[Congressional Record Volume 151, Number 13 (Wednesday, February 9, 2005)]
[Senate]
[Pages S1208-S1214]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. SMITH (for himself, Mr. Bingaman, Ms. Snowe, Mr. Jeffords, 
        Mr. Santorum, Mr. Kerry, Mr. DeWine, Mr. Durbin, Mr. Chafee, 
        Mrs. Lincoln, Ms. Collins, Mr. Nelson of Nebraska, Mr. 
        Voinovich, Mr. Corzine, and Mr. Coleman):
  S. 338. A bill to provide for the establishment of a Bipartisan 
Commission on Medicaid; to the Committee on Finance.
  Mr. SMITH. Mr. President, first, let me thank the twenty-or-so 
organizations that have offered their support for our bill which 
creates a Medicaid Commission. I ask unanimous consent that the full 
list of groups and their letters of support be printed in the Record. 
The importance of this bill, I believe, is demonstrated by the 
outpouring of support expressed by such a diverse group of people 
representing state and local elected officials, providers and 
advocates. It is truly impressive.
  With the debate growing over the President's budget proposal for the 
Medicaid program, Senator Bingaman and I are joining together with many 
of our colleagues to introduce this bill that calls for the creation of 
a Medicaid Commission. We are joined by Senators Snowe, Lincoln, 
Santorum, Ben Nelson, DeWine, Jeffords, Collins, Durbin, Chafee and 
Kerry in introducing the bill today.
  For too long Medicaid has gone unnoticed by policy makers. Over the 
past few decades Congress has spent a great deal of time and effort 
modernizing the Medicare program, developing ideas to fund Social 
Security, reforming our intelligence gathering apparatus, and enacting 
legislation that stimulates the economy. Yet, through it all Medicaid 
has gone unnoticed, even though it recently became the nation's largest 
health care program.
  As the former President of the Oregon Senate, I have long championed 
Medicaid and worked to protect the vulnerable populations who are 
helped by it. As a new member of the Finance Committee in 2003, I 
helped lead the effort to provide $20 billion in short-term fiscal 
assistance. However, since that time it has become clear that Medicaid 
requires more than band-aide fixes.
  Medicaid requires a thorough review that should be performed by all 
key stakeholders working together to evaluate the program. We need to 
consider its pluses and minuses, and then chart a new path for the 
future. Our proposed Medicaid Commission will do just that.
  As I have discussed with Governors, Secretary Leavitt and 
Administrator McClellan, we have a unique opportunity in the history of 
the Medicaid program. For once, everyone seems to be focused on 
protecting and improving the program. The challenge lies in bringing 
everyone together.
  It certainly won't be easy, but accomplishing great things never is. 
It will require both parties to work together. It will require Congress 
to reach out to the Administration, Governors, State Legislators, 
providers and advocates to determine how best to improve such a vital 
program.
  And it will require advocates and providers to be willing to listen 
to new ideas that may help improve the program by creating 
efficiencies, improving quality and expanding access to care. This 
can't be accomplished working against each other or only with select 
partners--it can only be accomplished when everyone works together.
  I have never argued that this Commission is necessary because 
Medicaid is broken. I truly believe in this program because I have seen 
the difference it makes in Americans' lives. It helps support poor 
children so they can go to school healthy and ready to learn.
  It helps a poor expectant-mother receive the prenatal care necessary 
for her new child to be born healthy and able to live a fulfilling 
life, it helps a family manage the care of a disabled child, and it 
helps an elderly person spend their last few years living with dignity. 
However, this program is not perfect; improvements can and should be 
made.
  I don't have to look any further than my home State of Oregon to see 
that change can be beneficial. In Oregon, most people who live with a 
disability or who are elderly are served in their home or community. It 
seems appropriate that this would happen, but Oregon actually had to 
apply for a waiver to care for people in this way. That's because under 
Medicaid States receive incentives to care for people in nursing homes, 
it's called an institutional bias.
  On the other hand, extreme reforms should be instituted simply to 
save money. Medicaid is expensive, but so is private health care 
coverage in this country. And in comparison, Medicaid is a pretty good 
deal.
  On a per-capita basis, Medicaid has only grown at a little more than 
four percent while private sector health care costs have grown at over 
12 percent. The problem with Medicaid is that enrollment is growing and 
a lot more money is being spent on long-term care compared to years 
past.
  Much work is ahead of us. And one of the best ways to keep Medicaid 
on the right path and ensure its long-term sustainability is to enact 
this bill right now. If this Commission were made law today, we could 
have its recommendations in time to inform Congress' deliberations next 
year. We have a short window of opportunity before us. I urge my 
colleagues, the President and all supporters to embrace this bill today 
and call for its passage so the Medicaid Commission can get to work.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

 Organizations Supporting the Bipartisan Commission on Medicaid Act of 
                                  2005

       National Alliance for the Mentally Ill (NAMI); National 
     Association of Public Hospitals & Health Systems (NAPH); 
     American Hospitals Association (AHA); National Association of 
     Community Health Centers (NACHC); National Association of 
     Children's Hospitals (NACH); AIDS Institute; National Rural 
     Health Association; Catholic Health Association of the United 
     States; National Conference on Aging (NCOA); Conference of 
     State Legislatures (NCSL); National Hispanic Medical 
     Association (NHMA); The American Academy of HIV Medicine; 
     American Association of Family Physicians (AAFP); Association 
     for Community Affiliated Plans (ACAP); American Health Care 
     Association (AHCA); National Association of Counties (NACo); 
     American College of Obstetricians & Gynecologists (ACOG); 
     American Dental Association (ADA); American Psychiatric 
     Association; Alliance for Quality Nursing Home Care; American 
     Geriatrics Society.
                                  ____



                             American Health Care Association,

                                 Washington, DC, February 7, 2005.
     Hon. Gordon Smith,
     U.S. Senate, Russell Senate Office Building, Washington, DC.
     Hon. Jeff Bingaman,
     U.S. Senate, Hart Senate Office Building, Washington, DC.
       Dear Senators Smith and Bingaman: I am writing on behalf of 
     the American Health

[[Page S1209]]

     Care Association and the National Center for Assisted Living, 
     the nation's leading long term care organizations. AHCA/NCAL 
     represent more than 10,000 non-profit and proprietary 
     facilities dedicated to continuous improvement in the 
     delivery of professional and compassionate care for our 
     nation's frail, elderly and disabled citizens who live in 
     nursing facilities, assisted living residences, subacute 
     centers and homes for persons with mental retardation and 
     developmental disabilities. AHCA/NCAL and their membership 
     are committed to performance excellence and Quality First, a 
     covenant for healthy, affordable and ethical long term care.
       We review with great interest your draft legislation that 
     would establish a Bipartisan Commission on Medicaid and the 
     Medically Underserved. We welcome focus on the Medicaid 
     program from a population and a payment perspective. Long 
     term care is unique in that the government is the purchaser 
     of almost all nursing home services. The government demands 
     that quality be first rate--as it should--yet the payment 
     structure that would support greater quality is regulated in 
     silos, separate from each other. At a time when we as a 
     nation ought to be strengthening our long term care 
     infrastructure to prepare for the wave of baby-boom retirees 
     who will enter the system, we are, instead, allowing the 
     infrastructure to deteriorate.
       Heretofore, Congress has focused on Medicare primarily for 
     the long term care sector, yet Medicare is a small albeit 
     significant portion of our patient population. lt is becoming 
     a better known fact that the Medicaid program funds the 
     majority of the care for people in nursing homes. 
     Approximately 67% of the average nursing home patient 
     population relies on Medicaid to pay their bill. And, 
     approximately 50% of the average nursing home's revenues come 
     from Medicaid.
       This is why we find it illogical that the Medicare Payment 
     Advisory Commission (MEDPAC) continues to focus solely on the 
     sector's Medicare-only issues--without also looking at 
     Medicaid. When it comes to making important public policy 
     recommendations that truly impact people's lives, it is 
     inconceivable that data used to reach conclusions about the 
     sufficiency of Medicare funding fails to look collectively at 
     the real, and growing, interdependence between Medicare and 
     Medicaid.
       We must take steps to begin to reform the long term care 
     system in terms of its reliance on the Medicaid program. Yet, 
     reform does not happen in a vacuum and we must have a debate 
     of ideas. We know a key stakeholder--the National Governors 
     Association--has placed this issue high on their list of 
     priorities. We are also beginning to see this issue raised 
     within the Social Security debate.
       We support your legislation but do so with some 
     recommendations. First, we recommend that your legislation 
     consider the entire long term sector in terms of our payment 
     structure. Second, time is running out for reform and so we 
     believe the Commission should be vested with adequate power 
     and authority that its recommendations make a significant 
     impact on the policymaking process. We are not sure if the 
     Commission in its current form has enough force to really be 
     the catalyst for new ideas for reform.
       We wholeheartedly believe that a far more holistic 
     evaluation is called for at this critical point in time, so 
     that beneficiaries will not fall through the cracks due to an 
     incomplete data picture and a short-sighted policy. Again, 
     thank you for the opportunity to review your legislation and 
     I look forward to working with you on Medicaid issues this 
     year.
           Sincerely,
                                                         Hal Daub,
     CEO and President.
                                  ____



                                           The AIDS Institute,

                                 Washington, DC, January 24, 2005.
     Re Bipartisan Commission on Medicaid and the Medically 
         Underserved Act of 2005.

     Senator Gordon Smith,
     U.S. Senate,
     Washington, DC.
     Senator Jeff Bingaman,
     U.S. Senate,
     Washington DC.
       Dear Senators Smith and Bingaman: As the single largest 
     source of federal financing of health care and treatment for 
     low income people with HIV/AIDS, the future viability of our 
     Nation's Medicaid program will have a direct bearing on the 
     health of hundreds of thousands of Americans living with HIV/
     AIDS. Since Medicaid provides access to healthcare for 55 
     percent of all people living with AIDS, 44 percent of people 
     with HIV, and 90 percent of all children living with AIDS, it 
     plays a critical role in providing access to life-saving 
     medications that prevent illness and disability, and allow 
     people to live longer, more productive lives.
       Because many people with HIV/AIDS are low income, or become 
     low income-and disabled, Medicaid is an important source of 
     coverage. In FY 2002, Medicaid spending on AIDS care totaled 
     $7.7 billion, including $4.2 billion in federal dollars and 
     $3.5 billion in state funds.
       Any radical change to the benefits provided by Medicaid or 
     its financing structure can have devastating impacts that can 
     seriously jeopardize access to HIV/AIDS care in the United 
     States. What is needed is a carefully crafted, long term 
     solution to the current challenges facing the Medicaid 
     program so that low income and disabled Americans, including 
     those living with HIV/AIDS, are provided the necessary 
     healthcare they require.
       The AIDS Institute applauds you on the introduction of the 
     ``Bipartisan Commission on Medicaid and the Medically 
     Underserved Act of 2005'', and looks forward to its passage 
     in the very near future. The Bipartisan Commission envisioned 
     by the bill would create the necessary careful review of the 
     Medicaid program in a truly bipartisan manner with the 
     expertise of representatives of the affected communities and 
     government entities. The AIDS Institute strongly believes 
     that such a review, as designed by your legislation, will 
     result in a process to conduct a thoughtful review of the 
     Medicaid program outside of the often partisan political 
     process.
       The AIDS Institute congratulates you on your leadership on 
     this program, which is critically important to so many people 
     living with HIV/AIDS, and the introduction of the 
     ``Bipartisan Commission on Medicaid and the Medically 
     Underserved Act of 2005''. We look forward to its enactment, 
     participating in the Commission activities, and the eventual 
     recommendations of its final report.
           Sincerely,
                                              Dr. A. Gene Copello,
     Executive Director.
                                  ____

                                           National Association of


                                         Children's Hospitals,

                                 Alexandria, VA, February 8, 2005.
     Hon. Gordon Smith,
     U.S. Senate,
     Washington, DC.
     Hon. Jeff Bingaman,
     U.S. Senate,
     Washington, DC.
       Dear Senator Smith and Senator Bingaman: On behalf of the 
     National Association of Children's Hospitals (N.A.C.H.) and 
     our more than 120 members nationwide, I thank you for your 
     leadership in introducing the ``Bipartisan Commission on 
     Medicaid Act of 2005.'' Medicaid's critical role in providing 
     health coverage to low-income children, as a major payer for 
     children's hospital services and the primary safety net in 
     the nation's pediatric health care infrastructure cannot be 
     overstated. We welcome a thoughtful review to strengthen and 
     secure this vital program for years to come.
       Medicaid is now the largest single source of health care 
     coverage for children in the nation. Half of its 53 million 
     enrollees are children and one in four children in the 
     country relies on Medicaid for health coverage. But children 
     account for only 22 percent of the costs, with the lion's 
     share of the costs attributable to people with significant 
     health and long term care needs such as the elderly and 
     people with disabilities.
       Medicaid and children's hospitals are partners in caring 
     for children. Our member hospitals are major providers of 
     both inpatient and outpatient care to children on Medicaid. 
     In fact, children on Medicaid represented 47 percent of all 
     discharges and 41 percent of all outpatient visits at 
     children's hospitals in FY 2003.
       And children's hospitals rely on Medicaid to serve all 
     children, not just low-income children. When provider 
     reimbursements are cut, or benefits and eligibility changes 
     are made, it affects children's hospitals' ability to provide 
     a wide range of services that all children rely upon.
       As the single largest payer of children's health care, 
     Medicaid's performance affects the health care of all 
     children. It's coverage of low income children has enabled 
     advancements in pediatric medicine that would not have been 
     otherwise possible. We need to sustain Medicaid's successes 
     and move forward to ensure that eligible children are 
     enrolled, with access to appropriate, effective and safe 
     care.
       Your legislation recognizes, as do our member hospitals, 
     that the future of Medicaid is not simply about cost. A hasty 
     move toward program reforms without a thorough review of the 
     program with input from those most closely associated with 
     the program would be irresponsible. The National Association 
     of Children's Hospitals applauds your efforts to direct 
     attention to how to improve service delivery and quality care 
     in Medicaid.
       We again congratulate you on your leadership in introducing 
     this important legislation and we look forward to working 
     toward its enactment.
           Sincerely,
     Lawrence A. McAndrews.
                                  ____

                                                   Association for


                                   Community Affiliated Plans,

                                 Washington, DC, February 8, 2005.
     Hon. Gordon Smith,
     Hon. Jeff Bingaman,
     U.S. Senate,
     Washington, DC.
       Dear Senators Smith and Bingaman: I write today on behalf 
     of the members of the Association for Community Affiliated 
     Plans (ACAP), an organization of Medicaid-focused community 
     affiliated health plans committed to improving the health of 
     vulnerable

[[Page S1210]]

     populations and the providers who serve them, to express our 
     support for your legislation, ``The Bipartisan Commission on 
     Medicaid Act of 2005.'' ACAP's Medicaid-focused managed care 
     plans serve over 1.7 million Medicaid beneficiaries in states 
     across the country.
       The demand for efficiency and quality in our nation's 
     health care system combined with the fiscal pressures on the 
     federal, state and local governments has spurred 
     consideration of a broad spectrum of proposals to reform the 
     Medicaid program. Like you, ACAP believes the forty year-old 
     program is in need of updating. However meaningful and 
     sustainable changes will only occur if federal and state 
     policymakers along with providers, health plans, consumers 
     and others undertake a comprehensive and forthright 
     examination of the Medicaid program.
       The purpose of such a review should be to improve the 
     efficiency of the Medicaid program based on historical 
     experiences and recent advances in health care while 
     preserving the fundamental purpose of the program--to serve 
     as the nation's health care safety net for the millions of 
     low income children, families, elderly, and disabled.
       ACAP believes that your legislation establishing a Medicaid 
     commission would move our nation's policymakers and health 
     care leaders in the right direction. The commission's work 
     would be instrumental in understanding the underlying 
     inefficiencies as well as the initiatives and programs that 
     have proven successful. In turn, the commission would direct 
     health care leaders to respond accordingly with improvements 
     that can and should be made to the Medicaid program.
       Should your legislation be enacted into law, we encourage 
     you to include a representative of the managed care plans on 
     the Commission. Medicaid managed care has been shown to 
     provide greater quality of care and access to providers at a 
     lower price than the traditional fee-for-service programs. As 
     such, it can serve as a model for reform of the Medicaid 
     program.
       Tens of millions of Americans rely on Medicaid to receive 
     health care services. ACAP believes your commission would 
     result in reform that will be thoughtfully considered in 
     light of the significant consequences for Medicaid enrollees 
     as well as the providers that deliver their care.
       Please do not hesitate to contact me if there is any way we 
     can contribute further to this effort.
           Sincerely,
                                               Margaret A. Murray,
     Executive Director.
                                  ____

                                           National Association of


                               Community Health Centers, Inc.,

                                 Washington, DC, February 7, 2005.
     Hon. Gordon Smith,
     Hon. Jeff Bingaman,
     U.S. Senate,
     Washington, DC.
       Dear Senators Smith and Bingaman: On behalf of the National 
     Association of Community Health Centers, the advocate voice 
     for our nation's Community, Migrant, Public Housing and 
     Homeless Health Centers, and the more than 15 million 
     underserved people cared for by them, I am writing to offer 
     our strong endorsement of your legislation to create a 
     bipartisan commission on Medicaid.
       Pressure undoubtedly is growing at the federal and state 
     levels to consider reforms to Medicaid, some of which could 
     dramatically alter its fundamental structure. The commission 
     envisioned by your legislation would provide the necessary 
     leadership and serve as a credible forum for developing 
     viable solutions to strengthen Medicaid's long-term financial 
     health and assure that it continues its crucial role as a 
     safety net for our nation's most vulnerable populations.
       Community health centers serve as a major provider of 
     primary and preventive care to nearly 6 million of the 
     estimated 51 million people served by Medicaid. Moreover, 
     studies continue to demonstrate that health centers save 
     Medicaid 30% in total health care costs compared to other 
     providers. Unfortunately, some reform proposals now being 
     discussed merely seek to cap spending or restrict Medicaid's 
     long-term cost, raising significant concerns about the 
     continued ability of health centers and other safety net 
     providers to provide quality health care to Medicaid 
     patients.
       Health centers believe efforts to improve Medicaid should 
     seek to preserve the federal guarantee of its coverage, and 
     not reduce or eliminate its services or consumer protections. 
     In addition, we also believe it is important that these 
     efforts recognize the critical role that health centers and 
     other safety net providers play as essential sources of care 
     for millions of Medicaid recipients and uninsured Americans.
       Medicaid is a health insurance program of critical 
     importance in this country, and finding solutions to its 
     current challenges can be daunting. However, lawmakers must 
     strive to forge a bipartisan consensus that aims to protect 
     the public's health, while ensuring that its benefits and 
     services remain a reality for low-income individuals. We 
     strongly believe that your commission is the appropriate 
     forum to achieve this goal. Therefore, we are proud to 
     endorse and offer our full support for your legislation, and 
     we stand ready to assist you in helping to achieve its 
     enactment.
       Please do not hesitate to contact me or Licy Do Canto, 
     Assistant Director of Health Care Financing Policy, if there 
     is any way we can contribute further to this effort.
           Sincerely,

                                       Daniel R. Hawkins, Jr.,

                                Vice President for Federal, State,
     and Public Affairs.
                                  ____


                    The Catholic Health Association,

                                 Washington, DC, February 8, 2005.
     Hon. Gordon Smith,
     Chairman, Special Committee on Aging, U.S. Senate, 
         Washington, DC.
       Dear Chairman Smith: On behalf of the Catholic Health 
     Association of the United States (CHA), the national 
     leadership organization of more than 2,000 Catholic health 
     care sponsors, systems, facilities, and related 
     organizations, I am writing to express our strong support for 
     the ``Bipartisan Commission on Medicaid Act of 2005.''
       As you know, Medicaid provides crucial services to over 50 
     million low-income children and pregnant women, the elderly, 
     and persons with disabilities. Many of these individuals 
     receive care in Catholic hospitals and Catholic long-term 
     care facilities. Without a strong and vibrant Medicaid 
     program, the number of uninsured individuals in the United 
     States would be dramatically worse. In light of the critical 
     role that Medicaid plays in the health of our nation, we 
     believe that it is important to undertake a comprehensive 
     review of the program before making any dramatic changes. To 
     do otherwise could further unravel an already frail health 
     care safety net.
       For that reason, we are pleased to offer our support for 
     your legislation. By assembling a 23-member commission to 
     undertake a thorough review of the Medicaid program, your 
     legislation can help ensure that Medicaid continues to play a 
     key role in the health care safety net for years to come. We 
     are particularly pleased that the commission would be 
     comprised in part from important stakeholders in the Medicaid 
     program, including representation from the health care 
     provider community and advocates for Medicaid beneficiaries.
       We are grateful for your continued efforts in support of 
     the Medicaid program. If we can be of further assistance, 
     please do not hesitate to contact me.
           Sincerely,
                                                  Michael Rodgers,
     Vice President, Advocacy and Public Policy.
                                  ____



                                National Association of Public

                                 Hospitals and Health Systems,

                                  Washington, DC February 8, 2005.
     Hon. Gordon Smith,
     Hon. Jeff Bingaman,
     U.S. Senate,
     Washington, DC.
       Dear Senators Smith and Bingaman: I am writing on behalf of 
     the National Association of Public Hospitals and Health 
     Systems (NAPH) to express our support for the Bipartisan 
     Commission on Medicaid Act of 2005. The legislation 
     recognizes Medicaid's critical role in supporting our 
     nation's safety net and emphasizes the need to carefully 
     consider any changes to the program in order to protect 
     Medicaid patients and the providers who serve them.
       NAPH represents more than 100 of America's metropolitan 
     area safety net hospitals and health systems. NAPH hospital 
     systems serve unique roles in their communities often as the 
     largest provider of inpatient and ambulatory care to Medicaid 
     patients and patients without insurance and as providers of 
     essential services needed by everyone in their communities, 
     such as trauma and burn care services. Medicaid is the 
     primary mechanism for ensuring the provision of access to 
     health care for low-income patients. It supports safety net 
     providers, including NAPH members, who dedicate themselves to 
     providing high quality care to anyone, regardless of their 
     ability to pay. Medicaid payments provide 49 percent of the 
     net patient care revenues of NAPH members and Medicaid 
     disproportionate share hospital (DSH) payments alone support 
     nearly 25 percent of the unreimbursed care provided by NAPH 
     members. Therefore, Medicaid payment issues are of critical 
     importance to NAPH members.
       The proposed Commission on Medicaid could play an important 
     role in protecting the future of Medicaid and in ensuring 
     that any changes to Medicaid account for the various roles 
     that the program currently serves. Promoting a thorough 
     discussion among representatives of various Medicaid 
     stakeholders to develop comprehensive recommendations is a 
     responsible approach to examining the program. Measured 
     consideration is especially important today as the number of 
     uninsured continues to rise and as state Medicaid budgets 
     experience increasing pressure. NAPH does not believe that 
     reductions in the rate of growth or caps on Medicaid spending 
     are necessary to achieve stability in the program.
       Thank you for your ongoing support of Medicaid and safety 
     net providers. We look forward to continuing to work with you 
     on finding sustainable ways to preserve and protect Medicaid.
           Sincerely,
                                                    Larry S. Gage,
     President.
                                  ____



                                                         NAMI,

                                  Arlington, VA, February 7, 2005.
     Hon. Gordon Smith,
     Hon. Jeff Bingaman,
     U.S. Senate,
     Washington, DC.
       Dear Senators Smith and Bingaman: On behalf of the 210,000 
     members and 1,200 affiliates of the National Alliance for the 
     Mentally III (NAMI), I am writing to express our

[[Page S1211]]

     strong support for your legislation to form a bipartisan 
     commission to study the future of the Medicaid program. As 
     the nation's largest organization representing people with 
     severe mental illnesses and their families, NAMI is pleased 
     to support this important measure.
       As you know, Medicaid is now the dominant source of funding 
     for treatment and support services for both children and 
     adults living with severe mental illness--currently, Medicaid 
     comprises 50% of overall public mental health spending, a 
     figure that is expected to rise to 60% by 2010. More 
     importantly, Medicaid is a safety net program that is 
     intended to protect the most disabled and vulnerable children 
     and adults struggling with severe chronic illness and severe 
     disabilities such as mental illness.
       At the same time, Medicaid is facing enormous stress at the 
     state level and in 2005 we expect more and more states will 
     be seeking to curtail future spending. NAMI remains extremely 
     concerned that these cuts are being made at the state level 
     without any discussion about the long-term impact of the 
     program. It is critically important that this debate gets 
     beyond cost and considers reforms that can make the program 
     more effective in meeting the needs of individuals who depend 
     on Medicaid as a health care and community support safety 
     net.
       Your legislation to establish a bipartisan commission on 
     Medicaid is critically important step forward to helping the 
     federal government and the states consider and promote 
     policies that improve the program and maintain its role in 
     protecting the needs of low income people with severe 
     disabilities. NAMI thanks you for your leadership on this 
     important issue. We look forward to working with you to move 
     this important legislation forward in 2005.
           Sincerely,
                                   Michael J. Fitzpatrick, M.S.W.,
     Executive Director.
                                  ____



                            The National Council on the Aging,

                                 Washington, DC, February 8, 2005.
     Hon. Gordon Smith,
     Russell Office Building,
     Washington, DC.
       Dear Senator Smith: On behalf of the National Council on 
     the Aging (NCOA)--the first organization formed to represent 
     America's seniors and those who serve them--is grateful for 
     your leadership on Medicaid issues and supports your proposal 
     to establish a bipartisan Commission on Medicaid.
       Medicaid is the critical health care safety net for over 50 
     million of our nation's most vulnerable, poorest citizens. 
     Seniors who depend on Medicaid are our oldest and most frail.
       While Medicaid is an extremely important program, it is 
     also quite expensive. Some have gone so far as to question 
     our ability to continue to afford the essential services 
     provided under the program. We fear that some proposals to 
     reform Medicaid may be driven solely by budget concerns and 
     misplaced priorities, rather than what is best for our nation 
     and its citizens.
       Medicaid is also a very complex program. We fear that only 
     a small handful of members in the Congress and their staff 
     understand how the program works, who it serves and what it 
     covers.
       Largely due to our record federal budget deficit and 
     increasing budget challenges in the states, Medicaid this 
     year is being considered for significant spending reductions 
     and possible structural reforms. In our view, we should be 
     very cautious before moving forward with far-reaching changes 
     that could harm millions of Americans in need.
       With the aging of the baby boom generation, Medicaid will 
     face increasingly serious challenges in the future, not 
     unlike those under the Medicare and Social Security programs. 
     For those programs, Congress established bipartisan 
     Commissions to consider reforms to strengthen and improve 
     them as we begin to address demographic challenges. A similar 
     non-partisan analysis is desirable for Medicaid. Bringing 
     together experts and key stakeholders is a necessary 
     prerequisite to reforming the program. For example, we need 
     to be more creative about how to finance long-term care, 
     while promoting access to a broader range of home and 
     community services. We therefore support your proposal to 
     establish a bipartisan Commission on Medicaid and look 
     forward to working with you to enact legislation into law.
           Sincerely
                                                     James Firman,
     President and CEO.
                                  ____



                                American Hospital Association,

                                 Washington, DC, February 4, 2005.
     Hon. Gordon Smith,
     Hon. Jeff Bingaman,
     U.S. Senate,
     Washington, DC.
       Dear Senators Smith and Bingaman: On behalf of our 4,700 
     hospitals, health care systems, and other health care 
     provider members, and our 31,000 individual members, the 
     American Hospital Association (AHA) strongly supports your 
     legislation to create a bipartisan commission on Medicaid and 
     the uninsured. Pressure is mounting to reform Medicaid, our 
     nation's largest health care safety net program. Your 
     commission would provide the right setting to carefully 
     deliberate needed policy changes and ensure the long-term 
     financial stability of the program.
       Medicaid serves over 52 million people, surpassing the 
     number served by the Medicare program. Half of Medicaid's 
     beneficiaries are children and one-quarter are elderly and 
     disabled. It serves our nation's most vulnerable populations, 
     and provides half of all the dollars spent on long term care 
     in this country. Reform will have enormous consequences for 
     those Medicaid covers and the providers that deliver their 
     care. The blue ribbon panel you propose would be a 
     responsible approach to examining the program.
       The American Hospital Association does not believe that 
     reductions in the rate of growth or caps on spending for 
     Medicaid is needed to achieve positive, successful 
     modernizations. The AHA stands ready to assist you in 
     securing passage legislation for thoughtful, deliberate 
     change to protect our most vulnerable citizens.
           Sincerely,
                                                     Rick Pollack,
     Executive Vice President.
                                  ____



                             American Psychiatric Association,

                                  Arlington, VA, February 9, 2005.
     Hon. Gordon Smith,
     Chairman, Senate, Special Committee on Aging,
     Washington, DC.
     Hon. Jeff Bingaman,
     Senator,
     Washington, DC.
       Dear Chairman Smith and Senator Bingaman: The American 
     Psychiatric Association (APA), the nation's oldest medical 
     specialty society representing more than 35,000 psychiatric 
     physicians nationwide, is pleased to commend your legislation 
     to establish the Bipartisan Commission on Medicaid and the 
     Medically Underserved. The establishment of a Commission to 
     examine Medicaid and the medically underserved will help 
     identify Medicaid's current benefits and areas of needed 
     strengthening.
       For millions of Americans with mental illnesses, Medicaid 
     is a critical source of care. Medicaid is especially 
     important to states as they face deficits that threaten the 
     stability of Medicaid funding for patients. We are also 
     concerned about the possible consequences for those of our 
     dual eligible patients who face potential disruptions of 
     treatment as they shift from Medicaid to Medicare. This bears 
     close attention.
       Your leadership in calling for an assessment of Medicaid is 
     timely and appreciated. APA would be pleased to be a resource 
     of expertise in psychiatry and medicine with respect to 
     Medicaid.
       Thank you again for your leadership in assessing the needs 
     of the nation's medically underserved.
           Sincerely,
                                        James H. Scully Jr., M.D.,
     Medical Director.
                                  ____



                                  American Dental Association,

                                 Washington, DC, February 8, 2005.
     Hon. Gordon Smith,
     Hon. Jeff Bingaman,
     U.S. Senate,
     Washington, DC.
       Dear Senators Smith and Bingaman: On behalf of the American 
     Dental Association (ADA), our 152,000 members and 597 state 
     and local dental societies, we would like to offer strong 
     support for your legislation to establish a bipartisan 
     commission on Medicaid and the uninsured. As Congress and 
     individual states begin to contemplate and propose Medicaid 
     reform options, it is critical to ensure an open dialogue 
     with all Medicaid stakeholders. Your commission would allow 
     policymakers, practitioners, provider institutions, patients 
     and others to work together to provide necessary reforms to 
     this important program.
       The ADA is particularly concerned with improving access to 
     oral health care for low-income children and adults served by 
     the Medicaid program. In the 2000 landmark report, Oral 
     Health in America, the Surgeon General concluded that dental 
     decay is the most prevalent childhood disease--five times as 
     common as asthma, particularly for this population. We know 
     that only one-in-four children enrolled in Medicaid receives 
     dental care and only eight states currently provide 
     comprehensive adult dental benefits. Cumbersome 
     administrative requirements, lack of case management and 
     inadequate payment rates affect dentist participation in the 
     program and utilization of dental services. More must be done 
     to improve the Medicaid program to ensure adequate access to 
     oral health services.
       The ADA looks forward to working with you to pass this 
     legislation and address ways to strengthen and improve the 
     dental Medicaid program, and the Medicaid program as a whole.
           Sincerely,
                                           Richard Haught, D.D.S.,
                                                        President.
                                         James B. Bramson, D.D.S.,
                                               Executive Director.

  Mr. BINGAMAN. Mr. President, Senator Smith and I have worked together 
successfully on several issues within the last year to defend and 
improve our Nation's health care safety, including on an amendment to 
the Medicare prescription drug bill addressing community health center 
payments within Medicare that passed by a vote of 94-1. However, none 
of these initiatives have been more important than the legislation that 
we are introducing together today, along with a list of 13 other 
senators--7 Republicans, 5 Democrats, and 1 Independent, 7 of which 
serve on the Senate Finance Committee--to create a Bipartisan 
Commission on Medicaid.

[[Page S1212]]

Joining Senator Smith and I as original cosponsors are: Senators Snowe, 
Jeffords, Santorum, Kerry, DeWine, Durbin, Chafee, Lincoln, Collins, 
Nelson of Nebraska, Voinovich, Corzine, and Coleman.
  I will not go into the specifics of the legislation, as Senator Smith 
has explained how the Commission would be formed and would operate. 
Instead, I will take the time to explain why it is that the formation 
of commission is so important.
  Medicaid is a critically important health care safety net program 
that provides health care services to over 50 million low-income 
children, pregnant women, seniors, and people with disabilities.
  In New Mexico, Medicaid is the single largest payor for health care. 
All told, Medicaid covers the health care costs of more than 400,000 
New Mexicans--nearly one-quarter of our State's population.
  Although the least expensive to cover, those who benefit most from 
Medicaid are nearly 300,000 of New Mexico's children. Of the various 
populations covered, children represent almost two-thirds of all our 
State's beneficiaries, which is the highest ratio in the Nation 
according to data from the Kaiser Family Foundation.
  However, Medicaid is much more than just a safety net program for 
children from low-income families. It also serves low-income adults and 
pregnant women. It also serves senior citizens and people with 
disabilities who receive the bulk of their health care through Medicare 
but who still rely on Medicaid for a substantial share of their 
benefits and cost-sharing assistance. Medicaid also provides critically 
needed funding to support our Nation's safety net providers, including 
disproportionate share hospitals.
  In the President's budget that was just released, the administration 
has proposed cutting Medicaid by $60 billion over the next 10 years. 
Secretary Leavitt recently testified in the Senate Finance Committee 
that he believes ``Medicaid is flawed and inefficient.''
  There are others that believe Medicaid is not working and that costs 
are spiraling out of control and so the program needs dramatic 
overhaul.
  In contrast. there are also those that will attest that there is 
absolutely nothing wrong with Medicaid. I firmly believe neither point 
of view is correct.
  First, Medicaid is far from broken. The cost per person in Medicaid 
rose just 4.5 percent per year from 2000 to 2004. That compares to a 12 
percent rise in the annual cost of premiums in the private sector. If 
that is the comparison, Medicaid seems to be about the most efficient 
health care program around, even more so than Medicare.
  The overall cost of Medicaid is going up largely, not because the 
program is inefficient, but because more and more people find 
themselves depending on this safety net program for their health care 
during a recession. When nearly 5 million people lost employer coverage 
between 2000 and 2003, Medicaid added nearly 6 million to its program. 
Costs rose in Medicaid precisely because it is working--and working 
well--as our Nation's safety net program.
  Consequently, as noted previously, Medicaid now provides health care 
to over 50 million low-income Americans, including one-quarter of all 
New Mexicans.
  This is precisely why I so strongly oppose block grants or any 
arbitrary caps on Federal spending for Medicaid. If we had caps in 2000 
and Medicaid could not have responded to the economic downturn, we 
would have 50 million uninsured today. Medicaid is a Federal-State 
partnership and an arbitrary cap of the Federal share to States is 
nothing more than the Federal Government trying to shift all risk to 
States.
  On the other hand, it is also not true that Medicaid is not in need 
of improvement. The administration is rightly concerned about certain 
State efforts to provide ``enhanced payments'' to institutional 
providers as a significant factor in driving Medicaid costs. Secretary 
Leavitt, in a speech to the World Health Care Congress on February 1, 
2005, referred to State efforts to maximize Federal funding as ``the 
Seven Harmful Habits of Highly Desperate States.'' As a result, he 
called for ``an uncomfortable, but necessary, conversation with our 
funding partners, the States.''
  Unfortunately, Medicaid reform driven by a budget reconciliation 
process is not a dialogue or conversation. It is a one-way mechanism 
for the Federal Government to impose its will on the States. The 
administration's budget calls for $60 billion in cuts to Medicaid, 
including $40 billion that would directly harm States.
  Where is the conversation in that? In fact, the States have a fair 
amount of complaint with Federal cost shifting to the States. While I 
certainly do not speak for the National Governors' Association or 
National Conference of States Legislatures, some of those grievances 
are rather obvious and I share them.
  For example, according to data from Kaiser Family Foundation, 42 
percent of the costs in Medicaid are due to Medicare dual eligible 
beneficiaries. These dual eligibles are also a major driver of health 
costs in Medicare and this is a prime example of where better 
coordination between Medicare and Medicaid could improve both programs. 
States have been calling for better coordination for years to no avail.

  In the Medicare prescription drug bill that was passed by the 
Congress in 2003, the Federal Government imposed what is referred to as 
a ``clawback'' mechanism which forces the States to help pay for the 
Federally-passed Medicare prescription drug benefit. Although States 
will derive a financial windfall from moving dual eligibles from 
Medicaid coverage to Medicare, some of the States believe the 
``clawback'' will cost them more than if they continued to provide 
prescription drug coverage themselves.
  The prescription drug bill also impacted States financially in a host 
of other ways that went largely unnoticed, including those that 
increased Medicaid costs for dual eligibles as a result of increases in 
the Medicare Part B deductible and increased payments to the new 
Medicare Advantage plans. The law also required States to help enroll 
low-income Medicare beneficiaries into the low-income drug benefit.
  In fact, the Congressional Budget Office, or CBO, estimated that 
States had $5.8 billion in added enrollment of dual eligibles in 
Medicaid due to what they refer to as a ``woodworking'' effect on dual 
eligibles trying to sign up for the low-income drug benefit discovering 
they are also eligible for Medicaid benefits. CBO further estimated 
that States had $3.1 billion in new administrative and other costs 
added by the prescription drug legislation.
  States had no ability to ``have a conversation'' with the Federal 
Government about the imposition of such costs on them when the Medicare 
prescription1rrug drug bill was passed, but they should have and will 
have in our Bipartisan Commission on Medicaid.
  Furthermore, due to a recent rebenchmarking done by the Department of 
Commerce's Bureau of Economic Affairs with respect to the calculation 
of per capita income in the States and the application of that data by 
the Centers for Medicare and Medicaid Services, or CMS, the Medicaid 
Federal Medical Assistance Percentage, or FMAP, many States, including 
New Mexico, will see a rather dramatic decline in their Federal 
Medicaid matching percentage. In fact, due to the rebenchmarking and 
other factors, 29 states will lose Medicaid funding in 2006 by an 
amount of in excess of $800 million. Again, this occurred with no 
dialogue or conversation.
  Mr. President, I agree with Secretary Leavitt that there should be a 
conversation among all the stakeholders about the future of Medicaid 
and about what are the fair division of responsibilities between the 
Federal Government, States, local governments, providers, and the over 
50 million people served by Medicaid. It is for this reason that the 
Bipartisan Commission on Medicaid includes all of those stakeholders at 
the table to have a full discussion and debate about the future of 
Medicaid.
  It is our intent that the recommendations would not be focused on 
cutting costs but about improving health care delivery to our Nation's 
most vulnerable citizens. However, they are not mutually exclusive. In 
fact, both can and should be done.
  There are those that will argue that a commission may not reach a 
consensus to make recommendations to

[[Page S1213]]

improve the Medicaid program and so is not worth the effort. I would 
strongly disagree and point to the fact that the National Academy for 
State Health Policy recently convened a workgroup they called Making 
Medicaid Work for the 21st Century that included many of the Medicaid 
stakeholders and came forth with a 78-page report with numerous 
recommendations with respect to eligibility, benefits, and financing. 
According to the report entitled Improving Health and Long-Term Care 
Coverage for Low-Income Americans, the workgroup attempted to ``assess 
areas where it would be most productive to focus on improvement in the 
program, and to develop consensus around recommendations for reform.'' 
I would underscore the emphasis of the workgroup on ``improving'' 
Medicaid and health coverage. This should be the primary and overriding 
goal of the Bipartisan Commission on Medicaid that we are introducing 
today.
  Before closing, I once again thank Senator Smith, the other 12 Senate 
cosponsors, and the various stakeholders--State and local governments, 
providers, and consumers that have endorsed this legislation--in an 
effort, not to cut Medicaid, but to make it more efficient and 
effective in the delivery of care to our Nation's most vulnerable 
citizens.
  I ask unanimous consent to have a copy of the Fact Sheet accompanying 
this legislation printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                               Fact Sheet


                   BIPARTISAN COMMISSION ON MEDICAID

       Senators Gordon Smith (R-OR), Jeff Bingaman (D-NM), Olympia 
     Snowe (R-ME), Jim Jeffords (I-VT), Rick Santorum (R-PA), John 
     Kerry (D-MA), Mike DeWine (R-OH), Richard J. Durbin (D-IL), 
     Lincoln D. Chafee (R-RI) Blanche L. Lincoln (D-AR), Susan 
     Collins (R-ME), Ben Nelson (D-NE), George Voinovich (R-OH), 
     Jon S. Corzine (D-NJ), and Norm Coleman (R-MN) are 
     introducing legislation that calls for the creation of a 
     Bipartisan Commission on Medicaid.
       Just as the Balanced Budget Act of 1997 called for the 
     creation of the Bipartisan Commission on the Future of 
     Medicare, the Medicaid program should also undergo a 
     comprehensive and thorough review of what is and is not 
     working and how to improve service delivery and quality in 
     the most cost-effective way possible.
       This legislation recognizes that determining the future of 
     Medicaid is not simply about cost. While Medicaid is 
     estimated to cost the federal government $188 billion in FY 
     2005, attention also should be given to the diverse 
     population served. Over 50 million people receive care 
     through Medicaid, including low-income seniors, people with 
     disabilities, children, and pregnant women. Further, it is 
     important to note that while costs are increasing, Medicaid 
     is growing at a slower per capita rate than either Medicare 
     or the private sector.
       The Medicaid Commission would be charged with a number of 
     duties, including reviewing and making recommendations with 
     respect to the long-term goals, populations served, financial 
     sustainability (federal and state responsibility), 
     interaction with Medicare and the uninsured, and the quality 
     of care provided.
       Medicaid is a critically important program helping meet the 
     health care needs of a diverse population through four 
     different programs by serving as:
       (1) a source of traditional insurance for poor children and 
     some of their parents;
       (2) a payer for a complex range of acute and long term care 
     services for the frail elderly and people with disabi1ities;
       (3) a source of wrap-around coverage or assistance for low-
     income seniors and people with disabilities on Medicare, 
     including coverage of additional benefits and assistance with 
     Medicare premiums and copayments; and,
       (4) the primary source of funding to safety net providers 
     that serve both Medicaid patients and the 45 million 
     uninsured.
       In recognition of this diversity, the bill's Medicaid 
     Commission would be comprised of 23 members that reflect all 
     the stakeholders and components in the Medicaid program. 
     Those members include the following: One Member appointed by 
     the President; Two House members (current or former) 
     appointed by the Speaker and Minority Leader; Two Senators 
     (current or former) appointed by the Majority and Minority 
     Leader; Two Governors designated by NGA; Two Legislators 
     designated by NCSL; Two state Medicaid directors designated 
     by NASMD; Two local elected officials appointed by NACo; Four 
     consumer advocates appointed by congressional leadership; 
     Four providers appointed by congressional leadership; Two 
     program experts appointed by Comptroller General.
       The Commission has just one year to hold public hearings, 
     conduct its evaluations and deliberations, and issue its 
     report and recommendations to the President, the Congress, 
     and the public.

  Ms. SNOWE. Mr. President, I am pleased to join with a number of my 
colleagues in cosponsoring the Bipartisan Commission on Medicaid and 
the Medically Underserved Act of 2005, which Senator Smith and Senator 
Bingaman are introducing today.
  The Medicaid program provides essential medical services to low-
income and uninsured children and their families, pregnant women, 
senior citizens, individuals with disabilities, and others. Last year, 
nearly 55 million Americans were enrolled in Medicaid, including more 
than 300,000 in Maine where one in five people now receive health care 
services through MaineCare, our State's Medicaid program.
  Individuals who rely upon Medicaid-funded health services have no 
other option. Without Medicaid, they would join the ever growing ranks 
of the uninsured in this country, which now numbers an all-time high of 
more than 45 million Americans who lacked health coverage at some point 
last year. These two groups represent a total of 100 million Americans 
who would have no health insurance were it not for Medicaid coverage 
which reaches just over half of them. And to the extent that the 
Federal Government reduces its support for Medicaid funding, the 
numbers of uninsured Americans will rise at an even faster rate.
  As Congress begins to consider the administration's Fiscal Year 2006 
Budget, I believe we must take a balanced approach that is both 
fiscally responsible and reflects our long-standing commitments to 
provide health care for many of the low-income and uninsured through 
the Medicaid program. Although we face growing budget deficits and ever 
tightening Federal budgets, the Federal Government cannot simply 
abandon its responsibility to help states provide health care access to 
our most vulnerable citizens.
  Today, Medicaid is the fastest growing component of State budgets, 
according to the most recent survey of the National Governors 
Association. Total Medicaid spending nationwide now averages 22 percent 
of State budgets, while State spending on all healthcare functions is 
approximately 31 percent. However, although its costs are increasing, 
the annual growth in Medicaid spending on a per capita basis is growing 
more slowly, at 4.5 percent a year, than the private sector where 
health insurance premiums have increased an average of 12.5 percent a 
year for the last 3 years.
  The economic downturn which State economies experienced several years 
ago, and from which many States are only now emerging, has continued to 
leave many families jobless and without health insurance, forcing them 
to turn to Medicaid. This has put an enormous strain on the states 
already strapped with budget scarcities. Many States reduced Medicaid 
benefits last year and even more restricted Medicaid eligibility in an 
effort to satisfy their budgetary obligations.
  In fact, the Chairman of the National Governors Association, Governor 
Warner of Virginia, and the Vice Chairman, Governor Huckabee of 
Arkansas, recently warned Congress that if Federal spending for 
Medicaid were capped and the number of Medicaid recipients increased 
sharply, States would face dire fiscal consequences. According to the 
Governors, total costs for State Medicaid programs are growing at an 
annual rate of 12 percent, and total Medicaid expenditures now exceed 
that of Medicare, due primarily to factors beyond States' control, 
especially the costs of long-term care: Medicaid now accounts for 50 
percent of all State long-term care spending and pays for the care of 
70 percent of those in nursing homes.

  At this time, therefore, it is crucial that we continue to provide 
sufficient Federal funding for Medicaid, which has worked so well since 
it began providing care for some of our most vulnerable populations 40 
years ago. We must proceed cautiously before making any significant 
changes in the program, and the Medicaid Commission established by this 
bill will ensure that necessary deliberative approach.
  The concept of a commission to undertake a comprehensive review of 
the Medicaid program and recommend possible changes is similar to the 
commission which Congress established in the late 1990s, the Bipartisan 
Commission on the Future of Medicare. That commission examined various 
aspects of

[[Page S1214]]

the Medicare program to determine areas that should be modernized and 
later recommended a number of changes, including a prescription drug 
benefit. Those recommendations initiated the process of congressional 
debate and consideration of reforming the Medicare program, culminating 
in the Medicare Prescription Drug, Improvement, and Modernization Act 
which passed in 2003 and, among other reforms, included the new 
prescription drug benefit for seniors which will take effect next year.
  The new Medicare prescription drug benefit will have a major impact 
on Medicaid since it will shift Federal expenditures for drug benefits 
currently provided by Medicaid for the ``dual eligible'' population--
those who are eligible for both Medicaid and Medicare--to Medicare. 
However, this will not lift most of the financial responsibility and 
burden of prescription drug costs from the States. Recent estimates by 
the National Governors Association show that currently 42 percent of 
all Medicaid dollars are spent on ``dual eligible'' Medicare 
beneficiaries, although they comprise only a small percentage of 
Medicaid cases, and they are covered by Medicare for other services.
  The new prescription drug program includes a provision known as the 
``claw-back'' which will require States to remit funds to the Federal 
Government, based on their inflation-adjusted 2003 per person Medicaid 
expenditures for prescription drugs for these beneficiaries. Although 
the percentage share of drug costs that States must pay for the dual 
eligibles will decline over time, from 90 percent to 75 percent, States 
will continue to pay the lion's share of dual eligibles' prescription 
drug costs. Many States are just now recognizing this fact and are 
looking for ways to accommodate these ongoing costs.
  Unanswered questions like these remain concerning the ultimate impact 
of the Medicare drug program on State budgets and Medicaid programs. 
One of the primary duties of the Medicaid Commission would be to review 
and make recommendations on the interaction of Medicaid with Medicare 
and other Federal health programs.
  Moreover, the formula for calculating the Federal matching rate, 
known as the Federal Medical Assistance Percentage, FMAP, which 
determines the Federal Government's share of a State's expenditures for 
Medicaid each year, has also contributed to the Medicaid problems that 
States are facing. The FMAP formula is designed so that the Federal 
Government pays a larger portion of Medicaid costs in States with a per 
capita income lower than the national average. However, the formula 
looks back 3 years, to points in time that are not necessarily 
reflective of a State's current financial situation.

  In fiscal year 2003, for example, the FMAP for that year was 
calculated in 2001 for the fiscal year beginning October 2002. The FMAP 
for FY 2003 was determined on the basis of State per capita income over 
the 3-year period of 1998 through 2000, when State economies were 
growing significantly. Yet in 2003, when this matching rate was in 
effect, a serious economic downturn was affecting many State budgets, 
and that downturn has contributed greatly to the growth of Medicaid for 
several years now.
  We recognized this situation in the last Congress and provided for 
State fiscal relief by providing a temporary increase in the Federal 
Medicaid matching rate, which provided $10 billion in fiscal relief to 
States during fiscal 2003 and 2004, when we passed the Jobs and Growth 
Tax Relief Reconciliation Act of 2003. But that fiscal relief has 
sunset.
  One of the duties of the Medicaid Commission would be to make 
recommendations on how to make Federal matching payments more equitable 
with respect to the States and the populations they serve, as well as 
how to make them more responsive to changes in States' economic 
conditions.
  The fact is, Medicaid and Medicare have complex responsibilities, 
financing, and interrelationships and that is why a Medicaid Commission 
is vital for the future state budgets and the Medicaid program as a 
whole.
  I urge my colleagues to join us supporting this legislation to help 
sustain and improve this critical health care safety net for our most 
vulnerable Americans.
                                 ______