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Contacted House of Representative John Carter and his reply

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I contacted my House of Representative John Carter, to voice my opinion, to urge him to oppose President Obama's pro abortion health care plan.

April 5, 2010

Mr. Nicholas S. Baker
[address deleted ]

Dear Mr. Baker:

Thank you for contacting me express your opposition to the health care reform plan pushed by President Obama and his congressional allies. Your constant support and comments helped guide me in my decision to oppose this plan.

As you already know, the Democrats passed the government takeover of health care and President Obama signed it into law on March 23, 2010. It passed without my support or the support of any Republicans. While bipartisan legislation could have benefitted all Americans and enacted true reform, the only thing bipartisan about this bill was the 34 Democrats who united with Republicans in opposition. This victory was one of politics--not a victory for the best interests of the American people. You spoke loudly and they did not listen.

I recognize that this health care legislation does make some positive changes in health care reform. For instance, it prevents insurance companies from denying people coverage because of preexisting conditions, prevents people from getting dropped from their plans if they fall ill, and allows children to stay on their parents' insurance plans until they turn 26.

This legislation will force nearly 9 million Americans to lose the coverage they currently have. This is because they will be forced to purchase "acceptable" health care coverage or face a tax of 2.5% of modified adjusted gross income. The definition provided in the bill for "acceptable" coverage will require people to purchase plans that include coverage they cannot afford, or don't want or need. That said, your insurance premiums will increase by 10-13%. This is because the bill creates new taxes on insurance policies, health care products, and new regulations that drive up costs for patients of any and all ages.

With a looming trillion-dollar deficit with no solution in sight, we can't afford this bill. The total cost of the bill, estimated by the non-partisan Congressional Budget Office (CBO), is more than $1.33 trillion, when including the cost to states for mandated Medicaid expansion ($20 billion) and authorized discretionary spending for grants, public programs, changes and funding for a variety of agencies that would be responsible for implementing the bill. The "true cost" of the bill once fully implemented (FY2014-2023) is over $2.6 trillion.

One of the major expenses is the sheer administrative cost of all that this bill plans to do. The bill creates 159 new government agencies to regulate insurance and medical care for Americans. To do much of the administering, the bill has expanded the Internal Revenue Services' powers. The IRS will have to hire to 16,500 additional auditors, agents, and other employees just to enforce all the new taxes and penalties. The bill would empower the IRS to: (1) verify that Americans have "acceptable" health care coverage; (2) fine Americans up to $2,085 or 2 percent of income (whichever is greater) for the failure to purchase "minimum essential coverage"; (3) confiscate tax refunds; and (4) increase audits.

Adding to the estimated cost of this bill is the fact that it fails to adequately address tort reform and citizen verification. Due to vague language in the bill, individuals applying for low-income affordability subsidies, enrolling in Medicaid/CHIP, or enrolling in high risk pools are not required to verify their citizenship, therefore opening the door for coverage of illegal immigrants. Instead of real tort reform that was addressed prolifically in Republican ideas, the Democrats chose to side with trial lawyers rather than eliminate the costs associated with defense medicine. Texas has been a model for medical malpractice law, capping damages awards and lessening the malpractice insurance for doctors that often drives up the cost of health care.

Overall, the bill increases taxes by $569.2 billion over ten years, including taxes that will harm small businesses and middle-class families.

President Obama, in his campaign, promised that he would not tax the middle class. However, this bill contains direct and indirect taxes that would raise taxes on those making less than $200,000 for singles and $250,000 for couples. These include: (1) a "Cadillac tax" on high-cost plans, (2) an individual mandate tax on Americans who do not purchase government-approved health insurance, (3) an increase in the 7.5% AGI floor for medical expense deductions to 10%, (4) limits on Flexible Spending Accounts in cafeteria plans, (5) increased penalties for nonqualified HSA distributions, (6) other restrictions on Health Savings Accounts, Health Reimbursement Accounts, and Flexible Spending Accounts, (7) a tax on tanning services, (Cool an employer mandate tax, (9) a sales tax on medical devices, (10) a tax on health insurance premiums, (11) a tax on prescription drugs, and (12) a tax on insured and self-insured health plans.

At a time when small businesses are struggling to keep their doors open, we should be cutting taxes to encourage their growth to rejuvenate our economy. However, this health care bill taxes small businesses in a way that could very well put them out of business. The employer mandate imposes a new tax on business, which will destroy current and new jobs during a time when millions of Americans are already unemployed. Employers who do not offer coverage would face a $2,000 fine per employee - if at least one full-time employee is enrolled in an exchange plan and receives a premium subsidy. Even if an employer offers coverage, it will have to pay up to $3,000 per employee if the coverage is deemed "unaffordable" by the federal government.

This bill is already having a detrimental effect on our economy. Some of our biggest businesses and providers of hundreds of thousands of American jobs already feel the burden of the tax hikes imposed by this bill. It will cost Caterpillar, world's largest producer of bulldozers, $100 million, farm equipment maker Deere & Co. will face $150 million in increased costs, and AT&T will face $1 billion in first quarter costs, triggered by a change in the tax treatment of Medicare subsidies. Due to this astronomical cost, AT&T must now consider changes to the benefits it offers its current and retired employees.

One of the worst parts of this legislation is how it affects Medicare. In short, the bill includes $528.5 billion in cuts to Medicare, cutting benefits and raising premiums on seniors. These cuts are not used to reduce the deficit, or improve the solvency of the Medicare program but instead to create new entitlement programs. CBO released an analysis detailing just how harmful these cuts would be to those on Medicare Advantage (MA). Today, nearly 11 million seniors rely on MA plans for their health benefits. This program is targeted for $135.6 billion in cuts. CBO then confirms that because of these cuts, 4.8 million fewer seniors will be enrolled in these plans in 2019. It would further close the Medicare Part D "donut hole" by increasing the drug discount program by $5 billion (to $42.6 billion), and increase the Medicare cuts from the Independent Payment Advisory Board (IPAB) by $2.2 billion (to $15.5 billion).

The Medicare payroll tax will increase by 0.9% on individuals making $200,000 and families making $250,000 (not indexed to inflation), which in turn creates a new marriage penalty and over time will hit more of the middle class. Furthermore, the bill adds an additional 3.8% tax on net investment income for these same individuals, estates, and trusts (net gain from selling property).

The increase in federal spending on Medicaid /Children's Health Insurance Program (CHIP) would be by $48 billion, making it $434 billion. Additionally, we all know that one of the factors driving up health care costs is the estimated $80 billion in taxpayer dollars lost every year due to Medicare and Medicaid fraud. Regardless, the bill drastically expands the currently unsustainable Medicaid program from 100% of the federal poverty level to 133%. For Texas, that means a $24 billion state liability over the next ten years.

As you well know, this bill does not prohibit the federal funding of abortions. In order to gain votes, the President issued an Executive Order to prohibit funding for abortions. However, an Executive Order in no way changes the law, and for that matter can be rescinded just as easily was it was written. Therefore, the only way to truly prevent taxpayer funding of abortions is to enact a law that prevents taxpayer funding of abortions. This legislation does not meet that standard. Please know that as a committed member of the Pro-Life Caucus, I will continue to defend the sanctity of human life at all stages and will fight for the unborn on this issue.

You may be wondering, "What now?" This was most likely the most unpopular and unconstitutional bill ever approved by Congress through illegal procedures and deception, but I want you to know that the fight to kill this bill is not over.

Repeal is an option, but it's important to qualify this. With a new House in January we can strip the federal government of the ability to implement this bill. However, President Obama will still be in office and have the power of veto. To that end, only with a supermajority can we override a veto, or by winning the Presidency in 2012 can we repeal it outright.

However, I have joined with my Republican colleagues to overturn this legislation and approach solutions for real reform. You may be interested to know that I have begun a multi-tiered approach to stopping this bill. Not only will I work to repeal and replace it, but I have joined 15 other states' attorney generals in an effort to challenge the constitutionality of this law.

We all agree that the status quo in health care is unsustainable. It's too expensive; it's bankrupting families with major illnesses and bankrupting the government. Every American should have access to affordable health insurance, and the ability to acquire preventive health care and treatment - regardless of employment, health status, or income level. However, the solution to the health care problem is not more government control.

I will work tirelessly to stop the threat to freedom and the degradation of our economic competitiveness that this bill will cause, and I will work to stop this bill from entering your life. I will continue to work tirelessly for the best interests of America and Central Texas. I have attached a timeline of the implementation dates of the provision in this bill. Thank you once again for your support and action, and for taking the time to keep me updated with your views. Please do not hesitate to contact me in the future if I can be of any further assistance.


John Carter
Member of Congress

For more information on what I am doing in Congress, please visit my website at http://www.house.gov/carter. If you would like a weekly update, you may also sign up to receive my newsletter while you're there.

Wall Street Journal, March 22, 2010


* begin for small businesses to provide coverage to employees.
* Insurance companies barred from denying coverage to children with pre-existing illness.
* Children permitted to stay on their parents' insurance policies until their 26th birthday.


* Set up long-term care program under which people pay premiums into system for at least five years and become eligible for support payments if they need assistance in daily living.

Taxes and fees

* Drug makers face annual fee of $2.5 billion (rises in subsequent years).

Taxes and fees

* New Medicare taxes on individuals earning more than $200,000 a year and couples filing jointly earning more than $250,000 a year.
* Tax on wages rises to 2.35% from 1.45%.
* New 3.8% tax on unearned income such as dividends and interest.
* Excise tax of 2.9% imposed on sale of medical devices.

Cost control

* Medicare pilot program begins to test bundled payments for care, in a bid to pay for quality rather than quantity of services.


* Create exchanges where people without employer coverage, as well as small businesses, can shop for health coverage. Insurance companies barred from denying coverage to anyone with pre-existing illness.

* Requirement begins for most people to have health insurance. Subsidies begin for lower and middle-income people. People at 133% of federal poverty level pay maximum of 3% of income for coverage. People at 400% of poverty level pay up to 9.5% of income. (Poverty level currently is about $22,000 for a family of four.)

* Medicaid, the federal-state program for the poor, expands to all Americans with income up to 133% of federal poverty level.

* Subsidies for small businesses to provide coverage increase. Businesses with 10 or fewer employees and average annual wages of less than $25,000 receive tax credit of up to 50% of employer's contribution. Tax credits phase out for larger businesses.

Taxes and fees

* Employers with more than 50 employees that don't provide affordable coverage must pay a fine if employees receive tax credits to buy insurance. Fine is up to $3,000 per employee, excluding first 30 employees.
* Insurance industry must pay annual fee of $8 billion (rises in subsequent years).

Cost control

* Independent Medicare board must begin to submit recommendations to curb Medicare spending, if costs are rising faster than inflation.

Taxes and fees

* Penalty for those who don't carry coverage rises to 2.5% of taxable income or $695, whichever is greater.


* Businesses with more than 100 employees can buy coverage on insurance exchanges, if state permits it.

Taxes and fees

* Excise tax of 40% imposed on health plans valued at more than $10,200 for individual coverage and $27,500 for family coverage.

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