[Congressional Record Volume 157, Number 84 (Monday, June 13, 2011)]
[Senate]
[Pages S3717-S3719]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


                                MEDICAID

  Mr. ROCKEFELLER. Mr. President, in 1964 President Johnson envisioned 
an America that ``rests on abundance and liberty for all.'' It was 
against LBJ's backdrop of the Great Society that we reignited a 
tradition of community. This was a little spillover of the 1960s and 
our flight to the Moon and all of that, but the Nation somehow came 
together, and we sensed that we were a community and that we had a 
mutual obligation to each other, and that is at the very least 
characteristic of the American people, more then than now. Programs 
such as VISTA, Peace Corps, Social Security, Medicare, and Medicaid 
were born in those few years, 1961 though 1964.
  Sadly, nearly 50 years after LBJ's war on poverty, we have witnessed 
vicious attempts to roll back government programs designed to give low-
income Americans a hand up in life. I do not mean just low-income 
Americans but disabled Americans, very poor senior Americans who 
qualify for both Medicare and Medicaid--such a difficult journey they 
have. What we want to do is not to give people a hand up but simply to 
be a safety net. That is what he said this country owed its people. 
That is true about defense, and that is true about social policy. We 
have responsibility, all of us, to do that, to make sure nobody is left 
out.
  There is no question that we must reduce our deficit, and I have a 
whole series of ways that can be done in abundance, but we should not 
do so on the backs of working families still struggling under the 
weight of this recession. Oh, yes, we are in a recession, so everything 
that was true about people who were having a hard time before is a lot 
truer now. Yet bill after bill proposed by Republicans seeks to do 
exactly that.
  The House Republican H.R. 1 was a direct attack on America's working 
families and the successful education, job-training, and community 
development programs designed to combat poverty.
  The Republican budget proposal for next year goes even further. It 
attacks Medicare and Medicaid, the health programs on which over 100 
million American people rely--some more than others, but all have to 
have that as a safety net.
  At a critical moment in our economic recovery, Republicans are more 
focused on settling old scores--evidently from health care reform and 
the bitterness of that fight--than they are on creating jobs or 
protecting people. The Republican plan for getting our deficit under 
control amounts to an upside-down government. Instead of helping those 
who depend on government programs to support their families, the 
Republican plan would guarantee that millionaires, billionaires, and 
large corporations continue to receive trillions of dollars--to wit, $4 
trillion under the new budget--in government subsidies, subsidies that 
will grow exponentially over time and substantially increase their 
benefit. They will do very, very well indeed were we to make the tragic 
mistake of accepting that.
  Republicans are not for a fair or balanced approach to deficit 
reduction, and it is a great mystery to me. It is a quandary to me. I 
mean, you can say it is theological or whatever, you can make up all 
kinds of nasty political views of it, but nevertheless that is what it 
is. What they are there for is a government that only exists to support 
big business and wealthy Americans--kind of a perpetual TARP for their 
friends.
  Well, I reject that notion, and the American people do too. In my 
estimation, there is no government program that more fully embodies our 
Nation's tradition of community than Medicaid, our sense of mutual 
obligation. Some people are born wealthy. Some people are born very 
poor. Some people are born in between. Some people are born wealthy and 
then become poor. Some people are born poor and then become wealthy. 
But while they are down, they have a safety net, and it is called 
Medicaid. You don't hear people talking about it very much, 
particularly, frankly--somewhat disappointedly--from my side of the 
aisle.
  After almost 50 years, Medicaid is still a lifesaving part of what we 
do as a government, what we are meant to do as a government. Medicaid 
is simply too important to millions of people.
  Nationally, there were 68 million people enrolled in Medicaid in 
2010--68 million children, seniors, people with disabilities, pregnant 
women. These are families who are living on the edge and barely making 
it. They now have a safety net, more efficient than any private 
insurance program in existence. They have that.
  In West Virginia, there were over 402,000 people enrolled in 2008, 
152,000 of those aged and disabled and 191,000 children--children. So 
almost 50 years later, Medicaid is still a lifesaving part of our 
Nation's health care system. In West Virginia, Medicaid covers 50 
percent of all births. That tells you something.
  In our country, 40 percent of all births are taken care of by 
Medicaid. That says a lot.
  Sixty-two percent of long-term care is Medicaid and, along with the 
Children's Health Insurance Program it covers 34 percent of the 
children in our country. There are a lot of people who fought very hard 
over a number of years to get the Children's Health Insurance Program 
that would insure more children who were not at that point eligible. 
Well, they are still getting it, but the House wants to get rid of that 
program altogether. That is 34 percent of the children in our country.
  Medicaid provides an essential lifeline to families during difficult 
economic times, when people lose jobs that have provided them health 
insurance.
  Medicaid is the health care program that helps States during crises--
not just people but States--including, obviously, the September 11 
attacks, Hurricanes Katrina and Rita, the recent floods and tornadoes 
in the South and the Midwest--all being helped by Medicaid.
  Medicaid is part of the fabric of our great Nation, and to be clear 
at this point, I need to say that the House bill that was passed by the 
House--and who voted for it and who did not obviously is very much on 
record--would devastate Medicaid and government in general out of 
discretionary spending.
  Anyway, people who are covered by Medicaid do matter. They are 
people. They are families. They have their needs, their wants, their 
ambitions, their dreams, their sadnesses, their depressions, whatever.
  Darren Hale, from Princeton, WV, wrote me.

       I am a disabled West Virginian whose family relies on 
     Medicare and Medicaid.

  That may be a dual-eligible--you know, poor enough to be on Medicaid, 
old enough to be on Medicare, not able to survive simply on just one or 
the other.

       I hope and pray that these health programs won't be ended 
     or totally changed. Please do not support Republican changes 
     to these programs as a way of cutting costs to the taxpayer. 
     The poor of West Virginia and elsewhere should not and cannot 
     bear the burden of the deficit reduction that Republicans 
     want.

  We need to think very seriously about our priorities. That is what 
this conversation really leads me to.
  Let's say I am a 10-year-old boy, and I am being brought up in West 
Virginia. My means are meager. I step out into a road, and I am hit by 
a car. I don't die, but perhaps my spine is fractured--probably--legs 
broken, and I am condemned to a life in a wheelchair.
  Now, that child is not protected by the private enterprise system. 
That child, unless they are an unusual child from a fairly wealthy 
family who then can provide insurance--but they will spend themselves 
down, with that insurance being so incredibly important, and they will 
eventually qualify for Medicaid.
  You know, when you are hit by a car, that is not something you plan 
on. It is not something you failed to do because you did not have a 
work ethic or whatever the common wisdom would be about that. It is 
just something that happened. But the fact remains that your health 
care is cut, your life is changed, and it grows more miserable because 
you have nothing in the way of a safety net if the Republican budget is 
passed, if we get too aggressive about cutting Medicaid.
  I am troubled. Members of Congress and senior advocates have 
rightfully rallied in staunch defense of Medicare. You can find 
wonderful groups here in Washington who rise up in anger when people 
talk about cutting Medicare. They are for Medicare. They know

[[Page S3718]]

what it is. They know what it was intended to do. They know what it 
does. They know what a difference it makes. But aside from an 
occasional editorial or story, there has been an unsettling silence 
about Medicaid, even from members of my own party. This is despite the 
fact that the five main arguments made in support of Medicare, which 
seem to have had a rebirth recently, are also true of Medicaid.
  No. 1, the public strongly supports Medicaid, just as they do 
Medicare. Sixty percent of people say they would prefer to keep 
Medicaid as it is now. That surprises me. I would have thought the 
figure would have been much lower. I will get into that in a moment.
  No. 2, Medicaid also creates jobs, unlike tax cuts for oil companies 
and rich people, et cetera. Every $1 million in Federal Medicaid 
spending results in 17.1 new jobs. Sounds boring. Maybe it is, but not 
to the people who get those jobs. That is at hospitals, that is at 
nursing homes, community health centers, and doctors' offices because 
that is what Medicaid covers.
  No. 3, a Medicaid block grant or a spending cap, which is proposed by 
some--the cap is proposed by some to get away from the words ``block 
grant,'' but the effect--don't be fooled by that--is the same. They 
would both reduce the Medicaid benefits and increase cost sharing for 
seniors--for all of the recipients on Medicaid from day one. Understand 
that clearly, I would say to my colleagues. Much has been said about a 
Medicare voucher system, but capping Medicaid spending would be just as 
bad for the 5.5 million seniors and 11 million individuals with 
disabilities enrolled in Medicaid.
  No. 4, instead of reducing the deficit, the savings achieved by 
drastically cutting Medicaid would also be used to pay for more tax 
breaks for wealthy Americans and large corporations.
  Here is where I come to what I just don't understand about what is 
going on in this body.
  Evidently, it is not going on outside in America. Sixty percent don't 
want Medicaid touched. The fact that it is a majority in Medicaid is 
amazing and wonderful to me. I just don't understand, Mr. President. I 
think it is political. I think people know that poor people and the 
disabled--I run into them often and seek them out sometimes, the 
disabled. They gather in clusters of 30, 50, or 75 people in 
wheelchairs. They depend upon Medicaid. That is what they depend on. We 
see them in the Capitol. Do people stop to see them? Not particularly, 
no. They know that. They are not very good lobbyists. They cannot be 
because it is hard for them to get around. So is it political?
  The Ryan budget cuts taxes on the wealthy, on big deal people and big 
deal corporations, by $4 trillion. But it cuts Medicaid. Is that an act 
of social conscience or budget wisdom, or is that a thought-through 
value system? Is it just political, basically because they know that 
poor people don't vote? That is what I think the answer is.
  You get worried about Medicare real fast.
  We saw the results. We saw the House back off from that. But 
Medicaid? Not so. And it won't be so unless people stand up for 
Medicaid because they don't have lobbyists; they cannot afford them. 
They don't even speak that much for themselves. I don't get as many 
letters from them as from others, by a factor of 10. They have a sense 
that life has it in for them. That is partly an Appalachian 
characteristic, and I think many other parts of the country. There is a 
certain fatalism in life--that God has a plan for you, and it is not 
necessarily very good. If people accept that--which I don't--as a 
theory, then they are not going to fight for what Lyndon Johnson gave 
to the Nation and passed overwhelmingly in 1965.
  Cuts to Medicaid will also, to the pleasure of some, undermine the 
health care reform law that we just passed--which is still law. 
Medicaid is the underpinning of the entire coverage expansion of 
reform. We talk about 32 million people that we are going to cover. 
That goes way down, Mr. President, if these Medicaid cuts are made.
  So I ask my colleagues, why is Medicaid so often treated like a 
second-class program? More to the point, why are people who are on 
Medicaid treated so often as second-class people? How does that work 
out? Is that a product of the American sense of justice, or is that a 
thoughtful America looking around them? We all have friends who have 
been on Medicaid, or are on it, and have made it out.
  Unfortunately, sometimes those people forget their Medicaid 
background and turn away from it because they are on to a new and 
better life. Somebody has to fight for these people.
  Is it the feeling that maybe they are an unwanted burden on society? 
We have a tendency in America to say if you don't work, it is because 
you don't want to. If you don't have a decent job and you have a shabby 
home, it is because that is what you sought, not what was given to you 
in your, at least, destiny of the moment.
  Again, I think, is it because most of the people enrolled are low-
income people and many do not vote? I think that sums it up pretty 
well. But it is more than that. You can't go into the hollows of 
Appalachia or Nebraska or many other places and organize poor people to 
vote because their sense is, why? What does it get me?
  Decade after decade, a little bit--is there a little disdain on the 
part of the American people for those on Medicaid? It is a glorious 
program, but sometimes it is an inglorious word because it implies they 
don't want to better themselves.
  I won't go through my experiences in West Virginia for the 58th time 
on this floor. But I have seen so many examples of people who are 
beaten down--not with a cudgel but because all economic opportunity 
vanished from their lives. The coal mines shut down, or there weren't 
any other jobs around. They didn't get to go to school because no 
schoolbus would come because they were too far away and county law said 
they don't have to be picked up.
  So is the deck stacked against them? Yes, it is. Out of that group, 
there is one--I guess a guy who is about 40; I will not mention his 
name. He has a terrific job. He works with the CSX System as one of 
their railroad maintenance people. He has a good family and is a 
wonderful person. But his parents were killed in a vehicle crash, and 
his brothers have been fighting all kinds of problems. So it really 
takes something special to fight your way out of that self-defined 
position and make your move forward.
  I must say to my colleagues, the point of a representative democracy 
is not to serve the few, not even to serve the many, but to serve all 
as best we can. Does that mean we don't touch anything in Medicaid? No, 
but does it mean that we keep Medicaid as a safety net? Yes, it does.
  We are not here elected by some people with incomes above X amount of 
dollars. We are here for all people--even the people who didn't vote 
for us or didn't vote at all. I take that very seriously, and I take my 
experience in West Virginia very seriously.
  Sixty-eight million people are enrolled in Medicaid. They deserve a 
voice in this debate, and I, for one, will speak out for them. It is 
because somehow we feel that Medicaid recipients are not worthy--and I 
have expressed that in different words--simply because they have fallen 
on hard times or were born in hard times.
  How do you help the fact that your father or mother didn't work 
because there wasn't any work available? What do you do about that 
situation? Or you were born in the ghetto. Oh, you just rise above 
that. Barack Obama did, therefore, anybody can. Life doesn't work like 
that, and the Presiding Officer knows that very well.
  Then I must ask of my colleagues, how could this be? We all have 
neighbors, friends, and family who have or do benefit from Medicaid--
even perhaps in their distant past. In fact, nearly half of all 
Americans have a friend or a family member that has received Medicaid 
assistance at some point, and they are absolutely worthy of our 
support.
  Is it because we believe Medicaid spending is truly out of control? 
Then I remind colleagues that Medicaid costs per beneficiary grew much 
lower over the past decade than costs for any private health insurance 
coverage. The administrative costs in Medicaid are between 1 and 2 
percent. An average health insurance company is probably 10, 15, or 20 
percent--and all of this despite the fact that Medicaid has more 
comprehensive benefits. They are much

[[Page S3719]]

larger benefits that cover more. They do more for people, and 
significantly lower cost sharing.
  I fervently believe the American tradition of shared responsibility--
everybody working together for the greater good--is a tradition worth 
upholding and that a government has an ongoing role to play in its 
preservation. It cannot play that role perfectly, but it can do it as 
best and most fairly as possible.
  Instead of shortchanging Medicaid, we must have the courage to rein 
in tax breaks for corporate America and for people of great wealth. 
Medicaid does exactly what it was designed to do all those years ago: 
provide a safety net for low-income Americans. There are lots of 
worthwhile and positive ways we can improve the program, I grant you 
that. But trashing Medicaid, gutting Medicaid--especially if it is sort 
of flipping it aside for political gain--cannot be an option.
  I thank the Chair and yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa is recognized.

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