1. United States
2. N.J.
3. Letter

I am a solo private practice psychiatrist, writing to you about the ACA credits that are set to expire in December. As my husband and I are both self-employed, we pay for our health insurance ourself. Each year, our premiums have increased in exchange for less and less coverage. I opted to buy out insurance thru the marketplace last year due to the financial savings. Losing the ACA credits towards our health insurance will increase our premium for a family of 3 from a little under $1100 monthly to just over $1900 monthly. We have no idea where this extra $800 per month will be coming from. I cannot just produce more patients to treat, and my office rent and home mortgage need to be paid too. Letting the ACA credits towards health insurance premiums lapse will hurt small businesses the hardest. Large corporations have bargaining power with the insurance companies. I have none. So I will have to decide whether to continue seeing patients in my office and paying rent, vs becoming an entirely virtual practice. This will then hurt my landlord by losing her a tenant. Another option would be to pull my daughter- who has ADHD and benefits not only from medication, but also through a variety of physical activities to help her regulate herself and to sleep- from one or more of her after-school activities. This in turn hurts the gymnastics coach that owns her own establishment, and the dance instructor who owns her own establishment, and the soccer coach who runs their own establishment, as well as the swim instructors that run their own business too. Without the ACA credits to help cover my family's insurance costs, we will likely not go on our yearly vacation to visit family in California, or our yearly ski trips to various locations across the country. More small businesses will be hurt by less vacationing, as how often can we really afford to go out to eat? Or to get our nails done? Or to get a massage? The GOP and the government in general likes to say they want to protect small businesses, but all I feel right now is a danger to my small business and to my family's happiness. I may eventually have to close my private practice and return to a corporate hospital system, where quite frankly, patients are booked together so tightly in order to build revenue, that medical care is also suffering- but that's another letter entirely. I implore you to do everything in your power to keep the ACA credits in place until an affordable health care option can be developed. Losing these credits means many of us risk losing our livelihood.