May 5, 2006 The Honorable Mitt Romney Massachusetts State House Office of the Governor Room 360 Boston, MA Dear Governor Romney: The plans we represent are all Massachusetts-based, not-for-profit companies serving over 4.5 million members and employing thousands of workers throughout the state. We are proud that U.S. News & World Report and the National Committee for Quality Assurance rank our plans among the top ten health plans in the nation for member satisfaction and quality of care. We are writing to express our serious concerns about the impact of legislation currently being considered by Congress which will seriously undermine the historic health care achievements that you and legislative leaders have made here in Massachusetts. S. 1955, The Health Insurance Marketplace Modernization and Affordability Act of 2006 sponsored by Senator Michael Enzi, may be considered by the full Senate during the second week of May. We urge you to oppose this legislation. We are particularly concerned about the Enzi legislation as it relates to rating requirements. If Enzi were to become law, it would allow medical underwriting and premium surcharges based on age, gender, geography and group size in the small group market in all 50 states. While a few young and healthy individuals may find insurance products more accessible, those who need it most will not. Under Massachusetts law, and the laws of other states with modified community rating, individuals and small employers are protected from the price spikes that occur when health status is considered as a factor. The price variances between those who are healthy and those who may suffer a health condition are dramatic and will impact people when they need health care most. S will also have an adverse impact on small employers with older employees. Again, the impact will be felt the most in states with modified community rating, where it is expected that there will be a rise in the number of uninsured as a result of the implementation of S

It is worth noting that in nine of the ten states that have community rating, the percentage of businesses that offer health insurance is higher than the national average. States with community rating also have uninsured rates below the national average. The Enzi legislation will threaten the strides that Massachusetts has made with the newly enacted health reform law, and could in fact dismantle this historic effort over time, specifically as it relates to market reforms. In the short-term, Enzi will create a serious dispute as to whether states will follow their own state statutes or the new federal Enzi provisions. This conflict will likely be resolved only by the courts after protracted litigation. In the long term, the Enzi legislation will stymie state efforts to seek innovations in health reform and instead will place the regulation of most insurance matters firmly within the domain of the federal government. Given the importance of the upcoming Senate vote, we hope you will reach out to the Massachusetts Congressional delegation to voice your opposition to the Enzi bill. We also urge you to contact your fellow governors and alert them to the fact that the federal legislation will chill innovation at the state level and limit a states authority over insurance matters. Thank you for your consideration of this important matter. James Roosevelt, Jr. Cleve L. Killingsworth President and CEO Charles D. Baker Eric H. Schultz President and CEO cc: Senator Edward M. Kennedy Senator John F. Kerry