For the past 10 months, the U.S. Congress has focused heavily on dismantling the Affordable Care Act (ACA).

This landmark legislation made health care insurance accessible for millions of Americans, including 70,000 low-income individuals in Hawaii. Because of subsidies, our most vulnerable residents in Hawaii have been offered access to quality, affordable care.

Other provisions in the ACA have benefited all Americans.

These include eliminating the lifetime cap on benefits, prohibiting insurers from using pre-existing conditions as a barrier to obtaining coverage, and allowing dependent children up through the age of 26 to remain on their parents’ policies.

Very few lawmakers believe the ACA is perfect. Congressional Democratic leaders have repeatedly stated their willingness to address areas of concern, and U.S. Sens. Bernie Sanders and Brian Schatz have both proposed alternatives to the ACA.

However, the recent comments from U.S. Sen. Ron Johnson (R-Wis.) to Hawaii’s Gov. David Ige are of particular concern (“Hawaii questioned on Medicaid surge,” Star-Advertiser, Sept. 28). Johnson wrote to Ige requesting information on why federal spending for Medicaid is “soaring” under the ACA, and why spending per enrollee is increasing “exponentially.”

The numbers quoted by the senator are not technically wrong, but they are very misleading. The way these specific numbers are being used do not accurately or fairly portray reality.

Johnson characterized Hawaii’s Medicaid spending as “out of control,” when in fact the total federal costs in Hawaii increased by 11 percent between 2014 and 2015 versus 12 percent nationally. This increase in total spend at both the state and federal level is due to the increase in enrollment.

Further, the total cost per person in Hawaii for Medicaid members decreased by 4 percent per person between 2014 and 2015, versus a 2 percent increase nationally.

Hawaii is one of the most efficient states in the national when it comes to health care.

Our per-person-spend for Medicare fee-for-service members is the second-lowest in the country and Hawaii families pay the 43rd lowest premiums for employer-based insurance.

We have some of the lowest hospital readmission rates in the country, and our nursing homes excel in several quality measures compared to their national peers. This is despite the fact that our hospitals, nursing homes and home health agencies have some of the lowest financial margins across the nation due to increased regulation and reimbursement methodologies that do not account for Hawaii’s unique geography.

Hawaii lawmakers, our congressional delegation, and Gov. Ige recognize the benefits of the ACA.

As an association representing acute care hospitals, long-term care facilities, home health agencies, hospices, assisted living facilities and many other provider organizations across the entire state, we are very appreciative of the work of our local and congressional lawmakers.

Our governor’s strong response to Johnson on Oct. 10 truly reflects the reality of Hawaii’s Medicaid spending, and results (“Ige defends Medicaid spending,” Star-Advertiser, Oct. 11). Hawaii’s Prepaid Health Care Act and early Medicaid expansion efforts make Hawaii’s health care system a model for the rest of the nation.