The letter (available here) is signed by all 41 GOP senators. They urge House and Senate leadership (and the Chairmen and ranking House and Senate Budget Committee members) not to use budget reconciliation in the healthcare process and that doing so would "make it difficult, if not impossible, to gain broad bipartisan support for the effort." The letter comes after Obama's latest HHS nominee (and latest tax cheat nominee) Kathleen Sebelius told a Senate committee that the administration would not take the controversial procedural tool off the table.