Congressman Thompson's Reply to Health Care Reform Ltr

I have a keen interest in healthcare, both as an individual and as a public servant. My wife Jan is a full-time nurse practitioner in our district and was a hospice nurse for years. I've had government sponsored healthcare in the Army - both here and overseas - and private healthcare with Kaiser Permanente and Blue Cross Blue Shield. Over the years, as a State Senator and U.S. Representative, I've talked with thousands of Northern Californians at length about the times when healthcare has been a blessing and, unfortunately, when it's failed them.

I first ran for office in 1990, and a big part of that decision was because of the challenges of healthcare policy and its importance. This issue has remained in the forefront of my attention ever since. In the State Senate, I passed legislation that required all group healthcare plans to provide preventive healthcare to children, improved healthcare policies in rural areas and supported the development of telemedicine. Since arriving in the House of Representatives, I continued this work by enacting legislation that waives co-pays for colonoscopies and mammograms for Medicare beneficiaries, helps doctors who are called away to service in the reserves or the National Guard, expands telehealth technology, reverses harmful cuts to Medicare reimbursement rates for physicians, promotes funding for rural clinics and addresses unfair geographic reimbursement policies that consistently underpay providers in our district.

Unfortunately, many problems like rising premiums, shortages of skilled healthcare workers and a deteriorating long-term fiscal outlook for programs like Medicare have grown worse. These issues are far larger, more complex and more pervasive than almost any others our nation faces. It is no surprise that they have also drawn the most passionate responses.

Some argue that any type of reform would lead to socialism, but the majority of constituents I've heard from want Congress to lower costs, provide access for everyone and improve the quality of care. Most opinions are heartfelt, but a few are startling, such as the writers who want to reject any government involvement in healthcare because it's "socialist" while they themselves are receiving healthcare through Medicare or the Veterans Administration. However, almost every person I talk to or hear from agrees - the current healthcare system needs to be fixed.

While I am a strong proponent of healthcare reform, we need to make sure that we do this right. As you no doubt know, our current healthcare system is not sustainable. In the last 15 years, healthcare spending has jumped 145% to over $2.24 trillion. This is the equivalence of one in every $6 we earn going for healthcare. At current rates, within a decade that figure is expected to rise to one in $5, and within 30 years it will be one out of every $3. Right now, this system is failing us all; from those who can't get insurance because of a pre-existing condition to the families that have coverage but are finding it harder and harder to afford their rising premiums and deductibles. We are on an unsustainable path and most Americans want this corrected.

The House of Representatives is now considering the America's Affordable Health Choices Act (H.R. 3200), which presents comprehensive solutions to the healthcare challenges faced by all Americans. This bill includes many of my priorities, such as:

o Better healthcare for everyone by requiring all plans to meet minimum benefits standards, prohibiting denials of coverage based on pre-existing conditions and eliminating co-payments for preventive care visits to a doctor;
o Strengthening Medicare by increasing reimbursement rates for Medicare providers to allow them to continue seeing Medicare patients and closing the "donut" hole in prescription coverage for Medicare Part D;
o Real choice in a health insurance marketplace where consumers can compare different plans, including a public plan option, while still retaining the freedom to keep their current doctor, hospital and plan if they choose;
o Ensuring access to healthcare in rural areas by providing a reimbursement increase to primary care physicians practicing in these communities and expanding telemedicine services to make specialized care available for patients in underserved areas.

As a member of the Ways and Means Committee, I helped write parts of this bill, and I know that there is a lot in the bill that will go far toward improving our system. Although the full House of Representatives will not consider H.R. 3200 until September, I voted for this important legislation when it was considered by the Ways and Means Committee on July 17. We needed to advance this bill so that we can continue the work of crafting a comprehensive plan that will fix our healthcare system.

However, it is important to remember that this is the beginning of the process, and there is much work that remains to be done in both houses of Congress before we will reach a final bill. Nevertheless, there is wide agreement that the final version must satisfy these principles:

o Reduce the long-term growth of healthcare costs;
o Provide a choice of doctors and health plans;
o Improve quality of care and invest in prevention and wellness; and,
o Ensure affordable healthcare for all Americans.

Currently there are five bills in Congress to reform healthcare, three in the House and two in the Senate. From these, members of the House and Senate will reconcile differences, make improvements and come up with an even better bill. I think we have a long way to go before we are where we need to be, but H.R. 3200 is an important first step.

Healthcare touches all of our lives in a very personal way. I absolutely understand why so many Americans are concerned about the effectiveness and cost of healthcare. That's why it's so important that you judge the facts of this bill for yourself, particularly when there's been much disinformation. I have attached answers to the most common questions my office has been receiving for your review. Additionally, you can go to the Ways and Means Committee website (waysandmeans.house.gov) to read the bill in its entirety as well as a section-by-section summary. I will continue to update you as this important legislation progresses.


Question: Has Congressman Thompson read the bill?
Answer: I have read and was involved in drafting the bill I voted on. For weeks before the introduction of H.R. 3200, members of the Ways and Means Committee, myself included, met daily to go through the bill line by line and section by section. As a group, we spent 86 hours going over this legislation.

Question: Will health reform force all Americans out of their private insurance plans and into a one-size-fits-all government plan?
Answer: No. H.R. 3200 builds on the current system of employer-based coverage, it doesn't replace it. If you are happy with your current plan, you can keep it. H.R. 3200 includes a public plan that individuals will have the option of purchasing, along with a variety of other private plans. This public plan will be required to be financially self-sustaining, as private plans are, covering its costs through premiums and co-pays.

Question: Does page 16 of the bill require me to join the public plan if I lose my private insurance coverage?
Answer: No one will be required to join the public plan. If you lose your insurance, you will be able to shop for a new plan at an online exchange that includes information on all insurance options. This exchange will bring together information that is currently scattered giving consumers the opportunity to quickly and effectively compare plans to make informed decisions about what coverage works best for them. The provision on page 16 merely requires individuals joining a private insurance plan after 2013 to do so through the exchange.

Question: Are Members of Congress exempt from changes that are being proposed for the rest of the country?
Answer: No. Members of Congress receive the same healthcare options as other federal employees, with a choice of plans from private insurers that vary by benefits, premiums and co-pays. This legislation would affect federal employees in the same ways that it affects everyone else who gets their health insurance through their employer.

Question: Does this bill cover illegal immigrants?
Answer: No. Section 246 of H.R. 3200 explicitly prohibits the payment of affordability credits designed to help low and moderate incomes families purchase insurance to anyone who is not lawfully present in the United States.

Question: Does this bill require seniors to attend mandatory counseling sessions on euthanasia?
Answer: No. H.R. 3200 states that Medicare will reimburse doctors and nurse practitioners for a counseling session with Medicare beneficiaries regarding advanced care planning. This consultation includes a discussion of laws and options regarding living wills, the roles and responsibilities of a health care proxy and other planning resources that may be available for the individual. These consultations are strictly voluntary; the rumor that seniors must attend is false.

Question: Will all small businesses be forced to provide coverage to their employees?
Answer: This bill exempts small businesses with a payroll of less than $250,000 from the requirement to provide health insurance for their workers. Businesses with payrolls above $250,000 that do not provide coverage will be charged a payroll tax that will gradually increase with the size of their payroll. The current version of the bill has this tax will start at 2% for payrolls above $250,000 and increase to a maximum of 8% for payrolls above $400,000, however, there are currently discussions to raise this exemption to $500,000. Proceeds from this tax will go to offset the cost of coverage for individuals purchasing insurance through the exchange. Small businesses that opt to offer insurance will receive tax credits to offset the cost of insurance.

Question: What does this bill do to stop fraud and abuse in Medicare?
Answer: This bill strengthens existing compliance and enforcement tools for Medicare, increases funding to support these efforts and creates new, tougher penalties for individuals who submit false claims or applications to Medicare. The Congressional Budget Office (CBO) has estimated that every $1 we invest in fighting waste, fraud and abuse will yield $1.75 in savings.

Question: Can our nation afford healthcare reform?
Answer: The truth is that the rising cost of healthcare for all Americans is a problem that will not fix itself and that we can't afford to not address. Today, our nation spends one out of every $6 we earn on healthcare. If we don't take action to slow the increase in costs, within a decade we will spend one out of every $5 on healthcare, and within 30 years this will rise to one in every $3. These facts make it clear, the longer we wait, the more it will cost to fix our broken healthcare system.

Question: How much will this bill cost?
Answer: There is no question that there will be significant costs to implement this legislation. The CBO's latest estimate puts the price tag at $1.042 trillion over ten years. Here is how we are going to pay for the bill. First, we are going to address inefficiencies in Medicare and Medicaid and crack down on fraud, waste and abuse in these programs to save $465 billion over the next ten years. Second, we will need to raise $583 billion in revenues to cover the rest of the cost. The Ways and Means Committee proposes to do this through a surcharge on the wealthiest 1.2% of income earners, who have enjoyed a tremendous advantage for the last eight years because of the Bush tax cuts (the average reduction in federal taxes for the top 1% in these tax cuts was $44,622). The Senate is considering other ways to raise these funds, and it is unclear how this issue will be dealt with in the final bill.

Question: Will this plan lead to rationing of healthcare? Will Congress be legislating what care my doctor can or must give me?
Answer: No. I believe that medical decisions should be left between patients and their doctors. Section 1401 explicitly forbids any studies or research called for in H.R. 3200 from being used to either mandate or deny care to a patient in any public or private plan. This research will gather data about what procedures are most effective to give doctors more information to consider when treating patients, not to replace your doctor's judgment with that of a bureaucrat from a private insurer or the government. The bill protects the ability of doctors to do what they think is necessary to help their patients without having to constantly worry about whether they will be reimbursed by an insurance company, which is why this bill has earned the strong support of the American Medical Association.

Question: Why is this bill being "rushed" through Congress?
Answer: Universal healthcare was first proposed by Teddy Roosevelt in 1912. President Harry Truman called for it in 1945. Former Representative John Dingell Sr. introduced a bill to provide universal healthcare in 1947 and his son, Representative John Dingell Jr., has reintroduced a bill every Congress since 1955. So, this is not a new issue and it was supported by both President Obama and Senator McCain in the November presidential election. This particular legislation has been crafted, reviewed and revised repeatedly since the 111th Congress began, and it has been changed to reflect the considerable input from those in the healthcare community, members on both sides of the aisle and constituents. This bill is not being rushed - it is long overdue.

Sincerely, MIKE THOMPSONMember of Congresshttp://www.mikethompson.house.gov