[Congressional Record Volume 149, Number 32 (Thursday, February 27, 2003)]
[Senate]
[Pages S2883-S2884]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                                Medicaid

  Mr. BINGAMAN. Mr. President, I rise to address two or three issues 
this afternoon. I very much appreciate the chance to do so. First, let 
me begin with a subject that is extremely important to my State and to 
many of our States. That is Medicaid. I want to address two different 
proposals there. First, there is a proposal the administration has made 
related to Medicaid.
  We don't have a written proposal as yet, but we do have various 
statements from Secretary Thompson. We had a hearing this morning in 
the Finance Committee that the Presiding Officer attended, as did I. We 
have had testimony and oral statements and very brief descriptions, but 
we do not have a written proposal or even a detailed outline of what 
might be proposed by the administration. But in what they are 
proposing, I find some real serious concerns.
  The other proposal I want to discuss is one I am working on with 
Congressman Dingell--we hope to introduce it probably early next week--
entitled ``Saving Our States.'' I will try to describe a little bit 
each of these.
  The Nation's Governors have been here this week. I had the good 
fortune to speak to them last Sunday at one of their subcommittee 
meetings on human resources about Medicaid. It is clear that they are 
under severe stress at this point fiscally. It is estimated the States 
are facing nearly a $30 billion shortfall this year and an $80 billion 
shortfall in fiscal year 2004. In my view, it is important that the 
Federal Government respond to that. We cannot just ignore the fact that 
a growing number of our citizens are uninsured and that more and more 
people are being dropped from the Medicaid Program and the SCHIP 
program.
  The Federal Government needs to fundamentally reassess its own role 
in providing health care and reassess its relationship to the States in 
this regard. As I indicated, I am working with Congressman Dingell to 
prepare legislation to do just that.
  Let me talk first about the administration's proposal in very broad 
terms, as I understand it. It contains two parts. One is a set of 
reforms where, as the Secretary very eloquently described, it would 
allow States to adopt the best practices. It would allow States to put 
more emphasis on preventive care for seniors. It would allow States to 
have the flexibility they need to meet their particular needs. All of 
that is, of course, very good public policy, at least as stated in its 
most general form.
  As a general matter, I certainly believe the President and the 
Secretary will find strong support in Congress for that effort. But the 
second part of their proposal is the one that gives me concern. That is 
the restructuring of the financing. This part is much more difficult. 
What this does is basically say that for optional groups and for 
optional services--and that is an interesting definition as to what is 
optional; you will find that most of the services and groups currently 
covered by Medicaid turn out to be optional, and most of the funding 
that is currently spent on Medicaid turns out to be funding for 
optional groups and optional services--States would have the ability to 
get extra money for the first 7 years if they agreed that they would 
essentially live by a capped amount of Federal funding from now on. It 
would be about what they were getting in the year 2000 plus a 9-percent 
increase per year. That is the basic proposal.
  In addition to that, they are saying not only are we going to give 
the States a little extra money, we will reduce the amount of growth in 
that portion that the State in fact provides. So this is going to save 
money for the Federal Government. It will save money for the States.
  The one thing that is not discussed and that I have great concern 
about is the effect on the people who are supposed to be getting the 
health care services under this program; that is, the low-income 
children and the seniors.
  When you look at these definitions, optional groups, which seniors 
would you think might be in an optional group? Well, under the 
definition I have been given, if your income is over 74 percent of the 
Federal poverty rate, you are in an optional group. That means if your 
income gets anywhere up over about $7,500 or $8,000 per year, somewhere 
in that range--and I can get the exact figure--you are in an optional 
group. That means the total resources going to assist in your health 
care are being capped and are not going to grow as the population 
needing those services grows, are not going to grow as the usage of 
those services grows, are not going to grow as the health care cost of 
those services grows. We all know that there is growth in all three of 
those areas. That concerns me greatly.
  The other part of this which I can understand and makes it somewhat 
attractive to Governors, some of the Governors who were here this week, 
is that the Federal proposal says, if you agree to this, not only do 
you get a little extra Federal money but the amount of State money that 
you are going to have to put in is also going to be capped. The growth 
in that is also going to be capped. In other words, we will be able to 
save you money in your State budget.
  This is great for the States; it is great for the Federal Government. 
The problem is that the health care services available to low-income 
children and to seniors in our society are going to be reduced and 
reduced very substantially over the next 10 years under this proposal. 
So that has been my concern.
  Allow me to cite a couple of quotations from people who have spent

[[Page S2884]]

a lot of time studying this. The AARP executive director and CEO, Bill 
Novelli, has said, in relation to the administration's proposal:

       This proposal handcuffs states because it leaves people 
     more vulnerable in future years as states struggle to meet 
     increased needs with decreased dollars.

  Another quote, from the Consortium for Citizens with Disabilities:

       The Bush Administration proposal fails people with 
     disabilities and dishonors the nation's commitment to its 
     residents--it is not in the national interest. . . .What the 
     Medicaid program calls ``optional'' services are, in reality, 
     mandatory disability services for the children and adults who 
     need them. These services often are not only life-saving, but 
     also the key to a positive quality of life--something 
     everyone in our nation deserves.

  I believe strongly that the Federal Government at this particular 
time in our Nation's history should not be stepping away from its 
commitment to seniors, to people with disabilities, and to low-income 
children. It should not be leaving the States with the primary 
responsibility for dealing with growth in the cost of the services to 
these groups in the future.
  The administration will point out that the proposal does provide more 
funding up front to the States. The proposal is to give $12.7 billion 
more over the first 7 years to help the States. But there is something 
of an element of bait and switch in that after the first 7 years, that 
additional funding goes away.
  Secretary Thompson noted in his press conference that is after he has 
left his position, and I am sure it is after most of the Governors will 
have left their positions and probably after many of us will have left 
the Senate. That does not give us an adequate justification for putting 
in place a system that cuts funding for these vitally needed services 
in future years.
  The administration points out that they are promising the block grant 
for optional populations in a way that will increase at the same 
percentages that are projected in its budget. This is difficult to 
respond to, frankly, until we see a written proposal. We need a written 
proposal from the administration. We do not have that as yet. We do not 
have that on the Medicaid subject. We do not have that on Medicare 
either. And I hope those will be forthcoming soon because they are 
extremely vital programs for all of our States.

  Let me also talk a little about the proposal that I have, along with 
Congressman Dingell, that we are going to introduce next week. And I 
will go into more detail about it next week.
  Our idea is that there are certain groups that receive health care 
services under Medicaid, where the Federal Government needs to step up 
and pay the full cost of those services--or something very close to the 
full cost. One such group is so-called dual eligibles. These are people 
who are eligible for Medicare benefits, but are also low income enough 
that they are eligible for Medicaid at the same time.
  Current law says for those who are covered under the Medicaid law the 
States pay the lion's share of that cost. We are saying the States 
should not have to pay the lion's share of that cost. This is something 
where these folks have become eligible for Medicare. We should be 
paying 100 percent of that cost at the Federal level.
  Another group the Federal Government should be underwriting the cost 
of providing services for are illegal immigrants who come to our health 
care providers needing emergency attention. Here you can get into quite 
a philosophical argument as to whether or not these services should be 
provided. The reality is, if you are a doctor, if you are working in an 
emergency room and someone shows up who needs emergency care, you are 
obligated under your Hippocratic oath and the laws of decency, 
basically, to provide that care, if you are able to do so. To turn a 
person away because they do not have the right health insurance 
coverage, or they cannot demonstrate to you their financial solvency, 
when their circumstance is critical, is just not the way we should do 
business.
  The question is, Once that person has come into that emergency room 
and asked for that emergency care, who should reimburse the hospital 
for it? Who should pay the cost of that physician? At the current time, 
the States are picking that up, or the counties are picking that up, or 
the health care providers themselves are doing this on a pro bono 
basis. The reality is the Federal Government should be responsible for 
that, and we are proposing that in our legislation.
  Another group, of course, is Native American citizens. We have a 
great many Native Americans in my home State. The Federal Government 
should be stepping up to its responsibility to ensure that health care 
for these individuals is provided. We propose that as part of our 
proposal for saving our States as well.
  I will have another chance to talk this ``saving our States'' 
proposal when we introduce it early next week. I very much wanted to 
make reference to it today and indicate my great concern about the 
proposal I understand the administration is about to present to us. The 
truth is, the cost of providing health care is very high, and it is not 
getting any cheaper. We need to budget that in and we need to 
acknowledge that and we need to recognize that as a matter of public 
policy in this country, we should provide that basic care to seniors, 
to low-income children, to those who are disabled. The Medicaid Program 
does that. We need to keep the Medicaid Program sound and not undermine 
it by rationing back on the dollars we are willing to spend on those 
basic services.