Click here to see the immediate benefits for Virginia in the Affordable Care Act.

In December 2009, I voted in favor of health care reform legislation in the Senate—which was signed into law by the President on March 23, 2010.  At the same time, as my colleagues know well, I worked very hard to narrow and improve the bill, including voting eight different times with my Republican colleagues to make changes. In the end, I voted in favor of the legislation despite some serious misgivings with portions of it because it does represent a true step forward in terms of quality, accessibility and affordability of health care for most Americans.

I hope that we can find a way to move forward with our colleagues across the aisle, fix provisions in this legislation, and make it truly the kind of bill that they say they would like to see as well.

The important point for us to remember today and tomorrow as we go through this process is that the bill is now law. The question before us now is how best to implement that law so that the benefits can be put into place and the many detriments that I was worried about can be addressed.

There are a number of strong points in this bill:

• Insurance companies will be prohibited from denying health care coverage to children with pre-existing conditions;
• Young adults will be able to stay on their parents’ insurance plans until their 26th birthday;
• Uninsured Americans with pre-existing conditions will have access to affordable insurance options;
• Insurance companies won’t be able to drop people from coverage when they get sick, they will be banned from implementing lifetime caps on coverage; and
• Seniors who hit the Medicare Part D “doughnut hole” gap in coverage will get a $250 check to help with the cost of their prescriptions, and the doughnut hole will be completely closed by 2020.

Access to insurance over the next couple of years is going to be expanded to 95% of Americans, and reforms will be implemented designed to slow skyrocketing health care costs. Working families won't have to worry about losing their health insurance or facing bankruptcy because of a job loss or because of illness. Insurance companies will be required to spend a majority of their money on patient care. The law will also:

• Provide tax credits to help make health insurance for individuals more affordable;
• Expand access to Medicaid for the low-income;
• Create a regulated marketplace where people can shop for the health insurance plan that best meets their needs; and
• Prohibit insurance companies from refusing to sell or renew policies due to an individual’s health status.

These are just some of the positive points of the law. 

In fairness—and I understand and appreciate some of the frustrations on the other side—there are serious problems in this bill.

I do not like the dramatic cuts in Medicare that this law proposes. In fact, I voted against them. I share the concerns of my Democratic colleague, Congressman Rick Boucher in Southwest Virginia, regarding the potential negative impact these cuts could have on rural areas, particularly the population of Southwest Virginia.

The law proposes to cut approximately $450 billion from Medicare spending over the next ten years at a time when Medicare is already mired in debt and as a bow wave of Baby Boomers is set to retire and start hitting the Medicare system immediately. Medicare Advantage, which provides better benefits than traditional Medicare and is a very valuable tool in rural and underserved areas, may decrease. This law does little to address the historic disparity in Medicare funding between urban areas and rural areas.

I am also very concerned about the cost and spending projections of this legislation. There is a great deal of debate about the real cost of this bill. A former CBO Director estimated in an article in the Wall Street Journal that the bill may increase the federal deficit by $562 billion over ten years because of some of these issues that I just discussed.

The official score maintains that the law would lower the deficit by $143 billion over that same period, but it includes a number of unlikely assumptions—Medicare cuts being one of them.

The system for reimbursing Medicare doctors—called the sustainable growth rate—is widely agreed to be broken, but we have not tried to fix it and that’s a $250 billion ticket.

Many, including myself, believe that the Community Living Assistance Services and Supports (CLASS) Act is structurally unsound. I voted against that as we were considering the bill. In addition, as my colleague Congressman Glenn Nye from the Norfolk/ Virginia Beach area pointed out; there is a great deal of concern among many families and small businesses regarding the impact of this bill. 

But again, the bill is now law. The question is how to make the law a better law. The process that got us here has been ugly. It has diminished the trust and respect that some citizens hold for our own government. We need to restore that trust through a genuine and transparent effort on both sides of the aisle to fix the problems in the law.

We also need to start working together again across the aisle on this and other issues that confront us in a bipartisan manner and with a sense of shared responsibility about the many, many problems that face this country.

I understand the concerns on the other side, and I respect them.  But I have called on my Republican friends to begin working in concert with us to address the inequities that we are all concerned about, to implement cost controls, and to work together for the good of the country.

The Department of Health and Human Services is largely responsible for implementing these laws.  For specific information and answers to questions on the health reform legislation, please visit www.healthcare.gov.  Further information for small business owners is available at http://www.sba.gov/healthcarereform/index.html.  Please check these sites often as information will be updated frequently.