[Congressional Record Volume 151, Number 146 (Monday, November 7, 2005)]
[House]
[Pages H9938-H9939]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 BUDGET RECONCILIATION: BALANCING THE BUDGET ON THE BACKS OF MEDICAID 
                             BENEFICIARIES

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Texas (Mr. Gene Green) is recognized for 5 minutes.
  Mr. GENE GREEN of Texas. Madam Speaker, I rise tonight to speak out 
against the budget reconciliation bill, which we will consider soon. 
The bill contains a number of harmful provisions, but my primary 
opposition to this legislation stems from its $11.9 billion in cuts to 
the Medicaid program. This reconciliation process has been flawed from 
day one.
  The Energy and Commerce Committee was given an arbitrary budget 
number and was forced to mold the policy to achieve that number. 
Without doubt, there are certainly ways that we can improve the 
Medicaid program, but sound public policy, not budget targets, must be 
the driving force behind any Medicaid reform.
  This quest to meet budget targets superseded Congress's 
responsibility to ensure that the Medicaid program continues to provide 
comprehensive and quality health care to our Nation's most vulnerable. 
Unfortunately, the bill the House will consider takes away that 
assurance and further frays the safety net that Medicaid beneficiaries 
depend on.
  While the Senate's bill largely shielded the beneficiaries from any 
cuts to Medicaid, the House bill places a bull's-eye squarely on the 
backs of Medicaid beneficiaries and aims Medicaid cuts directly at 
them. In fact, $8.8 billion of these cuts in this bill are achieved 
through cost-sharing and benefit reductions for beneficiaries. The 
increased cost-sharing allowed for in the bill exposes Medicaid 
beneficiaries to new premium requirements and copays that many 
beneficiaries simply cannot afford. The reason you are on Medicaid is 
because you are poor.
  What is more, Medicaid beneficiaries already pay a higher percentage 
of out-of-pocket health care costs than higher-income individuals who 
can better afford out-of-pocket costs. In 2002, higher-income adults 
with private insurance paid 0.7 percent of their income on the out-of-
pocket medical expenses. Yet during the same year low-income, 
nondisabled adults on Medicaid spent more than three times as much, 2.4 
percent of their income on out-of-pocket expenses.
  Low-income disabled adults on Medicaid fared even worse, forced to 
spend 5.6 percent of their income on out-of-pocket medical expenses. 
Unfortunately, the growth of out-of-pocket health care spending is more 
than double that of the income for Medicaid adults, with income growing 
at 4.6 percent annually, out-of-pocket increases increasing by 9.4 
percent annually.
  This bill is only going to make worse a problem we already know is 
occurring. Faced with increased out-of-pocket costs, Medicaid 
beneficiaries are less likely to seek health care, which is exactly the 
result that proponents of this bill are looking for. The problem is, 
health care conditions worsened for these folks, and they will only 
seek care when their health problems reach emergency portions and the 
cost of care is exponentially greater.
  While we do not want to encourage overutilization, we also do not 
want to cut off our nose to spite our face by discouraging preventive 
care. To make matters worse, the bill takes an extremely heavy-handed 
approach to the enforcement of those with cost-sharing measures. The 
bill will allow health care providers to refuse to treat sick Medicaid 
patients if they do not have the copay on hand.
  The State can also drop Medicaid beneficiaries altogether if they 
cannot afford the premium for the Medicaid. A recent study of cost-
sharing on Medicaid beneficiaries in Oregon foreshadows what will 
happen under these circumstances. Less than a year after Oregon 
implemented premium increases through a waiver process, its Medicaid 
population decreased by one-half.
  Make no mistake about it, the Medicaid program is the health insurer 
of last resort. Without health insurance through Medicaid, it is safe 
to say that these folks in Oregon joined the growing ranks of the 
uninsured, a trend we will likely see continued if we enact this bill 
to allow every State in the Nation to follow Oregon's lead.

                              {time}  2015

  Not only does the bill make Medicaid beneficiaries pay more for 
health care; it also reduces the health care benefits they receive 
under Medicaid.
  The bill allows States to reduce benefits as long as the Medicaid 
package mirrors private coverage or SCHIP coverage.
  The flaw in that policy lies in the fact that the Medicaid program 
was always intended to provide benefits that low-income individuals 
could not afford to purchase through private coverage, such as an array 
of benefits needed by disabled individuals.
  This reduction in benefits flies in the face of the goal shared by 
Democrats and Republicans alike to remove the institutional bias 
inherent in the Medicaid program by providing the necessary tools to 
keep disabled individuals in the community.
  Without these benefits, low-income disabled individuals will have no 
option other than to enter a nursing home setting.
  This bill also eliminates a benefit that has long served as the 
cornerstone of the Medicaid program's approach toward children's 
health.
  If Medicaid costs are truly growing at an unsustainable rate, there 
is no way increased costs can be attributed to children.
  Health care for pregnant women and children is arguably the most 
cost-beneficial aspect of the Medicaid program, with pregnant women or 
children accounting for nearly 70 percent of all Medicaid enrollees, 
but only 30 percent of the program's costs.
  The bill's elimination of the Early, Periodic, Screening, Detection 
and Treatment program for children above the poverty level means that 
childhood illnesses will not be detected as early, and more low-income 
children will lack the good health that puts them on the path of 
learning and productivity.
  According to the March of Dimes, the situation would be even more 
dire for children with significant physical and developmental 
conditions.

[[Page H9939]]

  In a recent analysis of Medicaid coverage in all 50 States, the March 
of Dimes found that each State would significantly restrict coverage 
for services needed by children with physical and developmental 
disabilities, States that were exempt from the mandates of the Early, 
Periodic, Screening, Detection and Treatment program.
  Unfortunately, this bill puts the wheels in motion for States to deny 
necessary health care benefits to disabled children.
  Madam Speaker, the light has been shined on this process. This is not 
a process to reduce the deficit. This is a process to finance 
additional tax cuts.
  There is no way to deny this fact when the same budget that protects 
$34.7 billion in decreased mandatory spending allows for $70 billion in 
tax cuts that will decrease revenues used to fund government programs.
  It is inconceivable Congress would balance this budget on the backs 
of low-income Americans, but to finance tax cuts on the backs of 
America's most vulnerable, that is downright shameful.

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