October 13, 2009
The Honorable Harry Reid
The Honorable Max Baucus
United States Senate
United States Senate
Washington, DC 20510
Washington, DC 20510
The Honorable Tom Harkin
The Honorable Chris Dodd
United States Senate
United States Senate
Washington, DC 20510
Washington, DC 20510
The Honorable Michael Enzi
The Honorable Charles Grassley
United States Senate
United States Senate
Washington, DC 20510
Washington, DC 20510
Dear Senators Reid, Baucus, Harkin, Dodd, Enzi and Grassley:
As national non-profit healthcare organizations and foundations, we thank you for the leadership you are
exercising in merging the Senate Finance Committee and HELP Committee bills. Our organizations
encourage you to eliminate preexisting condition exclusions and waiting periods for all individuals in every
health insurance market to ensure access to care. The timing of implementation of this insurance reform
measure is critical. Currently, the proposals allow for implementation to be completed in 2022. The
constituents served by the groups represented on this letter urge you to shorten this implementation time-
frame to allow initial implementation to begin in single insured and small group plans in 2010 and to
complete implementation with large group and self-funded plans in 2011. While the bills you are merging
deserve to be commended for addressing the problems preexisting condition restrictions impose on
Americans through the elimination of waiting periods and look back periods, the undersigned
organizations strongly support the principle that affordable health insurance absent waiting periods based
on preexisting conditions is required as a cornerstone of healthcare reform. The imposition of preexisting
requirements is the gate blocking access for those who today have at least one chronic illness that subjects
them to preexisting condition limitations and locks them into existing plans and employment.
Currently, our laws allow significant gaps in coverage. These gaps are particularly devastating for
Americans struggling to treat or manage a preexisting condition, which can include anything from seasonal
allergies to cancer to heart disease. According to the Centers for Disease Control & Prevention,
approximately 133 million Americans, or 45% of the population, have at least one chronic disease, placing
them at potential risk of a preexisting condition exclusion. In addition, 20% of school-aged children have
at least one chronic condition.
The Senate HELP Committee bill requires states to eliminate preexisting conditions exclusions and waiting
periods within four years of the bill's enactment for all insurance markets, though states may act sooner.
Under the Finance Committee bill, states are given five years beginning January 1, 2013 to phase-in
insurance market reforms in the small group market. Beginning in 2017, large and self-insured employers
would have 5 years to phase-in the elimination of preexisting conditions under the Finance bill.
According to the Employee Benefit Research Institute, as many as 73 million Americans, 55% of those
receiving health coverage through their employer, are covered in self-insured health plans. The current
health care reform proposals would perpetuate the discriminatory treatment of these Americans by

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insulating large and self-insured employers for an unreasonably protracted period of time from
requirements under the bill to assure fair and equitable treatment without regard to health status. Our
organizations ask that the merged Senate health care reform bill address our request to construct
implementation across a shortened timeline of 2010 and 2011. Early elimination of pre-existing conditions
and waiting periods for individuals in every health insurance market will create an equal opportunity for
improved access to coverage for all Americans.
Respectfully submitted:
American Lung Association
American Psychosocial Society
Breast Cancer Network of Strength
C3: Colorectal Cancer Coalition
Coalition of Cancer Cooperative Groups
First Focus
International Myeloma Foundation
Lance Armstrong Foundation
Lupus Foundation of America
National Health Council
National Patient Advocate Foundation
Susan G. Komen for the Cure Advocacy Alliance
Us TOO International Prostate Cancer Education & Support

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