate neurological issues, heart and liver complications, and a mildly increased risk of leukemia diagnosis overall the average person (did you know that treatment for leukemia can also cause leukemia? Because it can…). That means that long term, I absolutely need to stay on insurance because I’m at risk of several expensive complicated issues. I don’t have the option of rolling the dice for a few decades.

Putting maximum dollar amounts means that basically anyone diagnosed with what I got is either dead or bankrupt. Emergency services are only required by law to treat your symptoms, not any underlying causes, so if you show up in the ER because of leukemia-related things, you will get a blood/platelet transfusion, some antivirals and/or anti-bacterials, and maybe some pain killers if you’re lucky. Not having health insurance is a death sentence if you have leukemia.

I just want to reiterate something: my total insurance billing, to date, has been just over $2 million. However, I want to stress that my treatment and recovery was basically a *string* of best case scenarios. In terms of setbacks and complications and other issues, I’ve been on the low end of all of those projections. For example, my stem cell transplant has a range of potential side effects from mild skin issues (what I have) all the way to “your immune system attacks everything in your body at all times”. My bill *very easily* could have been much, much higher. ~128 days in the hospital was *almost* the bare minimum I could have gotten away with. If I had gone with chemo-only instead of the stem cell transplant, that might have been 200+ days in a hospital, and my bill might have been more than 3 or 4 million dollars.

If at any point, my insurance company had been allowed to say “That’s all for the year / life”, essentially the next day, I would have no longer been able to afford care. So, death.  Isn’t that the whole point of having insurance? For stuff like that? And yet I could be punitively punished and prevented from having health insurance in later years when I will *definitely* need it. Definitely meaning, even more than a normal person would as they age.

High Risk Pools: Again, I can’t imagine an implementation of this that *doesn’t* group me into high risk pools. That means that my insurance costs will sky rocket. Keep in mind that I have literally never not had health insurance, and yet, could absolutely be grouped in high risk pools and pay exorbitant premiums and out of pocket costs.  

Converting to an HSA: If I put away $1,000 a month into an HSA, I’d only need to save for ~187 years to be able to afford the services I’ve already received. Even using the discounted amount that my insurance actually paid out would require ~133 years. So yeah, let me travel back in time to 1825 and start saving up. BRB.

Allowing insurance companies to use out of state insurance plans: This is a complicated one. To be honest, I’m not sure that I understand the implications with allowing insurance companies to comply with different state requirements as long as at least one offered plan complies with the actual state’s rules. I honestly can’t say. To me, it sounds like it would allow insurance companies in NY to offer plans that don’t discriminate against pre-existing conditions (required by the state), but those plans could cost $Texas. And then the plans that are “affordable” are allowed to discriminate against pre-existing conditions because they comply with some other lax state’s laws.

I honestly can’t say which of these frightens me the most. They’re all horrifying, basically.


Déjà vu All Over Again

On Thursday, Senate Majority Leader Mitch McConnell released a revised version of the BCRA, the healthcare reform bill that’s really a bill focused on cutting both taxes for the rich and benefits for the poor. The entire process seems to at least mirror the previous bill’s, if not just cut and paste it. The CBO was set to release its score of the revised bill early this week, but with McCain being absent from the Senate due to surgery, that score was delayed, as well as the vote itself. Despite (or perhaps because of) the bill’s similarity to the previous version, enough Republican Senators have declared their intentions to vote No on a motion to proceed with the bill, resulting in yet another effectively failed attempt at an ACA repeal.

On the whole, this version wasn’t particularly different than the previous Senate bill. It still enacted savage cuts to Medicaid, loosened restrictions and regulations on the kind of insurance offered, allowed insurance companies to charge different demographics (i.e. older people) more for their insurance, and so on. The latest revision kept two taxes from the ACA that were previously cut. It allocated $45 billion dollars over 10 years to fight the opioid crisis instead of two billion, an amount which is still not adequate to deal with the problem. It expanded the allowed usage of Health Savings Accounts (or HSAs), but those are only used by people who can afford to maintain and add to them, making this provision useless for those with lower incomes. The bill also allocated $70 billion to help stabilize higher risk pools, but the implementation involves matching by the states, so in total the stabilization is $132 billion. We won’t know whether this fund would be sufficient to keep the markets stable until official estimates come out (assuming the bill will still be scored).

A late addition to this version of the bill was an amendment by Senator Ted Cruz (R-TX) that would allow insurance providers to provide plans that did not conform to ACA regulations, as long as they also offered plans that did. The CEOs of AHIP and Blue Cross/Blue Shield, the largest medical insurers in the US, released a letter calling the amendment’s plan “unworkable.” As this amendment was offered late, it was not included in the CBO submission. John Thune of South Dakota, the Republican Conference Chair, suggested allowing the HHS to score the amendment under the assumption that Secretary Price’s department would be much more favorable to the bill than the nonpartisan CBO. It is not clear whether this would comply with Senate rules.

Last time around, several Republican Senators declared they would not vote for the previous version of the BCRA. Some are seen as more moderate, or represent states whose greater populations of elderly or opioid-afflicted citizens are especially vulnerable to the BCRA’s cuts. In order to pass any version of this bill, McConnell needs them to flip and vote to approve it; he can only have two senators vote no and still succeed. Two senators, Rand Paul of Kentucky and Susan Collins of Maine, declared early on they would not vote for the revised bill, although for drastically different reasons. Paul believed that the new bill still hewed too close to the Affordable Care Act, and Collins remains against any drastic cuts to Medicaid. This meant McConnell could not spare any more No votes throughout his caucus. Senator Heller of Nevada has not yet commented on the new bill, although the Governor of his state, Brian Sandoval, has declared his opposition. Senator Capito of West Virginia declared she was waiting for the CBO, as did Senator Portman (R-OH). In what almost seems like a deliberate echo, the other potential no votes were also waiting for the CBO score.

Just like last time, McConnell planned for the vote later this week, extremely soon after the CBO score. Once again there would be no time for hearings, amendments, or the other processes that the Senate normally follows for legislation. The plan was and is still as little outside input as possible. However, Senator McCain of Arizona had surgery on Saturday, and on advice from his doctors will remain in Arizona for the week. McConnell announced he would “defer consideration” of the bill, effectively delaying it. With the August recess postponed, the Senate still has some time for health care reform (they also have to deal with the debt ceiling and a budget), but every delay increases the chance that this extremely unpopular bill will once again succumb to public pressure, no matter what minor revisions are made.

Late Monday night, Senators Moran of Kansas and Mike Lee of Utah announced that they too would not vote for the bill. This means the current bill is effectively dead. In the end, it was so unpopular that 41 of the 52 GOP senators were unwilling to commit to the bill at all. Mike Lee felt that even with the Cruz amendment, the bill did not move far enough in his preferred direction for health care policy. Moran’s objection, however is a little more intricate. Throughout the week, it was discovered that McConnell had been telling more moderate Republican senators that the Medicaid cuts couldn’t possibly go through, as future congresses and presidents wouldn’t allow such drastic reductions in services. This cynical double speak (echoing what Republicans said about the sequester, which did pass and is still in effect) angered Senator Johnson of Wisconsin, who feels that the Medicaid expansion was damaging to the healthcare system, and that the new healthcare bill needed those cutbacks. He withdrew support of the bill, which led Senator Moran to declare he would not vote for it.

However, while this bill is effectively dead (again), McConnell’s efforts to affect the health care system are not over. He wants those tax cuts, and will work extremely hard to get them. He has already declared his next attempt: Repeal now, replace later. America, and its Senate Republicans, seem doomed to an endless cycle of ACA repeal efforts until either a version arrives which garners near-universal support from a fractured GOP caucus or McConnell and the other Republican leaders admit defeat and move on.


BCRA is a Tax Break for the Rich and Funds itself by Sabotaging Medicaid

While Senators claimed that the Senate version of the AHCA, referred to the BCRA, would be written from the ground up, completely separate from the House version, they weren’t quite telling the truth. Part of this is not their fault. Most of them didn’t know what was in it until the rest of us did. Even the people that were on the committee appointed to write the bill hadn’t fully seen it before it was unveiled. However, now that is has been released, what we have seen and know about the bill is not encouraging.

First off, let’s be clear: this is not actually a healthcare bill. This is a finance bill that is a substantial tax cut for the massively wealthy. It cuts a significant portion of the taxes imposed by the ACA, to the tune of nearly $1 trillion. That is the main goal of the bill: not to provide healthcare, or improve it, but to return money to the significantly moneyed.

In order to fund the tax cuts, the bill sabotages the ACA in a variety of ways. It lessens the subsidy formulas, it cuts the regulations on what healthcare insurance must cover, and so on. In essence, it makes the ACA stingier.

The most significant changes, however are to Medicaid. Just as the House bill eliminated the Medicaid expansion, so too does the Senate bill, although with different phase in rates (3 years instead of 1 year) that are more window dressing than significant policy difference.

The Senate Health bill also sabotages Medicaid as a whole, just as the House bill did. It institutes either per capita spending caps, or block grants that would be much less regulated. These would also result in funding cuts that are steeper, if phased in somewhat more gradually. The rate of reimbursement would be much lower, leading to steeper cuts in the future. Additionally, as time moves on the gap between reimbursement and funding would grow even more, so that the most Medicaid programs would be encouraged to prioritize younger and cheaper recipients over older, more expensive ones. Further, any states that funds on a per beneficiary above 25% of the average is penalized with further caps, whereas states that spend less than 25% below the average get additional funding, creating a horrid race to the bottom, with deadly consequences.

The CBO estimate for the BCRA is that 22 million people will lose their insurance, better than the AHCA only on a technicality. That is still disastrous for millions of Americans. In the end, after the cuts to the capital gains taxes that fund the ACA, the gutting of Medicaid, and all of the other cuts and adjustments, the government would save about $321 Billion over the next 10 years. Premiums would increase by about 20%, and eventually the poor would have to choose between either premiums they couldn’t afford for adequate care, or deductibles they couldn’t pay for subpar care.

The release of the CBO estimate has galvanized reactions across the spectrum. The AARP came out against the bill when the draft was released, and are not appreciative of what it calls unfair targeting of the elderly. The AMA itself came out with a statement that the bill would violate the first precept of medical ethics, Primum non nocere, or “first, do no harm.” The United States Conference of Catholic Bishops has also come out and said that the bill is “unacceptable as written”.

All Democratic Senators are opposed to this bill. Therefore, Senate Majority Leader McConnell can only afford 2 defections on his side so that he can pass the bill with Vice President Pence’s tie breaking vote. The most significant development on this front is a group of 4 conservative senators who have announced they are voting no on the bill. Sens. Rand Paul (Ky), Ron Johnson(Wi), Ted Cruz (Tx) and Mike Lee (Ut) all have concerns that while the bill does away with much of the ACA, it still keeps the framework. They object from the conservative position of promising to repeal the ACA as a whole. After the CBO estimate, Senator Paul continued his objections, as did Senator Johnson. Senator Cruz was noncommittal, and Senator Lee has come out against the BCRA as well.

One other senator has also announced he is a no vote. In a state moving increasingly Democratic, that has a significant medicaid population, Senator Dean Heller of Nevada has also announced he is voting no. He objects to removing healthcare from millions, to the secretive process McConnell used, without input, hearing, or amendment. It seems there is little that can be done to get his vote on the bill.

And he seems to be serious. He is up for reelection next year, and pro-Trump groups are already spending against him. His seat is seen as one of the most vulnerable to Democrats (certainly part of his calculus for voting no), and so this sort of infighting probably does not help.

There are two other votes that are significant at this time. One is Lisa Murkoswki of Alaska. She is notoriously independent of the Republican Party as whole (in her 2010 campaign, she retained her seat as a write in candidate after losing the primary to a Tea Party candidate). Alaska also has a significant Medicaid population, and while there are provisions in the bill for low density states to spend more on Medicaid, the cuts would eventually hit the state hard. She also supports Planned Parenthood, which the bill completely defunds. After the CBO estimate, she is still “gathering information”.

Another supporter of Planned Parenthood is Senator Susan Collins of Maine. She is also one of the more moderate Republican Senators, and she has expressed some reservations with the bill. She is eyeing the governor’s mansion next year (she ran and lost in 1994, beaten by her fellow Senator, Angus King), and so must consider Maine’s more moderate (and older) demographic. Defending the 1 in 5 Mainers on Medicaid, among other reasons, Collins has committed that she is voting no, unless drastic changes are made.

The Senate Health Bill is going to hurt if it passes. It will hurt the poor, the elderly, the lower and middle class: everyone not fantastically wealthy. But it hasn’t passed yet. There is still time for Republican opposition to the bill to coalesce. West Virginia seems to be a promising start, for example. Constituents are not going to let this go without a fight, even if they have to be carried out of their wheelchairs. McConnell is relying on speed and subterfuge to get this bill passed. Hopefully, there is too much of a spotlight on him.

While the wave of negative reaction from Republicans may be comforting, McConnell is not done with this. Until the no’s have actually been voted, the BCRA is not finished. At this stage, McConnell will attempt to convince those senators to change their vote to yes, with more opioid treatment funding to convince Johnson and Capito of West Virginia, for example. With the $321 billion in cuts, McConnell has around $200 billion to use to fund different programs to convince Senators to come on board.  And they will try again. The conservatives want their tax cut, and they want the ACA gone. They don’t particularly care who they hurt to get there.

Update: It has been announced that voting on the BCRA has been delayed until at least after the July 4 recess.


AHCA Stories: The Cost of Meds is the Cost of Living

Stephen’s last name has been omitted at his request.

Question

Let’s establish some background. What’s your name, where are you from, and what do you do? Tell me a little about yourself and your family.

 

Stephen

I’m Stephen, originally from NY and currently living in NC, and I work for IBM as a tape librarian. 29 years old, parents are in CA helping my brother raise his daughter, and sister also lives in NC with her boyfriend.

 

Question

Thank you. You are concerned about the American Health Care Act. Mind giving us a brief rundown of why?

 

Stephen

It’s an awful bit of legislation that is A) not thought out at all to the point where an upsetting amount of the Republicans who voted in favor of it admitted to not reading it/knowing what it entails, B) exists solely to kill the ACA rather than try and fix the aspects of it that don’t exactly work well, C) will rob millions of healthcare all to put more money in the pockets of the old white men who want to swing the axe, and D) is claimed to vastly lower premiums and costs despite all the evidence to the contrary.

 

Question

And how will this bill affect you and those close to you if it is made into law?

 

Stephen

For starters, I have had gallbladder surgery due to gallstones five years ago. I don’t require any medication for it nor have had complications, but you never know what might crop up. I was also diagnosed with GAD(General Anxiety Disorder) a year later. I have made peace with it so I don’t need my medication for anxiety very often outside of really nerve-wracking moments such as planes and boats (I greatly dislike moments where I’m outside of control of whatever’s going on, so having my safety in someone else’s hands causes it to crop up, plus lack of gallbladder makes motion sickness more common, leading to even more anxiety). And in a month I will be beginning HRT as I recently discovered that I am nonbinary, so not only could the AHCA severely screw me over during my transition but if it gets passed prior to June 23rd the cost of the bloodwork alone to start could skyrocket.

Outside of myself, my mom had a sort of facial cancer and requires a special kind of soap that her doctor prescribes her, my friend Mark has been reliant upon his inhaler for most of his life and is self-employed, and my friend Greg is severely allergic to lactose products to the point where he could be hospitalized if he eats something wrong.

And, of course, those monsters would claim that pregnancy is a pre-existing condition, which means they could find ways of messing with my mom in more ways, not to mention my sister-in-law, aunts, and grandmother.

 

Question

What is the nature of your current insurance? Is it employer provided, personally purchased, or do you get it via Medicaid?

 

Stephen

Employer provided, BCBS. It’s not great; when the first vote for the AHCA was approaching, I went and got my anxiety medications (busperone for day-to-day as needed, lorazepam for planes/boats) refilled in case they managed to pass it, and it cost $140 to fill them. A few weeks later, it was $160 to go to urgent care since I had water trapped in my ear, and had to get medication to prevent an ear infection.

 

Question

What are the premiums on your insurance? 

 

Stephen

I’m not exactly sure, to be honest. I know I have the basic plan and my deductible is $5000.

 

Question

You mentioned your anxiety medication. How often do you need to get refills?

 

Stephen

Not very often. I get 30 busperone and 10 lorazepam per refill; the lorazepam is really strong stuff that can get people addicted to it so it’s heavily regulated, and I use the busperone so infrequently that I don’t need much. Maybe once a year?

 

Question

You mentioned your concern for your mother and your friends. Do you have any knowledge on their current insurance situation?

 

Stephen

Not exactly. I know my mom continued the insurance she got from the school district she retired from, but am unsure as to what sort of coverage my friends have.

 

Question

Would you feel as if you could comfortably leave your current job or switch to a new one if the AHCA were to pass?

 

Stephen

Probably not, to be honest. My current insurance may suck, but who knows how much worse another employer’s coverage may provide, or if I might get sick during the period of time between insurances. I’d be really screwed in the latter scenario.

 

Question

Moving to the future, what would your preferences be in regards to government involvement in healthcare?

 

Stephen

We need single payer and a greater focus on actually lowering the costs of coverage. With people like Trump in power, we’re cutting into healthcare and education to bolster an already over-inflated military. It’s these cuts that cause situations like this to occur, as we have more and more uninformed and ailing demographics who are willing to buy into people like The Orange Authoritarian when he says he’ll make it all better.

Maybe try staffing these agencies with people who actually know the subjects and not who will grovel before a president, guys.

 

Question

Who is your representative in the House?

 

Stephen

They’re Butterfield, Foxx, Pittenger, and Meadows.

 

Question

Have you tried to contact the Representative of your district before or after this?

 

Stephen

I started recently via ResistBot, but did call up my Rep about DeVos prior to her confirmation.

 

Question

Do you feel your Representative has properly represented you thus far?

 

Stephen

Not at all.

 

Question

Representative Mo Brooks (R-Alabama) has suggested that people who lead “good lives” should pay less for insurance. What is your opinion on this statement?

 

Stephen

That might as well be saying that people who are born rich should pay less taxes; it’s a greedy “screw you, got mine” stance that ignores the less fortunate.

 

Question

Before we conclude, is there anything you would like to say?

 

Stephen

The next few months could greatly change our nation for better or worse. We need to continue to slam Congress and the Senate with all the reasons why none of Trump’s antics nor the choices by the GOP are normal nor okay. If they get their way, progress will revert back decades to their benefit and our detriment.

Don’t let them win.

 

Question

Thank you for your time Stephen! I hope your situation and stories help people understand how this affects people.

 

Stephen

No problem, thanks for presenting me with an outlet to express my concerns.

 

 


AHCA Stories: “Your parent, child, sibling, or neighbor could be impacted”

Torchlight continues to speak with individuals whose life would be deeply impacted by the American Health Care Act becoming law. The following transcript has been lightly edited for clarity.


Q: Let’s establish some background for the moment. What’s your name, where are you from, what do you do? Tell us about yourself and your family.

Brad Williams: I’m Brad Williams, I live in a small town in Vermont called Bradford. No relation. With me are my wife Cassie, and my daughter Jaina, as well as three cats and a dog. My wife and I met at GameStop years ago. I had hired her as a sales associate, but we got close and she left the company so we could pursue a relationship.

We both now work for a major electronics retailer, she as an in-store supervisor, and me as an in-home install/repair guy. I mostly repair computers (remove malware, replace parts, etc) and build networks for larger homes, but I also do a bit of home theater as well.

After my wife and I were married for a few years, we discovered that I was unable to have children. It took a while, but after four attempts with donor sperm, we welcomed our little Jaina. She just turned two last month, and she’s been through some stuff since birth. But she’s beautiful, tough, and a heck of a lot of fun.

Q: Thank you. You have concerns about how the recently passed American Health Care Act could affect your family. Could you tell me a bit about this?

Brad Williams: Well, I mentioned she’s been through some stuff. [Jaina] was born with Transposition of the Great Arteries, so her pulmonary and arterial lines were reversed. Basically, oxygenated blood was going back to her lungs instead of filtering out to her body. We didn’t find out about this until about twelve hours after her birth, and didn’t get to hold her much at all. She was driven that Wednesday night from Dartmouth Hitchcock to Boston Children’s, and underwent open heart surgery Friday. The issue was corrected completely, but she needs yearly check-ins with a cardiologist. I’m sure you can guess that TGA is a pre-existing condition. So, right now my wife and I have decent enough insurance through my employer. But with the ACA protections for pre-existing conditions being threatened, things become very scary. What if I lose my job and we have a gap in benefits? Or what if something happens to me? Whatever happens to me happens, I’ll live, but they’re coming after my daughter.

Question: Are there any common complications that can arise after TGA has been corrected?

Brad Williams: So, we’re not sure, which is part of why she sees a cardiologist once a year. The procedure has only been done since the mid-80s, and since it’s performed right around birth, issues later in life aren’t known for sure yet. Right now, the main risks they look out for are coronary artery problems and the possibility of leaking valves.

Question: So it’s effectively an unknown value that could lead to gaps in coverage. If the AHCA were made law would you feel as though you could leave or switch jobs?

Brad Williams: No way. Thankfully I like my job, but when you get a new job, there’s that period that you can’t get coverage for, usually around 90 days. That’s 90 days for something to go wrong, and not a risk I’d be willing to take for her. And, while I enjoy my job and wouldn’t leave it voluntarily, the chance of me losing my job due to factors I can’t control is not exactly zero, and we couldn’t afford COBRA. That’s what worries me most, having a short period without coverage and giving the insurance an excuse to stop covering her.

Question: Additionally, prior to the ACA there could be a longer wait period for those with pre-existing conditions. Do you recall what your insurance situation was like pre-ACA?

Brad Williams: I’ve had insurance most of my life. When I changed companies in 2007 I was without for the typical 90 days, and that happened again when I changed to this job almost two years ago. Thankfully nothing major happened to any of us during that period.

Question: Moving on to the future, how would you like the government to approach healthcare?

Brad Williams: Honestly? I know the healthcare system is a mess. It’s not easy. And I’m one of the fortunate ones that has had OK-to-great insurance his whole life. But I really think we need to get with the rest of the modern world and move to single payer of some form. Too many people are left without any care, while many others like my daughter are at risk of being denied care should the AHCA go through. All for something that isn’t their fault.

Even if it costs me more out of each paycheck, having that safety net for not only my family, but other people in the community, is important for the long term well being of the country.

Question: Who is your representative in the House?

Brad Williams: Peter Welch. He represents all of Vermont, and voted against the AHCA.

Question: How politically active have you been? Have you tried contacting Welch?

Brad Williams: Not as active as I should be, if I’m honest. We donated to the DNC last year before the election, and we’ve written emails and letters in the past about other things (Title II, for instance). It’s been on my mind, though, and even though Welch voted against the AHCA, and Sanders and Leahy most certainly will if it reaches the Senate, I should reach out.

Question: And do you think your Representative will be amenable to your concerns?

Brad Williams: He’s supposed to be representing the people of Vermont, so I certainly hope so. Only one way to find out, though.

Question: Anything you want to say or tell people before we wrap this up?

Brad Williams: I just want people to realize how dangerous this is. Even if you yourself are not affected right now, you may be later. Your parent, child, sibling, or neighbor could be impacted. I’d hate to end this interview with “please think of the children,” but it’s not far from the truth in this case.

Question: Thank you for speaking with me Brad, it has been a big help.

Brad Williams: You’re welcome, and thank you for inviting me.


14 Million Uninsured Next Year Under AHCA, says CBO

On Wednesday, the Congressional Budget Office (CBO) released their score of the American Healthcare Act of 2017 (AHCA), twenty days after Republicans within the House of Representatives passed the bill. Their findings are less than ideal for the poor in the U.S., as twenty three million Americans are estimated to see a loss of coverage within the next decade as compared to the ACA. Particularly, within the next year there will be fourteen million more uninsured then there would be under the ACA. The effects will be dramatic and quick if the law is passed as is.

The deficit will also drop by $119 billion and premiums will go down in some areas, a point which will likely receive a lot of reverberation amongst conservative politicians. The effects of the bill, however, are not so simple. While it is true that premiums will go down for some, the benefits of their insurance will also drop due to relaxed regulations on insurance included in the bill. Particularly, allowing companies to discriminate based on the ill-defined category of pre-existing conditions will enable insurance companies to drop premiums for the healthy. Meanwhile, those with chronic conditions, expensive prescriptions, and general health issues will likely see their premiums rise, in some cases dramatically. Many will simply be unable to afford the care they need, or will be removed from their plans due to higher costs and lax regulations allowing for more limited coverage.

Also according to the CBO score, the health insurance market is estimated to become extremely unstable for a full sixth of the population. One of the key differences between this version of the AHCA and the version which failed to pass the House in March are amendments which allow states to apply for waivers releasing them from Obamacare requirements that insurance companies not discriminate by raising prices on those with pre-existing conditions and that insurance plans cover a set of essential health benefits. The CBO is predicting that as a result, the health insurance market will split into two segments. Healthy individuals will have low-premium, low-coverage plans in a stable market, while sick individuals will find their insurance in a “death spiral” of increasing premiums as higher costs and incomplete coverage drive anyone who can’t afford it out of that part of the market. This second market will be unstable, and particularly threaten to affect the poor and the elderly as well as the sick. Under AHCA, premiums on the elderly are likely to rise, possibly by a staggering 800%–or up to sixty percent of their income if they are earning a yearly income of $26,500 a year (according to a report by the Washington Post). A large segment of the population will find themselves paying much more for much less.

After years of complaints about the ACA being passed too quickly (despite a process that lasted more than a year), that the AHCA was passed in a matter of weeks and several weeks before the release of this CBO score seemed immensely irresponsible then. With the CBO now having given their estimates, it is obvious that it was, in fact, grossly irresponsible from both a process and a policy perspective. Tens of millions of Americans will lose insurance under the bill very soon and that number will continue to rise over the ten year estimate period, with an estimated 51 million people under the age of 65 left without coverage by 2026. Many will die or suffer from treatable conditions with no recourse. Others will experience extreme financial hardship just to stay alive.

Republicans will likely have a hard time arguing that the AHCA’s small decrease in the deficit is worth it to those individuals who will no longer be covered. However, the relatively small reduction does enable to Republicans in the House to submit the bill to the Senate for review and potential passage under reconciliation, a process allowing for passage of the bill via a simple majority. Hopefully, whatever decision Senate Republicans come to will be better for the American people than what has been passed by the House.


AHCA Stories: “This is about real people’s lives.”

In the wake of the House passage of the American Health Care Act, I spoke with one individual whose life would be deeply impacted by the AHCA becoming law. The following transcript has been lightly edited and annotated for clarity.


Q:

Let’s start with some background. What’s your full name, where are you from, what do you do? Tell me a little about yourself, your family, etc.

(Justin Passage):

My name is Justin Passage and I am from the Metro Detroit area in Michigan, I am the IT director of a non-profit that provides care for people with developmental disabilities. My wife and I have been married for 10 years and I am the proud stepfather to our son who just turned 24. She is 50 and I am 38.

Q:

What’s your wife’s name?

(Justin Passage):

Tanya but she prefers to go by Shelley.

Q:

Okay. Let’s talk about why you’re concerned about the American Health Care Act that just passed the House.

(Justin Passage):

Okay. My wife has always had a nebulous auto immune disorder. She has a diagnosis from a long time ago of chronic fatigue. So insurance was never easy to get for her. Mostly it just manifested in bouts of tiredness until about three years ago.

Three years ago she started to lose her balance. It started as a minor thing but got worse. Due to the ACA, we were able to get her insurance and a diagnosis.

As we went to doctors after the ACA, she was diagnosed with a large acoustic neuroma. [Editor’s note: this is a noncancerous tumor that presses on the main nerve leading from the inner ear to the brain, causing nerve damage, resulting in impairment.] It was at the point where it was life threatening. Even during the time it took her to get diagnosed, she had regressed down to not being able to walk at all.

She had successful surgery on April 12th 2016, but there have been a lot of ancillary and new diagnoses after that. At this point she has about six to seven different conditions diagnosed. Without a pre-existing conditions clause and the ability to not allow that to affect premiums, we’d be at over double my take home pay at least in premiums.

Q:

Let’s talk about insurance specifically. The AHCA seems set to take us back to the era before the ACA was passed in 2010; how long before that did Shelley have this diagnosis of chronic fatigue, and how did that affect her ability to get or pay for health insurance?

(Justin Passage):

She was not able to get insurance that she could afford with that diagnosis. She had that diagnosis for at least 30 years if I am correct on the dates.

Q:

So she had basically no insurance for most of her adult life?

(Justin Passage):

When I met her she had no insurance. She did not get insurance until the ACA passed, because we could never find insurance that would cover her for anything affordable.

Q:

How did that impact her ability to pay for healthcare?

(Justin Passage):

My job has really bad insurance because we are a non-profit, so there is no employer donation for spouses and the costs before the ACA were very high.

Q:

Would you pay out of pocket for things like checkups and preventative care, or would Shelley just go without?

(Justin Passage):

She mostly went without. If there was an emergency we paid out of pocket.

Q:

That must have been very difficult not knowing if you were going to suddenly take a big financial hit like that.

(Justin Passage):

It was.

When she lost her hearing in her ear, which was a sign of the tumor, the clinic doctor told her he could see nothing and that it was a latent viral infection.

Q:

Wow. So because she didn’t have access to better healthcare, she was misdiagnosed?

(Justin Passage):

Yes. After getting on an insurance plan she was also diagnosed with rheumatoid arthritis, which the doctor said was what the chronic fatigue should have been diagnosed as. [Editor’s note: rheumatoid arthritis is a chronic inflammatory disorder which causes joint pain, joint deformation, and worse in advanced cases.]

Q:

Those are both problems that get worse over time if they go untreated, right?

(Justin Passage):

Correct. According to the neurosurgeon the tumor was months away from killing her.

If she loses her insurance because premiums are in the 100k+ range for all her pre-existing conditions, she will not be able to get her MRIs. They took most of the tumor out, but there is a very small bit left. As of yet is has not grown, but it could. She needs yearly MRIs to watch it.

Q:

If it does start to grow again, she’ll need another surgery?

(Justin Passage):

Yes. Because it would grow unchecked like the last one in the same way

Q:

What about her arthritis, does she get regular treatment for that?

(Justin Passage):

Yes. Right now they are trying to find the right balance of medications. They are getting closer but left untreated she is in a lot of pain. To do the operation on the tumor they had to megadose her with steroids; so when the steroids wore off it caused the RA [rheumatoid arthritis] to come back worse than it had been. That level of pain keeps her from doing her PT [physical therapy] exercises and she loses progress on her mobility.

Q:

What kind of symptoms does she experience from these issues, and how do they affect her ability to live a normal, productive life?

(Justin Passage):

She has palsy in half her face, her right hand shakes and she just got off the cane. She has vision issues due to complications with that eye not closing right and a corneal abrasion. There might also be nerve involvement in the vision. She lost total hearing in her right ear. She is legally blind.

There’s a decent amount.

Q:

Which side was the tumor on?

(Justin Passage):

It was on the right. It began in the ear canal and grew out and got tangled in the nerve cluster. A lot of her issues are down to the fact that most of her major nerves were impacted.

Q:

Let’s go back to the insurance side of things. Do you remember when after ACA she was finally able to get affordable insurance coverage?

(Justin Passage):

It was one year out. She had a distrust of Insurance and the medical system after trying so long to try and get something affordable. So almost one year after the ACA took effect we got her on a plan, so the second open enrollment.

Q:

Did she go through the exchanges or did she get on yours?

(Justin Passage):

Exchange. My insurance is really bad, and at that point her health was declining pretty fast. We would have paid a lot more had she been on mine even with the ACA mandated plan.

Q:

Do you remember which level of plan she got? Bronze, Silver, Gold, and Platinum are I think the categories.

(Justin Passage):

Silver.

Q:

What was that monthly premium, roughly, if you remember?

(Justin Passage):

$403-404.

Q:

And she’s still on that plan?

(Justin Passage):

No. That plan discontinued and the new plan they said was comparable was anything but. They sent a list of new things they were no longer covering. Out of 10 items, four of them were things she had had done.

So we changed plans. 10% increase. We pay $441 now. Less is covered outright. It’s been a struggle even under the ACA, but it’s better than her not getting an MRI and the tumor growing unknowingly.

Q:

The AHCA gives states the right to ask for a waiver from the pre-existing conditions protections of ACA that force insurance companies not to charge more for individuals who have those conditions. How much would Shelley’s premiums rise if your state received that waiver under AHCA?

(Justin Passage):

It would be anywhere from 100k on the low end up to 175k on the high end.

Q:

Per year?

(Justin Passage):

Yes. Depending on how they classify the tumor, and how precancerous polyp classifies as well. Because they found that when she was in for the brain tumor and removed it. They saved her life twice.

Q:

What would you and Shelley do if that came to pass?

(Justin Passage):

We have multiple plans depending. We could get divorced and remarry so it’s a qualifying event for my work insurance. Which would at least be something. It would be out of pocket over $500 though.

If that insurance also has the pre-existing conditions problems, we might have to get divorced and have her move in with her mom. I really think that’s the nuclear option. It would keep her alive, though. Because she could get SSI then, and Medicare. We could just pay out of pocket for diagnostic stuff, but if it did grow I do not know how we’d pay for another surgery.

None of these are good options.

Q:

What does an MRI go for out of pocket, do you know?

(Justin Passage):

About $800 I believe. But we’d also have to figure out the RA [rheumatoid arthritis] stuff. Some of the medicines for that can really be expensive. The oral she’s on is only kind of working and they might move her up to an injectable. Without a Doctor’s visit she couldn’t get that.

Q:

What do you want out of health care reform, broadly speaking? Do you want to see the ACA’s issues fixed? Would you rather see us move to single payer?

(Justin Passage):

I believe single payer is the best option but at the very least I would like to see the ACA fixed.

Q:

Were you bothered by how the House passed this, on a short notice and without a score from the Congressional Budget Office?

(Justin Passage):

Yes. I tried to contact my Congressman and couldn’t. His phone went straight to a full voicemail all morning. I then sent an email saying how much this would hurt my family and to not do it. This was ignored. I was very upset that not only did he not listen to the people he is supposed to represent but he also did it on flimsy knowledge and party loyalty. That is not how someone who is supposed to represent you should act.

Q:

Who is your representative?

(Justin Passage):

David Trott, Michigan 11th.

Q:

How do you feel about this overall? Are you hopeful about the future of healthcare in this country?

(Justin Passage):

I am very upset right now. I would like to believe that it can be made better but I do not see how that happens before 2020. I believe if Trott and some of the others who voted this in are gone we might be able to maintain something until then, though. We eventually have to have the discussion of why we are the only Western country without single payer.

Q:

Before we conclude the interview, is there anything else you would like to say to our readers?

(Justin Passage):

I just want people to know that this is about real people’s lives. I wake up every morning next to a woman who has fought and survived and if she goes out because some rich people want a tax cut and we have an irrational fear of socialism, that is a sad indictment on our society as a whole.

Q:

Justin, I want to thank you very much for your time and for sharing your story with us. You have my sympathies for Shelley’s suffering and yours, and for what this political process has put you through.

(Justin Passage):

Thank you. I appreciate the opportunity to share our story with you and your readers.


These are the People Who Voted to Kill Americans

Courtesy of the Washington Post, here is a list of members of the House of Representatives who voted to strip health insurance from millions of Americans. If you find that your representative’s name is on this list, you can get his or her contact information here.

Robert B. Aderholt, (R – Alabama)
Mo Brooks, (R – Alabama)
Bradley Byrne, (R – Alabama)
Gary Palmer, (R – Alabama)
Martha Roby, (R – Alabama)
Mike D. Rogers, (R – Alabama)
Don Young, (R – Alaska)
Trent Franks, (R – Arizona)
Paul A. Gosar, (R – Arizona)
Martha McSally, (R – Arizona)
David Schweikert, (R – Arizona)
Eric A. “Rick” Crawford, (R – Arkansas)
French Hill, (R – Arkansas)
Bruce Westerman, (R – Arkansas)
Steve Womack, (R – Arkansas)
Jeff Denham, (R – California)
Ken Calvert, (R – California)
Paul Cook, (R – California)
Duncan D. Hunter, (R – California)
Darrell Issa, (R – California)
Steve Knight, (R – California)
Doug LaMalfa, (R – California)
Kevin McCarthy, (R – California)
Tom McClintock, (R – California)
Devin Nunes, (R – California)
Dana Rohrabacher, (R – California)
Edward R. Royce, (R – California)
David Valadao, (R – California)
Mimi Walters, (R – California)
Ken Buck, (R – Colorado)
Doug Lamborn, (R – Colorado)
Scott R. Tipton, (R – Colorado)
Carlos Curbelo, (R – Florida)
Gus M. Bilirakis, (R – Florida)
Vern Buchanan, (R – Florida)
Ron DeSantis, (R – Florida)
Mario Diaz-Balart, (R – Florida)
Neal Dunn, (R – Florida)
Matt Gaetz, (R – Florida)
Brian Mast, (R – Florida)
Bill Posey, (R – Florida)
Francis Rooney, (R – Florida)
Thomas J. Rooney, (R – Florida)
Dennis A. Ross, (R – Florida)
John Rutherford, (R – Florida)
Daniel Webster, (R – Florida)
Ted Yoho, (R – Florida)
Rick Allen, (R – Georgia)
Earl L. “Buddy” Carter, (R – Georgia)
Douglas A. Collins, (R – Georgia)
Drew Ferguson, (R – Georgia)
Tom Graves, (R – Georgia)
Jody Hice, (R – Georgia)
Barry Loudermilk, (R – Georgia)
Austin Scott, (R – Georgia)
Rob Woodall, (R – Georgia)
Raúl R. Labrador, (R – Idaho)
Mike Simpson, (R – Idaho)
Mike Bost, (R – Illinois)
Rodney Davis, (R – Illinois)
Randy Hultgren, (R – Illinois)
Adam Kinzinger, (R – Illinois)
Darin LaHood, (R – Illinois)
Peter J. Roskam, (R – Illinois)
John Shimkus, (R – Illinois)
Jim Banks, (R – Indiana)
Susan Brooks, (R – Indiana)
Larry Bucshon, (R – Indiana)
Trey Hollingsworth, (R – Indiana)
Luke Messer, (R – Indiana)
Todd Rokita, (R – Indiana)
Jackie Walorski, (R – Indiana)
David Young, (R – Iowa)
Rod Blum, (R – Iowa)
Steve King, (R – Iowa)
Lynn Jenkins, (R – Kansas)
Roger Marshall, (R – Kansas)
Ron Estes, (R – Kansas)
Kevin Yoder, (R – Kansas)
Garland “Andy” Barr, (R – Kentucky)
James Comer, (R – Kentucky)
Brett Guthrie, (R – Kentucky)
Harold Rogers, (R – Kentucky)
Ralph Abraham, (R – Louisiana)
Garret Graves, (R – Louisiana)
Clay Higgins, (R – Louisiana)
Mike Johnson, (R – Louisiana)
Steve Scalise, (R – Louisiana)
Bruce Poliquin, (R – Maine)
Andy Harris, (R – Maryland)
Justin Amash, (R – Michigan)
Jack Bergman, (R – Michigan)
Mike Bishop, (R – Michigan)
Bill Huizenga, (R – Michigan)
Paul Mitchell, (R – Michigan)
John Moolenaar, (R – Michigan)
Dave Trott, (R – Michigan)
Fred Upton, (R – Michigan)
Tim Walberg, (R – Michigan)
Tom Emmer, (R – Minnesota)
Jason Lewis, (R – Minnesota)
Erik Paulsen, (R – Minnesota)
Gregg Harper, (R – Mississippi)
Trent Kelly, (R – Mississippi)
Steven M. Palazzo, (R – Mississippi)
Sam Graves, (R – Missouri)
Vicky Hartzler, (R – Missouri)
Billy Long, (R – Missouri)
Blaine Luetkemeyer, (R – Missouri)
Jason T. Smith, (R – Missouri)
Ann Wagner, (R – Missouri)
Jeff Fortenberry, (R – Nebraska)
Adrian Smith, (R – Nebraska)
Don Bacon, (R – Nebraska)
Mark Amodei, (R – Nevada)
Rodney Frelinghuysen, (R – New Jersey)
Tom MacArthur, (R – New Jersey)
Stevan Pearce, (R – New Mexico)
Chris Collins, (R – New York)
John Faso, (R – New York)
Peter T. King, (R – New York)
Tom Reed, (R – New York)
Elise Stefanik, (R – New York)
Claudia Tenney, (R – New York)
Lee Zeldin, (R – New York)
Ted Budd, (R – North Carolina)
Virginia Foxx, (R – North Carolina)
George Holding, (R – North Carolina)
Richard Hudson, (R – North Carolina)
Patrick T. McHenry, (R – North Carolina)
Mark Meadows, (R – North Carolina)
Robert Pittenger, (R – North Carolina)
David Rouzer, (R – North Carolina)
Mark Walker, (R – North Carolina)
Kevin Cramer, (R – North Dakota)
Steve Chabot, (R – Ohio)
Warren Davidson, (R – Ohio)
Bob Gibbs, (R – Ohio)
Bill Johnson, (R – Ohio)
Jim Jordan, (R – Ohio)
Robert E. Latta, (R – Ohio)
James B. Renacci, (R – Ohio)
Steve Stivers, (R – Ohio)
Patrick J. Tiberi, (R – Ohio)
Brad Wenstrup, (R – Ohio)
Jim Bridenstine, (R – Oklahoma)
Tom Cole, (R – Oklahoma)
Frank D. Lucas, (R – Oklahoma)
Markwayne Mullin, (R – Oklahoma)
Steve Russell, (R – Oklahoma)
Greg Walden, (R – Oregon)
Lou Barletta, (R – Pennsylvania)
Mike Kelly, (R – Pennsylvania)
Tom Marino, (R – Pennsylvania)
Tim Murphy, (R – Pennsylvania)
Scott Perry, (R – Pennsylvania)
Keith Rothfus, (R – Pennsylvania)
Bill Shuster, (R – Pennsylvania)
Lloyd Smucker, (R – Pennsylvania)
Glenn Thompson, (R – Pennsylvania)
Jeff Duncan, (R – South Carolina)
Trey Gowdy, (R – South Carolina)
Tom Rice, (R – South Carolina)
Mark Sanford, (R – South Carolina)
Joe Wilson, (R – South Carolina)
Kristi L. Noem, (R – South Dakota)
Diane Black, (R – Tennessee)
Marsha Blackburn, (R – Tennessee)
Scott DesJarlais, (R – Tennessee)
John J. Duncan Jr., (R – Tennessee)
Charles J. “Chuck” Fleischmann, (R – Tennessee)
David Kustoff, (R – Tennessee)
Phil Roe, (R – Tennessee)
Jodey Arrington, (R – Texas)
Brian Babin, (R – Texas)
Joe Barton, (R – Texas)
Kevin Brady, (R – Texas)
Michael C. Burgess, (R – Texas)
John Carter, (R – Texas)
K. Michael Conaway, (R – Texas)
John Abney Culberson, (R – Texas)
Blake Farenthold, (R – Texas)
Bill Flores, (R – Texas)
Louie Gohmert, (R – Texas)
Kay Granger, (R – Texas)
Jeb Hensarling, (R – Texas)
Sam Johnson, (R – Texas)
Kenny Marchant, (R – Texas)
Michael McCaul, (R – Texas)
Pete Olson, (R – Texas)
Ted Poe, (R – Texas)
John Ratcliffe, (R – Texas)
Pete Sessions, (R – Texas)
Lamar Smith, (R – Texas)
Mac Thornberry, (R – Texas)
Randy Weber, (R – Texas)
Roger Williams, (R – Texas)
Rob Bishop, (R – Utah)
Jason Chaffetz, (R – Utah)
Mia Love, (R – Utah)
Chris Stewart, (R – Utah)
Dave Brat, (R – Virginia)
C Thomas Garrett, (R – Virginia)
Bob Goodlatte, (R – Virginia)
H. Morgan Griffith, (R – Virginia)
Scott W. Taylor, (R – Virginia)
Rob Wittman, (R – Virginia)
Cathy McMorris Rodgers, (R – Washington)
Evan Jenkins, (R – West Virginia)
David B. McKinley, (R – West Virginia)
Alex Mooney, (R – West Virginia)
Sean P. Duffy, (R – Wisconsin)
Mike Gallagher, (R – Wisconsin)
Glenn Grothman, (R – Wisconsin)
Paul D. Ryan, (R – Wisconsin)
James Sensenbrenner, (R – Wisconsin)
Liz Cheney, (R – Wyoming)