Dear Senators & House Representatives:
We the undersigned are sending you this "Change of Health Care Provider Form" for you to sign to pledge to sign up for the Government Program that will be available to your constituents.
I hereby ______________________________(name of Senator, House Representative) swear that I will enroll myself , my children, my parents and all living relatives in the public option in the newly drafted "Affordable Health Care for Americans" bill. Being that I am employed by the Government, a government provided, co-oped Plan would be the Health Care plan logically available to me and my family.
I also waive the exemption of members of Congress as outlined in the "Affordable Health Care for American's" bill. I cannot in good conscience vote on any bill / law for my constituents that I myself would not live under and abide by.
If you are not voting for the aforementioned Bill please sign here, than you cannot pledge to accept the conditions and terms of a government run or co-oped plan:
__________________________________
(Senator or House Representative Name)
Thank you for signing the petition to send the above "Change in Benefits Form " to our Senators, and House of Representative members, Republican and Democrat alike.
