Kratovil Plays Devils Advocate in his NO Vote for Obama’s Deathcare Package – Desperate to Save his seat

From: Congressman Frank Kratovil, Jr.
Date: 4/28/2010 3:56:58 PM
Subject: Responding to your message
Dear :
Thank you for contacting my office to share your thoughts on health care reform.  Our nation spends over $2.6 trillion, or 16% of Gross Domestic Product (GDP), on health care services and products.  The skyrocketing cost of health care represents one of the greatest threats to our long term economic security.  For nearly a year, the Congress and the American people have passionately debated the best way to reform our health care system.
I recognize that health care reform is an urgent priority; if left unchecked, rising costs threaten to bankrupt families, employers, and the federal government.  The question, therefore, is how to reform the system in a manner that will lower costs to families and small businesses, preserve consumer choice, expand coverage to those currently uninsured, and “bend the cost curve” of the federal government’s health care obligations over the long-term.  Over the past year, I have worked with colleagues on both sides of the aisle in the hopes of accomplishing these goals. On March 21, 2010, after months of debate and consideration, the House of Representatives voted on H.R. 3590 (the Patient Protection and Affordable Care Act) and H.R. 4872 (the Health Care and Education Reconciliation Act of 2010).  After studying the package extensively and evaluating its strengths and weaknesses, I reached the conclusion that this bill did not represent a fiscally sustainable approach to accomplishing these goals.   Consequently, I was unable to support this legislation and voted no on both measures.
To be clear, I do not believe that the status quo is acceptable.  An estimated forty- five million Americans are living without health care insurance. I believe it is simply unacceptable for children and families in the richest nation in the history of the world to have their lives put at risk because they lack basic health coverage. It is true that the package passed by Congress and signed by the President will expand coverage to a significant number of currently uninsured Americans, in part by ending pre-existing condition exclusions, prohibiting insurance companies from dropping customers after they get sick and covering children on their parents’ plan to the age of 26.  I strongly support these common-sense reforms.  But while the bill did include what I considered to be positive insurance reforms, these positives were not sufficient in my mind to outweigh the significant concerns I had relating to the legislation’s price tag, its failure to adequately reduce costs, its potential impact on the deficit, and its consequences for jobs and employment.
While some discussion of the health reform package has focused on the Congressional Budget Office’s[1] projected “score” of the bill’s deficit impact, these discussions often only touch the top-line projections while ignoring the significant concerns also voiced by the CBO about the likelihood of these savings ever being realized.  In a March 20th report analyzing the proposals, CBO Director Douglass Elmendorf stated that “these longer-term calculations reflect an assumption that the provisions of the reconciliation proposal and H.R. 3590 are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation. For example, the sustainable growth rate mechanism governing Medicare’s payments to physicians has frequently been modified (either through legislation or administrative action) to avoid reductions in those payments, and legislation to do so again is currently under consideration by the Congress.”
The sustainable growth rate (SGR) mechanism referenced in that statement represents one of the most significant hidden costs of the this health care reform bill.  Under current law, reimbursement fees to doctors who treat Medicare patients are scheduled to be reduced by 21% in 2010 and by about 5% in each of the next four years.   However, Congress has repeatedly acted to postpone these cuts in recent years, principally because of the drastic impact such cuts would have on the ability of many doctors to continue accepting Medicare patients.  There is broad agreement that SGR needs to be replaced with a permanent viable solution, but the CBO has estimated that this “Doc Fix” will cost more than $208 billion over the next 10 years.  This “Doc Fix” was included in the initial draft House health care reform legislation last summer (H.R. 3200), but was subsequently removed and passed by the House in a companion bill (H.R. 3961) in order to “reduce” the overall cost of the main reform package.   Adding the cost of this necessary fix back into the calculations more than wipes out the project budget savings of the final package; in a March 19th letter, CBO Director Elmendorf stated that enacting the “Doc Fix” alongside H.R. 4872 and H.R. 3590 “would add $59 billion to budget deficits.”  Furthermore, the CBO stated that, “the long-term budgetary impact could be quite different if key provisions of the legislation were ultimately changed or not fully implemented.”  With our national debt already an alarming $12 trillion, we cannot afford legislation that potentially further buries future generations in debt.
I also believe that in order to be effective, any health care reform package must also “bend the cost curve” by lowering costs for both the individuals and the federal government.  Unfortunately, in its March 20th report on H.R. 3590 and H.R. 4872, CBO noted that these measures would actually increase the federal obligation to health care by $390 billion over the next 10 years.  While the bill is projected to do a better job of containing costs after the first 10 years, CBO has noted that these projections are again based on unlikely assumptions, such as Congress failing to pass a “Doc Fix” and Medicare costs growing at a significantly slower rate in the future than they have in the recent past.  CBO has also stated that some individuals, specifically younger Americans and middle class families in non-group plans, may actually see their premiums rise as a result of this legislation. Furthermore, I am concerned that some of the proposals contained in the package – namely the employer mandate and associated penalties – could have a negative impact on job creation at a time when reducing unemployment must be our top priority.
In the end, these flaws led me to vote against H.R. 3590 and H.R. 4872.  While these bills contained some very positive ideas, I was not convinced that these positives outweighed the concerns detailed above.  Although these bills passed and are now the law of the land, I believe lawmakers now have a responsibility to go back and fix these flaws.  I am committed to working with colleagues on both sides of the aisle to responsibly address the shortcomings of the recently-passed legislation, while still preserving and maintaining the important insurance industry reforms that have been put in place.
Please do not hesitate to contact me again in the future regarding issues that concern you. I believe that continuous communication with the residents of the First District is essential to helping me be an effective advocate for you in Congress. To stay informed, please visit my website at
Thank you again for contacting me and I look forward to hearing from you.
The Congressional Budget Office (CBO) is the non-partisan office that acts as the official “scorekeeper” for Congress.  Its data and reports are relied upon by both parties to determine the true costs of legislation.


Frank M. Kratovil, Jr.
Member of Congress


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