[Congressional Record Volume 151, Number 52 (Tuesday, April 26, 2005)]
[House]
[Pages H2509-H2518]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
APPOINTMENT OF CONFEREES ON H. CON. RES. 95, CONCURRENT RESOLUTION ON
THE BUDGET FOR FISCAL YEAR 2006
Mr. NUSSLE. Madam Speaker, I ask unanimous consent to take from the
Speaker's table the concurrent resolution (H. Con. Res. 95)
establishing the congressional budget for the United States Government
for fiscal year 2006, revising appropriate budgetary levels for fiscal
year 2005, and setting forth appropriate budgetary levels for fiscal
years 2007 through 2010, with a Senate amendment thereto, disagree to
the Senate amendment, and agree to the conference asked by the Senate.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Iowa?
There was no objection.
Motion to Instruct Offered by Ms. Herseth
Ms. HERSETH. Madam Speaker, I offer a motion to instruct conferees.
The Clerk read as follows:
Ms. Herseth of South Dakota moves that the managers on the
part of the House at the conference on the disagreeing votes
of the two Houses on the Senate amendment to the concurrent
resolution H. Con. Res. 95 be instructed, to the maximum
extent possible within the scope of the conference--
(1) to recede to the following findings of the Senate: (A)
Medicaid provides essential health care and long-term care
services to more than 50 million low-income children,
pregnant women, parents, individuals with disabilities, and
senior citizens; and (B) Medicaid is a Federal guarantee that
ensures the most vulnerable will have access to needed
medical services;
(2) to strike reconciliation instructions to the Committee
on Energy and Commerce and recede to the Senate by including
language declaring that a reconciliation bill shall not be
reported that achieves spending reductions that would (A)
undermine the role the Medicaid program plays as a critical
component of the health care system of the United States; (B)
cap Federal Medicaid spending, or otherwise shift Medicaid
cost burdens to State or local governments and their
taxpayers and health providers; or (C) undermine the Federal
guarantee of health insurance coverage Medicaid provides,
which would threaten not only the health care safety net of
the United States, but the entire health care system;
(3) to recede to the Senate on section 310 (entitled
``Reserve Fund for the Bipartisan Medicaid Commission'') of
the Senate amendment; and
(4) to make adjustments necessary to offset the cost of
these instructions without resulting in any increase in the
deficit for any fiscal year covered by the resolution.
The SPEAKER pro tempore. Pursuant to clause 7 of rule XXII, the
gentlewoman from South Dakota (Ms. Herseth) and the gentleman from Iowa
(Mr. Nussle) each will control 30 minutes.
The Chair recognizes the gentlewoman from South Dakota (Ms. Herseth).
Ms. HERSETH. Madam Speaker, to explain the motion, I yield myself
such time as I may consume.
The House-passed budget directs the Committee on Energy and Commerce
to cut spending on programs within its jurisdiction by $20 billion over
5 years. The vast majority of this $20 billion in spending cuts, if not
all of it, will likely fall on Medicaid. I and many of my colleagues in
this body strongly oppose this language.
The majority of our counterparts in the Senate apparently share some
of our concerns. The Senate approved an amendment by Senators Smith and
Bingaman to strike reconciliation instructions in the Senate budget
that would have directed the Committee on Finance to cut spending by
$15 billion over 5 years, which all would have been from Medicaid. The
Senate amendment
[[Page H2510]]
also created a reserve fund allowing for the creation of a bipartisan
commission on Medicaid reform.
This motion protects Medicaid by instructing conferees to follow the
Senate's lead and strike reconciliation instructions that target
Medicaid for funding cuts and instead include a $1.5 million reserve
fund for the creation of a bipartisan Medicaid reform commission.
Forty-four of my Republican colleagues in the House recently wrote a
letter to the chairman of the Committee on the Budget, urging him to
remove Medicaid reductions in the budget resolution. In this letter
they stated, ``We are concerned that the inclusion of up to $20 billion
in reductions from projected growth in the Medicaid program will
negatively impact people who depend on the program and the providers
who deliver health care to them . . .''
``We strongly urge you to remove these reductions and the
reconciliation instructions targeted at Medicaid and, in their place,
include a $1.5 million reserve fund for the creation of a bipartisan
Medicaid Commission . . .''
Fifty-two Senators, including several Republicans, voted to strike
Medicaid cuts in the Senate budget resolution and instead allow for the
creation of a bipartisan Medicaid commission. The amendment's sponsor
in the Senate, Mr. Smith of Oregon, stated that ``I would rather do
this right than do this fast . . . I don't know where the original
Senate cut of $14 billion came from. But I know what it is going to
mean: another 60,000 Oregonians may be losing health care, pressuring
private plans, overwhelming emergency rooms.''
During that same debate, Senator McCain of Arizona stated that ``cuts
to Medicaid that result in reduction of covered individuals would flood
hospital emergency rooms with additional uninsured patients, forcing
hospitals to absorb additional costs for uncompensated care.''
And Governors are virtually unanimous in their opposition to allowing
arbitrary budget cuts to drive Medicaid policy. For example, the
Republican Governor of Ohio said, ``We do not support recommendations
that would save the Federal Government money at the expense of the
States.'' Perhaps Arkansas's Republican Governor stated it best when he
said, ``People need to remember that to balance the Federal budget off
the backs of the poorest people in the country is simply
unacceptable.''
And the American people agree. Four out of five Americans oppose
cutting Medicaid to reduce the Federal debt, according to a poll
released today by AARP. Across the country many hospitals, assisted
living centers, and nursing homes have high Medicaid utilization rates
and are reliant on Medicaid as a major source of funding.
But Medicaid is not keeping pace with the cost of providing health
care. This is particularly true in rural States like South Dakota,
which is one of the States hit hardest by Medicaid's shortfalls.
According to a new report to be released tomorrow, Medicaid long-term
care for economically disadvantaged elderly persons is underfunded by
$4.5 billion annually. The results are both real and devastating.
In 2004, South Dakota's Evangelical Lutheran Good Samaritan Society
facilities saw a net operating loss for Medicaid patients of over $3.5
million for the year. In January the Good Samaritan Society announced
it would be closing three facilities in eastern South Dakota.
This means that for some South Dakotans, they will not have access to
the medical and long-term care services they need, or they will find
themselves moving further from their families in order to find an
available facility. This also means the loss of jobs in our smaller
communities. And it means as a Nation we are failing our poor, our
elderly, and our rural communities.
Talk of cutting $20 billion out of the Medicaid system over the next
5 years is completely at odds with the needs of people in South Dakota
and across America.
In fact, a coalition of 135 organizations that represent groups
ranging from medical specialties to faith-based groups have asked the
conferees to eliminate all proposed reductions in Federal funding for
Medicaid from the final fiscal year 2006 budget. The letter, signed by
the American Diabetes Association, Catholic Charities USA, and other
organizations, said that the ``elimination of such cuts is essential
for the health and long-term care of Medicaid enrollees, the providers
who serve them, and State and local units of governments.''
{time} 1745
That is why this motion is so important. It protects this critical
program by instructing conferees to follow the Senate's lead and strike
reconciliation instructions that target Medicaid for funding cuts. I
urge my colleagues to support this motion and to protect Medicaid.
Madam Speaker, I reserve the balance of my time.
Mr. NUSSLE. Madam Speaker, I yield myself such time as I may consume.
Madam Speaker, this is a very interesting motion to instruct
conferees. First of all, I am happy that we are at the point in time
where we are able to go to the conference with the other body and
complete our work on the Concurrent Budget Resolution for Fiscal Year
2006. This is never an easy road to travel when you are trying to
accomplish so much, when you are trying to accomplish reforms in some
very challenged programs that by anyone's estimation are unsustainable
and are growing beyond the means not only of the Federal Government to
fund but also State governments to fund.
It is always difficult when you have different ideas from different
chairmen, different bodies, different leaders, different parties who
want to come forward and make their mark on exactly what that spending
blueprint should be. But I would like to acknowledge that I think we
are all happy we are finally getting to a conference and the ability to
work out our differences.
As such, I look at this motion to instruct conferees, and I am
wondering what the controversy is. All of what the gentlewoman just
said are comments that my colleagues on both sides, whether you are
Republican or Democrat, have made throughout the entire debate over the
budget.
We have an unsustainable program called Medicaid which is not serving
the most vulnerable people in our society to the fullest extent that it
should or that it must in order to meet not only the obligations that
we have entrusted in the program but also to make sure that it is
sustainable, not only in the short run of our budget, but also long
term in our overall fiscal situation that our country faces and that
many of our States face. So as I read the motion to instruct conferees,
I am puzzled by what the controversy is.
It says we should recede to the following findings. Those findings
are that Medicaid provides essential health care and long-term care
services to more than 50 million low-income children, pregnant women,
parents, probably grandparents as well and great grandparents of many
of ours, individuals with disabilities and senior citizens; and that,
B, Medicaid is a Federal guarantee that ensures the most vulnerable
will have access to most needed medical services.
We all agree. There is nobody here that disagrees with that. That is
what the program was set up for; and that is the reason why we are so
intent on reforming it, so that it continues to meet that mission and
continues to deliver quality health care services for our parents and
our grandparents, children who may be of low-income families and people
with disabilities and senior citizens. It is a guarantee. It is
something that we all believe in. We are here to help people who cannot
help themselves.
Unfortunately, this program in many instances in its current state,
40 years old now, you might not be surprised to hear that it needs a
little bit of work, it needs a little bit of reforming. The Governors
have figured that out, and they have come to Washington with proposals
that find savings, not cuts. They are themselves proposing savings in
the neighborhood of $8 billion to $9 billion, and that is just their
first inception, that is just their first proposal, before we even go
down that road.
Then I looked further at the motion to instruct conferees and it
says: ``To strike reconciliation instructions to
[[Page H2511]]
the Committee on Energy and Commerce and recede to the Senate by
including language declaring that a reconciliation bill shall not be
reported that achieves spending reductions that would undermine the
role the Medicaid program plays as a critical component of the health
care system of the United States.''
I say again, there is no controversy in that. That is not the intent
of the budget, that is not the intent of the conference, that certainly
is not the intent of either reconciliation instruction. In fact, we
think it is a pretty good idea to set up a conference and to set up an
opportunity to take a look at this in some type forum, whether it is a
task force, whether it is a working group, however you want to put it
together, in order to come up with ideas and resolve this problem.
We want to invite the Governors to the table. Certainly they have the
best perspective when it comes to how this program works in their
individual States. Many of them have sought waivers in order to be able
to reform the program on the ground in which they see it so that that
program which delivers these essential services can be met and
delivered in a more quality way to our seniors and to our citizens with
disabilities, to our parents and grandparents, and to our most
vulnerable who may be low income.
So I do not see the controversy. I understand that because, as the
gentlewoman said, there are polls, there certainly is politics
involved. Anytime that anyone wants to bring forward any kind of reform
measure, the immediate thing is to rush breathlessly to the floor and
claim that it is cutting funds for people, and it is cutting the most
vulnerable and it is hurting people, and that is exactly what was said
about the welfare reform bill when it came to the floor not 10 years
ago, and it did not happen. It helped people. It unlocked from poverty
thousands upon thousands of families and children in our society who
all they needed was a hand up. For a while they may even have needed a
handout. But because of the requirements that we passed in a bipartisan
way, we were able to rise above the politics and the rhetoric and help
people. That is what we want to do here.
There is not one Member who can come to the floor and say this
Medicaid program is working in your State to its fullest extent, not
one of you. Not one of you can say that. There is not one Member in the
other body who can say that. There is, I dare say, not one Governor who
can claim the Medicaid program in their State is working. So you are
asking us here today in a political way, in a nonbinding motion to
instruct, to do nothing.
Thankfully, that is not how you crafted technically your motion to
instruct. You gave just a little bit of a backdoor, because you know as
well as we do that this program needs attention, that it needs
reformation, that it needs Governors and Congress and the
administration to sit down and talk about the future of a program that
is needed in order to deal with the most vulnerable in our society. So
thank you for not crafting this in such a fail-safe way so that we had
to vote against it and suggest that Medicaid should not be reformed,
because, of course, it should.
I hope that is not what you are saying. If you are, say it. If you
are saying do not reform Medicaid, do not touch it, do not change it,
it is perfect, it is helping people, come to the floor and dare to say
that. But if that is not what you are saying, then save that political
rhetoric for some other time and let us work together to fix it.
That is what this ought to be about. Republican and Democrat
Governors are certainly willing to do that. They are sitting down. I
have got proposals here that add up to $8.6 billion of ideas that the
Governors have already agreed to as a starting point. Now, are we
claiming that those Governors are cutting? Are they gouging? Are they
throwing people out on the street? Are they hurting seniors and people
with disabilities?
Certainly that is not what we are saying. That is not what we would
claim they are doing. They see a problem, they have come together to
try to fix it, and that is what we should do as well. Reconciliation
gives us that opportunity.
So I appreciate the gentlewoman's motion to instruct. It is crafted
perfectly so that political points can be made. But there is just that
little backdoor that says, you know what, even though we kind of like
the Senate language, we like the fact that they are putting together
ideas, we like the fact that the Governors are coming to the table, we
heard all of that rhetoric, even though we want to make some political
points today, there is a little bit of a backdoor so we can all vote
for this and say that the Medicaid program, as most of our Governors
would suggest, is unsustainable. It is unsustainable whether you are in
the capital of your State or whether you are in Washington, D.C. And
that is why we need to come together as Republicans and Democrats, in
order to fix this.
So I appreciate the way the gentlewoman has crafted it. I am going to
urge my colleagues to vote for the motion to instruct. I think it is
well-crafted, to give everybody the opportunity to make the political
points, to issue your press releases. I know you are going to do that.
Knock yourselves out. I am sure they are already on the fax machine.
But in the meantime, after all of the fax paper has cleared the air,
let us sit down and talk about ways to fix this program so it actually
does help people who are in need and were truly meant to be the focal
point of this program when it was invented 40 years ago and which has
rarely been changed from a Washington perspective ever since.
Madam Speaker, I reserve the balance of my time.
Ms. HERSETH. Madam Speaker, I yield 5\1/2\ minutes to my good friend,
the gentleman from Maryland (Mr. Hoyer), the distinguished Democrat
whip.
(Mr. HOYER asked and was given permission to revise and extend his
remarks.)
Mr. HOYER. Madam Speaker, I thank the gentlewoman for yielding me
time, and I thank her for her leadership on this very important issue.
Cleverness says that when you are going to lose, declare victory.
That is what the gentleman from Iowa (Chairman Nussle) is going to do;
he is going to declare victory, because what he says is there is
consensus on his rhetoric. He is correct.
What there is not consensus on are the policies pursued by the
chairman, the Committee on the Budget, and the majority. The chairman's
budgets have put America $2.4 trillion in additional debt from when he
took over just 4 years ago. As a result of putting us $2.4 trillion in
additional debt, we are having trouble paying our bills.
This year alone we are going to have a budget deficit of half a
trillion dollars. They do not count some of it. They pretend some of it
is emergency spending, and they do not even count AMT fixes. There are
a lot of things they do not count. But the fact of the matter is that
their policies undercut their rhetoric, and the reason the chairman is
going to support the gentlewoman's resolution is because of this chart:
44 of his Republican colleagues who said this is bad policy, do not do
it. Not Democrats, Republicans. Forty-four of them.
Madam Speaker, I thank you for signing on to that letter, because you
knew that the policies proposed by the Republican budget were, in this
instance, not policies you wanted to pursue.
Madam Speaker, less than 4 weeks ago, on March 31, the President of
the United States said, ``The essence of civilization is that the
strong have a duty to protect the weak.'' On that very same day, the
majority leader in this body, the gentleman from Texas (Mr. DeLay),
stated, ``The one major responsibility of a government is to protect
innocent, vulnerable people from being preyed upon.''
I absolutely agree that we not only have a duty but we have a moral
responsibility to protect the weakest and most vulnerable citizens in
our Nation. That, I tell the chairman of the Committee on the Budget,
is what Medicaid is all about. And the gentleman's rationalization that
Medicaid must be fixed, in which he is also correct, we all agree. But
like your Social Security solution, of privatizing Social Security
because it has financial problems, realizing full well that your
privatization does not affect solvency at all, is an empty solution,
because you do not know how to solve it yet because you
[[Page H2512]]
have not come across with a suggestion.
All you have said is to cut the legs out from the most vulnerable,
which Medicaid serves. That is what you have said. That is why these 44
colleagues of yours, not Democrats, Mr. Chairman, Republicans, 44
signed this letter.
You know you are going to lose this motion, and so you are going to
agree with this motion on some rationalization that we suggest a
commission to come up with a solution, because you are right,
absolutely right: we know that we have to come up with a solution
because we cannot let down the most vulnerable in our society.
{time} 1800
But I do not understand, notwithstanding the Speaker's rhetoric,
notwithstanding the rhetoric of the gentleman from Texas (Mr. DeLay),
notwithstanding the chairman's rhetoric, notwithstanding the
President's rhetoric; if the President, the majority leader, and the
House Republicans are truly concerned about protecting the weak and
vulnerable, why are they so intent on slashing Medicaid funding so
deeply?
The fact is, Medicaid finances health care for more than 58 million
Americans, including 28 million low-income children, nearly 16 million
parents, and nearly 15 million elderly and disabled citizens. Yet the
House Republicans' budget would cut Medicaid funding by $20 billion
over 5 years, a cut so draconian that 44 House Republicans, as I said,
have said no to that cut.
I urge my colleagues to support this motion to instruct. My
understanding is the chairman is going to support it. I am pleased
about that, but nobody ought to misunderstand that ``this is a
political judgment that we are going to lose, so we will pretend that
we win.'' He did the same thing when the gentleman from South Carolina
(Mr. Spratt) offered his motion and we were going to win last year.
We need to protect our vulnerable citizens. The President of the
United States is correct, the gentleman from Texas (Mr. DeLay) is
correct. Vote for this motion to instruct. Not only that, I hope the
Chairman will take this motion to instruct not just as a request, but
as a moral duty.
Mr. NUSSLE. Madam Speaker, I yield myself 1\1/2\ minutes.
I want Members who are listening, maybe in their offices or here on
the floor, and anyone else that is interested in listening to this
debate today, listen for four things. Listen to whether you hear anyone
come to the floor today and defend the Medicaid program as it stands
today as perfect. My colleagues did not hear the gentleman from
Maryland say that because, of course, he does not agree with that.
Listen to hear if you hear any Member come to the floor and say,
absolutely not, you cannot find a nickel's worth of savings in the
program. You will not hear any Member come to the floor today and say
that. I dare say the gentleman from Maryland would not say that.
Listen to this: Did the gentleman say he was against reform? Of
course not. The gentleman from Maryland knows that in Maryland, as in
Iowa, the program needs help if it is going to meet the needs of a
changing world and meet the needs of its original mission. And listen
to hear whether you hear any of them come forward and disagree with the
bipartisan result of the Governors coming forth with savings. Not one
Member will come today, I would dare say, and suggest that they are
going to disagree with the Governors who come forth with ideas. My
colleagues will not hear that.
So make your political points; even bring in Social Security. Did my
colleagues hear that one? Social Security was even raised today. Boy,
we are going to hear all sorts of great arguments, but we will not hear
one that says we cannot find savings, this program is perfect, we are
against reform, and we disagree with the Governors. We will not hear
that. That is why we need to move forward with a reform of the Medicaid
program ushered in by this budget.
Madam Speaker, I reserve the balance of my time.
Ms. HERSETH. Madam Speaker, I yield 30 seconds to the gentleman from
Maryland (Mr. Hoyer).
Mr. HOYER. Madam Speaker, I say to the chairman of the Committee on
the Budget, my suggestion is to come forward with a reform program. Let
us consider it. But do not cut vulnerable people prior to coming up
with solutions. Do not make them pay the price of losing Medicaid while
we are trying to solve the problem. Let us solve the problem.
The gentleman is right, and we are not going to come to the floor
saying there is no problem. But we are going to come to the floor and
say, do not have vulnerable people let down while we are trying to
solve that problem.
Mr. NUSSLE. Madam Speaker, I yield myself 15 seconds to just say I
have a reform idea right here from the Governors that I would agree to
right now.
Mr. HOYER. Madam Speaker, if the gentleman will yield, the gentleman
is on the Committee on Ways and Means. Pass it and make it policy.
Mr. NUSSLE. Madam Speaker, reclaiming my time, the Committee on
Energy and Commerce has jurisdiction. But be that as it may, I yield
myself 15 more seconds to say that all I am suggesting is there are
some good ideas that are out there, and the budget is a vehicle to
accomplish a reform schedule. That is what we are trying to agree to,
and I appreciate the fact the gentleman wrote the motion to instruct to
give us the opportunity to meet that reform schedule in a bipartisan
way, I hope.
Madam Speaker, I reserve the balance of my time.
Ms. HERSETH. Madam Speaker, I yield 2 minutes to the gentleman from
Michigan (Mr. Dingell), my esteemed colleague and ranking member of the
Committee on Energy and Commerce.
(Mr. DINGELL asked and was given permission to revise and extend his
remarks.)
Mr. DINGELL. Madam Speaker, I rise in strong support of the motion to
instruct, and I observe that this motion instructs the conferees to
recede to the Senate position. Instead of Medicaid cuts, a nonpartisan,
independently appointed commission would be instructed to come up with
improvements in the program. That is exactly what the gentleman from
Iowa suggests.
Now, let us look. There is money here to make a better use of public
funds. The MEDPAC, the Medicare Payment Advisory Commission, observed
that we overpay the HMOs by $20 billion. That happens to be just about
exactly the amount of the cut that we are talking about here.
Every Governor in the United States is in favor of this motion.
Medicaid is critically important to more than 50 million Americans. It
provides health care for 1 in 4 children. It is a lifeline for the
elderly and for individuals with disabilities. It pays for long-term
care, and it helps those who have had the misfortune of becoming ill
and needing help in their basic activities of daily living.
The proposed cuts in the program would cause undue harm to millions
of our most vulnerable Americans. If a $10 billion cut were enacted, my
home State alone stands to lose more than a quarter of a billion
dollars over the next 5 years. I would tell the gentleman from Iowa, he
better look to see what happens to his State. A bipartisan majority of
both the House and Senate oppose cuts in this program. Nearly 1,000
State organizations and more than 800 national organizations have
voiced strong opposition to this.
The problem is not Medicaid. It has done a better job in holding down
costs than has private insurance. Medicaid is absorbing the costs of
care not covered under Medicare. An independent look at Medicaid may
show that there is a better solution, but the better solution does not
involve blindly cutting monies now so desperately important to people
of this kind and so urgent for the States.
Mr. NUSSLE. Madam Speaker, I yield myself such time as I may consume
just to respond and say, okay, I stand corrected. I thought no one was
going to come to the floor and say do nothing. But I guess there are
going to be a few Members who come to the floor and say do nothing. I
am surprised by that. I think there will be a bipartisan vote today to
do something, but doing nothing I really believe is not an option, and
I guess I am surprised that there will be Members who will come to the
floor today and do absolutely nothing to help improve the Medicaid
program.
[[Page H2513]]
But I know someone who wants to do something.
Madam Speaker, I yield 3 minutes to the gentleman from Georgia (Mr.
Deal), the very distinguished chairman from the Committee on Energy and
Commerce.
Mr. DEAL of Georgia. Madam Speaker, I thank the gentleman for
yielding me this time.
As I look across the aisle, I see some of my colleagues who work with
me on the Committee on Energy and Commerce, and I truly believe that
all of us want to do what is right. We want to find a solution.
The fact is that the issue is one that on a bipartisan basis
Governors say has to be dealt with. In fact, as recently as only over a
week ago, Governor Mark Warner, a Democrat Governor of Virginia, who is
the chairperson of the Governors' Association, National Governors'
Association, made this comment: ``We are on our way to a meltdown.''
That is the message that we hear repeatedly when we talk with
Governors. And the reason is that the cost of Medicaid to States has
now exceeded the cost of both elementary and secondary education in
their State budgets, and they need relief. The relief that they seek in
the current system is to come to Washington and ask for a waiver. And
repeatedly, Governors come and say to us at the Federal level, the
program that you have in place is too rigid. It does not allow us the
flexibility to deal with the problems that we face in our State to give
the best health care to our citizens. So they are asking for waivers.
I, for one, and I commend the gentleman from Iowa (Chairman Nussle)
for his efforts in this regard; I believe that now is the appropriate
time for us to give the Governors that relief. I think that relief
should come in the form of changing the program.
I had a Governor recently who said his approach to it is to ask the
question, if you were drafting Medicaid today, would it look like what
it looks like now? And everybody agrees it would not.
So I think this is an opportunity, one that we should not allow to be
bypassed, one that we should work cooperatively across the aisle here
in this body, as the Governors are working in a bipartisan fashion of
their own. The gentleman from Iowa (Chairman Nussle) alluded to some
points that the Governors have agreed to on a bipartisan basis, and
certainly those are very significant. The score that I see now is about
$8.6 billion on the score that I have seen on the parts that they have
agreed to. I think there will be more. I think we will hear some very
innovative suggestions from the Governors, and I think that if we work
together and put aside our partisanship and try to do what is not only
best for the citizens we represent in our congressional districts, but
what our Governors do in our respective States and, working together,
we will arrive at a solution.
Ms. HERSETH. Madam Speaker, I yield 1 minute to the Democratic
leader, the esteemed gentlewoman from California (Ms. Pelosi).
Ms. PELOSI. Madam Speaker, I thank the gentlewoman for yielding me
this time, and I commend her for her leadership in bringing this very
important motion to instruct to the floor.
It is crystal clear, Madam Speaker, that a majority of Members in
both bodies oppose cuts to Medicaid. The other body voted to remove
such cuts on the floor of the Senate. With 44 House Republicans signing
a letter calling for no Medicaid cuts and a solid Democratic
opposition, a majority of this body also prefers a solution with no
Medicaid cuts.
The regular order, as my colleagues know, Madam Speaker, is to
appoint conferees, instruct those conferees, resolve differences with
the other body, and report back a conference agreement. But the
Republican leadership knew they could not defeat a motion to protect
Medicaid, so rather than follow the regular order, they negotiated
behind closed doors to include Medicaid cuts in the final budget
report, regardless of how the majority in both Houses vote and how we
vote in this House on the motion to instruct.
I usually do not like to talk about process in the House, but this is
a time when process has a very direct impact on policy, and a policy
that has a direct impact on the health of the American people.
Press reports indicate that the final agreement between the House and
Senate will contain between $8 billion to $10 billion in Medicaid cuts.
This conference report would not only ignore the will of the majority
of both houses but, according to the Congressional Budget Office, it
would include deeper cuts than originally proposed by the President,
and vehemently opposed in both houses.
Madam Speaker, States have undergone a wrenching budget process. When
the President first proposed Medicaid cuts in early February, many
Republican Governors spoke out against them. One of them, Republican
Governor Mike Huckabee of Arkansas, said, ``People need to remember
that to balance the Federal budget off the backs of the poorest people
in the country is simply unacceptable.''
It is unacceptable but, unfortunately, it is standard operating
procedure for the Republican leadership in Congress.
I am hopeful that a significant number of Republicans will join our
motion to instruct, being true to the letter that they sent opposing
cuts, and protect Medicaid.
If Congress cuts Medicaid funding, States will be forced to reduce
Medicaid coverage or benefits, jeopardizing needed services for low-
income Americans. Over the last 4 years, more than 5 million people
have joined the ranks of the uninsured. That number would more than
double if it were not for the Medicaid program.
Make no mistake: Cutting Medicaid funds will increase the number of
low-income Americans who are uninsured to partially pay for $70 billion
in tax cuts. Many of these uninsured poor Americans are children. I do
not think that it really is a statement of our values in a budget to
cut the health care for our children, for the poorest children in
America, in order to give the tax cuts to the wealthiest people in
America.
{time} 1815
And yet at the end of the day, this budget will do all of that and
increase our deficits. This is wrong. This is unjust. And I urge my
colleagues to vote for this very important motion to instruct to return
a conference report to this body with zero Medicaid cuts.
Mr. NUSSLE. Madam Speaker, I yield 4 minutes to the distinguished
gentleman from Florida (Mr. Putnam), a member of the Budget Committee.
Mr. PUTNAM. Madam Speaker, I thank the chairman for yielding me some
time. It is interesting to hear the comments of the distinguished
minority whip and minority leader. But I am curious about something. I
am curious how such a great party and the party that gave birth to some
of the pillars of domestic policy in this country, has become the party
of denial, the party of doing nothing.
When it comes to discussing Social Security reform, their answer is,
do nothing. We have until 2040 or 2041.
When it came time to reform Medicare and even enrich and modernize
the benefits available for seniors, their answer was vote against it.
Do nothing.
And here today we are discussing a third pillar of domestic policy in
this country that helps enrich the lives and provides a safety net for
so many of those who are less fortunate in our society, and to put
forward a reform proposal, and their answer is to do nothing.
Governor Mark Sanford, the Governor of the State of the ranking
member of the Budget Committee, said the subject of Medicaid reform is
important and timely. Our system, as currently configured, works
fundamentally against the taxpayer and against the consumers in the
form of Medicaid recipients and patients.
Governor Blunt of Missouri and Governor Granholm of Michigan agreed
that the program is unsustainable.
Governor Vilsack of Iowa: ``If you do the numbers, they just do not
add up.''
The South Dakota Governor, opening the legislative session, bemoaned
the dramatic increases in how they are cutting into available funds for
other folk, for other programs, and pointed out that the State health
care program is growing at a 2 percent rate and Medicaid is going up at
18 percent, something that is unsustainable.
The Governors, on a bipartisan basis, have already, after this
subject just coming forward weeks ago under the leadership of the
gentleman from Iowa
[[Page H2514]]
(Chairman Nussle) and the Budget Committee, have already developed a
plan that generates nearly $9 billion in savings, and that is the first
draft.
How is it that the great party that stood for great opportunities to
help those in need has gone into denial and said, we will not change a
thing. Everyone agrees the rate is unsustainable. Everyone agrees the
costs are eating up State budgets. Everyone agrees that there is
tremendous opportunity for savings that can then benefit other
important programs; but our answer is to do nothing, or to outsource
the job to a commission. And if the pattern holds, when the commission,
if it is appointed, comes back with their findings, they will besmirch
the reputation of the members of that commission, particularly those
from their own party who were selected in one form or another by the
President or by the Congress. That is what happened with the Social
Security Commission and the distinguished Senator Moynihan. Why would
this be any different?
Why would the party that is so responsible for originating these
grand ideas be so irresponsible about making them relevant to people of
my generation or the distinguished gentlelady from South Dakota's
generation? Why is that? Why would you outsource the responsibility to
provide a solution?
It is an important step that the House Budget Committee took in
directing the Energy and Commerce Committee to take a hard look at
these programs and find savings. It did not specify where they would
come from. It did not tell them how to do their job. It directed them
to take a hard look at where 55 percent of our budget today is going in
the form of mandatory spending. And a huge part of that is in the
Medicaid program.
I would encourage all of us to agree that there is a problem and move
forward with some commonsense reforms that include saving the taxpayers
money when possible.
Ms. HERSETH. Madam Speaker, I yield 1 minute to the gentleman from
South Carolina (Mr. Spratt), ranking member of the Budget Committee.
Mr. SPRATT. Madam Speaker, let me say in response to the last speaker
that this party proudly presented a budget resolution that brought the
budget to balance in the year 2012 and did not do it on the backs of
the most deserving in our country, the sick and the elderly who depend
upon Medicaid.
And lest there be some misunderstanding, this budget makes the
deficit worse, not better, because it calls for $106 billion in
additional tax cuts. And the primary purpose and function and reason
for these Medicaid cuts is to diminish the $106 billion so it does not
swell the deficit any more grossly out of proportion than it already
is. This does not go to the bottom line and reduce the bottom line at
all. It leaves us with a bigger deficit because it only partially
offsets the $106 billion in tax reduction that the resolution also
calls for. So it is not necessary. And that is recognized by the 44
Republican House Members who signed the letter urging that this
resolution not contain any cuts in Medicaid.
Mr. NUSSLE. Madam Speaker, I yield myself as much time as I may
consume.
I want to make sure people are, and Members are, listening to this
debate and are reading the language, because again, if you want to come
down here and vote politics again, you want to put out your press
releases and fax machines are going whizzing around, hey, knock
yourselves out.
But we have got a job to do down here, and we should read the
language in front of us. And, again, it says that we should not report
a reconciliation bill that achieves spending reductions. I just want to
make sure people understand that, because I want to give you the actual
numbers for Medicaid. If you are bored about numbers, turn down the
sound because I am about to quote some numbers. But this is serious
business.
I want to tell you what the Medicaid program is going to spend over
the next 10 years. And I want you to listen to the numbers and the
increases. This year we are going to spend $183 billion, which is
almost a 4 percent increase from last year; $190 billion the next year,
$202 billion. It goes up: $220. It goes up by 9 percent that year; $239
billion, goes up by almost 9 percent that year. $260 billion by 2010.
By 2010, $260 billion. That is almost as much as we are spending on
national defense right now. $282 billion, $304 billion. It goes up
every single one of those years. Out of that $1.1 trillion or more, it
is actually a little bit more than that I just quoted, we are saying in
the House budget, even before we talk about a compromise with the other
body, we are saying, instead of growing at an average rate of growth
per year of 7\1/2\ percent, we want to grow at 7.3 percent.
We are going to grow every year. There are not spending reductions.
Every single year of the House budget spending for Medicaid goes up.
Every single year. Every year it goes up. There were no spending
reductions.
Now, are we slowing down the growth?
Yes. And that is what the Governors have asked us to do. That is what
they are coming here with proposals to accomplish. And their proposals
that they have put forth, some have not even yet been scored, but the
ones that have been scored by the Congressional Budget Office, which
tries to add all that up and to find out what savings we have got, of
the six main proposals that the bipartisan Governors have come forth
with, they have already found $8.6 billion, and three of the proposals
have not even yet been scored.
So to say there is no savings, to say that we are hurting the most
vulnerable, to suggest that nobody wants reform, again, I would ask
colleagues to listen to the debate.
Will there be political rhetoric today?
Yes. Unfortunately, that will be true. The same happened in the
welfare reform debate. Members came to the floor saying we should not
do anything. We should not make changes, we should not reform the
program. Let us keep what we have got. We changed the program, and
people were helped.
No Member is going to come to the floor today and say the Medicaid
program is perfect. I dare say no Member would come to the floor and
tell you that. No Member is going to come to the floor today and say we
cannot find savings.
Actual cuts? I can understand why they might come to the floor. But
that is not what is being proposed.
But can we find savings? Every Member will come to the floor today
and say of course. If you look at a program long enough that is 40
years old and has never been changed, of course you can find savings,
particularly one that in a bipartisan way every Governor is either
asking to get out of through a waiver or is coming to Washington to
suggest that we need to reform.
No Member is going to come to the floor today and say we should do
absolutely nothing, with just a few exceptions. There may be a few
Members who try and do that. And there will be no Members who come to
the floor today and suggest that the Governors in a bipartisan way have
put forth ideas that are not worthy of consideration. We need to
consider it.
Again, I am very happy that the Members on the other side have given
us a motion to instruct conferees with a fail-safe, with a trapdoor
that allows us to keep the momentum of reform building and allows them
to make their political points. That is what they are allowed to do, is
to come to the floor and make their political points. But thank
goodness we still have a process that says we have got to move forward.
This is an unsustainable growth rate, that every year the program
grows and grows and grows. There are no cuts.
Are there savings that we suggest? Yes. That was true in welfare
reform. It is true as we look at Medicaid. And we need to look for the
savings, because without reform the program not only will bankrupt
itself, but more important than all of the talk about numbers and
budgets and all of those things, it will begin to hurt people who truly
are the most vulnerable that this program endeavors to assist.
So the commission approach that the gentlewoman from New Mexico (Mrs.
Wilson) has put forward is a good idea. She has many cosponsors. That
is not something that the budget itself can accomplish. But, certainly,
we endorse that kind of an approach to look for ways to bring all
interested parties together to find reform.
And I hope that instead of just putting out your faxes, which you
will do, and make out your political statements, that is fine. We
understand
[[Page H2515]]
that. But you will also, after all of the dust settles, come forward
with your ideas the way Democratic Governors and Republican Governors
have done, so that we can begin to resolve this issue and not just have
rhetoric. We need results, not just the rhetoric of today. And that is
what this budget accomplishes.
Madam Speaker, I reserve the balance of my time.
Ms. HERSETH. I would inquire as to the balance of our time remaining,
Madam Speaker.
The SPEAKER pro tempore (Mrs. Biggert). The gentlewoman from South
Dakota has 15 minutes and the gentleman from Iowa has 4\1/2\ minutes.
Ms. HERSETH. Madam Speaker, I yield 2 minutes to the gentleman from
California (Mr. Stark), ranking member of the Health Subcommittee of
the Committee on Ways and Means.
(Mr. STARK asked and was given permission to revise and extend his
remarks.)
Mr. STARK. Madam Speaker, I guess I would be willing to suggest that
the Medicaid programs are perfect, but for one major problem, and that
would be the Republican Party in the Congress of the United States.
What changes would I make? I would enforce the ethics rules to keep
their hands out of the pockets of the lobbyists for the pharmaceutical
industry who fly them about in jets and give them hundreds of millions
of dollars in campaign contributions, which keeps them from allowing
reimportation of drugs which would save many of the Governors a good
bit of money on their Medicaid programs.
Changing the ethics rules that let people who might make unethical
moves would be another great move, so it would prevent the managed care
industry from getting extra money in the Medicare bill which would
prevent the Republicans having the money to help Medicaid.
{time} 1830
The Medicaid growth is due largely to the lousy job the President has
done in job growth, the worst job since Herbert Hoover and the last
Republican who had low job growth which increases the demand on
Medicaid and the number of poor children and low-income workers who are
forced to get their medical care through Medicaid because they are out
of work through no fault of their own.
So if we would have decent ethics rules, if we would allow
reimportation of drugs, if we would stop allowing the lobbyists to buy
votes, we would be able to get the kinds of reform that are needed. The
money is currently available in the excesses we are paying to the
pharmaceutical industry and the excesses we are paying to the managed
care industry which the chair of the Committee on the Budget
understands very well, and that is the reform that is needed.
Change Congress. Make the Republicans behave in an ethical manner,
and you will have the money for Medicaid.
As Hubert Humphrey once said, ``The moral test of Government is how
that Government treats those who are in the dawn of life, the children;
those who are in the twilight of life, the elderly; and those who are
in the shadows of life, the sick, the needy and the handicapped.''
With all due respect for many of my colleagues, none of us could more
eloquently make the case for Medicaid, which takes care of those in the
dawn, twilight and shadows of life.
Yet the budget we are going to consider this week fails the moral
test of government by requiring savings that will result in deep cuts
in Medicaid and other programs that serve low-income, vulnerable
populations.
A budget is a statement of priorities. Once again, we are faced with
a Republican budget that put tax breaks for the rich and payola to
corporate interests, ahead of basic government obligations.
Just as when we debated the Medicare bill in 2003, it appears we will
be asked to vote on entitlement policy without adequate information as
to its effect. We do not know, for example, how the cuts will be
distributed across states and populations. How many people will lose
coverage? How many states will be forced to raise taxes--and by how
much.
To make up for the shortfall in funding and increased need?
The saddest part of this debate is that Republicans don't need to
target Medicaid. We can raise more than the amount Republicans expect
to extract from Medicaid and income security programs simply by
eliminating the overpayments currently paid to Medicare HMOs.
We pay these plans more than we would for care provided through
traditional Medicare. That's wrong!
In fact, MedPAC--the non-partisan Congressional advisory commission--
has recommended that Congress enact changes that would result in
``payment neutrality.'' Doing so would result in savings of more than
$21 billion over 5 years--more than enough to offset this budget's
proposed Medicaid cuts.
Sadly, I doubt Republicans will go after this low-hanging fruit. It
would evoke howls of protest from their contributors. Consider this
budget a word of warning to individuals in the dawn, twilight and
shadows of life.
Those who run on a moral values platform should consider that when
they cast their votes on the budget this week.
Vote for the Spratt Motion to Instruct, and against the Resolution
itself later this week.
Ms. HERSETH. Madam Speaker, I yield 2 minutes to the gentlewoman from
California (Mrs. Capps).
Mrs. CAPPS. Madam Speaker, I rise in support of the Herseth motion to
instruct conferees.
The House-passed budget cuts, $20 billion for Medicaid. It denies
States, health care providers, and low-income working families $20
billion for health care services they vitally need. While closing
loopholes and fighting waste, fraud, and abuse is important, there is
no way it is going to save near that amount. As our colleague from
South Dakota has forcefully stated, a clear majority of the Congress
opposes these cuts, and for good reason.
Medicaid provides health care to 52 million low-income children,
pregnant women, parents and the elderly. It is a critical source of
acute and long-term care for 13 million elderly and disabled. These are
the people who would be affected by cutting billions out of Medicaid.
Since the President took office, the number of uninsured has increased
by 5.2 million. Medicaid enrollment grew by 6 million over the same
period, covering many people who would otherwise have been uninsured.
Even so, Medicaid costs have grown about half as fast as private health
care insurance premiums.
Between 2000 and 2003, Medicaid per capita spending went up by 6.9
percent, while private insurance premiums went up almost twice that
amount, 12.6 percent. And the growth in costs we have seen as a result
of the skyrocketing health costs this President has allowed, not
Medicaid itself.
If these cuts in Medicaid are made, the ranks of the uninsured are
surely going to increase even more, weakening our economy, and health
care would be more expensive because of fewer regular check-ups and
preventative measures and a rise of emergency room procedures. That is
why the National Governors Association opposes these cuts. It is why
faith-based organizations across the board oppose these cuts.
Organizations like the March of Dimes, the National Association of
Children's Hospitals, the American Academy of Pediatrics and the AARP
all oppose these cuts. That is why a majority of the Congress opposes
these cuts.
I urge my colleagues to vote for this motion. Tell the conferees to
remove Medicaid cuts from this budget.
Mr. NUSSLE. Madam Speaker, who has the right to close?
The SPEAKER pro tempore (Mrs. Biggert). The proponent has the right
to close.
Mr. NUSSLE. Madam Speaker, I am the final speaker so I will reserve
the balance of my time.
Ms. HERSETH. Madam Speaker, I yield 2 minutes to the gentleman from
Michigan (Mr. Stupak).
Mr. STUPAK. Mr. Speaker, I urge my colleagues to support the Herseth
motion to instruct; and I thank the gentlewoman for her leadership as
we stand with seniors, with disabled Americans, with working families,
and with children as we unite against these Medicaid cuts.
This Medicaid program is working but it is woefully underfunded by
the Republican-controlled majority in this Congress. Medicaid accounts
for 25 percent of Michigan's budget. With an aging population and a
weak economy where manufacturing jobs are being shipped abroad, we can
ill afford to cut this safety net out from under our most needy
citizens.
This House resolution would require between 15 and $20 billion in
cuts in
[[Page H2516]]
Medicaid over 5 years. How can we ask between 1.8 to 2.5 million
seniors, children, and low-income, hardworking families to sacrifice so
there can be another $106 billion in tax cuts?
We have a responsibility to look at ways to modernize Medicaid, to
help our States and provide better health care, but it is heartless to
subject our most vulnerable citizens to the meat-axe approach of this
budget.
This motion to instruct conferees asks to reject the Medicaid cuts
and calls for a bipartisan, independent Medicaid commission to address
the concerns.
Michigan's Medicaid program has grown 30 percent in 4 years, serving
roughly 1.4 million citizens or 1 out of every 7 Michiganders. Who are
these citizens? In 2004 Michigan Medicaid paid for about 70 percent of
all the nursing home care in our State, 40 percent of all the births in
our State; 27 percent of the adults on Medicaid have a job and are
working. The State is meeting the growth in beneficiaries while holding
down spending to approximately 1.5 percent.
It is time to stand up for their most vulnerable citizens and against
these Medicaid cuts. It is the right thing to do. It is the moral thing
to do. Vote for the motion to instruct.
Ms. HERSETH. Madam Speaker, I yield 2 minutes to the gentleman from
Ohio (Mr. Brown).
Mr. BROWN of Ohio. Madam Speaker, 44 Members on the Republican side
defied their party, not because some deep-pocketed lobbyist asked them
to, but because fighting for people in desperate need was and is the
right thing to do.
Medicaid health and long-term coverage is already limited to the
impoverished elderly in nursing homes, the lowest-income children, and
other vulnerable populations. My friend, the gentleman from Iowa (Mr.
Nussle) expressed shock that Medicaid costs have actually grown. I
think he must know that private insurance growth in this country is
greater than 12 percent, Medicare costs are going up around 7 or 8
percent. Medicaid costs are going up only about 6 percent, half the
pace of private insurance. There is no cost-effective alternative to
Medicaid. Medicaid is the cost-effective alternative.
Medicaid cuts would not only jeopardize 5 million elderly Americans
who would lack access to nursing home care without it, these cuts would
place every nursing home resident, on Medicaid or not, in this country
at risk. Each year nursing homes serve 2.5 million Americans. Medicaid
covers 70 percent of these Americans.
The very health and safety of nursing home residents hinges on
adequate Medicaid reimbursement. As it stands, Medicaid funding is
insufficient to cover both those Americans who need nursing home
services and those who need home and community-based care. If the
Federal Government makes further cuts in Medicaid, we must take
responsibility in abandoning people who have no where else to turn.
Two-thirds of people in nursing homes have no living spouse or
relative. The fact is we, the Medicaid program, the Federal Government,
are all the family who cares for them that they have.
I hope that before any Member of this body votes against this motion,
you might just imagine trading places with an elderly American in a
nursing home. Put yourself in their shoes; then decide whether starving
Medicaid is responsible for reprehensible.
Ms. HERSETH. Madam Speaker, I yield 3\1/2\ minutes to the gentleman
from South Carolina (Mr. Spratt).
(Mr. SPRATT asked and was given permission to revise and extend his
remarks.)
Mr. SPRATT. Madam Speaker, I thank the gentlewoman for yielding me
time.
Madam Speaker, the House and the Senate passed their own versions of
budget resolutions on March 17. That was more than a month ago. I am
glad that we finally are going to conference because that will bring
the deliberations on the budget at least a bit out into the open. And
if there is any aspect of the budget resolution that needs to be
brought into the open and resolved with a public debate, all the
stakeholders included, it is this provision that we have been
discussing, and that is a provision that would cut Medicaid, over 5
years, by $20 billion.
This motion to instruct conferees protects Medicaid from those
spending cuts. Let me explain how those spending cuts would come about.
The House-passed Republican budget resolution directs the Committee on
Energy and Commerce to cut spending on programming within its
jurisdiction by $20 billion. But the Republican leadership has made it
clear. The resolution calls for $20 billion in cuts within the
jurisdiction of the Committee on Energy and Commerce, but the
Republican leadership has made it clear that those cuts should not
include Medicare. That only leaves Medicaid.
It leaves Medicaid subject to $20 billion in cuts over 5 years, per
the language of the resolution passed by the House.
On our side of the aisle, all Democrats oppose unanimously the House
budget resolution which included the Medicaid cut. Now, 44 Republicans
have signed a letter urging that the Medicaid cut be dropped in the
conference report. As a result, it appears that a majority of the House
Members are on record against the Medicaid cuts. Medicaid cuts,
therefore, should not be included if the conference report is to
reflect the will of the majority in the conference report.
In the other body, the Senate, a majority also opposed the Medicaid
cuts, with 52 Senators, including every Democrat and 7 Republicans,
voting to strike the Medicaid cuts from the Senate budget resolution
and, instead, to set up a bipartisan commission.
So the purpose of this motion is to formalize the fact that both
houses, a majority in both houses, are formally on record as opposed to
the cut in Medicaid of $20 billion. And this motion simply instructs
the conferees, it does not suggest, it does not tell them to consider,
it instructs the conferees to follow the Senate's lead and strike the
reconciliation instructions that target Medicaid for funding cuts and,
instead, put up $1.5 million so we can have a fair bipartisan Medicaid
commission to make these decisions.
I am glad that the chairman of the Committee on the Budget, the
gentleman from Iowa (Mr. Nussle), has said that he will recommend to
his members to vote for this resolution. I am disturbed to hear him
emphasize that it is nonbinding.
Given the fact that the majority in both houses support the dropping
of this $20 billion cut in Medicaid, I think this should be, as the
gentleman from Maryland (Mr. Hoyer) put it, a moral mandate for the
conferees. If it will bring back a conference report that reflects the
will of the House, it should not include $20 million in cuts in the
Medicaid program.
Ms. HERSETH. Madam Speaker, I yield 2 minutes to the gentleman from
Texas (Mr. Gene Green).
(Mr. GENE GREEN of Texas asked and was given permission to revise and
extend his remarks.)
Mr. GENE GREEN of Texas. Madam Speaker, I would like to read a part
of a letter from the National Governors Association to both the Speaker
and the Democratic leader and Senator Frist and Senator Reid.
It says, ``Reform, however, should not be part of a 2006 fiscal year
budget reduction and reconciliation process, especially if it does
nothing more than shift additional costs to the States.''
We have a problem with health care costs in our country. Medicaid is
one part of it. Medicare costs and private insurance and private health
care is actually rising higher faster than Medicaid. Yet what we are
doing with this budget resolution is actually penalizing senior
citizens, and particularly children, because so much of our children's
hospitals, so much of their funding comes from Medicaid because they
deal with children totally.
I know in Houston, the Texas Medical Center, we have the Texas
Children's Hospital, over 50 percent of their funding comes from
Medicaid because they take care of children. We have to deal with
health care costs, but let us not balance it on the backs of our
children and our senior citizens.
[[Page H2517]]
National Governors Association,
December 22, 2004.
Hon. Bill Frist,
Majority Leader, U.S. Senate,
Washington, DC.
Hon. Harry Reid,
Minority Leader-elect, U.S. Senate,
Washington, DC.
Hon. J. Dennis Hastert,
Speaker, House of Representatives,
Washington, DC.
Hon. Nancy Pelosi,
Minority Leader, House of Representatives,
Washington, DC.
Dear Senator Frist, Senator Reid, Speaker Hastert, and
Representative Pelosi: The Nation's Governors look forward to
working closely with the Administration and Congress to
reform Medicaid. Reforming the Medicaid system is the highest
priority for the Governors, and will result in cost savings
and efficiencies for both the federal and state governments.
Reform, however, should not be part of a 2006 fiscal year
budget reduction and reconciliation process, especially if it
does nothing more than shift additional costs to states.
Governors are committed to administering the Medicaid
program in a very cost-effective way, and as equal partners
in the program have a tremendous incentive to continue doing
so. This is reflected in the fact that the annual growth in
Medicaid per capita spending has not exceeded approximately
4.5 percent per year, substantially below the growth rate of
private health insurance premiums, which have averaged 12.5
percent per year for the last three years. Total Medicaid
costs, however, are growing at a rate of 12 percent per year
and now total Medicaid expenditures exceed that of Medicare
primarily due to two major factors that are largely beyond
the control of states. First, states, over the last four
years, have experienced large case load increases of
approximately 33 percent. Second, and far more costly to
states, are the impacts of long-term care and of the dual
eligible population. Medicaid currently accounts for 50
percent of all long-term care dollars and finances the care
for 70 percent of all people in nursing homes. Furthermore,
42 percent of all Medicaid expenditures are spent on Medicare
beneficiaries, despite the fact that they comprise a small
percentage of the Medicaid caseload and are already fully
insured by the Medicare program. Benefits for the dual
eligible population should be 100 percent financed by
Medicare.
We agree that maintaining the status quo in Medicaid is not
acceptable. However, it is equally unacceptable in any
deficit reduction strategy to simply shift federal costs to
states, as Medicaid continues to impose sever strains on
state budgets. Our most recent survey of states shows
Medicaid now averages 22 percent of state budgets. This
commitment has caused a strain on funding for other crucial
state responsibilities. These funding challenges will become
more acute as states absorb new costs to help implement the
Medicare Modernization Act for the millions of dual eligible
beneficiaries.
We look forward to working with you on Medicaid reform.
Sincerely,
Governor Mark R. Warner,
Chairman.
Governor Mike Huckabee,
Vice Chairman.
Ms. HERSETH. Madam Speaker, I reserve the balance of my time.
Mr. NUSSLE. Madam Speaker, I yield myself the balance of my time.
Madam Speaker, those who actually administer the Medicaid program,
our State Governors, have clearly told us in a bipartisan way that
Medicaid must be reformed.
Wake up.
For those of you who are about to vote on this motion, this is a good
motion. What it does is it says it is time to reform the program. It is
time to consider the proposals that the Governors have put forth in a
bipartisan way. They have clearly told us that their hands have been
tied.
{time} 1845
Their hands have been tied, Madam Speaker, by a program that is
inefficient. It is ridiculously out of date, a health care delivery
system that has not and will not under its current structure deal with
the demands of the 21st century.
There is not one Governor that is suggesting do nothing. There is not
one Member on the Republican side of the aisle that is suggesting do
nothing. The 44 Members who signed the letter saying we are concerned
about the future of Medicaid, they are not saying do nothing.
Everyone who is interested in the reform of this program understands
that the budget this year gives us a schedule and an opportunity to
finally get our arms around the Medicaid program.
I understand that there are going to be all sorts of political press
releases put out about gouging and cutting and all sorts of things like
that; but if anyone is interested in the actual technical language of
the budget, they will discover that every single year the program under
the House budget grows, every year.
What we are suggesting is that, with reform, it does not have to grow
as much. Instead of growing at 7.5 percent, it can grow at a level a
little lower, maybe 7.3 percent or 7.4 percent. Every year it should
still grow because there are vulnerable people, there are senior
citizens, there are people with disabilities who rely on this program.
Our States rely on this program. We rely on this program in order to
meet the needs of many people in this country who cannot help
themselves.
Do not let anybody fool my colleagues. No one came to the floor today
in support of this motion and said the program's perfect; the Governors
are wrong; we do not like what they came up with; we do not think we
should reform the program.
In fact, let us look at the reforms they have come up with. They have
said let us restructure the pharmacy reimbursements to more closely
align with the Medicaid pharmacy payments and pharmacy costs. That
alone will save $5 billion. Bipartisan support from the Governors. I
dare say we could support that here today.
Second proposal, revising what is called ``asset transfer.'' That
will save the government $1.4 billion. Bipartisan support by the
Governors.
Please do not come to the floor or issue press releases today that
says do nothing. I understand my colleagues want to make a political
point. That is fine. That is what motions to instruct conferees often
do, but we are going to vote on a budget later on this week that says
it is time to do something, it is time to reform the program, it is
time to save a little bit of money and improve a program that is for
our most deserved people, people who cannot help themselves. This is
something we can do in a bipartisan way.
The same way Governors in a bipartisan way have come forward with
their ideas, I would invite all Members to let their members of the
Committee on Energy and Commerce know what their ideas are because we
are going to go forward with reform. It is not going to actually cut
any money. It is going to find savings. It is going to improve a
program. It is going to reform it.
If the gentlewoman, who is the proponent of this motion, thinks the
program is perfect, let her say so. If she thinks that we cannot find
any savings, let her say so. If she thinks the Governors are wrong, let
her say so. But no Member has come to the floor to say that yet today.
So that is why we should support this motion and move the budget
forward to reform the Medicaid program and save some money as well.
Ms. HERSETH. Madam Speaker, I yield myself such time as I may
consume.
I want to thank all of my colleagues who spoke in support of this
motion to instruct conferees, including the gentleman from Iowa
(Chairman Nussle) and his willingness to encourage his Republican
colleagues to support this important motion.
In response to the closing of the gentleman from Iowa, I do not stand
here today, nor do my colleagues, suggesting that we do nothing. I do
not stand here today suggesting we cannot find savings. I do not stand
here today suggesting that we cannot find a way, in a bipartisan
manner, to reform Medicaid.
To the extent that there are press releases that go out to
constituents who will be breathing a sigh of relief, from Governors to
health care providers, to advocates of disabled citizens and the
elderly and children, it will be that we found agreement in this body
to supplement the important work of the Governors across this country
to undertake real reform, to find those savings but not to let
arbitrary cuts drive the reform; and that is exactly what the House
budget resolution did. It is exactly what this motion to instruct
conferees attempts to set right.
Those in my generation understand that we cannot do nothing, whether
it comes to Social Security reform or Medicaid reform; but we also
understand that the facts speak for themselves, that we have time to do
this right, rather than to work so fast and to let arbitrary cuts of
$20 billion over 5 years drive the reform; that it should truly have a
commission and the $1.5
[[Page H2518]]
million today this motion to instruct would encourage to have set aside
in the reserve fund to have a bipartisan commission undertake this
important task of reform.
Mr. HOLT. Mr. Speaker, I voted against the FY2006 Concurrent Budget
Resolution that was reported by the House Budget Committee and narrowly
passed the House on a 218-214 vote last month. I did so for a variety
of reasons.
First, President Bush and the majority party in this Congress want us
to keep borrowing against our future and that of our children, and
perhaps their children. The budget deficit for this year is a record
$427 billion. We added $114 billion to the deficit in February, the
first time it has ever gone over $100 billion in one month. This is how
we have added more to the national debt in the past four years than in
the prior two centuries of our nation's history. Therefore, a vote in
favor of this budget resolution is a vote for more ``borrow and spend''
policies that are responsible for our country's current fiscal plight.
Second, the House-passed budget plan shortchanges many Americans who
are most deserving or in need of help, including our veterans,
children, and elderly. At the same time, it slashes funding for many of
our nation's important priorities--education, healthcare, AMTRAK and
alternative transportation and energy initiatives, homeland security,
environmental protection, job training, research and development, and
small business innovation.
Let me cite a few glaring examples.
The House-passed budget cuts veterans' health care by $14 billion
below what is currently needed over the next five years. These cuts can
only be achieved by imposing new fees for veterans's healthcare, or by
reducing veterans' benefits such as disability pay, pension benefits,
or education benefits.
It actually cuts funding for education programs by $2.5 billion for
next fiscal year relative to Fiscal Year 2005, and $38 billion over the
next five years below what is needed to maintain the status quo. It
actually matches the budget President Bush sent to Congress last month,
which called for the elimination of 48 education programs worth $4.3
billion. These cuts will include $1.3 billion less for vocational
education, as well as less funding for elementary, secondary, and
college aid programs.
It also fails to protect and strengthen Social Security. It calls for
spending every penny of the Social Security Trust Fund surplus to
continue to help finance record deficits and continued tax breaks for
the wealthiest Americans. Unlike the alternative budget plan I voted
for, the House-passed budget plan contains no budget enforcement
mechanisms to protect the current surplus Social Security Trust Fund.
Instead, President Bush and the supporters of this budget resolution
advocate a Social Security privatization scheme that would weaken
Social Security upon which so many elderly and disabled Americans
depend just to make ends meet. In fact, there is not one cent in the
House-passed budget plan to meet any of the $754 billion price tag
needed between now and 2015 to create private accounts.
Third, the House-passed budget resolution is incomplete and
misleading. It does not address the ongoing costs of the U.S. military
occupation of Iraq and the war on terrorism. Then, the budget also
invokes an assumption that economic growth will reduce deficits. In
fact, it fails to show any deficit figures at all after 2010. Budgets
should not be based on wishful thinking.
How is that we confront both increased deficits and serious program
cuts in the same budget? Because the majority party in this Congress
continues to push tax cuts for those who need them the least. The
results are growing inequity in American society and mounting anxiety
in financial markets.
I believe this Congress can and should make better choices and adopt
a much more balanced and fiscally responsible alternative budget plan--
one that more closely reflects the values of most Americans, the
sacrifices of our men and women in uniform, and the aspirations of our
children. That is why I voted for the alternative budget plan offered
by my colleague, U.S. Representative John Spratt of South Carolina. Had
it been adopted, it would have insisted upon more fiscal discipline
with budgets that pay as you go this year and beyond. It would have
offered more help and hope for all Americans to achieve greater
financial security. That means investing more in the American people
and in deserving programs to help create good-paying jobs, improve
education, lower healthcare costs, make college more affordable, grow
small businesses, keep faith with our veterans and military families,
protects our homeland, and promotes environmental sustainability.
In so doing, we could build upon what has worked in the past when our
economy was growing by leaps and bounds and creating millions of new
jobs, as recently as the 1990s. We could abandon the fraud of supply-
side economics, once and for all, step up, and reassert control over
shaping our preferred economic future--one that offers more good jobs,
a higher standard of living, and real economic opportunity for all of
the American people. Sadly, this budget resolution takes us farther
down the wrong track.
If we want to strengthen our economy again, in the future, if we want
to create new, good-paying jobs for all of our people, and promote
broad-based, sustainable economic development, then I believe we must
become more creative and provide more support from the public and
private sector for cutting-edge research and development. We have to
stop borrowing and spending. We have to stop eating our seed corn. We
have to provide increased and more sustained support from the public
and private sectors for basic research and development.
Up to now, America has always been a nation of explorers, creators,
and inventors. We need to regain that edge and ride a new wave of
research and follow-on commercial development into a new age of
economic growth and prosperity. But the budget resolution approval in
the House last week does none of this. The supporters of the Republican
budget plan don't want to keep faith and invest in the American people,
increase federal support for research, development, and entrepreneurial
drive, and rebuild American competitiveness in the global economy. If
they did, they could not in good conscience have voted for the skewed
priorities of the recently-approved budget resolution and the
Draconian, counterproductive cuts it will dictate.
Ms. HERSETH. Madam Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mrs. Biggert). Without objection, the
previous question is ordered on the motion to instruct.
There was no objection.
The SPEAKER pro tempore. The question is on the motion to instruct
offered by the gentlewoman from South Dakota (Ms. Herseth).
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Ms. HERSETH. Madam Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further
proceedings are postponed.
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