This is a letter to my Congressman, Leonard Lance of Hunterdon County, N.J.

I’ve been disappointed with your voting record for a number of years, and after writing this I can’t even threaten to stop voting for you since I haven’t voted for you in more than a decade. If you had maybe worked harder as a state senator to help build the new high school my kids would have the opportunity to attend, maybe I would have voted for you. But you didn’t and as a result they attended a high school built for 900 that served 2,000 kids and had 33 trailers, a condition that somehow failed for years to move you to action.

But, they, like many other Phillipsburg kids, overcame your indifference and are doing well.

Part of the reason I didn’t vote for or against you, of course, is that I was gerrymandered out of your Congressional district, and used those years to vote against Scott Garrett, a skinflint so skinflinty he voted against refunding Head Start, as if that few million dollars used to help three and four year olds learn to read would threaten the national interests.

But you’re back, and judging your Congressional voting record, I shall have the privilege of voting against you again.

Which, in a narrow political sense, means that you have no reason to listen to me, especially regarding your persistent opposition to the Affordable Care Act.

I understand, you have taken your principled conservative stance against the ACA because government has no place in running the health care system, and you don’t like the notion of shifting wealth around from the wealthy to the less well off because it seems like socialism, or some nonsense.

And because it was named after, you know, a Democratic president.

And I expect that you will vote with your fellow GOP cowards to repeal the ACA, without a replacement, even though every constituency from doctors, hospitals, insurers, medical device makers – the real money guys — even Republican governors, and of course patients, have said it would be a bad idea.

Our founders said the country was created to ensure “life, liberty and the pursuit of happiness.” In modern, more complicated times, that sense includes being able to receive health care when needed and not have to trade food for medicine.
We have created a complicated health care system, but threatening its existence should not be a front-burner cause; this is an area that because of the nature of aging, calls for great care. And your party so far has not shown any.

Ensuring that all have access to a reasonable level of health care can be seen as part of what the founders called making “a more perfect union,”  a wonderfully open-ended phrase that means we solve the complications of a diverse society as they surface, be it, racism, slavery, voting rights for women, and in these modern days, rights for the LGBTQ  community, the disabled and the elderly; it means seeking remedies that come from economic displacement, educational shortfalls, and providing opportunities for all.

Now is that time, Congressman.

You do realize that you and your 307 other Republicans in Congress are about the only people who might think repeal is a good idea. That’s a mighty small minority.

And you will make that vote even though after seven years, your party does not have an alternative, which is just, for lack of a better work, irresponsible, which is not the word I was going to use, but, I’ll be polite.

OK, stupid.

Let’s look at that has happened since the ACA was passed. And, yes, it’s not perfect, but it’s better than what was in place before.

Yeah, millions more people got health insurance, many through the Medicaid expansion.

Opponents like yourself presume that means more money is being spent on healthcare

Actually the size of the pot of money is about the same.

What the ACA did was  create more private health insurance customers by in part better using state (and federal) tax dollars to support the private health market.  The feds did not write the policies, the insurers did. It’s not perfect.

That was the beauty of Romneycare in Massachusetts:  It took state taxes used to pay charity care to hospitals for treating the uninsured into HC premium supports, which helped people pay for their own health care.  In New Jersey, that change has meant the state budget support charity care had dropped from over $1 billion less than a decade ago to $352 million this year.

State officials said more than 700,000 New Jersey residents have obtained health insurance since the Affordable Care Act took effect, reducing hospitals’ claims for uncompensated care.

That said, this is not a perfect trade-off, but a transitional one.  More need to be done here.

Just as important is the organizational shift taking place in the HC businesses. Hospitals and doctors and others, have taken steps worth millions, to realign care from a fee-for-service model to one that pushes prevention and outpatient care.

I spent a couple weeks last month speaking with people engaged in making that model real on a street and granular level.

It was a story on the Union County (NJ) health care assessment, a requirement of the ACA. All counties have done them.

The folks I spoke with  are dealing with health care on a basic level far beyond the effort being made in the ossified atmospheres  of Trenton and Washington, D.C.

You should speak with them, Mr. Congressmen, to see how much work is being done to improve the delivery of health care and how important your constituents understand the ACA is to their lives.

Because health care policy goes beyond your narrow political view and includes access to transportation and good, fresh food, education and screenings, sidewalks that are safe so senior citizens can safely exercise; they spoke about how nonprofits are working together to provide staff and meeting rooms to educate people about their health, and to gain understanding about how the system is failing to reach those in need; how these efforts overtime begin to bend down the curve of HC costs.

That is the real change in the ACA era, not your worry that rich people are being taxed to support a public good.

When has than never been true, Congressman?

Besides, the rich have enough money.  Despite your party’s complaints about the Obama economy, your rich constituents got richer. Using the stock market as an imperfect marker, it is tickling 20,000, three times higher than eight years ago, and I imagine your smart, rich constituents took advantage of that.

But, I know, you represent a well-off district. The median home value is $429,800, higher than the NJ state average of $299,500. One with a median income of $101,000, again higher than the state median of $72,220.

But, using the measurement in the ALICE report by the United Way of Northern New Jersey, as a yardstick,  about one-third of your constituents qualify as the working poor.

Here are some of that study’s key finding:

ALICE households are working households; they hold jobs, pay taxes, and provide services that are vital to the New Jersey economy, in a variety of positions such as retail salespeople, laborers and movers, customer service representatives, and nursing assistants.

The average annual Household Survival Budget for a four-person family living in New Jersey is $61,200, an increase of 19 percent from the start of the Great Recession in 2007, driven primarily by a 17 percent increase in one of the budget’s largest costs, housing, and even larger increases in transportation and health care. The Household Survival Budget for a family translates to an hourly wage of $30.60, 40 hours per week for 50 weeks per year for one parent (or $15.30 per hour each, if two parents work). The annual Household Survival

Budget for a single adult is $27,552, an increase of 18 percent since 2007. The single-adult budget translates to an hourly wage of $13.78.

Why are you working so hard to make it more difficult for this group to help themselves?

It’s been sad to watch your career drift from being a smart Assemblyman to being a Congressional back-bencher.

In that time your district has changed, and needs have been revealed that don’t appear to matter.

The largest employer in your western district moved out as part of an industry merger; your district is home to one of the busiest, more deadly federal highways in the region, some of your towns are losing population because in part of  reactionary zoning put in place decades ago; and many of your older, important towns are struggling with redevelopment issues in an effort to remain viable.

These are solvable issues that need your attention, and one that your, old, bolder self would have tackled.

You once did, when you stood up to Christie Whitman’s effort to borrow $3 billion from the pension fund, an act that cost you a committee chairmanship.

But you voted against that move, and you were right to do so.

Where’d that guy go?

One of the wisest things I was ever told by an officeholder was said by former Morris County Freeholder Gene Feyl, who said that every person in office needs to be ready to cast the vote that would end their career.

You can face that moment and vote against the party leadership to screw up the nation’s HC system, harm millions of U.S. citizens, and thousands of your own constituents, and potentially cost many companies millions of dollars, or you can retire to the back bench and disappear.

And know what, the vote will not cost you your seat. You are in one of safest GOP districts in the state. They might yell at you or challenge you in a primary, but you’ll win.