[Congressional Record Volume 142, Number 97 (Thursday, June 27, 1996)]
[Senate]
[Pages S7171-S7172]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      WELFARE AND MEDICAID REFORM

  Mr. ROTH. Madam President, it has been stated countless times that 
the American people want three things: real welfare reform, a balanced 
budget, and compromise, if necessary to get the job done. Yesterday, 
the Finance Committee approved S. 1795, the Personal Responsibility and 
Work Opportunity Act of 1996. This legislation reflects the will of the 
American people on all three of these issues.
  Let me first address bipartisanship and compromise. This past 
February, the Nation's Governors gathered in Washington and approved 
two resolutions dealing with welfare reform and Medicaid. Their efforts 
were lauded across the country, including by President Clinton.
  For more than 3 years, President Clinton has been saying that, ``what 
keeps people on welfare is the cost of health care and child care for 
their kids.''
  Under S. 1795, we are providing more child care funding than under 
current law and more mandatory child care funding than President 
Clinton has proposed. This legislation will help families make that all 
important transition into the work force.
  When the Democratic and Republican Governors were working together on 
welfare and Medicaid reform, he did not tell the Governors to abandon 
their efforts because he would not sign Medicaid reform. In fact, he 
encouraged them. On the eve of the NGA proposal, the President 
encouraged the bipartisan Governors' group to ``try to reach agreement 
on a number of issues that are important to your people and to us here 
in Washington, including Medicaid and welfare * * *''.
  In order to protect the President from his own words, many Democrats 
are now demanding that welfare be separated from Medicaid. The 
Governors understand there is no real welfare reform without Medicaid 
reform.
  The compromise forged last February was supported by the most liberal 
Governor and the most conservative Governor and everyone in between. No 
one liked everything, but there was something for everyone in these 
resolutions. That is the essence of bipartisanship.
  On May 22, I introduced S. 1795, the Personal Responsibility and Work 
Opportunity Act of 1996. An identical bill was introduced in the House 
of Representatives by Chairman Archer and Chairman Bliley.
  My colleagues in the House and I made every effort to meet the goals 
adopted by the Democratic and Republican Governors.
  Last week, members of the Finance Committee submitted 163 amendments 
to S. 1795. There were 53 Republican amendments and 110 Democrat 
amendments. Based on the Finance Committee work, S. 1795, as amended, 
includes more than 50 Democratic amendments.
  Nearly half of the Democratic amendments offered are included in this 
legislation.
  Turning to the subject of welfare reform itself, it is critical to 
not lose sight of the overall goal of this legislation. That goal is to 
replace a system which has failed the very people it was intended to 
serve. The Governors understand that there is no real welfare reform 
without also restructuring Medicaid. Democratic and Republican 
Governors alike understand that Medicaid reform is a critical component 
of moving families from welfare to work.
  More than 3 years ago, President Clinton told the Nation's Governors 
that,

       * * * many people stay on welfare not because of the checks 
     * * * they do it solely because they do not want to put their 
     children at risk of losing health care or because they do not 
     have the money to pay for child care * * *.

  This is precisely the purpose of S. 1795.
  Madam President, there is plenty of talk coming from the other side 
of the aisle that the Governors and State legislatures cannot wait to 
abandon the children in their State. That is nonsense. If a family 
stays on welfare, that family will bet both a welfare check and 
Medicaid. Under this reform proposal, the States have greater 
incentives to expand Medicaid coverage and help prevent families from 
being forced onto the welfare rolls in the first place. Reform is a 
critical component of getting those now on welfare off of cash 
assistance.
  The Governors also understand that under current law, Medicaid is an 
all or nothing proposition. The current system contains built-in 
incentives for families to impoverish themselves in order to qualify 
for Medicaid.
  The Governors also understand that under today's all or nothing 
scheme, a lot of low-income working families get nothing. As if to add 
insult to injury, many low-income families are paying for the benefits 
a welfare family is getting while their own children go without 
coverage.
  Medicaid is an important program for our elderly citizens in terms of 
long-term care coverage. But the current system is far from perfect in 
serving our senior citizens. The current system forces elderly citizens 
into poverty even before any benefits can be provided.
  Our senior citizens often do not receive the most appropriate 
services because the current system, run under rules dictated by the 
Federal Government, is not flexible enough. What is good for the 
bureaucracy is not necessarily good for the individual. S. 1795 will 
give the States greater flexibility to redesign benefits so that our 
senior citizens can be better served.
  The Clinton administration is scaring the elderly and hiding behind 
children. The very idea that the current system must remain in place in 
order to protect our vulnerable citizens from their Governors and State 
legislators is not only insulting. It is wrong. More than half of the 
money being spent on Medicaid is there solely because the States have 
chosen to provide optional benefits and extend optional coverage to a 
greater number of people.
  The administration is trying to scare people with a convoluted 
argument that S. 1795 lacks a Federal guarantee. This argument is 
completely hollow. As Secretary Shalala acknowledged to the Finance 
Committee earlier this month, the States could take nearly $70 billion 
today out of the current Medicaid system without needing her approval.
  S. 1795 did not create the linkage between welfare and Medicaid. That 
was done more than 30 years ago when Medicaid was created.
  This legislation meets the four primary goals of the NGA Medicaid 
resolution:
  First, the basic health care needs of the Nation's most vulnerable 
populations must be guaranteed.

[[Page S7172]]

  S. 1795 guarantees coverage and benefits for poor children, children 
in foster care, pregnant women, senior citizens, persons with 
disabilities, and families on welfare.
  If anything, the legislation goes beyond the NGA resolution in terms 
of setting guarantees. Yesterday we extended those Medicaid guarantees 
even further to phase-in coverage of children ages 13 to 18.
  We also extended coverage to families leaving welfare. The 
modification also requires states to provide health coverage under the 
new Medicaid program for 1 year to families leaving welfare to go into 
the work force.
  Second, the growth in health care expenditures must be brought under 
control.
  While slowing the rate of growth, the Federal commitment to Medicaid 
remains intact. Even after reform, Medicaid spending will rise faster 
than Social Security.
  The Federal Government will spend an estimated $827.1 billion between 
1996 and 2002 on Medicaid, an average annual increase of approximately 
6 percent.
  We have met the President halfway in terms of Medicaid savings. The 
difference between us is less than 2 percent of total Federal cost of 
Medicaid.
  That is a difference of about two dimes a day per beneficiary.
  The American people should fully understand that the critical 
difference between President Clinton and this legislation is not about 
the level of spending. The difference between us is who controls the 
spending. The fundamental issue is whether or not the Governors and 
State legislators and judges can do a better job in running the $2.4 
trillion welfare system than the bureaucracy in Washington.
  The essence of the administration's opposition to S. 1795 is that the 
States cannot be trusted. The Clinton plan is built on the premise that 
Washington must control the decision making.
  This goal of the Governors also goes directly to issue of a balanced 
budget, the third major issue of concern to the American people. Simply 
put, the Federal budget cannot be balanced without Medicaid reform. It 
is the third largest domestic program in the Federal budget. It costs 
more than AFDC, food stamps, and SSI combined.
  Medicaid reform is also critical to balancing State budgets and 
priorities. One out of every $5 spent by the State goes to Medicaid. 
The National Association of State Budget Officers reports that Medicaid 
surpassed higher education as the second largest program in 1990.
  If nothing changes, Medicaid spending may soon overtake elementary 
and secondary education spending as well.
  To those taxpayers who are wondering why there is not more money for 
schools, to repair roads, and build bridges, a large part of the answer 
is the uncontrolled spending of Medicaid.
  Third, States must have maximum flexibility in the design and 
implementation of cost-effective systems of care.
  Among a number of provisions in meeting this goal, S. 1795 repeals 
the Boren amendment as requested by the Governors.
  It frees the States from Federal restrictions which impede the 
movement into managed care.
  Fourth, States must be protected from unanticipated program costs 
resulting from economic fluctuations in the business cycle, changing 
demographics, and natural disasters.
  S. 1795 includes an open-ended supplemental umbrella mechanism to 
provide additional funds for unexpected growth in guaranteed 
populations as well as certain specified optional populations.
  This legislation achieves each of these goals.
  It will replace a failed welfare system in which dependence is 
measured in generations and illegitimacy is the norm, with a system 
that encourages work and helps keep families together.
  This legislation will return power and flexibility to the states, 
while retaining guarantee of a safety net for the most vulnerable 
populations.
  Thirty-nine months ago, President Clinton promised the Nation's 
Governors and the American people that he would end welfare as we know 
it. Nothing happened.
  He abandoned welfare reform and instead pursued a misguided attempt 
to take government control over the world's finest health care system. 
It didn't work.
  Yesterday, the Finance Committee reported out legislation which will 
deliver on the promise of welfare reform and expand health coverage to 
many low income families.
  After 30 years, we know that Washington does not know how to build 
strong families. It is time to end the incentives for staying in 
poverty. It is time to end a system in which welfare pays more than 
work.
  Over 5 years, a typical welfare family receives more than $50,000 in 
tax free benefits. In a number of States, the benefits are 
significantly higher. It is appropriate to set a time limit on benefits 
and say enough is enough.
  There is now little difference between this plan and the President's 
own plan in terms of Federal spending levels on Medicaid.
  Secretary Shalala appeared before the Finance Committee earlier this 
month and acknowledged the President proposed to cut Medicaid by $59 
billion.
  Republican Governors have compromised. Democratic Governors have 
compromised. The legislation approved by the Finance Committee 
yesterday is a compromise.
  There have been ample reference to political motivations launched by 
the other side of the aisle about the linkage between welfare and 
Medicaid. It is time to question why, after all of these changes, the 
President would not sign authentic welfare reform which includes 
Medicaid.
  Last January, President Clinton vetoed welfare reform which did not 
include Medicaid.
  In doing so, he also veto a bill which provided more support, 
including child care, for welfare families than his own legislation 
does.
  H.R. 4 did not include Medicaid. But it did include the sweeping 
child support enforcement reform for which millions of American 
families are waiting. This legislation, again included in S. 1795, goes 
light years beyond anything the President could ever accomplish solely 
through administrative actions. How many thousands of children will 
remain in poverty or under the threat of poverty for at least another 6 
months because they will not receive cash assistance and medical 
insurance of their absent parent as a result of President Clinton's 
vetoes?
  Earlier this year, President Clinton declared that the era of big 
government is over. His action on this legislation will determine 
whether indeed that time is here.
  This legislation will be a test to see if President Clinton is truly 
committed to ending the era of big government. Nothing could 
demonstrate a true allegiance to this pledge better than to return the 
responsibility and authority for welfare programs, including Medicaid, 
to the States.

                          ____________________