[Congressional Record Volume 141, Number 194 (Thursday, December 7, 1995)]
[House]
[Pages H14227-H14229]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              {time}  1815
                                MEDICAID

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentlewoman from North Carolina [Mrs. Clayton] is recognized for 60 
minutes.
  Mrs. CLAYTON. Mr. Speaker, the debate over the budget reconciliation 
is really about people. We heard the other side just talk about the 
letter they received from their constituent and their grandson. It is 
about people. The reconciliation is about how we treat people, how we 
will have certain sectors of our community to survive and how others 
indeed may suffer. It will talk about whether we will reward those who 
are the wealthiest in our society and what sacrifices all of us must 
make in order to have a balanced budget.
  So the balanced budget is not about programs or not just to balance 
the budget for balance sake, but it is indeed to balance the budget for 
the financial security of this country, so it can respond to the future 
of this country as well as respond to the current responsibilities of 
this country.
  The question really is, should we treat Americans fairly or should we 
treat those who have great influence with due deference? Do we treat 
those that are wealthy with new respect or should we treat everybody 
right? Should those who have influence and who have wealth have the 
lion's share of the $245 billion worth of tax cuts or should some of 
those cuts also be shared by those who make $28,000 or less?
  Those are the questions I think that should be a part of this debate, 
rather than trying to rationalize a budget proposal that balances the 
budget on the backs of the poor, the elderly, students, and the 
disabled in our community.
  We should not put poor families, particularly those who are elderly, 
children and the disabled, under great stress. We should make sure that 
they have opportunities for the future so they can be contributing 
members of the society as anyone else.
  Medicaid emphasizes that perhaps better than anything else. If we 
look under Medicaid, we will see that poor families, the elderly, 
children, particularly the disabled indeed will pay great cost and make 
substantial sacrifice for the benefit of the wealthiest of those, to do 
what, to give wealthiest Americans a tax break.
  When we understand that Medicaid really is often the only health care 
that some of our poorest elderly will have, because Medicare spends out 
very quickly, many of our elderly who need long-term health care will 
not be able to get that unless indeed they had Medicaid as a part of 
that.
  The Republicans say that their plan does not cut Medicaid, that it 
only slows the growth by 5 percent. Well, when you examine that growth 
over a period of time, Medicaid costs have been going up about 10 
percent, in part because a large number of people are eligible for 
Medicaid.
  Now, I ask you, if you cut that by 5 percent, which of those eligible 
people who now will become eligible do you say, I no longer serve? They 
say it is not a cut, it is just limiting the growth. Well, if you have 
5 percent less than you would have before, but yet you are going to 
have 10- to 15-percent more people, tell me who then indeed will not be 
served? Who do you choose? How do we make choices between which 
American will be served and which American is not served?
  If we must make sacrifices, and I contend that we must make 
sacrifices if indeed we are going to have a balanced budget, why should 
that sacrifice not be a balanced one? The one certainly the Republicans 
have put forth, particularly on Medicaid, is not that way.
  Understand their program well, now. This will turn back this program 
to the States as a block grant. Why? They say because the States, they 
are closest to the people and they know best how to treat the citizens 
of that State.
  I share with you, I am a former county commissioner and I think I 
treated my constituents, and persons I had responsibility for very 
well, chaired my board and know the responsibilities that I had as a 
Chair trying to match the funds of Medicaid. But I can tell you with no 
reservation whatsoever, I would not have been able to provide the kind 
of help that we need at the local level unless the Federal Government 
was there.
  Further, I contend there is a responsibility of the American people 
that the Federal Government has in providing health care to those who 
are most vulnerable. Furthermore, the States are in no position 
financially to take this up.
  People are worried in my State of North Carolina. I refer, Mr. 
Speaker, and enter into the Record a news article that is from the News 
Observer this week, which is a local paper in my district:

                        [From the News Observer]

                   Medicaid Changes Frighten Families

                            (By John Wagner)

       Before long, North Carolina lawmakers may have to decide 
     whether the state can continue to care for families like 
     Deborah Altice's the way it does now.
       Since Altice's husband was disabled by an auto accident a 
     decade ago, Medicaid--the state-run health program for the 
     poor--has paid for his medicine and numberous back 
     operations. It has covered doctor's bills for the Zebulon 
     couple's 9-year-old son and 7-year-old daughter. And just 
     last month, Medicaid paid for the delivery of Altice's baby 
     boy.
       ``We'd be in a pretty desperate situation without it,'' 
     Altice says of Medicaid. ``We'd have bills coming in, and 
     there'd be no way we could afford to pay them.''
       Altice and her family are among tens of thousands of poor, 
     disabled and elderly North Carolinians who have benefited 
     during the last decade from a dramatic expansion of the 
     state's Medicaid program.
       The number of residents eligible for assistance has tripled 
     since 1985. And spending on the program has grown even more 
     rapidly--from about $700 million a decade ago to a projected 
     $3.5 billion this year.
       That's all about to change.
       Under Congress' plan to balance the federal budget, North 
     Carolina stands to lose more than a quarter of the Medicaid 
     dollars it had expected to get from Washington by the year 
     2002. By one estimate, only six other states would lose a 
     greater percentage of their federal funds.
       President Clinton has pledged to fight Congress' cutbacks, 
     but an alternative Medicaid plan being crafted by the White 
     House curbs spending significantly as well.
       As a result, North Carolina lawmakers are bracing for what 
     many fear will be ugly fights at the General Assembly in 
     coming years, with advocates for the poor, elderly and 
     disabled all pitted against one another to maintain their 
     share of the state's Medicaid spending.
       ``We're going to have to make some very difficult 
     decisions,'' says state Sen. Roy Cooper, a Rocky Mount 
     Democrat. ``It will be a huge task, no doubt about it.''
       Cooper is one of a dozen lawmakers assigned to a study 
     group on Medicaid that is scheduled to meet for the first 
     time Tuesday.
       The wide-ranging program they'll begin scrutinizing now 
     serves more than 835,000 people--nearly one in seven North 
     Carolina residents. Recipients range from poor families like 
     Altice's to thousands of nursing-home residents to disabled 
     folks like Dan Stanford, who benefits from a program that 
     just started receiving Medicaid funding this year.
       A Cary resident, Stanford, 26, is mentally retarded, 
     autistic, deaf and legally blind. Medicaid pays for an 
     around-the-clock assistant in his apartment to help him and a 
     roommate with basic living skills such as getting dressed, 
     making their beds and taking medication.
       The cost to taxpayers for Stanford's help is about $65,000 
     a year.
       Stanford's parents say they're worried that the state will 
     no longer be able to afford their son's services--services 
     that they say have made his life more meaningful.
       ``We feel really helpless,'' says Dan's father, Bill 
     Stanford. ``We're not very optimistic about our chances.''
       Much of the tremendous growth in North Carolina's Medicaid 
     spending has been fueled by actions state lawmakers have 
     taken to extend coverage to new groups of people.
       Before 1988, for example, Medicaid covered pregnant women 
     only if they were on welfare 

[[Page H 14228]]
     or disabled. Today, all pregnant women in families with an income up to 
     almost twice the poverty level are eligible for prenatal care 
     and other assistance.
       The federal government sets general guidelines for states' 
     Medicaid programs and provides much of the funding--almost 
     two-thirds of North Carolina's spending. But states have had 
     significant latitude to determine who is covered and what 
     benefits they receive.
       Under the bill passed by Congress, federal spending on 
     Medicaid would continue to grow each year--but not nearly 
     enough to accommodate all the new people that state planners 
     anticipate would qualify for benefits under existing 
     criteria.
       As a result, North Carolina officials predict that over the 
     next seven years the state will be more than $4 billion short 
     of what it needs to pay the bills of all its Medicaid 
     recipients. Other policy analysts think the gap could be even 
     greater.
       The blow to the state would be relatively soft at first, 
     but grow increasingly painful over the next six years.
       Some legislators, such as Cooper, say they are open to 
     spending more state money to make up for the drop-off in 
     federal funds. But given the magnitude of cutbacks being 
     talked about in Washington, few people believe it will be 
     realistic for the state to bridge the entire gap.
       At this point, no one can say for sure how much money state 
     lawmakers will have to work with, where they'll try to 
     constrain spending--or who will be hurt most by their 
     actions.
       ``What's seems certain is there's going to be less money, 
     and something has to give,'' says Craig Souza, a lobbyist for 
     the nursing-home industry.
       As they look for ways to hold down spending, legislators 
     will have relatively few strategies to pursue, none of them 
     attractive.
       Here are some options they are likely to consider:
       Backtracking on expansions in eligibility that they 
     approved in recent years.
       Those decisions will be especially difficult because, in 
     many cases, the wider coverage has produced measurable gains 
     in health care. North Carolina's infant mortality rate was 
     among the worst in the nation in 1988. But it has dropped 
     considerably since lawmakers made it easier for low-income 
     women to get prenatal care through Medicaid.
       Also, North Carolina has only recently extended benefits to 
     some groups that other states covered long ago. In 1994, for 
     example, the legislature voted to offer Medicaid coverage to 
     recipients of Supplemental Security Income, a federal program 
     that provides monthly payments to low-income elderly, blind 
     and disabled people. Most states have been doing that since 
     the mid-1970s.
       Lowering the state's payments to medical providers.
       In many cases, that strategy poses risks. The state's 
     nursing homes, for example, relay on Medicaid payments for 73 
     percent their revenue. Souza, the industry lobbyists, says 
     most homes would be forced to cut staff if the state reduces 
     the amount it gives them to care for Medicaid patients. And 
     critics say most nursing homes already are understaffed.
       Pushing more of the poor into managed-care programs, which 
     limit their choice of doctors.
       The state has had a small managed-care program since 1986. 
     Analysts say expanding it would save some money. But the 
     biggest factor behind the state's skyrocketing Medicaid 
     spending has not been the rising cost of care, but the number 
     of new people eligible for coverage. In fact, since 1988, the 
     money spent, on average, per Medicaid patent has grown more 
     slowly in North Carolina than in all but nine other states.
       Meanwhile, the number of low-income people in need of 
     medical help in the state continues to grow faster than in 
     all but a few other states--and that's one reason why North 
     Carolina would get hit so hard under Congress' plan.
       For example, North Carolina's elderly population is 
     expected to double by the year 2020. Today, many of the 
     state's senior citizens eventually move to nursing home, and 
     once their savings run out, Medicaid picks up a large part of 
     the cost.
       In the years ahead, state loanmakers will have an 
     increasingly difficult task weighing that need against all 
     the services that Medicaid provides to people like Deborah 
     Altice and Dan Stanford.
       ``There will have to be some cuts,'' says Gov. Jim Hunt. 
     ``The worst thing I could do is to give the impression that 
     we can somehow make this all up. We can't. But we sure will 
     look at every way we can to try to ease this burden and be 
     fair to our people.''

  Mrs. CLAYTON. This article says, and I quote from that, Deborah 
Altice, the wife of a disabled husband who has both a 9-year-old son 
and 7-year-old daughter, and she says, ``I don't know what I would do 
without Medicaid. I don't know. My husband's been now disabled for 
almost 10 years.'' And Medicaid has taken care of her husband's 
operation, provides for her 9-year-old son and her 7-year-old daughter. 
She says we would be devastated, indeed, if we did not have Medicaid.
  This is about people, not really about numbers. We may sound pious up 
here, as if we have some theory that is going to save America, but at 
the sacrifice of people and particularly those who are the most 
vulnerable in our society.
  Again if the Republican plan was passed as they had proposed, in my 
State alone by the year 2002 they would have lost one-fourth of the 
Medicaid dollars that they were expected to receive. Again, one might 
say, well, that is not a reduction. That is simply limiting the growth.
  Well, I would have you understand how the growth has occurred in my 
State. Again referring to the same news article, the growth in my 
State, it has grown in terms of percentage, it has grown from 1991 to 
1995 by some 14 percent in the eligibility.
  Now you say you cut this by 5 percent, and this is not a cut. Excuse 
me? Who is not understanding the realities or the consequences of our 
action? Whether you meant that or not, what will happen to this family? 
It would mean, if not this family, perhaps another family would not 
have that opportunity for health care.
  Again under the proposed plan which the President vetoed yesterday, 
we would have seen that families of nursing home patients would be put 
under great stress because they now must indeed find how do they make 
up that average cost of a nursing home, which costs some $38,000 in 
America and about $32,000 in my State. Working families in my State, 
those who must contend with raising their children, who again the 
Republicans pay great homage to.
  I am a mother of four adult children, also a mother of three 
grandchildren, and want for them the very prosperity that I have been 
blessed to have. But I also want for those who are disabled the same 
thing I want for my children. Why should I want any less for my 
children than I would want for the Altice family, who happen to have a 
disabled husband who is not able to work and a 9-year-old son and a 7-
year-old daughter?
  Again, indeed if we put the stress that is imposed, we now must find 
that families of senior citizens would be put at liability in securing 
the cost of a nursing home. A nursing home recipient who now receives 
on average about 72 percent of their care from Medicaid would find 
themselves at a decisive disadvantage.
  Medicaid is an important program, a very, very important program. It 
provides the only health care for poor families. Some 36 million 
families, including women, children, the elderly and the disabled only 
know of their health care coming from Medicaid.
  On the block grant to States, it says that we will make an 
entitlement to States but not an entitlement to those 36 million 
people. What is this Government about? ``We the people'' means what? To 
the State, to us, as I was in the local government? It really means 
that we should be about serving the people well, all of the people, not 
just some, all of the people.
  The block grant will end that entitlement to those who are now 
eligible under that.
  This is the wrong way to go. The Government needs to keep this 
entitlement. There are some programs the Government should, indeed only 
the Federal Government is in the position to make that kind of 
financial commitment. To turn this back to the States under some 
disguise of flexibility or trusting the State is doing the State a 
disservice.
  I can tell you in North Carolina they will not be able to make up 
that gap. I have county commissioners now wondering will they have to 
raise their property taxes in order to make up that deficit that will 
surely occur if the plan indeed is anywhere like the plan that the 
President has just vetoed. I say the President should have vetoed it, 
because he understood the American family would be put at great 
disadvantage and insecurity financially if indeed that plan had gone 
forth.
  Let me just share in terms of the costs of Medicaid. Where do those 
dollars go? We think of Medicaid, and I have said and I will say it 
again, that Medicaid is the only program that many poor and poor 
families will receive. In North Carolina, while poor families and their 
children account for almost two-thirds of the people eligible for 
Medicaid, they receive only about one-third of the State's Medicaid 
dollars. Care for the elderly and the disabled tends to be more 
expensive.

[[Page H 14229]]

  So indeed Medicaid is not only for the poor, it is for the elderly as 
well as for those who are disabled. To cut this program drastically or 
to put families of nursing home patients in distress or to block-grant 
this program is the wrong way.
  Mr. Speaker, I started my remarks earlier to say that this debate was 
about people. It was about those we cared about, and it was about 
shared sacrifice.
  I will end my remarks to say again, as we go into the next 5, 6, or 
10 days, this debate, particularly around Medicaid, I urge my 
colleagues to consider the opportunity they have to make this program 
work.
  Let me just further say, we ought to spend our money wisely even 
under Medicaid. There is a lot of demagogery that goes on on this floor 
about teenage pregnancy, a lot of demagogery about we cannot sustain a 
continuation of 10- and 12- and 15-year-old kids having children. I 
agree with that. We should. Demagogery is so easy, but actually coming 
to a solution or having a reasonable plan is far more difficult.
  One way we could begin to think of this is using the Medicaid dollars 
to assist teenagers before they get pregnant and prevention of 
pregnancy, teaching them counseling and a variety of activities and 
techniques that are proven. If we enact it, we could use just a little 
of the Medicaid dollars and that could go a substantial way to reducing 
the Medicaid dollars we are now using.
  One could use $1,000 in prevention and possibly save $10,000 in the 
care. Prevention and preventing pregnancy, unwanted pregnancy, 
particularly in teenagers, would mean not only that young teenager 
whose life is no longer productive, contributing to society, but also 
perhaps a troubled birth which would cause the Government to pay.
  We pay for that teenager, mind you. Once she becomes pregnant, we 
will pay as much probably as $10,000. Indeed, if that young teenager 
has a troubled pregnancy where the young baby is not safe or 
underweight, that could be in thousands and tens of thousands of 
dollars. It makes no sense. It is unwise.
  We should use our money wisely and use our money fairly. This debate 
about Medicaid is about what priorities we will set as a governing body 
and as a Congress as we meet this debate. I urge my colleagues to go 
forth in this but go forth with this in a reasonable way.

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