[Congressional Record Volume 151, Number 123 (Wednesday, September 28, 2005)]
[Senate]
[Pages S10578-S10579]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                EMERGENCY HEALTH CARE RELIEF ACT OF 2005

  Mr. McCAIN. Mr. President, I am in the Senate to mention that there 
is ongoing discussions between the Senator from Iowa, Mr. Grassley, the 
distinguished chairman of the Committee on Finance, and a number of 
Members who have been concerned about S. 1716, the Emergency Health 
Care Relief Act of 2005. I fully support the desire of the Senator and 
members of the Committee on Finance to provide health care relief for 
the victims of Hurricane Katrina. We have noted that it has about a $9 
billion price tag, and we have been in ongoing discussions which I 
believe will bear fruit with the Senator from Iowa.
  It is important to know that the administration also objects to S. 
1716, and I ask unanimous consent the letter from Secretary Leavitt be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                           The Secretary of Health


                                           and Human Services,

                               Washington, DC, September 27, 2005.
     Hon. William H. Frist,
     Majority Leader, U.S. Senate,
     Washington, DC.
       Dear Senator Frist: I am writing to express the views of 
     the Department of Health and Human Services (HHS) with 
     respect to S. 1716, the ``Emergency Health Care Relief Act of 
     2005''.
       We understand and appreciate that the intent of S. 1716 is 
     to help provide, in the most timely manner possible, 
     emergency health care relief to the victims of Hurricane 
     Katrina. The Department is strongly committed to this same 
     objective, and we have

[[Page S10579]]

     engaged in our utmost efforts to furnish such relief directly 
     to Katrina victims as well as to support State efforts to 
     provide emergency health care and related services (see 
     addendum below). We believe these ongoing efforts largely 
     preclude the need for the activities proposed under S. 1716. 
     Moreover, we have serious concerns with S. 1716, as 
     enunciated below.
       In addition, the bill spends significant amounts on 
     adjustments to the Medicaid FMAP (Federal medical assistance 
     percentage) for individuals who are not survivors of 
     Hurricane Katrina. We think this is inadvisable and that 
     resources should be targeted to services for these survivors.


                 Title I--Emergency Health Care Relief

       Title I of S. 1716 establishes a new Disaster Relief 
     Medicaid (DRM) program for survivors of Hurricane Katrina. 
     Survivors of the hurricane would be entitled to five months 
     of Medicaid coverage, and the President is given the option 
     to extend the program for another five months. Individuals 
     who were previously receiving Medicaid before the hurricane 
     are deemed eligible for this assistance. In addition DRM 
     eligibility is also available to pregnant women and children 
     with incomes up to 200% FPL, disabled individuals up to 300% 
     SSI, and other individuals with incomes up to 100% FPL. As a 
     result, a new eligibility category for childless adults is 
     established. There are no resource or residency requirements 
     for DRM. DRM recipients will receive the benefits package 
     available to categorically needy beneficiaries under the 
     Medicaid state plan. States may also provide extended mental 
     health benefits and coordination benefits to DRM eligibles, 
     which are not limited to conditions directly resulting from 
     the hurricane.
       The legislation requires a new Medicaid entitlement for 
     Katrina survivors, regardless of whether that will work best 
     for those survivors or the states. This new program is 
     unnecessary. CMS is already acting to meet the health care 
     needs of hurricane survivors through the establishment of a 
     new Medicaid/State Children's Health Insurance Program 
     (SCHIP) waiver program that builds upon existing Medicaid/
     SCRIP eligibility and other program rules to provide 
     immediate, comprehensive relief without the need for 
     congressional action. This waiver program allows individuals 
     who otherwise would be eligible for Medicaid in their home 
     states to receive 5 months of temporary eligibility without 
     going through a complex and burdensome application process. 
     Texas, Alabama, Florida, and Mississippi now have these 
     programs in place, and more states with significant numbers 
     of evacuees are very close to establishing similar programs. 
     With this new waiver program, we are providing relief 
     quickly, rather than waiting to implement an unprecedented 
     new federal program as envisioned by S. 1716.
       The bill (section 108) also establishes a massive new 
     Federal program which would be administered by the Secretary 
     of HHS, rather than states. The fund would provide $800 
     million for direct payments to Medicaid providers to offset 
     their costs incurred as a result of Hurricane Katrina, and 
     for payments to state insurance commissioners for health 
     insurance premiums for individuals otherwise eligible for 
     DRM. Again, S. 1716 is duplicating efforts which are well 
     underway at CMS through the uncompensated care pools 
     referenced in the new waiver program The Federal 
     uncompensated care fund envisioned by S. 1716 would create 
     uncertainty and delay progress being made right now. To make 
     the system envisioned by the bill work, CMS would have to 
     develop a brand new Federal system with new forms and 
     applications, eligibility criteria, program requirements, 
     criteria for reviewing applications and determining payment 
     amounts, as well as other rules and procedures. Providers 
     would need to learn this new system and provide new kinds of 
     documentation. It is far more expeditious to use existing 
     state systems.
       We believe states are better equipped than the Federal 
     Government to work directly with local providers to solve the 
     problems of uncompensated care. The state-based uncompensated 
     care pool in the CMS waiver will pay providers more quickly 
     through the existing state payment systems without 
     establishing a new bureaucratic process. It will also allow 
     for care in settings and from providers that do not usually 
     participate in Medicaid, enabling evacuees to get the best 
     care and the providers in the state to deliver it as 
     effectively as possible. The waiver program also allows for 
     new interactions with expanded community-based health care 
     centers, mobile units for providing basic care at convenient 
     locations for evacuees, and new referral networks. The pool 
     will permit states to pay for additional services needed by 
     evacuees, such as additional mental health services, that are 
     not generally covered by Medicaid.
       While we prefer the state-based uncompensated care pool 
     referenced in the CMS waiver, we look forward to working with 
     the committee to ensure care to evacuees and solve the 
     problems of uncompensated care.
       We believe that S. 1716 does not appropriately target 
     spending to the true victims of Hurricane Katrina. Section 
     103 spends $4 billion on a 100% FMAP rate for services (and 
     related administrative activities) provided from August 28, 
     2005 through December 31, 2006 under the State Medicaid or 
     SCHIP plan to any individual residing in a major disaster 
     parish or county, regardless of whether the individual was 
     affected by Hurricane Katrina. Section 108 spends almost $700 
     million for 29 states, most of which were not affected by the 
     hurricane, by preventing a drop in the FMAP for Medicaid that 
     otherwise would have occurred on October 1. We believe that 
     these provisions are inadvisable and that federal resources 
     should be targeted to meeting the needs of those harmed by 
     Hurricane Katrina.
       In addition, S. 1716 includes several provisions that 
     affect the timely implementation of the new Medicare Part D 
     program. We do not support any changes to the Medicare Part D 
     program. We note that under S. 1716, DRM dual eligibles are 
     excluded from the low-income subsidy program. We think it 
     would be far more advantageous to ensure that dual eligibles 
     are timely enrolled in a Part D plan so that they receive the 
     low-cost drug coverage available to them under the new 
     Medicare drug benefit.


                         Title II--TANF Relief

       Under title II, S. 1716 would also make a number of 
     adjustments to P.L. 109-68 the ``TANF Emergency Response and 
     Recovery Act of 2005,'' which was signed into law on 
     September 21. For the most part, these adjustments would be 
     unnecessary and would complicate State administration of 
     Temporary Assistance for Needy Families (TANF) benefits in 
     the wake of Hurricane Katrina.
       HHS believes that the existing administrative authority 
     under the TANF program under title IV-A of the Social 
     Security Act (as extended through December 31, 2005 by P.L. 
     109-68 and several earlier temporary extensions), coupled 
     with the special hurricane-related provisions of the new law, 
     has given States the ability to be responsive to the most 
     significant issues confronting them as a result of Hurricane 
     Katrina. We provided early administrative guidance reminding 
     States of their flexibility to amend their TANF plans to meet 
     the special circumstances of the hurricane aftermath such as 
     adjusting State plans, streamlining the eligibility process, 
     making residency optional, and using in-kind and non-Federal 
     cash expenditures to meet the maintenance of effort 
     requirements.
       In addition to this program flexibility, which continues 
     under title IV-A (as so extended), P.L. 109-68 also provides 
     special flexibility for TANF in areas such as the contingency 
     fund, loan program, and penalty waivers.
       We are especially concerned about the dual contingency fund 
     provisions in S. 1716, under which a State may be reimbursed 
     from the contingency fund if it qualifies as a ``needy 
     State'' based on Hurricane Katrina-related criteria, while 
     still remaining eligible to receive reimbursement from the 
     fund if it meets the current law definition of a ``needy 
     State'' (based on certain Food Stamp and unemployment-related 
     criteria).
       We are advised by the Office of Management and Budget that 
     there is no objection to the submission of this letter to the 
     Congress from the standpoint of the Administration's program.
           Sincerely,
                                               Michael O. Leavitt.

  Mr. McCAIN. I say again to my friend from Iowa, I think he does a 
tremendous job as chairman of our Committee on Finance. He continues to 
distinguish himself in that role. But I do believe--and we had, I 
think, a very productive meeting with the Senator from New Hampshire, 
Mr. Sununu, and Senator Lott, who, obviously, has a very deep and 
abiding interest in this situation, as well as the Senator from Iowa. I 
hope we can work out the objections that the administration has, as 
well as the concerns that others of us have on this issue.
  Again, I thank the Senator from Iowa for his diligent efforts in 
trying to get this legislation done and, at the same time, satisfy the 
concerns of many who are concerned about the scope of it, as well as 
his efforts to attempt to satisfy the concerns of the administration.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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