[Congressional Record Volume 151, Number 125 (Friday, September 30, 2005)]
[Senate]
[Pages S10784-S10791]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
UNANIMOUS CONSENT REQUEST--S. 1716
Mr. BAUCUS. Mr. President, there are an estimated 1.5 million
individuals who survived Hurricane Katrina who are now scattered across
the Nation. The stories of what they have already experienced are
harrowing. They are suffering deprivation beyond what many of us could
imagine, and their needs, especially for health care services, are
greater than most of us hope to ever know.
Today I come to the floor to share with you a few stories of those
survivors and the problems they are facing in getting the health care
services they need. Many are uninsured and without means to pay for
food and shelter, let alone prescription drugs or a doctor's visit.
As I said when I spoke on the Senate floor on Wednesday night, one in
three survivors who have applied for Medicaid in Louisiana have been
turned away. Why? Because they do not meet Medicaid's traditional
eligibility criteria.
These people need help. The Grassley-Baucus bill would deliver it to
them without delay, without uncertainty.
As we consider moving forward on this legislation, I remind my
colleagues of the faces of those we are trying to help. The survivors
of Hurricane Katrina are people such as Eugene Johnson, age 57, a
retired plumber and a diabetic who lost his home to Katrina. He, his
wife, and four of his five children have moved from shelter to shelter.
He needs eye medicine that he left behind in New Orleans, but he cannot
afford the $119 cost of the prescription. Without his medicine, he will
go blind.
An aid group, the Children's Health Fund, provided him with the
medicine and responded with these words:
We're a stopgap. Nothing more.
Maude Jordan, who slept on top of her refrigerator for 3 days before
being rescued in New Orleans, penniless and diabetic, was taken to a
relief center in Baton Rouge. Her application was rejected by Medicaid.
However, she was unable to establish eligibility because she could not
establish categorical eligibility; that is, she was rejected because--
this is what Medicaid said--she
[[Page S10785]]
was ``unable to establish eligibility because cannot establish
categorical eligibility.'' Give me a break. She needs help now. That is
what our bill does.
Dwayne Russ, 44, who had lived independently in a specially outfitted
apartment in New Orleans and maneuvered in an electric wheelchair, lost
his wheelchair when he was evacuated to Georgia and was placed in a
nursing home. The local director of advocacy at a specialty hospital
and rehabilitation center helped him out but stated:
Dwayne is just one person but he demonstrates there's lots
of people out there in his same predicament who are not
getting the help they need.
Tom Leynes, age 49, was a carpenter with an apartment just off the
beach, a happy family man. After Katrina, he found the bodies of his
two little girls holding hands. Now he is struggling with depression,
living in a tent, taking medication, and trying to deal with the pain.
He needs help.
Theresa Bieller, 39, Gulfport, MS, was following a 15-pill regimen
for a heart problem and other conditions before the storm. Most of her
prescriptions were already low or empty. To make matters worse, she had
no electricity to operate a nebulizer for her 2-year-old asthmatic
daughter, Chloe. After a few days without medicine, her chest pain and
weakness mounting, Bieller checked into a hospital. She came out the
next day with a mere 3 days' supply, not 15. She has no insurance and
little cash to buy the expensive drugs. She needs help.
``Precious'' is the name given by nursing home staff to an elderly
woman evacuated from New Orleans to Tennessee who cannot remember her
name. Precious can talk, but she is unable to tell staff who she is or
what her health care problems are. She spent 4 days in a hospital
before becoming a resident at Bordeaux Long-Term Care. Who and how her
care will be paid for is unknown.
These survivors and hundreds of thousands like them are waiting for
Congress to act to make sure they can get the health care services they
need. They cannot afford to wait another moment for this assistance,
and neither can we. I urge my colleagues to join me in supporting this
motion which I will now offer by unanimous consent on the Grassley-
Baucus Emergency Health Care Relief Act.
I ask unanimous consent that the Senate proceed to the immediate
consideration of Calendar No. 214, S. 1716; that the Grassley-Baucus
substitute bill which is at the desk be considered and agreed to; that
the bill, as amended, be read a third time and passed; that the motion
to reconsider be laid upon the table; and that all of this occur with
no intervening action or debate.
The PRESIDING OFFICER. Is there objection?
The Senator from New Hampshire.
Mr. SUNUNU. Mr. President, if I might momentarily reserve the right
to object, Mr. Baucus, the Senator from Montana, has given a powerful
description of people who are in great need of help. There is no
question about that. Many of the States that are affected and other
States have taken steps to provide help in many areas, to set up
uncompensated care funds to provide assistance to evacuees. I think the
Senator from Montana would argue that it is not enough, he would like
to do more, and his intention is obviously to bring this bill to the
floor to deal with some of these concerns. I have spoken before on this
and will not speak at great length now. I do not believe this bill is
the right way and the best way to address those concerns. It has a cost
of $9 billion. It does include provisions for assistance to States
regardless of whether they have evacuees located in them, regardless
whether they were hit by the hurricanes.
I and other Members have been working with Senator Grassley and
Senator Baucus and their staffs to try to come to some agreement, but
that has not happened. The question is not whether we should or want to
provide assistance, but we want to make sure we do it in a way that
ensures that resources get where they are most needed and in a way that
takes advantage of the $45 billion or so that has already been
appropriated but has not been committed yet.
So I do object to the unanimous consent request. I know Senator
Lincoln from Arkansas and Senator Landrieu from Louisiana wish to speak
on this issue, and I will be more than happy to let each of them do so
before returning to the floor, if I am able to do so today, and offer a
few remarks.
I do object at this time.
The PRESIDING OFFICER. The objection is heard.
The Senator from Louisiana.
Ms. LANDRIEU. Mr. President, I rise to support my colleague from
Montana and his counterpart from Iowa, Chairman Grassley, who have
stepped up to the plate, along with the Senator from Arkansas on the
Finance Committee and other Members, to put forward a bill that is
absolutely crucial for the hundreds of thousands, in fact millions, of
people who have been impacted directly by these two storms and the
subsequent failing of a levee system in a major metropolitan area of
this Nation.
This is an unprecedented natural disaster. We have said it so much
that maybe it is a cliche and people are not quite understanding the
magnitude of this, but these hurricanes and the subsequent levee breaks
have truly displaced 1.5 million people who are without homes, without
businesses, without their churches, without their synagogues, without
their extended families around them, without their pharmacists, without
their doctors, and they need help now.
I wish we had organized, funded, and resourced FEMA in such a way
that this could be taken care of, and actually the next time this
happens I hope we will have done just that. But for today, for the
people of Louisiana, Mississippi, Alabama, and now Texas, who were also
hit with this last storm Rita just 6 days ago, we have not had time to
reform and reorganize FEMA. So if we wait for FEMA to do this, these
people will not get the help they so desperately need.
We need some additional resources. That has been documented on radio,
television, in print newspapers from conservative to liberal to right
up the middle that FEMA is not functioning as well as it once did. This
is not about blaming anybody, this is about recognizing that fact and
moving on. So Senators Baucus and Grassley, the good leaders that they
are, in a bipartisan fashion, without trying to blame anyone, have
said: OK, let us step in the gap. We have people who need help. We have
the money to help them. Let us help them. They have put a bill together
that will do that.
We are now 31 days since Katrina made landfall, the most powerful
storm and subsequent levee break in the history of the country, and 6
days since Rita. Maybe people can wait another week or two, maybe
three, maybe the people who just got hit 6 days ago can hold on
literally to their life, their health, their children, their parents,
with no health insurance, nowhere to get medical coverage, maybe they
can, but maybe they cannot. Why should we again make them victims of
our inability to act?
This is not a Democratic bill. This is not a Republican bill. This is
a bill put together by Republicans and Democrats, tightly and carefully
drawn. Maybe some other additional compromises can be made; I do not
know, but what I do know is we have to pass this bill very shortly or
we are going to end up spiraling downward instead of upward in this
region.
The needs are great. It is not just health care and not just
unemployment benefits, but when there are big cities and small towns
from the Texas coast to the Louisiana coast to the Mississippi coast
that are obliterated, they are not functioning, there is not a building
standing--in some communities such as Waveland or in parts of Biloxi or
Cameron Parish, which is a large but sparsely populated parish in my
State, 10,000 people, there is not a structure standing as far as the
eye can see, except the courthouse that was built in the early 1930s.
In New Orleans, still a large part in the West of the city is like a
ghost town. The mayor is doing a good job getting people back to the
city. Our city council is working hard. Our sheriffs, our policemen,
our firemen--all of them are working very hard trying to get people
back to the city. The health care system that existed just 32 days ago
in New Orleans does not exist anymore. The one that existed in Waveland
is completely gone. The one that was in Cameron is gone.
[[Page S10786]]
So I wish FEMA had showed up the next day and said: Here are your
health care cards, here is what you do, here is help. But that did not
happen. I am not here to fuss with FEMA; I am here to fix the problem.
We do not have a lot of time.
Let me say something else to my colleagues. Congress normally does
not work quickly. It is not what we are created to do. I understand
that. I have been in the Senate now 6 years. We are created to sort of
go slowly. It is because the Founders did not want us in passion to
move too quickly. I understand that. But we were also supposed to take
the responsibility to create agencies that could act quickly,
efficiently, and effectively. In large measure, we have failed to do
that. It was not the Republicans' fault or the Democrats' fault or this
administration or the previous administration. I am not interested in
that. I am just saying the reality is the people--2 million and more
because other people have been impacted--need help. We have to provide
it.
There are some problems over in the House of Representatives, and
people know about those problems. I can understand that. But the
Senate, Republicans and Democrats, has put together not just this bill,
we have put together four or five bills on education, health care,
small business tax relief, community development block grants, getting
people immediate help to relieve their mortgage payments. If we do not
do this in the next few days, the economy of the gulf coast will begin
a downward spiral, and I do not know what else it will take with it.
Everybody keeps saying this is a local problem, this is about New
Orleans or Plaquemine or Saint Bernard or just Waveland. It is not. It
is a regional crisis. It is a very important region for our country. It
is the heart of the oil and gas industry. It is the largest river
system in the Nation. It is the largest fisheries and maritime complex
in the country. This is not time to cower.
The Presiding Officer is from the South, a different part of the
South, but as a Governor he most certainly understands the dynamics of
the Washington-Virginia region, and if it was impacted in such a way,
it could have national ramifications. The Chair most certainly
understands that. That is what is happening in our region.
Slidell, a population of 25,000--direct hit, the eye. Most of these
people work at the Stennis Space Center in Mississippi or they work in
New Orleans East, which is completely gone--most of the residents are--
at NASA at the Michoud plant. A lot of people in Slidell are poor,
middle income and wealthy. The neighborhoods have all been hurt and
affected. Some are doctors, some are small businesses.
Lake Charles, 71,000--not a direct hit but took a big hit in the
hurricane, and the small cities around there, Sulphur and White Lake. I
have mentioned Waveland and Pass Christian, MS, Beaumont, TX, Bay Saint
Louis, MS, just to name a few. These are the people, the working folks
who support the maritime and the energy industry.
It is a complex and comprehensive plan that is necessary for
rebuilding, and we are working on the pieces of how to do that. There
are many different ideas that are floating around. Something will come
together, whether it is done for each individual State or whether we
end up coming together as a gulf coast region and doing something. I am
confident, with the good ideas I have heard expressed here, some
compromise will come together.
But we can't wait for this huge structure of rebuilding before we
take care of some of the urgent and immediate needs: water,
electricity, food, health care--the basic needs, the basic fundamentals
of those governments, so small businesses can actually have a permit to
stay in business, so businesses who want to locate actually have
somewhere to send their letter: ``Dear Mr. Mayor, I would like to
locate in your town.''
If there is no city hall, there are no people on the payroll, there
is no executive assistant to the mayor, where do they send the letter
to open a business?
I know I might be exaggerating a little bit, but I do it to make the
point that, yes, we need tax cuts, yes, we need incentives for small
business, but no small businesses can operate on an island by
themselves. They actually have to plug into electricity and hook up to
water. They have to be able to file their permits with city hall.
We have cities right now deciding whether they need to lay off all of
their employees, half of their employees--maybe we will lay off 10
percent every week until somebody in Washington hears us.
I don't know why we have trouble hearing in Washington. I am not
certain; maybe we talk too much. I most certainly myself could be
blamed for that. I do a lot of talking. People say, Mary, you talk a
lot, and I have to admit I probably talk too much and maybe I need to
listen a little bit more. But I am starting to think a lot of people in
Washington are not listening because the people in my State are crying
desperately for help. I can hear people from Mississippi and Texas and
Alabama crying for help. I know we do not normally act quickly, but we
have to figure out a way to do it.
I am not talking about taking the Treasury and dumping money down
there. I am talking about passing the bill of Senators Baucus and
Grassley that was worked out by Democrats and Republicans. Maybe we can
tighten it even more. Maybe there is a compromise even further to be
had. But there are a lot of Republicans supporting this bill. We need
the House and we need this administration to support this bill and get
it passed before we leave next week.
I am going to conclude because Senator Lincoln, who is truly an
expert on this subject, wants to speak about this particular bill. But
when we come back next week, I, as the Senator from Louisiana, want my
colleagues to understand it is going to be very difficult for any of
us--and for me particularly--to go home next weekend for a break when
nobody in Louisiana, very few people in Texas, Mississippi, or Alabama
have had any break and will not for a while. The only thing they are
going to get as a break is broken homes and broken hearts, displaced
families. We cannot go home without helping them to more quickly get
back home.
We are grateful for the hospitality of Arkansas and New York. I went
to New York to personally thank New York Mayor Bloomberg and the police
and firemen for everything they did to help us. I have had people from
all over the world in my office, thanking them for coming to our aid--
internationally as well as nationally--but we cannot go home next week
without helping the people from the gulf coast get home. We have to fix
the education crisis. I am going to list a few things we have to do
before we leave:
We have to fix the education crisis. Lamar Alexander, the Senator
from Tennessee, has been working very hard all week on a compromise. I
would like to see his bill passed.
We have to pass the Grassley-Baucus, or Baucus-Grassley Medicaid
proposal for health care for people.
We are going to have to pass some kind of mortgage relief. We have
hundreds of thousands of people for whom--some of them--their home was
their largest asset. If we do not give them some relief, they are going
to lose the largest asset, the only real asset they have. Some people
have more than that, but most people have their wealth in their home.
They are getting ready to lose it all because of the conflicts between
the insurance companies and whether it was wind or whether it was
flood. We are not asking for forgiveness, but a break for 6 months. We
have to give them that.
My staff told me today, a few minutes before I came down here--and I
am sorry I do not have the document--that the report just came out that
there has been the highest number of people in the history of the
country who have defaulted on credit card payments. Does anybody wonder
why? Is anyone confused about why this month, this report would show
the highest number of people in the history of the country to default
on credit card payments? It is because the people who are lucky enough
to have credit cards and who still have not yet hit their limit are
using their credit cards and their cash cards to literally stay alive.
They have no health insurance, no hospital, no job, and virtually no
action from Congress. They have a credit card and they will hit their
limit.
So if we do not get some response quickly, in a bipartisan manner--I
see Harry Reid on the floor, our leader,
[[Page S10787]]
who knows this well. For the last 2 weeks he has been working to keep
Democrats and Republicans working together to get this done--we are
going to be in a serious situation. There are some things we have to
get done next week.
In conclusion, I thank Senator Baucus and Senator Grassley for
bringing their bill up again to the floor. We are going to have to get
some things done before we can go home next Friday. I look forward to
working with my colleagues in that regard next week.
The PRESIDING OFFICER. The Democratic leader.
Mr. REID. Mr. President, words to express my consternation are
difficult to come by right now.
First, to express my appreciation to Senator Baucus for his tireless
efforts. Montana is a State without a lot of people. It is a State that
grows hardy stock. I have been there. Every time I have been there, it
has been with Senator Baucus. It is a beautiful State--big sky country.
Senator Baucus does not have many people in his State that this
legislation he is attempting to put forward would help. He is doing it
for the precious people in the world, not just the one he talked about
with the name Precious, but precious people who have no place else to
go than to someone like Senator Baucus, who is a leader from the State
of Montana, who finds himself in a situation of responsibility in which
he must reach out.
He first is a Senator from the State of Montana. But most important,
his title is a U.S. Senator. He is concerned about the people of
Louisiana, about the people who may not be named Precious, but they are
precious. People in the State of Arkansas, because of close proximity
to the areas where the hurricane struck, took in as many as 65,000
people. They are not all there now--most of them are there--but
wherever they have gone, they have left in the State of Arkansas a lot
of unpaid bills. That is not because they are trying to get away from
responsibilities they have. It is because this Government has programs
that are supposed to protect people such as Precious. The State of
Arkansas deserves more from us than they have gotten.
This legislation Senator Baucus is propounding has the support of the
vast majority of the Senate--I hope on a bipartisan basis.
While I am talking about bipartisanship, I have also to throw a
bouquet to the chairman of the committee, Senator Grassley. He has
taken a lot of grief for working with Senator Baucus to come up with
this legislation. Why did Chuck Grassley do that? Because he is a
United States Senator and has responsibilities outside the State of
Iowa. This legislation is a model for bipartisan compromise.
Senator Lincoln was misled, I say with all due respect to some of my
colleagues, because she filed a similar amendment to the Commerce,
Justice appropriations bill. Why did she withdraw this? She withdrew
the amendment in exchange for the promise that the Finance Committee
would reach a bipartisan agreement, which they did, and it would be
brought to the floor and we would vote on it. We have had no vote on
it. Senators Baucus and Grassley fulfilled their promise. Her
legislation wasn't exactly like this, but it was so close it is not
worth discussing the difference at this time. A handful of Senators
have blocked consideration of this bill on the floor, twice already
that I know of, and I think maybe three times.
The administration has the audacity to argue that this is not
necessary. They want to do it with a bunch of waivers. Anyone who
understands Government knows that is absolutely ridiculous. Their
approach creates more bureaucracy while failing to provide funding
guarantees for the States that badly need this. More important, their
approach not only leaves but has left tens of thousands of Katrina's
victims without care. We need to provide swift access to health care
for Katrina's victims with guarantees of full Federal funding for the
States who are generous and step forward at a time of need.
This is the time to allow us to pass this legislation. We are here
now on a Defense appropriations bill. That is what we are going to be
doing now. Couldn't we set aside 20 minutes, 10 minutes of debate on
each side, and vote on this? We have a handful, maybe a half dozen
Senators, holding up this legislation. Couldn't we spare the American
people 20 minutes of debate time on the Senate floor to deal with
people who are in dire need of help? As Senator Baucus explained, these
are people who cannot even speak. We want to help them.
Continued failure to do so ignores the support of the bipartisan
majority of the Senate. It also ignores the wishes of this country's
bipartisan Governors. The Governor from the State of Arkansas is a
Republican. The Governor from the State of Louisiana is a Democrat.
They want help. Mayors, county commissioners, patients, hospitals,
nurses, doctors--my good friend, the majority leader of the Senate, is
a physician, a prominent, eminent transplant surgeon. I know how he
cares about people who are sick. But we need the majority leader to
push aside the loud voices of this very small minority over here and
stop this. He needs to stop this and let us move forward with this
legislation.
He has decided not to run for reelection. He is going to be here a
year plus a few months. Is this a legacy that he wants to leave?
Katrina? People, after 5 weeks, with no health care? Is it going to be
7 weeks? 5 months? Maybe ignore them, maybe that is what they want,
ignore them.
These few Senators are standing complaining about maybe it costs too
much. Maybe the first place the majority leader should look, with his
friends who are holding this up--let's look at the budget that is out
here, of which Protestant leaders of this country, on the night it was
passed, said it would be an immoral document.
I am very grateful to the Senator from Louisiana, Ms. Landrieu, and
my friend of many years, Senator Baucus, for doing what they are doing,
and the advocacy of Senator Lincoln from Arkansas. I so appreciate
their not letting this issue die in the eyes of the American people. We
must continue doing this. It is the right thing to do.
The PRESIDING OFFICER. The Senator from Arkansas.
Mrs. LINCOLN. Mr. President, I come to the floor today to join my
colleagues in what we hope to be an opportunity to bring about an
awareness of the dire need, not only of the evacuees, of those
individuals in the affected States who have received such incredible,
devastating natural disasters, but also the other Americans who are
involved in this circumstance, the other Americans who have opened
their hearts and their homes, their hospitals and clinics, their
pharmacies and their community centers, their church basements--these
communities who have recognized what it means to be an American. They
have recognized what it means to be fellow Americans. They have
recognized what it means to be a good neighbor--I was, I guess--tongue
in cheek--perhaps I was criticized being a little overpassionate on
this issue, so I will resume my good, soft-spoken, and commonsense
approach to what I think to be a very real problem--to have deeper
roots, in terms of what are the values we as Americans do profess and
for which we are willing to put our money where our mouth is when we
speak of these values to really talk about not the immediate impact but
also the long-term impact of the decisions that we make or we fail to
make in a timely way.
I will come at it from a different perspective. Maybe keeping my
compassion down a little bit will be helpful, but it is hard when we
look out and see the kind of compassion in the faces of the incredible
constituents that we serve, that we represent, that we have the
privilege of coming to this floor to represent each and every day.
We also look out at the private sector, for which we also can be
proud, our Nation's health care providers and States that have been
there, at a time when vulnerable Americans need them the most.
The moment that Hurricane Katrina hit the gulf coast--now about a
month ago--they jumped into action. They didn't have to be asked. They
didn't have to be told what their job was. Medical, professional, and
community leaders knew what their job was. Their job was to reach out
to their neighbors, to their fellow Americans, and to their fellow
human beings, who were in unbelievably devastating circumstances.
Cities and States all around the country opened their doors to
welcome Katrina survivors from throughout the
[[Page S10788]]
gulf coast region. Hospitals evacuated those who needed immediate
attention. Doctors, nurses, and other health care providers have come
together to provide health care to thousands of victims of this
horrific natural disaster in the gulf coast. And they did all of it
with no questions asked. They didn't ask: Who is going pay for this?
Who is going to reimburse us? Who is going to take care of us? When the
high numbers of Medicaid patients jump way beyond a survivable number,
who is going to make us whole?
They did not ask those questions because they believed in this
country. They believed in who we are in this body as Americans, who
know our responsibility as neighbors. I happen to be somewhat of a
neighbor of the President in the chair today. When my family is here
and we are in session, northern Virginia provides an incredible
neighborhood for us, just like our neighborhood in Little Rock.
We reach out to our fellow neighbors out there, as we do our
neighbors in Arkansas.
It is what we are about in this country. It is being there for our
fellow man. That is what these providers have done. Now it is our time.
We have an opportunity in this body to demonstrate that we understand
what that means, we understand what it means to be a good American, to
be a good neighbor and to provide to our fellow man who is in the
neediest time in his life the kind of care and love and support that he
needs--he or she--at that time without asking questions.
We could pass the Emergency Health Care Relief Act that Senator
Baucus and Senator Grassley have worked so hard, in a bipartisan way,
to bring about. I offered an amendment a month ago. I could see from my
providers, those doctors and nurses, those pharmacists who worked 24-7,
who spent their entire Labor Day weekend taking care of their neighbors
from Mississippi and Louisiana, who didn't ask questions, I could see
that there was going to be a tremendous need down the road to provide
them piece of mind--that not only they were doing the right thing in
helping those neighbors but also that they could continue to do the
good job in providing services to the constituency, the community, and
the neighbors they have known all of their lives.
Many of our communities in east Arkansas, particularly in the Delta
region, are already disproportionately poverty counties. Hospitals and
clinics, community health centers before Katrina were already
disproportionately Medicaid and Medicare facilities. They were already
heavily dependent.
Tomorrow, they are going to take a cut. To save money in this
country, to look at where we are going to save money, we are going to
reduce the Federal share of their Medicaid reimbursement as of October
1. Out of the 29 States that are going to see a cut in their Medicaid
reimbursement, the most affected 7 States in the country by this
natural disaster will see a cut tomorrow in their reimbursement for the
neediest, those who depend on the health care safety net of this
country because we are so trapped, so paralyzed in the redtape that we
want to create in this body.
We do have an opportunity, though, to not only provide for Katrina
survivors and victims of such an incredible natural disaster, but to
also prove to the private industry of this Nation that we can react
without the unbelievable web of redtape that leaves them hanging, that
leaves them holding the bag for the cost of something that we should be
held accountable for--not just held accountable because we are the
Government but held accountable because we are the institution that
wraps its arms around the American people when they are most in need.
We can do so in an efficient and effective way.
To my colleagues on the other side who are so desperately worried
about the cost of what we are doing, who are so afraid of helping one
too many needy people, I say to you: Look at what we have become.
We have worked hard to keep the costs down. We have made it temporary
so it wouldn't explode or overexpand--yes--an already very expansive
program.
These people are not going home tomorrow.
I saw a piece in my hometown of Helena about a couple that left in
haste out of New Orleans. They went to Jackson and could find no help.
They went to Memphis and were sent to Tunica, MS. In Tunica, at the Red
Cross facility, they were told there was already overcapacity, and they
were simply sent away. They went to the next bridge that crossed the
great Mississippi River and into my hometown, remembering someone they
had grown up with in their childhood from Chicago, and called him
hoping that he would be there. He was. He was a pastor of a church. He
had opened his church doors and his home. He and his wife opened their
home and welcomed them in, as well as other families that were already
living there. They reached out to one of the most poverty-stricken
counties already in the country--reached out to a small health care
foundation that this community had managed to put together over the
last several years to try to reinvigorate their health care
infrastructure because they know how important it is as a component of
rebuilding the vitality of their community and creating jobs for those
who want to get into a more independent situation.
But who locates businesses, or factories, or jobs in an area where
you don't have the necessary health care to begin with?
So you have a small nonprofit health care foundation paying for this
couple's health care because the providers have no earthly idea whether
their Federal Government is going to be there for them.
We are bigger than that. We are not talking about an open-ended
payment.
We are talking about a temporary ability to give peace of mind to the
people who, since day one when this disaster struck, have not asked
questions, have put their full faith and hope in this Federal
Government--that for once it will disregard the redtape, look wisely at
something that we already have in place, and look wisely at past
experience such as 9/11, when we were able to temporarily offer a
health care safety net to survivors, and expect that we could come up
with the wisdom and the courage in this body to provide them the peace
of mind that what they have done for their fellow man was the right
thing to do.
We are talking about ensuring full Federal funding within the area
where medical care has been provided for victims of the hurricane.
Medicaid is our health care safety net in this country. I think this
crisis itself has shown us how important this safety net is to our
Nation.
We have to make sure it does not unravel in the face of this national
emergency.
Do we have concerns about Medicaid? Do we feel as though there are
places where we could be more efficient and effective in that program?
You bet there are places we can be more efficient and effective.
Chairman Grassley has suggested some in terms of the cost of
prescription drugs through Medicaid that can be negotiated in a better,
more efficient way, to provide more cost-effective drugs in that
program and hopefully lead the way to seeing us provide more cost-
effective pharmaceuticals for all other programs, as we do with the
Veterans' Administration. We can do that when we work together.
To scrap a program designed as a safety net for people who are in the
most devastating circumstances is not the way to do that.
The administration promised they wanted to make whole financially the
States that were providing health coverage to evacuees. They say there
is no need for the Grassley-Baucus initiative to provide full Federal
funding for Medicaid because they want to use waiver policy. What they
did not say is there is no Federal funding, no Federal dollars in
providing that waiver policy. There are no dollars that they will put
behind that.
They have asked Louisiana, Mississippi, and Alabama, the affected
States, to sign memorandums of understanding to agree to be on the hook
financially for a portion of the Medicaid costs of the survivors. How
humiliating to go to a State that has been devastated and say: We are
going to put you on the hook right here and now for the costs of what
your neighbors want to provide. And we, as a nation, supposedly the
wealthiest nation in the world, should be able to care for our American
citizens.
[[Page S10789]]
We know those States are in no position financially to incur that
kind of cost. Those three Governors testified before the Committee on
Finance earlier this week. One of the Governors mentioned she did not
even have the resources through her State legislature to overcome the
increase in costs they were going to see because of the loss of Federal
dollars they are going to experience tomorrow when their Federal
matching portion of Medicaid is cut. That was before Katrina ever hit.
Before this devastation hit, they could not find the resources in their
State--with a disproportionate share of low income, dependent on that
safety net--to be able to cover that. That was before the disaster.
Those Governors were highly concerned. They expressed it in their
testimony and in their questions and comments about making sure the
Federal Government would be there for them to make them whole, to
extend help to their States--Louisiana, Mississippi, and Alabama--when
they were unable to deal with that under their current budgets.
For Arkansas, what does it mean? Does it mean we are left holding the
bag due to budgetary issues, due to the fact that there are a few
people in the Senate that are more worried about the temporary spending
to help the neediest of this devastation than they were about the $62
billion we vetted for FEMA? Nobody objected to that. I have no
objections for taking the money from that. FEMA will probably come back
and ask for more money anyway.
If it were your mother or your sister or brother or niece or nephew,
uncle or parents or grandparents who had been displaced, who found
themselves in a strange community with a chronic illness--whether it
was heart disease, diabetes, perhaps cancer patients in need of
treatment, perhaps it was a child who needed health care--can you
imagine the fear of thinking you would not be able to access it? Or to
find the provider that was providing it for you was scared to death
that it was going to push them over the edge; that if they helped
enough of the people without any assurance or piece of mind, eventually
their doors would be closed and they would no longer be able to provide
that kind of care.
As I toured the evacuee camps, there was an unbelievable feeling of
gratitude among those displaced at a time when they had to have been
devastated. A woman was about to get married who had lost her wedding
dress in New Orleans. But the people in our community in Arkansas
provided a wedding dress and a wedding for people who had been
displaced who did not know where their other family members were, who
were separated, yet who were still so grateful for the food, the
warmth, the hospitality, the love and the arms that enveloped them in
the evacuee camps where they found themselves. Some of them have
dispersed and gone to stay with cousins, aunts or uncles, sisters or
brothers in other States. That is one of the reasons we want the
expansion.
We do not want it just for the State of Arkansas. We know we have
already sent many evacuees to Pennsylvania, West Virginia, North
Carolina, Iowa, Utah. They too are going to need health care because
they do not know when they will be able to go back, and they do not
know what they will be going back to. They do not know what happened to
their jobs, the health care they may have had which is provided for in
this bill to keep private insurance still in the go-along to make sure
we make it whole as well, that we put as few people as possible into
that Federal safety net.
We have an opportunity. I hope as a nation we can realize spending
more and more time to try to bring up convoluted waivers--and our State
Medicaid directors know that most of what is in the waivers is an empty
promise. Last night in Arkansas, we got a waiver from HHS, but it
certainly has contributed only to more redtape in addition to what has
already been created. It provides more questions than answers. There is
no money attached to it so it really is an empty promise that they will
do something about that.
The survivors, the health care providers in the States, have received
no relief, no legitimate help. They are out there doing this without
any assurance of from where it will come.
We do not know in the waivers what services will be cut. How do we
expect providers to know what they can provide and what they can't?
Most of them were given the assurances from their State: Don't worry,
we are part of a great Nation.
When you treated those people over the weekend on Labor Day, we are
going to ask them to go back in their minds 4 months and fill out the
kind of paperwork to ensure they can get reimbursed for a tetanus shot
or for a procedure, whatever it might have been. They, in good faith,
have filled out what the State has asked them to fill out to make sure
they are accountable for the services they have provided. Yet through
the waiver processes, there is yet one more piece of redtape, one more
form to be filled out, one more web of Washington bureaucracy they will
have to deal with, without any guarantee that there is money behind it,
that there are resources to actually pay for that.
As we look at the waivers that have been offered, they create
uncertainty about reimbursement. The administration has suggested
creating a new uncompensated care pool to reimburse health care
providers. When we asked where was the money going to come from, that
is what they told us--a new uncompensated care pool. Why wouldn't we
use something that already exists, that already has fraud and abuse
stipulations and cautions? Why wouldn't we use a system that we can
continually improve on? But we will create a new uncompensated care
pool. We will not know where the money will come from.
I question my colleagues who are looking at fiscal responsibility. A
new uncompensated care pool does not have any parameters to it, it does
not have any protections from fraud and abuse.
Health care providers receive no guarantee about which services and
how much care will actually be reimbursed through this uncompensated
care pool. I go back to the story I used in committee the other day
about the woman who survived on top of her refrigerator. She was
reported in The Economist. She survived on her refrigerator for 3 days
and was able to finally get out. She made it as far as Baton Rouge. She
was a diabetic and quite in need of care. She went to seek out health
care and was told she was categorically incorrect and could not get
care.
That is the kind of redtape we will perpetuate if we do not look at
the reasonable proposal that Senator Grassley and Senator Baucus have
come together to produce.
Does it go as far as I would like it to go? It does not. I have been
out there and have seen what the people are up against--both the
providers and the evacuees. I see what their families are going
through--not just the lack of care, the lack of essentials or the
communities that are trying to provide for them, but the dignity they
want to maintain while finding themselves without a home, without any
possessions, dislocated from their family, their neighbors, the people
who care for them and love them, finding themselves in strange places
with people who are trying desperately to give them that sense of
dignity and care.
In my soft-spoken and commonsense way, I appeal to my colleagues. We
can be fiscally responsible. We can look for ways we can provide care
and peace of mind to those who need the health care and to those who,
without reservation, are providing it to some of the neediest, most
destitute of Americans at this time in our country. I ask my
colleagues: Please, do not put this off for yet another week. Don't
send us home to our States to tell our providers, to tell the Americans
that have evacuated the gulf coast, that they are not important enough
for Congress to deal with this issue in a more timely fashion.
I compliment my friend from Montana for his and Senator Grassley's
attempt to work through this issue and to bring about something that is
not only practical and common sense-oriented, that is limited in its
timeframe, but that is also compassionate toward our fellow Americans.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, I know the people in the State of Arkansas
already know how much their Senator fights for them. I state my
perspective: The Senator from Arkansas is one of the best. She is a
believer. She fights
[[Page S10790]]
for her people and all are grateful for that.
I make a couple of points. One, this legislation to help the health
care needs of evacuees and victims of Katrina is desperately needed. It
will pass. It is a question of when that willful band of three or four
Senators will finally recognize that so we can get on with it and help
people who really need some people. That is what this comes down to.
I hear a couple of complaints about this legislation. Let me briefly
explain what this is all about. Basically, this is an effort to help
people. It is a modest effort. It is legislation designed by the
chairman of the committee, Senator Grassley, a Republican, and myself,
the ranking Democrat. We have worked with all the members of the
committee. We have worked with staffs of the committees.
We have worked with Senators from States directly affected, asking
their views. This has been scrubbed. This has been examined. This has
been worked over many days in many ways. It is balanced. It is not
nearly as extreme as some of the suggestions of some Senators. I might
say, a couple of the Senators backed off and did not offer their
legislation on the promise that we in the Finance Committee would come
up with a bill, a balanced bill--Senator Grassley and myself--and bring
that bill to the floor.
Well, here we are. It is a couple weeks later. We in the Finance
Committee did our part. It is up to the Senate now to do its part and
take up this bill and pass it, recognizing that this is only temporary.
This is only temporary relief, only temporary assistance for the health
care needs of the people in Louisiana, Arkansas, Alabama, the States
affected. This is not permanent. By ``temporary,'' I mean about 5
months. My gosh, by the time we get this enacted, virtually a month
will have already passed. We are talking about legislation which is 5
months in duration.
Some are concerned: Well, gee, this is an additional entitlement. It
is more money. It is an entitlement.
Well, I think it is important to remind ourselves that in our country
we have a program called Medicaid. What is Medicaid? Medicaid is our
safety net. It is kind of the last resort for people to get health care
if they cannot afford it otherwise, or do not have it otherwise--they
cannot get it at their place of employment, or if they are not wealthy,
they cannot buy health insurance.
So we have something called Medicaid. It is health care for low-
income people, people who do not have much money whatsoever. It is kind
of a safety net to catch people who otherwise would fall between the
cracks. It is directly designed for people such as those who are
affected by Katrina.
So many people in Louisiana and other States do not have health
insurance. They do not have it. They do not have it for several
reasons: One, they could not afford it; or they work for small
businesses, which we know have a harder time providing health
insurance; or their business has laid them off, so they do not have
health insurance because they do not have the income. For whatever
reason, they do not have health insurance and they need health care
now--especially diabetics, especially people who need dialysis,
especially seniors, or maybe not seniors, who have very definite,
immediate, extraordinary health needs.
One out of three Medicaid applications in the States affected--at
least in Louisiana--has been turned down because they did not meet the
criteria. The criteria, as we know today, are pretty low. Or I might
say it differently. It is difficult to get on Medicaid if you have
significant income or just some income, if you have some assets. If you
have some income and some assets, you do not get health care.
So we are saying, let's raise the eligibility criteria a little bit
to the same measures we provided for victims of 9/11. It is the same
provision. The income levels are increased only very modestly, very
slightly, and the categories that are covered are virtually the same.
I ask my colleagues, if the survivors of 9/11 could get this kind of
Medicaid health care insurance, why in the world can't people who are
affected by Katrina get the same coverage? It is the same. The people
of New York City got help right away. It was passed very quickly. Why
can't the people of Louisiana, Arkansas, Mississippi, and Alabama get
the same coverage? It does not make any sense to me.
Now, the catchall objection I heard earlier today was: Well, gee,
this isn't quite right. It is not the best. Well, there is never going
to be ``the best.'' We all know it is often important to not let
perfection be the enemy of the good. Is it going to be perfect? No. Is
it very, very good? Yes. Can we adjust it and change it if we need to
make some changes? Certainly. But let's begin.
This is an emergency. It is a bit reminiscent--I do not want to be
too melodramatic about this, but we have had crises in our Nation's
past, whether it was Pearl Harbor, Sputnik, or whatever it might have
been, and this Congress reacted very quickly to those crises. This,
too, is a crisis for these people in that part of the country. We need
to act quickly. It is a crisis for them. If we do not act, many people
will not get the health care they need; or, looking at it differently,
they are going to be burdened with an additional concern, whether they
are going to get their health care, whether they are covered under
Medicaid, whether it is going to be there. That will be added to all
the other problems they have: Where are they going to live? Where are
some of their lost loved ones? What is next for them? Are they going to
be able to make their car payment or house payment? The problems the
people in Louisiana and these other States are coming up with are
incredible. Why can't we, then, in a small way, help with health care?
Now, I have heard the objection: Well, gee, Senator, your legislation
does not allow a reduction in FMAP payments to 29 States. After all, 29
States is a lot of States. There are only about three or four or five
or six or seven States that are most affected.
Let me explain this. Currently, there is a scheduled reduction in
Federal payments to States. It is called FMAP. It is irrespective of
Katrina. It is in the law. It is because certain States, a few years
ago, had higher incomes. Because of averaging and data lags, the
information is quite dated. But the point is, this legislation says,
OK, for those 29 States that are going to have their Federal payments
to cover Medicaid drop automatically, we are saying they will not
drop--temporarily. We are not increasing the Federal payment to States.
We are not increasing it at all. We are saying it will not drop for 29
States for which it otherwise is scheduled to drop. And this is only
temporary. I think it is for a year's term.
Well, why is that so important? Why is it important not to let
Federal payments drop to those States? It is pretty simple. These are
States which have a lot of additional costs. A lot of evacuees are
going to these States. Many are going to these States, which puts an
additional burden on these States. Now, it is not just Medicaid
burdens; these States are going to have to pay additional Medicaid
costs or other social services costs, other education costs, to pay for
the people who are now coming to their States and who need help.
Let me give you a little bit of a flavor of what that means in terms
of dollars and cents. Let's take the State of Arizona. They are
scheduled to have about a half a percent reduction. That is a drop of
$30 million in payments to the State of Arizona for Medicaid, and
that State is now going to pick up at least 2,000 more people. That
does not make a lot of sense.
Let's take the State of Nevada: It is about a 1.14-percent drop in
Federal payments under Medicaid. That is about $14 million less Nevada
is going to otherwise receive. They have to pick up about 1,500
additional people.
Let's take the State of Oklahoma. It is almost a 2.25-percent
reduction. That is about a $66 million reduction. There are about 4,000
people, at least who we know of, who are going to be living
temporarily, at least, in Oklahoma, and they will have to pick up those
other costs.
We are not asking for an increase. We are just saying: No reduction
in Federal payments to States affected.
I might add that 25 of the 29 States on this list are States where
the President has declared a public health emergency because of
Katrina. Twenty-five of the 29 States are States where the
[[Page S10791]]
President has declared a public health emergency, indicating there are
additional pressures on those States and additional pressures on the
people in those States. We are trying to provide some temporary help.
Now, you hear sometimes: Well, the administration is suggesting a
waiver. Senators mentioned the problems with the waiver. I will very
briefly list them. One is that the waiver does not cover a lot of
people who are going to need care. A major category is childless
adults. If you are a single man or single woman, you do not get any
assistance here. That does not make any sense. It does make sense to
give assistance to women and children, but it does not make sense not
to give any assistance to a single man or a single woman. That is an
effect of the waiver that the administration is talking about.
Why create all these additional misconceptions? Let's say, as the
legislation does: OK, we are going to utilize this Medicaid safety net,
and I don't care whether you are single, you are a parent, you are old,
or what; if you do not have the income, you are covered. We are going
to help you out for 5 months. What is wrong with that? Doesn't that
make sense? To me, it makes a lot more sense.
It is important to add, too, this legislation is strongly supported
by the Governors in the States affected. It is bipartisan, supported by
Republican Governors, Democratic Governors. Governor Riley of Alabama
wants the legislation. Governor Barbour of Mississippi wants this
legislation. Governor Blanco of Louisiana wants this legislation. It is
supported by Republicans and Democrats.
A lot of Senators around here say: Well, gee, the local people know
what the needs are. The local people know best. We in Congress are too
top-down. We issue these ultimatums, we pass this legislation, but it
is the local people who know.
It is important to note, the local people want this. It is the local
people who are asking us for this. The Senators from Louisiana--from
both sides of the aisle--want this. Senator Lott and Senator Cochran
want this. It is the same with the Senators from Alabama, who are both
Republicans. They want this legislation. It is the same with the
Senators from Louisiana. One is a Republican and one is a Democrat.
They want this. I mentioned the Governors want it. The House
delegations want it. Again, I remind my colleagues, it is temporary. It
is only for 5 months, this Medicaid help.
Now let's get into the question of uncompensated care to hospitals.
This legislation--again, scrubbed, worked over--provides for $800
million of uncompensated care to providers in the States affected, to
be administered by HHS, and grants for uncompensated care for those
hospitals; whereas, the administration says: Well, we will give
uncompensated care in waivers. But we are not saying how much. We are
not saying how. It is only a promise. I am saying, it is deeds. It is
not words. It is deeds.
I might also add the waiver process the administration talks about as
an alternative has huge, big problems, to be honest about it. What are
they? Well, the basic problem is this. The administration says: OK, we
will make you States whole under Medicaid; that is, you have the
charges, then you bill us, and we will pay you. There is a real
question whether they have the authority under the law to do that. It
is a huge issue. In fact, coming to work today, I heard a George
Washington professor talk about this. She says under the law they
cannot do that.
Do you know what I think is going to happen? Some are going to duck
under this waiver ``idea'' saying: OK, it will make you whole, States.
Then there will be a big debate whether legally the administration can
do that. Then, well, it kind of fades away and--guess what--these
States are not going to get it. These hospitals are not going to get
that extra uncompensated care, either.
All I am saying is, this is a quick, certain way. It is Medicaid. We
all know Medicaid. We know it works. The provider networks are set up.
The process is set up. The people are there. So let's raise the income
levels a little bit--just a little bit--temporarily, for 5 months.
Let's get on with it, rather than this very uncertain administrative
idea of waivers and what they are, what they can and cannot do.
We have already established under the law one thing they cannot do.
They cannot give Medicaid assistance by picking and choosing in that
picking and choosing, there is discrimination against who gets help and
who does not.
Katrina survivors need to know, are they going to get any help or
not? They do not need the additional worry of whether they are going to
be discriminated against.
Finally, I would like to say, this question before us, to a large
degree, tests us as a Nation, as a people, as a Senate, as a Congress.
Who are we? What do we stand for? Are we going to stand here and bicker
over minute details while people need help? Are we going to be kind of
FEMA-like and be hesitant and not respond immediately? What signal does
that send? What signal does that send to the people affected? What
signal does that send to the rest of the country? What signal does that
send to the world?
Here we are, the Congress is bickering over whether to provide health
care benefits to the people who need them, people who are down and out
because of a natural disaster.
We are supposed to be America, a big heart, model for the world.
Sure, we have to make sure there is no waste. That is one of the
reasons we should go through Medicaid. There are already antifraud
provisions and protections set up under Medicaid today. That is already
in existence. It is pretty simple. It doesn't take rocket science to
figure this one out. Let's help these people. Let's do it now. We will
take up other disaster assistance matters in subsequent weeks and days
and have an opportunity then to make adjustments that may or may not
seem necessary. But at the very least, let's pass this legislation now.
We are going to pass it. Obviously, if you are going to do something,
you might as well do it earlier rather than later and get on with it so
we can get on with other things. We are going to pass this. I hope
Senators who are opposed to this, for reasons I can't fully understand,
will finally sit down and say: OK, sometimes discretion is the better
part of valor. Let's pass it and get on with it.
The PRESIDING OFFICER. The Senator from Arizona.
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