[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.