[Congressional Record Volume 163, Number 13 (Tuesday, January 24, 2017)]
[Senate]
[Pages S417-S418]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                                MEDICAID

  Mr. CASEY. Mr. President, I rise today to speak about the Medicaid 
Program, a program that I am sure a lot of folks in Washington and 
around the country hear about a lot. We talk about it a lot, but I am 
not sure that people around here have a real sense of what it means to 
folks back at home.
  Medicaid is a program that is more than 50 years old now. In some 
ways, the name doesn't convey the scope of it. In some ways, I wish it 
had a different name because it would remind people who benefits from 
it.
  Instead of referring to it as the Medicaid Program, if you called it 
the ``kids, seniors, and folks with disabilities program,'' or 
something like that, you would be accurately describing the scope and 
the reach of the program because it has a profound impact on the lives 
of children, on the lives of older citizens trying to get long-term 
care in nursing homes, and, of course, it has a huge impact on 
individuals with disabilities.
  We know that in the campaign, President Trump made a statement. I am 
not quoting him exactly, but it was a brief statement during his 
campaign, and it was in writing that he would not cut Social Security, 
Medicare, or Medicaid. I think a lot of people had forgotten about that 
third one.
  One of the tasks that we have in the Senate is to make sure that, 
when a statement like that is made, any President is held accountable 
to that promise.
  The examples I could cite are many about the impact of Medicaid. Just 
a couple are significant. Not by way of exclusion, but I will just 
mention a few.
  I am holding here a March of Dimes document. It is an issue brief by 
the March of Dimes, and it is entitled ``The Value of Medicaid.'' I 
won't read it all, but here is just one fact that I am not sure a lot 
of people know. ``Medicaid covers 45% of all births''--and they have a 
footnote for that. I am not sure there are many in Washington who know 
that. But that is why I referred to it earlier in a more informal way 
as ``the baby program,'' because all of those children come into the 
world paid for by Medicaid.
  Medicaid has a substantial impact on rural families, rural America, 
and rural hospitals. By one estimate a couple of years ago, First 
Focus, one of the advocacy groups here in Washington that tracks issues 
that relate to children, estimated that as of 2012--and I doubt that it 
has changed much since then--more than 45 percent of rural children got 
their health care through Medicaid or the Children's Health Insurance 
Program. So almost half of rural children were benefitting from one 
program or the other.
  Here are just a couple more. One in five seniors receives Medicare 
assistance through Medicaid, and that includes premium assistance, cost 
sharing, long-term care, dental care, and vision care.
  Another important number is that two-thirds of nursing home residents 
are covered by Medicaid.
  I mentioned children before and the profound impact it has on their 
lives. Medicaid covers 40 percent of all children in the country. I 
mentioned CHIP and Medicaid combined covering almost half of rural 
children. Just Medicaid alone covers 40 percent of all children--rural, 
urban, and everywhere in between. If you just consider low-income kids, 
or children who come from low-income families, Medicaid covers some 75 
percent of those children.
  So there is a lot to talk about. But one issue that we are in the 
process of engaging on as an issue is: What will happen to Medicaid?
  Despite what the President said when he was campaigning--and I am 
talking specifically about Medicaid--just this weekend, the 
administration announced--without much attention drawn to it at the 
time, but I hope increasingly more attention--that the administration 
would support block-granting Medicaid. That is at variance with what 
the President said. In my judgment, it is a total contradiction of what 
he said, and now, apparently, his administration has embraced the House 
Republican approach to Medicaid, which is block-granting.
  There are a lot of ways to measure the impact of block-granting. One 
that I will just cite for the record is a report by the Center on 
Budget and Policy Priorities dated March 15, 2016, entitled ``Medicaid 
Block Grant Would Add Millions to Uninsured and Underinsured,'' which I 
ask unanimous consent to have printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

    [From the Center on Budget and Policy Priorities, Mar. 15, 2016]

 Medicaid Block Grant Would Add Millions to Uninsured and Underinsured

                            (By Edwin Park)

       House Budget Committee Chairman Tom Price's budget plan 
     would radically restructure Medicaid by converting it to a 
     block grant, cutting federal funding by about $1 trillion 
     over the next decade. It would also repeal health reform's 
     Medicaid expansion. The combined result would be a total 
     Medicaid cut of $2.1 trillion over the next ten years, 
     relative to current law, likely making tens of millions of 
     Americans uninsured or underinsured.
       Repealing the Medicaid expansion means that at least 14 
     million people would lose Medicaid or not get it in the 
     future, based on Congressional Budget Office (CBO) estimates. 
     In addition, the large and growing funding cut from the block 
     grant would almost certainly force states to sharply scale 
     back their Medicaid programs.
       The Price plan would also repeal health reform's other 
     coverage expansions, including the subsidies to help people 
     afford marketplace coverage.
       All told, not only would the estimated 20 million Americans 
     who've already gained coverage through health reform lose it, 
     but millions more who qualify for Medicaid apart from health 
     reform would likely lose their Medicaid coverage as well. 
     Tens of millions of Americans would likely become uninsured.
       Under Price's ``State Flexibilities Funds'' block grant 
     proposal, the federal government would no longer pay a fixed 
     share of states' Medicaid costs, apparently starting in 2018. 
     Instead, states would get a fixed dollar amount of federal 
     funding, which would rise only modestly each year, as 
     explained below.
       Block-grant funding would fall further behind state needs 
     each year. The annual increase in the block grant would 
     average about 4.3 percentage points less than Medicaid's 
     currently projected growth rate over the next ten years. In 
     the plan's tenth year (2026), federal Medicaid and Children's 
     Health Insurance Program (CHIP) funding would be $169 
     billion--or roughly 33 percent--less than under current law 
     (see graph). And the cuts would likely keep growing after 
     2026.
       The block grant would cut federal Medicaid funding by $1 
     trillion from 2017-2026. A small share of these cuts could 
     come from CHIP which the Price plan would presumably merge 
     into the Medicaid block grant as in past House Republican 
     budget plans. Over the next ten years (2017-2026), the budget 
     plan would provide nearly 25 percent less in federal Medicaid 
     and CHIP funding to states than under current law--not 
     counting the lost federal funding for the Medicaid expansion.
       The loss of federal funding would be greater in years when 
     enrollment or per-beneficiary health care costs rose faster 
     than expected--for example, due to a recession or new 
     treatment that improved patients' health but raised costs. 
     Currently, the federal government and the states share in 
     those unanticipated costs; under the Price plan, states alone 
     would bear them.
       As CBO concluded in 2012 when analyzing a similar Medicaid 
     block grant from then-House Budget Committee Chairman Paul 
     Ryan:
       ``The magnitude of the reduction in spending . . . means 
     that states would need to increase their spending on these 
     programs, make considerable cutbacks in them, or both. 
     Cutbacks might involve reduced eligibility, . . . coverage of 
     fewer services, lower payments to providers, or increased 
     cost-sharing by beneficiaries--all of which would reduce 
     access to care.''
       In making these cuts, states would likely use the large 
     added flexibility that the Price plan would give them. For 
     example, the plan would likely let states cap Medicaid 
     enrollment and turn eligible people away from the program, or 
     drop benefits that people with

[[Page S418]]

     disabilities or other special health problems need.
       The Urban Institute estimated that the 2012 Ryan proposal 
     would lead states to drop between 14.3 million and 20.5 
     million people from Medicaid by the tenth year (outside of 
     the effects of repealing health reform's Medicaid expansion). 
     That's an enrollment decline of 25 to 35 percent. Urban also 
     estimated that the Ryan plan would lead states to cut 
     reimbursements to health care providers by more than 30 
     percent. The Price block-grant proposal likely would mean 
     similarly draconian cuts.

  Mr. CASEY. Here is one of the headlines of that article, one of the 
basic inclusions by a respected organization that tracks this 
information. I will just read that headline: ``The block grant would 
cut federal Medicaid funding by $1 trillion from 2017-2026.''
  So if you are saying you are going to protect children and you are 
going to protect seniors and you are going to make sure that those with 
disabilities don't have any problems going forward, it is pretty 
difficult to do that if you take a trillion dollars out of the Medicaid 
Program over the course of a decade.
  There was an op-ed in the New York Times on Christmas Day. It was 
interesting that it actually was printed on that holy day. There was an 
op-ed by Gene Sperling. Gene is someone who many people in Washington 
know. But for those who don't, Gene served two Presidents; he served 
both President Clinton and President Obama as the Director of the 
National Economic Council.
  Here is one of the conclusions that Gene reached, based upon his 
research and his vast experience. I will quote him directly from the 
December 25 op-ed in the New York Times entitled ``The Quiet War on 
Medicaid'': ``Together, full repeal''--and there he means full repeal 
of the Patient Protection and Affordable Care Act--``and block granting 
would cut Medicaid and the Children's Health Insurance Program funding 
by about $2.1 trillion over the next 10 years--a 40 percent cut.''
  So whether you look at it in terms of block granting's impact on 
Medicaid or the combination of that block-granting policy, which the 
administration has now embraced fully, and the repeal of the Affordable 
Care Act, the result of that is that you adversely impact two 
programs--the Children's Health Insurance Program and the Medicaid 
Program.
  Let me bring this back to real people. I just want to highlight a 
couple of excerpts from a letter I received recently, and then I will 
conclude.
  This is a letter from Coatesville, PA, the southeastern corner of our 
State, a letter sent to me by Pamela E. Simpson. I will just call her 
Pam, even though I don't know her personally.
  She wrote me a letter about her son. Pam Simpson's son is Rowan. She 
said that Rowan, who I guess is now 5 years old, back in 2015 was 
diagnosed with autism spectrum disorder. She went on to say how much 
Rowan has benefitted from the Medicaid Program. We call it Medical 
Assistance in Pennsylvania.
  She said that among the services he received was the behavioral 
specialist consultant helping him and a therapeutic staff support 
worker. They received direct help, direct intervention so that Rowan 
could grow and benefit from those direct services.
  She said that the agency that administers these kinds of wraparound 
services for Rowan and children like him--in this case, the Child 
Guidance Resource Centers--started a particular program focused on 
social skills, especially for children with autism.
  But here is how she concluded her letter, and this is why I want to 
cite it in the context of this critically important debate we are going 
to have about Medicaid and the question of block granting, which sounds 
kind of benign; doesn't it? When you say it, it doesn't sound that bad. 
But in my judgment, it would be devastating to these families.
  She said to me in the letter: Please think of my dear Rowan and his 
happy face, his big blue eyes, and his lovely strawberry blonde hair.
  You can see him in these pictures that I should have mentioned 
earlier. Rowan is in these two different pictures, and there he is 
dressed as a firefighter.
  She continued: Please think of me and my husband, working every day 
to support our family, and please think of my 9-month-old daughter Luna 
who smiles at her brother daily.
  There is Luna in the picture, being held by Rowan.
  She says that she is worried that that little girl, when she is much 
older, will have to take care of Rowan later in life when Pam and her 
husband are gone.
  She ends the letter this way: Overall, we are desperately in need of 
Rowan's Medical Assistance and would be devastated if we lost these 
benefits. What she is referring to there, of course, is Medicaid.
  I have real trouble believing that if the Trump administration's 
proposal on block granting Medicaid marches forward, now that they have 
embraced the proposal that Republicans in Washington have embraced for 
years--they had voted for block granting over and over and over again. 
Now it is a live issue. Now it is no longer just voting. Now it is an 
issue that could be enacted into law, and I think that would be a 
terrible step in the wrong direction.
  So I think we have to remember that when we consider these budget 
debates, when we consider the debate about health care, and especially 
when we consider real families like Pam's and real children like Rowan.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. LEAHY. Mr. President, I ask unanimous consent to be recognized in 
morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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