[Congressional Record Volume 151, Number 106 (Friday, July 29, 2005)]
[Senate]
[Pages S9541-S9544]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 SENATE CONCURRENT RESOLUTION 49--EXPRESSING THE SENSE OF THE CONGRESS 
WITH RESPECT TO THE IMPORTANCE OF MEDICAID IN THE HEALTH CARE SYSTEM OF 
                               OUR NATION

  Mr. Kennedy (for himself, Mr. Rockefeller, Mr. Baucus, Mr. Bingaman, 
Mr. Reid, Mr. Durbin, Ms. Stabenow, Mrs. Murray, Mr. Corzine, Mr. 
Schumer, Mr. Jeffords, Mr. Obama, Ms. Landrieu, Mr. Harkin, Mr. Reed, 
Mr. Sarbanes, Mr. Kohl, Mr. Dorgan, Ms. Cantwell, Mrs. Clinton, Mr. 
Wyden, Mr. Feingold, Mr. Nelson of Florida, Mrs. Feinstein, Mr. Biden, 
Mr. Dayton, Mr. Levin, Mr. Kerry, Mr. Johnson, Mrs. Lincoln, Mr. 
Lautenberg, Ms. Mikulski, Mr. Salazar, Mrs. Boxer, Mr. Pryor, Mr. Dodd, 
Mr. Bayh, Mr. Liberman, Mr. Conrad, Mr. Inouye, Mr. Akaka, Mr. Leahy, 
Mr. Byrd, and Mr. Carper) submitted the following concurrent 
resolution; which was referred to the Committee on Finance.

                            S. Con. Res. 49

       Whereas Medicaid was signed into law by President Lyndon B. 
     Johnson in Independence, Missouri, on July 30, 1965, as title 
     XIX of the Social Security Act;

[[Page S9542]]

       Whereas under the Social Security Act, two programs were 
     established to provide health insurance: Medicare for the 
     elderly and Medicaid for the poor;
       Whereas Medicaid is one of the Nation's major public health 
     insurance programs, providing health and long-term care for 
     more than 58 million Americans, including children, pregnant 
     women, individuals with disabilities, and the elderly who are 
     poor and frail;
       Whereas Medicaid serves in a counter-cyclical role during 
     economic downturns and during the recent economic slump 
     between 2001 and 2002, Medicaid enrollment grew by three 
     million people who, if not for Medicaid, would have become 
     uninsured;
       Whereas Medicaid is the most efficient payor in the market 
     such that the average growth rate for Medicaid costs was 
     nearly 7 percent per enrollee, substantially lower than the 
     12.6 percent growth in employer-sponsored insurance premiums 
     from 2000 to 2003;
       Whereas Medicaid provides health coverage to more than one 
     in four of the Nation's children and those children represent 
     nearly half of all Medicaid enrollees;
       Whereas studies have found that children enrolled in public 
     health insurance programs experienced substantial improvement 
     in school attendance and behavior and increased engagement in 
     normal childhood activities;
       Whereas Medicaid is an important source of health care 
     coverage for women in general, and low-income women in 
     particular, in that women are twice as likely to qualify for 
     Medicaid than men, women constitute over 70 percent of the 
     adult beneficiaries, and one in five low-income women are 
     covered by Medicaid;
       Whereas Medicaid plays a particularly critical role for 
     women of childbearing age in that Medicaid is the primary 
     provider of necessary prenatal care for low-income pregnant 
     women and covers nearly 40 percent of all births in the 
     United States;
       Whereas Medicaid is an important source of financial help 
     for more than 7 million Medicare beneficiaries living in 
     poverty by paying their Medicare premiums and cost sharing, 
     and covering the costs of other essential services not 
     provided by Medicare, such as dental care, long-term care, 
     and vision care;
       Whereas Medicaid is a lifeline for individuals living with 
     disabilities, providing health insurance coverage to 
     approximately eight million, or one-in-five, 
     noninstitutionalized, non-elderly people who have specific, 
     chronic disabilities, and is often the only source of health 
     care for individuals with spinal cord injury, mental illness, 
     and other disabling conditions such as cerebral palsy, cystic 
     fibrosis, Downs syndrome, mental retardation, muscular 
     dystrophy, autism, spina bifida, and HIV/AIDS;
       Whereas Medicaid reduces disparities in health care 
     delivery to racial and ethnic minorities, who make up 
     approximately one-third of the total United States population 
     but constitute more than half of those who receive health 
     care through Medicaid and, without Medicaid, racial and 
     ethnic minorities would make up a disproportionate number of 
     Americans who are uninsured;
       Whereas Medicaid plays a critical role in ensuring that 
     Americans living in rural areas receive health care insofar 
     as residents in rural counties are 50 percent more likely to 
     have Medicaid coverage than residents in urban counties and 
     Medicaid covers nearly 30 percent of children in rural areas 
     compared to less than 19 percent of children in urban areas; 
     and
       Whereas Medicaid's protection against high out-of-pocket 
     expenses for vulnerable, low-income Americans has encouraged 
     and increased access to necessary health care and more than 
     40 percent of low-income adults who are under the age of 65, 
     when forced to pay cost sharing, will choose to forego 
     medical visits for clinically effective health care and low-
     income children receive 44 percent fewer clinically effective 
     health care services: Now, therefore, be it
       Resolved by the Senate (the House of Representatives 
     concurring), That it is the sense of the Congress that--
       (1) over the past four decades Medicaid has been a core 
     component of the American health system;
       (2) Medicaid has ensured that the vast majority of Medicaid 
     beneficiaries did not join the ranks of the current 45 
     million Americans with no health insurance; and
       (3) Congress must continue and strengthen the State-Federal 
     partnership that provides this vital health insurance 
     program.

  Mr. KENNEDY. Mr. President, this Saturday marks the 40th anniversary 
of Medicaid. Over the past 4 decades, Medicaid has provided quality 
health care to millions of the most vulnerable members of our society--
low-income children and parents, pregnant women, disabled persons, and 
senior citizens. While anniversary should be a time to celebrate the 
progress we have made in improving the health of those who are less 
fortunate--but instead, we find ourselves defending the program against 
harsh cuts that will destroy the health security of many of our fellow 
citizens.
  Medicaid has served the Nation well over the past 40 years. It 
provides a critical safety net for those with nowhere else to turn for 
health care. The majority of Medicaid beneficiaries are too poor or too 
sick to buy coverage in the private market. Many have disabilities or 
multiple chronic conditions, or need long-term care. Others have severe 
mental health problems. More than 50 million people receive health 
coverage under Medicaid today, and most of them would be uninsured and 
uninsurable without it. States have significant flexibility to design 
Medicaid programs that meet the needs of their residents, with 
important Federal oversight to make sure that minimal standards are 
maintained.
  Today, Medicaid covers nearly 40 percent of all births. It provides 
health coverage for one in four children. It's Early and Periodic 
Screening, Diagnosis, and Treatment benefit has been a success in 
making sure that children receive the care they need.
  Medicaid also provides prenatal care for many low-income women, and 
it fills in the gaps in coverage for low-income seniors and disabled 
persons, covering long-term care services that are not covered by 
Medicare. It is also a major source of coverage for mental health and 
substance abuse care and is the largest payer of services for AIDS 
patients.
  Medicaid enrollment has grown rapidly over the past few years as more 
and more Americans not only lost their jobs but lost the health care 
their employers offered. Low-income working families increasingly lost 
coverage as employers dropped coverage or couldn't afford it, because 
health costs soared while wages stagnated. It's true that Medicaid 
costs have risen over the past few years, but this growth is driven 
primarily by increased need. Medicaid does its job well--responding to 
economic downturns and providing a health safety net for those with 
nowhere else to turn.
  Yet Medicaid is once again under attack by some who want to undermine 
the progress we have made. This year's budget mandates mean-spirited 
cuts in the program under the guise of balancing the budget, even 
though the very same budget includes large new tax breaks for the 
wealthy. These cuts were ordered even though a bipartisan majority of 
Senators voted against them.
  Any changes in Medicaid should be made to improve the care offered to 
its beneficiaries, not to pay for even greater tax breaks for the 
wealthy. We need to consider ways to improve Medicaid and make it 
function more effectively, and we can't accept reforms that do 
otherwise. Cutting benefits or increasing costs for the poor will keep 
them from getting the care they need, and cost the Nation far more in 
the long-run.
  Cutting health care for those who rely on Medicaid has real 
consequences. We know what limiting their access to care will do: it 
will result in more pain and suffering; it will lead to more deaths 
because treatable diseases will be diagnosed too late; it will lead to 
emergency rooms overcrowded with patients with no where else to turn; 
and it will lead to increased costs for those with health insurance, as 
they are charged more to make up for the cost of covering those with no 
insurance.
  I look forward to celebrating many more Medicaid anniversaries. My 
hope is that we will continue to improve and modernize the program, not 
abandon it. We need to make it work for those it serves, especially the 
millions of low-income children who will grow up to healthy adults 
tomorrow, because we kept the faith with Medicaid today.
  Mr. CORZINE. Mr. President, tomorrow marks the 40th Anniversary of 
the Medicare and Medicaid programs. On July 30, 1965, President Lyndon 
Baines Johnson traveled to Independence, MO to sign the Medicare and 
Medicaid programs into law. That day, President Johnson signed a 
contract with the citizens of this country. The contract states that 
our Nation recognizes that health care is a fundamental human right and 
that a just society will marshal resources to provide basic medical 
care for those most in need. Forty years later, the Medicare and 
Medicaid programs continue to abide by that contract, providing 
government safety nets that keep the elderly, disabled, and 
economically disadvantaged from falling into the ranks of the 
uninsured.
  In passing legislation to establish the Medicare program, Members of 
this

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body took a courageous step by guaranteeing health insurance coverage 
to seniors and people with disabilities--regardless of a person's 
income and regardless of a person's illness. Medicare is a commitment 
to America's seniors that if you are over 65 or disabled, no matter 
what your income, we will stand by you and you will get the health care 
you need.
  Before the Medicare program was established, nearly 50 percent of 
seniors lived their golden years without health coverage. Seniors were 
forced to choose between a trip to the grocery store and a visit to the 
doctor's office. Today, because of Medicare, 98 percent of older 
Americans have access to and can afford to get the medical care they 
need. Of the forty-two million Americans currently covered by Medicare, 
including 35 million seniors and 6 million people with disabilities or 
end-stage renal disease, 1.3 million live in my home State of New 
Jersey. I've spoken with many of those beneficiaries from throughout my 
State and it's clear there is great uncertainty about what the future 
of Medicare holds for beneficiaries.
  On the 40th Anniversary of the Medicare program, we should be 
cheering the dramatic impact Medicare has had on the health and 
wellbeing of this country. Yet, I would be remiss if I failed to 
mention the real fear I have that Medicare beneficiaries will be in for 
a rude awakening early next year. This coming January, a prescription 
drug benefit will be added to the Medicare program. Since the day I 
joined the Senate, I consistently supported ensuring seniors access to 
affordable prescription drugs by adding prescription drug coverage to 
Medicare. In June, 2003, I was one of 76 Senators to vote to pass 
legislation to establish a comprehensive, affordable prescription drug 
benefit under Medicare. While bill was not perfect, on the whole the 
legislation would have been good for Medicare beneficiaries in New 
Jersey and those across the Nation. Yet, Mr. President, the bill that 
came back from House-Senate conference and was ultimately signed by the 
President does more harm than good.
  For most New Jersey beneficiaries, the prescription drug plan set to 
take effect January 1, 2006 is neither affordable, nor comprehensive. 
It will cost seniors $3600 for $5,000 in drug benefits, will result in 
over 90,000 New Jersey retirees losing their drug coverage from their 
former employers, and could force nearly 200,000 New Jersey seniors out 
of Medicare as they know it into private HMOs.
  Most troubling is the impact that the prescription drug plan will 
have on low and middle income beneficiaries in my state. My colleague 
Senator Lautenberg and I worked hard to save New Jersey's PAAD and 
Senior Gold programs--which the original Republican plan would have 
scrapped. But unlike New Jersey's PAAD and Senior Gold programs, the 
Medicare plan will have drug formularies that will restrict seniors' 
access to certain drugs. This means that a senior in PAAD or Senior 
Gold who now has complete prescription drug access may face limited 
drug access or substantially higher costs for their drugs.
  One of the few bright spots that came of the Medicare prescription 
drug bill is the establishment of a ``Welcome to Medicare'' physical 
exam for new beneficiaries. For the majority of Medicare beneficiaries, 
this program has been a treatment program, not a preventive health 
program. Instead of covering preventive services like colonoscopy, 
cardiovascular screenings, and wellness programs that keep 
beneficiaries healthy, Medicare has traditionally focused more on 
treating the patient once he or she gets sick. We need to continue to 
promote prevention, instead of just reacting to illness, under the 
program. Not only will a focus on prevention keep our beneficiaries 
healthier and more independent, but the imminent retirement of the baby 
boom generation will continue to drive the costs of the program higher. 
The simplest way to constrain Medicare spending while also keeping 
Americans in their home and out of the hospital is to advance the 
program's focus on providing coverage of preventive health services.
  I have no doubt that expanding Medicare coverage to include 
preventive measures will continue to improve the health and wellbeing 
beneficiaries. On the whole, however, I have grave reservations about 
the impact that the new prescription drug plan will have on what has, 
for 40 years, been a reliable and affordable health coverage program 
for this country's elderly and disabled citizens. One of the guiding 
principles of health care is, ``do no harm.'' My real fear is that the 
prescription drug plan will seriously undermine the Medicare program by 
shifting costs and limiting access to lifesaving services. These terms 
were not part of the contract President Johnson signed to establish 
Medicare.
  Forty years ago, along with the Medicare program, President Johnson 
signed legislation establishing Medicaid. This health insurance program 
was designed to keep the Nation's most vulnerable populations--the 
poorest and sickest, from falling onto the rolls of the uninsured. 
Medicaid is based on the proposition that the health of a nation should 
be judged by the health of its people. For the last 40 years, Medicaid 
has provided health care for 105 million Americans with disabilities, 
working families, the elderly, children, and pregnant women. The 
success of this federal-state partnership is a tribute to President 
Johnson and the members of Congress who were brave enough to recognize 
that, in the world's richest country, basic medical care should be a 
right, not a privilege.
  The Medicaid program has grown and evolved from a safety net program 
to the primary source of care for millions of Americans. Today, 
Medicaid provides vital health care services more than 53 million 
Americans. For millions of low-income children and families, including 
500,000 children in New Jersey, Medicaid covers primary and preventive 
health care services that they otherwise could not afford. Medicaid 
provides crucial primary care health services for children with 
disabilities. And as my colleagues know, Medicaid is the Nation's 
largest payer of nursing home and other long-term care services. The 
amazing thing about Medicaid is the fact that the program covers people 
who can't get health coverage anywhere else, and it does so at a 
fraction of the cost of other programs. A recent study found that the 
cost of serving an adult in Medicaid in 2001 was about 30 percent lower 
than if that same person were instead covered by private health 
insurance. And Medicaid spends about half as much on administrative 
costs as private insurance. In 2003, only 6.9 percent of Medicaid costs 
were administrative expenses compared to 13.6 percent for private 
insurance. It is truly remarkable that Medicaid is able to do so much 
for so many Americans.

  As we take time to celebrate the dramatic success Medicaid has had in 
covering our most vulnerable populations, we must be cognizant that 
there is much more to do and that the program itself is vulnerable. 
Clearly, Medicaid does a remarkable job covering Americans who would 
otherwise be uninsured, but the reach of the program is becoming more 
and more limited. Forty-five million Americans were uninsured at some 
point during the past year. For many of these Americans, their primary 
source of care is hospital emergency rooms. Many could have been kept 
out of the hospital emergency room if they had access to basic health 
services under Medicaid, and this could have been achieved at a 
fraction of the cost. Yet, arguing that the program is rife with waste, 
fraud, and abuse, Republicans passed a budget earlier this year that 
cuts $10 billion out of the Medicaid program. Clearly, there's always 
room for improvement, and I don't think there is a member of this body 
who believes we shouldn't rid the program of any waste, fraud, and 
abuse that exists. However, I have seen no credible evidence to 
convince me that there is $10 billion in savings to be had from such 
efforts. Instead the evidence suggests that $240 million of the $10 
billion in cuts will come directly from the New Jersey Medicaid 
program. For $240 million, New Jersey could cover 100,000 more 
children, 17,000 more seniors, or 12,000 more residents with 
disabilities. Instead of expanding the Medicaid program to these 
populations, the $10 billion in cuts will likely come at the expense of 
beneficiaries--pregnant women, children, and people with disabilities--
people who rely on the program for their basic medical needs.
  Dramatic changes to Medicaid based not on sound public policy but on

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achieving $10 billion in savings would be a grave mistake. It would be 
a huge step backward for Medicaid beneficiaries in New Jersey or across 
the country. It simply is not possible to cut $10 billion from the 
Medicaid program without chipping away at the foundation on which the 
program is based. Make no mistake about it, in a federal-state 
partnership such as this, cutting $10 billion from Medicaid means 
taking $10 billion away from the States ability to cover their 
uninsured. It means that States will be left with the tough choices of 
decreasing reimbursements to providers, eliminating services like 
prescription drugs and specialized services for the mentally ill, or 
raising taxes to preserve these services.
  The most egregious aspect of the proposed Medicaid cuts is that these 
cuts come in a budget that includes the $204 billion cost of making 
permanent the President's tax cuts for millionaires. How do we, as 
legislators, look hard-working Americans in the eye and tell them 
honestly that we can't afford $10 billion for health coverage for low-
income Americans, but we can afford $204 billion in tax breaks for the 
most well-off? Is this the same legislative body that recognized the 
social value of offering a helping hand to those who could otherwise 
not help themselves? Instead of tax cuts for those Americans least in 
need of tax cuts, we should be preserving and expanding access to 
health care for our Nation's most vulnerable by maintaining our Federal 
obligation to the States to pay our fair share for these services.
  As we celebrate the 40th anniversary of Medicare and Medicaid, we 
must recognize that some of those who have urged the dismantling of 
these programs are the same people who argue that these programs are 
the epitome of big government run amuck. On the contrary, Medicare and 
Medicaid are government at its finest. For 40 years, these programs 
have been examples of government up to the plate to provide a lifeline 
for citizens who would otherwise fall through the cracks of society. On 
July 30, 1965, Medicare and Medicaid were the vision of a stronger, 
healthier, more prosperous America. We must continue to share this 
vision today, as we have for the past 40 years.

                          ____________________