[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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