Unintended Consequences of Repealing the ACA (An Open Letter to Congress)

I am very concerned about the effect that repealing the ACA will have on small businesses in America. I foresee a mass exodus of talent and experience fleeing from small businesses to large corporations simply because of the need for employee health insurance. The ACA gave small businesses the opportunity to attract qualified employees regardless of their ability to provide health insurance. Without it, even the best small businesses will lose experienced employees. Repealing the ACA will kill entrepreneurship in the United States.

I live a healthy life style, am well educated, and have always been employed, at least part time. After earning my Master’s degree in Architecture, I took some time off to raise a family. I was offered part time employment that would allow me to stay home with my children, but the company was too small to offer employer sponsored health insurance. Due to my healthy lifestyle, I was able to qualify for an affordable rate as a self payer on private health insurance.

In 2013, at the age of 37, I suffered a rare form of heart attack that affects young, healthy people called Spontaneous Coronary Artery Dissection. My hospital bills quickly rose into the millions of dollars. Thankfully, my private insurance was not able to drop my coverage or exercise a life time cap. I was able to emerge without debt. My health insurance provided both the medical care and financial assistance that allowed me to continue to be a productive member in society. I retained my private insurance until January of 2016 when I received notice that private insurance through Cigna was no longer available in Colorado to those who self- insure. My only option for continued insurance was to transfer to a comparable ACA plan through Cigna. It is my understanding that I will have to reapply for single payer health insurance if the ACA is repealed.

If Congress and the President repeal the ACA without a replacement requiring coverage for preexisting health conditions, people with these conditions will no longer qualify for private single-payer insurance. I am the sole provider for my family, and like many Americans with pre-existing health conditions, I am left with three choices due to my heart attacks: find full time employment with a large company, go on disability/apply for Medicaid, or remain with the small business I work for and take my chances with being uninsured.

I love the small business for which I have been working for the last fifteen years, however, I am currently seeking employment elsewhere. Not because I am unsatisfied with my job, but because I need health insurance and will be denied the opportunity to provide my own if the proposed changes to health insurance prevail. I am willing to take a position literally anywhere that offers employee health insurance benefits. Many other employees of small businesses or self-employed individuals are doing the same. The result will be that the large corporations will get the best and most qualified employees and the small businesses will be left with employees who did not qualify for a position with a company that offers health care. The small business owners themselves may have to close down and find jobs in large companies as they require health insurance as well, which could hasten the end of the proverbial “Main Street” in America.

If I am physically unable to work a full time job, or am not able secure employment with a company that offers health insurance, my best option would be to apply for disability and Medicaid. My medical needs will be taken care of, however it would be at a greater cost to the American taxpayer than the cost of an ACA plan.

The third choice, of course, is to take my chances and be uninsured. A heart attack typically costs over one million dollars to treat. Even with a repayment plan, most people will never be able to repay a fraction of the cost incurred by the doctors and hospitals to treat them. The cost of unreimbursed life saving treatment of uninsured Coloradoans (and Americans in general) will drain the finances from doctor’s offices and hospitals, making it difficult for them to stay afloat without government assistance.

The options that I laid out above all seem much more expensive to the economy than preserving the ACA or eliminating the right for private insurance companies to deny coverage for pre-existing health conditions. A logical and economical way to solve the problem is to give individuals who are willing to work and pay for their own insurance an avenue to do so. It would preserve the culture of entrepreneur-ism that we hold so dear in this country and allow individuals with pre-existing medical conditions to pursue the dignity of work.


The phone number for the Capitol Hill switchboard in Washington D.C. is 202–224–3121. When you call they’ll ask for your zip code, and once you enter it you can choose which of your legislators — Senate or House — for whom you wish to leave a message.

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