Congressman Holt Responds

Below is the Honorable Congressman Rush Holt's response to my email, received some weeks ago. I am delighted that he took the time and resources to reply with such a thorough response, though I am sure much of the content was from prepared material. I believe Rep. Holt to be sincere, even though I may disagree with him on policies and issues.



Dear Mr. Consorti:

Thank you for contacting me regarding health insurance reform. I appreciate hearing from you and I apologize for the delay in my reply.

As the spouse of a physician, I have heard the problems occurring at the front-lines of our health care system. In 2009. health care spending throughout the U.S. is projected to reach $8,160 per person, according to the National Health Expenditure Survey. This should be more than sufficient to provide excellent care for everyone, yet 16 percent of New Jerseyans lacked insurance in 2007, according to the Kaiser Family Foundation, and family insurance premiums are projected to rise from $14,000 in 2009 to $24,000 in 2019, based on a study from the Center for American Progress. In a country where we are projected to spend 18 percent of our Gross Domestic Product ($2.6 trillion) this year on health care, we can do better.

The House of Representatives is currently considering H.R. 3200, America's Affordable Health Choices Act, which seeks to reduce health costs, increase coverage, and improve health care quality. This bill was considered by the three House of Representatives committees that oversee health policies: the Energy and Commerce Committee, the Ways and Means Committee, and the Education and Labor Committee, on which I serve. H.R. 3200 now awaits consideration by the entire House of Representatives. I will keep your thoughts in mind as this bill progresses through the legislative process.

America's Affordable Health Choices Act would accomplish three objectives. First, the legislation would lead to stable health Gosts that will not threaten family finances by establishing several consumer protections for those purchasing private insurance. The bill would eliminate insurance benefit caps to ensure families do not have to worry about leaving the hospital with bills too big to pay because their benefits have run out. The bill would set an annual cap on out-of-pocket health expenses to eliminate cases where one disease forces a family into bankruptcy. According to a Congressional cOlumittee report, the legislation would prevent ll1edical bankruptcies that affected 460 families in Central New Jersey this past year.

Second, it would provide stable coverage for those between jobs or the self-employed by creating an insurance store, called an exchange, where they could get insurance at a group rate. Most of the policies in this insurance stofe would be private insurance (such as Blue Cross or Aetna), while one of the plans would be a non-profit plan, presumably administered by the government, and subject to the same requirements and regulations as the for-profit plans in the exchange. The bill also would eliminate the practice where patients with a pre-existing condition like diabetes or cancer or pregnancy cannot purchase insurance. According to a Congressional committee report, the bill would help 28,000 uninsured individuals in Central New Jersey gain access to affordable health insurance.

Third, the bill would strengthen Medicare by starting to pay physicians for treating the whole patient and by encouraging doctorsto coordinate a patient's medical care instead of paying for each aspirin or test. The legIslation would strengthen the long-term health of the Medicare trust fund by increasing the efficiency of the program, expanding its ability to fight waste, fraud, and abuse, and eliminating wasteful subsidies to private insurance companies. Further, the bill would improve the prescription drug benefit to provide real coverage for seniors by eliminating the so-called "doughnut hole."

While the bill would lead to other useful changes, such as increasing the number of primary care doctors and expanding the number of nurses, these are the principle elements of the House health reform bill.

I support the inclusion of a public health insurance plan in any reform proposals to lower costs and improve health care delivery. Under tl1e proposed legislation, Americans without health insurance and small businesses would be able to select a health insurance plan from an array of choices including private insurance plans and one or more publically-run [sic] non-profit plans. A public plan would lower costs by increasing competition, as Americans in many regions ofthe country currently only have one or two insurance options available. A single insurance company controls more than half the insurance market in 16 states, while in New Jersey the top two companies control almost 60 percent of the market. The public plan would serve as a benchmark to encourage private plans to focus on providing value. A public plan also would provide a way to test innovative strategies to deliver higher-quality health care, such as increasing primary care and encouraging care focused on healthy outcomes of integrated treatments, eliminating the approach based on a long list of disconnected and sometimes unnecessary procedures.

I appreciate learning of your support for limiting medical malpractice claims. Medical liability legal reform has been added to H.R. 3200 by Rep. Bart Gordon (D-TN) as an amendment in committee; and it may be addressed further in future drafts as the legislation moves forward. While there is certainly room to improve the medical malpractice process, it is surely not the primary re~son for escalating health care costs. States like Texas have passed strin,g,ent..limits on ,medical malpractice claims, yet cities like McAllen, Texas have some ofihe most expe.1hsive health care in the country. The non-partisan Congressional Budget Office found that limits on malpractice claims would reduce health care spending by less than 0.5 percent of total health care spending. However, I recognize that the indirect effects of medical malpractice through defensive medicine practices concern many physicians.

Medical malpractice and tort law have always resided under the jurisdiction of state courts. Of course, everyone wants doctors to practice medicine at the highest standard, not defensively. Frivolous and excessive litigation do not benefit society. Yet, patients who are harmed by malpractice must be protected and treated fairly. Those are two countervailing interests, which I believe are addressed adequately in H.R. 3200.

I was pleased to work with my coll.~'agueson the\&:ducation and Labor Committee to strengthen the bill. I wrote an amendment that would expand online job training programs for health care workers, modeled after a successful program originating at Rutgers University. This amendment was adopted by the Education and Labor Committee. I also worked with my colleagues Rep. Phil Hare (D-IL) and Rep. Rob Andrews (D-NJ) to include language that allows affiliated small businesses to join together to purchase insurance. This would provide a valuable option in addition to the exchange for small businesses that are currently unable to find affordable health insurance.

Again, thank you for contacting me about this important issue. I look forward to hearing from you again about this or any other issue of concern.

RUSH HOLT
Member of Congress