[Congressional Record Volume 161, Number 67 (Tuesday, May 5, 2015)]
[Senate]
[Pages S2645-S2646]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                                MEDICAID

  Mr. CASEY. Mr. President, I rise to speak about one aspect of the 
budget debate that has been before us, and it involves a major program 
that affects the lives of not just millions of Americans but literally 
tens of millions.
  We have debates and discussions in this body all the time about our 
commitment to children, our commitment to older citizens, and a whole 
range of folks we are concerned about. All of us at one time or another 
have made pronouncements about how important it is to support children, 
especially vulnerable children. We also are very concerned that as our 
parents or older relatives reach a certain age, they get the quality 
care in the twilight of their lives that we would expect. They are 
helped through a range of programs and services, actually starting with 
Medicare.
  So we are concerned about our children, we are concerned about our 
older citizens, and we are also concerned about the middle class. We 
hear a lot of us speaking about strategies or efforts to help boost the 
middle class and all of the challenges of the middle class. It is 
interesting, though, that some issues affect all three of those broad 
groups of Americans. The issue I am going to talk about is Medicaid. It 
affects, obviously, children. It affects individuals with disabilities. 
It certainly affects older citizens across the country. And, indeed, it 
affects the middle class.
  The Senate Republican budget cuts Medicaid funding by more than $1.3 
trillion, and in my judgment--and this is an assertion of an opinion--
it would end the program as we know it because of the dimensions of 
those cuts. The budget would repeal the Medicaid expansion, threatening 
health insurance for some 14 million Americans, and convert much of the 
program's funding into block grants.
  Let me talk about seniors for a moment. We have had lots of debates 
about the best policy going forward in the budget as it relates to a 
whole range of issues, especially programs such as Medicaid. But at the 
end of the day, it is not the rhetoric or the speeches; it is the votes 
that tell where one stands and what we prioritize.
  We all have our own personal stories about those who have gone before 
us, and we, of course, always remember our own parents. But when we are 
talking about our seniors, we are talking about Americans who fought 
our wars, worked in our factories, taught our children, built the 
middle class, and

[[Page S2646]]

did so much for us, including giving us life and love. We want to make 
sure we are doing everything possible to provide them with the quality 
care they deserve when they reach the age of 65 or older.
  We know Medicaid provides older beneficiaries the dignity in their 
later years that they should have a right to expect, as well as the 
flexibility to design where they receive care.
  In my home State of Pennsylvania, over 40 percent of Medicaid 
spending on long-term services and supports goes towards home and 
community-based care. Many assume the Medicare Program--Medicare, not 
Medicaid--will cover long-term care. In fact, it is Medicaid that is 
the largest single provider of long-term care in America--not Medicare, 
but Medicaid.
  Medicaid covers approximately 40 percent of all long-term care 
services provided in the United States, and 4 out of 10 people is a big 
number, obviously. It is lots of folks we care about and interact with 
in the course of a day, whether they are neighbors or family members or 
coworkers across the board.
  As enrollment continues to grow, more Americans are relying upon 
Medicaid than ever before. Medicaid is the major long-term care program 
for the middle class. So I would ask we all keep that in mind as we 
consider the determinations made through the budget process.
  Let me give one example of a man living in Philadelphia--his example 
and his mother's. After her husband's passing, this individual's mom 
had health problems and her health deteriorated quickly. Kidney 
problems forced her in and out of the hospital. She was living on a 
fixed income, with medical bills piling up. She sold her apartment and 
used that money to pay for a few more years of care. This woman and her 
son were using every penny they could to help with her care, but it 
wasn't enough. She needed constant assistance. Her son, as the only 
child in the family, couldn't do it himself while raising his own two 
children.
  Eventually, this man's mother received Medicaid benefits and moved 
into a nursing home in Philadelphia. Her son says he doesn't know what 
his family would have done without Medicaid. Paying for nursing home 
care would have quickly eaten his salary, and he would have had to sell 
his family home. Again, he was raising two children. Medicaid allowed 
him to avoid that vicious cycle.
  Like millions of Americans, this man went to school and worked hard 
to get a good job so he could make a decent living. But despite being 
employed as a professional, without Medicaid to help his mom, he would 
have had to impoverish his own family--his two children--to care for 
his aging mom. This would have put his children's future at risk.
  Medicaid offered this individual some help--obviously, his mother 
some help--in providing for his family and offering a way to have his 
mother get the care she needed.
  This is not atypical. This is reality for so many families. Here is 
one quick statistic. Then I will move to children, and then I will wrap 
up.
  In Pennsylvania, seniors accounted for just 10 percent of Medicaid 
enrollees but over 22 percent of spending in 2011. The national numbers 
aren't much different than that. The number of enrollees might be 
around 10 percent or in that lower range, but the spending, because of 
the kind of care they received, is of a higher cost.
  Let me talk for a couple of minutes about children. Together, 
Medicaid and the Children's Health Insurance Program, which we know as 
CHIP, served more than 45 million children in Federal fiscal year 2013, 
representing one in three children in the United States. So Medicaid 
plus CHIP is the health care for more than one in three children.
  We know CHIP is the health insurance program that impacts a lot of 
middle-income or at least lower-income families with children. In 
Pennsylvania, for example, just the Medicaid Program covered 34 percent 
of children ages 0 to 18. So just a little more than a third of 
Pennsylvania children rely upon Medicaid--a critically important 
program for those children.
  One of the groups here in Washington that tracks programs and 
policies for children is First Focus. They had a report in September of 
2014 where they reported that in calendar year 2012, 47 percent of 
rural children were covered by public insurance, meaning Medicaid or 
the Children's Health Insurance Program or maybe a third option. So 47 
percent of rural children were covered by public health insurance and 
only 38 percent of urban children.
  I know that sounds counterintuitive for some here, but rural children 
in America rely substantially upon Medicaid and the CHIP program. So 
improving access to health insurance for low-income children not only 
leads to better health outcomes in the short run and in the long run, 
but it also improves educational outcomes and government savings in the 
long term.
  Compared to their uninsured counterparts, children covered by 
Medicaid or CHIP are more likely to complete high school and college. 
These important programs help children literally succeed in life 
because they stay in school, whereas they would not at that rate if 
they were uninsured.
  Some claim Medicaid is a highly inefficient program--that is one of 
the charges against it--whose costs are growing out of control. In 
fact, Medicaid's cost per child is 27 percent lower than the per-child 
cost for private insurance. And Medicaid's costs per beneficiary have 
been growing more slowly--per beneficiary costs--than under private 
coverage. I would argue it is not only efficient but effective in 
delivering quality health care to our children.
  We know there is more to be done. We know there are improvements that 
Medicaid could incorporate. We need to improve dental and behavioral 
health care for children and increase access to screenings and 
vaccinations to make sure our children are protected.
  Let me just close with a couple of observations about children and 
pregnant women. We know that Medicaid is also an important addition for 
children, but it is very important for pregnant women, with prenatal, 
labor, delivery, and postpartum care.
  Nationwide, Medicaid finances 45 percent of all births--45 percent. 
We have a lot of folks in both parties who say how much they care about 
pregnant women and children. Well, if 45 percent of all births are in 
Medicaid, we better protect Medicaid. It is vitally important.
  Children who have health insurance, such as Medicaid and CHIP, are 
more likely to receive vaccinations, have regular medical checkups, and 
avoid preventable childhood illnesses.
  So let me conclude with this thought. We know we have to find 
savings. We know we have to work towards a fiscally responsible budget. 
But I don't think anyone here believes the way to do that is to do it 
on the backs of children who are poor but receive good health care 
through Medicaid or to do it by way of short-circuiting or limiting 
substantially the opportunities that older citizens have to go to a 
nursing home. Everyone in this building knows someone who is in a 
nursing home solely because of Medicaid--not everyone, but plenty of 
people either we know and love or people we know and encounter during 
the course of the year.
  So if we care about pregnant women, if we care about kids, if we care 
about older citizens and individuals with disabilities, we should think 
long and hard before we substantially cut, as this budget does, 
Medicaid.
  With that, I yield the floor.

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