Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.
Health Care as a Human Right
If there is anything to take away from my over half a century of professional experience at the crossroads of law, medicine, and health care — including my being brought to Congress to advise lawmakers as the Affordable Care Act was being crafted in 2009-10 — it is that Americans believe health care is a right — and should be affordable — and not a privilege for only those wealthy enough to pay for the right type of coverage. After all, without the ability to acquire, maintain, or regain our health, none of us is much good to ourselves or our families, friends, loved ones, and communities, and certainly not to our employers. It is more costly for any of us to be sick than well.
The concept of health care being a right goes back many, many decades, and the ACA is the most recent incarnation of that belief — despite ongoing political risks. The latest gamble has been the nearly six-week shutdown and only the promise that the Senate will vote within a month to address the ACA’s enhanced subsidies (“Why Democrats Are Casting the Government Shutdown as a Health Care Showdown,” Oct. 6).
It is consequently not hyperbole to say that the ACA was intended as, and still remains, an indisputable lifeline for millions to achieve health. Of course, that goal is in jeopardy, or at a minimum an open question, since the subsidies will either be eliminated by year’s end if the promised vote on the Democrats’ Senate bill fails in that chamber, or, if it passes, never becomes law. Regardless, notices to insureds of huge premium increases without the subsidies have started reaching mailboxes.
From my perch (and without considering the brouhaha over also limiting Medicaid and decreases in Medicare provider funding that became law courtesy of this year’s budget bill), it is incredulous and maddening to suffer through the longest government shutdown in the nation’s history without honest, credible, and earnest negotiation. All this because a present majority of our federal legislative branch, along with a sparse number of Senate Democrats and one independent now breaking with their caucus, believe denying Americans the right to be healthy remains a tool for political leverage.
— Miles Zaremski, Highland Park, Illinois
Surprise Bills While on Medicaid
I just read your article about the family that had wages garnished to pay medical bills even though they were covered by Medicaid (“Workers’ Wages Siphoned To Pay Medical Bills, Despite Consumer Protections,” Oct. 2). I live in Chaffee County, Colorado. The local nonprofit hospital, the Heart of the Rockies Regional Medical Center, billed my family on four separate occasions (from mid-2021 through late 2023) while we were on Medicaid. Outrageous!
Fortunately, I knew that we weren’t supposed to be getting those bills. I called the state Medicaid office every time, and it issued notices regarding illegal billing actions. I have kept copies of all those letters. Just a completely ridiculous situation, and I wonder how many of my neighbors on Medicaid went ahead and paid such illegal bills.
— Melanie Jacobs, Salida, Colorado
A Menace Metastasized
How can you publish the article “‘Cancer Doesn’t Care’: Citizen Lobbyists Unite To Push Past Washington’s Ugly Politics” (Oct. 21) and not:
1) Address that President Donald Trump and the Republicans have cut funding for numerous cancer research-related initiatives in the name of unfair DEI (diversity, equity, and inclusion)?
2) Address that it is Trump and the Republican Party who won’t negotiate on health care benefits?
3) Ask the Republicans (and Democrats) quoted in this piece what they think about the above? Did it not occur to you to ask Mary Catherine Johnson what she thinks of these policies, given her own cancer?
KFF Health News seems unable to call out fascism for what it is and hold people accountable for their votes. Is a simple “Who did you vote for and do you agree with these policies?” too much to ask?
Being scared to call out the Trump administration and its policies is shameful.
— James Martinez, Tucson
The Long Arm of KFF Health News
Your fabulous 2019 scoop on the secret FDA database on medical device adverse events (“Hidden FDA Reports Detail Harm Caused by Scores of Medical Devices,” March 7, 2019) made a great impact. It served as the basis for this follow-up, showing how the data, once public, vastly altered the industry. Huzzah!
— Jeff Bailey, Denver
The Balkanization of Health Funding
Jim Mangia’s proposal to tax Los Angeles County residents for community health center funding is both strategically brilliant and deeply troubling (“Health Centers Face Risks as Government Funding Lapses,” Oct. 3). As a master of public health student designing a similar ballot measure for Nevada, I’m becoming an expert in what I can only describe as managed abandonment.
My thesis examines the expansion of federally qualified health centers in Nevada, a state ranking near the bottom in primary care provider access. After federal grants were frozen in January and with Medicaid facing massive cuts, my academic project became a case study in health care feudalism: Access to primary care now depends on your county’s wealth and political composition.
Here’s the arithmetic that haunts me: Nevada has about 3.2 million residents across 17 counties. Clark County (with a population of 2.3 million people and encompassing Las Vegas) could potentially pass a health tax generating $90 million-$100 million annually. Eureka County has around 1,800 residents. You see the problem.
Mangia, who is president and CEO of St. John’s Community Health, is right that federal and state governments are unreliable. A Clark County ballot measure could keep FQHCs open and patients alive. That’s emergency triage. But let’s be clear about what we’re designing: 3,000 separate county health care systems in which wealthy urban areas provide care and poor rural counties cannot.
I’m helping design Nevada’s version anyway, because people need care today. But I’m documenting what this represents: not innovation, but the devolution of a federal responsibility to local governments least equipped to handle it equitably.
County health taxes are considered harm reduction for health care access, like providing naloxone while fighting addiction’s root causes. They’re necessary. They’re insufficient. And they’re dangerous precisely because they might work well enough in enough places to let Congress off the hook.
My thesis will recommend multitiered advocacy: county ballot measures where feasible, state emergency funding for rural areas that cannot tax themselves adequately, regional compacts for resource-sharing, and relentless federal pressure for restoration of the Community Health Center Fund and for Medicaid expansion.
But here’s what keeps me awake: Every hour I spend designing county ballot measures normalizes the idea that health care funding is a local responsibility. Every successful local tax makes it easier for Congress to justify cutting federal programs.
We’re teaching the next generation of public health professionals to triage federal abandonment. We’re getting good at it. That’s what terrifies me.
When we look back in 10 years at a health care system balkanized by county, where your access depends on local elections and ballot measures, we need to remember: This wasn’t innovation. This was what we did when the federal safety net collapsed. And we knew it was unjust at the time.
— Pragya Thakur, Bartonsville, Pennsylvania
Paying as I Go
I read with interest your article about hospitals arguing with insurance companies over the results of out-of-network status (“Health Care Helpline: So Your Insurance Dropped Your Doctor. Now What?” Oct. 29). One option you didn’t mention was self-pay.
I’m a retired financial adviser who went back to graduate school at age 62. I am in excellent health and see a doctor only for my annual checkups. So I self-insure.
The interesting thing is that self-pay costs are often discounted by 90% or more. I recently needed a procedure that would have cost $25,000 at the hospital vs. $2,500 at a specialist doctor’s office.
— Paula Schoenhoff, Louisville
