Posted on November 11, 2009

Three Frequently Asked Questions about the House Bill HR 3962 and Reform


By Mass-Care: The Massachusetts Campaign for Single Payer Health Care

1) What is actually in the bill that passed and how will it impact Massachusetts?

2) What happened to the single payer amendments, and is there more we can do to support making health care a right this Congressional session? and

3) How do we respond to Democratic organizations (such as, Organizing for America, etc) who have threatened to punish Representatives voting against the bill?

HR 3962, the Affordable Health Care for America Act (AHCAA), has a number of “market reforms” - such as preventing insurance companies from denying coverage to people with pre-existing conditions, limiting their ability to drop people who become sick, and limits on how much they can charge different premiums based on who is applying. These reforms would go into effect immediately, but we have most of these already in Massachusetts, so the bill would have little short-term impact in our state, but would curb some of the worst excesses of the insurance industry in other states. Remember, these are terrible, morally reprehensible excesses that should be banned, but they are not at the root of our health care crisis, which is high and rising costs and unequal access to care.

The main provisions of the AHCAA wouldn’t go into effect until 2013. This was done because the President promised to keep the bill under $1 trillion over 10 years, and this is only possible by delaying implementation until the 4th year, making a 6 year budget look like a 10 year budget. If reform passes through the Senate and is signed into law by President Obama, we are likely to see no change whatsoever in Massachusetts for the next three years.

Two of the major components in the bill that would begin in 2013 also will have little impact in Massachusetts: an individual mandate requiring uninsured people to purchase insurance, and subsidies for low-income people. These policies are already in place in Massachusetts, however the national bills are tending towards affordability standards that are worse than what we have in MA.

Virtually the only thing that would be new for Massachusetts is the public option. The public option in the House bill would begin in 2013, when it would be open only to uninsured individuals and to employers with 25 or fewer employees. In 2014 the public option would be open to employers with 50 or fewer employees, and in 2015 those with 100 or fewer employees. Beyond 2015, a federal Commissioner would have discretion over opening the public option to larger employers. The public option would not be allowed to pay Medicare rates to health care providers, but would have to negotiate rates on its own in each state. This arrangement virtually guarantees that the public option will have few enrollees, and little bargaining clout with which to negotiate fair prices with providers. The law also bans the option from negotiating rates lower than Medicare rates, as well as paying rates higher than the average paid by private insurers. If private insurers are able to cherry pick healthy enrollees, while the sick and expensive turn to the public plan for help, this will mean the public plan cannot raise its rates and will have to go bankrupt.

On July 30, 57 members of the Congressional Progressive Caucus (CPC) wrote a letter to the House Leadership stating that they would NOT vote for a bill that did not include a public option based on Medicare rates. The letter was signed by 5 Massachusetts representatives. However, only 2 signers of the letter - single payer leaders - actually voted against 3962 over the weekend, Dennis Kucinich of Ohio and Eric Massa of New York. Here are links to the CPC letter, and press releases from Kucinich and Massa on their votes:,24&itemid=466

The Kucinich amendment which would have granted individual states the ability to choose single payer was stripped out of the bill before it was brought to the House floor. Most amendments were not allowed to come up, and so there was limited ability for grassroots advocates to have an impact on this decision. A full floor vote on single payer was also supposed to be introduced by Representative Anthony Weiner from New York, but was withdrawn at the last moment. See these links for press releases from Representative Weiner and Speaker Pelosi:

There will still likely be a single payer vote on the floor of the Senate, however, introduced by Bernie Sanders. PLEASE contact your two Senators Kirk and Kerry to ask them to vote YES!

If you are a member of or Organizing for America, please let your voice be heard that they should not be in the business of punishing progressive legislators who attempt to hold the line on health reform that serves the people. In the House, Kucinich and Massa merely followed through on the promise made by the Progressive Caucus not to support reform without a strong public option. Senator Bernie Sanders is similarly promising not to vote for a bill without a strong public option on the Senate - for public option advocacy groups to attack the progressive wing of their own movement will be incredibly self-destructive.

Thank you for all your continued work, and we will keep you updated as Congressional health reform moves ahead!