[Congressional Record Volume 155, Number 156 (Monday, October 26, 2009)]
[Senate]
[Pages S10721-S10722]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                       HEALTH CARE WEEK XV, DAY I

  Mr. McCONNELL. Madam President, as the debate over health care 
continues, I think it is important, once again, to remind the American 
people that every lawmaker in Washington recognizes the need for 
reform. Health care costs are rising at an unsustainable rate, and if 
we don't get these costs under control, we can't expect to maintain the 
quality of care or the access to care most Americans currently enjoy. 
This is the primary problem with our system, and it is the primary 
reason our Nation is so engaged in this debate.
  One of the proposed solutions for increasing access is the expansion 
of Medicaid. This afternoon, some of my Republican colleagues have been 
discussing why we, and many others from across the political spectrum, 
believe this is a very bad idea. The proposal that is being considered 
would expand Medicaid to about 14 million new people by 2019, including 
nearly 250,000 in my own State of Kentucky. On its face, this seems 
like a potentially effective way to increase the ranks of the insured. 
The reality is, however, it would make current problems much worse.
  First of all, Medicaid is already in serious trouble. Leaving aside 
its exploding costs, the program is increasingly unable to match 
doctors with patients because a growing number of doctors refuse to see 
Medicaid patients. This is a serious problem already. It would be a far 
worse problem if the program is expanded to include millions more 
without any expansion in the number of doctors willing to see Medicaid 
patients.
  So while the need to expand coverage is real, Medicaid is exactly the 
wrong program to choose as a foundation for achieving that goal. 
Senator Enzi, the ranking member of the Health Committee, put it best 
when he said:

       Instead of trapping poor Americans in a substandard health 
     care plan, we should be giving everyone more options to find 
     the care they need. Senators get to choose between competing 
     private plans; so should low-income Americans.

  Another reason we shouldn't be looking to Medicaid as a solution to 
our problem is the States, which run the program, are begging us--
begging us--not to. There is a simple reason why: The States simply 
don't have the money. The recession is hitting the States particularly 
hard, and expanding Medicaid would make their problems far worse. That 
is because, unlike the Federal Government in Washington, every State 
except one is either constitutionally or statutorily required to 
balance its budget. In other words, while lawmakers in Washington 
continue to ring up everything on the government credit card, States 
actually have to pay their bills at the end of the year. So if 
Washington tells them they have to expand Medicaid by $1 billion, that 
is $1 billion less they have for something else. For States, expanding 
Medicaid would almost certainly mean shrinking services or raising 
taxes in the middle of a recession.
  It is easy to see why the bill writers would propose Medicaid as a 
solution. It is a lot easier for Washington to push its problems onto 
the States, but in the context of reforming health care, this makes no 
sense at all. Expanding Medicaid would worsen the quality of care for 
those who already have Medicaid, and new enrollees would be entering a 
system with even fewer doctors per capita than there already are. 
Additionally, States could very well be bankrupted by the additional 
cost imposed by Washington, and even if they weren't, there is no doubt 
services would be reduced.

  This is why Governors of both parties are insisting Washington not 
use Medicaid as a vehicle for expanding health care. Here is a sample 
of what we have heard. Governor Rendell, Democrat of Pennsylvania, put 
it this way:

       We just don't have the wherewithal to absorb it without 
     some new revenue source.

  Gov. Bill Richardson, Democrat of New Mexico, said:

       We can't afford [it] and [it's] not acceptable.

  Bill Bredesen, a Democrat of Tennessee, called the plan:

       The mother of all unfunded mandates.

  Ted Strickland, the Democratic Governor of Ohio, summed it up like 
this:


[[Page S10722]]


       The States, with our financial challenges right now, are 
     not in a position to accept additional Medicaid 
     responsibilities.

  Senators who have worked in State government also recognize the 
problem. That is why so many of them from both parties are expressing 
serious misgivings about forcing States to expand Medicaid. Take one 
example. Senator Nelson of Nebraska, the former Governor, has 
explicitly said he would not support the new mandate. As he put it:

       I will not support saddling the states with further 
     obligations . . . you can take me out of the governor's 
     office, but you can't take the governor out of me.

  Even Senators who haven't said they oppose the idea are acknowledging 
the problem by working behind the scenes to have their States exempted 
from the mandate or to have it softened, a tacit admission of what the 
rest of us are saying; that expanding Medicaid is bad for States and 
bad if the goal is better health care.
  Republicans tried to keep the idea out of the final health care bill, 
but those attempts were rejected. It is a shame, since there are a good 
many ways to increase access without expanding Medicaid--ways that 
would lead to better care and which wouldn't harm States financially. 
Increasing competition would lower costs and enable those who are 
currently uninsured to get good private coverage, private coverage that 
would provide them with far greater access to the care they need than 
Medicaid would and which would help lower overall costs for everyone. 
We should look to these ideas rather than looking to Medicaid as a 
solution to our problems, especially since so many people from both 
parties are massing against the idea of expanding Medicaid.
  It is not too late to seek commonsense solutions to the problem of 
access. All of us acknowledge the problem. Now is the time to come up 
with a solution that all of us--Republicans and Democrats alike--
support.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Arizona.

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