[Congressional Record Volume 152, Number 29 (Wednesday, March 8, 2006)]
[Senate]
[Pages S1885-S1887]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
[[Page S1885]]
REPEAL OF MEDICAID VERIFICATION REQUIREMENT
Mr. AKAKA. Mr. President, we must enact my legislation, S. 2305, to
repeal a provision in the Deficit Reduction Act that will require
people applying or reapplying for Medicaid to verify their citizenship
with a U.S. passport or birth certificate. Congress must act to repeal
this shortsighted policy before it goes into effect July 1, 2006,
because it will create barriers to health care, is unnecessary, and
will be an administrative burden to implement.
Mr. President, I ask unanimous consent that additional letters of
support for S. 2305 from the California Immigrant Welfare
Collaborative, the Coalition for Humane Immigrant Rights of Los
Angeles, the National Health Law Program, Families USA, the Children's
Defense Fund, the National Association for the Advancement of Colored
People, and the American Public Health Association, be printed in the
Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
California Immigrant
Welfare Collaborative,
Sacramento, CA, February 16, 2006.
Senator Daniel Kahikina Akaka,
U.S. Senate,
Washington, DC.
Dear Senator Akaka: The California Immigrant Welfare
Collaborative (CIWC) is a statewide partnership of four
immigrant rights organizations: Asian Pacific American Legal
Center of Southern California, Coalition for Humane Immigrant
Rights of Los Angeles, National Immigration Law Center and
Services, Immigrant Rights and Education Network of San Jose.
We work directly in communities as well as with policy makers
in order to respond to changes in health and welfare laws and
to advocate for low-income immigrants.
We are writing in support of your Senate bill to amend
title XIX of the Social Security Act to repeal the amendments
made by the Deficit Reduction Act of 2005 requiring
documentation evidencing citizenship or nationality as a
condition for receipt of medical assistance under the
Medicaid program. This provision would apply to all current
beneficiaries and future applicants, allowing no exceptions,
even for those with serious mental or physical disabilities
such as Alzheimer's disease or those who lack documents due
to homelessness or a disaster such as Hurricane Katrina.
About 49 million U.S.-born citizens (and two million
naturalized citizens) who are covered by Medicaid over the
course of a year would be required to submit these documents
or forfeit their health insurance coverage. New Medicaid
applicants also would have to meet this requirement.
According to a recent survey conducted by the Center on
Budget and Policy Priorities and by the Opinion Research
Corporation the new requirement could have large consequences
on the health insurance coverage of millions of low-income
U.S. citizens. Key findings from the survey include:
About one in every twelve (8 percent) U.S.-born adults age
18 or older who have incomes below $25,000 report they do not
have a U.S. passport or U.S. birth certificate in their
possession. Applying this percentage to the number of adult
citizens covered by Medicaid over the course of a year
indicates that approximately 1.7 million U.S.-born adults who
are covered by Medicaid could lose their health insurance
because of the new requirement or experience delays in
obtaining coverage as they attempt to secure these documents.
More than one tenth of U.S.-born adults with children who
have incomes below $25,000 reported they did not have a birth
certificate or passport for at least one of their children.
This indicates that between 1.4 and 2.9 million children
enrolled in Medicaid appear not to have the paperwork
required.
Taken together, the survey indicates that Medicaid coverage
could be in jeopardy for 3.2 to 4.6 million U.S.-born
citizens because they do not have a U.S. passport or birth
certificate readily available.
Some types of citizens would shoulder a greater risk of
losing Medicaid than others because they are less likely to
have the required documents. While 5.7 percent of all adults
in the survey (i.e., adults at all income levels) reported
they lack these documents, the percentage was larger for
certain groups: African American adults: 9 percent; Senior
citizens 65 or older: 7 percent; Adults without a high school
diploma: 9 percent; Adults living in rural areas: 9 percent.
These data and earlier research also suggest that elderly
African Americans with low incomes may experience particular
difficulties because a significant number of them were never
issued birth certificates.
These results are conservative as many of those who would
be most likely to experience difficulty in securing these
documents--such as nursing-home residents, Katrina survivors
living in temporary facilities, and homeless people--were not
represented in the survey. Had the survey included such
people, the percentage of people likely to be harmed by the
requirement would almost certainly have been found to be
higher.
In California, birth certificates cost $17 and require a
notarized application, or sworn statement under penalty of
perjury. In addition to the added expense of notarizing, an
additional $25-$50 depending on the ability of often-
unscrupulous notaries to charge, making people swear under
penalty of perjury is intimidating and will discourage people
from applying. It takes four to six months to obtain birth
certificates for newborns and if obtained in person, require
travel to a different office than for duplicate copies that
might be needed for adults or other children who need them.
We see no flexibility in the amendments as passed to allow
for families with no disposable income to obtain the birth
certificates timely.
We understand that the new requirement for documentation in
Medicaid is intended to prevent undocumented immigrants from
declaring they are citizens and obtaining Medicaid benefits.
The HHS Inspector General however found no substantial
evidence that this is occurring. Instead, the principal
effect of the provision would likely be to endanger health-
care coverage for millions of poor U.S. citizens, because
substantial numbers of native-born citizens do not have a
passport or birth certificate readily available. We also
anticipate the provision will add yet another barrier and
have a chilling effect on the many immigrants who are
federally eligible for Medicaid but may get turned away due
to confusion in the rules when this is implemented in all 50
states. We support your efforts to repeal this amendment as
it could have terrible consequences for all Medicaid
recipients.
Sincerely,
Jeanette Zanipatin,
Statewide Policy Analyst/CIWC.
____
The Coalition for Humane
Immigrant Rights of Los Angeles,
Los Angeles, CA.
Senator Daniel Kahikina Akaka,
U.S. Senate,
Washington, DC.
Dear Senator Akaka: The Coalition for Humane Immigrant
Rights of Los Angeles (CHIRLA) is a multi-ethnic nonprofit
coalition founded in 1986 to advance the human and civil
rights of immigrants and refugees in Los Angeles; promotes
harmonious multi-ethnic and multi-racial human relations; and
through coalition-building, advocacy, community education and
organizing, empower immigrants and their allies to build a
more just society.
We are writing in support of your Senate bill to amend
title XIX of the Social Security Act to repeal the amendments
made by the Deficit Reduction Act of 2005 requiring
documentation evidencing citizenship or nationality as a
condition for receipt of medical assistance under the
Medicaid program. This provision would apply to all current
beneficiaries and future applicants, allowing no exceptions,
even for those with serious mental or physical disabilities
such as Alzheimer's disease or those who lack documents due
to homelessness or a disaster such as Hurricane Katrina.
About 49 million U.S.-born citizens (and two million
naturalized citizens) who are covered by Medicaid over the
course of a year would be required to submit these documents
or forfeit their health insurance coverage. New Medicaid
applicants also would have to meet this requirement.
According to a recent survey conducted by the Center on
Budget and Policy Priorities and by the Opinion Research
Corporation the new requirement could have large consequences
on the health insurance coverage of millions of low-income
U.S. citizens. Key findings from the survey include:
About one in every twelve (8 percent) U.S.-born adults age
18 or older who have incomes below $25,000 report they do not
have a U.S. passport or U.S. birth certificate in their
possession. Applying this percentage to the number of adult
citizens covered by Medicaid over the course of a year
indicates that approximately 1.7 million U.S.-born adults who
are covered by Medicaid could lose their health insurance
because of the new requirement or experience delays in
obtaining coverage as they attempt to secure these documents.
More than one tenth of U.S.-born adults with children who
have incomes below $25,000 reported they did not have a birth
certificate or passport for at least one of their children.
This indicates that between 1.4 and 2.9 million children
enrolled in Medicaid appear not to have the paperwork
required.
Taken together, the survey indicates that Medicaid coverage
could be in jeopardy for 3.2 to 4.6 million U.S.-born
citizens because they do not have a U.S. passport or birth
certificate readily available.
Some types of citizens would shoulder a greater risk of
losing Medicaid than others because they are less likely to
have the required documents. While 5.7 percent of all adults
in the survey (i.e., adults at all income levels) reported
they lack these documents, the percentage was larger for
certain groups: African American adults: 9 percent; senior
citizens 65 or older: 7 percent; adults without a high school
diploma: 9 percent; and adults living in rural areas: 9
percent.
These data and earlier research also suggest that elderly
African Americans with low incomes may experience particular
difficulties because a significant number of them were never
issued birth certificates.
These results are conservative as many of those who would
be most likely to experience difficulty in securing these
documents--such as nursing-home residents,
[[Page S1886]]
Katrina survivors living in temporary facilities, and
homeless people--were not represented in the survey. Had the
survey included such people, the percentage of people likely
to be harmed by the requirement would almost certainly have
been found to be higher.
In California, birth certificates cost $17 and require a
notarized application, or sworn statement under penalty of
perjury. In addition to the added expense of notarizing, an
additional $25-$50 depending on the ability of often-
unscrupulous notaries to charge, making people swear under
penalty of perjury is intimidating and will discourage people
from applying. It takes four to six months to obtain birth
certificates for newborns and if obtained in person, require
travel to a different office than for duplicate copies that
might be needed for adults or other children who need them.
We see no flexibility in the amendments as passed to allow
for families with no disposable income to obtain the birth
certificates timely.
We understand that the new requirement for documentation in
Medicaid is intended to prevent undocumented immigrants from
declaring they are citizens and obtaining Medicaid benefits.
The HHS Inspector General however found no substantial
evidence that this is occurring.
Instead, the principal effect of the provision would likely
be to endanger health-care coverage for millions of poor U.S.
citizens, because substantial numbers of native-born citizens
do not have a passport or birth certificate readily
available. We also anticipate the provision will add yet
another barrier and have a chilling effect on the many
immigrants who are federally eligible for Medicaid but may
get turned away due to confusion in the rules when this is
implemented in all 50 states. We support your efforts to
repeal this amendment as it could have terrible consequences
for all Medicaid recipients.
Sincerely,
Joseph Villela,
State Policy Advocate.
____
National Health Law Program,
Washington, DC, February 16, 2006.
Senator Daniel K. Akaka,
Senate Hart Office Building,
Washington, DC.
Dear Senator Akaka, The National Health Law Program (NHeLP)
supports the repeal of Section 6036 of the Deficit Reduction
Act. This section requires documentation evidencing
citizenship or nationality as a condition of receipt of
Medicaid. The arbitrary and unnecessary documentation
requirements embedded in Section 6036 will adversely and
disproportionately deny medical care to elderly, minority,
and rural U.S. citizens.
Currently, citizens are allowed to self-declare their
citizenship under penalty of perjury when they apply for
Medicaid. Proponents of Section 6036 suggest the provision
will prevent immigrants from falsely obtaining Medicaid by
claiming they are citizens. Yet the Office of the Inspector
General of the Department of Health and Human Services
conducted a comprehensive review of this subject and did not
recommend new documentation requirements such as those
contained in Section 3145, and the Centers for Medicare &
Medicaid Services concurred in that judgment.
Rather, to the extent that Section 6036 would produce cost
savings, it would do so by denying desperately needed health
care coverage to many of this country's neediest native-born
citizens, especially those who are African American, Native
American, elderly and/or born in rural areas. For example, a
study by the Center on Budget and Policy Priorities noted
that approximately 1.7 million adult citizens and 1.4 to 2.9
million citizen children on Medicaid do not have a passport
or birth certificate available at home. Some of these
individuals cannot get a birth certificate because they were
not born in hospitals. For example, a 1950 study found that
one out of five African Americans lacked a birth
registration. And the difficultly of obtaining the
documentation, especially for those with mental disabilities,
will effectively preclude eligible individuals from enrolling
in Medicaid.
Even without its likely discriminatory impact, Section 6036
represents bad policy. Adding new paperwork requirements
imposes unnecessary delays at a time when many need prompt
medical coverage. Individuals could face long delays in
getting birth certificates due to the high volume of requests
that state vital statistics offices will need to field.
Further, Section 6036 effectively creates an application fee
for Medicaid--a passport currently costs $97.00; copies of a
birth certificate can cost $5 to $23. As a result, native-
born citizens poor enough to qualify for Medicaid will often
be too poor to prove that they qualify because they cannot
afford the required documentation.
We applaud your introduction of a bill to repeal Section
6036. Please feel free to contact Mara Youdelman at 202-289-
7661 if you would like to discuss this or any other issue
about which we may be of assistance.
Sincerely,
Laurence M. Lavin,
Director.
____
Washington, DC, Feb. 21, 2006.
Senator Daniel K. Akaka,
Hart Senate Office Building,
Washington, DC.
Dear Senator Akaka: Families USA thanks you for introducing
S. 2305, a bill that would remove provisions requiring
Medicaid recipients to prove their citizenship by producing a
passport or birth certificate, and we hope to see your
proposed bill enacted into law.
We are concerned that increasing documentation requirements
to access Medicaid would wrongfully block many native-born
American citizens and legal immigrants that qualify for
Medicaid from enrolling. In fact, 5.7% of all adults at all
income levels report that they lack birth certificates or
passports, and that number is even higher for African-
Americans, senior citizens, Americans residing in rural
areas, and foster children. The Center on Budget and Policy
Priorities estimates that more than 51 million individuals
would be burdened by having to produce this additional
documentation. If the documentation provisions are not
repealed, then otherwise eligible beneficiaries would be
unable to prove their own citizenship and therefore be forced
to go without health care, adding to our nation's already
burgeoning pool of 46 million uninsured.
The Office of the Inspector General of the Department of
Health and Human Services concluded that no evidence exists
that shows that immigrants are enrolling in Medicaid by
claiming to be U.S. citizens. Since government officials
investigating the matter concluded that there is no problem,
and since enacting any provisions that would require
beneficiaries to show more documents would cost millions of
dollars in increased administrative expenses to a number of
government agencies, Families USA believes policies calling
for more documentation to be neither prudent nor responsible
uses of taxpayers' dollars.
Denying Medicaid to some of our Nation's neediest citizens
in order to chase the phantom problem of illegal immigrants
dubiously enrolling in Medicaid is an unacceptable
inefficiency that will increase the tax burden on hard-
working Americans. We appreciate your insight in correcting
such a deficient policy and support your proposed
legislation.
Sincerely,
Ronald F. Pollack,
Executive Director.
____
Children's Defense Fund,
March 3, 2006.
Hon. Daniel K. Akaka,
U.S. Senate, Hart Senate Office Building, Washington, DC.
Dear Senator Akaka: I am writing to offer the support of
the Children's Defense Fund for your bill, S. 2305, to repeal
one of the harmful amendments made to Title XIX of the Social
Security Act by the Deficit Reduction Act of 2005. We support
the elimination of the new requirement that U.S. citizens
eligible for Medicaid must confirm their citizenship by
submitting a birth certificate or passport (or other
naturalization papers) to receive Medicaid.
This harmful and unnecessary provision will deny health
care to millions of children and adults who need it to
address their health and mental health needs and who are
legally entitled to it. A recent survey conducted by the
Opinion Research Corporation indicates that between 1.4 and
2.9 million children could lose their Medicaid coverage
because their U.S. born parents do not have birth
certificates or passports for them. In California and Texas,
just two of the states where CDF has offices, it is estimated
that as many as 11 million individuals could be denied health
care because of this requirement.
While this provision was intended to prevent immigrants who
are not eligible for Medicaid from receiving it illegally,
the Centers for Medicare and Medicaid Services and the Office
of the Inspector General agree that there is no substantial
evidence that immigrants are attempting to obtain Medicaid by
falsely attesting to their citizenship.
S. 2305 will help spare children and adults, who need
health and mental health care, from having to navigate
through additional red tape to receive benefits from the
Medicaid program. We applaud your effort to take a step
forward in making affordable health care available to those
who need it.
The Children's Defense Fund looks forward to working with
you to ensure that all children receive health care without
the unwanted burden of producing unnecessary documentation.
Sincerely,
Marian Wright Edelman.
____
Washington Bureau, National Association for the
Advancement of Colored People,
Washington, DC, March, 3, 2006.
Re NAACP support for S. 1580, the Healthcare Equality and
Accountability Act
Hon. Daniel Akaka,
U.S. Senate,
Washington, DC.
Dear Senator Akaka. On behalf of the National Association
for the Advancement of Colored People (NAACP), our nation's
oldest, largest and most widely-recognized grassroots civil
rights organization, I am writing to let you know that at our
recent Annual Meeting we passed a resolution expressing our
strong support of S. 1580, the Healthcare Equality and
Accountability Act.
The fact of the matter is that huge discrepancies remain in
health care in the United States today. The quality and
quantity of health care services you receive depends greatly
upon your racial or ethnic background, the make-up and
location of the
[[Page S1887]]
community in which you live, and your economic status.
Currently, one seventh of all Americans, 42 million people,
lack insurance and suffer unnecessary illness and premature
death; a disparate number of these people are racial or
ethnic minority Americans.
Despite being first in spending, the World Health
Organization has ranked the United States 37th among all
nations in terms of meeting the health care needs of its
people. Furthermore, despite the numerous advances that have
been made in health care over the decades, racial and ethnic
minority Americans continue to suffer disproportionately from
many severe health problems and have higher mortality rates
than whites for many treatable health conditions. Diabetes
strikes African Americans 70% more often than Caucasian
Americans; Hispanic Americans twice as often as whites; the
diabetes rate for Native Americans is even higher. striking
members of this community 180% more often than Caucasian
Americans. African Americans are 40% more likely to die from
coronary heart disease and 35% more likely to die from cancer
than Caucasian Americans.
It is because of these glaring disparities, the NAACP
strongly supports the efforts of the Congressional Black
Caucus, the Congressional Hispanic Caucus and the
Congressional Asian/Pacific Islander Caucus to address these
problems with the introduction of comprehensive legislation
which expands health care access, improves health care
quality, strengthens key academic institutions and research
centers, and bolsters the health care infrastructure in
underserved communities.
Given the importance of this legislation, and the NAACP's
historic mission to eliminate racial disparities wherever
they exist and to promote affordable, adequate health care
among racial and ethnic minorities it is our honor, as well
as our duty as some might argue, to support this legislation
in the strongest terms possible. Thus the NAACP is committed
to using all of our available resources to see this bill's
quick enactment.
Thank you for your leadership in this area: I look forward
to working with you toward our common goal. Should you have
any questions, please feel free to contact us.
Sincerely,
Hilary O. Shelton,
Director.
____
American Public
Health Association,
Washington, DC, March 7, 2006.
Hon. Daniel Akaka,
U.S. Senate,
Washington, DC.
Dear Senator Akaka: On behalf of the American Public Health
Association (APHA), the oldest, largest and most diverse
organization of public health professionals in the world,
dedicated to protecting all Americans and their communities
from preventable, serious health threats and assuring
community-based health promotion and disease prevention
activities and preventive health services are universally
accessible in the United States, I write in support of S.
2305. This legislation would repeal the provision of the
Deficit Reduction Act of 2005 that would require
documentation evidencing citizenship or nationality as a
condition for being enrolled in the Medicaid program.
APHA strongly supports efforts to reverse the cuts and
changes to the Medicaid program included in the Deficit
Reduction Act of 2005 that jeopardize the health of our
nation's most vulnerable, including Medicaid beneficiaries.
Several Medicaid reforms included in the bill have unintended
and severe consequences and will not result in the projected
cost savings. Of note is the provision in the legislation
that requires individuals to present citizenship or residency
documentation in order to enroll in the Medicaid program.
Although not its intent, this provision is expected to have a
devastating impact on the health coverage and status of
native-born citizens who are in every way eligible for the
Medicaid program.
Citizenship and verification requirements in Medicaid and
the State Children's Health Insurance Program have been
proven to reduce enrollment in the programs among the
eligible population. The provision included in the Deficit
Reduction Act of 2005 that would require individuals to
present documentation proving citizenship or nationality in
order to enroll in the Medicaid program is expected to cause
thousands of Medicaid beneficiaries who are native-born
citizens but do not have a birth certificate or passport in
their possession to join the country's uninsured ranks. This
provision will likely exacerbate existing racial/ethnic and
rural/urban health disparities, as it is expected to
disproportionately affect elderly African Americans,
individuals residing in rural areas and Katrina survivors,
many of whom were not born in a hospital or lost such
documentation during Hurricane Katrina or other life
tragedies. Also, Medicaid beneficiaries and applicants with
mental disorders will likely be adversely affected, as the
provision did not include exceptions for any populations,
including those with severe physical or mental impairments
such as Alzheimer's disease.
Therefore, there is the need to now take a vital step to
protect the public's health and repeal this harmful provision
included in the Deficit Reduction Act of 2005. We thank you
for taking a leadership role in doing so, and look forward to
working with you as this legislation moves forward.
Sincerely,
Georges C. Benjamin,
Executive Director.
____________________