You, Too, Can Write to the President

Re. — Medicare & ACO Reach

North Country Access to Health Care Committee
PO Box 784, Long Lake, NY 12847

April 22, 2022

The Hon. Joseph R. Biden, President
United States of America
The White House
1600 Pennsylvania Avenue
Washington, D.C.   20500

Re, — Medicare & ACO Reach

Dear Mr. President:

Greetings. I trust you are well. 

My name is Dr. Jack Carney, a native of Brooklyn but currently living in Long Lake in northern New York’s Adirondacks. Let me proceed by telling you we have a lot in common: same age, 79; stutterers in our youth; raised Roman Catholic (although I, unlike you, am non-practicing); and both most likely to outlive traditional Medicare, or Medicare as we have known it for our entire lives.

Yes, next year, 2023, the above-referenced ACO Medicare Reach program will become operational; which means the entire Medicare Trust Fund, which pays out close to $1T annually, will be open to bidding from for-profit private healthcare insurance companies and, for the first time, Wall St. private equity firms. You know about the latter, whose sole objective is to make hefty profits for its shareholders.

In this instance, the aptly named ACO Reach will facilitate this in two ways: first, by allowing both the insurance companies and the Wall St. firms to claim a 40% overhead to pay for their administrative costs and provide themselves a generous profit. That’s with taxpayer dollars. Your staff and certainly HHS Secretary Becerra know that this is more than double the overhead of 15-18% allowed for-profit insurance companies that manage Medicare Advantage plans and 20X more than Traditional Medicare’s current overhead of 2%. Secondly, as managers of the 50+ Reach programs to be established nationwide, they will be free to cut costs and enhance profits, the surest way to which is to cut services.

“Cost-cutting”  — that’s the political mantra or cover for cutting services, which has been the objective of the Federal government since 1973 when the Nixon Administration introduced “HMO’s” or Health Maintenance Organizations to do just that. That was your first  year in the US Senate, Mr. President. The term “ACO” or accountable care organization was first suggested as a vehicle to cut Federal healthcare costs in 2006 by Elliot Fisher and was modelled on HMO’s. It was then incorporated in the Affordable Care Act in 2011, which you were active in shaping, and more recently adopted  by the Trump administration in 2017 as its own cost-/services-cutting measure. In every instance, ACO-type initiatives have produced no savings but have curtailed services. Articles posted on the Kaiser Family Foundation website have documented this.

In 2020, Trump and his Director of CMS, Seema Verna, took their ACO/managed care initiative a step further and began field-testing Reach’s predecessor, Direct Contracting Entities. It soon became apparent to me and others that Trump’s and Verna’s aim was to fulfill a long-sought right wing objective — to give Wall St. access to the Trust Fund’s billions, fully privatize Medicare’s several components, and end Traditional Medicare as a Federally-controlled and -funded entity. 

Unfortunately, your administration has adopted Trump’s flawed strategy. Fierce pushback by Physicians for a National Health Plan and its allies asking you to put an end to the program, which you can do via executive order, obliged you and Secretary Becerra to respond and you did  — via an ill-chosen sleight of hand: you changed the program’s name to ACO Reach but not its organization and ultimate objective.

The future well-being of 60 million Medicare subscribers is yours to protect. We are now looking to a future where our healthcare choices will be circumscribed, where deductibles and co-payments will be increased, where less services will be available to us. I had a heart transplant 8 years ago and any heart-related treatment curtailments will jeopardize my life, and I’m far from unique, with over 40,000 transplants performed annually in the US, or over 300,000 since I got my heart. 

ACO Reach, like DCE’s, has been labelled a pilot or research program and is housed in CMS’s Innovation Center, Executive branch territory – calculated camouflage but one which allows you to make bold steps without the usual ensuing political brouhaha. I frankly loathe the idea that hundreds of millions of my and my fellow Americans’ tax dollars paid into the Medicare Trust Fund during the course of our working careers will just be blithely turned over to Wall St. to do with it as its private equity firms please. Sticks in my throat.

For your part, you’ve been an on-the-scene witness to all these developments during the entirety of your fifty-years long political career. You should know better. We expect you to do the right thing and not sacrifice our interests to Wall St. opportunism and greed. End ACO Reach now, with the one fell swoop of an Executive Order. I look forward to your response.


Jack Carney, DSW

cc.- HHS Secretary Xavier Becerra
        Senate Majority Leader Charles Schumer
        Senator Kirsten Gillibrand
        Senator Bernie Sanders
        U.S. Representative Pramila Jayapal

* * * * * * * * *

Greetings, dear reader. It’s important that you join this effort to petition the President to issue an Executive Order blocking the implementation of ACO Reach.
Please find in the boxes immediately below two PDF attachments:
SAMPLE LETTER/BIDEN, a shorter version of my original letter which requires some cutting and pasting on your part to make it your own;
SAMPLE COVER CC’S & ADDRESSES, containing an example of cover letter that can be used with each of the officials I listed, along with their addresses.



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