[Congressional Record Volume 151, Number 62 (Thursday, May 12, 2005)]
[House]
[Pages H3246-H3249]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MAKING HEALTH CARE ACCESSIBLE AND AFFORDABLE
The SPEAKER pro tempore (Mr. Jindal). Under the Speaker's announced
policy of January 4, 2005, the gentleman from Georgia (Mr. Gingrey) is
recognized for 60 minutes as the designee of the majority leader.
Mr. GINGREY. Mr. Speaker, it is indeed a coincidence today that
Democrats in their one hour special order would be led by a Georgian,
my colleague, the gentlewoman from Georgia
[[Page H3247]]
(Ms. McKinney), and the Republican hour today would be led by myself,
another Georgian. I am really, of course, pleased to have this
opportunity.
I am going to talk on an entirely different subject to my colleagues,
Mr. Speaker, than what we just heard for the previous hour. This time
is dedicated really to the Republican Conference Health Care Access and
Affordability Public Affairs Team. We put together this team for the
purpose of letting our colleagues know, letting the American people
know, that the Republicans care deeply about the health of this Nation,
particularly in regard to those who are the neediest, whether they are
white, black or Latino. It does not matter. People in this country who
need health care that really cannot afford it, who are struggling
through no fault of their own, we are deeply committed to solving these
problems, whether we are talking about Medicare, Medicaid or Social
Security for that matter.
These are the so-called entitlement programs, the mandatory spending.
When we talk about a budget for fiscal year 2006 of $2.6 trillion, two-
thirds of that budget goes to mandatory spending. That means those who
meet eligibility requirements, obviously Social Security retirees and
disabled and widows and dependent children; the Medicare program, you
are 65; or you are younger than 65 and you are disabled, the Medicaid
program; or you are poor.
{time} 1600
And you do not have the means or the wherewithal to purchase private
health insurance or maybe you do not have a job, you do not have an
employer that provides health insurance for you. These are the people
who meet those eligibility standards, and that is called mandatory
spending; and it includes two-thirds of our Federal budget. We have a
huge problem with the growth in those numbers because, as our
population grows, there are more and more people who are struggling who
become eligible for one of these three mandatory benefits. It is
becoming a tremendous strain on this country.
Tonight I will focus primarily on the Medicaid program, because our
States are in such dire economic stress because of Medicaid, which is a
joint Federal-State program, a shared program, if you will.
The President, during the last couple of months, has spent a lot of
time talking about the Social Security program. My colleagues know that
he has been going all over this country trying to explain to the
American people that we are in a real crisis; and certainly, at least I
think everybody would agree, there is a serious problem with Social
Security because of demographics, because of the fact that thankfully,
thankfully, people today are living longer and they are healthier.
As the baby boomers fully mature and that starts the first wave, the
leading edge of that wave is upon us in 2008, and as they fully mature,
we go from 45 million Social Security beneficiaries today to within 10
or 15 years to having 77 million. And trying to fund that program with
a payroll tax that has not increased in a number of years, it is a
tremendously difficult problem; and it needs to be solved. It is not
something we can put off for other Congresses.
I hear from some of my colleagues, particularly on the other side of
the aisle, well, it is not that bad of a problem; why do we not just
kind of wait awhile and let somebody else deal with it. I mean after
all, 2006 will be upon us pretty soon, and it is the next election that
is most important, not the next generation.
I certainly do not agree with that, and I know this President and
this Republican leadership does not agree with that at all.
But what we are hearing a lot of times is, well, why are you focusing
on Social Security when we have these huge problems with Medicare and
Medicaid? I know my colleagues on both sides of the aisle have heard
that argument. The point, of course, is that we have focused on
Medicare, and I am very surprised at how quickly they forget. It was,
after all, just December of 2003 when this body, this Congress, in a
bipartisan fashion, passed the Medicare Modernization and Prescription
Drug Act. That prescription drug part of Medicare, of course, does not
become operational until January of next year, 2006. So we have not had
an opportunity to see what benefits that will bring to the program.
We have had an interim program, I think, that has worked very, very
well. It is called the Transitional Medicare Prescription Drug Discount
Card program. All of my colleagues, Mr. Speaker, remember that, the
1\1/2\ to 2-year program, before we get started in the part D
prescription drug premium-based, voluntary part of Medicare next year,
to give immediate relief, as we did in December of 2003, to let our
seniors obtain, for no more than $30 a year and, in most instances, a
free Medicare prescription drug discount card, which would allow them
to go to the drugstore with those four or five prescriptions that their
doctor had written for high blood pressure or control of their blood
sugar so their diabetes did not get worse, or something to prevent
osteoporosis, or to, as I say, lower blood pressure and cholesterol.
So when they went to the drugstore, they were not paying sticker
price. They were getting the same kinds of discounts, competitive
discounts that people who were working and had employer-sponsored
health care, maybe under an HMO, and they got deep discounts on their
drug prices.
This is what the discount program, the transitional program brought
to our neediest seniors; and, in fact, those living at or below the
Federal poverty level were credited on that card. It became not a
credit card, but a debit card; and they got $600 a year for those two
years, 2004 and 2005, a total of $1,200 that they could apply to the
cost of their prescription medication.
There were other things, Mr. Speaker, and I know my colleagues
remember that. If not, hopefully, this will be a reminder. For the
first time ever under the Medicare program, new beneficiaries, those
just turning 65, were having the opportunity to go to their doctor, to
their general doctor, their internist, their family practitioner and
having a complete, thorough, head-to-toe physical examination. In the
past, Medicare did not pay for that. You could only get reimbursed for
a doctor visit if you were sick, if your nose was bleeding, if you had
pain in your chest from a coronary and you were staggering because you
were about to have a stroke, or you showed up in the emergency room.
But just to have a routine physical to find out, hey, is everything
okay, to get your blood pressure checked and have that cholesterol
level determined, and the screening procedures, or maybe if you had a
mammogram to rule out a very early breast cancer; these things were not
covered under Medicare.
But under this leadership, this Speaker, this Republican-led
Congress, this President brought, in December of 2003, the Medicare
Modernization and Prescription Drug Act.
So for everybody to suggest that this Congress is not focused on
health care and has done nothing and is wasting our time trying to
solve the Social Security problem is just absolutely untrue; and I
think fair-minded Members of this body, whether Republicans or
Democrats, know that. They know that. They know that we have devoted a
lot of attention to Medicare. It remains to be seen, really, how that
program is going to work.
All we hear from the opposition is, oh, well, you know, it is going
to cost a lot. They misled us, they lied to us, they said it was only
going to cost $395 billion, and now it is going to cost $750 billion. I
do not know what the true cost is, but I do know this: when, Mr.
Speaker, the Congressional Budget Office is calculating the expense of
the program, they are talking about what it is going to cost to provide
a prescription drug benefit, even though it is premium-based. Like part
B, sure, there will be a cost to the taxpayer. The part B Medicare
program, Mr. Speaker, a lot of people probably do not realize this, but
the premiums, even though they have gone up every year since 1965, and
now are approaching $80 a month, they only cover 25 percent. The
general fund taxpayers are supporting 75 percent of that cost.
So the prescription drug program will be very similar to that. There
will, indeed, be a cost. But what is so misleading is no credit
whatsoever is given to the fact that if a person is taking a blood
pressure medication to keep them from having a stroke, if a person can
now afford to go to the drugstore
[[Page H3248]]
and get Lipitor or Pravachol or one of these statin drugs to lower
their cholesterol and avert the need for open heart surgery, or someone
is able to take Glucophage or insulin so that that diabetic condition
does not get so bad that it destroys their kidneys or causes blindness
or causes peripheral vascular disease to the point that they need an
amputation of a limb or renal dialysis or maybe even a kidney
transplant; all of those things, by the way, are currently today
covered under Medicare, but extremely expensive.
If we can prevent that by allowing our seniors, our neediest seniors
to afford the medication and treat these diseases in a timely fashion,
then we save money on part A, being the hospital, the nursing home
care, for those who have had a stroke and maybe have to spend the rest
of their lives in a nursing home; part B would be the fee that the
cardiothoracic surgeons charge to do open heart surgery. We save that
money, yet you get no credit, you get no score for that. But, Mr.
Speaker, surely, if this program is going to work and if it makes
sense, and it certainly makes sense for this physician Member of this
body and, furthermore, it is the compassionate thing to do.
So, indeed, to suggest that the Republican majority in this body, led
by our Speaker, the gentleman from Illinois (Mr. Hastert), and that
President Bush and his administration do not care about health care and
have ignored and narrowly focused on Social Security and forgotten
about the needy in this society regarding health care, it is just
absolutely, Mr. Speaker, absolutely untrue. I think, again, fair-minded
Members of this body on both sides of the aisle would readily admit
that.
Now, I spoke at the outset of this hour of the Republican Conference
on Health Care, Access, and Affordability Public Affairs Team. That is
us; that is me. I am taking all of the time this evening, but we have a
strong team. We are not just health care providers, although many of us
are physicians and dentists and other people involved in health care. I
wanted to take this time to share with our colleagues our vision and
our focus and what we are doing to try to make sure that we have a good
policy that is fair and balanced and that we are taking care of those
who are in most need in regard to health care.
Mr. Speaker, one of the huge problems right now, of course, is the
Medicaid program. Again, this is part of our entitlement spending, the
mandatory spending, as I outlined at the beginning of the hour, the
two-thirds of the Federal budget. Medicaid is a Federal-State program,
with the Federal Government actually paying, in most cases, more than
the State does, to provide health care for the neediest in our society,
especially for children and single mothers. It is a great program. It
has served us very, very well. In fact, I have a slide, Mr. Speaker,
that I will get up in just a few minutes and I would like to point out
how that Federal-State match works.
It is based, really, on average income in a State. A State with a
lower average income, a poor State, there is going to be a higher
Federal percentage; and the parameters range from a 50-50 participation
to 80-20. And if we can focus on this chart to my left, this is not all
of the States; I think I was informed that the machine broke and they
were not able to get but about half of the States on the chart. But it
does include my State of Georgia; and last year in Georgia, the Federal
match was 60, almost 60.5 percent, and the anticipated match for the
fiscal year 2006 is 60.6. So in Georgia it is about a 60-40 split.
I was looking for Mississippi, which I think is probably one of the
States that has the lowest per capita income where the Federal match
actually approaches the maximum 80 percent.
{time} 1615
It is not on this board. But I think the Federal match in the State
of Mississippi is about 78 percent. But it varies. Alabama is here,
70.1 percent Federal participation in 2005. And in 2006, that dropped
down to 69.5 percent. There are other States, like I say, that are 50/
50. Illinois, as an example, is 50/50. The State of Massachusetts is
about 50/50.
Mr. Speaker, this is the way it should be. We should indeed
participate more for those States who have the greatest need. One
thing, though, that really concerns us, and I think one of the main
problems with the Medicaid system, is that there is a significant
amount of waste and abuse of the system. And yes, in fact, Mr. Speaker,
in some instances, downright fraud. And if a State is a 50/50 state,
there may not be much advantage to take an advantage of the system. But
if the State has a higher Federal match than the State match, you can
see that if you are abusing the system, gaming the system, if you will,
then there is an advantage because you are pulling down more Federal
dollars than you are spending at the State level.
And so these are some of our problems, of course, that we are facing
now with the Medicaid program. The spending is growing more, of course,
in times of economic stress and distress. And we have gone through a
lot of that in the last several years, particularly since 9/11. And of
course the population growth, you are going to have more people who are
legitimately eligible for this care. So the spending is going to go up.
But we want to make sure that we get dollars to those who are in need
and not to those who are in greed, if you will. And that is very
important.
And there will be a very strong focus on Medicaid reform, led, quite
honestly, by the governors, by the Governors Association, both
Democratic and Republican governors. They have been here. They have
talked to the President. They have talked to Congress. They have some
very good ideas of how to make this system work better and make sure
that those who have the greatest need have access to those Medicaid
dollars.
I wanted, Mr. Speaker, to share with my colleagues just a few numbers
about the magnitude of really what I am talking about. In the year
2002, the total Federal dollars spent on the Medicaid program, now this
is just the Federal dollars, $140 billion. That is in the year 2002. In
the year 2004, that number has gone up to $184 billion. You know, we
are talking about significant increases. From 2001 to 2002, the Federal
spending Medicare increased 8 percent. From 2002 to 2003, it was about
9 percent. From 2003 to 2004, in the same range. And on and on and on.
So when people say to me from back home, Congressman, do not cut
Medicaid spending because, you know, you are affecting my program. And
that could be a physician talking about, you know, his or her
reimbursement. It could be a hospital. It certainly is likely to be one
of these rural hospitals that is called a disproportionate share, which
means their clientele is disproportionately weighted toward the
Medicaid program because they are a poor community. And they are
concerned, and I understand that.
But what the President did in the 2006 budget that he submitted to us
was to cut a certain number of Medicaid dollars over a 5-year period of
time. What we have done here in the Congress, the President recommends,
and then we legislate. We make the final decision. And it looks like we
are going to have a Medicaid funding cut over the next 5 years of $10
billion. That is $2 billion a year but that, we hope and I feel very
confident, we can find those savings by eliminating this situation that
I described, waste, fraud and abuse.
Now, let me just give you one example, Mr. Speaker, and I want to
share that with my colleagues, the nursing home situation, long-term
care in a skilled facility. Medicare, under Part A only covers a
certain number of days. I think it is something like 100. And after
that, the patient is pretty much on their own, and that has to come out
of their pocket. If they do not have long-term care insurance, and most
people do not, we are trying to address that. This Congress is trying
to address that, the Republican leadership, and that is why we put
health savings accounts in the Medicare modernization bill of December
2003, so that that money in those accounts can be used without any tax
penalty whatsoever to purchase long-term health care insurance. But
most people do not have that today. And if a loved one ends up in a
nursing home, then once those Medicare dollars, those days of
eligibility are utilized, and the person has no other resources, they
become what is known as dual eligible because they
[[Page H3249]]
have no wealth and no source of income, then all of a sudden they are
eligible for Medicaid.
So, the reality today, my colleagues, is that probably 70 percent of
nursing home reimbursement is from the Medicaid program. Now, some of
that is appropriate. But some of it is inappropriate.
And indeed, there is actually a cottage industry out there where our
good attorneys advise people how to hide their income, how to shift
their possessions and their net worth to maybe another family member,
and all of a sudden they have got nothing. They do not have any wealth.
They do not have any income, and they are dual eligible for Medicaid.
That, my colleagues, is what I call gaming the system. And when you do
that, you take money away from the program, desperately needed money
for single moms, for the poor who need prenatal care, for little
infants that are born prematurely that need a good start in life, and
they cannot get it because there is no money there.
This is something that we, the Republican majority, and hopefully in
a bipartisan fashion with our colleagues on the other side of the
aisle, we are giving very serious attention to it. And yes, we can walk
and chew gum at the same time. We can work on the Social Security
problem and fix that, get out of that crisis situation and work on
solving the Medicaid problem at the same time. Absolutely, we can. We
will. We are doing that, and we will get to the finish line on both of
these programs, and we will do it sooner rather than later.
We will not be irresponsible on these issues and put this off and
say, Hey, you know, we do not want to touch that third rail because we
are worried about our re-election in 2006 and keeping our majority. We
are going to keep our majority by doing the right thing. And we will
let the elections take care of themselves.
But we have to make sure that we understand, the American people
understand, and that we do not let the nay-sayers poison the well like
they tried to do on that Medicare discount card.
I was at a little town hall meeting in one of my poorest counties
recently in Southwest Georgia, Talbot County, a great community,
wonderful people, but poor, very low tax base. And we were talking
about Social Security. Miss Menafee came up to me after the hour and a
half town hall meeting, and she said, Congressman, thank you for that
information on Social Security. I think I really understand it better
now. I have been getting those automated phone calls and those slick
glossy mailers. I do not know whether they were from AFL-CIO or George
Soros and some 527, but thank you, Congressman for helping me
understand it better, to see how an individual personal account can
grow and have the miracle of compound interest. But I just want to say
to you, also, thank you for Medicare modernization. And thank you from
the bottom of my heart for that prescription drug discount card, that
transitional program.
Miss Menafee told me that she had been spending something like $400 a
month for five or six drugs that she desperately needed, and because
she was eligible for that $1,200 credit and the lowest pricing, in
fact, I think maybe a dollar, $3 copay, she said she had reduced over
$400 a month worth of medical expenses to $9 a month.
Miss Menafee, God bless you. And she is 80 years old and looks
healthy, and I think she is going to outlive us all because of what we
did. So that is the compassion. That is the thoughtfulness that this
Republican leadership, this majority has in regard to the health care
program.
Mr. Speaker, I guess I could go on probably long beyond my allotted
hour. But I am going to try to go ahead and bring this to a close
because I think, hopefully, my colleagues have heard me loud and clear
and understand that we care about health care. We care about the
uninsured.
We have passed association health plans in this body at least twice,
and we will continue to pass it. We have passed tort reform so that
doctors and hospitals are not ordering all these unnecessary tests. And
every individual that walks into an emergency room with a headache does
not need a CAT scan, but they are getting it because the doctors are
afraid they are going to be sued, or the hospital, and that is why
people cannot afford health insurance.
All that defensive medicine, these additional lab tests, it drives
the price of health insurance up so high that it is out of reach for
far too many people. And we end up with 43 million in this country who
have no health insurance, and most of them are working. But we are
going to help them. Again, we are going to help them by what we have
done in Medicare modernization, give them an opportunity to set up
through their employer a health savings account where they can get
catastrophic insurance for a very low premium, Mr. Speaker, a very low
monthly premium, and then the employer or a relative or a friend can
help them fund an account that can grow, that can enjoy the miracle of
compound interest, that they can use that money for a lot of types of
things that traditional health insurance does not even cover, eye care,
dental care, mental health services, just so many things.
So it is a pleasure to be part of this team, to be here tonight, to
be talking about what we, the Republican health care access team, is
doing.
But, you know, again, I want to make sure my colleagues understand
that I am not an overly partisan person. It is not all about left
versus right or Republican versus Democrat. It is right versus wrong,
and I think we need to focus on doing the right thing, and we ought to
try to do it as much as we can in a bipartisan fashion.
And to that point, Mr. Speaker, I want to let my colleagues know that
we have recently formed a medical/dental doctors in Congress caucus in
this House. There are 13 of us. There are three dentists. There are ten
MDs. Three of those MDs are on the democratic side; seven on the
Republican side. And we are going to work on these issues in a
bipartisan fashion.
You know, I thought yesterday, as we had that plane, that little
Cessna that inadvertently got in the airspace over the Capitol, and we
all went just, I mean, pouring out of here in semi panic, although the
Capitol police did an excellent job of keeping people calm, but, you
know, making sure that we got out of harm's way as quickly as possible.
{time} 1630
You have to take every one of these threats seriously, and I could
not help but thinking as I was running down the street, where are the
other 12 members of our physician and dental doctor caucus?
We probably were all going in a different direction. My co-chairman
of that caucus is the gentleman from Arkansas (Mr. Snyder), Mr.
Speaker, a great Member of this body. The gentleman has been here a
good bit longer than I have been, a fine doctor from Arkansas.
The gentleman and I have been working together. That was one of the
things we were talking about last week. The next meeting we have, we
are going to make sure that we work with the House physician so that
this team would know what we would do in a situation like that so we
were not all going in different directions. Maybe all 13 of us,
hopefully the caucus will grow, I like doctors and dentists in
Congress, but we could go to a designated spot so if this really truly
turned out to be a terrorist attack, we would be part of the solution
and not part of the problem.
Again, as I speak to my colleagues this afternoon and I am deeply
appreciative, Mr. Speaker, of the opportunity to talk about what the
Republican majority is doing on health care, I do not want to forget
that the American people do not like a lot of partisanship and
animosity and, indeed, hatred. We do not accomplish anything in that
fashion. I am very proud to be part of that new bipartisan caucus as we
work towards solving these problems.
____________________