Dear Congressman Goodlatte:

Thank you for your email of May 22 responding to our concerns about the American Health Care Act that you support.

Our concerns can be divided into two classes: One, our moral commitment to what is best for the common good and two, our self-interest in what is best for our daughter Sarah. For now, we’ll leave the moral concerns to the good debate about the AHCA that is playing out in various journals and editorial pages. Our comments here are entirely selfish, regarding Sarah.

As I have shared with your Staunton office and in online comments to the White House, Sarah is a self-disciplined, articulate, responsible 26-year-old walking “pre-existing condition.” With bone-cancer presenting in her upper right arm at 15, she has had limb-sparing surgery, lung surgery for metastasis, a successful bone-marrow transplant, and most recently, brain surgery on a slow-growing tumor that causes minor seizures and raises questions about future treatment.

Having aged out of our good insurance coverage through Washington and Lee University (where we, her parents, are both on the faculty), Sarah is getting an extension of the same coverage under COBRA for just over $600 a month. But that will run out by mid-2018. Then she will have to seek coverage from the marketplace exchanges. At that point, the question is which system would be better for her, the ACA or the AHCA. We know the current system would likely present higher premiums and limited choices for her, particularly if Congress doesn’t fix some of the obvious flaws with the law (Obamacare), which incorporates huge political compromises with the big insurance companies. (As you know, the law also reflects GOP demands, even though those compromises didn’t win any votes.) She would need the highest-level of coverage.

You claim that the ACHA would give her the same protections she has under the ACA. At least I think that’s what you mean: “The AHCA would only allow insurance companies to consider health status when assessing premiums if that person has not maintained continuous coverage.”

Sarah graduated with honors from Sewanee. Her parents have graduate degrees. Although we have experienced the absurdity of the theory that there’s such a thing as “consumer-driven health care choices” when dealing with health insurance companies, the three of us can probably guard against discontinuous coverage in Sarah’s case. But will coverage be affordable for her?

The CBO report says it might not: “Community-rated premiums would rise over time, and people who are less healthy … would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all.”

What does this mean? David Nather, the health care editor at Axios, explained it this way on May 25: “In the states that get waivers from the ACA’s pricing and benefit rules, people with pre-existing conditions could be priced out of the market. Those states would cover about one sixth of the population.”

I respect that you “firmly believe” in your bill. However, when that belief is so firm that you rush to vote without allowing any committee hearings, without listening to the objections of the associations of doctors, hospitals, nurses and AARP (virtually all groups involved except the insurance companies), and without hearing from the Congressional Budget Office, I wonder if reason and the public good have been squelched.

Please think of Sarah and her parents, your constituents in Virginia’s beautiful 6^th District.

Sincerely,

Douglas and Elizabeth Cumming