Rep Herseth Sandlin explains her vote

Here's the response I received today from my at-large Representative.

Dear ____________,

Thank you for contacting me to express your thoughts regarding H.R. 3962, the Affordable Health Care for America Act. I appreciate hearing from you on this important issue.

H.R. 3962, a broad health care reform bill, passed the U.S. House of Representatives on November 7, 2009, by a vote of 220 to 215.

I could not support H.R. 3962, but I believe it's critical that we control rising health care costs, increase quality and value within our health care system, and improve access to health care and affordable health insurance coverage.

The House vote on H.R. 3962 represented one of the most important votes of the year, on an issue that has been a priority for me since I first was given the honor of representing South Dakota in Congress. I have long believed that the strength of our communities in South Dakota depends on the health of our people and that, unfortunately, access to quality, affordable care remains out of reach for far too many South Dakotans. That is why, over a number of months this year, I worked very hard to negotiate improvements in the legislation, and that is why I was so disappointed that the final bill didn't achieve the goals that I believe are essential for a successful and sustainable health care reform effort.

Nonetheless, I am convinced this Congress and the President will achieve fundamental reform because our country must fix what's broken in our health care system. The status quo is unsustainable. There is simply too much at stake for South Dakota's families and businesses, who have either seen their premiums rise sharply year after year, or who still have no access to an affordable plan.

Done right, health care reform will both ensure that more people have access to quality and affordable health care, and, just as critically, make the common-sense reforms that are necessary to fix an unsustainable system that threatens our fiscal future. These twin goals of improving access, quality and affordability on the one hand, and solidifying the country's fiscal outlook on the other, are not mutually exclusive. In fact, they are complementary.

Unfortunately, the House bill misses this critical opportunity. While it does include many good provisions, it is not the right answer for South Dakota, it could threaten existing access to health care in our state, and it does not include nearly enough cost-containment and deficit-reduction measures.

I am concerned by the projected impact of the bill's Medicaid provisions on South Dakota's state budget and the reductions in payments for long-term care under Medicare. Our state is not only facing large deficits in the Medicaid program, but early analysis suggests that the House bill Medicaid provisions would impose at least $87.6 million more in new Medicaid costs on the state than alternative legislation approved with bipartisan support by the Senate Finance Committee. Given that budgetary impact, we have to consider the likelihood that dramatic service cuts would be the end result in South Dakota if the House bill were implemented, and that is a source of serious concern for me.

I also have serious concerns about how the House bill would affect the future of long-term care in our state for seniors. I am concerned that the payment changes under Medicare to nursing homes are unsustainable, and put undue financial pressure on this essential part of the health care infrastructure of South Dakota.

Underlying my concerns relating to Medicaid, long-term care and other issues is a fundamental concern about the effect of the broader House health care reform bill on the nation's long-term deficit, and more specifically, my view that it doesn't do enough to start bringing down the deficit and health care costs in the future.

When it comes to the net change in the federal budgetary commitment to health care, the House bill increases that commitment seven times more than the Senate Finance Committee bill, while failing to include a number of essential cost-containment measures necessary to restrain the future growth of health care spending.

The House bill does include a number of good provisions on which the vast majority of South Dakotans I have talked to agree. For instance, I strongly support provisions in this bill to require insurance companies to cover people with preexisting conditions, and to end the insurance companies' ability to cancel coverage when someone becomes sick. These practices must end. In addition, I support establishing health insurance exchanges to provide a transparent and competitive marketplace for individuals and businesses to buy more affordable health care plans.

Unfortunately, in my view the House bill has not come far enough from where it started, and the bill does not yet represent the right formula for South Dakota. Nonetheless, I am very optimistic that, with the House and Senate working together with the President, we will achieve a good bill for South Dakota and the country during this Congress, because the time has come for fundamental reform.

Again, I believe the Congress has a responsibility to pass health care reform legislation that is deficit-neutral, that ensures access, fairness and affordability of coverage for South Dakotans, and that takes a responsible approach to long-term costs with a focus on achieving higher quality health care outcomes. This bill meets some of these goals but not all, and therefore, I could not support it. I remain steadfastly committed to improving this legislation and I am optimistic that through the legislative process we will achieve what South Dakotans deserve, which is a fiscally responsible and sustainable reform of the health care system that will dramatically improve coverage and quality for all.

I'll keep your thoughts in mind as Congress continues to consider these issues. Thanks again for contacting me. If I can be of further assistance, please don't hesitate to let me know.

Sincerely,

Stephanie Herseth Sandlin
Member of Congress