April 5, 2010

Health Care

Dear Friends,

Since the passing of the historic health care bill, I have continued to receive feedback from constituents while I have been home for a district work period. As always, I appreciate hearing from you. Some people have wondered why I seemed reluctant to embrace whatever proposal the Administration put forth. I would like to offer regular readers of our e-update additional insight into my thinking leading up to the health care vote.

Let me begin with what I know you already recognize — I have always fully supported expanding health care coverage to all Americans. There are many ways to achieve that goal and each are worthy of consideration. There are challenges, however, associated with the various approaches and it is my responsibility as a Member of Congress to make sure we do not unintentionally harm what we already enjoy in Massachusetts. In this case, that means maintaining our excellent health care system as well as the hundreds of thousands of jobs associated with it in Massachusetts.

Over the last two weeks of this debate, it became clear that the reform proposal would fall short of true universal access to health care; millions of Americans would be left out of our solution. But the perfect can never be the enemy of the good and most people understand and accept this reality. Many acknowledged that this bill was imperfect and fell short of our goals. However, many of us, including myself, concluded that in its broad outline this bill would be good for our country.

That was the relatively easy part for me as debate really got underway. The harder part of my decision came AFTER I accepted the general aspects of the health care bill. First, let me remind everyone that the language of the reconciliation package was made available only 72 hours before the final vote. Certainly, we had a broad understanding of what might be included, but details matter in this process and no thoughtful person should commit their support or opposition before they review the specific language of such an important proposal.

During debate on national issues, it's important to remember that each and every Member of Congress represents a defined geographic area. We all know that our actions affect the world and the country as a whole, but we are elected to represent the people of one area. In the House, we each represent about 650,000 people. I represent the people who live in Cambridge , Chelsea, Somerville and about 70% of Boston. I cannot imagine ever knowingly voting against their interests.

As you know, the 8th Congressional District includes or abuts every major teaching hospital in Greater Boston, more than 15 Community Health Centers and hundreds of health care related businesses. A reasonable estimate indicates that at least 150,000 people work directly for a health-care related business in the 8th Congressional District. That number does not include the many more who work for research entities associated with hospitals, the construction workers who maintain and expand hospitals, the people who clean the hospital laundry off-site or the people who supply the hospital cafeterias. Nor does it include the professors and researchers who come here from around the world because of the opportunities our district offers to unite theoretical and practical work. Nor does it include the hundreds of thousands of people who work in the health care system across the Commonwealth — from Pittsfield to Provincetown.

Clearly, health care is more than a social issue in my district and across the Commonwealth; it is a very important economic issue both directly and indirectly. Few people would ask me to support a bill that was both short of our goals AND would undermine our regional economy.

For these reasons, as you know, I spent the two weeks prior to the vote ensuring that Massachusetts' interests were protected. I remain happy to report that success and more...

• The final bill provides Massachusetts with $2.15 billion to ensure we are not inadvertently punished for expanding health coverage before other states did. This is almost $2 billion MORE than the Senate bill provided and $850 million more than the House bill. This money will be used to protect and improve our regional health care, expand research, and both save and create jobs in Massachusetts.
• The final 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 by resisting a very aggressive push from those states that would have benefited greatly by our loss. If we had lost this issue, Massachusetts could have lost thousands of jobs very quickly and our health care system would have been harmed irreparably.
• The final 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 final bill reduces the cut in Disproportionate Share Hospital payments AND retains language beneficial to Massachusetts. These provisions should protect millions of dollars paid to our hospitals that service our most vulnerable citizens — like Boston Medical Center and the Cambridge Health Alliance.

Each of these issues was the subject of multiple, serious internal debates and lengthy, private meetings during the weeks prior to the final vote. I personally participated in most of those meetings, some that lasted past midnight. There was no way I was committing my vote until these issues were settled. I would ask you — could you have supported this bill if Massachusetts lost $4 billion? How many jobs in Greater Boston would you be willing to give up for the “greater good?"

I am proud that the Massachusetts delegation did not have to make this painful choice. The greater good was served AND Massachusetts jobs were protected. In fact, the health care sector of the Greater Boston economy will be enhanced and strengthened because of what we did in the two weeks prior to the vote on this bill.

I hope this behind-the-scenes review helps you understand what I was doing during the last weeks of the debate and why. We will also post a few of the comments we received from various groups on our website for your review.

Regards,