[Congressional Record Volume 141, Number 147 (Wednesday, September 20, 1995)]
[Extensions of Remarks]
[Pages E1817-E1818]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


  STATEMENT OF CONGRESSWOMAN SHEILA JACKSON-LEE REGARDING THE PLANNED 
                     REPUBLICAN CHANGES TO MEDICAID

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                        HON. SHEILA JACKSON-LEE

                                of texas

                    in the house of representatives

                     Wednesday, September 20, 1995
  Ms. JACKSON-LEE. Mr. Sepaker, the Republican majority of this 
Congress has revealed its plan to decimate Medicaid less than 24 hours 
before the start of markup and voting activities were to begin in the 
House Commerce Committee. Without one single public hearing, 
Republicans are attempting to cut $182 billion from a program which 
millions of low-income working people and poor people depend upon for 
the most basic of medical services.
  Good public policy takes something there is * * * Republican plan, I 
think my colleagues and I would be remiss if we did not demand, for 
ourselves and those we represent, time to study the repercussions of 
such a far reaching plan. Indeed, this plan does more to Medicaid than 
their plan will to Medicare, and they are proposing at least one day of 
hearings for it.
  I can not but but believe that my cohorts across the aisle had 
nothing but good intentions when they and the thirty Republican 
governors crafted this plan. However, I must take issue with many parts 
of it which leave vulnerable many people who have no other means of 
medical support. This plan attempts to provide states with flexibility 
in how they may use their Medicaid funds. However, in attempting to do 
so, they have stripped the Federal government of its ability to protect 
the poor and the old, precisely those who need both protection and 
health care the most. Congress can no longer specify minimum 
requirements of health care. The states must do that. Congress can no 
longer specify eligibility requirements. The states must do that. 
Congress can no longer specify quality standards or guidelines. The 
states must do that. I believe that this plan is asking too much of the 
states.
  The first point I take issue with is that of eligibility. Under the 
plan before the Commerce Committee, individual entitlement to medical 
assistance would be abolished for all
 populations. That spells disaster for healthcare for the needy across 
the nation. Furthermore, the plan earmarks a certain percentage of the 
states' plans for pregnant women and children, disabled people under 65 
and elderly people, but the plan does not exactly define the 
requirements of eligibility within these groups.

  Then there is the issue of access to healthcare. Within the plan, the 
States' ability to require beneficiary cost-sharing is almost 
unlimited--except for families below 100% of poverty that include 
either a pregnant woman or child--and elderly and disabled enrollees 
could be required to pay large premiums, deductibles and copayments. 
This version of cost-sharing reduces necessary utilization of services 
among low income populations. As a result, these requirements would 
effectively restrict beneficiaries' access to much needed health 
services.
  The Republican party shields itself behind false and misleading 
statements regarding Medicaid, always blaming the poor for Medicaid's 
problems. Yet, current protections preventing impoverishment of the 
spouses or sons and daughters and their families to care for those 
needing long term care are gone. There would be no guarantee that 
spouses of nursing home residents would be able to retain enough 
monthly income to remain in the community. The Republicans are 
allowing, under their plan, families to go broke while trying to care 
for their elderly members seems slightly hypocritical.
  The lack of specification of standards with respect to delivery 
systems is in my opinion, criminal in its neglect and thoughtlessness. 
This plan does not include quality standards, or general quality 
guidelines, for capitated managed care plans. The Federal Government is 
prevented from enforcing current access standards, such as physician to 
patient ratios as well as time and distance requirements. Finally, the 
ability of states to contract with managed care plans for services, 
case management, or coordination would be completely unfettered which 
could result in the reemergence of ``Medicaid mills''. This lack of 
accountability concerns
 me a great deal. I worry about all the unprotected older Americans who 
will be left naked and defenseless against the bean-counting efficiency 
experts of state governments and healthcare providers.

  Not only does this plan cheat the young, elderly and disabled, but it 
also finds a way to inflict its suffering on the special populations of 
this country. Regardless of one's feelings towards undocumented 
workers, can anyone declare that those merely searching for a better 
life should be denied emergency services for the simple crime of not 
having been born a United States citizen? I think not. With regard to 
Native Americans, states would no longer be required to pay for 
services in IHS facilities. This country owes a certain debt to the 
Native peoples of this land, and I believe we should not forget or 
abrogate that responsibility.
  Program integrity is indeed addressed in the GOP plan. Their version 
requires states to operate fraud control units to investigate and 
prosecute fraud, abuse and neglect of beneficiaries, but it does not 
provide funding to do so. If I am not mistaken, this is an unfunded 
state mandate, is it not?
  Amongst many other things, the public needs to know that this 
revolutionary plan has language which says that ``No person''-meaning 
beneficiary, doctor, hospital or private health plan--shall have a 
basis to sue a state for failing to comply with Federal Medicaid 
statues or the terms of the state's Medicaid 

[[Page E 1818]]
program. Thus, this plan has stripped not only the Federal government 
of its ability to protect beneficiaries, but has also stripped the 
beneficiaries any means of protecting themselves. Once again, the 
questions about accountability must be asked and answered.
  Under the Republican plan, Texas will loose over $11 billion during 
the next seven years and I have been told by public healthcare 
providers in my district that these cuts will cause great harm to the 
people they serve. These providers are concerned about having to close 
neighborhood clinics which administer preventive and primary care. They 
are concerned that the fiscal burden of caring for the poorer people of 
my district will increasingly fall upon the shoulders of the area 
taxpayers. They are worried that they will have to turn away the 
children they have sworn to help. And it is for these reasons that I am 
worried.


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