The intentional attack on the Affordable Care Act, which is playing out in Washington, is both cruel and immoral. It would undermine the progress in health care we have made while 23 million Americans would lose their coverage. In Maryland alone, based upon the new Congressional Budget Office score, 181,204 individuals in the private market would lose coverage, Medicaid would be eviscerated and premiums would rise even more. This is unacceptable ("House GOP's health bill would leave 23 million more uninsured, CBO analysis finds," May 24).

Equally so is the enormous market anxiety being created by the Trump administration as it refuses to commit to continuing cost-sharing reduction payments. These are absolutely critical to making health care services affordable for lower-income people and keeping insurers in the marketplace. In Maryland, more than 83,000 individuals are projected to benefit from over $97 million in cost-sharing reduction payments in 2017.


The administration recently sought a 90-day delay in a legal fight over the payments, adding to the uncertainty and the president's proposed budget for next year does not include funding for these subsidies.

The action in Washington is already damaging the insurance marketplace. CareFirst, the state's largest insurer, is seeking rate increases of more than 50 percent for policies sold on the state's exchange. As if that wasn't alarming enough, CareFirst President and CEO Chet Burrell has said that if the federal subsidies are not made, the company will further increase its already staggering proposed rates, making coverage unaffordable for many more Marylanders.

Fortunately, some Maryland leaders are working to preserve as much coverage as possible in the state. Attorney General Brian Frosh joined with 16 of his counterparts around the country to intervene in a lawsuit focused on the federal subsidies. Another step that could be considered is a reinsurance program, either through a 1332 waiver or with state funds, which could help protect Marylanders from premium increases.

There is much at stake as those opposed to the Affordable Care Act move to blow it up. Hundreds of thousands of Marylanders could lose their insurance and access to affordable health care. We are particularly concerned about the most vulnerable among us, but we are also concerned about the fiscal impact on our state's economy and on the well-being of our communities.

Maryland has always been a leader on health care reform. Now is the time for our leaders to step up and refuse to allow the progress we have made in Maryland to be subverted by those in Washington who appear to have lost their moral compass.

Jeananne Sciabarra and Leni Preston, Ellicott City

The writers are, respectively, executive director and president of Consumer Health First.