[Congressional Record Volume 141, Number 173 (Friday, November 3, 1995)]
[Senate]
[Pages S16643-S16648]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                       AN AMERICAN SUCCESS STORY

  Mr. GRAHAM. Mr. President, for the past 30 years, the Medicaid 
Program has been the lifeblood of the United States health and long-
term care delivery system for millions of Americans. Today, I will 
begin a series of presentations on the Medicaid Program. Today, I will 
be refuting the false notion that the Medicaid Program has been a 
failure and that it should therefore be abandoned. The fact is that 
Medicaid is an American success story.
  Next week, I will continue by exposing the bogus economic basis upon 
which the block grant proposal is built and which is used as a 
purported replacement of our current Federal-State Medicaid 
partnership. I will suggest to the Senate through a side-by-side 
analysis what we know to be the demand for health care services under 
Medicaid and what has actually been provided under the Senate-passed 
bill.
  Finally, I will conclude with a proposal on how a consensus can be 
reached which would accomplish an objective of reducing the cost of the 
Medicaid Program, potentially by tens of billions of dollars, over the 
next 7 years without destroying the essential Federal-State 
partnership.
  The word ``failure'' has been used frequently and casually as a 
justification for why this country must abandon the Federal-State 
partnership in health care for poor children and their mothers, for the 
frail elderly, and for the disabled. Critics have bellowed that 
Medicaid is a failure, and in the next breath they say that since 
Medicaid is a failure we can go ahead and back out $187 billion from 
what has been projected as the necessary amount of money to meet the 
needs of those traditionally served under Medicaid.
  There is a story that needs to be told. That story is an American 
success story, and the name of that American success story is Medicaid.
  If my colleagues truly pondered the significance of this Federal-
State partnership, they would not seek to plunder $187 billion from 
Medicaid at the expense of the health and safety of the 37 million--I 
repeat, 37 million--Americans who depend upon Medicaid.
  The Medicaid Program truly is an American success story. The Senate 
should be building upon that success story, not retreating from it. The 
truth is the Medicaid Program has been a lifesaver. One need only look 
at the role Medicaid has played in reducing infant mortality in 
America.
  When I was Governor of the State of Florida, the Southern Governors 
Association under the leadership of the then Governor of South Carolina 
and now Secretary of Education, Richard Riley, decided to tackle the 
unacceptably high infant mortality rate among Southern States--a rate 
which put the Southern States on par with some developing countries 
around the world. So in 1984, we formed the southern regional infant 
mortality project. We decided to tackle infant mortality through 
enhancing prenatal care, screening pregnant mothers to identify at-risk 
babies, and making sure that nutrition services and other resources 
were brought to bear on the infant mortality rate.
  During the period 1984 to 1992, national infant mortality decreased 
21 percent. A great deal of that progress was due to the improved 
performance of the Southern States. My own State of Florida knew that 
it had a scandalously high infant mortality rate so that it made a 
conscious decision to decrease infant mortality, low birthweight 
deliveries, and the number of women lacking prenatal care. The Federal 
Government was a full partner 

[[Page S 16644]]
with each of the Southern States to help achieve their impressive 
results. The name of that full partnership, the name of that American 
success story is Medicaid.
  What happened in just a decade? In 1985, Florida had a rate of 11.3 
stillbirths for each 1,000 live births. By 1992, that number had 
dropped to 8.8, a decline of over 22 percent. I am pleased to say that 
that rate of infant mortality in Florida continues to decline. Today 
the rate is 7.6 per 1,000 to live births.

  Mr. President, nearly 1,000 Florida children are alive today who, had 
we continued the rate of infant mortality of a decade ago, would have 
died at birth but for the Medicaid initiative called Healthy Start.
  Mr. President, prevention pays because healthier babies were born due 
to earlier intervention efforts, and tens of millions of dollars, 
Federal and State, have been saved. Florida, through the Medicaid 
Program, has been able to invest in success rather than simply pay for 
failure.
  Success stories like that where States are willing to make a 
commitment to improve the lives of their citizens found a willing 
Federal partner. Those States cry out for the continuation of the 
Federal-State partnership, the American success story called Medicaid.
  In total, Medicaid pays for more than one-third of the births in 
America. I would like to repeat that, Mr. President. Medicaid pays for 
more than one-third of the births in America. Medicaid covers one-
fourth of all of America's children's health care. The great majority 
of those 1-in-4 children are children who are living in homes with 
working but uninsured parents.
  In Florida, that translates into 991,000 children, children who, 
because of Medicaid, are eligible for immunizations, checkups and other 
preventative measures. So many of these Medicaid recipients are the 
casualties of the private sector's retreat from the health insurance 
needs of their employees and the families of their employees. The 
General Accounting Office reported that between 1989 and 1993, the 
percentage of children with employment-based health insurance declined 
9 percent.
  This could have resulted in a national crisis in health care for poor 
children. How was that crisis averted? A success story was written in 
America, and the name of that American success story is Medicaid. 
Because of Medicaid, the number of uninsured children did not increase 
when employers were dropping coverage for those children.
  As the General Accounting Office has reported, as the private sector 
retreated from the provision of private health insurance to their 
employees, and particularly to the dependents of their employees, 
Medicaid has become the lifesaver for those poor children. It has been 
the lifeline for those children who otherwise would have been an 
American crisis, health crisis.
  Mr. President, Medicaid has also been a lifeline for our Nation's 
frail elderly. Over 60 percent of the nearly 2 million nursing home 
residents in this country qualify for Medicaid, many qualifying only 
after their life savings have been depleted by successive medical 
crises in their own lives.
  Approximately a quarter of a million older Floridians receive 
Medicaid, and 70 percent of Florida's Medicaid budget goes to pay for 
services to the elderly and disabled. Great strides have been made in 
improving the quality of care for our elderly who depend on Medicaid 
for their survival.
  I would like to look for a moment at the qualified Medicare 
beneficiary program which covers Medicare premiums, deductibles, and 
copayments for beneficiaries who have incomes below the Federal poverty 
level. Mr. President, there are 5 million low-income elderly Americans 
who qualify for Medicare but could not pay the $46.10--soon to be 
almost double that amount--of monthly payments in order to participate 
in the voluntary Medicare Program to provide physician services. They 
could not afford to pay the $100 deductible--soon to be a $210 
deductible--but for the fact they were able to receive the financing 
for that deductible through the Medicaid Program.
  They did not have the private resources to pay for prescription 
medication. And, therefore, Medicaid came to the aid of 5 million poor 
older Americans to provide critically needed prescription medication. 
This program has meant the difference between preventive care in a 
doctor's office and intensive care in a hospital or acute care in a 
nursing home.
  Medicaid is an American success story. Mr. President, the individuals 
whose lives have been bettered through the Medicaid Program each have 
their own story to tell.
  I ask unanimous consent that a sampling of those stories provided by 
Families USA Foundation and the Long Term Care Campaign be printed in 
the Record at the conclusion of my remarks.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See exhibit 1.)
  Mr. GRAHAM. Mr. President, I appreciate your accepting those stories, 
which are profiles in courage, the courage of a loving family trying to 
deal with health setbacks and scarce resources. These families could 
have been your family, they could have been my family, they could have 
been any American family.
  We cannot turn our backs on our citizens who have given so much to 
our country, nor can we retreat on the gains we have made in providing 
a decent quality of life for our Nation's developmentally disabled 
citizens. We all remember when a consensus emerged from across the 
country, ``Stop warehousing the handicapped in those shamefully large 
institutions.'' That was the goal, an ambitious goal, to get as many 
people out of institutions and into community-based home settings as 
possible.
  The Federal-State partnership called Medicaid became the framework to 
achieve that national objective. Medicaid said to the States, ``If you 
are interested in providing a more humane living environment for your 
vulnerable citizens, we will be a full partner with you.'' Some States, 
many States, moved quickly. Unfortunately, others chose not to do so.
  That is one of the attributes of the Medicaid Program. It is a 
Federal-State partnership, but the results for those States which did 
move speak for themselves. In 1967, there were 194,000 mentally 
retarded or developmentally disabled persons living in State 
institutions. By 1994, there were 67,600.
  When you look at the cost of care, it costs $65,000 per year per 
institution bed. It costs the State and the Federal Government $26,000, 
on average, to provide a home waiver bed.
  These numbers provide some sense of the huge cost savings which the 
American success story of Medicaid has made available to American 
people while at the same time enhancing the quality of lives of some of 
our most vulnerable fellow citizens. But even more impressive than the 
savings are the number of people whose families stayed together, at 
home, because of Medicaid.
  Mr. President, that incredible effort at deinstitutionalization of 
the handicapped and helping them live at home or in home-like settings 
is a success story. And the name of that American success story is 
Medicaid.
  Today, some 6 million disabled Americans are covered under Medicaid. 
I submit that there is a compelling national interest in assuring a 
humane quality of life for the disabled and the infirm. The nursing 
home standards, the Medicaid waiver programs, the spousal 
impoverishment provisions, these and so many more tools have helped to 
build a decent quality of life for persons who live at our mercy and 
their families.
  Recently, Mr. President, I visited the Arnold Palmer Clinic at the 
Orlando Regional Medical Center. I was struck by the number of infants 
and toddlers who were developmentally delayed or disabled and that were 
being served at the Arnold Palmer Clinic. The directors of the clinic 
stressed that if you can bring therapy and treatment to those children 
from infancy to the age of 3, you can avert many of the problems that 
will otherwise occur in later life.
  I was impressed with the results that I saw. What they are doing at 
the Arnold Palmer Clinic is writing a success story. And the name of 
that success story is Medicaid. Fully two-thirds of the children who 
were participating in the Arnold Palmer Clinic for handicapped and 
disabled children were being served under the Medicaid part H program. 

[[Page S 16645]]

  Yet, the children, the disabled, the elderly, are not the only ones 
with a huge stake in the Medicaid debate. So often the debate on 
Medicaid has been dominated by doctors, hospitals, nursing homes, and 
those whom they serve. We forget how the mentally ill and those 
overcoming substance abuse problems will be affected by the pending 
proposal to cut $187 billion out of the projected needs for Medicaid 
over the next 7 years.
  In fact, those will be some of the first to feel the pain, the first 
to be cut, because they do not have lobbies, Mr. President, they do not 
have political action committees.
  They do not have much political muscle. That statement is not a scare 
tactic. This is not a residue from Halloween, this is a fact.
  Last year, when the State of Florida had to cut back on its Medicaid 
Program due to a State budget crisis, the mentally ill and their 
providers were the first to feel the sharp edge of the budget cutting 
knife. Children's mental health programs were cut, payments to 
providers were reduced, and this year the cutbacks are expected to be 
even more severe.
  Has anyone on the Senate floor discussed how Medicaid funds the 
institutions for the mentally ill? Has anyone talked about how it is 
possible to cut costs in caring for persons who are found not guilty by 
reason of insanity or incompetent to proceed to trial? How do you cut 
costs here? Do you put them on the honor system? Do you cut back in 
security at the facilities?
  Yes, Mr. President, it is a well-kept secret, but Medicaid helps to 
keep our streets safe. In Florida, a full $50 million in Federal 
dollars this year primarily through Medicaid goes to the residential 
and treatment service for forensic patients. In total, Medicaid covers 
41 percent of the budget for State mental health programs. Let me 
repeat that, Mr. President, because I do not believe that many of our 
colleagues understand that fully 41 percent of the budget for State 
mental health programs is financed through a program that we are 
proposing to cut $187 billion from projected needs over the next 7 
years.
  In some States, the percentage is substantially higher than 41 
percent, particularly in those States which have abused the 
disproportionate share of funding for hospitals.
  Next week, I intend to talk in detail about the abuses that have 
occurred in the disproportionate share program. Believe it or not, we 
are about to reward the very abusers of the Medicaid system and even 
worse, Mr. President, to pay for those rewards by raiding the Social 
Security trust fund. That is what happened a week ago today.
  Of course, because of the blind rush to pass sweeping changes in 
Medicaid without so much as a hearing, the U.S. Senate has not fully 
heard from the children who have been sexually abused and mentally 
scarred, children whose chance to have a normal life hinges on mental 
health services that are funded through Medicaid.
  The Nation currently has over 300,000 children who have been abused 
while living in foster homes. So many of them receive little or no 
mental health services. The State of Florida has over 9,000 foster 
children and is in Federal court as a defendant because of the lack of 
mental health services for these children. It is not ironic that the 
Senate will maintain the entitlement status of its foster care title IV 
program while gutting the entitlement that helps foster children get 
mental health treatment. It is not ironic, it is schizophrenic.
  We are saying to foster children that we will keep the entitlement 
that covers the cost of a roof over their heads, but we will no longer 
help them deal with the wounds of their heart. We are going to cut $187 
billion and, of course, that means that mental health, AIDS, program 
for the handicapped are on the chopping block first. What a shame it 
would be to abdicate responsibilities to such populations where so many 
great strides have and are being made.
  The Presiding Officer now represents the State of Mississippi, one of 
the States that participated in the program that I referred to earlier, 
the effort across the South to reduce infant mortality. I mentioned, 
Mr. President, that in my State of Florida when this effort began in 
1985, we had a ratio of 11.3 stillbirths for every 1,000 live births, 
and today, largely because of the kind of initiatives that Medicaid has 
funded, that has been reduced in the State of Florida to 8.8 per 1,000. 
You might be interested, in the State of Mississippi, in 1985, the rate 
of infant mortality was 13.7 per 1,000 live births. Today, that has 
been reduced to 11.9, or a 13.1-percent reduction, in the period from 
1985 to 1992.
  That is illustrative of the kind of success stories that are 
attributable to the Federal-State partnership of Medicaid.
  I say shame on the Governors of the States who are now cheerleading 
for the destruction of that partnership. I have a warning for them, or 
more accurately a proverb for them. The proverb goes as follows: Fish 
see the worm not the hook.
  These Governors who are salivating, who are so anxious to gobble up 
block grants being proposed, will feel the hook when their economies 
stumble, when an epidemic strikes, when a natural disaster hits, when 
inflation creeps up again, or when their population grows. Worst of 
all, they will be held accountable in history for killing a program 
that actually had achieved its objectives and nurtured a national pride 
in providing basic health care for fragile and vulnerable citizens.
  I have strained my eyes to see and my ears to hear the justification, 
the policy basis for the amount of $187 billion. What is the rationale? 
What is the health policy behind reducing this program $187 billion 
over the next 7 years, reducing it below what its current projections 
are that will be necessary in order to continue to provide health care 
to poor children, their mothers, the disabled, and the frail elderly?
  The response to this is dim words and inaudible whispers. There is no 
answer to the question of what is the policy rationale behind the 
reduction in terms of health care for the American people.
  Is it any wonder that millions of Americans, including this Senator, 
are left to conclude that the measuring stick being used for the $187 
billion Medicaid cut is the width of the wallets that will be fattened 
by the tax cut, a cut taken in part out of the lives of working people 
and defenseless people?
  To tout Medicaid's success is not to ignore its faults. There is work 
to be done to improve its accountability, to combat fraud and waste, 
and to monitor its growth in spending. Next week, I will talk about how 
we can achieve these objectives without discarding the Federal-State 
partnership that has helped to maintain this country as a Union of 
States and has helped to maintain a basic American value: That we care 
about all of our people; that we particularly care about poor children; 
that we particularly care about the health of the mothers of those poor 
children; that we particularly care about those who live in the shadows 
of life, the disabled, and the frail and elderly.
  I have only skimmed through the pages of 30 years of the success 
story which is Medicaid. I urge my colleagues to think twice before 
closing this chapter of America's history. Medicaid has not been a 
failure, it has been a success. This success story needs to be told and 
retold from the healthy infant born to the frail elderly living in 
dignity; from the disabled adult to the handicapped child; from the 
abused child to the immunized child. These are the faces of the success 
story that is called Medicaid. These are the faces that are watching 
the Senate at this defining moment of American history.

                               Exhibit 1

   [From ``Hurting Real People: The Human Impact of Medicaid Cuts'']

               Families Who Depend on Medicaid's Lifeline

       Here's a sampling of stories of people on Medicaid. For 
     more names and numbers, call Greg Marchildon.


                               california

       Angela Mack, Los Osos, CA.--Angela, 43, was employed as a 
     journalist until she suffered from a rare spinal cord 
     disorder. She is now quadriplegic. For two years, she lived 
     in a nursing home, but now she is able to get four hours of 
     personal care paid by Medicaid per day and live at home. 
     Medicaid pays this monthly cost of $1032, pays some of her 
     prescriptions and pays the share of doctor bills not paid by 
     Medicare. Angela receives $990 monthly in social security 
     disability benefits and pays $350 of it as her share of 
     medical costs. She is fortunate to live in HUD assisted 
     housing. Still, when she finishes paying for medical supplies 
     not covered by insurance, a high-fiber diet, and other 
     necessary expenses, she ends the month with $0 

[[Page S 16646]]
     to $2. Recently, she was notified that MediCal will cover six 
     prescriptions per month. Right now, she takes seven. Her 
     monthly prescription bills total $185.


                                delaware

       Sharon and Bob Dudek, Delaware.--Before Medicaid came to 
     their aid, Bob had to tell his sons they would not be able to 
     play Little League. ``[They] needed the money to help mommy 
     feel better.'' Their mom, Sharon, has progressive Multiple 
     Sclerosis and is bedridden. She is unable to care for 
     herself, much less their two sons. Bob had to enroll the kids 
     in day care so that he could continue working. He tried his 
     best for a year to care for Sharon himself, but then he 
     realized how much he was neglecting his children. He was also 
     taking away from their futures. Their college funds were 
     dwindling as were the rest of the family's funds. He asked 
     Medicaid for help. Now Medicaid pays for a nurse's aide, 
     nursing care, physical therapy, medical supplies and a 
     hospital bed. This care would cost the Dudeks $34000 a month. 
     Bob has employer health insurance that pays for Sharon's 
     acute care. But he said that Medicaid has allowed him to keep 
     his family together. Without it, he would not be able to keep 
     Sharon at home and take care of his boys.


                          district of columbia

       Millie Ross, Washington, DC.--Ms. Ross has high blood 
     pressure, high cholesterol, ulcers, infective cysts and a 
     problematic intestine. She had surgery on her left eye and 
     her colon last year. The hospital bills helped her qualify 
     for Medicaid under the medically needy program. She paid 50 
     cents for each of eight prescriptions. Her Medicaid coverage 
     ended in March and she must now meet a new spend-down of over 
     $1,000 to be covered. Meanwhile, her drugs cost over $200 a 
     month. Her monthly income is only about $720. She has had to 
     save money by limiting her food and drug purchases. She 
     credits Medicaid for enabling her to buy more nutritious food 
     when she was covered.


                                indiana

       Argene Carson, Indianapolis, IN.--Argene, 80, has arthritis 
     and has had cataract surgery. Without Medicaid, her costs 
     would be astronomical for the drugs and the supplies 
     necessary to properly care for herself. Medicaid allows her 
     to have a home nurse and the funds to pay for specialized 
     equipment. With this kind of assistance, she can live at home 
     and remain independent.


                                 kansas

       Inez Williams, Kansas City, KS.--Inez, 62, worked hard 
     running a day care center before she became ill in 1991 from 
     heart disease and high blood pressure. Her medical treatment 
     quickly totalled $150,000 and she had to rely on getting 
     Medicaid to pay her bills. She had an artery transplant and a 
     throat operation last year. She had to pay $25 copayments for 
     each of these treatments, which was already a stretch on her 
     family's $500 monthly income. If she had been required to pay 
     more, she would not have been able to get the lifesaving 
     treatment she needed.


                               louisiana

       Denise and John Oehlerts, Baton Rouge, LA.--Denise learned 
     that she was pregnant when her husband was in a masters 
     program in landscape architecture at LSU. Denise was working 
     as a floral designer, but did not receive health benefits and 
     they had a very low income. Their small income qualified them 
     for Medicaid and allowed them to receive the prenatal care 
     necessary to have a healthy child. Their baby, Katie, is 
     covered by Medicaid until October, when the Oehlerts must 
     reapply for coverage. John is now a part-time student and 
     works full time in a landscape architecture firm. Denise 
     still works full time as a floral designer. Neither of their 
     jobs offers health insurance.
       Karen, Dan and Alison Higginbotham, Opelousas, LA.--Alison 
     is seven years old, but functions like an 18-month-old child. 
     She has physical and mental disabilities from a rare seizure 
     disorder called infantile spasms. She cannot attend to her 
     personal needs and she cannot speak. She uses a wheelchair to 
     travel any distance. Alison needs physical, occupational, and 
     speech therapy every week. Her care would total $30,000 a 
     year in doctor and therapy fees. Medicaid covers the expenses 
     of her specialists and treatments as well as her specialized 
     equipment. Karen also gets respite and personal care 
     assistance through a home and community based waiver. At 
     first, Danny's company health insurance was paying for part 
     of Alison's care and Medicaid was paying the rest. Danny was 
     earning $23,000 a year until he was let go by the company 
     without any explanation. Danny has found another job and is 
     making $19,000 a year, but the company does not offer health 
     benefits. Medicaid covers most of Alison's expenses.


                                maryland

       Emily Holloway, Baltimore, MD.--Ms. Holloway, 73, was a 
     history teacher and a counselor, but retired without a 
     pension. She now receives only Social Security and SSI. Her 
     monthly income is $478. Though she has been relatively 
     healthy, Medicaid pays for two or three prescriptions, yearly 
     checkups and flu shots that Ms. Holloway could not otherwise 
     afford. A recent biopsy showed potentially scary results. Ms. 
     Holloway is thankful that Medicaid will pay for further 
     testing and treatment.
       Bill Mauer, son of Leopoldini Mauer, Bowie, MD.--Mr. and 
     Mrs. Mauer saved over $70,000 during their working careers. 
     Mr. Mauer was a head waiter and Mrs. Mauer worked part time 
     in school cafeterias. They lived modestly, and invested in 
     stocks and land. Sixteen years after her husband's death, a 
     series of ministrokes left Mrs. Mauer with dementia and she 
     went to live with her son's family. Then she fell and 
     fractured her hip. She was admitted to a hospital and then to 
     a nursing home in 1992. Medicare paid for the first two weeks 
     of care. After that, all of Mrs. Mauer's life savings went to 
     pay for the nursing home. Now she has $2,500 remaining. She 
     contributes her monthly social security check to the nursing 
     home. Without Medicaid, she would not be able to pay the 
     remaining cost of her nursing home care, which is over $3,400 
     a month.


                                missouri

       Katherine Williams, Kansas City, MO.--Katherine, 42, is 
     legally blind and has asthma. Her esophagus is closed and she 
     can only drink fluids and small amounts of food. She hasn't 
     seen a doctor in three months because she knows he will tell 
     her she has to have surgery, but she can't afford it. She has 
     been trying to get Social Security for two years and she 
     still hasn't been given an official decision. Medicaid pays 
     for her doctor appointments and medicine.


                                  ohio

       Melvin and Toi Patrick, Columbus, Ohio.--Melvin and Toi 
     have six children, three of whom have asthma. They have some 
     health insurance through Melvin's company, the Central Ohio 
     Transit Authority. However, the children's asthma is 
     considered a pre-existing condition and care for that ailment 
     is not covered. The children's medical care, including 
     hospital stays, daily medications and treatment, costs 
     thousands of dollars each year. ``Had it not been for 
     Medicaid,'' Toi said, ``the high costs of my children's 
     health care would have bled us dry. Medicaid assistance has 
     enabled us to remain financially independent.''
       Yvette Elkins, Columbus, OH.--After giving birth to her 
     first child, Yvette stopped working to stay home with her 
     baby. Shortly after she resigned, she learned that she was 
     pregnant again. Soon after, her husband left her and the 
     baby. For the first time in her life, Yvette began receiving 
     welfare. Two weeks after her second child was born, Yvette 
     began interviewing for full-time jobs. She depended on 
     Medicaid to bridge the gap between homelessness and gainful 
     employment. Medicaid paid for prescription drugs, doctor 
     visits, and emergency visits; all critical services since 
     Yvette's younger child suffers from chronic ear infections. 
     Transitional Medicaid allowed Yvette to catch up on back 
     bills and advance far enough to obtain a job that offers 
     benefits.


                              pennsylvania

       Lester Thomas, Philadelphia, PA.--Lester thought that 
     everyone had insurance and only lazy people were unemployed--
     until he was laid off and left without insurance. The 
     computer cabinet manufacturing company to which he had 
     devoted 17 years of his life, went out of business. Lester 
     was left to provide for his wife and daughter with no income 
     and no medical coverage. Six months before the layoff, Lester 
     had been diagnosed with diabetes. His wife has chronic 
     sinusitis that requires almost $200 a month in prescription 
     drugs. His daughter has occasional sinusitis. After some time 
     and some guidance from the Philadelphia Unemployment Project, 
     Lester got his medical assistance card. Medicaid covered his 
     family for the next 14 months while Lester looked for another 
     job. He found employment with Paper Manufacturers in 
     Pennsylvania, until that business had to downsize. Lester was 
     let go once more. He went back on Medicaid for nine months 
     until he got a new job.


                              south dakota

       Jackie Nies, Draper, SD.--Jackie's father has Alzheimer's 
     disease. She and her brother worked very hard to care for him 
     and help him live at home for almost four years. But when he 
     started to show up at his son's home for breakfast about 15 
     times a day, and would scorch pans because he left the stove 
     on all night, they realized that it was not safe for him to 
     live at home any more. He needed round-the-clock care so he 
     wouldn't wander off or injure himself. Nursing home costs in 
     South Dakota are very expensive. The home Jackie chose for 
     her dad costs $23,000 a year. In a few short years, she and 
     her brother had spent more than $65,000 on their dad's care. 
     Their families had nothing left. For two years now, Medicaid 
     has paid the nursing home fees that her dad's Social Security 
     checks won't cover. Jackie and her brother can now rest a 
     little easier because they know their dad's getting good 
     care, and their families won't have to face total financial 
     devastation.


                               tennessee

       Donna Guyton, Nashville, TN.--A mosquito bite is generally 
     irritating, but hardly ever life-threatening. After a fateful 
     family vacation to Michigan in 1990, Donna's son, Patrick, 
     contracted viral encephalitis, possibly from a mosquito bite. 
     He was hospitalized for three and a half months and suffered 
     from severe seizures. He eventually had to be placed in a 
     drug-induced coma. Until September of 1991, he was covered 
     under his father's health insurance. Then his father's 
     company was bought out, and when they re-enlisted in the 
     plan, Patrick was not covered. Patrick was covered by COBRA 
     for 29 months and in November 1992, he was enrolled in the 
     Medicaid Model Waiver Program. Patrick then enrolled in 
     Vanderbilt 

[[Page S 16647]]
     HMO so that he could receive care from the specialists he needed. But 
     Vanderbilt's medical director consistently denied the care 
     that the specialists requested. As a result of poor attention 
     and insufficient medication, Patrick has been out of school 
     for eight months and has had other health emotional problems.


                                 texas

       Peggy Sackett, Austin, TX.--Peggy 36, got freon gas 
     poisoning while working through a temp agency. She now has 
     Respiratory Airway Dysfunction Syndrome (RADS) and is totally 
     disabled. Her husband works for SAM's Club and their health 
     insurance company considers Peggy too high of a risk. She is 
     insured through her previous company, but only for the next 
     two years and she is only covered for problems relating to 
     her lung injury. They almost lost the house paying for 
     medical bills while trying to support two children. She is 
     not able to work anymore so they are supporting the household 
     on one income. She is on Medicaid and Medicare.
       Doris Brisson, Mesquite, TX.--Doris is only able to pay for 
     two of the four medications her doctor prescribed for her. 
     She is a low-income widow and received SSI and Medicaid until 
     she was 62, when she started collecting her late husband's 
     social security. She then lost her SSI. She does qualify for 
     the QMB benefits, but that does not cover her drug costs. 
     Right now she can only afford to pay for arthritis and high 
     blood pressure medication. She goes without the anti-
     depressants and the stomach medications her doctor 
     prescribed.


                                virginia

       Edna Faris, Alexandria, VA.--Mrs. Faris is 76 years old. 
     Her husband, Wilson, worked hard most of his life. After he 
     served his country in the Navy, he spent 23 years working as 
     a science teacher during the day, and at a supermarket in the 
     evening. In 1990, Mr. Faris was diagnosed with Alzheimer's 
     disease. Mrs. Faris took care of her husband at home for 
     three years, feeding, dressing and bathing him. His condition 
     progressively worsened, until he became combative, and Mrs. 
     Faris was forced to place him in a nursing home. The Farises 
     did not have anywhere near the $48,000 yearly fee for a 
     nursing home, so Mrs. Faris applied for Medicaid. Now 
     Medicaid picks up most of the nursing home's tab, and allows 
     Mrs. Faris to keep a portion of her small income to live on.


                               washington

       Vicki and Sean Russell, Lynnwood, WA.--Sean, 4, has a-gamma 
     globulin anemia, an immune deficiency. In order for Sean to 
     live, he must get infusions of gammamune into his bloodstream 
     every three weeks. Each infusion cost about $800. Sean was 
     insured through his father's Blue Cross/Blue Shield plan, but 
     when his parents were separating, his father stopped paying 
     the premiums. Vicki works part time as an administrative 
     assistant at a law firm and as a beauty consultant--neither 
     job offers health benefits. The only way Vicki can afford 
     Sean's lifesaving treatment is through Medicaid. Sean has 
     been on Medicaid since last August.


                             west virginia

       Joyce and Amy Altizer, Huntington, WV.--Joyce's daughter, 
     Amy, now 20, suffers from a multiple congenital anomaly which 
     has left her severely mentally retarded. She has lost 70 
     percent of her hearing, she has a seizure disorder as well as 
     behavioral problems. Through the Medicaid Home and Community 
     Based Waiver Program, Any receives case management therapy, 
     day and residential habilitation, and medical care. Her 
     family gets respite care so they can spend time with Amy's 
     sister and do other things typical families take for granted. 
     Amy has also learned to be more independent with therapy.


                               wisconsin

       Nathan and Hannah Iverson, Plum City, WI.--Nathan, age 
     three, and Hannah, age five, both receive well-child visits, 
     immunizations, treatment of ear infections and bronchitis, 
     and prescription medicines through Medicaid. Nathan has a 
     speech disorder. The area of his brain which controls his 
     mouth is not fully developed. Medicaid covers his speech 
     therapy, and, with this help, Nathan has just started to 
     speak. Mr. and Mrs. Iverson are farmers. They have had 
     trouble finding private insurance for their family due to 
     Nathan's problems. They have only been able to purchase 
     limited family coverage with a $3,000 deductible. Their 
     policy would help pay expenses for a serious accident or 
     illness, but is not useful for routine health care, nor for 
     Nathan's therapy. The Iversons live modestly. Their farm 
     income is about $12,000 per year. Because the Iverson's 
     income is close to the poverty line, the children qualify for 
     Medicaid.

                   [From the Long-Term Care Campaign]

                         The Faces of Medicaid

       Claudia and Harvey, Council Bluffs, IA.
       A family struggles to pay for nursing home care.--Harvey 
     began exhibiting the symptoms of Alzheimer's disease in his 
     mid-50s. He lost his job as a credit manager, and tried to 
     find work he could still handle, working as a janitor at 
     Creighton Unviersity for a while. But eventually, Alzheimer's 
     caught up with him, and for the past 7 years, he has lived in 
     a nursing home. After years worlding in department stores, 
     Claudia had just opened her own small women's clothing store. 
     But when the bills for Harvey's care began to come in, she 
     had to give that up. Within two years, they used all of their 
     savings to pay over $80,000 in nursing home bills: and Harvey 
     now qualifies for Medicaid. Most of his social security 
     check--$755 a month--still goes to the nursing home. 
     (Medicaid picks up the balance.) Claudia gets $253 Harvey's 
     check, under spousal improverishment rules. She works in a 
     local department store to get enough money to make the house 
     payments, pay for insurance, utilities and food. As she says, 
     she goes from pay day to pay day, never knowing for sure 
     whether there will be enough to make ends meet. (Claudia is 
     starting a new job with a new store that is just opening. It 
     means a slight increase in her salary, but she will not have 
     any more money because the amount she is allowed to keep from 
     Harvey's check will be reduced--and that will go to the 
     nursing home.) Harvey's nursing home now costs over $3,000 a 
     month. They have no way to pay that bill without Medicaid.
       David, New London, NH.
       Medicaid allows a young man to work and live 
     independently.--David is a 30 year old man who lives 
     independently and works three days a week at the Granite 
     State Independent Living Foundation as a Public Information 
     Coordinator. In 1990 when he was a college student, David had 
     an accident that left him a quadriplegic. After a three month 
     hospital stay and another three months of rehabilitation, 
     David was ready to continue with his life. Medicaid home and 
     community-based services allows David to do just that. 
     Medicaid paid for the purchase of an electric wheelchair 
     which enables David to be mobile and independent. Medicaid 
     pays for the Personal Care Attendants who assist David in his 
     home daily. PCA services are provided eight hours a day and 
     they help David bathe, dress, transfer, prepare food, do 
     laundry and work on range of motion exercises. David's 
     employer provides health insurance coverage, but the policy 
     does not include the long term services and supports David 
     needs to live independently and work in the community. 
     Medicaid has made it possible for David to rent his own place 
     and work several days a week at a job he enjoys.
       Bob and Sharon, Wilmington, DE.
       A family struggles to keep their mother at home.--Bob and 
     Sharon met at the Rochester Institute of Technology, married 
     and moved to Wilmington in 1981 when Bob went to work for 
     DuPont. Sharon was stricken with multiple sclerosis in 1983 
     while she was pregnant with her second son, Matthew. Though 
     bedridden for two years, Sharon fought back, even re-
     qualifiying for her driver's license. In 1988, her condition 
     deteriorated rapidly and she became completely disabled. She 
     cannot talk and communicates only by signaling ``yes'' or 
     ``no'' with her eyes. She eats and takes medication 
     through a tube in her stomach and is bedridden 24 hours a 
     day. Sharon's two sons, Matthew and Mark help their dad 
     care for her. Medicaid home care allows her to live with 
     her family, providing the care that allows her to stay out 
     of a nursing home. Bob says, ``My objective is to keep my 
     wife and family together for as long as possible. . . . 
     Cuts in Medicaid would force us to put her into a nursing 
     home.''
       Elaine and Stewart, Central Michigan.
       A family spends everything they have and Medicaid provides 
     a safety net.--Stewart spent 17 years in a small law 
     practice, then was ordained a Lutheran minister and spent the 
     next 25 years as a pastor. He and Elaine raised their 
     children and saved for their retirement. Then Stewart got 
     Alzheimer's disease. Elaine cared for him at home as long as 
     she could, but she became ill and simply couldn't provide all 
     the care he needed. When Stewart finally had to move to a 
     nursing home, Medicare was no help because the kind of care 
     he needed was considered ``custodial''. Elaine liquidated 
     every asset they had--life insurance, savings, IRAs--and 
     spent it to pay for his care. Finally, she spent everything 
     except the $17,000 Michigan allows her to keep under spousal 
     impoverishment rules. Elaine now spends half of her remaining 
     income on her share of the nursing home bill; Medicaid pays 
     the balance. This leaves her with about $1,200 a month to 
     live on. With nursing home expenses running $100 a day, even 
     if Elaine spent every penny she had left, she would not have 
     enough to pay the bill without help from Medicaid. Bringing 
     Stewart home again is not an option--Elaine is just not 
     strong enough to provide the round-the-clock attention and 
     physical care he requires.
       Louise and Stewart, Pinellas Park, FL.
       Home and community-based services allows a husband to keep 
     his wife out of a nursing home.--Stewart has been a caregiver 
     for his wife Louise for eight years. For seven of the past 
     eight years, Louise has been able to remain at home with her 
     husband with the help of Medicaid home and community-based 
     services. When she first received services in 1988, she was 
     unable to walk and communication was difficult--consisting of 
     an occasional word or sentence. Louise needed assistance with 
     all activities of daily living and instrumental activities of 
     daily living. Today, Louise is bedbound. She can no longer 
     speak and must be fed. Though working hard to provide care 
     for Louise, Stewart has health problems of his own, including 
     prostrate cancer and an injured back which prevents him from 
     doing any lifting. Because of these problems, Stewart is 
     unable to give Louise all the care that she needs. But the 
     home and community-based services Louise receives has allowed 
     her to remain at home. An aide comes to their home for two 
     hours a day, five days a week to give Louise a bath, 

[[Page S 16648]]
     feed her and change the bed. During these two hours a day, Stewart is 
     able to run errands, go to the grocery store, and attend a 
     support group. The long term care services Louise receives at 
     home costs $9,224 a year. Without these services, Stewart 
     would have no other option than to place Louise in a nursing 
     home. He says ``I feel secure knowing Louise is getting the 
     best of care.'' Several weeks ago, Stewart spilled hot grease 
     on his right hand. He did not request additional services 
     because he doesn't want to use any more than he absolutely 
     needs.
       Mary, Rogue River, OR.
       A woman receives long term care at home and doesn't need to 
     be institutionalized.--Mary is living at home with her 
     husband and is able to visit with her grandchildren and 
     friends on a regular basis in spite of physical problems 
     which would have otherwise confined her to a nursing facility 
     years ago. For four decades Mary has suffered from severe 
     arthritis and several years ago her activities were curtailed 
     even further because she had a stroke. Her health problems 
     also include diabetes, edema, and depression. Mary needs 
     assistance with bathing, transferring, mobility, meal 
     preparation, medication management, and transportation. Until 
     recently, her husband provided all this care that she needs. 
     Three years ago, because he found it difficult to keep up 
     with the physical demands of providing care as he got older, 
     Mary's husband enlisted the help of a in-home aide for 26 
     hours per month. The aid helps with bathing, medication 
     management and meals. The state pays $144.56 per month for 
     this home-based long term care. The family's only source of 
     income is Social Security. Medicaid pays for all Mary's 
     medications. Without Medicaid supplementing her husband's 
     care, Mary would need to be in a nursing home.
       Jonathan, Debra and Doug, Lakeview, IA.
       Medicaid allows a family to keep their child with special 
     needs at home.--Twelve year old Jonathan attends fifth grade 
     in a public school hopes to join a junior bowling league next 
     year. But Jonathan has severe cerebral palsy and 
     developmental disabilities. Jonathan began receiving Medicaid 
     at the age of two because of his severe disabilities. He has 
     undergone four surgeries and hundreds of medical 
     appointments. His disability will require ongoing medical 
     treatment and the use of customized durable medical equipment 
     and assistive technology. Medicaid pays for his electric 
     wheelchair so he can go to school and get around. Jonathan's 
     family provides the care he needs with the help of Medicaid 
     which provides thirty hours a month of supported community 
     living. These hours help Jon become more independent in the 
     community by helping him with mobility, money management and 
     other skills. ``It's far cheaper to raise a child with a 
     disability in their home than it is to institutionalize a 
     child. Plus it just is better for families and better for 
     communities,'' says his mother Debra. ``I think my biggest 
     fear is that they'll cut back on services or tighten 
     guidelines on how much they'll pay on a piece of equipment.''
       Dana, Chicago Heights, IL.
       Medicaid helps a woman care for her sister who has mental 
     retardation.--Dana and her sister have lived together for the 
     last 30 years. Dana has partial paralysis on her left side 
     and mental retardation; she requires assistance with personal 
     care, housekeeping, laundry, shopping, errands, and meal 
     preparation. Dana's sister, along with her nephew, and in 
     partnership with Medicaid, has provided that care for the 
     last thirty years, keeping Dana out of an institution. Her 
     sister is limited in her ability to care for Dana due to 
     health problems of her own. Dana's income is about $275 a 
     month from Social Security, and another $145 a month from 
     SSI. At the same time, she pays about $50 for her 
     medications. Dana, Dana's sister, and even Dana's nephew have 
     all pitched in to try and make things work. But without 
     Medicaid, Dana would be forced into an institution--and 
     Dana's sister would face the difficult task of placing her in 
     that institution.
       Fredda, Salt Lake City, UT.
       A blind woman struggles to remain in the community.--Fredda 
     is a 68 year old woman who has diabetes. She is legally 
     blind, hypertensive, has chronic heart failure and joint 
     disease--and is firmly determined to maintain her 
     independence. An educated woman, books have long been an 
     important part of her life, and the loss of her ability to 
     read was traumatic. In response, Fredda soon became connected 
     to the library system's book-on-tape program. But as much as 
     Fredda values her independence and her ability to live on her 
     own, she could not make it without Medicaid. Her income is a 
     mere $500 a month, and conditions make it impossible to make 
     it alone. Medicaid helps her pay for prescriptions and also 
     provides needed services. An aide helps her with her bathing, 
     housekeeping, and runs basic errands for her. Fredda lives 
     alone and thrives on her independence. Medicaid helps make 
     that happen.
       Betty and Howard, Paducah, KY.
       Medicaid helps a wife keep her husband at home.--Betty and 
     Howard married 35 years ago. Betty was in the WAVES in World 
     War II, then came back to a job in their County Court House, 
     from which she is now retired. Howard started as a farmer, 
     sold cars, and finally worked as a guard for a private 
     security force. Neither of them ever had high paying jobs, 
     but they paid off their mortgage and saved what they could 
     for their retirement. Now, at the age of 71. Betty provides 
     round-the-clock care for Howard, age 79, who has Parkinson's 
     and Alzheimer's disease, diabetes, and congestive heart 
     failure. They live on their combined retirement income of 
     less than $1,000 a month. After spending down their savings 
     to spousal impoverishment levels. Howard now qualifies for 
     Medicaid waiver services. That gives them about $150 worth of 
     help a week--Howard goes to a day care center for 4 hours two 
     days a week, and Betty gets help with him at home for another 
     6-8 hours a week. This is the only time she has for 
     uninterrupted sleep, to shop for groceries and Howard's 
     diapers and medications, or to take care of herself. Betty 
     and Howard do not have children. Their three siblings are all 
     in their 70's and 80's and have their own health problems. 
     With help from Medicaid, Berry is managing enough time to 
     keep herself reasonably healthy and to keep Howard at home. 
     Without these services, Betty says, both she and Howard would 
     quickly end up in a nursing home (with no money to pay the 
     bill).
  The PRESIDING OFFICER (Mr. Cochran). The time of the Senator from 
Florida has expired. Can the Senator suggest the absence of a quorum?
  Mr. GRAHAM. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. FAIRCLOTH. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________