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U.S. Rep. Doggett: Settling for Second-Rate Health Care Doesn’t Serve Texans

Doggett, Members of the Texas Democratic Delegation Urge President Obama, House Leadership to Adopt National Health Insurance Exchange

WashingtonToday, U.S. Congressman Lloyd Doggett (D-TX-25), a senior Member of the Ways and Means Health Subcommittee, and Members of the Texas Democratic Delegation, urged President Obama, Speaker Pelosi, and Majority Leader Hoyer, to adopt a single, national health insurance exchange, to protect Texans from second-rate care.  A state-based plan reduces the market leverage of the exchange, increases complexity, and relies on laggard state leadership that, in Texas, would be unwilling or unable to administer the exchange, leaving millions of Texans no better off. Larger exchanges and stronger regulators are better exchanges with more competition and more protection for consumers.  The Members urged adoption of the House’s national exchange.

“With 1 in 4 Texans living without insurance, we should not settle for second-rate care.  Instead we should ensure access to the lowest cost, highest-quality insurance plans, which means we need a national health insurance exchange,” said Rep. Doggett. 

Historically in Texas, relying on state authority to provide care for its citizens has proved a treacherous path.  As it stands today, not one Texas child has received any benefit from the Children’s Health Insurance Program Reauthorization Act approved by Congress early last year. 

The U.S. House of Representatives and U.S. Senate are currently working to merge their two bills, which will be sent to President Obama’s desk for signature.  

[The full text of the letter follows below] 

A letter was sent to Speaker Pelosi and Majority Leader Hoyer and President Obama. 

 President Barack Obama 

The White House 

1600 Pennsylvania Ave NW 

Washington, D.C. 20500

 Dear Mr. President: 

In adjusting the House and Senate versions of health insurance reform legislation, we know you share our goal of achieving reform that is real and meaningful.  Any bill that we support must not shortchange Texans by including weak, state-based health insurance exchanges. We cannot support second-rate coverage in our state with the highest rate of uninsured in the country – where 1 in 4 Texans lack insurance and health insurance premiums have increased more than 100% since 2000.  In order to ensure that Texans have access to the lowest cost, highest-quality health insurance plans as soon as possible, the bill we pass should include a single, national health insurance exchange, as adopted by the House in the Affordable Health Care for America Act. 

The House bill establishes a national insurance exchange, but allows states with the political will and the resources available to establish their own exchanges, as long as the state-based exchange meets the same strong standards as the national health insurance exchange. This approach protects existing state exchanges and allows innovation, while ensuring that consumers enjoy the same coverage and protections afforded in the national exchange.   

As you know, the Senate bill does not establish a national health insurance exchange. Instead, each state is required to set up its own exchange. If the state does not set up the exchange, then the Secretary of Health and Human Services is required to set up an exchange for the state. The states will set up one exchange for individual coverage and another exchange for small businesses. The state may also set up regional exchanges within the state, which would create multiple exchanges in one state. 

This approach not only reduces the market leverage of the exchange and increases complexity, but it also relies on states with indifferent state leadership that are unwilling or unable to administer and properly regulate a health insurance marketplace. A number of states opposed to health reform have already expressed an interest in obstruction. 

In Texas, we know from experience that the dangers to the uninsured from greater State authority are real.  Not one Texas child has yet received any benefit from the Children’s Health Insurance Program Reauthorization Act (CHIPRA), which we all championed, since Texas declined to expand eligibility or adopt best practices for enrollment. We also know that when states face difficult budget years, among the first programs to see reductions is Medicaid. The Senate approach would produce the same result — millions of people will be left no better off than before Congress acted.  Further, multiple exchanges fracture the market, diluting the risk pooling benefits of the exchange. This will be especially true if the state sets up multiple exchanges. Also, many states currently only have one or two dominant insurers. State-based exchanges will do nothing to bring more insurers into the area. The Senate bill also allows insurance companies to continue offering insurance outside of the exchange. This further weakens the risk pooling effect of the exchanges and creates incentives for adverse selection.  

Reforming our nation’s health care system is a national effort that requires a national solution, not a piecemeal approach.  A single, national health insurance exchange will not only administer federal affordability credits and receive federal start-up funds, but will also be charged with enforcing federal laws and regulations.  As the Commonwealth Fund recently reported, a single, national health insurance exchange would ensure uniform, national availability of health insurance plans, better serve consumers, and have the resources to appropriately regulate insurers.   

As we work toward the conclusion of the health care bill, please help us ensure that our constituents receive the care they deserve.  We are grateful for your leadership in advancing this reform and we stand ready to support your efforts to establish a national health insurance exchange.              

Lloyd Doggett                                                              Gene Green

 Henry Cuellar                                                               Solomon Ortiz

Sheila Jackson Lee                                                       Ciro Rodriguez


Silvestre Reyes                                                             Eddie Bernice Johnson

Charles Gonzalez                                                          Al Green

Ruben Hinojosa


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