Health Care reform is a necessity for our nation; however the law you have enacted is a travesty that does more to protect special interest groups like the insurance industry and the trial bar than your constituents, and it will undoubtedly dramatically increase tax costs for all North Carolinians, rather than actually reform the system. As our representatives (please remember that you are supposed to represent the people of your state/district - not the interests of a particular national political party), you have a duty to protect the interests of the people of NC. The issues listed below are major ways in which the current bill/law does not effectively “reform” health care or help your constituents. You still have time to add amendments or repeal sections of the bill before it goes into effect, and we ask that you address the following: 1. Why are the people in North Carolina going to be on the hook for the Medicaid costs for the state of Nebraska? It is unconscionable that the people from North Carolina should cover Medicaid costs for another state. Each and every Congressional representative of NC should be actively working to repeal that provision. 2. This bill/law will result in enormous increases in Medicaid costs for NC and we are already in tremendous economic trouble. We are losing jobs daily, our state legislature is practically bankrupt and our educational system faces tremendous budget cuts – where do you think this money can come from? We are already taxed at a higher rate than other states in the Southeast. Do you care about the actual economy in your own state? Change the responsibility for funding the costs to the federal government since it is a federal program. Individual states should not have to fund a federal program. While ultimately we will still foot part of the bill, our local government should not have to establish a revenue stream for it and find employees to run it when they have no ultimate control over the provisions of this legislation. 3. Where is a provision requiring that insurance companies charge each person/company within an individual state the same amount of money for the same type of insurance policies? With all the punitive measures you have included in this bill (individual fines for not buying personal insurance and penalties for companies that fail to provide it for employees), why not ensure equitable insurance rates available for everyone. It is hardly fair to fine a mid-sized business when BCBS charges them almost double what they charge IBM for the same insurance policy. Stop protecting the insurance industry make them accountable. Enact a requirement that insurance companies charge people within the same state the same rates for insurance regardless of the size of the employer or their employment status. Of course there could be differentiation in costs per age but for instance a 35 year old woman who wants a particular type of coverage should be charged the same rate by BCBS whether she is self employed, works for a small store or a big technology company. 4. Tort reform. We need tort reform to increase access to care. We have a dozen counties in NC with no obstetricians, malpractice costs play a large role in this. The people of our state need ACCESS to physicians, not just insurance. Require that caps on awards be set and that attorney’s fees be limited – not 30-40% of awards. It actually works to increase the number of a physicians – it certainly worked in Texas. Make it a requirement stop protecting the trial bar 5. Why fine a company $2000 for not providing health care for their employees – that is lower than what employers pay to insure their employees. This provision essentially encourages businesses to stop providing insurance for their employees. Get rid of this provision or make the fine higher – but again only if you actually require insurance companies to charge equitable rates for coverage. 6. Medicare reimbursement. The current law calls for payments to be cut drastically, this is going to reduce access to care for seniors. In Wake County, for example, it is virtually impossible for a new resident who is on Medicare to find a physician accepting new Medicare patients. This results in trips to the ER rather than trips to an internist. Why don’t they accept new Medicare patients? Because Medicare reimbursement pays so little that he reimbursement does not cover the costs to the office to see and bill etc for that patient. How can you reduce those payments further and expect people to find a doctor’s office that can afford to provide care for those on Medicare? If you are reducing those payouts then you need to a) significantly reduce the paperwork an office needs to file on their behalf and b) actually reimburse those offices in a timely fashion. Otherwise, once again this law will actually decrease access to care for seniors on Medicare. 7. Get rid of the student loan section of the bill – keep it simple by sticking to actual health care. Unless you amend the student loan section to specifically address student loans only for those going in to health care fields, including loan forgiveness particularly for those going into primary care, it should not be in this bill. 8. The bill should not require people to purchase insurance if they do not wish to, particularly since there is nothing in the bill requiring an insurance company to charge them an equitable rate. This is still the United States of America and people are entitled to free choice. There is still time for you to amend this law and actually accomplish something for the people of our state. We will remember that you had time to actually reform health care and also remember that this current legislation does not do anything of the kind – you have your chance to fix it. Don’t fail us: do your jobs and stop protecting special interests.