[Congressional Record Volume 146, Number 144 (Friday, November 3, 2000)]
[Extensions of Remarks]
[Pages E2083-E2084]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




MOTION TO INSTRUCT CONFEREES ON H.R. 4577, DEPARTMENTS OF LABOR, HEALTH 
AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS 
                                ACT 2001

                                 ______
                                 

                               speech of

                          HON. JOHN D. DINGELL

                              of michigan

                    in the house of representatives

                       Tuesday, October 31, 2000

  Mr. DINGELL. Mr. Speaker, recently, the House of Representatives 
passed legislation giving billions of dollars to Medicare providers, 
the bulk of which went to Medicare HMOs. This legislation did virtually 
nothing for providers under Medicaid. Yet, in almost every State across 
the nation, Medicaid payment rates are a fraction of what Medicare 
pays.
  The motion offered by the gentleman from Texas, Mr. Bentsen, insists 
that the conferees to the Labor HHS bill ensure provider payments in 
the Medicaid Program are adequate to ensure that the children, 
disabled, and working families covered by Medicaid have access to 
quality health care. I appreciate his commitment to readdress this in 
the next Congress.
  Medicaid covers 38 percent of all births in this country. It pays for 
30 percent of all visits to pediatricians. The Medicaid Program insures 
more than 21 million children in this country. It also pays for a 
significant portion of nursing home care for the elderly. Medicaid is 
an insurance program that provides care for the most vulnerable in our 
society. By failing to ensure that Medicaid provider payments are 
adequate, access is jeopardized and we are failing our children, our 
elderly parents, and the disabled who depend on this program for their 
health care.
  In my home State of Michigan, I have worked to ensure providers get 
adequate reimbursement so that they will continue to participate in the 
Medicaid Program and provide quality care. But, the situation remains 
dismal. Medicaid payments for obstetric care in Michigan are less than 
half of the Medicare rate. Payment for primary care services is also 
barely half of what Medicare pays. This, at a time when the state has 
more than a billion dollars in budget surplus and will receive more 
than 300 million dollars this fiscal year in tobacco settlement money.
  In Michigan, what is becoming increasingly troubling is that the 
state is attempting, by expanding the use of HMOs in Medicaid, to wash 
its hands completely of any responsibility to ensure providers are paid 
adequately. The state is shifting beneficiaries wholesale into managed 
care, yet the state is failing to monitor aggressively the adequacy of 
HMOs' payments to doctors, hospitals, and nursing homes that provide 
care for beneficiaries. In Michigan, inadequate provider payments by 
managed care plans under contract with the state have resulted in 
disruption in care and difficulty for many in obtaining care. 
Particularly acute problems have surfaced for individuals with HIV and 
children with special needs. We have a responsibility to ensure 
provider payments are adequate for beneficiaries whether they are in 
fee-for-service or managed care.
  Nursing homes too, receive woefully low reimbursement to care for 
Medicaid beneficiaries. In 2000, it is projected that more than

[[Page E2084]]

half of all nursing home care will be paid for by Medicaid. Yet, we 
know from research, much of which has been conducted by my colleague 
Henry Waxman and the Government Reform Committee Democratic staff, that 
conditions in many nursing homes do not meet even the most basic 
standards.
  Given that my colleague from Texas offered this motion, I would like 
to also mention a few facts about this problem in the state of Texas. A 
recent Government Reform Committee investigation in Texas examined the 
1,230 nursing homes in that state which serve more than 86,000 Texans. 
Their investigation found that there are serious deficiencies in many 
of these homes. More than 80 percent of the homes violated federal 
health and safety standards during recent state inspections. More than 
half of the homes had violations that caused actual harm to residents 
or placed them at risk of serious injury.
  The State of Texas ranks 45th out of 50 states in terms of nursing 
home payments for Medicaid beneficiaries. In 1999, the average Texas 
per diem rate was a little over $80 per person. The majority of nursing 
home beneficiaries are the frailest and most vulnerable of all. We have 
a responsibility to ensure that the payments for the care of our 
parents are adequate; that the payments do not encourage facilities to 
skimp on care; and that there is ample staffing to ensure the health 
and safety of nursing home residents. Unfortunately, many states have 
not been meeting these responsibilities.
  Low provider payments also thwart efforts to promote dental health. A 
recent Center for Health Care Strategies report on increasing access to 
dental services in Medicaid noted: ``In many states, dentists are not 
participating in Medicaid programs, mainly due to the low Medicaid 
reimbursement rates. Dentists have little financial incentive to see 
Medicaid patients, and often have a disincentive--they lose money on 
each patient, as reimbursement rates in many states do not cover 
costs.'' If states are not even paying dentists enough to cover costs, 
how can we expect them to participate?
  A September 2000 study by the General Accounting Office confirms this 
problem: ``While several factors contribute to the low use of dental 
services among low-income persons who have coverage for dental 
services, the major one is finding dentists to treat them. Some low-
income people live in areas where dental providers are in short supply, 
but many others live in areas where dental care for the rest of the 
population is readily available.''
  In Texas in 1998, there were 8,656 active dentists in the state--only 
1,923 of them--or 22 percent--treated Medicaid patients. This number is 
clearly not adequate to treat the 2,680,583 Medicaid patients enrolled 
in the state in that year. These low
  Letters from the National Governors' Association and the National 
Council of State Legislatures threatened cuts in state Medicaid 
programs and reductions in coverage if the motion were adopted. I am 
appalled by their callous statements. It is miserly and uncompassionate 
to say that, in this time of record prosperity, states cannot afford to 
pay providers so that the most vulnerable, sickest, and frailest 
members of society can be assured decent care. Especially when on 
average nearly 60% of every dollar of Medicaid spending is contributed 
by the Federal Government.
  Perhaps what the Republican governors who support the NGA threat mean 
is that they would choose to allocate their money differently. My home 
state of Michigan has managed to provide tax cuts for the rich in three 
of the past four years. Last year they enacted a $300 million tax cut, 
yet they have done little to address the inadequacy of provider 
payments in Medicaid. Many Republican governors, it appears, would 
rather help their wealthy friends, than spare a dime to help children, 
elderly, and pregnant women who depend on Medicaid for their health 
insurance coverage.
  Some members that oppose ensuring adequacy of Medicaid payments argue 
that we voted for the repeal of the so-called ``Boren Amendment'' in 
the Balanced Budget Act of 1997 (BBA) and now we're reversing our 
position. I would just remind my colleagues that we voted for a lot of 
provisions in the BBA. Many of us also voted for Medicaid provider 
cuts. Now, however, we recognize the deep impact on these cuts on 
providers and beneficaries--both in Medicare and Medicaid.
  We recently passed a bill that added billions to Medicare provider 
payments, but the Republican Leadership stripped out many of the 
provisions helping Medicaid providers. Medicaid providers must be paid 
adequately. How can we expect providers to remain committed to 
providing quality care and continue treating patients in Medicaid if 
their reimbursement does not even cover their overhead costs? About 20 
percent of children in this country are covered by Medicaid, as are 
about four million seniors. They don't have legions of well-paid 
lobbyists roaming the halls of Congress, and they don't contribute 
large sums of money to political campaigns. But they need and deserve 
our help.