[Congressional Record Volume 148, Number 102 (Wednesday, July 24, 2002)]
[Senate]
[Pages S7282-S7291]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
GREATER ACCESS TO AFFORDABLE PHARMACEUTICALS ACT OF 2001--Continued
Amendment No. 4315
The PRESIDING OFFICER. Under the previous order, there will now be 5
minutes of debate, equally divided, on the Hagel amendment No. 4315
prior to the vote on or in relation to the amendment.
Who yields time?
Mr. KENNEDY. Madam President, as I understand it, we are on the Hagel
amendment and we have 5 minutes evenly divided. Is that correct?
The PRESIDING OFFICER. The Senator is correct.
Mr. KENNEDY. I imagine the Senator from Nevada would want recognition
to make a statement in favor of his amendment.
Madam President, I will yield myself 2\1/2\ minutes and ask to be
notified of the last 15 seconds.
The PRESIDING OFFICER. The Senator from Massachusetts is recognized.
Mr. KENNEDY. Madam President, yesterday we voted in the Senate on
whether we were going to deal with a comprehensive prescription drug
program for our senior citizens--the 13 million who have none, the 10
million who have employer-based systems and are losing it, and the 4
million who have HMO coverage but have caps of $500 and $750. We
debated that.
I strongly supported the Graham-Miller proposal because it is built
upon the Medicare model, a tried and tested program. It was
comprehensive, affordable, and it would have met the needs of our
senior citizens. I differed with our Republican friends on this
particular proposal, but they believe they would achieve the same goal.
That isn't what the Hagel proposal is all about. It will only amount
to 10 or 12 cents out of every health care dollar.
[[Page S7283]]
I think our seniors are entitled to better. They are the men and women
who fought in the world wars, brought this country out of depression,
and now are frail and elderly.
The question is, Are we prepared to do for them what we did for them
in hospital care and physician services? They need the prescription
drugs. I believe we can still find common ground. I would like to find
common ground. It is the position of our Democratic leader to try to
find common ground in terms of a comprehensive program.
This is a drop in the bucket. This is smaller than a fig leaf to
cover the needs of our senior citizens. Let us in the Senate of the
United States perform nobly and protect our senior citizens: let's pass
a comprehensive program. The Hagel proposal does not do that. We need
to do that or we fail our senior citizens.
The PRESIDING OFFICER. The Senator from Nebraska is recognized.
Mr. HAGEL. Madam President, I yield to my distinguished colleague
from Nevada 1\1/2\ minutes of our 2\1/2\ minutes.
Mr. ENSIGN. Madam President, our plan is affordable to seniors as
well as to taxpayers in future generations. Our plan keeps senior
citizens involved in the choices they are making because they will pay
the first dollar out of pocket. They have the prescription drug
discount card so they will save 25 to 40 percent on the drugs they
purchase; but they will pay the first dollar out of pocket so it keeps
them involved in the choices they are making and helps the market work
and keeps downward pressure on prices.
It also works well with State plans. My State of Nevada used some of
its tobacco money to cover senior citizens below $21,500 in income. Our
plan fits in well with any of the State plans that have already been
put into effect.
The other advantage that this plan has is that it goes into effect at
least a year earlier than any of the other plans.
Lastly, our plan gives the help to those seniors who truly need it.
Regarding the really sad stories we have heard on the floor of the
Senate, this plan helps those seniors more than the Democrat plan, and
it helps them even more than the tripartisan plan. If you are a
moderate-income senior, with $17,000 of income or so and have $5,000 a
year in drug costs, our plan helps those seniors more than any of the
other two plans.
I urge the other Senators in this Chamber to support the Hagel-Ensign
plan.
The PRESIDING OFFICER. The Senator from Nebraska is recognized.
Mr. HAGEL. Madam President, my friend and distinguished colleague,
the senior Senator from Massachusetts, talks about a common ground.
This proposal is the common ground. As my colleague, Senator Ensign,
has just stated, this addresses those who need the help the most. We do
prioritize. We do focus on those seniors who need the help. Yet we do
it in a responsible way. We stay within the $300 billion budget cap
that this body voted on for a prescription drug plan over the next 10
years. It is immediate, it is permanent, and it uses the present market
system.
We don't build a new government bureaucracy. It is not impersonal. It
is direct. It caps the catastrophic dark cloud that hangs over all
senior citizens. We are doing something for this generation of seniors
as well as the next generation of seniors.
I hope our colleagues give this consideration and will vote for our
amendment.
The PRESIDING OFFICER (Mr. Carper). The Senator from Massachusetts is
recognized.
Mr. KENNEDY. Mr. President, the AARP opposes this amendment. Every
senior citizen group opposes this amendment for the reasons in this
letter.
I ask unanimous consent that the letter be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
American Association of
Retired Persons,
Washington, DC, July 23, 2002.
Dear Senator Hagel: Enacting a comprehensive prescription
drug benefit in Medicare this year remains the top priority
for AARP. Our members are counting on the Senate to pass a
meaningful drug benefit that is available and affordable to
all beneficiaries. Our members were promised in the last
election that a comprehensive drug benefit would be a
priority, and we are counting on you to make good on that
promise this year.
We appreciate the intent of your bill, S. 2736, the
``Medicare Rx Drug Discount and Security Act of 2002,'' to
provide a prescription drug discount card and stop-loss
protection to Medicare beneficiaries. However, in addition to
our substantive objections, we are concerned that by offering
this scaled-back proposal today, you would effectively derail
bipartisan discussion and compromise on more meaningful
comprehensive approaches. We believe Congress should focus
its efforts on enactment of a more comprehensive drug benefit
this year.
In addition to the timing of your proposal, AARP has
concerns about the approach taken in your bill, including:
Catastrophic coverage--While AARP has not opposed income-
relating premiums, income-relating the Medicare benefit
changes the nature of the program. This would set an
extremely dangerous precedent in Medicare. Further, the stop-
loss levels set in the bill do not provide enough protection
for lower income beneficiaries. A low-income couple could
spend 25 percent of their income just for drugs before this
plan offered assistance. Thirdly, there are a number of
issues involved in using tax returns to determine program
eligibility levels, and we believe other options should be
explored.
Discount card--While AARP supports the use of a discount
card program as a building block for a Medicare prescription
drug benefit, your proposal lacks the necessary
specifications to guaranty the level of discount, what level
of discount would be passed to beneficiaries, and the degree
of consumer protections required of plans.
Given these concerns, AARP opposes your amendment. We
remain fully committed to developing a comprehensive drug
benefit for all Medicare beneficiaries and we look forward to
working with you on legislation that our members can support.
Sincerely,
William D. Novelli,
Executive Director and CEO.
Mr. KENNEDY. Mr. President, I yield back the remainder of my time. I
believe all time has been yielded back.
Mr. President, I make a point of order that the pending amendment
violates section 302(f) of the Congressional Budget Act of 1974.
Mr. HAGEL. Mr. President, I move to waive the respective sections of
the Budget Act, and I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The question is on agreeing to the motion. The clerk will call the
roll.
The assistant legislative clerk called the roll.
Mr. NICKLES, I announce that the Senator from North Carolina (Mr.
Helms), is necessarily absent.
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The yeas and nays resulted--yeas 51, nays 48, as follows:
[Rollcall Vote No. 189 Leg.]
YEAS--51
Allard
Allen
Bennett
Bond
Breaux
Brownback
Bunning
Burns
Byrd
Campbell
Carper
Chafee
Cochran
Collins
Craig
Crapo
DeWine
Domenici
Ensign
Enzi
Fitzgerald
Frist
Gramm
Grassley
Gregg
Hagel
Hatch
Hutchison
Inhofe
Kyl
Lott
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Nickles
Roberts
Santorum
Sessions
Shelby
Smith (NH)
Smith (OR)
Snowe
Specter
Stevens
Thomas
Thompson
Thurmond
Voinovich
Warner
NAYS--48
Akaka
Baucus
Bayh
Biden
Bingaman
Boxer
Cantwell
Carnahan
Cleland
Clinton
Conrad
Corzine
Daschle
Dayton
Dodd
Dorgan
Durbin
Edwards
Feingold
Feinstein
Graham
Harkin
Hollings
Hutchinson
Inouye
Jeffords
Johnson
Kennedy
Kerry
Kohl
Landrieu
Leahy
Levin
Lieberman
Lincoln
Mikulski
Miller
Murray
Nelson (FL)
Reed
Reid
Rockefeller
Sarbanes
Schumer
Stabenow
Torricelli
Wellstone
Wyden
NOT VOTING--1
Helms
The PRESIDING OFFICER. On this question, the yeas are 51, the nays
are 48. Three fifths of the Senators duly chosen and sworn not having
voted in the affirmative, the motion is rejected. The point of order is
sustained. The amendment falls.
Mr. GRAMM. I move to reconsider the vote.
Mr. HAGEL. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
[[Page S7284]]
The PRESIDING OFFICER. Under the previous order, the Senator from
West Virginia, Mr. Rockefeller, is recognized to offer a second-degree
amendment.
Mr. REID. Mr. President, before the Senator from West Virginia
begins, I have spoken to the Senator from New Hampshire, who is the
manager of this bill. Following the debate on the Rockefeller second
degree amendment, we will go to Senator Gregg or his designee on a
second degree amendment, and then Senator Reid of Nevada or his
designee on the next second degree amendment. I ask unanimous consent
that that be the order.
The PRESIDING OFFICER. Without objection, it is so ordered.
The Senator from West Virginia.
Amendment No. 4316 to Amendment No. 4299
Mr. ROCKEFELLER. I send an amendment to the desk and ask for its
immediate consideration.
The PRESIDING OFFICER. The clerk will report.
The assistant legislative clerk read as follows:
The Senator from West Virginia [Mr. Rockefeller], for
himself, Ms. Collins, Mr. Nelson of Nebraska, Mr. Smith of
Oregon, Mrs. Lincoln, Mr. Durbin, Mr. Corzine, Mr. Harkin,
Mr. Murkowski, Mr. Hutchinson, Mrs. Clinton, Mr. Torricelli,
Mr. Wellstone, Mr. Schumer, Ms. Mikulski, Mr. Kerry, Ms.
Landrieu, Mr. Bingaman, Mrs. Feinstein, Mrs. Murray, Ms.
Snowe, Mr. Enzi, Mr. Johnson, Mr. Sarbanes, Mr. Dayton, Mr.
Leahy, Ms. Cantwell, Mr. Bayh, Mr. Kennedy, Mr. Jeffords, and
Mr. Cleland, proposes an amendment numbered 4316 to amendment
No. 4299.
Mr. ROCKEFELLER. I ask unanimous consent reading of the amendment be
dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:
(Purpose: To provide temporary State fiscal relief)
At the appropriate place, insert the following:
SEC. ____. TEMPORARY STATE FISCAL RELIEF.
(a) Temporary Increase of Medicaid FMAP.--
(1) Permitting maintenance of fiscal year 2001 fmap for
last 2 calendar quarters of fiscal year 2002.--
Notwithstanding any other provision of law, but subject to
paragraph (5), if the FMAP determined without regard to this
subsection for a State for fiscal year 2002 is less than the
FMAP as so determined for fiscal year 2001, the FMAP for the
State for fiscal year 2001 shall be substituted for the
State's FMAP for the third and fourth calendar quarters of
fiscal year 2002, before the application of this subsection.
(2) Permitting maintenance of fiscal year 2002 fmap for
fiscal year 2003.--Notwithstanding any other provision of
law, but subject to paragraph (5), if the FMAP determined
without regard to this subsection for a State for fiscal year
2003 is less than the FMAP as so determined for fiscal year
2002, the FMAP for the State for fiscal year 2002 shall be
substituted for the State's FMAP for each calendar quarter of
fiscal year 2003, before the application of this subsection.
(3) General 1.35 percentage points increase for last 2
calendar quarters of fiscal year 2002 and fiscal year 2003.--
Notwithstanding any other provision of law, but subject to
paragraphs (5) and (6), for each State for the third and
fourth calendar quarters of fiscal year 2002 and each
calendar quarter of fiscal year 2003, the FMAP (taking into
account the application of paragraphs (1) and (2)) shall be
increased by 1.35 percentage points.
(4) Increase in cap on medicaid payments to territories.--
Notwithstanding any other provision of law, but subject to
paragraph (6), with respect to the third and fourth calendar
quarters of fiscal year 2002 and each calendar quarter of
fiscal year 2003, the amounts otherwise determined for Puerto
Rico, the Virgin Islands, Guam, the Northern Mariana Islands,
and American Samoa under subsections (f) and (g) of section
1108 of the Social Security Act (42 U.S.C. 1308) shall each
be increased by an amount equal to 2.7 percent of such
amounts.
(5) Scope of application.--The increases in the FMAP for a
State under this subsection shall apply only for purposes of
title XIX of the Social Security Act and shall not apply with
respect to--
(A) disproportionate share hospital payments described in
section 1923 of such Act (42 U.S.C. 1396r-4); or
(B) payments under title IV or XXI of such Act (42 U.S.C.
601 et seq. and 1397aa et seq.).
(6) State eligibility.--
(A) In general.--Subject to subparagraph (B), a State is
eligible for an increase in its FMAP under paragraph (3) or
an increase in a cap amount under paragraph (4) only if the
eligibility under its State plan under title XIX of the
Social Security Act (including any waiver under such title or
under section 1115 of such Act (42 U.S.C. 1315)) is no more
restrictive than the eligibility under such plan (or waiver)
as in effect on January 1, 2002.
(B) State reinstatement of eligibility permitted.--A State
that has restricted eligibility under its State plan under
title XIX of the Social Security Act (including any waiver
under such title or under section 1115 of such Act (42 U.S.C.
1315)) after January 1, 2002, but prior to the date of
enactment of this Act is eligible for an increase in its FMAP
under paragraph (3) or an increase in a cap amount under
paragraph (4) in the first calendar quarter (and subsequent
calendar quarters) in which the State has reinstated
eligibility that is no more restrictive than the eligibility
under such plan (or waiver) as in effect on January 1, 2002.
(C) Rule of construction.--Nothing in subparagraph (A) or
(B) shall be construed as affecting a State's flexibility
with respect to benefits offered under the State medicaid
program under title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) (including any waiver under such title or under
section 1115 of such Act (42 U.S.C. 1315)).
(7) Definitions.--In this subsection:
(A) FMAP.--The term ``FMAP'' means the Federal medical
assistance percentage, as defined in section 1905(b) of the
Social Security Act (42 U.S.C. 1396d(b)).
(B) State.--The term ``State'' has the meaning given such
term for purposes of title XIX of the Social Security Act (42
U.S.C. 1396 et seq.).
(8) Repeal.--Effective as of October 1, 2003, this
subsection is repealed.
(b) Additional Temporary State Fiscal Relief.--
(1) In general.--Title XX of the Social Security Act (42
U.S.C. 1397-1397f) is amended by adding at the end the
following:
``SEC. 2008. ADDITIONAL TEMPORARY GRANTS FOR STATE FISCAL
RELIEF.
``(a) In General.--For the purpose of providing State
fiscal relief allotments to States under this section, there
are hereby appropriated, out of any funds in the Treasury not
otherwise appropriated, $3,000,000,000. Such funds shall be
available for obligation by the State through June 30, 2004,
and for expenditure by the State through September 30, 2004.
This section constitutes budget authority in advance of
appropriations Acts and represents the obligation of the
Federal Government to provide for the payment to States of
amounts provided under this section.
``(b) Allotment.--Funds appropriated under subsection (a)
shall be allotted by the Secretary among the States in
accordance with the following table:
------------------------------------------------------------------------
``State Allotment (in dollars)
------------------------------------------------------------------------
Alabama $33,918,100
Alaska $8,488,200
Amer. Samoa $88,600
Arizona $47,601,600
Arkansas $27,941,800
California $314,653,900
Colorado $27,906,200
Connecticut $41,551,200
Delaware $8,306,000
District of Columbia $12,374,400
Florida $128,271,100
Georgia $69,106,600
Guam $135,900
Hawaii $9,914,700
Idaho $10,293,600
Illinois $102,577,900
Indiana $50,659,800
Iowa $27,799,700
Kansas $21,414,300
Kentucky $44,508,400
Louisiana $50,974,000
Maine $17,841,100
Maryland $44,228,800
Massachusetts $100,770,700
Michigan $91,196,800
Minnesota $57,515,400
Mississippi $35,978,500
Missouri $62,189,600
Montana $8,242,000
Nebraska $16,671,600
Nevada $10,979,700
New Hampshire $10,549,400
New Jersey $87,577,300
New Mexico $21,807,600
New York $461,401,900
North Carolina $79,538,300
North Dakota $5,716,900
N. Mariana Islands $50,000
Ohio $116,367,800
Oklahoma $30,941,800
Oregon $34,327,200
Pennsylvania $159,089,700
Puerto Rico $3,991,900
Rhode Island $16,594,100
South Carolina $38,238,000
South Dakota $6,293,700
Tennessee $81,120,000
Texas $159,779,800
Utah $12,551,700
Vermont $8,003,800
Virgin Islands $128,800
Virginia $44,288,300
Washington $66,662,200
West Virginia $19,884,400
Wisconsin $47,218,900
Wyoming $3,776,400
------------------------------------------------------------------------
Total $3,000,000,000
------------------------------------------------------------------------
``(c) Use of Funds.--Funds appropriated under this section
may be used by a State for services directed at the goals set
forth in section 2001, subject to the requirements of this
title.
``(d) Payment to States.--Not later than 30 days after
amounts are appropriated under subsection (a), in addition to
any payment made under section 2002 or 2007, the Secretary
shall make a lump sum payment to a State of the total amount
of the allotment for the State as specified in subsection
(b).
``(e) Definition.--For purposes of this section, the term
`State' means the 50 States, the District of Columbia, and
the territories contained in the list under subsection
(b).''.
[[Page S7285]]
(2) Repeal.--Effective as of January 1, 2005, section 2008
of the Social Security Act, as added by paragraph (1), is
repealed.
(c) Emergency Designation.--The entire amount necessary to
carry out this section is designated by Congress as an
emergency requirement pursuant to section 252(e) of the
Balanced Budget and Emergency Deficit Control Act of 1985 (2
U.S.C. 902(e)).
Mr. ROCKEFELLER. Mr. President, I rise to offer this amendment on
behalf of many Senators. It is a very long list.
Most of my colleagues know we should have included State fiscal
relief and, in fact, did include it in our original stimulus package,
which we debated both before Christmas and afterward but did nothing
about. This is a stimulus package that we need now and need to complete
because we have very dangerous cuts going on in Medicaid and in the
health care programs in our States that affect our most vulnerable
Americans.
The amendment which I and about 30 other Senators offer is to provide
States with the assistance they need right now. State budgets, as the
Presiding Officer is more than aware, having been a Governor himself,
are in really bad shape financially, and 49 States, of course, cannot
spend any deficit money at all. More than 40 States in this fiscal year
faced a combined budget shortfall of between $40 and $50 billion,
according to the National Governors Association and the National
Association of State Budget Offices. It is a crisis. I hear from my
Governor from West Virginia as often as the Presiding Officer from the
State of Delaware hears from his Governor.
These deficits were caused by a combination of lower-than-expected
revenues, higher-than-expected expenditures, including increased
Medicaid costs, and Medicaid is our key, partly a result of the rise in
unemployment. When that happens, what is a State going to do but to
offer Medicaid?
There are some signs of an economic recovery at the national level. I
say that without any particular reason to know that or even to be
hopeful, but I will say that rather than just be pessimistic. However,
it will certainly take 12 to 18 months, if I am right in my optimism,
for the State to recover.
We offer this amendment to help address the States' fiscal crises.
Yes, we are the Federal Government. Yes, they are States. However, they
are deeply responsive to us and reactive to us with respect to Medicaid
and virtually all of our health care programs.
This amendment will provide about $9 billion to States over the next
year and a half by increasing the Federal Medicaid match, also by
holding States harmless for reductions in their Medicaid match that
would occur under current law and providing about $3 billion in new
money that States can use for other social service needs such as child
care.
I will explain that simply by saying when I conceived of this
amendment originally, it was all about the Federal matching percentage.
And then I got together with Senator Collins from Maine and Senator
Nelson from Nebraska and we worked out a compromise, which I think is a
far stronger amendment, which is to say that we want to do the Medicaid
match problem but we also want to work on social services block grants.
There is a block grant component here of $3 billion, which means less
for Medicaid but more for block grants, which means States can use it
for child care, for education, for child abuse and negligence, and a
variety of other services. It is a creative and good approach.
It is important that my colleagues support this amendment. I will say
a word or two about some of its provisions.
Some Senators might say we should help the States. That is what we
do. We often impose requirements and they get into trouble; we wander
off, forgetting what we have done.
Some might say, look, they got themselves into this mess; why should
we get them out of this mess? But the problem with that approach is,
No. 1, they didn't get themselves into that mess. It was a result of
what was going on nationally, economically, the way the whole formula
is figured, and I can get into that if my colleagues want to talk about
it.
Regardless of that, the problem is the people are affected, the
people of our States are the ones affected. Governor Patton of Kentucky
has noted:
Without fiscal relief the cuts necessary to close the
budget gaps will have profound effects on our Nation's
children and the programs which serve our most needy
populations.
Several States have already cut back coverage under their Medicaid
programs. If States cut back on Medicaid benefits, their residents will
be out in the cold. So we need to stop pointing fingers at the States
and ensure that the safety net is strong for this Nation's people who
are our most vulnerable citizens.
Despite the downturn in the economy that is affecting most areas of
the country, the proportion of Medicaid costs that the Federal
Government bears--in my State, it is 77, 78 percent, but the proportion
that the Federal Government is now paying is declining in 29 States. It
is declining in 29 States including the State of West Virginia.
So the States with reduced matched rates will lose well over half a
billion dollars. This is as a consequence of what is now going on under
current law. Our amendment would hold States harmless for these
decreases.
Our amendment will also provide a temporary increase in the Federal
Medicaid matching rates. I say temporary; it is not permanent. There
will be people here who will try to argue we are creating an
entitlement. It is a temporary program which we write into law.
I would say to the Presiding Officer, when we did the tax decreases,
we wrote that into law. We could write this into law. It will last a
certain period of time, the Medicaid match will be up until a certain
year, the social services block grant up until a certain year. We write
it into law. That is what we did with tax cuts. That is what we could
do in this amendment.
The pressure on States to cut back health insurance for low-income
families and individuals is enormous. The Governor of my State, this
Senator's State, Gov. Bob Wise, calls me constantly about this. The
State is in deficit for many reasons. It is not a wealthy State--it is
a wonderful State, but it is not a wealthy State--and he agonizes over
this because he knows at the end of the day he will have to make cuts
in Medicaid. He already has had to. He doesn't want to do that because
it affects so many of the people I represent--that we all represent.
Finally, I say to the Presiding Officer, the amendment will provide
States with money they can use for other social services. It is very
creative. It can be education. It can't be health care, but it can be
education; it can be child care, which plays very strongly into the
whole welfare reform debate issue. It can be for child abuse and
neglect.
All of us will offer meaningful assistance to States with ailing
budgets, lessening the need for States to cut programs or raise taxes
in the middle of something called a very bad recession. I cannot think
of a more important time to pass this than now.
My State will receive about $58.5 million under this amendment, which
it desperately needs in order to ensure coverage for our people.
I want to stress that this proposal is temporary. It will be
effective for 18 months from April 2002. Our amendment includes an
emergency designation. Why do we do that? Because that is the way it
originally was. That is the way it always was. It was part of the
stimulus package. It was part of getting America going again. Now more
than ever we need to get America moving again economically.
The total estimated cost of the proposal, for both the block grant
part and the FMAP part, the Medicaid match part, is $9 billion over 10
years. I believe it is appropriate that we provide the States with this
relief under the traditional emergency designation.
I will be glad to speak further, but I yield the floor.
The PRESIDING OFFICER. The Senator from Maine.
Ms. COLLINS. Mr. President, I rise today with my colleagues, Senator
Rockefeller, Senator Ben Nelson, and Senator Gordon Smith, as well as
with several other of our colleagues, to offer an amendment that begins
to address the fiscal plight of our States. I congratulate Senator
Rockefeller and Senator Nelson for their hard work on this issue.
Originally, we had slightly different approaches but, in an attempt
to get something done that will help our States that are struggling
with fiscal
[[Page S7286]]
crises, and more important, the low-income families who are dependent
on Medicaid for their health care needs, we joined together and came up
with a compromise that I hope will win widespread bipartisan support.
Here in Washington, consumed with our own budget issues, we too often
forget that we have 50 partners in our efforts to provide needed health
care, education, and other essential services to our citizens. Our
partners are our States, and they need our help and they need it now.
The recession may officially have come to an end, but its effects
still linger and they are being felt acutely by States from Maine to
Nebraska, from West Virginia to Oregon. The resulting rise in
unemployment, as well as the decline in tax revenues, coupled with the
aftermath of September 11, have placed enormous and unanticipated
strains on our State governments' budgets. States are facing a dramatic
and unexpected decrease in government revenues at precisely the time
when more revenues are needed to respond to the needs of more and more
Americans who are having difficulties making ends meet.
The combination of increasing demand for services and resources that
have declined is causing a fiscal crisis for States across the Nation.
According to the National Governors Association and the National
Association of State Budget Officers, more than 40 States are facing an
aggregate budget shortfall of between $40 billion and $50 billion. Most
States have seen their estimates of tax collections decrease, often
precipitously and unexpectedly. State governments are scrambling to
respond.
Forty-nine States are required by law or their constitution to
balance their budgets, so running a temporary deficit for these States
is not a possibility.
Moreover, the problem is getting worse. It is not likely to improve
anytime soon. A survey by the National Governors Association shows that
individual tax revenues for the first 4 months of this year are running
nearly 15 percent behind last year's level.
The problem also is not an isolated one. It is not limited to just
one area of the country. Mr. President, 39 States have been forced to
reduce their already-enacted budgets for fiscal 2002 by cutting
programs, tapping rainy day funds, laying off employees, and reducing
important services.
According to the Conference of State Legislators, States have been
forced to cut a number of critical programs. Twenty-nine States have
attempted to balance their budgets by cutting spending on higher
education--something no one likes to see; 25 States have cut
corrections programs. Others have cut K-12 education and the Medicaid
Program; 10 States have reduced aid to local governments. In addition,
a number of States have resorted to increasing taxes and fees by a
total of $2.4 billion.
The situation in my home State of Maine is typical of the problems
faced by many States. Our fiscal year just ended on June 30. Just this
past March, State revenues appeared to be on target at approximately
$2.4 billion. In April, after the State legislature had adjourned for
the year, State forecasters projected a shortfall of $90 million,
largely due to sluggish capital gain receipts.
By mid-June, the expected shortfall had risen by another $20 million,
due to lower than expected sales taxes, income taxes, and corporate
income tax receipts. All were off projections.
So you can see how quickly the financial system turned from
relatively positive to negative in my State and many others.
The shortfall in the fiscal year that just began in May looks even
worse. We may experience a shortfall of $180 million. That is
enormously difficult for a State such as Maine to deal with in a way
that does not hurt the people we serve.
To close the books on last year, the Governor of Maine had nearly
emptied our State's rainy day fund. This year, the choices are going to
be far tougher. Already, cuts in education funding, furloughs for
government workers, and cuts in the Medicaid Program are on the
horizon.
I believe States need to tighten their belts in times of fiscal
difficulty just as the Federal Government should do in austere fiscal
times.
We are not talking about taking the States off the hook. They are
still going to have to make a number of very difficult choices in order
to balance their budgets. But the unexpected nature and the severity of
the crisis that States now face has convinced me we need to give them
some temporary help. We should do so by targeting resources where they
are most needed for health care and social services programs.
Our amendment would provide a temporary increase in the Federal
Medicaid matching rate. It would also provide block grant funds to
every State. Specifically, it would provide $6 billion to States by
holding each State's Medicaid matching rate harmless for the next 18
months. It would also provide a temporary increase in the Medicaid
matching rate.
I note that over 30 States are scheduled to see a decrease in their
Federal matching under the Medicaid Program.
So we would hold these States harmless. They would no longer see
their Medicaid rate drop at the worst possible time for them from a
fiscal standpoint.
The legislation would also provide $3 billion through a temporary
block grant to help States pay for the rising demand in social services
resulting from the economic downturn. As Senator Rockefeller indicated,
that could be used, for example, for child care programs that are so
important to our States.
In order to be eligible for the increased Medicaid funds, States are
asked to maintain their Medicaid Programs. There are some States that
have acted to contract their Medicaid Programs in order to cut their
costs. But these States could reverse those actions and, thus, become
eligible for the increased Medicaid match that is provided by this
bill.
Regardless, every State is going to benefit from the package we put
together. Every State will receive a share of the block grant funding
and will be protected by the provisions that maintain the Medicaid
matching rates at no less than the current level. Those are the so-
called hold harmless provisions.
Our amendment is strongly supported by the National Governors
Association, as you might well expect. They need our help. But it is
also strongly endorsed by a number of health care providers that are
very concerned about their ability to continue to provide much-needed
quality health care to citizens who rely on the Medicaid Program. It
has been endorsed by the American Hospital Association, the American
Health Care Association, which represents our nursing homes, the
Visiting Nurse Associations of America, and a host of other health care
provider groups.
The support that our legislation has received underscores the
importance of providing assistance to States at a time when many are
being forced to look toward cuts in vital health care programs in order
to balance their budgets.
Our amendment targets most of our assistance on Medicaid. The reason
is that the Medicaid Program is the fastest growing component of State
budgets. While State revenues were stagnant or declined in many States
last year, Medicaid costs increased by 11 percent. This year, Medicaid
costs are increasing at an even greater rate--13.4 percent. My home
State of Maine is one of only a number of States that have been forced
to consider resorting to cuts in Medicaid in order to make up for their
budget shortfall.
The amendment we are offering today--I want to stress this point--
would not free States from the burden of making painful, difficult
choices in crafting their budgets for the current year. But it would
help to lessen the impact of the cuts. It would help to soften the blow
from a situation in which the States are really not to blame. It is a
combination of events--of declining tax revenues, lingering impact of a
recession, and the events of September 11--that has created the fiscal
crisis for our States.
Our legislation would help protect vital programs for those who can
least bear the cuts in services. To the State of Maine, our amendment
would mean $54 million for health care and social services that would
help our most needy citizens and assist our Governor
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and the legislature in producing a balanced budget without resorting to
draconian cuts that would have a terrible impact on our State citizens.
Congress is most effective when it stands arm in arm--not toe to
toe--with our partners, the States. Our States face a crisis of vast
and still expanding dimensions. I think we need to help, and we need to
help now. The longer we wait, the more difficult it is going to be for
our partners, the States.
This amendment is a modest amendment. Other versions of this
amendment were far more expensive. But in recognition of the fiscal
realities we face, we have limited its scope. But it is an amendment
that would make a difference to the States and to needy citizens across
our Nation. I urge my colleagues to join me in providing much needed
but temporary fiscal relief to the States.
The PRESIDING OFFICER. The Senator from Nebraska.
Mr. NELSON of Nebraska. Mr. President, I rise today to join my
colleagues and good friends, Senator Collins and Senator Rockefeller,
in discussing this issue, and to urge the support of our colleagues as
we strengthen the partnership that exists between the States and the
Federal Government as it relates to the Medicaid Program and social
services.
With the Presiding Officer having led the National Governors
Association, and having served as a Governor with the Presiding Officer
in the National Governors Association, I feel perhaps a little bit like
I am preaching to the choir. On the other hand, I think it is important
that we continue to point out the challenges facing the States today
which will put in doubt the continuing relationship of providing the
kinds of benefits necessary for Medicaid and for social services.
There is, in fact, a partnership. It has been a partnership--a
partnership where all the parties have responsibility and all the
parties have an opportunity to help the most vulnerable among our
society and our population. But as my colleagues have pointed out,
States today are experiencing the necessity of making cuts in spending
for important social services as well as for education and for a number
of other programs.
The current economic indicators suggest it could be years before
revenue levels return to what they were in the late 1990s. It will
continue, therefore, to be a herculean challenge for the States to
maintain a semblance of the services they were able to provide only a
few years ago. As is the case in any economic downturn, now is the time
when people need the services most.
Senator Collins and Senator Rockefeller have indicated the importance
of this particular legislation to their home States. I ask for the
opportunity and the courtesy to be able to do the same.
In my home State of Nebraska, unemployment levels are at their
highest mark in 15 years. For only the second time in history, Nebraska
will collect less revenue this year than it did last year. When those
two figures are put together, it should be abundantly clear that the
budget is being pressed on both sides, and eventually something will
break.
In Nebraska, cuts have already been made to child care programs,
rural development, and other essential services. A tax increase has
been passed by the legislature. These measures might relieve the strain
for today and tomorrow. But next year there will be more tough choices
and even fewer options.
Many of those options will likely involve cuts to Medicaid unless we
act to provide fiscal relief. According to the National Governors
Association, Medicaid spending has been a particular struggle for
States since expenditures have risen an average of 12 percent over the
past 2 years while State revenues rose to a total of 5 percent--where
they even increased, let alone where they decreased.
Medicaid spending has been driven by increases in health care costs
generally. For example, Medicaid costs for prescription drugs have
increased by 18 percent annually over the past 3 years. It has also
been increased by the recession-related increases in the number of
people who have become eligible for Medicaid due to the downturn in the
economy. This continues to grow worse.
As we look for a solution for Medicare and the prescription drug
benefit that we want to see provided to our seniors and to those who
have the need as part of the Medicare Program, we know what the
increase in cost has done to the average citizen. This program has felt
the same impact.
To date, most States have been able to reduce Medicaid spending
without cutting back eligibility significantly. Mr. President, 28
States have failed to budget enough funds for Medicaid this year, and
nearly all States have implemented Medicaid cost-containment measures,
such as reducing some benefits, increasing beneficiary cost-sharing, or
cutting or delaying payment to providers.
But as fiscal pressures continue to mount, many States are likely to
consider substantial reductions in Medicaid eligibility that would
leave hundreds of thousands more children, families, and seniors
uninsured. Medicaid, as you know, is often the second largest share of
State budgets after education, and States have already exhausted the
traditional budget balancing tools, such as tapping reserve funds and
using one-time measures, such as using tobacco settlement funds or
forward-funding spending programs, as well as Medicaid spending cuts
unrelated to eligibility. But the States need help.
It is important that we help the States today because part of the
partnership we have established with the States is welfare reform. To
the extent they are now faced with making cuts that will reverse the
success we have had in welfare reform, it would be a tremendous shame
to sit by and not do what we can to help avoid that sort of result.
As you know, Medicaid, as well as the eligibility requirements and
transitional benefits in social services, have helped transition people
from welfare to work. I think it would be a tremendous disservice if we
saw the absence and the withdrawal of those programs reverse the trend,
where people go from work back to welfare because they lose their child
support care and other valuable programs that have helped in the
transition.
For the past several months, we have been working together, Senator
Collins and I--and we have been so pleased to have been joined by
Senator Rockefeller in bringing about this coalition--to craft a
measure to help States through this period of fiscal crisis.
During the journey to bring our measure to the floor, it has gone
through some changes, but, more importantly, it has become even more of
a consensus measure along the way. As Senator Collins indicated, it has
the support of the National Governors Association, with the letter
today supporting it. And these are members of all political parties, a
tripartite group, where they are now supporting it and truly recognize
how important it is we work as quickly as we can to provide this
support to the States.
The Rockefeller-Collins-Nelson amendment will provide $9 billion, as
has been mentioned. It is a temporary measure that will provide enough
help, over the next 18 months, to ensure that low-income families,
children, seniors, and persons with disabilities most affected by the
economic downturn will get the health care as well as the other
services they need. It will also help to provide financial resources
for various hospitals, clinics, nursing homes, doctors, and other
providers that offer such services.
It is clear this amendment is, by no means, perfect. But it is a
consensus amendment, and it is a step in the right direction, on a
temporary basis, to help the States through these difficult times and,
moreover, to help the residents and the citizens of the States get
through this.
So I urge my colleagues to adopt this amendment and take this step to
avert, at least in part, potentially damaging cuts to Medicaid, as well
as to other social service programs.
I hope, as the list of supporters is included in the Record, numerous
senior groups and other groups interested in the outcome of the
Medicaid Program and social services--that that list will show there is
strong support, not only among the States but by those who are equally
interested in the outcome for seniors and for others, and that that
support will encourage and bring about the support of others of our
colleagues, so this amendment can be adopted.
[[Page S7288]]
It appears we are going to need the requisite 60 votes for this to be
adopted. We hope people will support it.
Mr. President, I yield the floor.
The PRESIDING OFFICER (Mr. Edwards). The Senator from Idaho.
Mr. CRAPO. Mr. President, I ask unanimous consent to speak for up to
5 minutes as in morning business.
The PRESIDING OFFICER. Without objection, it is so ordered.
(The remarks of Mr. Crapo are printed in today's Record under
``Morning Business.'')
Mr. KYL. Mr. President, I rise to express my concerns with Senator
Rockefeller's amendment. As you know, it would provide every state with
a 1.35 percent point increase in their Federal Medical Assistance
Percentage, FMAP,--the amount that the Federal Government supplements
States for their Medicaid costs.
Under FMAP, Medicaid funds are distributed to States based upon a
formula designed to provide a higher Federal matching percentage to
those States with lower relative per capita income, and a lower Federal
matching percentage to those States with higher per capita income. This
formula, although not perfect, is justified because States cannot
manipulate it for their own gain; the data is periodically published
and can be estimated with reasonable accuracy. Additionally, the use of
per capita income is a proxy for State tax capacity which, in turn,
relates to a State's ability to pay for medical services for needy
people. To put it simply: poorer states get more help than wealthier
States.
The Rockefeller amendment ignores the Medicaid formula and gives each
State a 1.35 percent point increase. Under the amendment, states that
have been determined by the Medicaid formula to receive the lowest FMAP
of 50 percent receive the greatest percentage increase in FMAP. States
with the highest FMAP receive the lowest percentage increase. This is
the exact opposite of how the funds should be allocated. The Medicaid
formula, whatever its faults, does indicate a relative sense of need.
It would be wrong to the give the least needy States the largest
percentage increase.
For example, Illinois' FMAP for fiscal year 2003 is 50 percent.
Increasing this to 51.35 percent, as the chairman's mark does,
increases Illinois' FMAP by 2.7 percent. Arizona's FMAP for fiscal year
2003 is 67.25 percent. Increasing this to 68.60 percent, as the
amendment does, increases Arizona's FMAP by only 2 percent and,
obviously, a much lower dollar figure. Illinois is receiving a 35
percent greater increase in its FMAP than Arizona, yet by the formula's
standards, Arizona has shown that it needs a far greater FMAP than
Illinois.
While the amendment is supposed to be a temporary increase in the
FMAP for just 18 months--I also worry that this temporarily increase
would become permanent, in which case it could cost upwards of $30
billion over 10 years.
Additionally, the Chairman of the Finance Committee had scheduled a
mark up on a proposal similar to this amendment. Unfortunately, the
mark up was canceled. I do not think that having an amendment on the
Senate floor without the legislation going through the committee
process is the best way to make changes in the Medicaid formula that
could become permanent.
Given these facts, I will not be able to support the Rockefeller
amendment.
The PRESIDING OFFICER. The Senator from West Virginia.
Mr. ROCKEFELLER. Mr. President, there are a variety of things that
have been said about this amendment, and there are a few more things
that could be said, but, basically, the nature of the amendment has
been laid out.
We are talking about an emergency designation. We did that in the
pre-last Christmas stimulus conference, of which I was a member, but it
did not get anywhere. We have talked about maintenance of effort. We
talked about the fact that this started out as just for Medicaid, and
now it is bifurcated in two parts, both of which are good. And it is a
stronger amendment.
I notice the presence of my distinguished colleague, Senator Smith,
on the floor, and hope that he will have some comments he will want to
make.
The PRESIDING OFFICER. The Senator from Oregon.
Mr. SMITH of Oregon. Mr. President, first, I thank the Senator from
West Virginia for his leadership in bringing together this coalition.
The amendment, that I hope we soon adopt by an over 60-vote margin,
is, in part, like what we adopted last December when, as part of the
supplemental bill or the stimulus package, Senator Baucus and I
authored an amendment that would have helped a great deal with respect
to Medicaid in the States' use of these funds. This bill is broader. It
allows States more discretion.
Senator Ben Nelson, Senator Collins, Senator Tim Hutchinson, I, and
others have come together to provide an amendment that our States
desperately need us to adopt.
Medicaid is an essential part of our health care safety net. Last
year, the Medicaid Program provided health coverage for 44 million of
the most vulnerable Americans 22.6 million children, 9.2 million adults
in low-income families, and 12 million elderly and disabled.
One in four American children are covered by this important program.
Yet, despite the program's importance, states around the country are
struggling to fund their share of their Medicaid programs.
The National Governors' Association reported several weeks ago that
States are in the worst financial situation in 20 years, and that they
expect next year's situation to be even worse.
During this current fiscal year, more than 40 States are experiencing
budget shortfalls totaling $45 billion. To close the gaps in funding,
many States are cutting public education, services to the elderly, and
health care to the poor--Medicaid--even as families are struggling to
get by in the weakened economy.
Twenty-two States have already acted to cut costs by eliminating
planned expansions of Medicaid or slashing current Medicaid
eligibility.
To keep State budgets in balance this year, Governors have cut
spending in many departments, tapped ``rainy day'' funds, and depleted
tobacco settlement funds. What this means is that, as we enter 2003,
the one-time fixes have been used up. In the words of Idaho's Governor
Kempthorne, ``The cupboard is bare.''
Going into legislative session this year, my home State of Oregon
faced a budget shortfall of more than $800 million, and the majority of
States are facing similar conditions.
The cruel irony of this situation is that just as State revenues have
dropped due to poor economic conditions, many more families are turning
to Medicaid as their only source of health care.
I know that in Oregon, the number of people on Medicaid has risen by
more than 10 percent since June of last year, and I suspect that many
of your States have experienced similar increases in demand.
Last year, more than 40 million Americans lived and worked without
health insurance, and it is estimated that the economic downturn will
add another 4 million to the ranks of the uninsured.
The amendment before the Senate today addresses a very real
emergency. It will allow States to continue providing health care to
our society's most vulnerable members in this economic downturn by
providing a temporary increase in the federal medical assistance
program, FMAP, funds States receive to pay their portion of the
Medicaid bill.
It will prevent the erosion of health insurance coverage and help
maintain a strong health care safety net for vulnerable Americans
during the economic downturn.
By temporarily increasing the Federal portion of the Medicaid bill,
the scope and depth of possible State budget cuts or tax increases will
be lessened, minimizing the potential negative impact on the economy
and our most vulnerable citizens across the country.
Including funds for States to use for a variety of social services
will also help provide services to the needy at a time when demand for
such services is demonstrably on the rise.
It is the right thing to do, and the right time to do it.
I urge my colleagues to support our amendment so we can clear the 60-
vote threshold.
Again, I thank our colleague from West Virginia, Senator Rockefeller,
[[Page S7289]]
for his leadership and look forward to joining him in support of this
critical and timely amendment.
I yield the floor.
The PRESIDING OFFICER. The Senator from Minnesota.
Mr. WELLSTONE. Mr. President, I thank Senator Rockefeller for his
leadership on this amendment and on health care policy. I have said to
the Senator from West Virginia, it is a little bit like the E.F. Hutton
ad: When E.F. Hutton speaks, people listen. Senator Rockefeller has
that credibility.
This is critically important. I know in Minnesota it is about $123
million in additional Medicaid funding. There is also the additional
social services block grant money that would also come to Minnesota.
Our State, just like many States in the country, is under siege
financially.
The other important feature is that one of the conditions upon
receiving this is to not cut back on Medicaid or medical assistance
eligibility which is extremely important. People need to be able to
keep their health insurance.
I ask unanimous consent to be an original cosponsor.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. WELLSTONE. I thank Senator Rockefeller for stepping forward and
taking the lead. I indicate to my colleagues my very strong support as
a Senator from Minnesota for this amendment.
I yield the floor.
Mr. REID. Mr. President, I say to my friend from West Virginia, the
sponsor of this amendment, the Senator from West Virginia would agree
to a reasonable time on this amendment; would he not?
Mr. ROCKEFELLER. The Senator is correct.
Mr. REID. There is not a manager on the floor, and there are other
things going on, such as the memorial service for the fallen police
officers in a few minutes. I would hope that we would be in a position
in the near future to arrive at some reasonable time to vote on this
amendment. It appears to have wide support. I would hope on this
amendment the majority leader would not have to file a cloture motion.
It is my understanding that the last time there were at least eight or
nine Republican cosponsors of this legislation; is that not true?
Mr. ROCKEFELLER. The Senator is correct. If the Senator will yield
for an additional comment.
Mr. REID. Yes.
Mr. ROCKEFELLER. It is a very interesting situation because we have a
compromise. It has very broad support. Nobody has come to speak against
it. There is a temptation to call for the yeas and nays; we are ready
to vote. We could have voted on this already. We voted in the Finance
Committee. If we voted on the floor, this is something I think would
pass well and easily. It is incredibly important to the States. I will
say something about that after I yield back to the Senator from Nevada.
Mr. REID. I appreciate the work that has been done by the Senator. I
hope this isn't happening. This is very typical, when someone knows
there is a good piece of legislation on the floor, to just ignore it
and go away. People don't want to speak against this because States are
helped as a result of the amendment of the Senator from West Virginia.
It is shaping up that maybe this will be our Friday vote. The leader
has indicated he will not go off this legislation at the drop of a hat.
He is working very hard to get a bipartisan prescription drug amendment
added to this underlying legislation.
We should move on this legislation the Senator has offered and not
waste time. The Senator from West Virginia or the Senator from Nevada
can't make that decision.
But we can suggest to the majority leader that it appears a big stall
went on here and maybe there should be a cloture motion filed on the
amendment of the Senator from West Virginia. Nothing is happening here
and this amendment has been on the floor. I have been watching all the
floor proceedings. Has anybody spoken against this amendment?
Mr. ROCKEFELLER. I say to the Senator, not a single voice has been
raised against it.
The PRESIDING OFFICER. The Senator from Oregon is recognized.
Mr. SMITH of Oregon. Mr. President, I say to the majority whip that
there is one individual--Senator Gramm of Texas--who came by as I was
about to speak and asked to speak before there is a vote or any final
agreement. He intends to speak in opposition to my position. He made
that clear. I will not speak for him, but as a courtesy to him I note
his interest in making a statement in opposition.
Mr. REID. Mr. President, I yield the floor.
The PRESIDING OFFICER. The Senator from West Virginia is recognized.
Mr. ROCKEFELLER. Mr. President, it is very perplexing, really,
because I was noting when the Senator from Nebraska was here, the floor
was crowded with Senators on our last votes. Obviously, all of a
sudden, the Senate floor was empty when we came to what is the single
most important part of the relationship with the Federal Government
that States are worried about and that is their Medicaid match.
This Senator was a Governor for 8 years. I remember what happened in
the early 1980s when we had the recession. I remember what happened in
Medicaid and I remember what happened in the public employees
insurance. Everything sort of collapsed. And then there is this body up
there in Washington that thinks it is so high and mighty that it
doesn't need to pay attention to the problems of States. We only pay
attention to the problems of the world and the country. This is an
example where this was part of the stimulus package and we were dealing
with the absolutely most critically important part of whether a child
eats, whether a child has medical services, whether a family has
medical services, and everybody is silent.
I have a very strong feeling that if this were taken to a vote, it
would get well over 60 votes. I know the Senator from Illinois is here
and so is the Senator from Minnesota. But there is this strange
silence, which sounds like a rolling filibuster without voice. I think
it is wrong. We are ready to go to a vote. I am going to keep saying
that because it is important.
Mr. WELLSTONE. Will the Senator yield for a question and comment?
Mr. ROCKEFELLER. Yes.
Mr. WELLSTONE. I urge the Senator--and I know he will do so--it is
hard to figure out the opposition, but I hope all of us think about our
States. This is an enormous contribution the Senator is making.
I ask the Senator from West Virginia whether he intends to persevere
and to keep it on the floor and do whatever he needs to do to bring it
to a vote.
Mr. ROCKEFELLER. This amendment is going to be voted on.
I notice the presence of the distinguished Senator from Illinois.
Mr. DURBIN. I would like to speak on behalf of the Senator's
amendment. I will seek recognition on my own time if that would be
appropriate.
Mr. ROCKEFELLER. I was trying to be courteous and friendly and
encourage the Senator to speak, and he will proceed as he does so well.
Mr. DURBIN. The Senator from West Virginia is always courteous.
Mr. President, the amendment before us, offered by the Senator from
West Virginia, is one of critical importance across the Nation. In
Illinois, we have cities large and small, hospitals large and small;
but we have health care needs that are universal. Whether you live in
small town America or in the middle of Chicago, there is genuine
concern about health care and its cost.
Now, one of the groups of Americans that we have made a special
effort to try to help are those who are in low-income situations. The
Medicaid Program is an effort by our country to say that no matter how
poor you might be, whatever your economic circumstances, we will not
let you go without basic medical care. That has been a commitment in
place for almost 50 years, and it is one that I think we honor as
Members of the Senate, both Democrats and Republicans.
What the Senator from West Virginia challenges us to face is the fact
that the amount of money we are sending to the States to meet that
obligation is not enough. It is not enough for several reasons. The
state of the economy is so poor, with unemployment, with businesses in
trouble, with people not receiving health insurance at their place of
employment. They turn in desperation to this Medicaid Program. I think
you will find that a substantial portion of those who turn to it are
children--the children of a working mother, the
[[Page S7290]]
children who otherwise might not receive the most basic medical care.
So the demand for services is increasing because of the sad state of
our economy.
The Senator from West Virginia knows that. He comes before the Senate
and says: If you are going to talk about health care in America, for
goodness' sake, be sensitive to the fact that there are more and more
people in desperate need. If the commitment of our Federal Government
to Medicaid is to be honored, certainly we must pay close attention to
the amendment.
Second, he raises a serious element, which is the fact that the cost
of this medical care is increasing. Ironically, one of the elements
that drives up cost is the cost of prescription drugs under the
Medicaid Program--under virtually every health care program. So in the
State of Illinois, in West Virginia, in North Carolina, and in
California, when you try to keep some young person, for example,
healthy so they don't have to be hospitalized, under Medicaid the cost
of prescription drugs to do it keeps increasing.
On a national average, the cost of prescription drugs went up 17 to
18 percent last year. So is it little wonder that, as we look at this
program, it is suffering because not only are there more demands but
the costs have gone up? Senator Rockefeller appropriately says to us,
for goodness' sake, you cannot ignore these realities. If you don't
provide additional resources for Medicaid, fewer people will be served
and we will literally threaten the quality of health care to millions
of Americans.
This bill sounds so simple--and it is--because it asks the Senate to
keep its word. If you are committed to the families of America, rich
and poor, that they will not be left without quality health care, are
you willing to vote for it?
It amazes me. As the Senator comes to the floor, you would expect
opponents of this legislation to be gathered and make the arguments
they are going to make. Yet you could shoot a cannon across this floor
and not hit an opponent. No one is here. I don't know if this is an
effort or a conspiracy of silence to not come and say anything and then
pray that the amendment doesn't come to a vote. Some colleagues live
and dread that they may have to vote for this one way or the other.
I am reminded of one of my favorite colleagues from the House of
Representatives, the late Mike Synar of Oklahoma, who used to say to
me, when a tough vote would come up on the House floor: I know you
don't want to cast that tough vote, but if you don't want to fight
fires, don't be a firefighter. If you don't want to vote on tough
issues, don't run for Congress.
Well, this is a tough call. We are saying to Democrats and
Republicans alike: Come to the floor and vote on whether we are going
to adequately fund Medicaid and reimburse the States that are
struggling with this economy. If you don't believe we should, then vote
no. But if you believe we should, as I do, join Senator Rockefeller in
this effort.
We all know what the States are going through. There is not a State
in the Nation that hasn't faced serious shortfalls in terms of State
revenue. My State of Illinois, and virtually every other State, has had
to make cuts and changes when, in fact, each and every one of them is
paying for them. At the same time, since September 11, all of the
States and localities are putting more money into security as we expect
them to do. They are providing law enforcement so we have a safe and
secure Nation. They are trying to maintain and protect our basic
infrastructure of America.
So as the economy is weakening, the demands on State revenue increase
and the costs of the Medicaid Program go up, and Senator Rockefeller
says it is time for the Federal Government to meet its obligation. What
he has proposed that we do is to increase the Medicaid reimbursement in
all States by 1.35 percent.
As I stand here and say that, many people listening to this debate
will say: How big a difference could that make? The fact is it could
make a substantial difference. It could provide our States up to $6
billion over the next 18 months; $6 billion right into the Medicaid
system, making certain that people receive basic health care.
It also says States with a lower FMAP this year than last year will
be held harmless. States do not lose money under this proposal. It says
States will also receive, if I understand correctly, $3 billion in
fiscal relief grants for a variety of social service programs which are
now suffering.
The Urban Institute estimates that Medicaid enrollment can be
expected to increase because of our weak economy by approximately
800,000 adults, 2 million children, and 260,000 people with
disabilities, if the unemployment rate rises from 4.5 percent to 6.5
percent. With that, of course, are the demands for more Federal money
and more State money.
I applaud my colleague from West Virginia. We have worked on this
before. We tried to bring this to the floor several different times.
This is the moment. If we are talking about health care costs, whether
it is the cost of prescription drugs, the availability of generic
drugs, as we address each of these issues, let's not overlook the
basics.
There are many people in this country struggling to get by today,
working part-time, unemployed, trying to keep their children healthy.
States are struggling to provide the services these folks need. In my
State, I can find them in rural areas, I am sure in Arkansas and North
Carolina. There are many small town hospitals which are threatened with
going out of existence. They are going to leave.
In one part of my State, as I traveled around, I said in Calhoun
County: What does it mean if that local hospital closes? They said
instead of a woman traveling 40 miles to deliver a baby, it is 75
miles. I have been through that three times with my wife, and the
prospect of getting in a car and driving 75 miles when she thinks the
baby is on the way is something no father, no member of any family can
look forward to. That is the real world affect of this amendment.
If we do not provide the assistance through Medicaid for those
hospitals and those doctors, we are going to say to some parts of
America, whether it is inner-city or rural America: You are going to
find a dramatic decline in the services and quality of service
available to you.
The block grant which Senator Rockefeller proposes to the States is
also going to help us in providing a variety of social services. This
increase in Federal support is essential if we are going to honor our
commitment to act as partners with our States to help our Nation's most
vulnerable people.
I urge my colleagues to support Senator Rockefeller's amendment and
to increase Federal assistance to States that are struggling to make
ends meet. This increase in Federal support is long overdue. We first
started talking about it last November. Senator Rockefeller and I tried
to include this in the energy package, if I am not mistaken. That was
one of our efforts. We cannot delay it further.
Anyone who opposes it--I hope no one does--if anyone opposes it, come
forward, make your argument, suggest your own amendment, but for
goodness' sake, let's not let this important issue slide by. There are
literally people in communities across America who are dependent on our
good work, and if we do not respond to this national emergency, there
are families and people who will suffer.
I thank Senator Rockefeller for his leadership on this issue. I ask
unanimous consent to be shown as a cosponsor of the amendment.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DURBIN. I yield the floor.
The PRESIDING OFFICER. The Senator from Arkansas.
Mrs. LINCOLN. Mr. President, I wish to say a special thanks to
Senator Rockefeller who has been tireless in this effort on behalf of
his constituents in West Virginia. The similarities in our States have
certainly given me a wonderful partner in fighting on behalf of this
issue. We have been fighting to increase Arkansas' share of Medicaid
dollars since last fall.
I remind the Senator from West Virginia that back in November, when
we were taking up the stimulus bill in the Finance Committee, we tried
even there to offer this type of an amendment, to recognize the
shortfall in our rural States and the problems they were suffering at
that point. We know
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that in terms of stimulating the economy, it is pretty hard to go to
work if you are sick and cannot get health care. It is pretty hard for
children to learn and become a great part of the future leadership and
the future workforce of this country if they are sick and cannot go to
school.
Back in February, we argued to get it into a slimmed down stimulus
package, but we did not pass it there either.
I worked with Senator Rockefeller to try to amend the energy bill,
but we did not get a vote on that back in March. Again, in April, I
cosponsored stand-alone legislation with Senator Rockefeller and
Senator Smith, and in May I cosponsored stand-alone legislation with
Senator Collins and Senator Nelson.
We have been working on this issue for quite some time. We recognized
last fall when many of our State Governors were having to take cuts
that those who were most vulnerable in our society were going to be
hurt the most, and we needed to do something and we needed to act.
I am a proud cosponsor of the amendment before us in which the two
previous proposals I mentioned have been merged. I thank my colleagues,
certainly Senator Rockefeller, Senator Smith, Senator Collins, and
Senator Nelson for their leadership and their perseverance.
In times of tight budgets and economic downturns in our States,
States are cutting their Medicaid budgets, and we are seeing it right
and left across this country. Who suffers because of this? Our most
vulnerable citizens: Our low-income families, our children, and our
senior citizens.
Medicaid funding plays a critical role in senior care, with two-
thirds of the residents of America's nursing homes depending on
Medicaid payments for their care. But many States, including Arkansas,
are facing real budget crunches with their Medicaid budgets. We are
seeing, because of a multitude of other medical underpayments, whether
it be UPL, whether it be physician payment reimbursement cuts, whether
we are talking about ambulance provider fee schedules, we are looking
at a crisis in rural America in the delivery of health care.
It is a serious problem that we are facing now, but if we do not do
something pretty quickly, we are going to see some devastation. I have
heard from hospitals in my State that are going to, in the next couple
of months, stop providing OB care. I have constituents at that point
who will have to travel 90 miles to get obstetric care. We are going
backward, not forward, in providing the health care across the board in
rural areas, as well as urban areas, that is so necessary to the
quality of life that each American deserves.
In Arkansas, our population of seniors is a snapshot of where the
Nation is going to be in the next few years. So we are already facing
the challenges with which other States will have to contend, the
challenges that other States will have to face in the next 10 to 15
years.
It is also true that we have a disproportionately high number of
seniors living in poverty, and many of them rely on Medicaid funding
for health care and long-term care. Especially in rural States such as
Arkansas where health care services are harder to come by, Medicaid
makes a huge difference in helping families afford care for their
seniors.
We need greater investment in Medicaid funding to States, especially
at a time when our States are in such a devastating budget situation.
The bills I have helped introduce in the Senate will adjust the FMAP
level so that States can benefit from greater Medicaid funding, which
will go a long way toward helping our most vulnerable citizens,
particularly our seniors.
I appreciate the support I have received from our colleagues today,
those who have worked tirelessly on this issue. And I can tell you that
we will all keep fighting to get this done. No matter what barriers
people may put before us, we are going to continue to make this fight.
I think the fact we have been doing it since last November should
indicate to our colleagues that this is essential, we know it is
important, our constituents know it is important, and the rest of the
Senate must learn that it is important enough for us to act now.
Under this amendment, Arkansas stands to gain $80 million over 18
months. This is a much needed injection into our economy and into the
quality of life of our most vulnerable citizens.
To my colleague from West Virginia, I thank him so much for his
leadership on this issue. I have enjoyed working with him since last
fall, and we are going to continue on this effort because we know how
important it is to the lives of the people we represent in this body.
It is so important we move forward as quickly as we possibly can.
I thank the Chair.
The PRESIDING OFFICER. The Senator from West Virginia.
Mr. ROCKEFELLER. Mr. President, for 60 seconds, I suggest the absence
of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The senior assistant bill clerk proceeded to call the roll.
Ms. COLLINS. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Ms. COLLINS. Mr. President, I ask unanimous consent that the Senator
from Mississippi, Mr. Cochran, be added as a cosponsor of the
Rockefeller-Collins-Smith, et cetera, amendment.
The PRESIDING OFFICER. Without objection, it is so ordered.
Ms. COLLINS. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The senior assistant bill clerk proceeded to call the roll.
Mr. ROCKEFELLER. Mr. President, I ask unanimous consent that the
order for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
____________________