Dear Ms. Walters:

Thank you for contacting me with your thoughts regarding current efforts to reform health care, particularly HR 3200, America‘s Affordable Health Choices Act of 2009. I appreciate hearing from you on this very important issue.

As you may know, HR 3200 was placed under the jurisdiction of three House committees: Energy and Commerce, of which I am a member, Ways and Means, and Education and Labor. All three committees have approved a version of HR 3200. I voted against the version of the bill which was considered by the Energy and Commerce Committee.

Just because I am not supportive of HR 3200 does not mean I support the status quo. Let me assure you that I am painfully aware of the problems with the American health care system as it currently exists. Prior to becoming a Member of Congress, I was a physician for over 20 years and have personally dealt with the flaws of our nation’s health care system as both a doctor and a patient. Because of my background in health care, I consider this to be the single most important issue in my tenure in Congress. Please be assured, despite the considerable length of HR 3200 (1,000+ pages), I have read every word several times over.

Many of my constituents have written me with the personal hardships they have faced in the current system. I heard from a woman who endured three rounds of cancer. The health insurance plan she was covered by denied payment for her procedures. Her family was forced to pay thousands of dollars out of pocket despite having health insurance.

I heard from another woman who, because of the high cost of insurance, can’t afford coverage. Because of this, her children have gone without proper health care and one son even had to forego needed surgery.

In the Energy and Commerce Committee, I also heard from a woman practicing pediatrics in rural Alabama who saw children covered by both Medicaid and private health insurance. Because of the lower reimbursement rates from Medicaid, she was in danger of having to close her practice. The population of her patients on private insurance did not provide enough reimbursements to offset the low reimbursements from Medicaid to keep her practice viable, and she was forced to dip into her retirement savings in order to continue to serve her patients.

I have heard from hundreds of others with stories just like the ones I mentioned above, and as a physician, I treated individuals just like these. I have seen the fear and despair that comes from facing the overwhelming costs of health care alone. Denying people access to coverage is an injustice that cannot be allowed to continue. These stories reinforce the fact that the health care system in our nation needs repair. I believe it is possible to enact policy that deals with these shortcomings without disrupting those who are happy with their current coverage.

Granted, anyone who genuinely needs care can access help at an Emergency Room (ER), but this is not an ideal situation due to how costly this is for the hospital and for taxpayers. Many of these people could have been treated earlier and helping more Americans to get insurance will lower costs of the system for all.

Health care reform has been and continues to be my number one priority as a Member of Congress. President Obama has echoed my concern, making health care reform one of his key focuses. He has stated that he will not sign off on a health care bill unless it accomplishes three goals. The first goal is to lower the cost of health care for the consumer. The second goal is to make sure that those Americans who are currently happy with their health care coverage can keep it. The third and final goal is to provide coverage for all those who are currently uninsured, whether because of pre-existing conditions or because they simply can’t afford it.

I wholeheartedly agree with all three of the President’s goals. Unfortunately, the legislation that is currently before the House does not accomplish these goals. Just because the Democratic leadership wrote a bill and called it “health care reform” does not mean that the bill will actually improve our health care system. Passing a bill simply to say that we have checked the box on health care could be highly detrimental, but doing nothing should not be an option. Congress must, therefore, take the time to ensure that our legislative efforts fix what is broken in our system. But we must also make sure that our final legislative product will not bring the government between the doctor and the patient. Actually, I’d love to see reforms that get insurance bureaucrats out of this relationship as well.

As stated earlier, HR 3200 was referred to three different House Committees. As HR 3200 was discussed and debated in these committees, the original bill was changed and each committee approved its own version of the same bill. On top of that, two Senate Committees were given jurisdiction of a completely different bill. Despite attempts to rush the bill through the House by the Majority Party, Congressional Committees still have not been able to agree on which version of the several different bills to use or how to merge them.

In any of its current forms, HR 3200 is fatally flawed. While some might be able to keep their current coverage, the requirements that insurance companies will be forced to meet will raise the premium prices for everyone, particularly those who are currently insured, which is counterproductive to President Obama’s goal of lowering consumer health costs. Others who receive health care through their employer may find themselves unwillingly switched from private health care to the public plan, as employers struggle to find ways to continue to provide health insurance to their employees. Many businesses, particularly small businesses, might find it cheaper to pay the fine under the bill than provide coverage.

The Congressional Budget Office (CBO), a non-political organization under the legislative branch, estimates that by 2016, about 9 million people who are covered by an employment-based plan under current law would not be enrolled in an employment-based plan under HR 3200. I believe this is a very low estimate.

Under one provision of the bill commonly referred to as “Page Sixteen,” the individual insurance market as we know it will be destroyed. It doesn’t outlaw private insurance companies. However, no new policy holders may join the insurance pools currently in place and, in a few years, if your policy does not meet the new requirements, you must either pay an additional tax or switch to a plan that does. The vast majority of current plans in the individual market will not meet these standards; people will have to switch off their current plan or pay higher taxes. Ultimately, I agree that people who like what they have should be able to keep their plan, and this bill does not allow that to happen.

HR 3200 also does not immediately address the problem of providing coverage for those who are currently uninsured. While this bill provides coverage to those uninsured who have pre-existing conditions-something everyone in Congress wholeheartedly agrees on-this coverage will not come into effect until 2013. While it is possible that insurance companies will begin to cover these people out of “good faith,” they will not be mandated to do so until the insurance requirements go into effect in 2013. This leaves a four-year gap for those who need this insurance immediately.

Regardless of an individual’s coverage status, HR 3200 will add to the national deficit, which has already been strained by unprecedented spending from the recent bailouts and stimulus packages. The CBO estimates that, over the next 10 years, HR 3200 would increase federal deficits by $239 billion. The tax hikes and Medicare cuts this bill would put in place would decrease the $1.2 trillion price tag of this bill to the $239 billion figure. However, this number is not based on legislative language and doesn’t include large parts of the bill that set aside appropriations. Because of this, I believe $239 billion is a very conservative number over the next 10 years.

The real issue occurs in Year 11, when the CBO’s estimates end. The deficit will increase by a tremendous amount and Congress will have to figure out how to continue to fund this bill. I’m not sure how we can do this, unless additional tax increases and Medicare cuts are put into place to the tune of over $100 billion a year. Both of these solutions are unappealing and would heap additional burdens on future generations.

I am opposed to this bill, not because it’s a Democratic bill, but because this legislation does not accomplish the previously stated goals. I believe that we must reevaluate the best way to address the health care needs of Americans. We shouldn’t rush a bill that doesn’t work just for the sake of passing a bill and checking health care off our to-do list. The American people deserve better than this. An issue as complex and important as our nation’s health care should be given thorough consideration.

I believe that we must start on a more focused scale. While the health care reform movement of the Clinton Administration did not come to fruition, the State Children’s Health Insurance Program (SCHIP) came to be because of it. While everyone did not agree on the larger reform movement, everyone could agree on what we now know as SCHIP. It is my hope that something similar can occur here. I want to specifically address each of the different health care issues individually, in order of priority, instead of trying to tackle every problem in one fell swoop that might be hit-or-miss.

I have personally introduced, or have introduced jointly with fellow Members of Congress from both sides of the aisle, over 30 health related bills that would address some of these individual problems, ranging from ensuring that patients have access to health care providers, to fixing the declining Medicare reimbursement rates our doctors face. Coverage becomes irrelevant if the patient cannot find a doctor willing to accept the patient. Decreased access to physicians will cause rationing of care for our most vulnerable citizens. This works against the goal of giving all Americans health care coverage, considering they won’t have access to the doctors they want with their plan.

I have received a great deal of correspondence from constituents asking me to support the inclusion of preventive care, chronic illnesses research funding, and many other noble causes. These enjoy wide support, another example of what could be accomplished more effectively in smaller increments. I have done my best to support these provisions while eliminating unhelpful, unnecessary spending and overbearing government intervention. I will continue to put my full effort toward this cause.

Both Republicans and Democrats introduced over three hundred amendments to HR 3200 in the “mark-up,” or debate in the Energy and Commerce Committee. This further illustrates the fact that Democrats, as well as Republicans, take serious issue with HR 3200. I personally offered 50 amendments to HR 3200. Unfortunately, many amendments were not given due attention; several were thrown out based on unjustified technicalities, while others failed due to partisan back-room politics. That said, several were accepted and I hope this demonstrates that Republicans and Democrats can work together on this issue.

Republicans have introduced numerous alternatives to HR 3200 including HR 3400, the Empowering Patients First Act, HR 3218, the Improving Health Care for All Americans Act, and HR 3520, the Patients’ Choice Act. These are not the only ideas and many of them are only pieces of the larger discussion of reform. We all have different ideas and, while not all of them are comprehensive, they are all important pieces of the puzzle.

While Republicans are taking the time to thoroughly scrutinize our ideas to make sure that they effectively solve the health care crisis and do not add additional burden, the Democrats are attempting to rush a bill that not only fails to help those who truly need better health care, but hurts those who are currently happy with their health care.

I have been appointed to every Republican taskforce that is focused on health care reform, including those with conservative members, more moderate members, and those led by Republican Congressional leadership. I have met with Chairman Waxman of the Energy and Commerce Committee so that we could discuss what really needs to be in health care reform. I have reached out to conservative “Blue Dog” Democrats to discuss health care reform. I am working with everyone I can to make sure that Congress passes health care reform that benefits every American.

Should HR 3200 pass with a public plan, I will do my best to make sure that Members of Congress, especially those who voted for the plan, are moved from their current health insurance to the public plan. For this reason, I am a co-sponsor of H Res 615, which would enroll all Members who vote in favor of HR 3200 in the public option. It is unjustifiable to force coverage on Americans that Congress does not view as good enough to use themselves.

I recently created a Health Care Caucus in the House of Representatives to find solutions to our health care problems. You can follow the Caucus’ participation in the health care reform debate in the House by visiting the Caucus website www.healthcaucus.org

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Thank you again for contacting me about health care reform legislation. As the debate on health care reform moves forward, I will continue to keep your opinions and concerns in mind. I encourage you to continue monitoring Congress’ actions regarding health care because our decisions in Washington, D.C. will affect everyone. In order to read the full text of HR 3200 for yourself, please visit www.thomas.gov

. Please continue to share your thoughts with me so that I can represent you better.