As you may know, current estimates suggest the U.S. spends more on health care than any other nation in the world and still many Americans live without any form of health insurance. In 2005, there were 46.6 million people in the U.S., almost 16% of the population who were without health insurance for at least part of the year. Many of these people are forced to rely on our over-burdened safety net hospitals for care.

Having spent my entire life in the San Joaquin Valley, I've seen examples of the best and worst our nation's health care system has to offer, or not offer, its residents. Without a doubt, we have some of the most devoted, hard-working health professionals anywhere in our doctors' offices, hospitals, and health centers in the Central Valley. But one doesn't have to spend more than a few minutes in one of these facilities to know that these health professionals and health facilities are stretched thin.

When the debate over health reform began this Congress, I outlined my list of basic priorities for any health reform bill. These include addressing issues of catastrophic care, portability, pre-existing conditions and preventive measures as well as assistance to develop a valley medical school to ease the strain on health professionals in our district.

My congressional district, California's 20th, has one of highest primary care health professional shortage designations anywhere in the country. We are not just short primary care doctors, but also mental health doctors, nurses, dentists and specialists. The Central Valley has approximately 31 percent fewer physicians and 51 percent fewer specialists than the rest of California.

In our valley, we have less than 1 doctor for every 1,000 residents. The rest of the country averages more than double that number. That is why I worked hard to include provisions to fund medical school development in health professional shortage areas like our valley and provide added incentives for doctors in the National Health Service Corps to come to the Central Valley for their service. Study after study has shown that doctors who come here for their medical education and residency tend to stay. Our struggle has always been getting them here in the first place. This is an issue I would think every valley legislator could and should be willing to support.

The need is in the valley is great. Nearly 27 percent of my district is uninsured. That's approximately 184,000 people that have no choice but to avoid care, delay care and, when they are at their sickest, seek care at our health centers and hospitals. This bill takes the burden off these facilities by providing added funding to health centers and increased rates for Medicaid reimbursement to help bridge the gap between the cost of care and what the doctors and hospitals get paid.

The cost of health care has been increasing at an out of control rate, making insurance increasingly unaffordable for families and businesses. In 2008, there were 1,200 health care-related bankruptcies in the district, and hundreds of citizens losing insurance as a result of cost and preexisting conditions. This bill will help approximately 156,000 households in the district afford health insurance. Nearly 10,000 small businesses between Fresno and Bakersfield will now qualify for tax credits to provide coverage to their employees. The over 21,000 individuals with preexisting conditions in my district will not have to worry about being denied care.

This bill is far from perfect, but, after listening to doctors, nurses, small businessmen and individuals throughout the district, I voted yes because I believe this bill is a step in the right direction for the Central Valley. I still have concerns about several provisions in the bill related to cost containment, and intend to closely follow changes that occur as the House and Senate continue to work their work on this legislation. Much like my vote on the House bill, my vote on a conference report will depend upon the needs of the San Joaquin Valley being met.

For more information on the House and Senate healthcare reform bills, please visit the following links:

House: The Affordable Health Care for America Act of 2009 ( H.R. 3962 ) 

Senate: Patient Protection and Affordable Care Act ( S.R. 3590)