[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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