Saturday, August 22, 2009


Dear Mr. Wrede:

Thank you for contacting me to express your thoughts regarding H.R. 3200, the America's Affordable Health Choices Act. I appreciate hearing from you regarding this important issue.

Our health care system is suffering. The United States spends twice as much on health care as any other nation, and yet is the only industrialized nation in the world that does not guarantee access to health care for all of its citizens. Overall, the U.S. spends more than twice as much per person on health care as any other Organization for Economic Cooperation and Development (OECD) country. Nearly 50 million Americans are without health care coverage of any kind, and millions more are underinsured.

In Oregon, 270 people are losing their health care every day. Comprehensive reform is our best shot at controlling health care costs, which we all know are currently spiraling out of control. Oregonians and all Americans deserve better than the health care status quo. They deserve quality health care that they can afford, that does not deny them for pre-existing conditions, and that they can keep their coverage if they lose their job.

H.R. 3200, the America's Affordable Health Choices Act, while not perfect, provides quality affordable health care for all Americans and helps controls health care costs. I have worked hard to improve the bill, and I will continue to work with my colleagues to make sure H.R. 3200 meets the health care needs of all Americans.

H.R. 3200 builds on what works in our current health care system and fixes many of the parts that are broken. It protects current coverage - allowing individuals to keep the insurance they have if they like it - and preserves choice of doctors, hospitals, and health plans. The legislation also creates a new health insurance exchange - a transparent marketplace for individuals and small employers to comparison shop among private and public insurers. The health insurance exchange works with state insurance departments to set and enforce insurance reforms and consumer protections, facilitates enrollment, and administers affordability credits to help low- and middle-income individuals and families purchase insurance.

The America's Affordable Health Choices Act also creates a public health insurance option. The public option will operate on a level playing field, and will be subject to the same market reforms and consumer protections as private plans in the exchange. And, the public option will be self-sustaining - financed only by its premiums.

H.R. 3200 will also reform the practices of health insurance companies so that they will no longer be able to engage in discriminatory practices like refusing to sell or renew policies due to an individual's health status, or exclude coverage of treatments for pre-existing health conditions. The legislation also protects consumers by prohibiting lifetime and annual limits on benefits, and limits the ability of insurance companies to charge higher rates due to health status, gender, or other factors. Under the America's Affordable Health Choices Act premiums can vary based only on age, geography and family size, and a new essential benefit package will serve as the basic benefit package for coverage in the health exchange. The basic package will include preventive services with no cost-sharing, mental health services, oral health and vision for children, and caps the amount of money a person or family spends on covered services in a year.

Under the America's Affordable Health Choices Act, affordability credits will be available to low- and moderate- income individuals and families. The credits are most generous for those who are just above the proposed new Medicaid eligibility levels and decline with income. The affordability credits will not only make insurance premiums affordable, they will also reduce cost-sharing to levels that ensure access to care.

H.R. 3200 also makes important improvements to Medicaid and Medicare. Under the legislation individuals and families with incomes at or below 133 percent of the federal poverty level will be eligible for an expanded and improved Medicaid program. To improve provider participation in this vital safety net - particularly for low-income children, individuals with disabilities and people with mental illnesses - reimbursement rates for primary care services will be increased with new federal funding.

Oregon is one of a number of states that receive Medicare reimbursements at rates far below the national average, despite delivering excellent and efficient care. Physicians across the state are suffering under these low rates, being paid for only a fraction of their comprehensive costs every time they see a Medicare patient. Because of this ongoing problem, I recently signed on to a letter to Speaker Nancy Pelosi expressing my serious concern that H.R. 3200 does not sufficiently address the geographic variation that exists in the flawed way Medicare reimburses physicians under the fee-for-service model, and calls for specific changes in the legislation to address these variations. I believe that Congress must take significant steps to address the inequities and inefficiencies in the system if we are to control costs and achieve meaningful health care reform. In past years I have sponsored legislation to address this problem and as Congress continues to work on health care reform I will continue to work to hard to ensure that legislation addresses geographic disparities in reimbursement and that Oregon health care providers are adequately reimbursed.

The America's Affordable Health Choices Act also expands and improves Medicare by closing coverage gaps in the Part D prescription drug program, eliminating cost-sharing for preventive services, enhancing the low-income subsidy programs, improving payment accuracy, encouraging delivery system reforms and extending solvency of the Medicare Trust Fund. The legislation also implements major delivery system reform in Medicare to reward efficient provision of health care, rolling out innovative concepts such as accountable care organizations, medical homes, and bundling of acute and post-acute provider payments.

H.R. 3200 creates a shared responsibility among individuals, employers and government to ensure that all Americans have affordable coverage of essential health benefits. The legislation builds on the employer-sponsored coverage that exists today, and employers will have the option of providing health insurance coverage for their workers or contributing funds on their behalf. Employers that choose to contribute will pay an amount based on eight percent of their payroll. Employers that choose to offer coverage must meet minimum benefit and contribution requirements. The smallest businesses, with payrolls that do not exceed $250,000, are exempt from the employer responsibility requirement. In addition, a new small business tax credit will be available for those firms that want to provide health coverage to their workers.

H.R. 3200 will also reduce the growth in health care spending by investing in stronger prevention and wellness measures, increasing access to primary care, reforming the health care delivery system, and improving payment accuracy. These measures will help slow the growth of health care costs over time and provide savings to families, employers, and taxpayers.

Additionally, in committee I amended the legislation to encourage adoption of electronic health records by remedying the current financial inequity between insurers, who will benefit from health information technology, and the providers, who must pay to install the new record systems. I also amended the bill to provide training opportunities for our current health care workforce. My amendment promotes training for low-income, entry-level employees, such as lab assistants, nurse assistants, floor or ward secretaries, and health education aides, so that they can fill higher-skilled gaps in our health care workforce.

While the quality of medical care in the United States is the best in the world, our health care system needs improvement, including providing access to health care to the millions of Americans who currently lack health care coverage. We can make our health care system much more efficient, affordable, and accessible and the America's Affordable Health Choices Act helps begin to move us toward meeting these important goals.

I believe that all Americans should have access to health care, and the America's Affordable Health Choices Act, while not perfect, does help move us toward providing health care for all Americans. I appreciate hearing from you and value your opinion. Again, thank you for sharing your views. If you have any questions or concerns in the future, please contact me at my Oregon office at 503-326-2901 or 800-422-4003.

With warm regards,

David Wu
Member of Congress

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