Read on Twitter
1/42 I sat at my dining room table and cried tears of relief when Sen. John McCain’s famous “thumbs down” 
put an end to Republican efforts in 2017 to repeal the ACA. I always respected Sen. McCain’s willingness to put patients over party. @SenMcSallyAZ? Not so much.
put an end to Republican efforts in 2017 to repeal the ACA. I always respected Sen. McCain’s willingness to put patients over party. @SenMcSallyAZ? Not so much.
2/42 I hope we elect @CaptMarkKelly in November. ( #Vote 
) 
But in the meantime, Sen. McSally and I are stuck with each other, and as a constituent, I really wanted her to understand what the loss of the ACA would mean to people like me. I sent a message to her office. 
) But in the meantime, Sen. McSally and I are stuck with each other, and as a constituent, I really wanted her to understand what the loss of the ACA would mean to people like me. I sent a message to her office.
3/42 “As an AZ'an w/ an autoimmune disease, I’d like to speak directly with Sen. McSally regarding her track record on health care. I want 2 ensure that she has a good understanding of the critical policy components underlying protections for people with pre-existing conditions.”
4/42 She called back immediately and said, “Wow, thank you! I’ve been looking for someone to help me better understand how health care policy directly impacts the lives of Arizonans with pre-existing conditions!”
Ha, ha! I’m kidding, of course. She emailed me a form letter.
Ha, ha! I’m kidding, of course. She emailed me a form letter.
5/42 First, what *wasn’t* in the letter was notable: her vote to repeal the ACA outright in 2015. And her support of the AHCA in 2017, which was opposed by patients, doctors, hospitals, & even the AARP. So she’s gone from “let’s get this f*cking thing done” to crickets. 
6/42 Keeping health care decisions “out of the hands of Washington bureaucrats”. Hmmm. So she’s pro-choice now? 
7/42 Yes, let’s make sure Americans can afford life-saving meds. But this wasn’t really the issue I wanted to discuss with her. I’m fortunate the meds for my AI disease aren’t super expensive. (Although if I get another AI disease, I’m well aware that I might not be so lucky
.)
.)
8/42 OK, let’s talk about the PROTECT Act. The PROTECT Act was introduced on by a group of Senate Republicans in April 2019, including Sen. Martha McSally. The PROTECT act sat around collecting cobwebs until it was miraculously pulled out by Mitch McConnell *just* last week. 
10/42 The PROTECT Act does ban insurers from denying a policy outright and provides some level of protection against premium increases. 
But the bill would allow insurers to increase rates based on *non-health* factors, such as charging women and older Americans more. 
But the bill would allow insurers to increase rates based on *non-health* factors, such as charging women and older Americans more.
11/42 As the L.A. Times Editorial Board noted, “The [Act] pretends to be about safeguarding Americans w/ pre-ex health conditions. But it’s really about protecting Senate R’s from the stink caused by the Trump administration’s efforts to repeal the ACA.
https://www.latimes.com/opinion/editorials/la-ed-protect-act-republican-health-bill-preexisting-conditions-20190412-story.html
https://www.latimes.com/opinion/editorials/la-ed-protect-act-republican-health-bill-preexisting-conditions-20190412-story.html
12/42 @sarahL202 w/ the Center for Budget & Policy Priorities said of a hypothetical cancer patient: “…benefits could run out b/c the insurer imposes an annual/lifetime limit, or the plan might not cover the prescription medicines that treat the cancer.” https://www.cbpp.org/blog/senate-bill-wouldnt-protect-people-from-texas-v-azar-fallout
13/42 And regarding a hypothetical patient with a substance abuse disorder: “Insurers would not have to cover substance use disorder treatment or any other essential health benefit a person might need.” https://www.cbpp.org/blog/senate-bill-wouldnt-protect-people-from-texas-v-azar-fallout
14/42 Wait. You DO know that if the ACA is overturned, not only would subsidies on the marketplace disappear, but ALSO the gains that AZ made through Medicaid expansion? And you DO know that one of the weaknesses of the PROTECT act is that women could be charged more? Right? 
15/42 Republicans keep lying about protecting ppl w/ pre-ex conditions. 
(Did you READ the EO from POTUS? Would you call that a “full & complete plan”?) So how am I supposed to “rest assured”? I literally *can’t* rest. It’s why I’ve been doom scrolling on Twitter at 2:00 a.m..
(Did you READ the EO from POTUS? Would you call that a “full & complete plan”?) So how am I supposed to “rest assured”? I literally *can’t* rest. It’s why I’ve been doom scrolling on Twitter at 2:00 a.m..
16/42 If you’d taken the time to talk to me, I’d have told you all this. I’d have told you about that late night sitting at my dining room table crying tears of relief after Sen. McCain’s “thumbs down”. I’d have told you what it meant to have my Senator put patients over party.
17/42 I would have told you it was an insult to me and an insult to Sen. McCain’s legacy when you run advertisements claiming that, “of course I will always protect people with pre-existing conditions.” Kaiser Health News rated this claim as false. https://khn.org/news/in-arizona-race-mcsally-makes-health-care-pledge-at-odds-with-track-record/
https://khn.org/news/in-arizona-race-mcsally-makes-health-care-pledge-at-odds-with-track-record/
18/42 I'd have asked you about “Kristin” – the lady in your ad who pre-ACA was dropped by her insurance co. b/c of severe health issues. Why didn’t you disclose that she worked for you crafting anti-ACA messaging? (And seriously, how could she do this?) https://www.azcentral.com/story/news/politics/elections/2020/04/30/martha-mcsally-ad-features-health-care-testimonial-former-aide-kristen-douglas-arizona-senate-race/3060865001/
19/42 – I would have asked you about “Whitney”, a young woman featured in another ad, who has a rare blood disorder. Whitney claimed, “I am so afraid of Mark Kelly and Joe Biden’s plan to put government in charge of our health care.” 
First, this is ridiculous, because…
First, this is ridiculous, because…
20/42 …both @CaptMarkKelly and @JoeBiden support adding a public option to the ACA. While there are concerns about a public option – particularly with regards to lower reimbursement rates – it’s flat-out dishonest to call this plan a “government takeover of health care”. 
21/42 As @AOC – who does support a single-payer health care system – recently admonished Republicans, “Most of you are just afraid to run against your actual Dem opponent. It’s lazy. Work harder.” She’s not wrong here. You’re being lazy, Sen. McSally. https://twitter.com/AOC/status/1306949898953207809
22/42 And as w/ the “Kristen” ad, there was more to the Whitney story. She was a Republican political operative who purchased on the ACA marketplace when she was unable to work regularly. She says that she incurred $38K in medical debt w/in a few months. https://www.azcentral.com/story/news/politics/arizona/2020/07/16/martha-mcsally-health-care-ad-features-whitney-lawrence-former-gop-operative/5434807002/
23/42 But I’d love to ask you HOW she could have $38K in medical bills in just a few months, when plans offered on the Arizona individual market cap your yearly out-of-pocket expenses. Let's figure out WHY and fix it. It could be a Step Therapy problem, not an ACA problem.
24/42 With step therapy, insurers only cover meds if you try them in a specific order, starting w/ cheapest, even if your doc *knows* a different med is right for you. There was bipartisan support in the #AZLEG this year to ensure Step Therapy protocols were evidence-based.
25/42 “Whitney” also says the cost of one of her meds went from $40K/mo to $700/mo when she switched to an employer-based plan. No surprise. But I’d ask you if Whitney knows if she loses that job & wants to freelance, she’ll have a hard time getting coverage if ACA is overturned.
***Intermission***
(For some reason, Twitter is making me send all these tweets before threading any more.)
(For some reason, Twitter is making me send all these tweets before threading any more.)
26/42 That’s because Arizona’s SB 1397 says insurers must give her *a* policy. But it doesn’t have to be an affordable policy, it doesn’t have to provide Essential Health benefits (such as the medication she needs), and her treatment could be cut off due to annual/lifetime caps.
27/42 I also would have asked about your interview w/ @VaughnHillyard . When asked if you had urged the Trump admin to drop its ACA lawsuit, you provided a two-minute-and-fourteen-second word salad sprinkled with gaslighting, deflection, and outright lies. https://twitter.com/VaughnHillyard/status/1293260435710304257
28/42 First, you said you were “working” to provide options. Working? By when? You know how we talk about a VP needing to be ready to lead on Day One? If you are rooting against the ACA, you’d better have a replacement that is ready to go on Day One if the ACA is overturned. 
29/42 And you again raised the threat of a “government takeover of health care”. (Lazy.) When asked re: your AHCA vote, you dodged the question. Did you know the CBO predicted millions of Americans would’ve lost coverage and prices would have increased for older Americans? 
30/42 You made vague references to assoc. plans (which one judge called an “end-run around the ACA”), to apps to let people find the cheapest prescriptions (already a thing), & using tech to help you decide what insurance to get (already a thing - check http://healthcare.gov ).
31/42 If you’d talked to me instead of sending a form letter, I would have told you this: If you hate the ACA, fine. I’d love for my premiums & deductible go down. 
But I need to see a plan that’s ready to go on Day One AND that addresses ALL of the following questions:
But I need to see a plan that’s ready to go on Day One AND that addresses ALL of the following questions:
32/42
Does the plan prevent insurers from denying you a policy b/c of a pre-ex cond.?
Does the plan prevent insurers from using riders 2 exclude coverage for treating specific conditions?
AZ SB 1397 stops here, which is why I've been critical of the bill. Also important:
Does the plan prevent insurers from denying you a policy b/c of a pre-ex cond.? Does the plan prevent insurers from using riders 2 exclude coverage for treating specific conditions?AZ SB 1397 stops here, which is why I've been critical of the bill. Also important:
33/42
Does the plan prevent insurers from deliberately setting unaffordably high premiums and deductibles for people with pre-existing conditions?
Does the plan ban annual and lifetime caps to ensure that patients with serious illnesses won’t have their coverage cut off?
Does the plan prevent insurers from deliberately setting unaffordably high premiums and deductibles for people with pre-existing conditions? Does the plan ban annual and lifetime caps to ensure that patients with serious illnesses won’t have their coverage cut off?
34/42
Does the plan include the ACA’s ten essential health benefits (EHBs)? This is important because EHBs include services such as emergency care, prescription medications, and hospitalization, which patients with chronic illnesses may require to manage their conditions.
Does the plan include the ACA’s ten essential health benefits (EHBs)? This is important because EHBs include services such as emergency care, prescription medications, and hospitalization, which patients with chronic illnesses may require to manage their conditions.
35/42
If the plan involves a high-risk pool, where does the funding come from? Is there adequate funding, particularly at the state level? Are you sure? Really sure?
How will the plan will incentivize young, healthy people to enroll?
If the plan involves a high-risk pool, where does the funding come from? Is there adequate funding, particularly at the state level? Are you sure? Really sure?How will the plan will incentivize young, healthy people to enroll?
36/42
Is there an age band that places an upper limit on what insurers can charge older customers? ACA has a 3:1 age band. The AHCA had a 5:1 age band. AARP noted that the age band & tax credit changes would have resulted in “significantly higher costs” for older Americans.
Is there an age band that places an upper limit on what insurers can charge older customers? ACA has a 3:1 age band. The AHCA had a 5:1 age band. AARP noted that the age band & tax credit changes would have resulted in “significantly higher costs” for older Americans.
37/42 If you don't have a plan ready to go on Day One that addresses these issues, be honest. Say, “I hate the ACA. I want to 
premiums 4 healthy people, but my plan won't cover some of you. Some of you will get sicker. Some of you will die. I’m willing to make that trade-off.”
premiums 4 healthy people, but my plan won't cover some of you. Some of you will get sicker. Some of you will die. I’m willing to make that trade-off.”
38/42 If it sounds cruel to let people w/ pre-ex conditions go w/o care, it is. It won’t make a good bumper sticker. And it sure won’t get you any votes. But at least you’d be telling the truth. The ads you are running & the claims you are making now are both dishonest AND cruel.
39/42 Finally, I'd have asked you 2 stand up to POTUS & Republicans on COVID-19. We need all of our electeds to provide consistent messaging and model good public health behavior. No conspiracy theories or hawking of unproven treatments. 
No mask shaming. 
Silence=Complicity.
No mask shaming. Silence=Complicity.
40/42 To my fellow AZ'ans, the person we elect to this seat will fill the remainder of Sen. John McCain’s term. I didn’t often agree with Sen. McCain, but I respected him. I’ll always be grateful that when it counted, he put patients over party, regardless of the political risk.
41/42 Yes, Sen. McSally recently voted w/ Dems to block the Trump admin from supporting the ACA lawsuit, even after dodging this exact question from Vaughn Hillyard. What was different? Sen. McSally *knew* this was a symbolic vote, as the bill had NO chance of reaching 60 votes.
42/42 But would Sen. McSally put patients over party when it’s not symbolic? Will she protect us when it counts, when it’s really hard, and when there will be consequences?
Signs point to no.
I look forward to casting my ballot in the coming days for @CaptMarkKelly.
- Fin -
Signs point to no.
I look forward to casting my ballot in the coming days for @CaptMarkKelly.
- Fin -
P.S. I meant to include this link in one of the other tweets in this thread. Here's "Stone Cold" Sen. John McCain saving Obamacare. Never. Gets. Old.
