[Congressional Record Volume 156, Number 53 (Thursday, April 15, 2010)]
[Extensions of Remarks]
[Pages E567-E568]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               PATIENT PROTECTION AND AFFORDABLE CARE ACT

                                 ______
                                 

                               speech of

                        HON. CAROLYN B. MALONEY

                              of new york

                    in the house of representatives

                         Sunday, March 21, 2010

  Mrs. MALONEY. Madam Speaker, today we will cast a series of historic 
votes.
  The outcome of the votes will result in 32 million people without 
health insurance gaining coverage and 94 percent of Americans with 
guaranteed health care coverage.
  In New York State, close to 2.5 million people who are currently 
uninsured will have health care coverage once the day is over.
  To get to this point, the House had to first vote on the Senate 
passed health care bill and then vote on a bill that makes important 
changes that have been negotiated by the House to dramatically improve 
the Senate bill--this is called the reconciliation bill.
  Without a promise of these important fixes, like taking out several 
of these ``special deals'' I would not vote for the Senate bill. 
However, with the guarantee of these improvements, today I will cast my 
vote in favor of the Senate health care bill.
  I appreciate the opportunity to outline some of my concerns with the 
Senate passed health care reform bill.
  Most importantly, the Senate bill would have cost New York close to a 
billion of dollars in Medicaid funding. Unlike the House bill which 
saves New York billions, the Senate bill penalizes States like New York 
for its expanded coverage of its citizens under Medicaid. Under the 
Senate bill, States that have not significantly expanded their Medicaid 
programs would receive a large influx of Federal funding, but States 
like New York are penalized for doing the right thing. The House bill 
contained a more equitable solution to sharing the costs of Medicaid 
expansion under health care reform by providing increased Federal 
funding for Medicaid expansion regardless of existing State eligibility 
levels. FMAP provisions in the Senate bill would result in a 
significant loss to New York State as a significant number of uninsured 
New Yorkers who are eligible for Medicaid enroll, while the House bill 
fairly shares in the costs for currently enrolled and newly enrolled 
childless adults and parents. Fortunately, the reconciliation bill that 
we will be voting on, fixes this problem, and the distribution of 
Federal Medicaid funding is more equitable and saves money for New 
York.
  The Senate bill similarly penalized New York in terms of its 
treatment of payments to Disproportionate Share Hospitals, DSH. 
Historically, Medicaid hospital reimbursement rates, on average, have 
been lower than the cost of providing care, and DSH payments were 
instituted to cover reimbursement shortfalls and uncompensated care 
costs. The need for DSH reimbursement will remain even after health 
care reform is passed since there will millions of newly eligible 
individuals who will receive care through Medicaid.
  The Senate bill reduced Federal funding for Medicaid DSH payments by 
$19 billion and Medicare DSH payments by $24 billion over 10 years; 
reductions to DSH payments of this magnitude will jeopardize the 
stability and the services provided by our safety net system. The 
original House bill which I supported had included more reasonable 
reductions of $10 billion each from Medicaid and Medicare DSH and 
similarly, the reconciliation bill, while not as good as the original 
House bill, reduces the cuts that the Senate bill would have imposed.
  I am also opposed to the restrictive abortion language contained in 
the Senate bill. The Senate bill is significantly onerous, stigmatizing 
abortion services and creating obstacles for those consumers who would 
like to purchase this coverage and to those insurance companies would 
like to provide this coverage. Though I am strongly opposed to these 
restrictions, I am voting for the final bill because overall, reforming 
our current health care system dramatically and positively impacts 
women. As Chair of the Joint Economic Committee, I prepared a report 
that looked at the specific health care challenges facing women and how 
women would benefit from comprehensive health care reform. More than 2 
million women have lost their health insurance since the recession 
began due to their own job loss or their spouse's job loss. 1.3 million 
women lost their health coverage when their spouse lost his job and an 
additional 800,000 women lost their health care as a result of their 
own job loss. More than 2 million women have faced the brutal double-
whammy of a lost job and lost health care. While job losses

[[Page E568]]

during this recession were much greater for men than women, women have 
fared worse than men in recent months. And this has had real 
consequences for women's health care coverage: in the last 6 months, 
the number of women losing health insurance benefits due to their own 
job losses has increased by nearly 50 percent. Over one quarter, 28 
percent of women ages 19-24 have no health insurance at all. Part of 
that number is likely explained by the economic challenges facing young 
women. Young women have been hit hard in the recession, facing an 
unemployment rate of 13.1 percent, significantly higher than the 
national rate of 9.7 percent, and making it less likely that they will 
have job-based coverage. Health care reform will help us to overcome 
inequities at the center of the current system--where women pay more 
than men for the same coverage, or even, where women who are not 
smokers pay more for coverage than men who are smokers. My report and 
the reality is that the current health care system is serving women 
poorly, the recession has made the situation worse, and now more than 
ever, we need health care reform.
  I have been a strong supporter of the public option and voted for the 
House bill in large part because it contained a public option. I 
believed then and I believe now that a public insurance option will 
increase competition and reform our current system. Every day, 14,000 
Americans lose their health care coverage. A public option would have 
brought down costs and expanded access. Unfortunately, the Senate was 
unable to pass a bill with a public option, though many Senators 
supported the provision. While I am disappointed that the final bill 
that will go to the President for signature will not include it, I feel 
confident that the end product will achieve the goals of covering the 
vast majority of Americans, reduce health care costs, and reduce our 
deficit by trillions of dollars.
  Madam Speaker, it is clear that the Senate bill had flaws and as 
passed was not as good of a bill for the State of New York as it should 
have been. If I was just casting one vote today, it would be a no vote 
on this bill. However, we are being given the opportunity to fix and 
improve the Senate bill with the upcoming reconciliation bill which is 
why I am able to vote in favor of this bill. With this vote, I am 
voting in favor of helping Americans gain affordable, quality health 
care they both need and deserve, I am voting in favor of dramatically 
reducing the Federal deficit by $143 billion in the first 10 years, and 
I am voting in favor of improving coverage by removing denials of 
coverage based on preexisting conditions or gender. I am voting in 
favor of a strong and healthy future for all Americans and for our 
great country.

                          ____________________