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Letter to Senator Cornyn
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Member Letter to Senator Cornyn


Sen. Cornyn,


I am a constituent and as a Licensed Clinical Social Worker I provide psychotherapy as a sole proprietor.  Besides an office practice, I see residents in nursing homes.  Although many people think of nursing home residents as little old ladies, there are quite a few younger people living there as well.  Since we have few long term care facilities for the mentally ill, many people with schizophrenia, Bipolar Disorder or Major Depressive Disorder reside in nursing homes.  I have a second, unrelated business as well.


In my psychotherapy practice, I accept Medicare and Medicaid, among others.  Almost all of my clients have a mental or physical disability, and some have both.  Since Trump was elected president, more and more of them have begun to express concern for their health.  Some have cried, literally, concerned for what will happen if they lose their coverage.  Last week, one was notified by her insurance company that they will no longer pay for one of her specialists.  When asked what she should do, I suggested she contact the insurance company to see what solutions they had and to contact her Representative and Senators to express her concerns regarding the changes proposed with the AHCA.


In 2010, my husband and I had a health care policy with a $10,000 deductible and premiums were around $850 per month.  It was considered a High Deductible Health Plan (HDHP) and qualified us to have Health Savings Accounts.  We are both healthy and I liked the arrangement because it allowed us to save more for our retirement years if we didn’t need it for health expenses.  In the fall of that year, he was in an automobile accident.  His truck rolled 4 times and had I been in the passenger seat I might have survived with a serious head injury.  He was taken by ambulance to the hospital and released the same day.  Diagnosis: he bit his tongue.  The total cost was about $9,500. 


The following January he became eligible for Medicare and I went on an ACA health plan with BCBS.  At that time, premiums were below $250 per month and the deductible was around $3,000 to $3,500.  Each year, BCBS cancelled the policy and reissued a new policy.  The deductibles and the premiums went up.  The coverage remained the same or was less than it had been.  In 2016, I moved to another HDHP  with Cigna.  At the end of the year, Cigna cancelled the policy.  The premiums were raised from about $550 per month to $809 per month and the deductible was now at $7,000.  There were no HDHPs offered in my area.  I could only get an HMO or similar plan which none of my doctors accept.  I opted out of health insurance and signed up for one of the collectives (not really insurance, and exempt from the penalty).  I also purchased a supplemental plan, similar to Aflac, that is not health insurance but pays me if I am in the hospital, etc.


As a provider, my rates have not gone up appreciably in years.  If the insurance companies are covering less, charging more, raising deductibles and not increasing reimbursements to providers, the money must be going to the insurance companies.  Last year, Aetna stated publicly that if there was any pressure in their efforts to merge with another insurance company, they would leave the marketplace.  The same week that the Justice Department began the required review of the merger, Aetna dropped out of the marketplace, suddenly stating that they could no longer afford it.  One does not have to be very intelligent to determine what was going on with Aetna.


The ACA has faults – the main one being that the insurance companies have too much control.  They set coverages, premiums, deductibles and reimbursement rates to a large extent.  They are pricing good people out of health care.   They are denying coverage to those that need it and who have been paying for it.  They are in the business to make money, not to be compassionate, or to be ethical.  That is why oversight is required.


The AHCA is a farce.  It is not a good plan.  Too many people would lose coverage.  Too many conditions are considered pre-existing.  We do not want people with mental illness, especially serious mental illness like schizophrenia, Bipolar Disorder and Major Depressive Disorder to go untreated or without medication.  That would be a potential social crisis, especially with Texas loosening the restrictions on gun ownership.  I understand that many in Washington are saying that the November election demonstrated that people want the ACA repealed.  However, one must consider the fact that Trump was not elected by a majority of the voters and that even more people have come out in opposition to the AHCA than are opposed to the ACA.  Many dislike the ACA simply because they dislike Obama and anything associated with his name (i.e. Obamacare).


In addition, I must also express the belief in self-determination and my right to make my own healthcare decisions.  These are decisions that I take seriously and that should be made with the advice of my physician, the consideration of my husband and family.  In no way should an elected official have a voice in these choices.  I would strongly recommend that the committee include women and persons of color (some groups have specific health concerns, such as diabetes and sickle-cell anemia).


Like many other providers, I am increasingly in favor of a single-payor system, not run by a profit-motivated insurance company.  I am not in favor of the attempt made in Texas with Medicaid outsourcing as the rules are nebulous and inconsistent.  I support the expansion of Medicare to younger and healthier people.  Many would remain on health insurance provided by their employer.  The premiums paid by younger members who generally require less coverage would be available to provide for the needs of the older population.  I don’t have the details worked out, but I think this is an excellent place to begin.


Your constituents, my clients, me and my family, all deserve access to quality, affordable healthcare.  I am optimistic that as my senator you will put our interests above the financial motivations of the insurance companies.


I would be more than happy to discuss my concerns with you directly or with someone on your staff.  As far as healthcare is concerned, I’m on the front lines.


Janet Brown

NASW Member

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