[Congressional Record Volume 151, Number 123 (Wednesday, September 28, 2005)]
[Senate]
[Pages S10579-S10582]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   UNANIMOUS CONSENT REQUEST--S. 1716

  Mr. BAUCUS. Mr. President, I come to the floor once again to insist 
that the Senate act on the emergency health care needs of Katrina 
victims. They need help. They need help now--not tomorrow, not the next 
day, now. The Senate must pass the Katrina health package that Chairman 
Grassley and I put together. Why? Obviously, to help the victims of 
Katrina. That is why. They need the help now.

[[Page S10580]]

  I might say, Senator Grassley and I have worked for weeks on this 
legislation. It has been 4 weeks since Katrina hit--4 weeks.
  Now, some suggest the administration was slow to respond, that FEMA 
was slow to respond, that FEMA was inadequate in responding. We have 
heard these complaints. A lot of them are accurate.
  Where is the Senate? Where is the Congress? Where? I ask Senators, 
where is the Senate? Where is the Congress? I will tell you where. We 
are poised to pass legislation, but the same people and the same 
political party that were slow with respect to FEMA and the 
administration are now here today slowing down and stopping this 
legislation from passing. The same group. The same group. I cannot 
believe it. I cannot understand it.
  This legislation has very broad support. It has the support of 
Senator Grassley, the chairman of the Finance Committee, the Republican 
chairman of the Finance Committee, who, I might say, is a very good 
man. He is a good man. He cares. He puts people above politics. He puts 
the needs of the Katrina victims above politics. He wants to do the 
right thing. And I very heartily and soundly congratulate him. He has 
done such a wonderful job.
  We have also consulted for weeks with the Senators from the States 
affected, working out the details of this legislation, crossing the 
T's, dotting the I's, making changes to make sure it works right. We 
have consulted with the Senators from the States affected, who are from 
both political parties. They want this legislation. They are from both 
political parties, and they want it.
  We spent a lot of time working on this--a lot of time. We have done 
the right thing. We made changes, as Senators suggested. We are trying 
to make it balanced, trying to make it fair, trying to make it respond 
to the needs of the people in Louisiana, Alabama, Texas--the States 
affected. We have tried our very best to do this right.
  I might repeat, not only the Senators of the States want this 
legislation, but the Governors of the States want this legislation. If 
we want to get to labels here, two of those Governors are Republicans. 
Today, publicly, I asked the question and Senator Grassley, the 
chairman, asked the question: Governors, what do you think of this 
legislation? Yes, they want it, they want it now.
  Ask Governor Blanco of Louisiana. They know the needs. They are 
there. They know the stakes. They are the Governors. They want this 
legislation passed now.
  Governor Riley of Alabama, he wants it now. Governor Barbour of 
Mississippi, he wants this legislation passed now. Governor Blanco of 
Louisiana, she would certainly like it passed now.
  I might say, too, this is a compromise. There are Senators here who 
would like to offer more sweeping legislation and try to get that 
legislation up for a vote. I daresay, if that legislation were up for a 
vote, it would pass by a very large margin.
  But there are Senators here who do not want to vote. They do not want 
to vote on that legislation. They do not want to vote on it. They do 
not want to vote on it. What is my evidence of that? Many times I have 
asked unanimous consent to bring up this legislation. Many times the 
chairman of the committee has asked to bring up this legislation. And 
we get objections from the other side of the aisle. We get objections 
from the other side of the aisle. Oh, it costs too much, I heard. That 
is one complaint.
  I do not know. This legislation is temporary. It is only for several 
months. It is only basically until the end of the year. It is basically 
to help people get health care under Medicaid, to get health care now.
  There are countless examples of people who cannot get health care 
today, victims of Katrina who cannot get health care today. Why in the 
world is the Senate, controlled by the same party as the White House, 
saying no? Oh, we hear: We want a compromise. Let me tell you this. 
What is the compromise I heard? The compromise I heard is: Take it all 
out of the $65 billion appropriated for Katrina. Take it out of that. 
That is what I have heard.
  Can you believe that? Can you believe that? They say some of that 
money has been misspent. So people who need health care shouldn't get 
the dollars? They shouldn't get support? They shouldn't get their 
health care because some of the FEMA dollars might have been misspent? 
Give me a break. Give me a break.
  What is going on here? What, in fact, is going on here? I don't 
understand it. I thought we were Senators. I thought we were elected to 
do the right thing, to rise up and help people who need help, 
particularly immediately. Sure, we should scrub this stuff and look at 
it closely. And we have. We have. Senator Grassley and I have. Our 
staffs have--very closely. We have tailored this down and cut it back 
down compared to what other Senators in the body want passed, some of 
the Senators in the committee wanted passed. We said: Oh, no, no, we 
are not going to go that far. We will take this a step at a time. We 
will pass limited legislation, only until the end of this year.
  These provisions, the Medicaid provisions, the FMAP provisions, the 
eligibility requirements only apply for several months, to the end of 
this year. Then they stop.
  Let me tell you, we met today, the Finance Committee, with experts--
one was George Yin, head of the Joint Tax Committee staff--trying to 
learn some lessons from New York that might be applied in this case. He 
made a very interesting point to us. He said: You must know, Senators, 
it is very hard to know the effectiveness of tax breaks because we 
don't have a lot of evidence. He also said something else. He said: 
Because these are of a short duration, the ones proposed in this bill, 
they probably will not be utilized very much because people don't know 
about them. People don't know they are there. It is hard to get the 
word out.
  So those Senators should not be too concerned this bill will be ``too 
expensive.'' If they are concerned about fraud, FEMA fraud, if they are 
concerned about waste, if they are concerned about money not being 
properly spent under FEMA, and so forth, I suggest when the next 
appropriations bill comes up to spend more money at FEMA, to give more 
cash, that is the proper place to look at any potential waste, any 
problems, if any, that occur under FEMA. I don't know what occurs and 
does not occur, but the Senators I have heard don't want this bill 
passed because they say: Oh, it is wasteful. FEMA wasted money. If that 
is the case, don't take it out of the hides of poor people who need 
help. You take it out of the hide of FEMA. You take it out of the hide 
of additional appropriations.
  I heard something else here tonight. I have heard the administration 
is opposed to this legislation. They quietly kind of are. I don't think 
they want to admit it. They sent this letter that the Senator from 
Arizona put in the Record. They say: Well, maybe we can do it with 
waivers. Maybe we can do it a little bit better. Come on. That is not 
going to work. Why isn't it going to work? It is not going to work 
because this waiver process is so vague, it is so amorphous. Nobody 
knows what it is. Nobody knows when it might go into effect.
  Let me give you an example of that. Today at the Finance Committee 
hearing, I raised the question: Governor Barbour, Governor Riley, 
Governor Blanco, what about waivers?
  Governor Barbour did not know anything about it. This is 4 weeks 
since Katrina. He said: I have to plead ignorance. I don't know. You 
would think if this waiver process is going into effect a little bit, 
if there has been discussion between the administration and some of 
these States, you would think the Governor of Mississippi, if this 
waiver program is worth anything, would know about it. No, he did not 
know anything about it. He wants this legislation passed.
  Mr. President, I ask unanimous consent that the letter Senator 
Grassley and I wrote back to Secretary Leavitt in response to that 
White House letter be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                      U.S. Senate,


                                         Committee on Finance,

                               Washington, DC, September 27, 2005.
     Hon. Michael O. Leavitt,
     Secretary, Department of Health and Human Services, 
         Washington, DC.
       Dear Mr. Secretary: The aftermath of Hurricane Katrina has 
     left hundreds of thousands of Americans displaced and in need 
     of

[[Page S10581]]

     assistance. We want to, first and foremost, thank you for 
     your assistance with Katrina relief. We share the goal of 
     addressing the immediate health care needs of people affected 
     by this disaster.
       We have, however, chosen different paths for achieving our 
     shared goal. We have introduced and sought to pass the 
     Emergency Health Care Relief Act, S. 1716, which would 
     provide immediate coverage for a temporary period for 
     Americans displaced by Hurricane Katrina, directly assist the 
     states of Louisiana, Mississippi and Alabama, and provide a 
     means for survivors to retain private health insurance 
     coverage. We believe that this program can be very quickly 
     and efficiently implemented by the Department. We have noted 
     your opposition to our bill and are puzzled at how you expect 
     to achieve our shared goal through the Department's waiver 
     process. Specifically, we would raise the following 
     questions:
       1. After the September 11, 2001, attacks on New York City, 
     the Department quickly approved a waiver to provide Medicaid 
     coverage for New Yorkers, even those not normally eligible 
     for Medicaid, for a temporary basis. While you refer to the 
     coverage provided through the waiver program as 
     ``comprehensive relief,'' the waiver in Texas does not 
     provide for the same eligibility for Katrina evacuees as was 
     provided through the New York waiver. Could you please 
     explain to us why the Katrina evacuees do not deserve the 
     same assistance provided the people of New York.
       2. Your waiver process appears to contemplate having those 
     Katrina evacuees without health care coverage covered by an 
     uncompromised care fund. Providers will provide charity care 
     and then seek reimbursement from the uncompensated care fund. 
     This raises numerous questions for us. First, how does the 
     Department believe it has the statutory authority to provide 
     funding for this uncompensated care fund when we believe it 
     is fairly obvious the Department does not have statutory 
     authority to do so? Second, it is unclear to us how much 
     money will be needed for the uncompensated care fund for 
     Texas and all other host states. How much money does the 
     Department anticipate needing for the fund? Finally, the 
     Medicaid program has known costs, payment rates and 
     control systems, which is why we sought to use the 
     Medicaid program for the temporary assistance program. How 
     does the Department plan to control expenditures for the 
     uncompensated care fund to protect against fraud and 
     abuse? What accountability measures will apply to these 
     new funds?
       3. The states of Louisiana, Mississippi and Alabama have 
     suffered tremendous devastation that will drastically affect 
     their ability to meet state obligations, including their 
     share of Medicaid. The Department's waiver process simply 
     bills claims for Katrina evacuees in Texas (and other host 
     states) back to Louisiana, Mississippi and Alabama. When the 
     bill comes due for those claims we would anticipate that the 
     Department is going to expect payment since the Department 
     does not have the statutory authority to waive those 
     payments. Will the Department be seeking a statutory response 
     or does the Department believe that the affected states do 
     not need assistance? If the Department does support relieving 
     Louisiana, Mississippi, and Alabama of some portion of the 
     state share requirement, what is your projection for the cost 
     of the assistance you might provide those states? New York 
     provided disaster relief Medicaid after September 11, with 
     the hope that their state match costs would be paid for 
     through FEMA grants, but they are still appealing FEMA's 
     denial of payment and have not received any funds. What 
     assurances can you give states that they will not find 
     themselves in similar circumstances?
       4. We believe that allowing individuals to preserve their 
     private insurance coverage is an important principle. The 
     bill that you oppose, the Emergency Health Care Relief Act, 
     provides for Disaster Relief Fund so that people may keep 
     private coverage. Your waiver process does not appear to 
     provide for assistance to people wishing to keep private 
     coverage except perhaps through the uncompensated care fund 
     which we have already established has no money. Do you oppose 
     preserving private coverage for Katrina survivors?
       5. We believe that the welfare provisions of S. 1716 are 
     very important. Though H.R. 3672 the TANF Emergency Response 
     and Recovery Act of 2005 (Public Law 109-68) makes some 
     modest progress towards getting states the help they need to 
     provide vital support services to evacuees and those in the 
     directly impacted states, we remain concerned that P.L. 109-
     68 falls short in several ways. Working in close conjunction 
     with members from the directly affected states, the Senate 
     bill makes a number of improvements to P.L. 109-68. P.L. 109-
     68 limits assistance to non-recurrent short-term cash 
     benefits S. 1716 allows funding to be available for any 
     allowable TANF expenditure. We understand that states would 
     like the flexibility to use these funds to provide non-cash 
     services such as employment readiness and job training for a 
     period of time that is not limited to four months. Do you 
     agree that it is appropriate to give states the greatest 
     amount of flexibility to serve the broad needs of these 
     families? Additionally, the Senate bill lifts the ``cap'' on 
     the Contingency Fund which would direct additional resources 
     to states that are providing services to Katrina survivors. 
     Do you agree that states should be confident that they will 
     be reimbursed for the costs of helping these families?
       6. We note that in your letter, you took special exception 
     to the provision in Title II--TANF RELIEF that would allow 
     states, such as Tennessee, that are currently drawing down 
     Contingency Funds in order to meet the needs of their 
     existing caseload to also qualify for the Contingency Fund in 
     order to meet the needs of evacuees. Are we to infer from 
     your letter that states like Tennessee should be prohibited 
     from accessing the Contingency Fund to provide services to 
     evacuees simply because of a dire state fiscal condition that 
     made them eligible for the Contingency Fund under existing 
     law?
       We would also like to bring to your attention certain 
     provisions of our bill that we would be surprised to find the 
     Department opposes.
       The bill provides the Secretary with the authority and 
     funding to assist providers whose ability to stay in business 
     has been jeopardized. We consider it critical that hospitals, 
     physician practices and other providers get immediate 
     assistance so that they may continue to function. If the 
     doors close on a hospital, it makes rebuilding that community 
     that much more difficult. We hope you would agree.
       2. The bill provides additional assistance for people who 
     have lost their job through extensions of unemployment 
     insurance. We feel that it is appropriate and necessary.
       3. The bill provides additional funding for the Office of 
     the Inspector General to ensure that relief funds are 
     appropriately spent. We certainly hope you approve of that 
     provision.
       4. The bill protects the taxpayer by reducing the micro-
     purchase threshold which limits purchases made outside of 
     existing federal procurement laws. These purchases are 
     commonly made through the use of government credit cards, a 
     medium which has a history of fraud, waste and abuse of 
     taxpayer dollars. The micro-purchase limits were capped by 
     law at $2,500 with an emergency limit of $15,000 domestically 
     and $25,000 abroad. These limits were drastically raised to 
     $250,000. While we understand the need for increased credit 
     limits to help deal with a disaster of Katrina's magnitude, 
     any increase should address the problem at hand, not create 
     new ones.
       We truly believe that we have similar interests in 
     assisting people displaced by this disaster. While we are 
     troubled that you have chosen to oppose our effort, we will 
     continue to work with you to meet our common goal. In that 
     spirit, we respectfully request that you respond to the 
     questions by this Friday, September 30, so that we may better 
     understand how you intend to proceed.
           Sincerely,
     Charles E. Grassley.
     Max Baucus.

  Mr. BAUCUS. That letter points out the glaring defects of the waiver 
process the administration talks about.
  First, the Government is amorphous, as I said. Second, the waiver 
kind of promises money to hospitals for uncompensated care. It does not 
say how it is going to happen. It is very unclear. It is very 
amorphous.
  I might say, at that point, for 9/11 FEMA was billed for several 
items, and FEMA did not pay for it. In this case the administration, in 
the waiver process, says, well, there might be some money for hospitals 
for all the uncompensated care they have provided. It is a promise. Who 
knows if it is empty or not empty. There are no dollars behind it.
  We have dollars in our legislation. It is $800 million. It goes for 
uncompensated care to hospitals. You talk to the administrators of the 
hospitals in these areas--Louisiana, New Orleans; other States, 
Arkansas, Texas--that are overwhelmed--and most of this is 
uncompensated care--they need help. We are providing it in this bill, 
$800 million.
  We also provide help for people who need care, who do not have health 
insurance, who live up to 100 percent of poverty. They are not wealthy 
people: only up to 100 percent of poverty, and 200 percent of poverty 
for mothers who have children, pregnant women and children. That is not 
very much. But no, we cannot pass that. Senators say that is too much. 
That might be wasteful.
  I don't get it. I don't get it. It reminds me of when I graduated 
from high school. This fellow sent me a congratulation card for 
graduating from high school. He said basically: Congratulations, and 
all this stuff. He said: Best of luck in those interstitial spaces when 
your brain runs against headlong perversity. This is one of those 
interstitial spaces in the sense that I don't get it. I can't fathom 
why people would not want to get this passed.
  We can go to conference. We can modify this bill in conference if 
there are real problems. That is what we do around here. If something 
is not perfect--nothing is ever perfect--you don't let perfection be 
the enemy of the good

[[Page S10582]]

around here. We go to conference. By that time, little wrinkles crop 
up, little problems. We take care of them in conference. No, we can't 
do that. We can't even pass the legislation. Some Senators say: No, we 
can't pass it. Wrong. Take it out of FEMA. It won't work. For the life 
of me, I don't understand why we are here.
  One small example, not so small for Tina. Who is Tina? Tina Eagerton 
is a lady who fled Louisiana 7 months pregnant but could not find a 
Florida doctor who would accept her Louisiana Medicaid card, wouldn't 
do it. With this legislation, Tina can get some help.
  I can talk about Rosalind Breaux, who has colon cancer and was 
scheduled for her third round of chemotherapy on August 31, the day 
after the flooding began. Her husband has lost his job. There is no 
health insurance. Rosalind is in a real bind.
  I mentioned the letter the administration has sent. The Senator from 
Arizona has mentioned that letter. I also mentioned the letter we sent 
in response, the chairman of the committee, Senator Grassley, and I. 
That letter from the administration says the administration claims it 
can provide relief without the need for congressional action. It can't. 
I must also say they do not have the authority. They do not have the 
authority to provide additional appropriations. That takes an act of 
Congress. They say, apparently, by implication, they do not need any 
dollars. That is the implication of that process. They don't 
appropriate dollars. It is against the law. We have to do that. They do 
not want us to do it.
  The waivers, I might say, also limit eligibility for Medicaid 
coverage to only those groups of people traditionally eligible for 
Medicaid. Adults without children, no matter how poor they are, or how 
much they need health care, would not be covered under the 
administration's waiver policy suggested by the letter the Senator from 
Arizona mentioned.
  The woman with diabetes would not be covered. She would not be 
covered. Diabetes is a very time-sensitive illness. Limiting access to 
benefits in the waiver would mean leaving tens of thousands of Katrina 
victims without aid.
  After Katrina, Louisiana dispatched Medicaid eligibility workers to 
more than 200 shelters to enroll evacuees in Medicaid. Of the 4,000 
potentially eligible families screened in these shelters, more than 1 
in 5 were screened out as ineligible. They did not meet Louisiana's 
traditional eligibility rules--1 out of 5. No help there. One out of 
five: You do not meet the traditional screening test.
  Our legislation would address that. One out of every three people who 
have applied for Medicaid in Louisiana following Katrina have been 
denied coverage. Let me repeat that. One out of every three people who 
applied for Medicaid in Louisiana following Katrina have been denied 
coverage. The waiver process is not going to help that out because the 
eligibility requirements are not raised. Most of these people are 
denied because they don't meet the eligibility criteria.
  Adult Katrina survivors need access to health care. A recent study of 
Katrina evacuees in Houston shelters found that most of the adult 
evacuees without children were uninsured. Among those, more than 40 
percent reported having a chronic condition. A third reported having 
trouble getting the prescription drugs they need. I can't believe it. 
What is going on here?
  Differentiating among individuals during this time of need is not 
right. This isn't legislation that is usual; this is an emergency. 
People need health care right now. Katrina did not differentiate. 
Katrina hit all the residents of the gulf hard. We should not 
differentiate in our efforts to help those in need.
  The second key difference between the administration's policy and 
what our bill does is the funds provided to defray the cost of 
uncompensated care that thousands of health care providers across our 
Nation are giving to Katrina survivors. I have already mentioned that. 
Let me repeat that point. The administration has said it will provide 
an uncompensated care fund. But the administration, in this waiver 
letter referred to on the floor a few minutes ago, has not given any 
further information about how much would be provided, not one iota, 
whether it be $1 or zero dollars. The administration has not even given 
information about how it will be spent.
  By contrast, the Grassley-Baucus bill includes an uncompensated care 
fund of up to $800 million to be spent on compensating those health 
care providers--that is, hospitals--who have seen a dramatic increase 
or drop in their patient load as a result of Katrina. The 
administration promises, but under our bill, there would be no doubt. 
We would be there. It is not words but deeds. The administration is 
words. Our legislation is deeds. It is getting it done.
  Third, our bill provides 100 percent Federal funding for all evacuees 
covered under Medicaid, wherever they are, and for the affected States. 
By contrast, the administration's waiver policy promises to make States 
whole. What does that mean? I have serious questions about how they can 
deliver on that without legislation, because it is unclear that the 
administration could, under its current statutory authority, provide 
these additional funds to States. I referred to that earlier. I don't 
think they have the legal authority to provide additional funds. I have 
no doubt they intend to do so. I am sure they do. Why wouldn't they? I 
just do not believe they have the legal authority to do so. So why 
should we get involved in this legal morass--do they have the 
authority; do they not have the authority? Are we going to sit down and 
argue about this, while the people need health care? I don't get it.
  At the same time the administration has asked for the three most 
affected States to sign a memorandum of understanding making them 
financially responsible for paying the cost of evacuees' care in other 
States. Louisiana, Mississippi, Alabama need our help, not more bills 
to pay--not now. We could straighten that out later.
  It is an outrage that a small number of willful Senators continue to 
stall this bill. Hurricane Katrina's health costs continue to spill in 
waves across the gulf coast region. Victims continue to suffer without 
proper medical care. Our bill will restore immediate access to basic 
health care. Our bill would relieve the financial burden health care 
providers have shouldered. We must act. Thus, at the appropriate time, 
I intend to join with my colleagues and ask unanimous consent for the 
Senate to pass our bill.
  In fact, I do so now. I ask unanimous consent that the Senate proceed 
to the immediate consideration of Calendar No. 214, S. 1716; that the 
Grassley-Baucus substitute amendment which is at the desk be considered 
and agreed to, that the bill as amended be read a third time, passed, 
and that the motion to reconsider be laid on the table, and that all of 
this occur with no intervening action or debate.
  The PRESIDING OFFICER. In my capacity as a Senator from Oklahoma, I 
object.
  Objection is heard. The unanimous consent request is not agreed to.
  The Senator from Iowa.

                          ____________________