March 20, 2010

Health Care

Dear Friends,

After careful review and absent any last minute changes on reconciliation, I will vote YES on health care reform. Although I am not happy with every aspect of this bill, I have come to the conclusion that the benefits for Massachusetts and the country outweigh the problems.

During the last week we have been able to significantly increase the amounts coming to Massachusetts and to secure other funds that had been in jeopardy.  In total, during this last week, roughly $4 billion has been protected for the Commonwealth as this bill has been readied for a vote. From a more general view, this bill also extends coverage to millions more Americans, prohibits insurance companies from denying coverage based on pre-existing conditions and creates health insurance exchanges for people to purchase affordable coverage. It also increases funding for Community Health Centers, and makes key investments in training doctors, nurses and other health care providers. And it does all this without harming the interests of Massachusetts.

A brief summary of what we have focused on during the last week will show the following:

• The House bill would have provided Massachusetts with about $1.3 Billion to avoid inadvertently "punishing" the state for expanding health coverage before other states did so. The Senate bill would have granted about $165 million for the same purpose. Language in the Reconciliation bill would provide $2.15 Billion for this protection — an increase of about $2 billion over the Senate proposal.
• The Reconciliation bill protects our Area Wage Index that will bring Massachusetts about $300 million per year from the federal government, funds we do not currently receive.
• The Reconciliation bill does NOT alter the Geographic Variation aspect of current Medicare law.  This protects Billions of dollars per year for our research hospitals.  This victory was secured after many hours of internal debate and a very aggressive push from those states that would have benefited greatly by our loss.
• The Reconciliation bill reduces the cut in Disproportionate Share Hospital (DSH) payments AND retains language beneficial to Massachusetts.  This will protect our most vulnerable citizens and the health care providers who service them.
• The Reconciliation bill keeps the language on Value Index that concerned me.  Although other informed observers share my concern, no one has suggested that I vote against the bill simply based on this concern. The Reconciliation bill keeps the language creating the Super IMAC.  Again, although other informed observers share my concern, no one has suggested that I vote against the bill simply based on this concern.

Does this bill do everything I want? No, and I can’t think of a single piece of legislation I ever voted on that did. As you all know, I support single payer and I wanted a strong public option in this bill. The House bill, which I supported, had a public option. This bill does not.  

Please note, although I support this bill, I reserve the right to change my mind if significant alterations are made during consideration of the reconciled bill. I do not think that will happen, otherwise I would have held back my decision. However, there are always last minute attempts to alter legislation. For example, until midnight last night there were still proposals to divert hundreds of millions of dollars a year away from Massachusetts and to other states.  I believe that this and my other concerns have been satisfied, but I remain vigilant.

As you know, I have consulted a wide range of experts on all of these matters. After the changes that will be made to the Senate bill in reconciliation, I cannot find a single hospital administrator, teaching hospital, community health center advocate, doctor association, nurse association, union representing hospital workers or health care advocacy group that represents the people and workers of Massachusetts who think I should cast a no vote. 

Thanks to all who have called, emailed and visited my offices to share your thoughts on health care reform. I value your opinion and am very grateful that you have given me the opportunity to represent your interests in Washington. It is a responsibility I take very seriously and that is why I have spent so much time carefully reviewing the Senate health care bill and the accompanying reconciliation language.

Best Regards,