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It's Time to Act

February 26, 2010

President Barack Obama

Senator Harry Reid Majority Leader

Senator Max Baucus, Chairman, Committee on Finance Senator

Tom Harkin Chairman, Committee on Health Education Labor and Pensions

Congresswoman Nancy Pelosi Speaker of the House of Representatives Congressman

Charles Rangel Committee on Ways & Means

Congressman Henry A. Waxman Committee on Energy and Commerce

Congressman George Miller Committee on Education and Labor

Dear Mr. President, Congressmen and Congresswomen

Our health care system is in crisis. America has higher per-capita medical spending than any other industrial democracy, Health care spending continues to increase, and is projected to reach $3.3 trillion by 2019. Health insurance premiums are rising rapidly, particularly within individual and small group markets. Meanwhile, the financial security traditionally offered by health insurance continues to erode, with rapid increases in out-of-pocket spending. Rising public health care program costs are driving large, ultimately unsustainable state and federal budget deficits. It is likely that more than 50 million Americans are now uninsured, with more losing coverage every day due to the twin challenges of deep recession and rising health care costs. Although this country has some of the best medical technology in the world, the quality and effectiveness of medical care often falls short of what every American deserves.

This week, the President put forth a proposal for finishing the job of enacting comprehensive health care reform with which Congress has struggled for the past year. Yesterday the President, House, and Senate leaders from parties spent much of the day in a nationally televised health care summit. This meeting identified areas of bipartisan agreement—many of which are already included in pending legislation. It also identified areas where future bipartisan agreement might be possible, such as malpractice reform. Yet the meeting also underscored the profound differences that separate the leadership of the two parties. Most notably, the President's proposal would cover 30 million people who would otherwise remain uninsured. The Congressional Budget office reports that Republican proposals would only expand coverage to 3 million.

We commend the President’s pursuit of bipartisan solutions. Yet the summit made plain that it is now time to move decisively and quickly to enact comprehensive reform. We believe that the only workable process at this point is to use the President's proposal to finish the job. After long debate, the House and Senate have passed two similar bills that do crucial things to improve US health care. All that needs to happen, if Republicans insist on blocking final improvements, is for the House and Senate to make the required adjustments and to pass these bills by majority vote in both houses. Given the likelihood of a filibuster, this legislation will likely require the majority-vote reconciliation process. Reconciliation has been used by both Democrats and Republicans to enact welfare reform, Reagan and Bush-era tax cuts, the state children's health insurance programs (SCHIP), and other key legislation. Reconciliation is an appropriate and justified mechanism to secure an up-or-down vote on this critical bill.

The President's proposal incorporates many of the best ideas proposed by Democrats and Republicans, patients, clinicians, and researchers. It combines and strengthens many elements of the House and Senate bills and repairs their deficits. It offers a strong foundation for comprehensive reform. Fully implemented, the President's proposal would:

  • Cover more than 30 million people who would otherwise go uninsured.
  • Provide financial help to make coverage affordable for millions of working families.
  • Strengthen competition and oversight of private insurance through insurance exchanges and increased regulation of private insurers and their rates
  • Provide unprecedented protection for Americans living with chronic illnesses and disabilities
  • Make significant investments in community health centers, prevention, and wellness.
  • Increase financial support to states to finance expanded Medicaid insurance coverage
  • Eliminate the Medicare prescription drug "donut hole"
  • Eliminate objectionable provisions such as special funds for Nebraska's Medicaid program
  • Reduce the federal budget deficit over the next ten years and beyond.
  • Provide a platform to improve the quality and economy of the health care system and to slow future growth of health expenditures.

We, the signatories of this letter, come from different perspectives. Some of us are long-standing advocates of progressive causes. Some of us are nonpartisan or identify as political moderates. From these differing perspectives, we agree on one thing: After months of extensive debate, expert analysis, and the historic passage of House and Senate bills, it is time to pass a final bill. The President's proposal provides a foundation for finishing this work -- and for future steps to build on this foundation..

It may be possible, as the President suggested, to incorporate proposals put forth by the Republican leadership. This proposal already incorporates many traditional Republican ideas for health reform, such as tax credits to help middle-income Americans pay for health care, organizing markets through health insurance exchanges, and creating a regulatory structure that allows insurers to sell coverage across state lines.

Time is short, however. If Republican leaders do not promptly offer constructive proposals in the context of comprehensive legislation that has already passed both the Senate and the House, Congress must move forward. It is time to act.


Henry Aaron, Brookings Institution
Emily Abel, UCLA
Ronald Andersen, UCLA
Dean Baker, Center for Economic and Policy Research
Ronald Bayer, Columbia
Linda Bergthold, Independent Consultant and Health Policy Researcher
Linda Blumberg, Urban Institute
Peter Bourne, Health Policy Advisor, President Jimmy Carter
Richard Brown, UCLA
Anna Burger, Secretary-Treasurers, SEIU
Deborah Burnett, University of Chicago
Paul Cleary, Yale University
David Cutler, Harvard University
Stephen Davidson, Boston University
Linda Degutis, Yale University
Judith Feder, Georgetown University
Eric Feldman, University of Pennsylvania
Brian Flay, Oregon State University
Lawrence Gostin, Georgetown University
David Grande, University of Pennsylvania
Tim Greaney, Saint Louis University
Colleen Grogan, University of Chicago
Jonathan Gruber, MIT
Jacob Hacker, Yale University
Mark Hall, Wake Forest University
Helen Halpin, University of California, Berkeley
Bradley Herring, Johns Hopkins University
Diana W. Hilberman, UCLA
Jim House, University of Michigan
Jill Horwitz, University of Michigan
William Hsiao, Harvard University
John Jacobi, Seton Hall University
Peter Jacobson, University of Michigan
Timothy Jost, Washington and Lee University
Daniel Kahneman, Princeton University
Rosalie A. Kane, University of Minnesota
George Kaplan, University of Michigan
Jerome Karabel, University of California, Berkeley
Eleanor Kinney, Indiana University-Indianapolis
Mark Kleiman, UCLA
Gerald Kominski, UCLA
Karl Kronebusch, Baruch College, City University of New York
Paula Lantz, University of Michigan
Miriam Laugesen, Columbia University
Robert Leflar, University of Arkansas
Arleen A. Leibowitz. UCLA
Carol Mangione, UCLA
Willard Manning, University of Chicago
Wendy Mariner, Boston University
Ted Marmor, Boston University
Jerry Mashaw, Yale University
Timothy McBride, Washington University
Michael Millenson, Northwestern
Farideh Motamedi, USC
Fitzhugh Mullan, George Washington University
Jack Needleman, UCLA
Len Nichols, George Mason University
Jonathan Oberlander, University of North Carolina
Gilbert Omenn, University of Michigan
Alexander Ortega, UCLA
David Orentlicher, Indiana University-, Indianapolis
Kevin Outterson, Boston University
Frank A. Pasquale, Seton Hall University
Mark Peterson, UCLA
Phillip Pizzo, Stanford University
Harold Pollack, University of Chicago
Daniel Polsky, University of Pennsylvania
Ninez Ponce, UCLA
Marc Rodwin, Suffolk University
Victor Rodwin, New York University
Sara Rosenbaum, George Washington University
Meredith Rosenthal, Harvard University
Lainie Friedman Ross, University of Chicago
William Sage, University of Texas
Jim Scott,, George Washington University School of Medicine and Health
Mark Schlesinger, Yale University
Steven Shortell, University of California, Berkeley
Theda Skocpol, Harvard University
Barbara Starfield, Johns Hopkins University
Paul Starr, Princeton University
Rosemary Stevens, Cornell University
Katherine Swartz, Harvard University
Donald H. Taylor, Jr., Duke University
William Terry, Brigham and Women's Hospital
James Toole, MBA Actuaries
James Tulsky, Duke University
Alexander Wagenaar, University of Florida
Rachel Werner, University of Pennsylvania
Celia Wcislo, SEIU
Joe White, Case Western University
Elizabeth Yano, UCLA
Fred Zimmerman, UCLA

(Titles and degrees omitted.  Institutional affiliations for identification