January 2010 U.S. Poverty Action

Final Health Care Bill Must Increase Access to Health Care

Contact Senators and Representatives, or Their Staff, Directly and Ask Them to Push For the Strongest Provisions for Medicaid and Community Health Centers

1. Thank them for passage of their chamber’s version of the health care bill.

2. Remind them of different Medicaid provisions in the two bills:

     a. The House bill covers all persons under 65 with incomes up to 150 percent of the federal poverty line (FPL) under Medicaid beginning in 2013; the Senate covers persons up to 133 percent FPL beginning 2014.

     b. The House bill expands Medicaid beginning in 2013 while the Senate version does not start until 2014.

     c. Both bills provide 100 percent federal funding of Medicaid expansion for the first two years; with the Senate covering the cost for an additional year. After that, federal contribution would drop and the states (with one possible exception) would bear part of the cost.

     d. The House bill increases the payments to Medicaid primary care providers to Medicare rates within three years.

3. Express support for the strongest possible Medicaid provisions in the final bill.

     a. Medicaid should cover everyone up to 150 percent FPL.

     b. Federal funding for the Medicaid expansion should start as early as possible and cover 100 percent of the cost for as long as possible.

     c. Medicaid reimbursement rates for primary care providers should equal Medicare reimbursement rates.

4. Also, urge negotiators to set funding for community health centers are the House level of $14 billion over five years, rather than the Senate’s funding level of $10 billion.

5. Request that the senator or representative speak directly to Speaker Pelosi or Senate Majority Leader Reid to support the strongest investments in Medicaid and community health centers which will help millions of uninsured people in the U.S. obtain coverage and access to quality, affordable health care. Health reform is not about doing what can be done; it is about doing what must be done, especially for the most vulnerable.

Note: To find contact information, including telephone numbers and addresses for congressional offices and the names of the health staffer, visit the Take Action Now page of the RESULTS website. For directory assistance, you can contact the U.S. Capitol Switchboard at (202) 224-3121.

Negotiations on Final Reform Bill Are Already Underway

The Senate passed the Patient Protection and Affordable Care Act (H.R.3590) on December 24, 2009. The House passed the Affordable Health Care for America Act (H.R.3962) on November 7. Leaders of the House and Senate must now negotiate to resolve differences between the two bills. Normally, a conference committee is convened to hammer out a compromise bill. However, it appears that congressional leaders will forego the formal conference procedure to avoid procedural votes that might give opponents of reform an opportunity to further stall reform. Instead, House and Senate leaders will negotiate informally and when a deal is reached, the House will pass the Senate bill with amendments to reflect the compromise, with the Senate following suit. Once passed by both chambers, the bill would be sent to President Obama for signature.

Be Strategic in Making Your Calls to Congress

This is it — our chance to capitalize on all the hard work we’ve done with congressional offices, the media and our community to get historic improvements in health coverage and access for millions and millions of low-income Americans. We have to be strategic as we look to shape the final bill:

RESULTS activists & allies → Key Cong. staff (and community VIPs) → Our reps. and senators → House and Senate leadership

Here are some specific ideas on how to make this happen:

  • Be strategic: take on the most important/influential members first. Given the nature of the debate, we urge you to focus on senators and Democrats as you divvy up your calls.
  • Coordinate: get everyone in your group involved — this is the time to reach out to other members of your state’s congressional delegation or beyond.
  • Your goal: get directly to the representative or senator (if possible) or key staff, whether by phone or personal e-mail.
    • Hopefully, you have built relationships with many of them already via conference calls and lobby meetings.
  • Be persistent: work through the local office, communicate via e-mail, get advice from other activists in your community about how to get through.

Do the Best We Can to Secure Health Coverage and Access to America’s Poor

Thank you for your hard work this year on Medicaid — it has indeed paid off. Assuming a final health care bill passes, it will include some kind of expansion of Medicaid. The issue is in how strong the expansion it will be. The House bill expands Medicaid to everyone at or below 150 percent of the federal poverty line; the Senate goes up to 133 percent. The House also begins the expansion a year earlier (2013) than the Senate (2014). Furthermore, the House stipulates that current and new enrollees in Medicaid will receive the same health benefits that people currently on Medicaid receive; the Senate bill does not guarantee this. However, the Senate bill does cover all the costs of the Medicaid expansion for three years, while the House only covers it for two years, before states have to pay for part of it.

Even with these changes, Medicaid coverage is not a guarantee for access to health care. Because Medicaid reimbursement rates are so low, many health providers will not accept Medicaid patients. If Medicaid is to serve as the foundation of expanded health care coverage, reimbursement rates must be brought up to a level that will encourage more providers to participate in the program. The House bill addresses this issue by raising the reimbursement rates for Medicaid up to the levels paid under Medicare within three years. RESULTS urges Congress to raise Medicaid reimbursement rates up to Medicare rates.

Finally, health care reform will not be complete without increased access to care through community health centers (CHC). CHCs provide vital primary care to low-income individuals and families. Yet despite their important value to low-income communities, their funding has failed to keep up with the demand for services. Fortunately, the health reform bill addresses this problem. While both the House and Senate bills make significant increases in CHC funding, the House bill provides the most effective levels of funding with $14 billion over five years, in contrast to the Senate investment of $10 billion over five years. Below are more details about two health reform bills and RESULTS position on the various provisions. Use this information to prepare for your calls with congressional staff:


RESULTS Position

Senate Patient Protection and Affordable Care Act (H.R. 3590) — passed 60-39

House Affordable Health Care for America Act (H.R.3962) — passed 220-215

Strengthening and Expanding Medicaid

Expand Medicaid to include everyone at or below 150% of the federal poverty line (FPL).


Finance Medicaid expansion with 100 percent federal financing.


Preserve existing Medicaid benefits for current and new enrollees.


Increase Medicaid reimbursement rates to no less than Medicare rates.

Expands Medicaid eligibility to everyone below age 65 at or below 133 percent FPL, beginning in 2014.


Federal government pays 100 %of the expansion for 3 years through 2016. States would then bear some of the financial responsibility, up to 10 percent, for the cost of the expansion.


All newly eligible adults will be guaranteed a benchmark benefit package that at least provides the essential health benefits.


No language on increasing Medicaid reimbursement rates.

Expands Medicaid coverage for everyone below age 65 up to 150% of the FPL, beginning in 2013.


Federal government pays 100% of the expansion for 2 years until 2015, then lowers it to 91% thereafter. The House bill also provides $23.5 billion to continue higher federal funding for Medicaid to help states during the current economic downturn.


Preserves existing Medicaid benefits for current and new enrollees.


Medicaid reimbursement rates for primary care will increase to Medicare within three years.

Community Health Centers (CHCs)

Increase funding for CHCs and the National Health Service by $14 billion over the next 5 years (the House version).

Improves access to care by increasing funding for CHCs and the National Health Service Corps by $10 billion over 5 years (effective fiscal year 2011); establishes new programs to support school-based health centers (effective fiscal year 2011) and nurse-managed health clinics(effective fiscal year 2010).

Improves access to care by increasing funding for CHCs and the National Health Service by $14 billion over 5 years; establishes new programs to support school-based health centers (effective July 1, 2010) and nurse-managed health centers (effective 2011).

We will discuss our Health Care for All campaign on the January National Conference Call — Saturday, January 9, at 12:30 pm, with longtime activist Nick Unger from the AFL-CIO. To participate, call (888) 409-6709 with your group by 12:25 pm ET.