My Decision on Health Care

March 20, 2010

Dear Friends,

After careful review and absent any last minute changes on reconciliation, I will vote YES on health care reform. Although I am not happy with every aspect of this bill, I have come to the conclusion that the benefits for Massachusetts and the country outweigh the problems.

During the last week we have been able to significantly increase the amounts coming to Massachusetts and to secure other funds that had been in jeopardy.  In total, during this last week, roughly $4 billion has been protected for the Commonwealth as this bill has been readied for a vote. From a more general view, this bill also extends coverage to millions more Americans, prohibits insurance companies from denying coverage based on pre-existing conditions and creates health insurance exchanges for people to purchase affordable coverage. It also increases funding for Community Health Centers, and makes key investments in training doctors, nurses and other health care providers. And it does all this without harming the interests of Massachusetts.


A brief summary of what we have focused on during the last week will show the following:

  • The House bill would have provided Massachusetts with about $1.3 Billion to avoid inadvertently “punishing” the state for expanding health coverage before other states did so. The Senate bill would have granted about $165 million for the same purpose. Language in the Reconciliation bill would provide $2.15 Billion for this protection – an increase of about $2 billion over the Senate proposal.
  • The Reconciliation 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 Reconciliation 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 a very aggressive push from those states that would have benefited greatly by our loss.
  • The Reconciliation bill reduces the cut in Disproportionate Share Hospital (DSH) payments AND retains language beneficial to Massachusetts.  This will protect our most vulnerable citizens and the health care providers who service them.
  • The Reconciliation bill keeps the language on Value Index that concerned me.  Although other informed observers share my concern, no one has suggested that I vote against the bill simply based on this concern.
  • The Reconciliation bill keeps the language creating the Super IMAC.  Again, although other informed observers share my concern, no one has suggested that I vote against the bill simply based on this concern.

    Does this bill do everything I want? No, and I can’t think of a single piece of legislation I ever voted on that did. As you all know, I support single payer and I wanted a strong public option in this bill. The House bill, which I supported, had a public option. This bill does not.  

    Please note, although I support this bill, I reserve the right to change my mind if significant alterations are made during consideration of the reconciled bill. I do not think that will happen, otherwise I would have held back my decision. However, there are always last minute attempts to alter legislation. For example, until midnight last night there were still proposals to divert hundreds of millions of dollars a year away from Massachusetts and to other states.  I believe that this and my other concerns have been satisfied, but I remain vigilant.

    As you know, I have consulted a wide range of experts on all of these matters. After the changes that will be made to the Senate bill in reconciliation, I cannot find a single hospital administrator, teaching hospital, community health center advocate, doctor association, nurse association, union representing hospital workers or health care advocacy group that represents the people and workers of Massachusetts who think I should cast a no vote.  

    Thanks to all who have called, emailed and visited my offices to share your thoughts on health care reform. I value your opinion and am very grateful that you have given me the opportunity to represent your interests in Washington. It is a responsibility I take very seriously and that is why I have spent so much time carefully reviewing the Senate health care bill and the accompanying reconciliation language.

    Best Regards,

    Mike

    I sent the above message to my official E-Update email list, you may sign up for it on my website at http://www.house.gov/capuano/e-updates/subscribe.shtml

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    Discuss

    9 Comments . Leave a comment below.
    1. $quot;Progress, not perfection$quot;

      First, thanks for posting this as I, like many readers outside your district, am not on your email list.

      As a long time practitioner of a 12-step program, one of the axioms I remind myself with, several times a day, is "Progress, not perfection."  Accepting only the perfect (presuming any of us would know it when we saw it) is in fact a recipe for inaction and an excuse.

      I hope health care access reform (that is how I think of it) in its current push is finished this weekend so the festering economic issues can be addressed with real focus.

      The health care access fight was so intense that it seems to me the economy, the need to figure out how to get the unemployed, laid off Americans whose jobs have been outsourced back to work.

      Maybe it will take a serious effort to return to "made in America".

      Maybe  not having to worry about pajamas that burst into flame, toys full of lead, and poisonous pet food is worth paying a bit more.  I think it is.

    2. Missing part of sentence, sorry

      after "back to work" add "seemed to have been put on hold."

      Thx!

    3. Process?

      Thank you for the thoughtful response. You state:

      I reserve the right to change my mind if significant alterations are made during consideration of the reconciled bill

      My understanding is that only the Senate will consider the reconciled bill, and by that time your vote will be irrevocably cast. If this is correct and the changes you outline don't come to pass, what will be your course of action?

    4. Glad that you are on board

      Dear Congressman Capuano:

      I was very glad to support you for U.S. Senate, and you have confirmed my faith in you by stating your support regarding this important legislation.

      I hope that Congressman Lynch will come around. Maybe you could speak to him regarding his apparent opposition and persuade him to do the right thing?

      Respectfully Submitted, Sincerely, Wayne J. Wilson, Jr. Democrat for State Senate Suffolk & Norfolk District ( Roslindale, Hyde Park, West Roxbury, Dedham, Westwood & Norwood )

      P.S. I called his Washington, D.C. office on my cell phone while I was on my break at work in Boston. I am sure it wasn't cheap, but it is an important issue.  

    5. Thanks Mike.

      It's too bad it couldn't be a better package.  Thank you for the thoroughness in reviewing this bill. Please continue to fight for improvements in HCR and make it a  priority to lower the cost of health care without compromising quality.  Please continue to push for a public option buy-in to be a part of the beauty of the United States.

    6. Kudos, and thank you

      I support the position you've taken and so clearly articulated. Thank you for doing so, and for doing so here.

      While I am sad to be moving out of Brookline (after more than ten years of proudly calling Barney Frank "my congressman"), I am very happy to be moving into Somerville and the 8th District. I look forward to supporting you as vigorously as I have supported Barney Frank.

    7. As Usual, A Great Job Congressman!

      Thanks from your friends in Ward 3!

    8. This is the stuff

      It's the due diligence I would hope all of our Representatives would do on every bill that affects Massachusetts. Too bad most of them don't.

      Incidentally, it looks like Rep. Capuano accomplished exactly what several comments on BMG insisted he could not do (or should not attempt to do) - restore protection for the Commonwealth from imposition of punishment for being ahead of the curve on health care reform. The people who claimed his efforts were a "stab in the back" should be ashamed.

    9. As always, great job

      Thank you Congressman for your vote but more importantly for your forthrightness in your decision. I love that you actually thought in great detail about this important decision and that you have shared your thought process with us.

      While i may not always agree with everything you do, I have the utmost trust and respect for you.  

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