[Congressional Record Volume 157, Number 60 (Thursday, May 5, 2011)]
[Senate]
[Pages S2725-S2726]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATE FLEXIBILITY ACT
Mr. BARRASSO. Madam President, I come to the Senate floor as a
physician who practiced medicine in Caspar, WY, for about a quarter of
a century, and I will talk about the concerns I have about the
President's health care law, part of which has taken over $500 billion
from our seniors on Medicare and taken that money not to help Medicare
or to help save Medicare or to strengthen Medicare but to put a whole
new government program in place.
They want to put about 16 million or so people on Medicaid. It is a
program that is not functioning well now. Many doctors don't want to
take care of patients on Medicaid. Yet as part of this health care law,
there is something called the Medicaid maintenance of effort, and 33
Governors have written to the President saying they don't want this to
apply to them.
I am delighted to be a cosponsor of a piece of legislation called the
State Flexibility Act. I do that and come to the floor with that as a
physician who practiced medicine, and I have been coming to the floor
week after week with a doctor's second opinion.
Today, my second opinion is that this State Flexibility Act is a good
idea. It gives States the flexibility they need to give the Governors
the flexibility they have requested. It is a bipartisan effort in the
sense that Governors, whether they be Republican or Democrat, are
looking for more flexibility with this Medicaid Program, and
specifically the Medicaid maintenance of effort.
I ask my colleague, the senior Senator from Utah, Mr. Hatch, if he
could perhaps tell us a little bit about this effort that he has now
introduced, which I have cosponsored, the State Flexibility Act.
The PRESIDING OFFICER. The Senator from Utah is recognized.
Mr. HATCH. I thank the Senator from Wyoming. I appreciate his
perspective on this important issue because he is a physician. The
Senator has cared for Medicaid patients, and he understands the
Medicaid Program better than anyone in this body. The Senator has also
served in the State legislature, so he has that experience. He
understands that, unlike Washington, States must balance their budgets
every year.
I want to talk about the rollback of the Medicaid maintenance of
effort or MOE requirement threatening both Medicare beneficiaries and
the financial health of many States throughout the country. I think it
is important to go through a little history on this subject.
When Medicaid was first established as a limited State-Federal
partnership, less than 5 million Americans used this program. Today,
nearly one in four is enrolled in this government program. Medicaid
spending now absorbs nearly one-quarter of all State government
budgets, often forcing severe cuts to other critical State programs.
Unfortunately, this situation is getting even worse with the Medicaid
mandate first imposed in the stimulus bill and again in the partisan
health care law. As a result of these Washington mandates, States are
being forced to make drastic cuts to important priorities, such as
education and law enforcement.
Unlike Washington, which too often just prints money to pay for out-
of-control spending, States actually have to make tough budget
decisions every year. States are facing the worst budget crisis since
the Great Depression, with a collective $175 billion shortfall.
Washington's micromanagement of State Medicaid programs makes it
incredibly difficult for the States to balance their budgets and
provide for those who are most in need. Because of the overly generous
benefit programs that Washington forces on the States, they are unable
to target health services to those most in need of assistance.
Governors are unable to undertake commonsense reforms that root out
program waste, fraud, and abuse.
The result of these MOE requirements is nothing short of a
Washington-induced State fiscal crisis.
Mr. BARRASSO. I ask my colleague this: We are from neighboring
States, Wyoming and Utah. I ask if the Senator could perhaps explain
exactly how these Medicaid maintenance of effort mandates--and I
believe they are onerous Washington mandates--directly impact Utah.
Mr. HATCH. In my home State of Utah, the fiscal year 2012 budget
shortfall will be approximately $390 million. That is a lot of money.
My State has said:
MOE requirements imposed by the Federal Government will
cost the State $3.2 million annually.
This might not sound like a lot to the people in Washington, DC, who
don't bat an eye at trillion-dollar deficits, but in Utah that is a lot
of money in the State budget. My close friend in Utah, Governor Gary
Herbert, said:
Not a State in this Nation is immune to tough budget
decisions, and sometimes Washington makes it even harder.
Utah must seriously weigh the real cost of Medicaid, one of
the largest and most expensive programs we have.
Unfortunately, Federal mandates tie our hands. Utah has zero
flexibility to respond to economic conditions, or the option
to scale the program back in a way that reflects local values
and priorities.
Governor Herbert and many others across the Nation have repeatedly
[[Page S2726]]
asked Washington to repeal these onerous Medicaid mandates. We have
introduced legislation--the State Flexibility Act, as the Senator
mentioned--to do exactly what the Governors have asked.
The State Flexibility Act fully repeals these burdensome Medicaid MOE
regulations. It starts to put States back in control to balance their
budgets while simultaneously lowering Federal entitlement spending. Our
legislation will save taxpayers $2.8 billion over just the first 5
years. That is a lot of money.
Regardless of political affiliation, I am confident this bill has the
potential to garner strong, bipartisan support in Congress, and it
represents a strong first step toward achieving comprehensive Medicaid
reform. Any Senator who has talked to his or her State's Governor knows
we need to pass this legislation to enable States to survive the
current fiscal crisis and to better care for the most vulnerable
Medicaid beneficiaries in their respective States.
It is time for Congress to roll back these unreasonable MOE mandates
and put the States, not Washington, back in charge.
I personally thank the Senator, my colleague from Wyoming, Mr.
Barrasso, for working with us on this legislation. Without him here, I
don't think we would be able to do anywhere near as much as we are
doing. The Senator, in particular, brings a unique perspective to the
debate over MOE requirements, and I don't know of any Senator who is
serving his State any better than he.
I would appreciate hearing more of the Senator's thoughts on this
matter because he has the experience, and he has operated on countless
people, and he has done it whether they have been Medicaid
beneficiaries, people who have insurance, or people who have nothing. I
know that. I have great admiration for the Senator from Wyoming. These
States have been heavily burdened with MOE requirements, which are
bureaucratic unnecessaries. I would like to hear from the Senator how
important that is.
Mr. BARRASSO. I appreciate the comments of my colleague. I have taken
care of Medicaid patients over the years, and I know this is a program
that is burdensome. I also served in the State legislature, and I know
the mandates coming out of Washington make it harder for the people
back home to take care of patients and harder for our State
legislatures to deal with helping people on Medicaid, making it more
difficult for physicians to take care of those patients, and making it
more expensive. There is a lot of waste in the mandate.
When Senator Hatch talked about the comments from his Governor, I
have comments from ours as well, Governor Matt Mead, who has been in
office only just since January. He wrote and was one of the 33
Governors who signed a letter to President Obama saying that the costs
of maintaining their Medicaid Programs are fast becoming a serious
threat to the State's general funds.
We live in a State where we have to balance the budget every year. He
went on to say that Wyoming needs to have flexibility, which is the key
word and the title of the bill introduced by Senator Hatch, S. 868, the
State Flexibility Act.
That is what Governors are asking for, flexibility, because with that
flexibility they can do better for the patients, and they can do it
cheaper. Wyoming needs the flexibility at the State level to ensure
that the Medicaid Program is operated efficiently and effectively.
People do not believe they are getting efficiency and effectiveness
out of Washington these days. They do not think they are getting value
for their money. I agree with the American people. I have heard them
loudly and clearly. I said it when I was practicing medicine and I say
it as a Member of the Senate.
Our Governor goes on: Wyoming strongly supports the removal of these
maintenance of effort requirements. This is why I come to the Senate
floor every week to talk about this health care law, the implications
of it, the impact on the people of this great country, and why I think
this health care law is one that is ultimately bad for patients, bad
for providers, the nurses and the doctors who take care of those
patients, and also bad for the American taxpayers. At a time when we
are borrowing 41 cents for every $1 we spend in this country, we cannot
afford to continue to waste money.
Our problem in this country is not that we are taxed too little, it
is that we spend too much and do not spend it well. We have to begin
focusing differently, and one of the ways we can do it--my
understanding from looking at this is actually the Congressional Budget
Office, which does the scoring on legislation, scored Senator Hatch's
State Flexibility Act as actually saving, I think, $2.8 billion total
over 5 years.
Mr. HATCH. Right.
Mr. BARRASSO. Isn't that what we are trying to do: save money, help
people, do it more efficiently, more effectively? That is why I am
proud to cosponsor with my friend, Senator Hatch, the State Flexibility
Act.
Mr. HATCH. And give the States flexibility to do what they can do
better than the Federal Government. As a former medical liability
defense lawyer back in my early days, I represented doctors, health
care providers, nurses, and hospitals in defending them from what were,
in most cases, frivolous suits that run up the cost of medicine.
I cannot tell you what it means to me to have Senator Barrasso in the
Senate with all the medical experience he has had. Frankly, the States
can do the job, but they cannot do it within budget if we keep piling
regulation and onerous burdens on them, such as the partisan health
care bill does.
Frankly, I want the Senator from Wyoming to know I feel it is an
honor to serve with him and an honor to have a couple of medical
doctors on our side. Dr. Barrasso and Dr. Coburn are both excellent
doctors. They have lived through these problems. They know what they
are like. They do not have to have anybody tell them what is wrong with
the approaches we are taking. They know what is wrong.
Frankly, I thank the Senator from Wyoming for being willing to serve
here.
Mr. BARRASSO. I appreciate the kindness and I appreciate the fact
that Senator Hatch is allowing me to work with him. He has a long and
illustrious career of leadership in the Senate, and he has been a
champion over the years of the fact that States are better than
Washington to make decisions because what works in one State may not
work in another State. If we give States the flexibility, ultimately
they will do it better. They are the laboratories of democracy. That is
why we believe in limited government and making decisions at the local
level as close to home as possible, which is why I know so many
Governors across the country support the State Flexibility Act. I am
hoping we get a successful vote in the Senate on it because whenever
Washington makes a one-size-fits-all decision, it hardly ever works for
most folks back home.
Mr. HATCH. That is right. I believe this will have great bipartisan
support among the Governors and hopefully in this body. I thank Senator
Barrasso for bringing this to our attention.
Mr. BARRASSO. I thank Senator Hatch.
Madam President, I will tell you, I still believe this is a law that
is bad for patients, it is bad for health care providers of this
country, the nurses and doctors who take care of them, bad for
taxpayers. I will be back at home in Wyoming over the weekend visiting
with patients, as well as providers, as well as taxpayers, listening to
what they have to say. I know the people of Wyoming have great concerns
about this health care law and would like the kind of flexibility that
is described in S. 868, the State Flexibility Act.
I yield the floor.
The PRESIDING OFFICER. The Senator from Mississippi is recognized.
Mr. COCHRAN. I thank the Chair.
(The remarks of Mr. Cochran pertaining to the submission of S. Res.
170 are located in today's Record under ``Submitted Resolutions.'')
Mr. COCHRAN. I yield the floor.
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