[Congressional Record Volume 147, Number 91 (Wednesday, June 27, 2001)]
[House]
[Page H3691]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  CORRECT UNEQUAL TREATMENT AMERICANS IN THE TERRITORIES RECEIVE FROM 
                            MEDICAID PROGRAM

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentlewoman from the Virgin Islands (Mrs. Christensen) is recognized 
for 5 minutes.
  Mrs. CHRISTENSEN. Mr. Speaker, I rise today to join my colleague from 
Guam in once again speaking out against the unequal treatment that the 
American citizens in the Territories receive from the Medicaid program. 
By virtue of where we live and only by virtue of where we live, low-
income Americans in the territories are not able to receive the full 
benefits of the Medicaid program.
  For the residents of my district, the U.S. Virgin Islands, in order 
for a family of 4 to qualify for medical care under Medicaid, the 
maximum salary that a family can earn is $8,500 a year, one-half of the 
Federal minimum wage. By contrast, in year 2002, all States at a 
minimum will provide Medicaid for all children 19 years old and younger 
living in families at or below the poverty level at $17,050 for a 
family of 4, more than twice that amount.
  Historically the Government of the Virgin Islands matched the Federal 
contribution with a combination of cash and in kind. When the value of 
both is added, it equaled and many times exceeded the Federal 
contribution. While this resolves the Federal requirement on paper, it 
has created a financial havoc for the Territorial hospitals and clinics 
that really incur the cost of in-kind services but never get 
reimbursed.
  Because of the cap and 50-50 local match, the local Virgin Islands 
Government also bears the brunt of the cost of the Medicaid program 
contributing 66 percent or more on average, adding to the burden of the 
Territory.
  In addition, because our hospitals do not get DSH payments to 
supplement the large amount of low-income patients that we serve, this 
creates an additional financial burden on the Territory's hospitals; 
and compounding this dilemma is the fact that the Virgin Islanders, nor 
do the residents of Guam, get SSI benefits, which means that our 
disabled citizens are also excluded from the benefits of this program, 
again just because of where we live. I place emphasis on ``where we 
choose to live'' because the fact that all a low-income Virgin Islands 
resident has to do to receive SSI or full Medicaid benefits is to move 
to Miami or New York where a growing number of our residents now 
reside. We would prefer to keep our poor, sick and disabled residents 
at home instead of sending them to these districts because of an 
inequity in the law.
  Moreover, it is plain wrong that families must move away from their 
homes and friends in order to receive a benefit that their fellow 
citizens on the mainland do not have to leave their home to receive.
  Why does this unequal treatment exist? The answer most given is that 
the Territories do not pay Federal income taxes, but it is not as 
simple as that. The fact is that people who receive SSI and themselves 
in the States do not pay Federal taxes because they do not earn enough 
money.
  This Congress in their wisdom, through the earned income tax credit 
and other tax credits, allow low-income Americans to pay very little 
Federal taxes. But these same citizens, like my constituents, all pay 
Social Security and Medicare payroll taxes for which there are no 
credits or exemptions.
  How is it that one group of American citizens, or even residents who 
are not yet citizens, can receive medical care even though they do not 
pay Federal taxes while another group does not. Likewise when my 
constituents are called to serve their country when we are at war or 
even when we are not, they are not asked whether they pay Federal 
taxes; and we serve willingly and proudly and in large numbers.
  Mr. Speaker, a recent report, the Access Improvement Project of the 
Virgin Islands, revealed that great disparities exist for Medicaid 
eligible children in the Virgin Islands compared to the continental 
United States. The report shows that while the Nation as a whole spends 
an average of $76 for EPSDT screening per Medicaid eligible child, the 
U.S. Virgin Islands only spent $1.20. Additionally, the total Medicaid 
expenditures per child also shows an astonishing disparity. In the age 
group 15 to 20, national Medicaid expenditures were approximately 599 
percent more than what is being spent in the Virgin Islands. We also 
received a 50 percent match, despite a State like Mississippi where the 
average income is $1,500 higher than ours. They receive 80 percent 
match. And the Virgin Islands Medicaid program cannot provide 
wheelchairs, hearing aids or prosthetic devices, and only provides 
physical and occupational therapy to a limited degree because of the 
limited funding.
  Mr. Speaker, the gentleman from Guam (Mr. Underwood) and I pledge to 
work to remove the Medicaid cap and to right this injustice on behalf 
of the poor and disabled in our districts. I hope that our colleagues 
will agree that it is not right to penalize American citizens of 
similar circumstances only because of where they live, and that they 
will join and support our efforts.

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