[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.
____________________