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Why Harry Mitchell voted for the Healthcare Bill

Dear Mr. Fink,


Thank you for contacting me regarding The Affordable Health Care for America Act, H.R. 3962.  This is an incredibly important and complex issue, and I appreciate hearing from you.


As I meet with people throughout the district, it seems that everyone has a passionate opinion on this deeply personal issue.  Many people who have insurance have been denied the care their doctors prescribe by their insurance companies.  Some have been dropped altogether when they get sick and some can never get coverage because of pre-existing conditions.  Others who have insurance and are happy with their coverage and their doctors want to make sure they will be able to keep what they have, and be able to afford it going forward.  Small business owners are finding it harder to cover their employees and remain competitive due to rising premium costs and seniors want to make sure that Medicare is strengthened and protected.  


One point on which almost everyone agrees is that something needs to be done. Doing nothing is not an option. Yet, most folks in  Washington are more concerned with scoring political points for an election than delivering the reform we need. Doing nothing is always the politically safe thing to do. But playing it safe, which I could do, is why big problems - like healthcare and immigration reform - have yet to be tackled by Congress. 


The Affordable Health Care for America Act, H.R. 3962 is far from perfect, but I believe we need to continue the legislative process and work with the Senate to bring about desperately needed health insurance reform. That is why I voted for H.R. 3962 on November 7, 2009, when it passed the House by a vote of 220 to 215.


I do believe further improvements need to be made and the House needs to work with the Senate to get it done.  I believe this bill can be better in order to improve our health insurance system. I also agree with the recent remarks of Republican Senator Olympia Snowe when she said that when history calls, history calls and that there should be no mistake about it: my first vote on H.R. 3962 is my first vote to advance reform. And it in no way forecasts my vote for a final bill in the future if improvements are not made. But we can only make improvements if we move the ball forward.


Right now, the rising cost of health care is severely hurting families in  Arizona and around the country - especially those with insurance.  According to a recent Kaiser Family Foundation study, the average family policy now exceeds $13,000 a year, and absent some kind of reform, it is likely to increase to $24,000 a year over the next decade.


Even worse, these families are being forced to pay for those without insurance, who show up at emergency rooms and get treated despite their inability to pay.  It is estimated that the average American family is already paying an extra $1,100 a year in premiums to pay for costs associated with treating the uninsured, a cost that will continue to grow as well.


Small businesses, which make up 73 percent of  Arizona's businesses, are facing a full-blown crisis.  Since 2000, health-insurance premiums for small businesses have risen 130 percent, and insurers are warning that they will go up another 15 percent next year.  In other words, a premium that cost $4,500 per employee in 2008 - and $4,800 this year - will cost $5,500 in 2010.  


Bigger employers are hurting as well.  Unable to keep up with the rising cost of health insurance, employers are increasingly shifting the costs to their workers and their families.  The Wall Street Journal recently reported that "in 2010, nearly two-thirds of employers plan to shift more of the cost of care to workers and their families through higher premium contributions, deductibles, and copayments."  The report went on to say that one in five companies plan to eliminate higher-costs plans and instead select plans for their employees with reduced benefits.  


But perhaps worst of all, many who want insurance and are willing to pay for it, are unable to do so because insurers refuse to cover them if they have a pre-existing condition - even if the condition is as benign as acne. An increasing number of Arizonans are finding themselves one medical emergency away from raiding their 401k, going into foreclosure, or declaring bankruptcy.


When employees are afraid to change jobs because they're afraid that they'll lose health insurance, and employers are afraid to hire because they can't afford to provide coverage, that's not just bad for our health, that's also bad for our economy. 


These are the problems we face.  All of us.  Republicans, Democrats and Independents. They will continue to get worse, not better, and that means doing nothing is not an option.


Some on the left have suggested that we eliminate private insurance, and replace it with an all government-run system. Some on the right have suggested that we eliminate our employer-based system, and build a new one based on tax credits.


I do not believe we need to get rid of our entire health insurance system and create a new one.  I continue to oppose a government takeover of our national health insurance system.  I believe we need to keep what works and fix what doesn't. I also believe that, despite the long and heated debate, there is common ground upon which we can build.


The Affordable Health Care for America Act, H.R. 3962 is not perfect, but I believe it can be improved, and I believe Congress should continue working to bring about reform. 


Many people have told me they already have insurance, and they ask what this reform would do to help them.  The Affordable Health Care for America Act would spur greater competition between health insurers and bring greater choice to consumers.   Among others, it has been endorsed by the American Medical Association (AMA), the nation's largest physician organization, as well as the American Association of Retired Persons (AARP), a leading voice for seniors.  


To increase competition, the bill would establish an insurance exchange through which businesses and individuals could comparison shop for policies that best meet their needs.  While more complex, the exchange would function, in a sense, like the system we currently use to purchase airline tickets online.  Just as the airlines bid for your travel business, health insurers would bid for your insurance business.  To participate in the exchange, insurers would have to meet certain minimum standards.  Most notably, insurers would no longer be allowed to refuse to cover someone because of a pre-existing condition, or place a cap on annual or lifetime coverage.  Members of Congress and federal employees have long had access to a system like this, and it has worked well.  So well, in fact, that Congress is frequently, and I believe correctly, criticized for giving itself better quality and more affordable health care than countless Americans.


For the 469,000 residents of  Arizona's Fifth District who currently receive health care coverage from an employer, reform would enable you to keep it, and prevent your insurer from dropping you if you get sick.  It would eliminate annual and lifetime caps on benefits, and in many cases limit the amount of out-of-pocket expenses.  It will also require insurers to allow young adults, up to 27 years of age, to remain on their parents' health care plans.


Reform would also greatly help seniors.  So much so, the bill has been endorsed by the AARP.   Among other things, the bill would fill the "donut-hole" in Medicare Part D, the prescription drug benefit, helping the 10,100 seniors in  Arizona's Fifth District who are forced to pay full drug costs because they fall into it.  The bill would further improve Medicare by eliminating out-of-pocket expenses for preventative services in Medicare. The bill does not, as some have alleged, weaken Medicare.  As someone who is over 65 and depends on Medicare myself, I would not vote for it if it did. 


Reform would also help small businesses, like the more than 17,800 in the Fifth District, who have been among the hardest hit by the present health insurance system.  Currently, without a large number of employees, businesses cannot negotiate bulk competitive rates with insurance companies.  Reform would enable small businesses to combine or "pool" their purchasing power, and then comparison-shop for competitive rates via an insurance exchange.  Approximately 15,700 small businesses in  Arizona's Fifth District would qualify for tax credits for up to 50 percent of the cost of insurance coverage.


Finally, reform would make it easier for those who lack insurance to be able to purchase it.  Over time, this would ease the burden on our local emergency rooms, which currently treat the uninsured, and then charge more to those of us with insurance to make up for it.


According to the nonpartisan Congressional Budget Office (CBO), the bill would reduce federal budget deficits by $109 billion from 2010 - 2019, with further reductions in federal budget deficits over the next decade.  CBO's analysis is available online at:  


Reform would not, as some have alleged, provide federal benefits for illegal immigrants, or allow federal funding for abortions.  The Affordable Health Care for America Act specifically prohibits any federal money from paying for health care for illegal immigrants, and specifically prohibits any federal money from paying for abortions.


H.R. 3962 would create a public alternative to private insurance, a provision which has generated a good deal of confusion and misinformation by both supporters and opponents.  Under the legislation, the public option would be a separate, non-profit insurance plan, funded by premiums - not tax dollars - that would be allowed to compete with private insurers in the insurance exchange.  No one would be required to use the public option.  If you prefer private insurance, nothing in this bill would prohibit or otherwise limit your ability to buy it.


As you may know, I opposed to the public option as drafted in H.R. 3200, the House bill that circulated over the summer.  In that bill, the public option's reimbursement rates for hospitals and providers would have been based on the reimbursement rates for Medicare.  This was troubling because basing reimbursement rates on Medicare represents an unfair competitive advantage that could ultimate limit patient choice.   In addition, basing reimbursement rates on Medicare rates could weaken the financial stability of local hospitals and doctors.  


In my view, any public option alternative must be on a level playing field with private insurers.  The public option in the Affordable Health Care for America Act would be based on negotiated rates, which is how private insurance companies operate.  


This is one of several key improvements that was made to the legislation since the summer due, in no small part, to feedback from constituents.  In addition, this new bill includes many bipartisan changes including allowing insurance to be sold across state lines and providing incentives for states to enact tort reforms.  A recent study by the nonpartisan Congressional Budget Office has estimated that litigation costs and malpractice insurance accounts for 1 - 1.5 percent of total medical costs.  While tort laws have traditionally been decided by state legislatures,   I believe we need to examine all appropriate ways to deal with rising health care costs.  


I continue to have concerns about the Affordable Health Care for America Act that I hope will be addressed as the Senate finalizes its health reform bill and the House and Senate conference to complete a final bill.   Most notably, I remain deeply concerned by the overall cost of the House legislation.  While I am pleased that the bill is deficit neutral, I believe we can achieve much of what this bill seeks to accomplish in a more fiscally responsible way.  In addition, as the bill progresses, I hope that members will focus on reducing the overall growth of health care spending.


I also hope that we continue to work to improve the public option.  I believe we should continue to consider concepts such as allowing states to opt out, co-ops, or a trigger, which would go into effect if private insurance plans fail to expand affordable coverage sufficiently.  This approach has worked successfully in the Medicare Prescription Drug Benefit plan.


No bill, no matter how carefully drafted, can solve all of these problems.  As the cost of health care increases, premiums will continue to rise, even with reform.  Over time, however, reform can slow the growth of premiums, increase competition between insurers, bring more choice to consumers, and stop insurers from dropping or denying you coverage because you get sick.


Once again, thank you for contacting me on this important issue. If you have additional questions or concerns on this or any other issue, please do not hesitate to contact me in the future.  In the mean time, if you would like more information about the Affordable Health Care for America Act, or you would like to receive email updates about how I am working on behalf of  Arizona's 5th Congressional District, I invite you to visit my web site at



Harry E. Mitchell
Member of Congress

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