Is the Patient Protection and Affordable Care Act (Obamacare) Good for America?
Barack H. Obama, JD, 44th President of the United States, stated the following on the 7th anniversary of signing the Affordable Care Act, as quoted in a Mar. 23, 2017 article by Ryan Teague Beckwith titled “Read Barack Obama’s Statement on the Anniversary of Obamacare,” published at time.com:
“Thanks to this law, more than twenty million Americans have gained the security and peace of mind of health insurance. Thanks to this law, more than ninety percent of Americans are insured – the highest rate in our history. Thanks to this law, the days when women could be charged more than men and Americans with pre-existing conditions could be denied coverage altogether are relics of the past. Seniors have bigger discounts on their prescription drugs. Young people can stay on their parents’ plans until they turn 26 years old. And Americans who already had insurance received an upgrade as well – from free preventive care, like mammograms and vaccines, to improvements in the quality of care in hospitals that has averted nearly 100,000 deaths so far.
All of that is thanks to the Affordable Care Act. And all the while, since the law passed, the pace of health care inflation has slowed dramatically. Prices are still rising, just as they have every year for decades – but under this law, they’ve been rising at the slowest rate in fifty years. Families who get coverage through their employer are paying, on average, thousands of dollars less per year than if costs kept rising as fast as they were before the law. And reality continues to discredit the false claim that this law is in a ‘death spiral,’ because while it’s true that some premiums have risen, the vast majority of Marketplace enrollees have experienced no average premium hike at all. And so long as the law is properly administered, this market will remain stable. Likewise, this law is no ‘job-killer,’ because America’s businesses went on a record-breaking streak of job growth in the seven years since I signed it.
So the reality is clear: America is stronger because of the Affordable Care Act.”Mar. 23, 2017
Joe Biden, 2020 presidential candidate and Vice President under President Obama, stated on a page titled “Health Care” on his campaign website, joebiden.com (accessed Dec. 10, 2019):
“On March 23, 2010, President Obama signed the Affordable Care Act into law, with Vice President Biden standing by his side, and made history. It was a victory 100 years in the making. It was the conclusion of a tough fight that required taking on Republicans, special interests, and the status quo to do what’s right. But the Obama-Biden Administration got it done.
Today, the Affordable Care Act is still a big deal. Because of Obamacare, over 100 million people no longer have to worry that an insurance company will deny coverage or charge higher premiums just because they have a pre-existing condition – whether cancer or diabetes or heart disease or a mental health challenge. Insurance companies can no longer set annual or lifetime limits on coverage. Roughly 20 million additional Americans obtained the peace of mind that comes with health insurance. Young people who are in transition from school to a job have the option to stay covered by their parents’ plan until age 26.”
Ezekiel J. Emanuel, MD, oncologist and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, wrote in a Mar. 22, 2019 article titled “Name the Much-Criticized Federal Program That Has Saved the U.S. $2.3 Trillion. Hint: It Starts with Affordable,” available at statnews.com:
“Barack Obama pledged on the campaign trail and as president that he would sign a health care bill that lowered family health insurance premiums by $2,500. Conservative politicians and pundits roundly mocked him. Yet the ACA has more than delivered on that promise, saving about $4,000 per family. And these lower health care premiums probably contribute to the recent rise in workers’ wages…
Despite constant criticism and occasional sabotage, the Affordable Care Act has successfully expanded health insurance coverage — even though it included individuals with pre-existing conditions — and controlled runaway health care costs. We need to build on its tremendous cost-control success.”
Kamala Harris, JD, US Senator (D-CA), stated the following in a Mar. 23, 2017 speech to the US Senate, a transcript of which is available at harris.senate.gov:
“Thanks to the ACA and Medicaid expansion, 20 million more Americans have health insurance. 20 million. That’s the population of the entire state of New York.
Thanks to the ACA, premiums are going up at the slowest rate in half a century…
Thanks to the ACA, insurers cannot set lifetime limits on your care—meaning your insurance company won’t tell you in the middle of a cancer treatment that they’ve paid all that they ever will.
Thanks to the ACA, millions of under-served Americans—in rural towns, and in cities, and everywhere in between—have access to care for the first time…
And thanks to the ACA, you can’t be discriminated against if you have a preexisting condition—including that preexisting condition called being a woman.
And of course, navigating the healthcare system is still daunting. But things are better. There are now some rules of the road to keep insurance companies from taking advantage of you during some of life’s most vulnerable moments.”Mar. 23, 2017
The American Public Health Association, in a Sep. 18, 2017 letter by Executive Director Georges C. Benjamin, MD, addressed the US Senate and available at apha.org, stated:
“The Affordable Care Act has made progress in addressing the biggest challenges facing our health system including reducing the number of uninsured, uneven quality of care, deaths due to medical errors, discriminatory practices by health insurance providers and the shrinking ranks of the nation’s primary care providers. The ACA has also made important progress in shifting our health system from one that focuses on treating the sick to one that focuses on keeping people healthy.[W]e urge you to continue the bipartisan efforts to improve and build upon the successes of the ACA.” Sep. 18, 2017
Paul Krugman, PhD, Nobel Prize-winning economist, stated in his Oct. 8, 2014 article for Rolling Stone titled “In Defense of Obama”:
“Obamacare means a huge improvement in the quality of life for tens of millions of Americans – not just better care, but greater financial security. And even those who were already insured have gained both security and freedom, because they now have a guarantee of coverage if they lose or change jobs.
What about the costs? Here, too, the news is better than anyone expected. In 2014, premiums on the insurance policies offered through the Obamacare exchanges were well below those originally projected by the Congressional Budget Office, and the available data indicates a mix of modest increases and actual reductions for 2015 – which is very good in a sector where premiums normally increase five percent or more each year. More broadly, overall health spending has slowed substantially, with the cost-control features of the ACA probably deserving some of the credit.
In other words, health reform is looking like a major policy success story. It’s a program that is coming in ahead of schedule – and below budget – costing less, and doing more to reduce overall health costs than even its supporters predicted…
And this big improvement in American society is almost surely here to stay… Health reform has made America a different, better place.”Oct. 8, 2014
The American College of Physicians (ACP), a national organization of internists, stated in its Feb. 11, 2014 letter to Kathleen Sebelius, then-US Secretary of Health and Human Services, written by then-ACP President Molly Cooke, MD, and available at the ACP website:
“With millions of Americans now enrolled or preparing to enroll in marketplace-based qualified health plans and Medicaid, it is apparent that the Affordable Care Act is approaching its goal to reduce the number of uninsured, improve the quality of the health care delivery system, and drive down costs.
ACP remains committed to supporting the Affordable Care Act and enabling the nation’s internists to provide their patients with the tools to enroll in affordable health insurance and steer the nation’s health care system to deliver high-quality, high-value care…
The College believes that the Affordable Care Act represents an historic step forward to providing all Americans with access to affordable coverage without regard to their health status, their gender, where they work or live, or how much they earn.”Feb. 11, 2014
Michael Hiltzik, MSc, Pulitzer Prize-winning journalist with the Los Angeles Times, stated in his Oct. 2, 2014 article titled “Obamacare at One Year: A Birthday Assessment,” available at latimes.com:
“How’s it [Obamacare] doing? The inescapable answer is: very well, thank you. This will disappoint the legions of politicians and pundits, chiefly Republicans and conservatives, who became heavily invested in the act’s failure–so heavily that where they couldn’t point to tangible evidence of failure, which was most of the time, they resorted to distortion, outright fabrication and obstructionist legal strategies…
The signs are that America’s old system of health coverage, which relied on employer-sponsored care and condemned those without it to enormous premiums, to uninsurability, and to unmet medical needs, is being supplanted by a new system in which coverage is available to everyone at a reasonable and affordable price, no one needs to feel trapped in a job merely for the insurance, and the prospect of medical bankruptcy will recede over time.
There remain holdouts who complain that the ACA is an infringement of ‘freedom.’ That’s true only under a bizarro-world definition of ‘freedom.’ Before the ACA, Americans were ‘free’ to be locked into jobs they detested; to be abused, ripped off or rejected outright by insurance companies; and to suffer medical conditions without treatment.
The ACA hasn’t changed every aspect of that in a single year, and its ability to meet all of its goals remains conjectural. But so far it has pointed the way to a better–yes, radically better–system of American healthcare.”Oct. 2, 2014
The American Medical Association stated, in an unpublished July 6, 2012 Letter to the Editor of the Wall Street Journal written by then-AMA President Jeremy A. Lazarus, MD, titled “AMA to Wall Street Journal: AMA Support of Affordable Care Act,” available at ama-assn.org:
“While the [Affordable Care Act]… is not perfect, the AMA, the nation’s largest physician organization, supported it because it makes necessary improvements to our health care system. We are pleased the law expands coverage to millions of uninsured who live sicker and die younger than those with insurance. It allows physicians to see patients earlier before care is more expensive, provides funding for research on drugs and treatments, increases Medicare and Medicaid payments for primary care physicians and includes Medicare bonus payments for general surgeons in underserved areas.”July 6, 2012
AARP (formerly the American Association of Retired People) stated in a June 28, 2012 press release titled “AARP Responds to Supreme Court Ruling on the Affordable Care Act,” available at aarp.org:
“This landmark legislation [the ACA] is already improving the health and financial security of our members and all Americans.
AARP supported this law because it helps many Medicare recipients avoid financially burdensome increases in prescription drug costs by closing the Medicare prescription drug coverage gap, or ‘doughnut hole.’ The ACA also expands the number of people eligible for free preventive and wellness benefits, and cracks down on Medicare fraud, waste and abuse. Finally, for those not yet eligible for Medicare, the ACA will be instrumental in eliminating discriminatory health insurance practices such as exclusions based on pre-existing conditions, and in limiting the use of age rating to charge exorbitant premiums for older Americans.
By starting to close the doughnut hole, 5.3 million people with Medicare Part D have saved $3.7 billion since the law was enacted. In the first five months of 2012, 745,000 people with Medicare saved a total of $485.3 million on prescription drugs in the doughnut hole coverage gap for an average of $651 in savings per person this year. Over 32.5 million Americans in Medicare used one or more free preventive services in 2011. And, over 2.2 million people with traditional Medicare benefited from the new Annual Wellness Visit in 2011.”June 28, 2012
USA Today stated in its Dec. 11, 2013 editorial titled “Obamacare Remains Worthy: Our View”:
“Until now, the law’s benefits have been mostly theoretical. But as more and more people select plans, the reasons Obamacare is necessary are becoming real:
• While people whose insurance is changing are inconvenienced, those who could never get insurance because of pre-existing conditions or the inability to pay are getting it, thanks to subsidies and an end to insurers’ ability to turn people away.
• Annual and lifetime insurance limits that bankrupted people with major illnesses or parents of chronically ill children are gone.
• Also gone is the ability of insurers to take away coverage when people really need it, on the pretext that they hadn’t disclosed some minor condition from years earlier.”Dec. 11, 2013
The American Academy of Family Physicians (AAFP) stated in its “Overview” of the Patient Protection and Affordable Care Act, available at aafp.org (accessed Apr. 24, 2015):
“The Patient Protection and Affordable Care Act (ACA) represents a significant shift in health care in the United States. Support for the legislation, now public law, is consistent with advocacy principles adopted by the AAFP Congress of Delegates in October 2009.
Specifically, the Patient Protection and Affordable Care Act:
• Guarantees coverage and expands access to health care for 32 million Americans;Apr. 24, 2015
• Helps shift the United States toward a health care delivery system based on primary care by increasing payment for primary care services and other measures;
• Advances the principles of the Patient Centered Medical Home;
• Invests in training more family physicians;
• Eliminates many of the worst practices of the health insurance industry, such as dropping patients when they get sick or denying coverage because of pre-existing conditions.”
Sally Kohn, JD, MPA, CNN political commentator, stated in her May 28, 2014 article for cnn.com titled “317 Million Reasons to Love Obamacare”:
“[T]here are millions [of] reasons to celebrate Obamacare…
— That’s how many Americans — i.e., all of us — potentially benefit from the requirement that insurance companies provide flu shots, HIV screenings, prostate exams, mammograms and FDA-approved contraception for free, without a co-pay.
— We all benefit from the new requirement that insurance companies publicly justify their actions if they want to raise premiums by 10% or more.
— We all benefit from knowing that our insurance can now never be capped or canceled at the whim of insurance companies…
Every day, as we all see the benefits of health care reform in our lives, support for Obamacare will grow stronger. Before long, not even the most partisan Republicans will be able to attack it.”May 28, 2014
Donald Trump, 45th President of the United States, stated the following during the Oct. 9, 2016 presidential debate at Washington University in St. Louis, MO, a transcript of which is available at nytimes.com:
“Obamacare is a disaster. You know it, we all know it. It’s going up at numbers that nobody’s ever seen, worldwide…
Obamacare will never work. It’s very bad, very bad health insurance. Far too expensive. And not only expensive for the person that has it, unbelievably expensive for our country. It’s going to be one of the biggest line items very shortly.
We have to repeal it and replace it with something absolutely much less expensive and something that works, where your plan can actually be tailored. We have to get rid of the lines around the state, artificial lines, where we stop insurance companies from coming in and competing, because they want — and President Obama and whoever was working on it — they want to leave those lines, because that gives the insurance companies essentially monopolies. We want competition…
President Obama said you keep your doctor, you keep your plan. The whole thing was a fraud, and it doesn’t work.”Oct. 9, 2016
Roger Stark, MD, healthcare policy analyst for the Washington Policy Center, wrote in an Oct. 25, 2019 article available at washingtonexaminer.com:
“Every single Democratic presidential candidate has joined President Trump. They all agree that Obamacare is a failure…
One thing that all the candidates have in common is that they don’t support the Affordable Care Act in its present form. They either want to radically restructure and expand Obamacare or they want to abolish it entirely and force Americans into a single-payer plan that they have rebranded as ‘Medicare for all.’
Obamacare was already in an obvious downward spiral even before the 2017 congressional tax reform legislation essentially eliminated the individual mandate. With or without the mandate, the ACA has failed miserably at holding down healthcare costs and achieving universal health insurance coverage.”
Joseph Jarvis, MD, public health consulting physician and former State Health Officer at the Nevada Division of Health, wrote in a June 21, 2019 op/ed titled “The Affordable Care Act Isn’t so Affordable, So, What Is?,” available at deseret.com:
“Middle-class families across the United States who have no employment-based health benefits are increasingly finding the cost of health insurance offered under the aegis of the so-called Affordable Care Act to be, well, unaffordable…
The Affordable Care Act is not affordable. It also didn’t protect any patients. But then, it never was about cost or quality. The legislation was principally aimed at providing coverage for uninsured Americans. And there it failed as well. Even with optimal implementation, tens of millions of Americans, mostly middle-class, were left behind without health financing.”
Mike Pence, Vice President of the United States under President Trump, stated in his June 13, 2017 remarks to the Department of Health and Human Services, available at whitehouse.gov on a page titled “Remarks by the Vice President on Healthcare”:
“I can promise you this President is fighting every single day to rescue the American people from this policy, to repeal and replace Obamacare, and give the American people access to the world-class healthcare that every American deserves…
Remember the last administration promised that Obamacare would lower premiums on the individual market by up to $2,500 for American families? The reality: Premiums have actually increased by nearly $3,000 on working families across this country…
And while costs are soaring, even worse still, choices are plummeting. Insurance companies are pulling out of Obamacare left and right…
For the past seven years, under Obamacare, we’ve had a healthcare system based on the misguided premise that the federal government should order every American to buy health insurance, whether they want it, or need it, or not; that politicians know better than patients and doctors; and that –worst of all, that the American people cannot be trusted to run their own lives or make their own healthcare choices.”
Tom Price, MD, former US Secretary of Health and Human Services, stated the following in his May 3, 2017 op/ed article titled “Obamacare Is on the ‘Verge of Collapse.’ It’s Time for Congress to Pass Health-Care Reform,” published at cnbc.com:
“If a house is on fire, you do not wait for it to burn to the ground before trying to save the family trapped inside. The situation we face today with Obamacare is no different: It is on the verge of collapse, buckling under the weight of its own toxic mix of mandates and regulations, and many of our fellow Americans are trapped inside…
The statistics tell the story that we know all too well. Since Obamacare’s central rules took effect, premiums for individual market plans have doubled. At the same time, insurance coverage rates have fallen far short of predictions. The Congressional Budget Office had projected that 23 million Americans would be enrolled in the law’s healthcare exchanges this year; the reality is that the number of Americans currently enrolled is less than half that estimate.
Patients increasingly don’t have a choice of insurers, either. In one-third of all counties in America, there is only one insurance company participating on the exchanges; in another 37 percent of counties, there are just two. The situation is especially acute in rural areas, where prices are high and access to care is already a struggle.”May 3, 2017
Ronna McDaniel, Chairwoman of the Republican National Committee (RNC), stated the following in her Mar. 23, 2017 article titled “Obamacare Is Broken, and Republicans Can Fix It,” available at usatoday.com:
“We were promised that Obamacare would bring down healthcare costs with increased competition between insurance providers. We were promised we could keep our healthcare plans. We were promised that Obamacare would not raise middle class taxes. Instead, the law brought the American people rising premiums, unaffordable deductibles, fewer insurance choices and higher taxes. We were let down.
This year alone, Obamacare premiums have gone up by an average of 25%, and in some places have risen by over 100%. Individuals have insurance that they cannot afford — high deductibles distort the meaning of coverage. Under the two most popular Obamacare health plans, thousands of families have been forced to shoulder burdensome deductibles equivalent to 10% and 6% of the median American household income. This is not affordable.
Obama’s promise of ‘choice’ has turned out to be fiction for people living in more than 1,000 counties who are left with one insurance provider on their state exchanges. No one can deny Obamacare is in a ‘death spiral’ when the number of Americans with only one insurer from which to choose jumps from 2% to 17% in one year. This is not choice.”Mar. 23, 2017
Jeffrey A. Singer, MD, Senior Fellow at the Cato Institute, stated in his Oct. 15, 2014 op-ed for The Hill titled “Why Doctors Give Obamacare a Failing Grade”:
“Count me among the discontented. Obamacare has harmed too many of my patients.
It has done so by disrupting the doctor-patient relationship and thereby worsening the quality of patients’ care. This is the heart and soul of medicine, as I have learned in in my 33 years as a practicing physician…
Obamacare’s assault on the doctor-patient relationship first manifested this time last year, when my patients began receiving cancellation letters indicating that their plans didn’t meet the law’s minimum requirements…
Nor does it appear that any thought was given to the regulatory burden that Obamacare has imposed on physicians. In their zeal to regulate and standardize health care, the law’s authors empowered bureaucrats in Washington to drown doctors like me in a deluge of paperwork and reporting requirements.
This has only forced doctors like me to spend less time treating patients. Compared to when Obamacare was passed, I now spend roughly half my time on data entry and administrative work. I feel more like a data entry clerk than a doctor. Surely this time would be better spent in the treatment room or on the phone with patients conducting follow-ups.”Oct. 15, 2014
Mitch McConnell, JD, US Senate Majority Leader (R-KY), stated during a Jan. 25, 2015 interview with 60 Minutes‘ Scott Pelley, available at cbsnews.com:
“Obamacare is the single worst piece of legislation that’s been passed in the last half-century. The biggest step in the direction of turning us into a European-type country…
The Congressional Budget Office, [which] doesn’t work for Republicans or Democrats, run by a former Clinton staffer, said that the best case scenario, Obamacare reduces the number of uninsured from forty million to thirty million. A twenty-seven hundred page bill that wreaks havoc with the private health insurance market, and in the end, doesn’t get everybody covered in the first place. Now that is not my view of how to improve the American health care delivery system. If we had the ability to do it, we ought to pull it out root and branch and start over.”Jan. 25, 2015
Michael Moore, documentary filmmaker, stated in his Dec. 31, 2013 op-ed for the New York Times titled “The Obamacare We Deserve”:
“Obamacare is awful.
I believe Obamacare’s rocky start — clueless planning, a lousy website, insurance companies raising rates, and the president’s telling people they could keep their coverage when, in fact, not all could — is a result of one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go. When right-wing critics ‘expose’ the fact that President Obama endorsed a single-payer system before 2004, they’re actually telling the truth.
By 2017, we will be funneling over $100 billion annually to private insurance companies. You can be sure they’ll use some of that to try to privatize Medicare.
For many people, the ‘affordable’ part of the Affordable Care Act risks being a cruel joke. The cheapest plan available to a 60-year-old couple making $65,000 a year in Hartford, Conn., will cost $11,800 in annual premiums. And their deductible will be $12,600. If both become seriously ill, they might have to pay almost $25,000 in a single year.”Dec. 31, 2013
Paul Ryan, US House Representative and Chairman of the House Ways and Means Committee, stated in his Jan. 6, 2015 op-ed for USA Today titled “Rep. Paul Ryan: Obamacare Is Beyond Repair”:
“You can’t fix a fundamentally broken law; you’ve got to replace it. That’s why Congress can’t save Obamacare with a few tweaks, despite what its defenders say. No quick fix can correct the main flaw: The law takes power away from patients and hands it to bureaucrats.
As millions of Americans have learned from their cancellation notices, Obamacare lets bureaucrats decide what insurance plans must cover. It buries doctors and hospitals in red tape. And it adds a whole host of new taxes and fees that drive up the cost of care. The law doesn’t make people’s health care decisions any easier; in many cases, it makes those decisions for them.
But the law’s effects go far beyond the doctor’s office, weighing down our economy and discouraging hiring. The law requires employers with more than 50 full-time employees to give them health insurance. But because the law defines ‘full time’ as 30 hours or more, employers are keeping employees below that threshold to avoid the mandate entirely.”Jan. 6, 2015
Robert Zarr, MD, President of Physicians for a National Health Program, stated in his Mar. 4, 2015 article titled “The Obamacare Challenge We Need? Improved, Expanded Medicare for All,” posted on the Common Dreams website:
“[T]he sad reality is that the ACA won’t be able to achieve universal coverage. It won’t make care affordable or protect people from medical bankruptcy. Nor will it be able to control costs.
The ACA is fundamentally flawed in these respects because, by design, it perpetuates the central role of the private insurance industry and other corporate and for-profit interests (e.g. Big Pharma) in U.S. health care.”Mar. 4, 2015
Ted Cruz, JD, US Senator (R-TX), stated in his Dec. 11, 2013 op-ed for USA Today titled “Obamacare is a Disaster: Ted Cruz”:
“Today, there can be no dispute that Obamacare is a disaster.
The reason Obamacare is failing is not its bungled website. It is because Americans are now seeing the fundamental trade-off behind the law — that in order to insure a relatively small number of the uninsured, many millions more Americans are likely to lose their private insurance, lose access to preferred doctors, or pay substantially more for their insurance.
President Obama promised that if this law was passed, you could keep your plan, you could keep your doctors, and your premiums would go down. Each of those promises has proved false.
Already, more than 4 million people have lost their insurance plans because of Obamacare. And millions more Americans’ health insurance is at risk. Some experts predict anywhere from 80 million to 129 million private health plans will be canceled or forcibly changed over the next year…
The president promised that the average family’s premiums would fall by $2,500; instead, they have risen by over $3,000 since 2008…
Moreover, Obamacare is a major jobs killer, especially for those struggling to climb the economic ladder. Workers are seeing their hours cut, and small businesses are unable to hire new employees.”Dec. 11, 2013
A group of 200 economists, including current and former officials at the Congressional Budget Office (CBO), Office of Management and Budget (OMB), and White House Council of Economic Advisors (CEA), stated the following in a Jan. 18, 2011 letter to House Speaker Boehner, House Minority Leader Pelosi, Senate Majority Leader Reid, and Senate Minority Leader McConnell, available at the American Action Forum website:
“To promote job growth and help to restore the federal government to fiscal balance, we, the undersigned, feel that it would be beneficial to repeal and replace the Patient Protection and Affordable Care Act (P.L. 111-148). Too many Americans remain unemployed and the United States faces a daunting budgetary outlook. We believe the Patient Protection and Affordable Care Act is a threat to U.S. businesses and will place a crushing debt burden on future generations of Americans…
The Patient Protection and Affordable Care Act contains expensive mandates and penalties that create major barriers to stronger job growth… The law also levies roughly $500 billion in new taxes that will enter the supply chain for medical services, raising the cost of medical services… these medical costs will translate to higher insurance premiums, further increasing the cost of operating a business in the United States…
The Patient Protection and Affordable Care Act does not constitute real health care reform… Congress should start with a clean sheet of paper and adopt initiatives that would encourage providers to offer higher-quality care at lower costs; reduce the cost pressures that threaten to bankrupt Medicare and Medicaid; and give every American access to more options for quality insurance.”Jan. 18, 2011 - Letter from 200 Economists to House leaders