[Congressional Record Volume 142, Number 69 (Thursday, May 16, 1996)]
[Senate]
[Pages S5177-S5186]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CONCURRENT RESOLUTION ON THE BUDGET
The Senate continued the consideration of the concurrent resolution.
Mr. DOMENICI. I suggest the absence of a quorum and ask it be charged
to both sides.
The PRESIDING OFFICER. The clerk will call the roll.
Mr. DOMENICI. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DOMENICI. Mr. President, we understand Senator Boxer from
California is prepared with an amendment at this point.
The PRESIDING OFFICER. The Senator from California is recognized.
Amendment No. 3982
(Purpose: To preserve, protect, and strengthen the Medicaid program by
controlling costs, providing state flexibility and restoring critical
standards and protections, including coverage for all populations
covered under current law. The amendment restores $18 billion in
excessive cuts, offset by corporate and business tax reforms)
Mrs. BOXER. Thank you very much, Mr. President. I thank my chairman
[[Page S5178]]
and ranking member for allowing me to offer this amendment at this
particular time. On my side, Senators Kennedy and Graham would like to
speak to this amendment, and I send it to the desk.
The PRESIDING OFFICER. The clerk will report.
The assistant legislative clerk read as follows:
The Senator from California [Mrs. Boxer], for herself, Mr.
Graham, Mr. Dorgan, and Mr. Kennedy, proposes an amendment
numbered 3982.
Mrs. BOXER. Mr. President, I ask unanimous consent that the reading
of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:
On page 3, line 5, increase the amount by $1,900,000,000.
On page 3, line 6, increase the amount by $2,500,000,000.
On page 3, line 7, increase the amount by $3,200,000,000.
On page 3, line 8, increase the amount by $2,700,000,000.
On page 3, line 9, increase the amount by $2,600,000,000.
On page 3, line 10, increase the amount by $5,400,000,000.
On page 3, line 14, increase the amount by $1,900,000,000.
On page 3, line 15, increase the amount by $2,500,000,000.
On page 3, line 16, increase the amount by $3,200,000,000.
On page 3, line 17, increase the amount by $2,700,000,000.
On page 3, line 18, increase the amount by $2,600,000,000.
On page 3, line 19, increase the amount by $5,400,000,000.
On page 4, line 8, increase the amount by $1,900,000,000.
On page 4, line 9, increase the amount by $2,500,000,000.
On page 4, line 10, increase the amount by $3,200,000,000.
On page 4, line 11, increase the amount by $2,700,000,000.
On page 4, line 12, increase the amount by $2,600,000,000.
On page 4, line 13, increase the amount by $5,400,000,000.
On page 4, line 17, increase the amount by $1,900,000,000.
On page 4, line 18, increase the amount by $2,500,000,000.
On page 4, line 19, increase the amount by $3,200,000,000.
On page 4, line 20, increase the amount by $2,700,000,000.
On page 4, line 21, increase the amount by $2,600,000,000.
On page 4, line 22, increase the amount by $5,400,000,000.
On page 27, line 16, increase the amount by $1,900,000,000.
On page 27, line 17, increase the amount by $1,900,000,000.
On page 27, line 23, increase the amount by $2,500,000,000.
On page 27, line 24, increase the amount by $2,500,000,000.
On page 28, line 5, increase the amount by $3,200,000,000.
On page 28, line 6, increase the amount by $3,200,000,000.
On page 28, line 12, increase the amount by $2,700,000,000.
On page 28, line 13, increase the amount by $2,700,000,000.
On page 28, line 19, increase the amount by $2,600,000,000.
On page 28, line 20, increase the amount by $2,600,000,000.
On page 29, line 2, increase the amount by $5,400,000,000.
On page 29, line 3, increase the amount by $5,400,000,000.
On page 46, line 12, decrease the amount by
$18,300,000,000.
At the appropriate place insert the following:
SEC. . SENSE OF THE SENATE.
It is the sense of the Senate that the provisions contained
in this budget resolution assume Medicaid reforms shall--
(1) maintain the guarantees in current law for Medicaid
coverage of seniors, children, pregnant women, and persons
with disabilities.
(2) preserve current laws protecting spouses and adult
children from the risk of impoverishment to pay for long-term
nursing home care;
(3) maintain the current Federal nursing home quality and
enforcement standards;
(4) protect states from unanticipated program costs
resulting from economic fluctuations in the business cycle,
changing demographics, and natural disasters;
(5) maintain the successful Federal-State partnership and
protect the Federal Treasury against practices that allow
States to decrease their fair share of Medicaid funding; and,
(6) continue to provide coverage of Medicare premiums and
cost-sharing payments for low-income Medicare beneficiaries,
consistent with current law.
Mrs. BOXER. Mr. President, I am honored and pleased to be able to
offer the Boxer-Graham-Dorgan-Kennedy amendment regarding Medicaid. The
purpose of this amendment is really quite simple and straightforward.
First, my amendment restores the $18 billion in excess cuts made by
the Republican budget, and it will be offset by closing corporate tax
loopholes.
Second, my amendment contains a sense of the Senate that any reforms
made to Medicaid maintain six particular principles, and I will outline
those principles briefly.
But before I do, I think it is important to ask the question, Who
does Medicaid really help in this everyday world? Who are the people
out there who depend on Medicaid?
First of all, 2 million senior citizens who are in nursing homes are
on Medicaid and depend on Medicaid. Two out of every three residents in
nursing homes depend on Medicaid.
We also know there are 18 million children who depend on Medicaid--
children. It is their lifeline. Half of these children live in working
families where their families work very hard. They are the working
poor, and their children rely on Medicaid.
The disabled--6 million of our citizens who are disabled rely on
Medicaid and perhaps up to 1 million pregnant women rely on Medicaid.
Of our children between the ages of 13 and 18, there are 2.5 million.
So millions and millions of Americans rely on Medicaid, and,
therefore, this amendment, I think--and I am so pleased that it has
broad support on this side of the aisle--is really key to real people.
So the first part of the amendment is that we restore $18 billion
that has been cut, what we call excess cuts. Second, we have a sense of
the Senate on six principles. They are as follows: First, maintain
Medicaid coverage for low-income seniors, children up to 18 years of
age, pregnant women, and the disabled; second, maintain current
protection against the impoverishment of spouses and adult children
whose family member is in a nursing home; third, maintain Federal
nursing home standards; fourth, protect States from unanticipated
increases in enrollment, which can occur as a result of economic
fluctuations such as recessions, changing demographics or natural
disasters; fifth, maintain the successful Federal-State partnership and
protect our Federal Treasury against practices that may allow States to
decrease their fair share of Medicaid funding; and sixth, continue to
provide Medicare premiums and cost-sharing payments for low-income
Medicare beneficiaries that are consistent with current law.
I would like to make this point, Mr. President. All of these six
principles that are outlined in this amendment are contained in the
President's budget, as well as in the Chafee-Breaux budget proposal;
however, they are not maintained or referenced in the Republican
budget.
So of the budgets that we will be looking at, namely, the President's
budget, the Republican budget, and the Chafee-Breaux budget, we find
the Republican budget does not address these six principles. Frankly,
we feel it is very important that these principles be adhered to.
Why do I say that? I think the backbone of all the other principles
is the guarantee of coverage that exists in current Medicaid law for
seniors, children, pregnant women, and persons with disabilities. We
know this is a real problem because in the reconciliation bill we saw
that there was a walking away from this commitment.
We also believe that a person with certain disabilities in one State
might not be considered disabled in another State under this budget. We
want to make sure that does not happen. Some States could decide to
define disability in such a way that it will not cover many serious
disabilities.
So we think it is very important that the people who are now covered
remain covered. We do not have that assurance at all in this budget. As
a matter of fact, the plans that the Republicans have talked about
would allow the States to decide these questions. I think it is very
important that it be a national standard here as to who is disabled and
who should definitely have coverage.
I want to talk about the guarantee to children. We have no certainty
in this Republican budget that children from the ages of 13 to 18 would
be covered. Let me tell you the problem. It would mean that a low-
income teenage girl, the only way she could get health coverage, if the
State decided to cut her
[[Page S5179]]
off, is to get pregnant. This is not a message that we want to send to
our young people. We should cover children until they turn 18. I think
we owe them that.
I want to talk a minute about the other principle, the spouses and
adult children who are at risk of impoverishment if one of their family
members winds up in a nursing home. Remember, there are 2 million
senior citizens in nursing homes, and two out of three of them are on
Medicaid. We passed a very important law, when I was over in the House
of Representatives, that said we will not drive the adult children of
nursing home residents and we will not drive the spouse of a nursing
home resident into the poor house simply because their family member is
in a nursing home.
I am very fearful that without saying something affirmative in this
budget, we could repeal this very important spousal impoverishment
provision. We should not be forcing spouses or adult children to be
thrust into poverty.
Why do I say that? The average cost for nursing home care, Mr.
President, is about $36,000 a year. Clearly, how many of our people
could really pay that?
I think it is crucial that we protect spouses and the adult children
of nursing home residents. I think if we do not pass this amendment,
our amendment that we have worked on here, that could happen.
Nursing home quality standards. Very clearly we ought to say that we
believe there ought to be national standards. Why do I say this?
Because we know what can happen. We saw what happened in the 1980's.
There were nursing home scandals. We know that our senior citizens were
being mistreated, abused. Some of the stories are hair-raising. I will
not go into them because time does not permit it. But they were
drugged, they were put into baths that were scalding.
What happened? We decided we would have standards and enforcement.
Now we have absolutely no assurance in this particular budget that is
before us that this will happen. That is why we hope we can get
bipartisan support for this particular amendment that I am offering. So
it is key to save those nursing home national standards.
One senior citizen in Nebraska is as important as a senior citizen in
New York or Ohio or Wyoming or Montana. We want to treat our grandmas
and grandpas and our great grandmas and great grandpas with respect. We
should have national standards and not back away from them.
We protect the States from unanticipated program costs in the sense
of the Senate. We say that, in fact, when you have a natural disaster
such as my State of California, or there is an unanticipated cost from
a recession, that we will help the States meet their Medicaid burdens.
Finally, an issue that I know Senator Graham is going to speak to
because he was a Governor of the great State of Florida. We want to
maintain the successful Federal-State partnership involving Medicaid.
We also want to make sure there are no scams in the States, that, in
fact, the States do not abuse the Medicaid program.
So, Mr. President, that concludes my remarks. I know that Senators
Kennedy and Graham would like to speak.
I would like at this time to yield them some time, if that is
agreeable.
Mr. President, I yield to the Senator from Massachusetts and then to
the Senator from Florida. We have had a little bit of intervening
debate and I just want to remind everyone what we are talking about
here are the people in our country who need us to stand with them: The
seniors in the nursing homes, the children with disabilities, the
pregnant women, the working poor, the people who are working very hard
to stay afloat and need us not to abandon them. I think this amendment
we are presenting to you will give them that reassurance that they will
not be abandoned.
It is my pleasure to yield 15 minutes to the Senator from
Massachusetts.
Mr. KENNEDY. Mr. President, my friend and colleague from Florida will
address the Senate on an extremely important aspect of this whole issue
of the cutback in Medicaid. I will try to be to the point but also
speak about the importance of this particular amendment.
First of all, I want to thank the Senator from California, Senator
Boxer, for being the leader on this particular issue as she has been on
so many of the issues involving working families, children, and their
parents and the disabled. All of us are grateful to her for her
leadership on this issue of restoring some $18 billion in the Medicaid
Program over the next 6 years.
Now, I think Members can ask whether this $18 billion we see under
the Republican program, the reduction of $72 billion, I think it is
important as we commence this debate to understand where that serious
cut will come from in the Republican budget and the benefits that this
program reaches in terms of children, the disabled and the elderly. The
importance of this amendment of the Senator from California is that
with the acceptance of some cuts in the Medicaid, those cuts basically
will be out of what we call the disproportionate share payments, which
go not to the individual reduction in benefits, but are basically funds
that go to the State generally. It is extremely important to understand
that every dollar in the Senate's program is a dollar that will make a
difference in the quality of life of children and seniors.
The second point which is an enormous part of the Senator's amendment
which I know that the Senator from Florida will cover is the
significance of the Republican budget cuts, which will mean $250
billion in reduced payments of benefits over the period of the next 6
years because of the changing of the formula in terms of what is
required by the States.
This is a very, very dramatic reduction and cut in who will be
affected by this. The people that will be affected by this, as the
Senator has pointed out, will be the children, the elderly people,
nursing homes, and the disabled in our country.
The further point I want to make this evening is that it is important
that we had the earlier vote on the Medicare and now on the Medicaid
because to a great extent we are talking about the same populations. We
are seeing the reductions in the Medicare programs that will affect our
seniors, and this is another significant reduction in services for our
elderly people as well as the children.
So if you look at the reductions in the Medicare Program, and you
look at the reductions in the Medicaid Program, you are finding those
cuts, together, are going to be an extremely heavy burden on the most
vulnerable in our society--the children, the frail elderly, and the
disabled in our community.
Medicaid is the companion program to Medicare, and the Republican
assault on Medicaid is just as misguided and unfair as their assault on
Medicare. The Republican plan would cut Federal Medicaid payments by
$72 billion over the next 6 years--but that is only the tip of the
iceberg. Under the Republican plan, total Medicaid spending would be
cut by a staggering $250 billion--and States will be allowed to spend
Federal Medicaid dollars on roads, bridges, and political patronage
rather than health care services.
In large measure, the Republican cuts in Medicaid will strike another
heavy blow at the same groups hurt by the Republican cuts in Medicare--
senior citizens and the disabled. Ten million elderly and disabled
individuals are enrolled in Medicaid. Seventy percent of all spending
under the program is for these two groups--much of it for long-term
nursing home care.
Another group will also be injured by the Republican plan--America's
children. Seventy percent of those who rely on Medicaid are children
and their parents--a total of 18 million children. One in every five
children in America depends on Medicaid. One in every three children
born in this country depend on Medicaid to cover their prenatal care
and delivery.
Every child deserves a healthy start in life. Under the Republican
plan millions of children who have adequate medical care today will be
forced to do without it tomorrow.
Medicaid provides good coverage to children today. They are
guaranteed prenatal care, immunizations, regular checkups,
developmental screenings, and both chronic and intensive physician and
hospital care.
The great bulk of Medicaid-covered children are in families with
working parents. Most of these parents work
[[Page S5180]]
full time--40 hours a week, 52 weeks a year--but all their hard work
does not buy them health care for their children, because their
employer does not provide it and they cannot afford it.
Even with Medicaid, over 10 million children are uninsured, and each
day the number rises. Soon, less than half of all children will be
covered by employer-based health insurance. We tried to address this
problem in the last Congress--but the Republicans said no. Today, they
are trying to undermine the only place that families can turn without
employer-provided coverage.
Last year, the Republicans proposed to eliminate all guarantees of
coverage for children. This year, it is ``only''--only--poor children
13 to 18 who will lose their coverage. In addition, children of all
ages--even babies--will lose their current guarantee that all medically
necessary treatments will be covered.
The 6 million disabled who depend on Medicaid are even less
fortunate. The Republican plan repeals all Federal standards for
coverage of the disabled.
States are also free to set any limits on scope and duration of
services that they choose. If a State budget is tight this year, why
not limit the sick to shorter hospital stays. If they need a week to
recover from serious illness or surgery--too bad. That's somebody
else's problem--if the Republican plan is adopted.
In a very real way, Medicaid is a lifeline for children and families
who have nowhere else to turn. Without access to Medicaid, many healthy
children will become sick and many sick children will die. It is wrong
to put children at risk to pay for tax breaks and special favors for
the wealthy and powerful. Greed is not a family value.
Under the Republican plan, senior citizens and the disabled suffer a
one-two punch. Deep Medicare cuts, and even deeper cuts in Medicaid.
Many will lose their Medicaid coverage or see their benefits cut back.
But they will also be victimized by one of the harshest parts of the
Republican plan--the elimination of Federal enforcement of quality
standards for nursing homes.
Strong quality standards for nursing homes were enacted by Congress
with solid bipartisan support in 1987, after a series of investigations
revealed appalling conditions in such homes throughout the Nation and
shocking abuse of senior citizens and the disabled.
Elderly patients were often allowed to go uncleaned for days, lying
in their own excrement. They were tied to wheelchairs and beds under
conditions that would not be tolerated in any prison in America.
Deliberate abuse and violence were used against helpless senior
citizens by callous or sadistic attendants. Painful, untreated, and
completely avoidable bedsores were widespread. Patients were scalded to
death in hot baths and showers. Others were sedated to the point of
unconsciousness, or isolated from all aspects of normal life by fly-by-
night nursing home operators bent on profiteering from the misery of
their patients.
These conditions, once revealed, shocked the conscience of the
Nation. The Federal standards enacted by Congress ended much of this
unconscionable abuse and achieved substantial improvement in the
quality of care for nursing home residents.
Last year, the Republican proposal eliminated these standards
altogether. When the public outcry was too great, they weakened the
standards instead. This year, they claim to leave them unchanged--but
they are proposing to leave enforcement to the States, even though it
was the States' failure to protect senior citizens that necessitated
passing the 1987 law in the first place.
Whatever the formal rules and regulations say, the Republican cuts in
Medicaid are so deep that even conscientious nursing home operators who
want to maintain high quality care will be hard-pressed to afford the
staff and equipment necessary to provide it.
It is difficult to believe that anyone, no matter how extreme their
ideology, would take us back to the harsh conditions before 1987. But
that is what the Republican plan will do.
Further, the Republican plan victimizes not only the elderly but
their families as well. Last year, the Republicans proposed to repeal
the spousal impoverishment protections that protected the husband or
wife of a nursing home resident against the double loss of a loved one
and the chance to maintain even a modest standard of living. They
proposed to repeal protections that have been in place since the
Medicaid program was enacted against adult children being required to
impoverish themselves to pay for the care of an aged parent.
Again, the public outcry was so great that the Republicans were
forced to modify their plan--but they left the fine print in place.
Spousal impoverishment provisions were supposedly retained--but they
were rendered meaningless by other parts of the Republican plan.
Without a guarantee of coverage, a protection against spousal
impoverishment is useless for those who can no longer qualify for
assistance in the first place. The plan allowed nursing homes to add
extra charges that Medicaid did not cover, and require families to make
large up-front deposits before a patient is admitted. Adult children
were protected--but only if their income was below the median. Families
whose total income is less than the cost of a year in a nursing home
would still be liable for the cost of care for their elderly family
member.
Republicans claim their new plan avoids this last set of abuses, but
the American people should read the fine print.
The Republican plan for Medicaid is an outrage. It says that our
society does not care about the most vulnerable groups in our country--
people with disabilities, senior citizens, and children.
These Republican proposals are too harsh and too extreme. They are
not what the American people voted for in the last election. They
should be rejected out of hand by the Congress, and the American people
should reject their sponsors in the next election.
I thank the Senator from California. I yield back whatever time
remains.
Mrs. BOXER. Mr. President, I thank my friend from Massachusetts.
Before he leaves, I think we have a chance to win this amendment, I say
to my friend, because, actually, the Democratic budget addresses these
issues. This amendment gives us a chance, those of us who supported
that budget, to vote in favor of it. The Chafee-Breaux budget actually
that will be presented to us does, in fact, make these commitments. So
if everyone who voted for Chafee-Breaux, who voted for the Democratic
budget, votes aye on this amendment, I say to my friend that maybe we
will have some better luck in the outcome.
My friend talked about turning our backs on those who need us the
most. I was present for a hearing that we held when we were doing the
health care bill in which we had disabled children who were relying on
Medicaid come into the Congress with their caregivers. Usually it was
their mom or dad. Just looking at those kids with spina bifida, with
kidney problems, with muscular dystrophy, or with multiple sclerosis,
trying to live their life with some dignity, relying completely on
these payments, it seems to me, I say to my colleagues at this late
hour, even if it is late, this is a little sacrifice to make when we
think of those children and the sacrifices that they make every day of
their lives and the sacrifices that their families make every day of
their lives. It is shameful that we would walk away from these
children. It is shameful.
Nobody needs to hear a lecture from one Senator to another. I do not
mean at all to sound that way, because I do not think that anyone who
votes against this amendment wants to hurt those children. But I do
think, in the end, that is what will happen.
I yield 15 minutes to my friend from Florida, Senator Graham.
The PRESIDING OFFICER. The Senator from Florida is recognized.
Mr. GRAHAM. I thank my colleague from California.
Mr. President, this debate should commence with one fundamental
truth: The Medicaid Program for the last 30 years has been a great
American success. The Medicaid Program has been a great American
success. Let me give you a few examples of that success.
In the early 1980's, in many parts of this country--I can speak
specifically for the American South--the rate of infant mortality was a
disgrace, rates of infant mortality that were close to those that would
be found in some of the less-developed nations of the world.
[[Page S5181]]
In that period, leaders in the South decided that they wanted to have
a different legacy for the future.
So under the leadership of Governors such as Lamar Alexander of
Tennessee, Bill Clinton of Arkansas, Governor Dick Riley of South
Carolina, who was designated to be the chair of a task force in the
South on the children of the South, Governor Riley made a series of
recommendations which were adopted by most of the Southern States. But
the keystone recommendation was that the South should take steps to
reduce its infant mortality by substantial increases in its commitment
to appropriate prenatal care, care for pregnant women, care for
infants, and care for children in those critical early days of life.
The effect of that program 10 years later has been a dramatic
reduction in infant mortality in the South, and because of that, a
significant reduction in infant mortality in the United States,
approximately a 20-percent reduction in the number of children who were
born without life or with a life that was less than it might have been.
Mr. President, Medicaid was an absolutely critical component of that
effort to reduce infant mortality in our Nation, and because of it,
there are literally hundreds of thousands of boys and girls who are
alive today, living lives that have great promise and opportunity.
Medicare is an American success story. Medicaid has also allowed
older Americans to live a life of dignity and respect when otherwise
they would have been consigned to the same condition of their parents
and grandparents. To get old in America and to be poor in America was
to be without dignity and respect.
You say, ``Why is this true of Medicaid? I thought it was Medicare
that provided services for older Americans.'' The fact is the two
programs work in a very compatible manner. Medicaid, for those elderly
who are unable to pay their premiums for Medicare, pays those premiums.
It allows the indigent elderly to continue to have access to Medicare
physician services. For those indigent elderly who cannot pay their
prescription medication, Medicaid pays for their prescriptions so that
they can have access to the modern miracles that make life possible and
make a quality of life possible.
For many Americans, it is Medicaid which provides access to long-term
care, whether that be in a community setting or in an institutional
setting such as a nursing home. As the Senator from California has
pointed out, most Americans who are in nursing homes today--over two
out of three--receive their nursing home monthly payments through the
Medicaid Program.
Medicaid is an American success story for older Americans. Medicaid
is an American success story because it has served as the fundamental
safety net under millions of poor children who without Medicaid would
be without any financing for their health care.
In 1980, of all Americans who were employed, approximately 65 to 70
percent were employed in a workplace which provided health care
coverage for themselves and for their families. That was part of what
we thought was the American dream, that if you worked hard and you
supported your family, you would have access to and the capacity to
afford to acquire health care. We in Congress promoted that by
providing very favorable tax treatment for employer-provided health
care benefits. But since 1980, there has been a precipitous decline in
the percentage of Americans who are covered at this point of employment
with health care. Today that number is below 60 percent, and the
estimate is that in the foreseeable future it will drop below 50
percent. Less than half of the Americans who are working will be
securing their health care through their place of employment.
The result of this has been literally millions of low-income, not
only the employees themselves but even more the dependents of those
employees, their spouses and their children, without health care
coverage.
What has happened is that as these people fell into medical
indigency, it was Medicaid which came to their rescue, and it has
provided them with access to health care coverage. If it had not been
for Medicaid, we would not be a nation today with some almost 40
million Americans without access to health care financing; we would be
a nation with 45 to 50 million Americans without access because persons
who had lost their coverage are able, and particularly their dependents
are able, to get it through the Medicaid Program.
So the Medicaid Program has been an American success story. Because
of that we should not be talking, as is suggested in the Republican
proposal of 1996, as it was in the Republican proposal of 1995, about
an amputation of Medicaid. Rather, we should be talking about
thoughtful reforms that will preserve the fundamental values of the
system while making it stronger and better and more adapted to some of
the current changes in health care delivery.
What are some of the fundamental issues in that reform of Medicaid?
One is, should we maintain the basic national partnership between the
Federal Government and the State governments in the financing and
delivery of Medicaid services?
There are those who would suggest that that partnership is an
anachronism, that it has had its day, but now we should amputate it,
cut it off. Let us look for some new mutation to take its place, and
that new mutation is going to be some form of block grants where the
Federal Government's role is essentially consigned to that of being a
check writer that on the October 1 will write 50 checks, send them off
to the State capitals of America and with very little involvement wash
its hands of the Medicaid Program.
The irony of this proposal, Mr. President, is that the very people
who make it with such ardor frequently on other issues look, as one of
their political North Stars, to former President Ronald Reagan and
suggest that he is in many ways the father of modern conservative
political thought.
Would Ronald Reagan have supported a program of block grants to the
States for Medicaid? As my colleague from California, who no doubt had
an opportunity to observe former Governor and then President Reagan
over a number of years, will certainly know, the answer is no, because
what President Reagan proposed was that rather than Balkanize Medicaid,
Medicaid should be federalized.
He had a couple of compelling reasons why he thought that should be
the case. The first was that as a Californian he recognized the fact
that if you had differentials in standards, there was a tendency for a
mobile population of poor people to seek out those communities that had
the most generous standards. In the 1960's and 1970's California had
among the most generous standards in the country and therefore served
as a magnet for persons to come in the State in order to access those
standards. So one rationale of President Reagan was that we needed to
have greater uniformity in order to avoid this inducement to move.
A second rationale which I think is extremely relevant today is that
President Reagan recognized that Medicaid, which had started as being
primarily a program for poor children and their families, was
increasingly becoming a program for the frail elderly. In my State
today about 60 to 70 percent of the Medicaid funding is spent on people
over 65, a very high percentage spent on people over 85. So President
Reagan felt that we needed to relook at both Medicare, the health care
financing program for the elderly, and Medicaid, the program for the
indigent, and attempt to rationalize, harmonize, knit those two
programs more effectively together, and that that knitting together
would occur with more likelihood if Medicaid was a Federal program than
if it were distributed to the States.
Mr. President, I think those two reasons of President Reagan were
compelling in the 1980's and, if anything, they are even more
compelling today. So it is somewhat of a shock now to see that the
descendents of the philosophy of Ronald Reagan want to go exactly in
the opposite direction from his advice, and that is to remove the
Federal Government as a continuing partner in this national program of
Medicaid.
Mr. FRIST. Mr. President, will the Senator from Florida yield for a
question for a second?
Mr. GRAHAM. The Senator from Florida is close to being through, and
at the conclusion of my remarks, I will be pleased to yield.
The second point is that the Medicaid Program requires a base of
financing in
[[Page S5182]]
order to meet its current needs and to be able to assume the new
responsibilities which clearly lie just over the horizon. As the
Senator from Massachusetts pointed out, the proposal of the Republicans
will reduce the total funds available for Medicaid over the next 7
years not just by the some $70 to $80 billion that will be eliminated
at the Federal level but by a figure of close to $250 billion because
the amount that will be asked of the States in their contribution to
participate in the Medicaid Program will be so reduced.
Mr. President, I do not believe any serious analysis of the
challenges facing Medicaid could come to the conclusion that we can
meet the health care needs of Americans with a $250 billion reduction
in funds available in the fundamental safety net program of our
national health care system, Medicaid. In fact, there are a number of
factors that are going to put Medicaid under greater pressure. One of
those factors is the fact that we have a growing number of children and
adolescents in our population.
To give just one statistic, last year America graduated approximately
2.5 million students from its high schools. Within less than 9 years,
we will be graduating over 3 million children from our high schools, as
an indication of this surge of youth that is coming through our
society, who in addition to having education needs will also have
health care needs which Medicaid would be the principal instrument for
meeting.
I ask the Senator from California if she could yield an additional 5
minutes.
Mrs. BOXER. I will do that.
The PRESIDING OFFICER. The Senator from Florida is recognized for 5
minutes.
Mr. GRAHAM. Also, there will continue, unfortunately, to be a decline
in the number of children covered by the health insurance of their
parents at a point of employment. The population will continue to age.
More people will be in the advanced ages, which is the greatest source
of additional cost to the Medicaid Program. We are making some policy
decisions such as those embedded in our recent vote on the immigration
bill that are going to result in greater demands on the Medicaid
system.
So there is no basis for the proposition that we can meet all of
these challenges to the Nation's health care system and sustain a $250
billion cut in the Medicaid Program, most of it being a cut at the
State level, not at the Federal level.
Finally, in the Medicaid system, one area of reform that cries out is
to treat all States fairly. Today we have extreme disparities in terms
of the funding that is provided for the poor child, the poor frail
elderly, and the disabled from one State to the next. Those disparities
are a function of history, the fact that we have built up a practice of
inducing States to come into expanded Medicaid services by the Federal
Government, matching or more than matching those State commitments.
Those States that had a sufficient level of affluence to afford a more
luxurious system have developed that, and, therefore, that has led to
substantially higher amounts of Federal support for their Medicaid
programs than for the less affluent States.
We also have the situation in which certain States severely abused a
program that had a good purpose: to recognize the special cost of
hospitals that served large numbers of indigent Americans. Those
hospitals were to be recognized by getting a disproportionate share of
Medicaid funds in order to pick up some of that cost that was otherwise
uncompensated. Unfortunately, that program was severely abused by a
handful of States and resulted in extreme distortions in where Federal
Medicaid money went, State to State.
The proposal we have before us would largely freeze those past
inequities into place and would make us live with them for the
foreseeable future. The amendment offered by the Senator from
California represents a clarion voice for reform and fair treatment in
that all Americans should be assured that they will be treated equally
by their National Government in terms of their access to quality health
care.
Those are some of the fundamental issues we are dealing with. Are we
going to maintain the Federal-State partnership which has served us so
well in reducing infant mortality, providing dignity for older
Americans, providing a safety net under an increasingly frayed system
of employer-based health insurance? Are we going to maintain an
adequate funding basis at both the Federal and the State level to meet
increasing demands on our Medicaid Program? And are we going to treat
all Americans, wherever they live, fairly?
The amendment that is offered by the Senator from California meets
those tests of fundamental fairness and vision for the future of
America. The underlying proposal fails on all of those tests.
I urge the adoption of the amendment of the Senator from California.
Mrs. Boxer addressed the Chair.
The PRESIDING OFFICER. The Senator from California.
Mrs. BOXER. Mr. President, I thank my friend from Florida, the former
Governor and distinguished U.S. Senator. He is on this floor with, I
think, very important advice for Senators. It is fiscally responsible.
He understands that when you help people who are trying to help
themselves, when you help people who deserve help, people who have such
problems, disabilities, infirmities, that in fact you are doing the
right thing. I thank him very much for his leadership on this.
I say to my friend from Tennessee, that concludes our discussion of
this amendment. I will be very happy to yield the floor at this time
for him if he wishes to rebut. But I again urge my colleagues to look
carefully at the Democratic budget, at the Breaux-Chafee budget--or
Chafee-Breaux budget, as it is called--and the Republican budget. You
will see that two out of three of these budgets believe in this
amendment, believe strongly in this amendment. I hope those who support
both the Democratic proposal and the Chafee-Breaux budget proposal will
support this amendment.
I yield the floor.
The PRESIDING OFFICER. The Senator from Tennessee.
Mr. FRIST. Does the distinguished Senator from California yield back
the remainder of her time?
Mrs. BOXER. If my friend is going to speak and wishes to debate this,
I have no need to take any amount of time other than to rebut, perhaps,
some of his comments if I feel I need to do so. It is not my intention
to prolong this debate.
Mr. FRIST. Mr. President, I rise to oppose the amendment of the
Senator from California for a number of reasons. Fundamentally, this
particular amendment results in more taxation and more spending. The
case I would like to lay out is that that increased taxation and
increased spending is unnecessary. It is unnecessary.
Let me say at the outset, we have heard a lot from people who care
very much about this Medicaid Program. The Medicaid Program is
something that I, too, care very much about. I have worked with Members
on both sides of the aisle to guarantee that we preserve what is a very
good program that has served millions of people, both today and over
time.
My role as a public servant, as a U.S. Senator, is one hat that I
wear, but in addition to that perspective, I wear the hat of a
physician who has taken care of the very people that we have heard
talked about tonight. It hurts me when people use words like ``walk
away from children.'' I have dedicated my entire adult life to helping
children, one on one, as a physician, and to have words like that used
on either side of the aisle hurts a great deal.
About 35 percent of the patients I have treated over the last 18
years of my life are Medicaid recipients. Night after night I have sat
at the bedside of children, of mothers, of fathers, of people who have
benefited from a program that served as a very important safety net for
people who otherwise might not have access to care. It is to those
people I say, to hear this accusation, it is not medagoguery, but it is
close, when we have these accusations of walking away. Again, I am not
sure it is intended that way, but the fact we are talking about the
case of individuals, of children, with accusations elevated to that
political--rhetorical, I think--level hurts.
When we heard here words about cut, and the distinguished Senator
from Massachusetts used cut again and again and again, and that is
associated
[[Page S5183]]
with the comments made about walking away from children and the
amputation of programs--the growth rate in our proposal is 6.5 percent
next year, the year after that, and the year after that--6.5 percent
annual growth rate. That means an increase, not a cut, year after year
over the next 6 years.
I think, finally, the public at large understands this is not a cut.
It was President Clinton who, 3 years ago, in 1993, in an AARP meeting
out on the west coast, said what we need to do for this program,
Medicaid, is slow the growth from about 10 to 11 percent down to two
times inflation. That is what we have done. A program that gives
flexibility to States, that covers the people who need to be covered--
and I will come to that shortly--we have slowed the growth to exactly
what the President said 3 years ago, down to more than two times the
rate of inflation. Anybody who has taken time to read what we proposed,
it is 6.5 percent growth, year after year.
The President's plan is 7.1 percent. I guess we can debate whether it
should be 7.1 or 6.5, but to say we are walking away from children and
we are cutting or amputating programs, it is not true and the American
people are going to see through that.
I do want to restate the ideas behind the Medicaid reforms and the
question I was going to ask earlier of my colleague from Florida,
because he kept saying this is a block grant to the States. It is not a
block grant. It is not even close to a block grant.
No. 2, he talked about the dissolution, what is no longer a joint
Federal-State partnership. It is just not true. It is not true. If you
read what our assumptions are in the concurrent budget resolution, it
is real simple. It basically says the committee's recommendation
assumes implementation of a bipartisan--bipartisan--Medicaid reform
plan approved by 48 Governors in early February. It was the unanimous
consent of 48 Governors, who put together the plan, which is the basis,
the foundation for the assumptions which resulted in our proposal.
It is important to say that, because the second half of the amendment
proposed by the Senator from California lists six principles. Let me
say at the outset that I agree with most all of those principles. I
think that is important. I do not agree we have to increase spending by
$18 billion to accomplish that, and I will come back to it.
But let me say what our plan--the assumptions in the 48 Governors'
unanimous consent bipartisan plan which is the foundation, the verbatim
foundation for our proposal--does. It is not a cut, it is an increase.
I have said that. It is not a block grant, it is a Federal-State
partnership.
It is not walking away from children. We cover the same populations,
and I will come back to that. We guarantee coverage in this plan of
low-income children who I have taken care of; and of pregnant women who
I have taken care of in the past; and of the senior citizens who I have
taken care of; and the individuals with disabilities for whom I am an
advocate. We guarantee coverage. Period.
No. 2, we maintain the Medicaid Program as a matching program.
Matching, that means Federal and that means State; a partnership; hand
in hand; money comes from both. It is not a block grant to the States.
No. 3, we continue the Federal minimum standards for nursing homes,
which were brought out in the principles of my colleague from
California.
No. 4, we continue Federal rules that prevent wives or husbands from
being required to impoverish themselves just to keep and obtain
Medicaid benefits for their spouses, requiring nursing home care. We
continue those Federal rules. Period.
No. 5, we provide coverage of Medicare premiums and cost sharing
payments for low-income seniors consistent with the unanimous 48
Governors'--at the National Governors Association--Medicaid policy.
That is what we do. Let us strip away the rhetoric.
The fundamental problem with Medicaid, because we do have a problem
with the program that does serve over 30 million people--we do have a
problem. Let us step away and look at the numbers, because we have the
budget. We have the assumptions I just talked about, but let us go back
to the numbers for one second.
The problem: Federal spending on Medicaid has doubled over the last 5
years; $90 billion in 1995. It is 20 percent of the State budget. That
means if you are a Governor today, anywhere from 18 to as high as 23
percent of all the money in your budget is going to Medicaid. You can
say, ``Should it be 20 percent? Should it be 15 percent? Should it be
25 percent?'' None of us can really answer that question. But what we
do know, if you have 20 percent of your budget and the other 80 percent
is being spent on crime and the environment and education and roads and
police, that if you let that 20 percent grow to 25 percent or 30
percent or 35 percent, what suffers? Education, environment, crime,
police, roads.
So at some point, the Governors have to sit back and say, ``We have
to do something about a program that is one-fifth of our budget that is
skyrocketing year after year at the Federal level,'' and by definition
at the State level, is doubling at least every 5 years. If you do not,
schools are going to get even worse, our environmental protection is
going to get worse, there are going to be fewer police on the streets.
So we have a problem. We all know it is a problem. We are all trying
to work together, in a bipartisan way--at least the Governors are, 48
of them--in addressing that problem.
This is why you do not have to raise taxes $18 billion in this
amendment that has been put on the table. You do not have to. Excessive
regulation results in waste.
What has happened over the last 30 years in this program is that with
our good intentions in this body, Washington, DC, inside the beltway,
we want to help people. How do we do that? We do that by coming to this
floor and passing a layer of regulations, and the next year, another
layer of regulations put on that, and then another layer of
regulations, to where you get to 1996 and you have a program with
50,000 regulations telling you how to spend a health care dollar, which
is the taxpayers' dollar, in taking care of that child who I had to do
a transplant on or do a heart operation on back at Vanderbilt Medical
Center where I was 3 years ago before I came here.
That taxpayer dollar gets eaten up, literally eaten up by the time it
gets down to the doctor-patient relationship, and that is the problem
we have. It is excessive regulation and waste.
Somebody else has realized that. It is not just us. Governor Bill
Clinton, before the House Government Operations Committee, December 8,
1990, I think said it much better than I can. He has been at this a lot
longer than I have. He knows how to say things, I think, pretty well.
He used the right words:
Medicaid used to be a program with a lot of options and few
mandates.
We are the ones who do the mandates.
Now it's just the opposite.
Let us face the facts. He had it right back in 1990, and in this
proposal we have today, we have it right. It is not perfect, but it is
a lot better than what we have today.
Why do we have to spend another $18 billion, increase spending $18
billion, increase taxes $18 billion, which is what this amendment
implies we have to do? Our contention, and the contention of the
Governors, is that if you strip away the regulations, if you strip away
the requirements of dictating that doctor-patient relationship, what
goes on, eligibility, out of Washington, DC, if you strip away those
50,000 regulations and you give much of that responsibility back to
States and give them the flexibility to run their programs, you can
save money.
You do not have to cut, you can still allow Medicaid to grow over 6
percent, over twice inflation, which is what we do, but you do not have
to let it grow at 15 to 17 percent a year.
Let me turn to this one chart just to show you. Tennessee--and we
have had discussions on both sides of the aisle of what are called
1115(a) waivers. It is hard to get these 1115(a) waivers. I can tell
you, before I came to this Senate, I went through that process with
Tennessee and it ain't easy.
The 1115(a) waiver says, in essence, we will let you, as a State, run
a program how you see best; we will give you the flexibility, instead
of mandating how you run it out of Washington, DC, and let us see what
you do.
[[Page S5184]]
Tennessee applied for a waiver, received that waiver and let me just
show you--it is not a perfect program, and I am not going to be here
defending everything about the program--but let me show you just the
dollars and cents of what can be done if you give those Governors the
responsibility, let them design an appropriate program over time.
This is the Medicaid expenditure growth in the State of Tennessee.
This starts in fiscal year 1986, 1987, continues to 1992, 1993, and
1994. The yellow bars are the percentage change in increased
expenditures in a State, the overall program, joint State and Federal
match.
You can see in fiscal year 1986, the Medicaid Program in Tennessee
was growing at 21 percent, and it has happened in all of our States at
varying levels. In 1987, it grew at 16 percent; in 1988, it grew at 21
percent; in 1989, a pretty good year, it grew at 14 percent; it grew at
20 percent; 20 percent; 1993, 13 percent; 1992, 34 percent.
Think, if you are a Governor and have a program growing on average
about 20 percent, which is this red line, each and every year and you
have your budget, 20 percent a year, that part of your budget is
growing, all of a sudden, you have to start saying, I can't spend as
much on education, I can't spend as much on fighting crime, on putting
police on the streets, because we're growing at 20 percent per year.
In Tennessee, for the same amount of money being spent, both at the
State and Federal level, by having these 50,000 regulations stripped
away, growth in 1994 was right at 1 percent --1 percent. That overall
budget about $2.5 billion did not grow over the course of 1 year. That
shows what can be done. It can be done if you give States that
flexibility.
That is why I oppose this amendment. You do not have to charge it;
$18 billion more in increased taxes and increased spending.
Let me go back to one other chart just to demonstrate what that
actually means. Again, we are talking dollars right now. I am coming
back to the eligibility.
This is TennCare in yellow. This is Medicaid in red, which is what
would have been projected if we had to still live under the Federal
regulations in the State of Tennessee, which other States have to live
under. This is in 1994 when the program started. If you look over time
with TennCare, you can see that cost and expenditures are controlled,
increasing, ironically, at a rate of about 6.5 percent a year in the
State of Tennessee.
Look what it would have increased to if we had to live under those
excessive, burdensome regulations. President Clinton said it best back
in 1990.
Someone might say, Well, I bet you did it in Tennessee by not
covering as many people. You are not doing as good a job. In some way
you are cutting back on benefits and cutting back on services. The
beauty is we do not have to let taxes grow, and at 20 percent of
expenditures. In 1993, 89 percent of the population was covered. This
is not very good. This is, of the entire population, 89 percent of all
Tennesseans were covered.
By giving States the right to look at their own programs, strip away
their regulations, for the same amount of money, for the same amount of
money for controlled growth, we were able to cover 94 percent of the
population. It is ironic; 89 percent was probably in the lower 10 or 15
of all States of people covered.
In 1994, Tennessee was the No. 1 State in the country in terms of
numbers of people covered. Why? Because we were able to cover more
people for the same amount of money by stripping away these excessive
Government regulations. What? This proposal? We heard a lot of things.
A lot of it has been rhetoric.
What is actually in our proposal? I have said, we are going to
increase Medicaid spending more than two times inflation, at a rate of
an average annual growth of 6.5 percent. Is that a cut? That is not a
cut. We are going to spend, in fact, $54 billion more than in last
year's budget resolution.
So we have moved from the resolution last year. The President's plan,
as I said, is 7.1 percent growth. The big thing, I think, is that all
of our assumptions, all of our savings, are based on the Governors'
Medicaid proposal. I think this was missed in all of the earlier
comments when we talked about block grants, we talked about no nursing
home standards, we talked about lack of eligibility.
Let me just tell you what the Governors' Medicaid proposal says.
Restructuring Medicaid. These are our assumptions.
Eligibility. It is guaranteed for pregnant women up to 133 percent of
poverty. It is guaranteed for children to age 6 to 133 percent of
poverty; age 6 through 12 to 100 percent of poverty. It is guaranteed
for the elderly who meet SSI income and resource standards. It is
guaranteed for individuals with disabilities.
Benefits. The following benefits are spelled out by the National
Governors' Association recommendation, which was accepted. We based all
our assumptions on adopting this plan. The benefits remain guaranteed
for in-patient and outpatient hospital services, physician services,
prenatal care, nursing facility services, home health care, family
planning services and supplies, laboratory and x-ray services,
pediatric and family nurse practitioner services, nurse midwife
services, and early and periodic screening and diagnosis treatment
services.
Nursing home reforms. Again, let me say that in terms of the
principles outlined in the amendment under discussion, I agree with
many of those principles.
Nursing home reforms. What is in the Governors' plan which is our
plan? States will abide by the OBRA '87 standards for nursing homes.
States will have the flexibility to determine enforcement strategies
for nursing home standards and will include them in their State plans.
Financing. We heard this statement that this was a block grant to the
States. Each State will have a maximum Federal allocation that provides
the State with the Federal capacity to cover Medicaid enrollees. The
match will continue.
We also have in that plan an insurance umbrella. The insurance
umbrella is designed to ensure that States will get access to
additional funds for certain populations if, because of unanticipated
consequences, the growth factor fails to accurately estimate the growth
in the populations. Funds are guaranteed on a per beneficiary basis for
those described below who are not included in the estimates of their
base and their group.
In closing, Mr. President, I oppose this amendment. I have made the
point that we do not need to spend and tax $18 billion or more to
accomplish the goals that are laid out. I have shown, in fact, how one
State required zero percent growth, not 10, 15, 20 percent growth, and
was able to treat, was able to cover more individuals. We do not need
to tax more and we do not need to spend more.
We heard of the amputation of programs. We heard of walking away from
children. I do hope we can stay away from that rhetoric because I, as a
physician--I am a Senator for awhile, but basically I am a physician. I
have taken an oath, and I have lived my life in the service of
individuals, again, with about a third of that population being
Medicaid recipients.
I want it there. I understand the value of it to be there. I
understand the importance of this program and feel that I, in a
bipartisan way, with 48 Governors who put their proposal on the table,
can achieve the goals that we all want, and that is to provide a safety
net for this population, for all three populations who need Medicaid
over time.
Mr. President, I yield the floor.
Mrs. BOXER addressed the Chair.
The PRESIDING OFFICER. The Senator from California.
Mrs. BOXER. I do not intend to take a great deal of time at all, but
I just want to make certain points in response to my friend from
Tennessee.
He said it hurt him to hear Senators on this side--and I guess he was
quoting me--say their budget, the Republican budget, is walking away
from children and poor seniors. When I made that remark, I said
specifically, I know no one intends that to be the case. I just happen
to believe it is the case. I do not think anyone intends to hurt a
child. To hurt a child with spina bifida, to hurt a child in a
wheelchair, to hurt a senior citizen who depends on others in nursing
homes--no one would ever want to hurt those people.
[[Page S5185]]
I just happen to believe that is the outcome. I am not alone in this.
I am not alone in this. I am going to talk a little bit about who on
the Republican side of the aisle would like to add even more back than
Senators Graham, Kennedy, Dorgan, and I are adding back.
So when I say I think this Republican budget, in terms of its
Medicare cuts--I call them excessive cuts--walks away from kids, I do
not mean it to hurt any Senators. I am saying it because I think in
pragmatic terms it is going to hurt kids and people who are quite
vulnerable.
I heard the Senator say that he is proud of the Governors and that
they decided they would cover children and they would cover the seniors
who are disabled and they would cover pregnant women. I am very glad
that they want to. But I would have to take it another step. If the
Senator believes it so important to cover pregnant women, if the
Senator believes it is so important to cover the disabled and the
seniors in nursing homes, then why do we not do it as Americans, as a
national Government, and not leave it up to 50 States? Because, let me
say this, States can say one thing today. They could be hit with a
natural disaster tomorrow, and simply not have the wherewithal to do
the job.
You know, when States want to get block grant funding, they may say
one thing, and a few years later, change their mind. Why does the
Senator think we have Federal nursing home standards? It is simply
because the States set the standard, and there was scandal after
scandal after scandal. And there were hearings.
I do not know what condition the Senator's State was in, but I can
tell you in my home State, there were scandals. Seniors were scalded in
bath tubs and were drugged. I know the Senator from Oregon, who has
been a champion for senior citizens, knows about those stories. We saw
spouses becoming impoverished. We saw adult children of those nursing
home residents becoming impoverished. We worked hard over in the House,
he and I, with Henry Waxman--and I remember it well--and Barbara
Mikulski over here on this side. We said never again will that happen.
Now the Senator from Tennessee says, is it not great that Governors
care. I believe that Governors care. But so do I. I happen to be a U.S.
Senator. He happens to be a U.S. Senator. We have a chance in the U.S.
Senate to say it is important to have Federal nursing home standards
and enforcement.
I also would like to say this. My friend says this is a very
expensive proposal, $18 billion. Does he know that Breaux-Chafee, a
bipartisan proposal in this U.S. Senate, adds $31 billion more to the
Republican budget? Does he think those people are spendthrifts? Does he
think Senator Bennett, Senator Bond, Senator Brown, Senator Chafee,
Senator Cohen, Senator Gorton, Senator Jeffords, Senator Specter,
Senator Simpson, Senator Snowe, his colleagues on the Republican side
of the aisle are spendthrifts and do not care about fiscal
responsibility? I am sure that he agrees with me that they do care. Yet
they are going to be $31 billion over the Republican budget.
In conclusion, I say this: This is not about rhetoric. This is about
adding back $18 billion, when Breaux-Chafee with all these Republican
Senators want to spend $31 billion more in that same time period.
My friend talks about bipartisanship. My goodness, our amendment is
less than their budget in terms of Medicaid. Clearly, there are three
proposals out here dealing with Medicaid: The Republican proposal, the
Democratic proposal, and Breaux-Chafee. The one, in my opinion, that
hurts children, and I do not mean to hurt the Senator when I say this,
I just think it is a result of his priority, that hurts seniors, that
hurts the disabled, happens to be the Republican budget. That is why I
hope we can join hands together, all of us, and support this amendment.
I know the hour is late and I thank my colleague from Florida, my
colleague from Massachusetts, my colleague from Oregon for his
patience.
I yield the floor.
Mr. FRIST. Mr. President, I oppose the amendment. I disagree on the
closing that this proposal hurts children. It is a statement, but there
is no data, evidence, or suggestion given that it hurts children. I
said eligibility covered children to age 6 through 12 to 100 percent of
poverty. This is a National Governors' assumption, proposals.
I guess we could say it hurts children, but there is no evidence and
no data that it hurts children. I see nothing, having taken care of
children with my hands in a Medicaid Program, I see nothing, nothing,
in this proposal that hurts children. Walk away from kids, hurting
children--I guess we will just disagree on that.
The Senator from California did strike--I think, again, this is a
difference we will not agree upon, but when she has argued that it
takes a national program, a National Government, to be able to protect
children----
Mrs. BOXER. Will the Senator yield?
I said national standards, not a national program. I said national
standards.
Mr. FRIST. If the statement was national standards, let me just say
that the standards in the Governors' proposal are basically standards
that will be carried out by every State. That is part of the
assumption. If it is just national standards, we are OK.
My feeling was at a national level it took us to best decide how to
take care of people in Tennessee or in Washington State or in Alabama
or Mississippi. That is a fundamental difference, I believe. I think
the more we can do at the State level and at the local level, the
better. That is where accountability will rest.
I argue strongly that this body, Washington Government, Washington,
DC, is not the body that can best cover children or protect children or
prevent people from hurting children. I argue it is the people closest
to home, that it is the Governors, it is the local governments that can
best watch after our children. That is a fundamental difference.
Third, on the Chafee-Breaux, Breaux-Chafee proposal, we have not had
that presented yet. I do not know what the dollar figures will be.
There are some assumptions that it might be that reform is delayed a
year. I have heard that mentioned in these particular proposals. I
cannot comment. I do not know the fact that they spend more makes it a
better program. I argue that increasing at 6 percent a year based on
what we have seen in at least one State, in Tennessee, we can
accomplish all of our goals without this radical increase in taxation,
more taxation and more spending.
Last, we will come back to the word ``bipartisan.'' I have already
mentioned from where we were in the budget resolution last year, we
have shifted $54 billion already. I will say what we have endorsed is a
bipartisan plan that Governors together came and endorsed. That is 100
percent of the assumptions we put in our budget. That is bipartisan. We
have endorsed that. That is the basis of our assumptions.
With that, I hope when we do vote on this amendment, again, agreeing
with many of those principles laid out, but arguing that many, if not
most of those proposals are spelled out in this very document which we
have endorsed, that we do not need that increased spending. It is
unnecessary.
Mr. President, could I ask my colleague from California if she is
willing to yield back her time?
Mrs. BOXER. I am happy to yield back all my time on this. I assume, I
say to my friend, that we will be voting on this amendment on Tuesday.
Is that correct?
Mr. FRIST. I understand it will be stacked on Tuesday.
Mrs. BOXER. I also ask unanimous consent that each side be allowed 1
minute before the vote to explain the amendment.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mrs. BOXER. Mr. President, I ask unanimous consent that the amendment
be laid aside so the Senator from Oregon can offer an amendment.
Mr. FRIST. I yield back all my time.
Amendment No. 3984
Mr. WYDEN. Mr. President, I send an amendment to the desk for
immediate consideration.
The PRESIDING OFFICER. The clerk will report.
The bill clerk read as follows:
The Senator from Oregon [Mr. Wyden], for himself and Mr.
Kerry, proposes an amendment numbered 3984.
Mr. WYDEN. Mr. President, I ask unanimous consent reading of the
amendment be dispensed with.
[[Page S5186]]
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:
At the appropriate place, insert the following new section:
SEC. . SENSE OF THE SENATE REGARDING REVENUE ASSUMPTIONS.
(a) Findings.--The Congress finds the following:
(1) Corporations and individuals have clear responsibility
to adhere to environmental laws. When they do not, and
environmental damage results, the federal and state
governments may impose fines and penalties, and assess
polluters for the cost of remediation.
(2) Assessment of these costs is important in the
enforcement process. They appropriately penalize wrongdoing.
They discourage future environmental damage. They ensure that
taxpayers do not bear the financial brunt of cleaning up
after damages done by polluters.
(3) In the case of the Exxon Valdez oil spill disaster in
Prince William Sound, Alaska, for example, the corporate
settlement with the federal government totaled $900 million.
(4) The tax code, however, currently allows polluters to
fully deduct all expenses, including penalties and fines
associated with these settlements. In the case of the Exxon
Valdez disaster, deductibility on that settlement at the
current corporate tax rate will result in $300 million in
losses to federal tax collections . . . losses which will
have to be made up through increased collections from
taxation of average American families.
(5) Additionally, these losses also will make it more
difficult to move aggressively and successfully toward a
balanced federal budget.
(b) Sense of the Senate.--It is the sense of the Senate
that--assumptions in this resolution assume that revenues
will be increased by a minimum of $100 million per year
through legislation that will not allow deductions for fines,
penalties and damages arising from a failure to comply with
federal or state environmental or health protection laws.
Mr. WYDEN. Mr. President, this amendment which I offer tonight with
Senator Kerry of Massachusetts would put the U.S. Senate on record as
saying that it is time to end tax writeoffs under our Tax Code for
polluters.
We know our country wants the Senate to get serious about balancing
the budget. I know this has been a slow moving exercise in the past.
They want a serious sprint to balancing the budget. I believe it is
possible to make real progress in balancing the budget. I said in my
campaign that I believe you can balance the budget, just the way Oregon
families have to balance their budget.
Under the proposal that I offer tonight, if it had been law over the
last 6 years, about $500 million would have gone to reducing the
deficit simply by ending tax writeoffs for those who pollute in our
country.
What happens today, even though we want a polluter-pay philosophy
with respect to environmental protection, what we do is under the tax
law provide a Macy's basement discount for those who actually have to
pay penalties.
So what I am proposing tonight with Senator Kerry of Massachusetts,
is basic tax fairness. Under our amendment, no longer would average
working families pay more on their taxes just because the polluter has
received a writeoff on their tax return. What we propose is to put the
Senate on record that all revenues collected, when you have the kind of
current tax treatment for these penalties, would go back to the
Treasury. It would not go into the pockets of the polluter.
Let me talk, for a moment, about the way it works today under our tax
laws. If you have a polluter who violates the Safe Drinking Water Act,
a statute that assures that the water our kids drink is safe, they then
have to pay a penalty. But under the Federal tax laws, they get a tax
break for that penalty that they would be paying.
The Clean Air Act assures that the air our families breathe is pure.
But if a polluter violates it and pays a penalty, they get another tax
break when they violate that important environmental law.
The Resource Conservation and Recovery Act protects our communities
against hazardous waste. When a polluter violates that statute, they
have to pay a penalty under the law, but they get a tax break under the
Tax Code when they do so.
The CERCLA Act is the one designed to clean up our Nation's Superfund
sites, some of the most hazardous and dangerous waste in our country.
When a polluter violates those laws, they pay penalties, and, again,
get tax writeoffs.
The Oil Pollution Act is a particularly important example of why this
change Senator Kerry and I propose tonight is needed. The Oil Pollution
Act seeks to guard against devastating oil spills like the Exxon
Valdez. In the case of the Exxon Valdez disaster in Prince William
Sound, the polluter agreed to a settlement of approximately $900
million. The defendant in that case took an immediate $150 million tax
deduction. Over the course of that 10-year payout on that particular
settlement, you have a polluter that is going to be able to write off
nearly $300 million of the total cost.
Now, some are going to argue that it makes sense to provide a tax
deduction as an incentive for polluters to somehow settle these damage
suits. I argue that the knowledge that these polluters are going to pay
the full freight of their damage is a lot more than incentive for them
to comply with the environmental laws and get serious about cleanup. I
do not think it provides any real incentive if you allow people to
write off on their taxes when they violate the environmental laws and
have to pay penalties. I think it erodes the fairness of the Tax Code
when you provide almost unlimited deductibility arrangements for the
polluters, where they get a discount of everything they pay up to 34
percent.
Now, the fact is, Mr. President, that all of the major environmental
organizations are in support of this particular amendment. They have
said this is one of their priorities with respect to the environment
and this budget resolution.
Every Member of this body who cares about tax fairness ought to
support this amendment. I do not see how a Member can go and stand up
at a community meeting, a town hall meeting in their own home State,
and justify, at a time when we are seeing pressure for deficit
reduction and many valuable programs cut, allowing a tax writeoff of up
to 34 percent when you have somebody violating environmental laws and
paying a penalty as a result.
So, Mr. President, if the manager for the majority is prepared to
yield back time on the amendment, I am prepared to yield back time, as
well. Let me see what the desire of the majority is.
Mr. FRIST. Mr. President, I will yield back my time, as well.
Mr. WYDEN. I yield back my time, Mr. President.
The PRESIDING OFFICER. All time is yielded back.
____________________