Congressman Albio Sires Newsletter



DEAR <>,,

Since the beginning of the 111th Congress, my colleagues and I have been diligently working to enact comprehensive health care reform. On November 7, 2009, the House of Representatives passed H.R. 3962, the Affordable Health Care for America Act. The legislation is the final product of three versions of reform bills passed by the House committees of jurisdiction in July.

It embodies the President’s key goals for health care reform by slowing the growth of sky-rocketing health costs and introducing competition into the health care marketplace to keep coverage affordable and insurers honest. Additionally, it will protect people’s choices of doctors and health plans, as well as guarantee that all Americans have access to quality, stable, affordable health care, including expanding access to coverage to nearly 115,000 currently uninsured individuals in the 13th District.

Increasing Choice and Competition

Primarily, H.R. 3962 will ensure affordability for workers and middle-class families, security for seniors with a stronger, more solvent Medicare program, and a healthy fiscal future. A key part of the bill works to increase choice and competition in the marketplace. If people like their current plans, they will be able to keep them, but for those individuals and small businesses that cannot afford insurance, a new Health Insurance Exchange will be created as a marketplace where consumers can comparison shop from a menu of affordable, quality health care options, including private plans, health co-ops, and a new public health insurance option. Financed by its own premiums, the public option will operate on a level playing field with private insurers to spur additional competition.

Giving Americans Peace of Mind

In addition, this bill imposes new requirements on insurers to ensure that Americans have portable, secure health care coverage so no one can lose care because their employer drops their plan or they lose their job. Every insurer will be required to provide plans that cover essential benefits and will no longer be allowed to deny coverage or increase premiums based upon pre-existing conditions, race, or gender. Insurers will also be required to eliminate co-pays for preventive care and a cap will be placed on out-of-pocket expenses to protect every American from medical bankruptcy, including 900 families in the 13th District.

Improving Quality of Care for Every American

Quality of care for every one will also be improved though this legislation by ensuring that Americans of all ages, from young children to retirees, have access to greater quality of care by focusing on prevention, wellness, and strengthening programs that work. Over a period of time, preventive care will be covered at no cost; children’s coverage will mandate dental, hearing, and vision benefits; and a boost will be given to the health care workforce to ensure that more doctors and nurses are available to provide quality care.

Ensuring Shared Responsiblity and Affordability

Moreover this bill calls on every one to play their part to ensure that our nation stays on a path towards a quality and sustainable health care system. Employers with payrolls over $500,000 will be required to offer coverage to their workers or contribute to the cost of coverage; all individuals, except in cases of hardship, will be required to get coverage either through their employer or the newly created Exchange; and the government will be tasked with ensuring that coverage is affordable by providing affordability credits to qualified individuals- including 164,000 residents of the 13th district that qualify- and tax credits to certain small employers to make premiums affordable.

Reducing the Deficit

Furthermore, this legislation will be entirely paid for- it will not add a dime to the deficit and will actually reduce the deficit over at least the next two decades. It will put Medicare and Medicaid on the path to a more fiscally sound future, so seniors and low-income Americans can continue to receive quality health care benefits for years to come.

Strengthening and Improving Medicare for Seniors

Medicare, which has provided health care for Americans age 65 and older for the last 44 years, is working, and would be strengthened under the House’s version of health care reform legislation, the Affordable Health Care for America Act (H.R. 3962), supported by AARP.

Without reform for all Americans, health care costs will keep rising, and it could jeopardize Medicare’s ability to keep covering costs. Rising costs have hit seniors’ wallets as well, with the average Part D plus Part B premium consuming an estimated 12 percent of the average Social Security benefit in 2010, and 16 percent by 2025.

H.R. 3962 will bring  lower drug costs for seniors by ending the ‘doughnut hole’ for prescription drug coverage. This will help the 4,700 seniors currently residing in the 13th District that hit the ‘doughnut hole’ each year and are forced to pay their full drug costs, despite having Part D drug coverage. Additionally, this bill will provide all Medicare beneficiaries with free preventive care, including mammograms and colonoscopies.

H.R. 3962 will also increase the quality and safety of care that seniors receive by developing national standards on quality measurement and reporting, investing in patient safety and rewarding doctors and nurses for high quality care.

This legislation will also mean tighter oversight as well by focusing health care dollars on senior care and cracking down on waste, fraud, abuse, and overpayments to enrich private companies.

Additionally, this bill will protect Medicare by extending the solvency of the Medicare Trust Fund by five years, to help ensure Medicare can cover every American as they get older.

The House is also working on separate legislation, the Medicare Physician Payment Reform Act (H.R. 3961), to ensure access to care by eliminating pay cuts facing doctors for Medicare reimbursements. Eliminating this cut would ensure that these doctors would still be able to care for seniors. 

While our mission for comprehensive health care reform is not yet complete- the Senate needs to pass their version of health care reform and then it must be reconciled with H.R. 3962 before being sent to the President’s desk- the passage of the Affordable Health Care for America Act marks an important milestone on the journey to comprehensive health care reform, not at any point in American history have we come this far. I will continue to fight to ensure that every resident within the 13th District and across the country has access to affordable and quality coverage.

For the most up-to-date information on the health care debate in Congress, please visit the Health Care Reform section of my website.


Albio Sires

Albio Sires