[Congressional Record Volume 155, Number 97 (Thursday, June 25, 2009)]
[Senate]
[Pages S7089-S7091]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ROCKEFELLER:
  S. 1377. A bill provide for an automatic increase in the federal 
matching rate for the Medicaid program during periods of national 
economic downturn to help States cope with increases in Medicaid costs; 
to the Committee on Finance.
  Mr. ROCKEFELLER. Mr. President, I rise today to introduce legislation 
that will guarantee that Medicaid remains available as a critical 
safety-net for working families in the event of another economic 
downturn. Medicaid is consistently the first program slated for cuts 
during a State budget crisis. My legislation would establish an 
automatic trigger for a temporary FMAP increase so that state Medicaid 
assistance becomes available in a timely and targeted manner during 
significant economic challenges.
  State cutbacks during the 2001-2003 recession eliminated public 
health coverage for more than one million Americans. According to the 
Kaiser Commission on Medicaid and the Uninsured, between fiscal years 
2002 and 2005, the loss of revenue led all 50 States to reduce Medicaid 
provider payment rates and implement prescription drug cost controls, 
38 States to reduce Medicaid eligibility and 34 States to reduce 
benefits. Many more Americans would have lost coverage if Congress had 
not provided states with $20 billion in Federal aid in 2003.
  Now, once again, the country is facing economic challenges unlike 
anything else we have faced since the Great Depression. Fortunately, 
the American Recovery and Reinvestment Act, ARRA, included $87 billion 
in Federal Medicaid relief for States. It is estimated that through 
this temporary FMAP increase, my State of West Virginia will receive 
nearly $450 million in

[[Page S7090]]

Federal funding over the next 2 years to help meet the existing and 
growing enrollment needs in Medicaid. This temporary FMAP increase will 
protect the health care coverage of nearly 400,000 West Virginians, and 
approximately 58 million Americans, as this country works to pull 
itself out of the current economic recession.
  After the last economic downturn, I joined a bipartisan group of my 
colleagues in requesting that the Government Accountability Office, 
GAO, study and report on options to protect Medicaid during future 
recessions. In response to this request, the GAO issued a report GAO-
07-97, entitled Medicaid: Strategies to Help States Address Increased 
Expenditures during Economic Downturn and developed a State and local 
government model that can simulate the fiscal outcomes for this sector 
in the aggregate for several decades into the future.
  The legislation I am introducing today is based on the findings of 
this GAO study. As we have seen in the past two recessions, waiting for 
Congress to act to provide necessary Federal Medicaid relief results in 
harmful delays in families getting the assistance they need. I believe 
that there should be an automatic economic trigger for State fiscal 
relief--independent of Congressional intervention--during future 
recessions. My legislation would create such a trigger for a temporary 
FMAP increase.
  State fiscal relief would become available when the average 
unemployment rate has increased by at least 10 percent in at least 23 
States. This type of automatic trigger would provide states with the 
timely, targeted, and temporary Federal Medicaid assistance that they 
need in the face of a significant economic downturn. More importantly, 
it would help Americans maintain access to health care in tough times.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1377

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. AUTOMATIC INCREASE IN THE FEDERAL MEDICAL 
                   ASSISTANCE PERCENTAGE DURING PERIODS OF 
                   NATIONAL ECONOMIC DOWNTURN.

       (a) National Economic Downturn Assistance FMAP.--
       (1) In general.--Section 1905 of the Social Security Act 
     (42 U.S.C. 1396d) is amended--
       (A) in subsection (b), in the first sentence--
       (i) by striking ``and (4)'' and inserting ``(4)''; and
       (ii) by inserting ``and (5) with respect to each fiscal 
     year quarter other than the first quarter of a national 
     economic downturn assistance period described in subsection 
     (y)(1), the Federal medical assistance percentage for any 
     State described in subsection (y)(2) shall be equal to the 
     national economic downturn assistance FMAP determined for the 
     State for the quarter under subsection (y)(3)'' before the 
     period; and
       (B) by adding at the end the following:
       ``(y) National Economic Downturn Assistance FMAP.--For 
     purposes of clause (5) of the first sentence of subsection 
     (b):
       ``(1) National economic downturn assistance period.--A 
     national economic downturn assistance period described in 
     this paragraph--
       ``(A) begins with the first fiscal year quarter for which 
     the Secretary determines that for at least 23 States, the 
     rolling average unemployment rate for that quarter has 
     increased by at least 10 percent over the corresponding 
     quarter for the most recent preceding 12-month period for 
     which data are available (in this subsection referred to as 
     the `trigger quarter'); and
       ``(B) ends with the first succeeding fiscal year quarter 
     for which the Secretary determines that less than 23 States 
     have a rolling average unemployment rate for that quarter 
     with an increase of at least 10 percent over the 
     corresponding quarter for the most recent preceding 12-month 
     period for which data are available.
       ``(2) Eligible state.--A State described in this paragraph 
     is a State for which the Secretary determines that the 
     rolling average unemployment rate for the State for any 
     quarter occurring during a national economic downturn 
     assistance period described in paragraph (1) has increased 
     over the corresponding quarter for the most recent preceding 
     12-month period for which data are available.
       ``(3) Determination of national economic downturn 
     assistance fmap.--
       ``(A) In general.--The national economic downturn 
     assistance FMAP for a fiscal year quarter determined with 
     respect to a State under this paragraph is equal to the 
     Federal medical assistance percentage for the State for that 
     quarter increased by the number of percentage points 
     determined by--
       ``(i) dividing--

       ``(I) the Medicaid additional unemployed increased cost 
     amount determined under subparagraph (B) for the quarter; by
       ``(II) the State's total Medicaid quarterly spending amount 
     determined under subparagraph (C) for the quarter; and

       ``(ii) multiplying the quotient determined under clause (i) 
     by 100.
       ``(B) Medicaid additional unemployed increased cost 
     amount.--For purposes of subparagraph (A)(i)(I), the Medicaid 
     additional unemployed increased cost amount determined under 
     this subparagraph with respect to a State and a quarter is 
     the product of the following:
       ``(i) State increase in rolling average number of 
     unemployed individuals from the base quarter of 
     unemployment.--

       ``(I) In general.--The amount determined by subtracting the 
     rolling average number of unemployed individuals in the State 
     for the base unemployment quarter for the State determined 
     under subclause (II) from the rolling average number of 
     unemployed individuals in the State for the quarter.
       ``(II) Base unemployment quarter defined.--

       ``(aa) In general.--For purposes of subclause (I), except 
     as provided in item (bb), the base quarter for a State is the 
     quarter with the lowest rolling average number of unemployed 
     individuals in the State in the 12-month period preceding the 
     trigger quarter for a national economic downturn assistance 
     period described in paragraph (1).
       ``(bb) Exception.--If the rolling average number of 
     unemployed individuals in a State for a quarter occurring 
     during a national economic downturn assistance period 
     described in paragraph (1) is less than the rolling average 
     number of unemployed individuals in the State for the base 
     quarter determined under item (aa), that quarter shall be 
     treated as the base quarter for the State for such national 
     economic downturn assistance period.
       ``(ii) National average amount of additional federal 
     medicaid spending per additional unemployed individual.--In 
     the case of--

       ``(I) a calendar quarter occurring in fiscal year 2012, 
     $350; and
       ``(II) a calendar quarter occurring in any succeeding 
     fiscal year, the amount applicable under this clause for 
     calendar quarters occurring during the preceding fiscal year, 
     increased by the annual percentage increase in the medical 
     care component of the consumer price index for all urban 
     consumers (U.S. city average), as rounded up in an 
     appropriate manner.

       ``(iii) State nondisabled, nonelderly adults and children 
     medicaid spending index.--

       ``(I) In general.--With respect to a State, the quotient 
     (not to exceed 1.00) of--

       ``(aa) the State expenditure per person in poverty amount 
     determined under subclause (II); divided by--
       ``(bb) the National expenditure per person in poverty 
     amount determined under subclause (III).

       ``(II) State expenditure per person in poverty amount.--For 
     purposes of subclause (I)(aa), the State expenditure per 
     person in poverty amount is the quotient of--

       ``(aa) the total amount of annual expenditures by the State 
     for providing medical assistance under the State plan to 
     nondisabled, nonelderly adults and children; divided by
       ``(bb) the total number of nonelderly adults and children 
     in poverty who reside in the State, as determined under 
     paragraph (4)(A).

       ``(III) National expenditure per person in poverty 
     amount.--For purposes of subclause (I)(bb), the National 
     expenditure per person in poverty amount is the quotient of--

       ``(aa) the sum of the total amounts determined under 
     subclause (II)(aa) for all States; divided by
       ``(bb) the sum of the total amounts determined under 
     subclause (II)(bb) for all States.
       ``(C) State's total medicaid quarterly spending amount.--
     For purposes of subparagraph (A)(i)(II), the State's total 
     Medicaid quarterly spending amount determined under this 
     subparagraph with respect to a State and a quarter is the 
     amount equal to--
       ``(i) the total amount of expenditures by the State for 
     providing medical assistance under the State plan to all 
     individuals enrolled in the plan for the most recent fiscal 
     year for which data is available; divided by
       ``(ii) 4.
       ``(4) Data.--In making the determinations required under 
     this subsection, the Secretary shall use, in addition to the 
     most recent available data from the Bureau of Labor 
     Statistics Local Area Unemployment Statistics for each State 
     referred to in paragraph (5), the most recently available--
       ``(A) data from the Bureau of the Census with respect to 
     the number of nonelderly adults and children who reside in a 
     State described in paragraph (2) with family income below the 
     poverty line (as defined in section 2110(c)(5)) applicable to 
     a family of the size involved, (or, if the Secretary 
     determines it appropriate, a multiyear average of such data);
       ``(B) data reported to the Secretary by a State described 
     in paragraph (2) with respect to expenditures for medical 
     assistance under the State plan under this title for 
     nondisabled, nonelderly adults and children; and
       ``(C) econometric studies of the responsiveness of Medicaid 
     enrollments and spending to changes in rolling average 
     unemployment rates and other factors, including State 
     spending on certain Medicaid populations.

[[Page S7091]]

       ``(5) Definition of `rolling average number of unemployed 
     individuals', `rolling average unemployment rate'.--In this 
     subsection, the term--
       ``(A) `rolling average number of unemployed individuals' 
     means, with respect to a calendar quarter and a State, the 
     average of the 12 most recent months of seasonally adjusted 
     unemployment data for each State;
       ``(B) `rolling average unemployment rate' means, with 
     respect to a calendar quarter and a State, the average of the 
     12 most recent monthly unemployment rates for the State; and
       ``(C) `monthly unemployment rate' means, with respect to a 
     State, the quotient of--
       ``(i) the monthly seasonally adjusted number of unemployed 
     individuals for the State; divided by
       ``(ii) the monthly seasonally adjusted number of the labor 
     force for the State,

     using the most recent data available from the Bureau of Labor 
     Statistics Local Area Unemployment Statistics for each State.
       ``(6) Increase in cap on payments to territories.--With 
     respect to any fiscal year quarter for which the national 
     economic downturn assistance Federal medical assistance 
     percentage applies to Puerto Rico, the Virgin Islands, Guam, 
     the Northern Mariana Islands, or American Samoa, the amounts 
     otherwise determined for such commonwealth or territory under 
     subsections (f) and (g) of section 1108 shall be increased by 
     such percentage of such amounts as the Secretary determines 
     is equal to twice the average increase in the national 
     economic downturn assistance FMAP determined for all States 
     described in paragraph (2) for the quarter.
       ``(7) Scope of application.--The national economic downturn 
     assistance FMAP shall only apply for purposes of payments 
     under section 1903 for a quarter and shall not apply with 
     respect to--
       ``(A) disproportionate share hospital payments described in 
     section 1923;
       ``(B) payments under title IV or XXI; or
       ``(C) any payments under this title that are based on the 
     enhanced FMAP described in section 2105(b).
       ``(8) Additional requirement for certain states.--In the 
     case of a State described in paragraph (2) that requires 
     political subdivisions within the State to contribute toward 
     the non-Federal share of expenditures required under section 
     1902(a)(2), the State shall not require that such political 
     subdivisions pay for any fiscal year quarters occurring 
     during a national economic downturn assistance period a 
     greater percentage of the non-Federal share of such 
     expenditures, or a greater percentage of the non-Federal 
     share of payments under section 1923, than the respective 
     percentage that would have been required by the State under 
     State law in effect on the first day of the fiscal year 
     quarter occurring immediately prior to the trigger quarter 
     for the period.''.
       (2) Effective date; no retroactive application.--The 
     amendments made by paragraph (1) take effect on January 1, 
     2012. In no event may a State receive a payment on the basis 
     of the national economic downturn assistance Federal medical 
     assistance percentage determined for the State under section 
     1905(y)(3) of the Social Security Act for amounts expended by 
     the State prior to January 1, 2012.
       (b) GAO Study and Report.--
       (1) Study.--The Comptroller General of the United States 
     shall analyze the previous periods of national economic 
     downturn, including the most recent such period in effect as 
     of the date of enactment of this Act, and the past and 
     projected effects of temporary increases in the Federal 
     medical assistance percentage under the Medicaid program with 
     respect to such periods.
       (2) Report.--Not later than April 1, 2011, the Comptroller 
     General of the United States shall submit a report to 
     Congress on the results of the analysis conducted under 
     paragraph (1). Such report shall include such recommendations 
     as the Comptroller General determines appropriate for 
     modifying the national economic downturn assistance FMAP 
     established under section 1905(y) of the Social Security Act 
     (as added by subsection (a)) to improve the effectiveness of 
     the application of such percentage in addressing the needs of 
     States during periods of national economic downturn, 
     including recommendations for--
       (A) improvements to the factors that begin and end the 
     application of such percentage;
       (B) how the determination of such percentage could be 
     adjusted to address State and regional economic variations 
     during such periods; and
       (C) how the determination of such percentage could be 
     adjusted to be more responsive to actual Medicaid costs 
     incurred by States during such periods, as well as to the 
     effects of any other specific economic indicators that the 
     Comptroller General determines appropriate.
                                 ______