Dannel P. Malloy

GOVERNOR
STATE OF CONNECTICUT

January 6, 2017

The Honorable Kevin McCarthy
Majority Leader

U.S. House of Representatives
Washington DC 20515

Dear Majority Leader McCarthy:

Thank you for inviting me to share the story of Connecticut?s success implementing the Affordable Care
Act (ACA) which has made health care more accessible and affordable in my state; transforming for the
better the lives of tens of thousands of families. Connecticut?s uninsured rate is at historic lows, and we
are consistently one of the healthiest states in the nation.

It is no secret that your intention is to repeal vital portions of the law, including the expansion of coverage
under Medicaid and the federal ?nancial assistance for marketplace coverage. I write on behalf of the
citizens of Connecticut to express my complete opposition to the repeal of the Affordable Care Act. By
repealing the ACA without an alternative in place, you will effectively destroy the current marketplace
and deny Americans access to quality, affordable and comprehensive health insurance.

If you wish to continue the progress we?ve made as a nation to improve access to health care for all
Americans, I urge you to build upon the bene?cial aspects of the ACA. To that end, I am committed to
working with you and your colleagues, and our partners in the federal government, health care and
insurance industries to make improvements in the existing health care system. Health care reform is an
iterative process. Indeed, President Obama himself has suggested ways to enhance the law. However,
repealing the ACA without a well thought out and transparent replacement will assuredly create
disastrous uncertainty for families and businesses who have come to rely on access to affordable health
care. Furthermore, it will absolutely threaten the stability of our domestic insurance market.

We have made far too much progress as a state and a nation to unravel all the good we have achieved for
our constituents. The uninsured rate in Connecticut has fallen from approximately 8 percent in 2013 to an
all-time low of 3.8 percent. Nearly 110,000 people annually obtain private insurance through our state
marketplace Access Health CT, and 80 percent of these consumers benefit from tax credits to help offset
the cost of their insurance. More than 200,000 of our citizens have secured coverage since Connecticut
became the ?rst state in the nation to expand Medicaid eligibility for low?income adults. In the two
months since the latest open enrollment began on November 1, our exchange has already logged 86,000
new enrollments.

For these thousands of people and their families those previously uninsured or underinsured the ACA
has been a lifeline to better health and wellness. Having a pre-existing condition is no longer a barrier to
accessing affordable health care. Giving parents the ability to cover their children up to 26 years of age
recognizes the economic realities of our millennial generation. Additionally, women no longer pay more

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just for being women. As a result of the ACA, health plans now cover preventive services at no cost
sharing to consumers bene?tting millions of people in Connecticut, most of whom have employer-
provided coverage.

Over the past four years the evidence is undeniable that consumers have grown more comfortable with
using health insurance and have come to rely on it. It has contributed to economic security and well-being
of our citizens including improved mental health by removing a signi?cant stressor that the lack of health
insurance creates. Ripping all of that away simply to make a political point is extremely dangerous and
tantamount to a betrayal of our fellow Americans. We cannot and must not cast them aside, back to
uncertainty and unhealthiness.

Uncertainty also looms over the health insurance industry, an extremely important Connecticut industry
for more than 150 years. Connecticut leads the nation in insurance jobs per capita. The insurance industry
employs 60,000 people directly and creates an additional 52,000 jobs indirectly in Connecticut -
contributing more than 5 percent of the totai state payroll. Three of the nation?s largest health insurers are
Connecticut domestic companies which provide products and services throughout the country and across
the globe. I have grave concerns that a full-blown and rash repeal will seriously disrupt the insurance
market, hurting consumers and our economy. Carriers need and deserve clarity and predictability, neither
of which will be provided if the ACA is repealed without an equivalent, comprehensive plan to cover the
millions of Americans who will be left without insurance. Repeal without a corresponding replacement
now will mean no one will write insurance policies for the next enrollment year.

With state input there are short?term regulatory changes that can be made sooner rather than later. We
should be encouraging more industry innovation with respect to product and bene?t design to give
consumers a greater variety of choices and create more competition. Connecticut is also committed to
working with appropriate stakeholders to further address the drivers behind the cost of health insurance 
medical and rising prescription drug costs. I have asked Connecticut?s Commissioner of Insurance to
address these issues more in a separate letter to you.

I would be remiss if I did not address a serious concern I have with another aspect of your health care
agenda that would signi?cantly undermine our state?s Medicaid program. Proposals to reduce federal
Medicaid spending by converting the program to a block grant or imposing per~capita caps necessarily
erode the federal-state partnership and the access to health care for Medicaid bene?ciaries. Reducing
federal support will likely force states to limit services, drastically cutting coverage to thousands, and as a
result, health care needs and costs will resurface in inappropriate and more expensive venues such as
hospital emergency rooms, shelters and prisons.

States already employ existing ?exibilities to innovate in their Medicaid programs. Connecticut, with its
unique managed fee for service model has implemented and continues to focus on care delivery and value
based payment reforms. As a result, it is one of the v_ery few Medicaid programs whose expenditures on a
per member per month basis have been relatively steady over the last 5 years, while maintaining excellent
outcomes. In addition, Connecticut has embarked on delivery system transformation through the State
Innovation Model. Over 150 stakeholders are working to bring down health care costs, improve health
care quality and our population?s health. All of this work is consistent with the bipartisan Medicare and
CHIP Reauthorization Act (MACRA). ACA repeal would jeopardize our investments to prepare
providers for MACRA and alternative payment models, regardless of payer. We would welcome the
opportunity to share with you in more detail Connecticut?s progress and impress on you the importance of
maintaining reliable federal funding to continue delivery system reforms that improve health outcomes
and reduce costs.

I am proud of our efforts in Connecticut to implement what has been one of the most important and vital
improvements to domestic welfare in generations. This progress required a great deal of collaboration,
innovation and unwavering commitment by all stakeholders. To repeal these reforms is simply
irresponsible. Millions of families will suffer as a result. Alternatively, I strongly urge you to build upon
the progress of the ACA, ensure our citizens can access affordable, quality health care and that our
insurance industry remains strong.

Sincerely,

    

Governor

cc: Connecticut congressional delegation
The Honorable Kevin Brady Chair, House Committee on Ways and Means
The Honorable Virginia Foxx Chair, House Committee on Education and the Workforce
The Honorable Greg Walden Chair, House Committee on Energy and Commerce