December 7, 2009

United States Senate

Washington, DC, 20510

Dear Senators:

U.S. PIRG, the federation of state Public Interest Research Groups, is a non-profit, non-partisan public
interest advocacy organization. For thirty-five years, we have fought to ensure that the concerns of
consumers and taxpayer, not those of powerful interests, are at the top of America's agenda. In this year's
health care debate, whether they are Republicans or Democrats, Americans' greatest concern is the
unchecked growth of health care costs. The Patient Protection and Affordable Care Act's outcomes
research, payment reform, and Independent Medicare Advisory Board (IMAB) provisions represent
unprecedented steps towards addressing that concern, and U.S. PIRG has endorsed the bill as introduced.

Now, with the introduction of two new amendments, the Senate can do even more to rein in health care
costs. We urge you to seize that opportunity and support the Freshmen package and the
Lieberman/Collins amendment, described below.

The Freshmen package, offered by first-term Senators Warner, Shaheen, Bennet, Tom Udall, Mark Udall,
Merkley, Hagan, Kaufman, Burris, Kirk, and Begich, ensures that innovative new delivery reforms extend
beyond public programs to the broader health care system by:
1. Requiring the IMAB 's recommendations to address national health spending;
2. Providing additional flexibility to implement additional models of Accountable Care
Organizations (ACOs) and integrating Medicare ACOs with private payers' reform efforts;
3. Expanding and accelerating pay for quality throughout Medicare; and
4. Moving toward standardized enrollment and other administrative processes across all payers.

Amendment SA 2898 offered by Senator Joe Lieberman (I-CT) and Senator Susan Collins (R-ME) would
improve transparency for health care consumers while strengthening and accelerating Medicare payment
reforms by:
1. Ensuring that any payment or delivery reform that proves successful and lowering costs while
maintaining or improving quality of care can be extended nationally;
2. Doubling the penalty on hospitals who fail to reduce the rate of hospital-associated infections;
3. Demanding that insurers publish information about their denial of health insurance claims;
4. Allowing comparison of providers' quality ratings on a publicly available website; and
5. Establishing a Medicare pilot program to encourage beneficiaries to use high-value providers.

With the inclusion of these two amendments, health reform legislation can better deliver on the promise
of lower-cost, high-quality health care. U.S. PIRG calls on each and every Senator to support the
Freshmen package and the Lieberman/Collins amendment.

Yours truly,

Larry C. McNeely II
Health Care Advocate