<table cellspacing="0" cellpadding="0" border="0" ><tr><td valign="top" style="font: inherit;"><DIV>I don't know if you all recieved this or not, but I thought you should have the latest..</DIV>
<DIV>Caroline<BR><BR>--- On <B>Tue, 8/4/09, ca14ima.pub@mail.house.gov <I><ca14ima.pub@mail.house.gov></I></B> wrote:<BR></DIV>
<BLOCKQUOTE style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: rgb(16,16,255) 2px solid"><BR>From: ca14ima.pub@mail.house.gov <ca14ima.pub@mail.house.gov><BR>Subject: Message From Rep. Anna G. Eshoo<BR>To: carolineyacoub@att.net<BR>Date: Tuesday, August 4, 2009, 2:11 PM<BR><BR>
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<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 11.5pt; COLOR: #ff0000"></SPAN> </SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 11.5pt"></SPAN><SPAN style="FONT-SIZE: 11.5pt">August 4, 2009</SPAN></SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 11.5pt"></SPAN> </SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 11.5pt"></SPAN><SPAN style="FONT-SIZE: 11.5pt">Mrs. Caroline Yacoub</SPAN></SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 11.5pt"></SPAN><SPAN style="FONT-SIZE: 11.5pt">323 North Murphy Avenue</SPAN></SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 11.5pt"></SPAN><SPAN style="FONT-SIZE: 11.5pt">Sunnyvale, California 94085-4312</SPAN></SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 11.5pt"></SPAN> </SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 11.5pt"></SPAN><SPAN style="FONT-SIZE: 11.5pt">Dear </SPAN><SPAN style="FONT-SIZE: 11.5pt">Mrs. Yacoub</SPAN><SPAN style="FONT-SIZE: 11.5pt">,</SPAN></SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 12pt"></SPAN> </SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 12pt"></SPAN><SPAN style="FONT-SIZE: 12pt">As Congress continues to </SPAN><SPAN style="FONT-SIZE: 12pt">develop</SPAN><SPAN style="FONT-SIZE: 12pt"> a healthcare reform bill, I want to </SPAN><SPAN style="FONT-SIZE: 12pt">give</SPAN><SPAN style="FONT-SIZE: 12pt"> you </SPAN><SPAN style="FONT-SIZE: 12pt">an update </SPAN><SPAN style="FONT-SIZE: 12pt">on the </SPAN><SPAN style="FONT-SIZE: 12pt">status of </SPAN><SPAN style="FONT-SIZE: 12pt">legislation in the House of Representatives and make you aware of some key issues.</SPAN></SPAN></DIV>
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<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 12pt"></SPAN><SPAN style="FONT-SIZE: 12pt">As I continue to work with my colleagues on the House bill, the Senate is working to craft their own legislation. While neither body has passed a final bill, I anticipate these votes will occur in September, with the differences </SPAN><SPAN style="FONT-SIZE: 12pt">in the two bills being </SPAN><SPAN style="FONT-SIZE: 12pt">worked out in Conference before being sent to the President</SPAN><SPAN style="FONT-SIZE: 12pt"> in the fall</SPAN><SPAN style="FONT-SIZE: 12pt">. </SPAN></SPAN></DIV>
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<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 12pt"></SPAN><SPAN style="FONT-SIZE: 12pt">The</SPAN><SPAN style="FONT-SIZE: 12pt"> House</SPAN><SPAN style="FONT-SIZE: 12pt"> </SPAN><SPAN style="FONT-SIZE: 12pt">legislation</SPAN><SPAN style="FONT-SIZE: 12pt"> </SPAN><SPAN style="FONT-SIZE: 12pt">as written today</SPAN><SPAN style="FONT-SIZE: 12pt"> will ensure that 97% of all Americans will have coverage under a healthcare plan that is affordable and offers quality, standard benefits</SPAN><SPAN style="FONT-SIZE: 12pt">.</SPAN><SPAN style="FONT-SIZE: 12pt"> </SPAN><SPAN style="FONT-SIZE: 12pt">It protects choice, it rewrites the rules of the insurance industry, it encourages competition with a public option, and it assists small businesses who are struggling to cover employees with an affordable plan. </SPAN></SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 12pt"></SPAN> </SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 12pt"></SPAN><SPAN style="FONT-SIZE: 12pt">Listed </SPAN><SPAN style="FONT-SIZE: 12pt">below</SPAN><SPAN style="FONT-SIZE: 12pt"> are</SPAN><SPAN style="FONT-SIZE: 12pt"> some of the bill's significant benefits for our Congressional District:</SPAN></SPAN></DIV>
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<P class=Normal-P style="MARGIN-LEFT: 36pt"><SPAN class=Normal-H><SPAN style="FONT-WEIGHT: normal; FONT-SIZE: 12pt; FONT-STYLE: normal; FONT-FAMILY: Wingdings; TEXT-DECORATION: none">w <SPAN style="PADDING-LEFT: 12.75pt"></SPAN></SPAN><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt; TEXT-DECORATION: none underline">Help for small businesses</SPAN><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt"> </SPAN><SPAN style="FONT-SIZE: 12pt">Under the legislation, small businesses with 25 employees or less and average wages of less than $40,000 </SPAN><SPAN style="FONT-SIZE: 12pt">would </SPAN><SPAN style="FONT-SIZE: 12pt">qualify for tax credits of up to 50% of the cost of providing health insurance. There are up to 15,000 small businesses in our District that </SPAN><SPAN style="FONT-SIZE: 12pt">w</SPAN><SPAN style="FONT-SIZE: 12pt">ould qualify for these credits.</SPAN><SPAN style="FONT-SIZE: 12pt"><BR
clear=all> </SPAN></SPAN></DIV>
<P class=Normal-P style="MARGIN-LEFT: 36pt"><SPAN class=Normal-H><SPAN style="FONT-WEIGHT: normal; FONT-SIZE: 12pt; FONT-STYLE: normal; FONT-FAMILY: Wingdings; TEXT-DECORATION: none">w <SPAN style="PADDING-LEFT: 12.75pt"></SPAN></SPAN><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt; TEXT-DECORATION: none underline">Help for seniors with drug costs in the Part D </SPAN><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt; TEXT-DECORATION: none underline">'</SPAN><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt; TEXT-DECORATION: none underline">donut hole</SPAN><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt; TEXT-DECORATION: none underline">'</SPAN><SPAN style="FONT-SIZE: 12pt"> Each year, 2,700 seniors in </SPAN><SPAN style="FONT-SIZE: 12pt">our</SPAN><SPAN style="FONT-SIZE: 12pt"> District hit the </SPAN><SPAN style="FONT-SIZE: 12pt">Medicare '</SPAN><SPAN style="FONT-SIZE: 12pt">donut hole</SPAN><SPAN style="FONT-SIZE:
12pt">'</SPAN><SPAN style="FONT-SIZE: 12pt"> and are forced to pay </SPAN><SPAN style="FONT-SIZE: 12pt">the full amount of their</SPAN><SPAN style="FONT-SIZE: 12pt"> drug costs, despite having Part D drug coverage. The legislation would provide them with immediate relief, cutting brand name drug costs in the </SPAN><SPAN style="FONT-SIZE: 12pt">donut hole</SPAN><SPAN style="FONT-SIZE: 12pt"> by 50% and ultimately eliminating </SPAN><SPAN style="FONT-SIZE: 12pt">it.</SPAN><SPAN style="FONT-SIZE: 12pt"><BR clear=all> </SPAN></SPAN></DIV>
<P class=Normal-P style="MARGIN-LEFT: 36pt"><SPAN class=Normal-H><SPAN style="FONT-WEIGHT: normal; FONT-SIZE: 12pt; FONT-STYLE: normal; FONT-FAMILY: Wingdings; TEXT-DECORATION: none">w <SPAN style="PADDING-LEFT: 12.75pt"></SPAN></SPAN><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt; TEXT-DECORATION: none underline">Relieving the burden of uncompensated care for hospitals and healthcare providers</SPAN><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt"> </SPAN><SPAN style="FONT-SIZE: 12pt">In 2008, healthcare providers in our District provided $46 million </SPAN><SPAN style="FONT-SIZE: 12pt">worth of uncompensated care. This is care</SPAN><SPAN style="FONT-SIZE: 12pt"> that was provided to individuals who lacked insurance coverage and were unable to pay their bills. Under the legislation, these costs of uncompensated care would be virtually eliminated.</SPAN><SPAN style="FONT-SIZE: 12pt"><BR clear=all> </SPAN></SPAN></DIV>
<P class=Normal-P style="MARGIN-LEFT: 36pt"><SPAN class=Normal-H><SPAN style="FONT-WEIGHT: normal; FONT-SIZE: 12pt; FONT-STYLE: normal; FONT-FAMILY: Wingdings; TEXT-DECORATION: none">w <SPAN style="PADDING-LEFT: 12.75pt"></SPAN></SPAN><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt; TEXT-DECORATION: none underline">Coverage of the uninsured</SPAN><SPAN style="FONT-SIZE: 12pt"> There are 49,000 </SPAN><SPAN style="FONT-SIZE: 12pt">(8%) </SPAN><SPAN style="FONT-SIZE: 12pt">uninsured individuals in </SPAN><SPAN style="FONT-SIZE: 12pt">our Congressional</SPAN><SPAN style="FONT-SIZE: 12pt"> District</SPAN><SPAN style="FONT-SIZE: 12pt">. </SPAN><SPAN style="FONT-SIZE: 12pt">The Congressional Budget Office (CBO) estimates that nationwide, 97% of all Americans will have insurance coverage when the bill takes effect. If this benchmark is reached in our District, 29,000 people who currently do not have health insurance</SPAN><SPAN
style="FONT-SIZE: 12pt">,</SPAN><SPAN style="FONT-SIZE: 12pt"> will receive coverage. </SPAN><SPAN style="FONT-SIZE: 12pt"><BR clear=all> </SPAN></SPAN></DIV>
<P class=Normal-P style="MARGIN-LEFT: 36pt"><SPAN class=Normal-H><SPAN style="FONT-WEIGHT: normal; FONT-SIZE: 12pt; FONT-STYLE: normal; FONT-FAMILY: Wingdings; TEXT-DECORATION: none">w <SPAN style="PADDING-LEFT: 12.75pt"></SPAN></SPAN><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt; TEXT-DECORATION: none underline">No deficit spending</SPAN><SPAN style="FONT-SIZE: 12pt"> </SPAN><SPAN style="FONT-SIZE: 12pt">Under the legislation, the</SPAN><SPAN style="FONT-SIZE: 12pt"> cost of heal</SPAN><SPAN style="FONT-SIZE: 12pt">thcare reform is fully paid for. H</SPAN><SPAN style="FONT-SIZE: 12pt">alf </SPAN><SPAN style="FONT-SIZE: 12pt">is paid for by </SPAN><SPAN style="FONT-SIZE: 12pt">making the Medicare and Medicaid programs more efficient</SPAN><SPAN style="FONT-SIZE: 12pt">,</SPAN><SPAN style="FONT-SIZE: 12pt"> and half through a surtax on the income of the wealthiest </SPAN><SPAN style="FONT-SIZE: 12pt">households ($350,000
or more</SPAN><SPAN style="FONT-SIZE: 12pt">.</SPAN><SPAN style="FONT-SIZE: 12pt">)</SPAN><SPAN style="FONT-SIZE: 12pt"> </SPAN><SPAN style="FONT-SIZE: 12pt">93% of taxpayers in our District would </SPAN><SPAN style="FONT-SIZE: 12pt; TEXT-DECORATION: none underline">not</SPAN><SPAN style="FONT-SIZE: 12pt"> be affected. </SPAN></SPAN></DIV>
<P class=Normal-P style="MARGIN-LEFT: 18pt"><SPAN class=Normal-H><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt; TEXT-DECORATION: none underline"></SPAN> </SPAN></DIV>
<P class=Normal-P style="MARGIN-LEFT: 36pt"><SPAN class=Normal-H><SPAN style="FONT-WEIGHT: normal; FONT-SIZE: 12pt; FONT-STYLE: normal; FONT-FAMILY: Wingdings; TEXT-DECORATION: none">w <SPAN style="PADDING-LEFT: 12.75pt"></SPAN></SPAN><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt; TEXT-DECORATION: none underline">Insurance Reforms </SPAN><SPAN style="FONT-SIZE: 12pt">The legislation bans insurance companies from discriminating against those with pre-existing conditions, and </SPAN><SPAN style="FONT-SIZE: 12pt">from </SPAN><SPAN style="FONT-SIZE: 12pt">dropping those who become ill. </SPAN></SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 12pt"></SPAN> </SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 12pt"></SPAN><SPAN style="FONT-SIZE: 12pt">The bill also</SPAN><SPAN style="FONT-SIZE: 12pt"> contains an important provision </SPAN><SPAN style="FONT-SIZE: 12pt">for</SPAN><SPAN style="FONT-SIZE: 12pt"> our District, especially </SPAN><SPAN style="FONT-SIZE: 12pt">Santa Cruz</SPAN><SPAN style="FONT-SIZE: 12pt"> </SPAN><SPAN style="FONT-SIZE: 12pt">County</SPAN><SPAN style="FONT-SIZE: 12pt"> where physicians who treat Medicare patients are severely underpaid. Due to outdated maps that classify </SPAN><SPAN style="FONT-SIZE: 12pt">Santa Cruz</SPAN><SPAN style="FONT-SIZE: 12pt"> </SPAN><SPAN style="FONT-SIZE: 12pt">County</SPAN><SPAN style="FONT-SIZE: 12pt"> as "rural", doctors are reimbursed at a lower rate for performing the same services as their </SPAN><SPAN style="FONT-SIZE: 12pt">San Mateo</SPAN><SPAN style="FONT-SIZE: 12pt"> and </SPAN><SPAN
style="FONT-SIZE: 12pt">Santa Clara</SPAN><SPAN style="FONT-SIZE: 12pt"> counterpart</SPAN><SPAN style="FONT-SIZE: 12pt">s</SPAN><SPAN style="FONT-SIZE: 12pt">. The provision, know</SPAN><SPAN style="FONT-SIZE: 12pt">n</SPAN><SPAN style="FONT-SIZE: 12pt"> as the Geographical Price Cost Index or GPCI, </SPAN><SPAN style="FONT-SIZE: 12pt">remedies this error and </SPAN><SPAN style="FONT-SIZE: 12pt">will allow</SPAN><SPAN style="FONT-SIZE: 12pt"> </SPAN><SPAN style="FONT-SIZE: 12pt">Santa Cruz</SPAN><SPAN style="FONT-SIZE: 12pt"> physicians t</SPAN><SPAN style="FONT-SIZE: 12pt">o receive proper reimbursement and once again accept Medicare patients.</SPAN></SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 12pt"></SPAN> </SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 12pt"></SPAN><SPAN style="FONT-SIZE: 12pt">I </SPAN><SPAN style="FONT-SIZE: 12pt">offered </SPAN><SPAN style="FONT-SIZE: 12pt">an amendment</SPAN><SPAN style="FONT-SIZE: 12pt">, and it was accepted,</SPAN><SPAN style="FONT-SIZE: 12pt"> to</SPAN><SPAN style="FONT-SIZE: 12pt"> the House Energy and Commerce Committee bill to create a </SPAN><SPAN style="FONT-SIZE: 12pt">pathway for biosimilar drugs. Biosimilars are </SPAN><SPAN style="FONT-SIZE: 12pt">new, cheaper versions of biologics already on the market and some of the most cutting-edge and life saving drugs available. </SPAN><SPAN style="FONT-SIZE: 12pt">While these drugs have </SPAN><SPAN style="FONT-SIZE: 12pt">tremendous</SPAN><SPAN style="FONT-SIZE: 12pt"> curative results, they </SPAN><SPAN style="FONT-SIZE: 12pt">are</SPAN><SPAN style="FONT-SIZE: 12pt"> also </SPAN><SPAN style="FONT-SIZE:
12pt">very</SPAN><SPAN style="FONT-SIZE: 12pt"> expensive. This provision will allow new generic versions to </SPAN><SPAN style="FONT-SIZE: 12pt">treat and </SPAN><SPAN style="FONT-SIZE: 12pt">save individuals</SPAN><SPAN style="FONT-SIZE: 12pt">, as well as saving</SPAN><SPAN style="FONT-SIZE: 12pt"> the government billions of dollars</SPAN><SPAN style="FONT-SIZE: 12pt"> and</SPAN><SPAN style="FONT-SIZE: 12pt"> allowing innovation to flourish. </SPAN></SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 12pt"></SPAN> </SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt"></SPAN><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt">Attached are </SPAN><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt">the</SPAN><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt"> most common questions </SPAN><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt">about</SPAN><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt"> healthcare reform</SPAN><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt"> legislation</SPAN><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt"> </SPAN><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt">I've </SPAN><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt">received from my constituents and answers to them.</SPAN></SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 11.5pt"></SPAN> </SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 11.5pt"></SPAN><SPAN style="FONT-SIZE: 11.5pt">If you have any thoughts or comments</SPAN><SPAN style="FONT-SIZE: 11.5pt">, </SPAN><SPAN style="FONT-SIZE: 11.5pt">please transmit them </SPAN><SPAN style="FONT-SIZE: 11.5pt">to me </SPAN><SPAN style="FONT-SIZE: 11.5pt">by email if possible. </SPAN><SPAN style="FONT-SIZE: 11.5pt">This will save</SPAN><SPAN style="FONT-SIZE: 11.5pt"> time and your tax</SPAN><SPAN style="FONT-SIZE: 11.5pt">payer dollars!</SPAN></SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 11.5pt"></SPAN> </SPAN></DIV>
<P class=Normal-P><SPAN class=Normal-H><SPAN style="FONT-SIZE: 11.5pt"></SPAN><SPAN style="FONT-SIZE: 11.5pt">I've created an ongoing </SPAN><SPAN style="FONT-SIZE: 11.5pt; FONT-STYLE: italic">e-newsletter</SPAN><SPAN style="FONT-SIZE: 11.5pt"> to keep constituents informed on a variety of congressional issues and legislation. Many constituents tell me how much they value reading it, and if you would like to as well, you can go to my website at </SPAN><A style="TEXT-DECORATION: none" href="http://eshoo.house.gov/" target=_blank rel=nofollow><SPAN class=Hyperlink-H style="FONT-SIZE: 11.5pt; TEXT-DECORATION: none underline">http://eshoo.house.gov</SPAN></A><SPAN style="FONT-SIZE: 11.5pt"> and click on "E-Mail Sign-Up." Your email address will never be used by anyone except my office to communicate with you, and your tax dollars will be conserved by using electronic communications rather than traditional
mailings.</SPAN></SPAN></DIV></DIV><BR>
<DIV>Sincerely, </DIV>Anna G. Eshoo<BR>Member of Congress<BR><BR>Enclosure<BR> </DIV></BLOCKQUOTE></td></tr></table>