July 29, 2009
The Honorable Harry Reid The Honorable Nancy Pelosi United States Senate United States House of Representatives 522 Hart Senate Building 235 Cannon House Office Building Washington, DC 20510 Washington, DC 20515
Dear Senator Reid and Speaker Pelosi:
We are writing to reiterate our concern with recent federal health reform efforts—particularly, the Medicare-modeled “public plan” and a national health insurance exchange—which we believe would trample states’ rights and lead Americans down the road to single-payer health care.
The American Legislative Exchange Council (ALEC) represents more than 1,800 state legislative members. ALEC is the nation’s largest nonpartisan, individual membership association of state legislators. Approximately one-third of all state legislators belong to ALEC, in addition to 78 ALEC “alumni” in Congress and more than 300 private-sector companies, national trade associations, and nonprofit organizations. The 167 undersigned members from 41 states are state legislators who chose to take an additional individual stand against the public plan and national health insurance exchange.
In May, ALEC’s lawmakers approved the Resolution on Preserving States’ Rights Regarding Federal Health Insurance Exchanges and a Public Plan (attached), which deems the public plan anti-competitive and invokes the Tenth Amendment to the U.S. Constitution in calling the national health insurance exchange a “federal takeover” of the states’ role in regulating health insurance.
As a representative to such a broad coalition of state interests, ALEC questions the wisdom and practicality of the public plan and the national health insurance exchange. Our concerns include:
* The public plan will not be competitive. It’s an unlevel playing field when the public plan can shift costs to our states’ private insurers because of low doctor and hospital reimbursement rates, and then raid the federal treasury for unlimited subsidies. Government will only compete when it can change the rules to win. To have government serve simultaneously as a regulator and a competitor defies common sense.
* The national health insurance exchange represents a federal takeover of the states’ role in regulating health insurance. States are the primary regulators of the health insurance market today. They provide aggressive oversight of all aspects of the market and ensure a local, responsive presence for consumers. A national health insurance exchange would shift decision- making to Washington and undermine states’ oversight role in health care.
* The national health insurance exchange would lead to a “Robin Hood in reverse” funding scheme in which states with lower health care costs subsidize states with higher costs. Health care costs vary considerably among states. If the national health insurance exchange leads to creating a regional or national pool, low-cost states would subsidize high-cost states. While this may be a good deal for a high-cost state, low-cost states would end up paying more for health insurance premiums.
* The public plan and national health insurance exchange will lead to single-payer health care . Political pressure to keep public plan premiums low and benefits high will result in the “crowding out” of private sector insurance alternatives. The Lewin Group estimates that nearly 119 million Americans will drop private coverage and enroll in the government plan. This represents a 60% reduction in the number of Americans with private health insurance—not to mention a significant drop in much-needed state premium tax revenue.
We all share the goal that patients deserve to choose their own quality, affordable, private health coverage. But health reform shouldn’t just be the job of the federal government. These goals are being advanced—and achieved—by state legislators nationwide. ALEC is a national leader in promoting many patient-centered health reforms at the state level, including:
* The Freedom of Choice in Health Care Act , introduced by seven states this session, which preserves patient rights to make health coverage decisions in the state constitution.
* The Health Care Choice Act for States , introduced by 10 states this session, which allows patients to purchase quality, affordable health coverage across state lines.
* The Affordable Health Insurance Act , enacted in Georgia last session, which provides state tax breaks to individuals, businesses, and insurers who buy and sell high-deductible health plans.
* The Mandated Benefits Review Act , enacted in 29 states, which provides an institutional check on costly health insurance mandates that keep people uninsured.
We wanted to thank you for taking the time to read this letter. Again, ALEC is troubled by the public plan and national health insurance exchange, which we believe will trample states’ rights and lead Americans down the road to single-payer health care. Our health policy staff welcomes the chance to work with you on developing patient-centered, free-market reforms—and we look forward to sharing with you the stories of ALEC’s state legislators who are advancing and achieving these goals every day.
Cordially,
William J. Howell Linda Upmeyer Alan B. Smith Speaker of the House, Virginia Minority Whip, Iowa House Executive Director, ALEC National Chairman, ALEC Chair, ALEC HHS Task Force
1101 Vermont Ave., NW, 11th Floor – Washington, DC 20005 – 202-466-3800 – f 202-466-3801 – www.alec.org 2
Representative Greg Canfield Representative Ed Garner Alabama House District 48 Arkansas House District 41
Representative Richard Laird Representative Dan Greenberg Alabama House District 37 Arkansas House District 31
Representative Cecil Ash Senator Barbara Horn Arizona House District 18 Arkansas Senate District 21
Representative Nancy Barto Senator Johnny Key Chairman, HHS Committee Arkansas Senate District 1 Arizona House District 7 Senator Jerry Taylor Senator Pamela Gorman Arkansas Senate District 23 Majority Whip Arizona Senate District 6 Representative Cindy Acree Colorado House District 40 Senator Jack Harper Arizona Senate District 4 Representative Kent Lambert Colorado House District 14 Representative John Kavanagh Arizona House District 8 Representative William Hamzy Deputy Minority Leader Representative Debra Lesko Connecticut House District 78 Arizona House District 9 Representative Lawrence Miller Representative John McComish Connecticut House District 122 Majority Leader Arizona House District 20 Representative Brad Drake Florida House District 5 Senator Russell Pearce Arizona Senate District 18 Representative Clay Ford Florida House District 3 Representative James P. Weiers Arizona House District 12 Representative D. Alan Hays Florida House District 25 Representative Steven B. Yarbrough Speaker of the House Representative Charlice Byrd Arizona House District 21 Georgia House District 20
Senator Cecile Bledsoe Representative Sharon Cooper Arkansas Senate District 8 Chairman, HHS Committee Georgia House District 41 Representative Leslie Carnine Arkansas House District 94
1101 Vermont Ave., NW, 11th Floor – Washington, DC 20005 – 202-466-3800 – f 202-466-3801 – www.alec.org 3
Representative Tom Graves Representative David Frizzell Georgia House District 12 Minority Whip Indiana House District 93 Representative Calvin Hill Georgia House District 21 Representative Eric Koch Indiana House District 65 Representative John Meadows Georgia House District 5 Representative Cindy Noe Indiana House District 87 Representative James Mills Georgia House District 25 Representative William Ruppel Indiana House District 22 Representative Tom Rice Georgia House District 51 Representative Eric Turner Indiana House District 32 Senator Chip Rogers Majority Leader Representative David Wolkins Georgia Senate District 21 Indiana House District 18
Representative Donna Sheldon Representative Linda Miller Georgia House District 105 Iowa House District 82
Senator Renee Unterman Senator James Seymour Vice-Chairman, HHS Committee Iowa Senate District 28 Georgia Senate District 45 Representative Richard Carlson Representative Gene Ward Kansas House District 61 Hawaii House District 17 Representative Mitch Holmes Representative James Clark Kansas House District 114 Idaho House District 3 Representative Steve Huebert Senator Patti Anne Lodge Kansas House District 90 Idaho Senate District 13 Senator Richard Kelsey Representative Jeff Thompson Kansas Senate District 26 Idaho House District 33 Representative Forrest Knox Senator Dale Risinger Kansas House District 13 Illinois Senate District 37 Representative Peggy Mast Representative Timothy Brown Kansas House District 76 Indiana House District 41 Representative Don Myers Representative Bill Davis Kansas House District 82 Indiana House District 33
1101 Vermont Ave., NW, 11th Floor – Washington, DC 20005 – 202-466-3800 – f 202-466-3801 – www.alec.org 4
Senator Ralph Ostmeyer Representative Susan Krebs Kansas Senate District 40 Maryland House District 9B
Representative Joe Patton Representative Tanya Shewell Kansas House District 54 Maryland House District 5A
Senator Mary Pilcher-Cook Representative Nancy Stocksdale Kansas Senate District 10 Maryland House District 5A
Representative Marc Rhoades Representative Matt Dean Kansas House District 72 Minnesota House District 52
Representative Don Schroeder Representative Steve Drazkowski Kansas House District 74 Minnesota House District 28B
Representative Scott Schwab Representative Sidney Bondurant Kansas House District 49 Mississippi House District 24
Senator Tom Buford Representative Becky Currie Vice-Chair, H & W Committee Mississippi House District 92 Kentucky Senate District 22 Representative Jeffrey S. Guice Senator Julie Denton Mississippi House District 114 Chairman, H & W Committee Kentucky Senate District 36 Representative Steven Palazzo Mississippi House District 116 Representative Mike Harmon Kentucky House District 54 Representative Gary Staples Mississippi House District 88 Representative Jackie Westwood Kentucky House District 23 Representative Sue Allen Missouri House District 92 Representative Frank Hoffman Louisiana House District 15 Representative Cynthia Davis Missouri House District 19 Senator Doug Smith Maine Senate District 27 Representative Ed Emery Missouri House District 126 Senator Carol Weston Maine Senate District 23 Representative Doug Ervin Missouri House District 35 Representative Gail Bates Maryland House District 9A Representative Cole McNary Missouri House District 86 Representative Adelaide Eckardt Maryland House District 37B
1101 Vermont Ave., NW, 11th Floor – Washington, DC 20005 – 202-466-3800 – f 202-466-3801 – www.alec.org 5
Representative Therese Sander Representative Jordan Ulery Missouri House District 22 New Hampshire House District 27
Representative Dee Brown Representative Francine Wendelboe Montana House District 3 New Hampshire House District 1
Senator Roy Brown Representative Anna Marie Crook Majority Whip New Mexico House District 64 Montana Senate District 25 Senator William Sharer Representative Dennis Himmelberger New Mexico Senate District 1 Montana House District 47 Senator Owen Johnson Representative Gary MacLaren New York Senate District 4 Montana House District 89 Representative George Cleveland Representative Mike Miller North Carolina House District 14 Montana House District 84 Senator John Andrist Representative Michael More North Dakota Senate District 2 Montana House District 70 Representative David Monson Representative Ken Peterson Speaker of the House Montana House District 46 North Dakota House District 10
Representative Cary Smith Representative John Adams Montana House District 55 Minority Whip Ohio House District 78 Representative James Settelmeyer Nevada House District 39 Representative Danny Bubp Ohio House District 88 Representative Jennifer Coffey New Hampshire House District 6 Representative Tim Derickson Ohio House District 53 Representative Gary Daniels New Hampshire House District 6 Representative Kris Jordan Ohio House District 2 Senator Robert Letourneau New Hampshire House District 19 Representative Jarrod Martin Ohio House District 70 Representative Beverly Rodeschin New Hampshire House District 2 Representative Seth Morgan Ohio House District 36 Representative William Smith New Hampshire House District 18 Representative Barbara Sears Ohio House District 46
1101 Vermont Ave., NW, 11th Floor – Washington, DC 20005 – 202-466-3800 – f 202-466-3801 – www.alec.org 6
Representative Joe Uecker Representative Betty Olson Ohio House District 66 South Dakota House District 28B
Senator Bill Brown Representative Jimmy Eldridge Oklahoma Senate District 36 Tennessee House District 73
Representative Sally Kern Representative Joshua Evans Oklahoma House District 88 Tennessee House District 66
Representative Ron Peters Representative Dale Ford Oklahoma House District 70 Tennessee House District 6
Representative Pam Peterson Representative Susan Lynn Oklahoma House District 67 Tennessee House District 57
Representative Sal Esquivel Representative William A. Callegari Oregon House District 6 Texas House District 136
Representative Bruce Hanna Representative Dan Flynn Minority Leader Texas House District 2 Oregon House District 7 Representative Kelly Hancock Representative Bill Kennemer Texas House District 91 Oregon House District 39 Representative Jodie Laubenberg Representative Gene Whisnant Texas House District 89 Oregon House District 53 Representative Jerry Madden Representative Ronald S. Marsico Texas House District 67 Pennsylvania House District 105 Representative John Otto Senator Chip Campsen Texas House District 18 South Carolina Senate District 43 Senator Curtis Bramble Senator Thomas Alexander Utah Senate District 15 South Carolina Senate District 1 Representative Christopher N. Herrod Representative Garry Smith Utah House District 62 South Carolina House District 27 Senator Wayne Niederhauser Senator Daniel Verdin Utah Senate District 8 South Carolina Senate District 9 Representative Carl Wimmer Representative Phil Jensen Utah House District 52 South Dakota House District 33
1101 Vermont Ave., NW, 11th Floor – Washington, DC 20005 – 202-466-3800 – f 202-466-3801 – www.alec.org 7
Delegate Kathy Byron Representative Matt Shea Virginia Delegate District 22 Washington House District 4
Delegate Mark L. Cole Delegate Jonathan Miller Virginia Delegate District 88 West Virginia Delegate District 53
Delegate James Massie Delegate Ronald N. Walters Virginia Delegate District 72 West Virginia Delegate District 32
Delegate Christopher Peace Senator Alberta Darling Virginia Delegate District 97 Wisconsin Senate District 8
Delegate Lacey Putney Representative Scott Suder Virginia Delegate District 19 Wisconsin House District 69
Senator Frederick M. Quayle Representative Amy Edmonds Virginia Senate District 13 Wyoming House District 12
Senator Frank Ruff Representative Peter Illoway Virginia Senator District 15 Wyoming House District 42
Delegate Robert Tata Senator Curt Meier Virginia Delegate District 85 Wyoming Senate District 3
Senator Jerome Delvin Representative Sue Wallis Washington Senate District 8 Wyoming House District 52
Representative Bill Hinkle Washington House District 13
cc:
Senator Robert Byrd Senator Chuck Grassley Senator Mitch McConnell Senator Edward Kennedy Senator Jon Kyl Senator Michael Enzi Representative Steny Hoyer Representative Charles Rangel Representative Jim Clyburn Representative Dave Camp Representative John Boehner Representative George Miller Representative Eric Cantor Representative John Kline Senator Max Baucus Representative Henry Waxman Representative Joe Barton
1101 Vermont Ave., NW, 11th Floor – Washington, DC 20005 – 202-466-3800 – f 202-466-3801 – www.alec.org 8
cc: ALEC members in Congress: Representative Rodney Alexander Representative Frank LoBiondo Representative Steve Austria Representative Frank Lucas Representative Spencer Bachus Representative Blaine Luetkemeyer Representative Marsha Blackburn Representative Ken Marchant Representative John Boehner Representative Tom McClintock Representative Dan Boren Representative John McHugh Representative Leonard Boswell Representative Cathy McMorris Rodgers Representative F.A. Boyd Representative Kendrick Meek Representative Kevin Brady Representative John Mica Representative Ginny Brown-Waite Representative Jeff Miller Representative Dan Burton Representative Jerry Moran Representative David Camp Representative Erik Paulsen Representative John Campbell Representative Ed Perlmutter Representative Eric Cantor Representative Joseph Pitts Representative Howard Coble Representative Todd Platts Representative Tom Cole Representative Bill Posey Representative John Culberson Representative Thomas Price Representative Charlie Dent Representative Adam Putnam Representative Mario Diaz-Balart Representative Michael J. Rogers Representative Mary Fallin Representative Mike Rogers Representative John Randy Forbes Representative Ileana Ros-Lehtinen Representative Rodney Frelinghuysen Representative Lucille Roybal-Allard Representative Scott Garrett Representative Edward Royce Representative James Gerlach Representative Jean Schmidt Representative Phil Gingrey Representative Kurt Schrader Representative Sam Graves Representative Michael Simpson Representative Brett Guthrie Representative Adrian Smith Representative Doc Hastings Representative John Sullivan Representative Lynn Jenkins Representative Todd Tiahrt Representative Sam Johnson Representative Pat Tiberi Representative Walter Jones Representative Lynn Westmoreland Representative Jim Jordan Representative Joe Wilson Representative Steve King Representative Don Young Representative Jack Kingston Senator Michael Enzi Representative Suzanne Kosmas Senator Lindsey Graham Representative Doug Lamborn Senator James Inhofe Representative Robert Latta Senator Jim Risch Representative Jerry Lewis Senator Richard Shelby Representative John Linder Senator Roger Wicker
1101 Vermont Ave., NW, 11th Floor – Washington, DC 20005 – 202-466-3800 – f 202-466-3801 – www.alec.org 9