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Friend -

As you know, the House of Representatives passed the American Health Care Act last week, with my support. If you have five minutes, I shared some of my thoughts on the bill and reasoning behind my position on Facebook immediately following the vote >> you can watch the video here or below.

I've been able to hear from many of you via direct conversations, phone calls, emails, and live telephone town halls, but I know many still have questions and concerns. Here's a step-by-step breakdown of the bill, addressing some of the most common questions I've heard, and laying out the process moving forward (the bill is just the first step):

Where we are today, under the Affordable Care Act...

• Costs: The Washington Post reports, "The head of the largest insurer in the Mid-Atlantic region warned Thursday that the Affordable Care Act marketplaces were in the early stages of a death spiral , a statement that came as the company announced its request for massive, double-digit premium increases for next year..."

• Care: According to Bloomberg, "Failing insurers. Rising premiums. Financial losses. The deteriorating Obamacare market that the health insurance industry feared is here. As concerns about the survival of the Affordable Care Act's market intensify, the role of nonprofit "co-op" health insurers -- meant to broaden choices under the law -- has gained prominence. Most of the original 23 co-ops have failed, dumping more than 800,000 members back onto the ACA markets over the last two years."

• Access: CNN reports, "More sick Americans are flocking to the Obamacare exchanges, which is pushing insurers' costs higher, Bertolini said at a Wall Street Journal forum. That, in turn, is forcing carriers to either abandon the market or raise their rates."

• Choice: According to Time, "According to a new analysis from the nonpartisan Kaiser Family Foundation, almost a third of counties will have just one insurer participating in the exchanges by 2017, significantly more than the 7% of counties who had one option this year. That equates to 19% of all enrollees facing just one insurance option.

It's getting worse, not better... Iowa is an example of an entire state that's down to one insurer. Last week, that one insurer announced it may have to pull out of 94 of the 99 counties in Iowa, leaving tens of thousands of Americans with no options at all. Additionally, because of "big Obamacare losses," residents in 27 Virginia counties will have only one insurer to choose from next year. Iowa and Virginia are not alone - Americans across the country are losing their options and losing their care.

So where does that leave us? It would be inaccurate to say Obamacare has 100% failed, since there are certainly some Americans who it has helped. However, we have to recognize the massive toll it has taken on too many American families, individuals, and employers as well as on our healthcare system as a whole. I found this an interesting article on that topic.

What action did the House of Representatives take?
Last week, the U.S. House of Representatives passed the American Health Care Act, with my support, to jumpstart the process of solving this crisis of care. Its goal is to provide free market-based answers to the question our country has been wrestling with for so long - how do we provide care for the most vulnerable while maintaining affordable costs for everyone?

Why did this action need to be taken now? We cannot continue to leave American families in crisis, without choices and without care. 

What does the House bill do?
1. It starts by tackling the challenging process of unwinding Obamacare:

• Rolls back $1 trillion in taxes, including taxes on health insurance and products that raise costs for consumers. Take a look at the list of tax hikes that are being repealed, here.

• Repeals the individual and employer mandates that have burdened businesses, employees, and families.

2. It also puts in place reforms designed to begin reducing YOUR costs and increasing YOUR choices:

• Creates Refundable Tax Credits that increase with age, for the purpose of buying insurance.

• Establishes a Patient and State Stability Fund and allots $100 billion to lower costs for patients and stabilize state insurance markets.

• Gives States More Flexibility. The House bill gives states the option to design their own package of "essential health benefits" tailored to their residents, instead of forcing compliance with a one-size-fits-all federal list.

• Expands Health Savings Accounts. This bill would nearly double the amount Americans can contribute to their Health Savings Accounts, which are tax-free health care savings accounts for Americans with high-deductible health plans. These are critical for helping Americans save and spend their health dollars wisely.

• Protects Pre-Existing Conditions. It creates "high-risk pools" -- a concept with proven success -- to help cover costs for those with expensive medical conditions, allocating an additional $15 billion specifically for maternity, mental health, and substance abuse treatment.

• In summary, these changes are designed to give individuals and families greater control over their healthcare decisions, while empowering states to innovate with new models to provide care and lower costs.

Where can I read the bill? You can read the entire text of the bill as well as breakdowns of the amendments, here.

What's next? The House bill is just the first step in a multi-pronged legislative and administrative process. Now, it goes to the Senate to be amended there, and then to the President's desk.

More frequently asked questions...

• Will people with pre-existing conditions no longer be able to get coverage?
  No. This bill prohibits insurers from denying coverage based on pre-existing conditions - period.

• What about states that apply for "waivers?"
  While the bill gives states the option to tailor insurance frameworks for their residents, the process is very strict. A state must explain how the waiver will lower premiums, increase enrollment, stabilize the market, and/or increase options for their residents. No state may obtain a waiver for things like pre-existing condition protection or prohibitions on gender discrimination.

• What happens to patients with pre-existing conditions in waiver states?
  The House bill is structured so that states can only receive the waiver if they establish a state or federal high-risk pool. "High-risk pools" are created for individuals with pre-existing conditions and are subsidized to ensure their coverage remains affordable without spiking costs for everyone.

• Can states raise costs for pre-existing conditions?
  You won't be charged more as long as you maintain continuous coverage. If you live in a waiver state, have a pre-existing condition, and go without insurance for more than 63 days, only then can an insurer charge you higher premiums based on health status; however, this would only apply during the year following your lapse in coverage and the AHCA provides significant resources at the federal and state level for risk-sharing programs to help lower your premiums.

• Will 24 million people be kicked off their health insurance?
  No. The House bill is designed to ensure everyone has access to affordable, quality health care, but not by using a government mandate to force them to buy insurance or fine them. Instead, the House bill provides refundable tax credits to low and middle income individuals so they have an incentive to purchase insurance.

• What about cuts to Medicaid?
  Our goal is to make sure no one gets the rug pulled out from under them, as we work to give states the flexibility they need to take care of those most in need. I believe Medicaid is an important and greatly needed safety net. I also believe we can do better. The program now has three times as many people and costs three times as much as it did under former President Clinton. The goal of the reforms in this bill are to give states flexibility to better address the unique needs of their residents, with the opportunity to increase access to real care. It will also encourage more efficient spending in the Medicaid program.

• Will coverage be taken away from survivors of rape and domestic violence?
  Providing care for victims of violence, particularly those who have suffered sexual violence, must always be a priority. However, the Washington Post recently conducted an in-depth review of this claim and ranked it as false - take a look here.

• Are Members of Congress and their staff bound to the same rules as everyone else?
  Yes. The House passed H.R. 1292, with my support, to ensure Members of Congress and their staff are treated the same way as everyone else under the American Health Care Act.

Further questions or concerns? I want to continue to hear from you. Please don't hesitate to contact one of my offices, send me an email, request a meeting, or sign up for one of my regularly scheduled, live telephone town halls. I appreciate all of the feedback and thoughts I have received so far, and I would invite those with concerns over the bill to bring forward their ideas to make it better. Let's continue to debate and hone the solutions it provides as the process moves forward.

This process is tough, no question. But if we can continue on a path towards patient-centered care -- with consumer protections and freedom of choice that lowers costs, while protecting the vulnerable -- it will be more than worth it.