[Congressional Record Volume 163, Number 40 (Wednesday, March 8, 2017)]
[Senate]
[Pages S1697-S1702]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PROVIDING FOR CONGRESSIONAL DISAPPROVAL OF A RULE SUBMITTED BY THE
DEPARTMENT OF EDUCATION--Continued
Order for Adjournment
Mr. McCONNELL. Mr. President, if there is no further business to come
before the Senate, I ask unanimous consent that it stand adjourned
under the previous order, following the remarks of Senators Lankford
and Warren.
The PRESIDING OFFICER. Without objection, it is so ordered.
The Senator from Oklahoma.
Mr. LANKFORD. Mr. President, in December of 2015, President Obama
signed the Every Student Succeeds Act after it passed this body with
overwhelming bipartisan support--85 of 100 Senators supported the bill.
The Wall Street Journal called the Every Student Succeeds Act ``the
largest devolution of federal control to the states in a quarter-
century.'' It also had the support of Governors, State legislators,
chief State school officers, school district superintendents, local
school boards, principals, and teachers unions, who all agreed on the
need to replace No Child Left Behind.
The core of the education reform in the Every Student Succeeds Act
was to restore local control to the States--not just control for them
but that they would have the responsibility and the authority for
things such as school accountability, teacher evaluation, student
evaluation. It is very clear. In fact, the Every Student Succeeds Act
says things very specifically. States are solely responsible for
choosing which standards to adopt. The Secretary cannot mandate,
direct, or control State standards. The Secretary of Education cannot
require, coerce, or incentivize States to adopt common core State
standards. States are responsible for choosing which assessments to
adopt. The Secretary of Education cannot mandate, direct, or control
State assessments for education. States design their own system for
holding schools accountable and decide which schools to identify for
school intervention and support. The Secretary cannot add new
requirements or criteria on State accountability systems that are not
in the law. States and local school districts decide what strategies
they will implement to help fix identified schools without Federal
interference. The Secretary of Education cannot prescribe how States
and local school districts improve those schools.
Congress passed that clear education law to take power out of
Washington, DC, and from the Department of Education and the Secretary
of Education and hand it back to the States.
Five months after the bill was signed, the Obama administration
changed their mind and released regulations to take back school
decisionmaking and accountability, in direct violation of the law.
Eighty-five of one hundred of us agreed that our passion is for every
school district, every parent, every State to take care of every child;
that no child would be left behind by switching to local control rather
than Federal centralized control. But when this new rule was put out by
the Obama administration, they reinterpreted that clear law. Let me
tell you what they said in the rule.
In the rule, they dictate to States the consequences for schools that
don't annually test at least 95 percent of their students.
They prescribe to the States and school districts how they would
intervene and improve schools that don't exit from this identification
process of being an underperforming school.
They limit how States may measure school quality or student success
based on 4-year graduation rates.
They define how much weight States must afford to non-test-based
indicators in their accountability systems.
This regulation prescribes the long-term goals and measurements of
progress that States would use for their student subgroups.
This new regulation prescribes when schools may exit from
comprehensive support based on improvement.
This new regulation mandates that States comply with specific
Washington, DC, created requirements instead of letting the school
districts or the States determine how best to proceed on those
requirements.
This new regulation limits how States award school improvement
funding to school districts and schools.
This new regulation adds a new and burdensome reporting requirement
every 4 years on States and local school districts that will drive up
compliance costs and will divert resources away from students in the
classrooms, in direct violation of what we passed.
This new regulation requires States to establish a statewide
definition for ``infective teacher,'' requiring a statewide system of
evaluation controlled by DC.
This new regulation limits how students are scored when they have
exited from special education.
This new regulation controls how the school report cards are created
and how long they are.
This is what we were exiting from with No Child Left Behind. We said
in that vote for Every Student Succeeds that Washington, DC, should not
do this. This rule directly violated the spirit and the letter of the
law and will put the new Secretary of Education, Betsy DeVos, in charge
of school evaluation, teacher evaluation, and student success. That is
not her role or the intent of this law when we passed it, regardless of
who is the Secretary of Education. Our intent was to provide maximum
flexibility for the States and the parents. The rule is central control
from Washington, DC.
It is essential that we stop this rule right now. While some of my
colleagues have said: Let's just wait, and we will do regulations, and
we will unwind some of this--they are basically admitting that the
Trump administration will fix the Obama administration overreach. I
understand that statement. I think there will be some unwinding of
regulations, but here is why it must be done right now--two reasons.
One is, when we do this right now with a Congressional Review Act, we
settle this forever, that no administration ever, as long as this law
is in place, can repromulgate a rule and turn right back around and say
Washington, DC, is going to control teacher evaluation, student success
evaluation, and school evaluation. This ends that forever.
The second thing is, right now schools in Oklahoma have already
diverted resources in their administration, and they are filling out
forms that are due to Washington, DC, in April to fulfill this new
requirement that was put down by the administration. If we don't end
this now, the districts in Oklahoma and in all of the States
represented by this great Senate--their administrators will be working
on forms for Washington, DC, rather than educating children at home.
Let's get those folks back in the classroom, working on things that
matter, not some form that no one in Washington, DC, will read anyway.
Why don't we allow our schools to focus on educating kids instead of
filling out forms for the Secretary of Education? That is the reason we
passed the Every Student Succeeds Act.
I encourage this body to support H.J. Res. 57 when it comes up. This
will fix this overreach and will put a permanent marker down to say we
meant it when Congress said to the administration: Do not control local
education. Let the States and the parents do it.
With that, I yield back.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The senior assistant legislative clerk proceeded to call the roll.
Mr. LANKFORD. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER (Mr. Sullivan). Without objection, it is so
ordered.
The Senator from Massachusetts.
Nomination of Seema Verma and the Republican Healthcare Bill
Ms. WARREN. Mr. President, I rise today to urge my colleagues to vote
against the confirmation of Seema Verma to serve as Administrator of
the Centers for Medicare and Medicaid Services.
CMS oversees the administration of the Medicare and Medicaid
Programs. These programs provide healthcare coverage to grandparents,
people with disabilities, foster kids, seniors living in nursing homes,
single mothers, and babies. CMS is also in charge of implementing many
parts of the Affordable Care Act and making sure that the protections
guaranteed in the law are enforced.
[[Page S1698]]
In other words, CMS is the part of government that we entrust with
carrying out the commitments we have made to protect our health and our
access to healthcare. We need someone to run these programs who is a
champion for Medicare, Medicaid, and the Affordable Care Act and
someone who can stand up to Republicans in Congress and stand up to the
Trump administration when they try to burn these promises and turn
their backs on the people who need help.
On Monday night, the Republicans finally revealed their latest plan
to rip health insurance away from millions of Americans. After years of
railing about how the ACA was too long and too complicated, the
Republicans spent weeks working on a secret plan--locked in a room,
hidden somewhere in the United States Capitol. They didn't want anyone
to see it. Here is a news flash: If you have to hide your plans from
the American public, that is a pretty good sign that you are headed in
the wrong direction.
Now we know why they were so afraid to let anyone else take a look at
the plan. The plan is ugly--really, really, ugly. The Republicans' plan
would rip health insurance away from millions of Americans.
Right off the top, the bill will end the Medicaid expansion
established in the ACA. Right now, 11 million adults are covered by
that expansion, and the Republican plan will end it. That is right--end
it. Millions more Americans are using ACA subsidies to buy their health
insurance. For the families who need it most, those subsidies will be
cut. For seniors, prices will rise, and that means millions more people
will not be able to afford health insurance.
The Republican bill promises tax credits to help people pay for their
insurance, but this is an empty promise because the tax credits are
designed to be too small to actually cover the costs of paying for
healthcare. If you have a 2-month break in your health insurance
coverage, no matter the reason, the Republican bill would let insurance
companies charge you a 30-percent penalty on top of your premium for an
entire year. That is right. If you lose your job and scramble to find a
new plan, you have exactly 62 days to lock down that plan because 1 day
longer than that, and you are slapped with a 30-percent penalty.
By the way, it is not a penalty paid to the government to help
finance healthcare. No. It is a penalty paid to a $1 billion insurance
company. Republicans should be ashamed of themselves.
Too bad if being able to buy affordable coverage on the ACA exchange
has given you access to health insurance while you start your small
business. Too bad if your healthcare has given you free cancer
screening. Too bad if your healthcare has given you access to treatment
for substance abuse disorder. All that is gone under the Republican
plan.
So there it is--the Republicans' plan to take away health insurance
for millions and millions of Americans. The Republican plan is cruel,
and it gets worse.
The Republican healthcare plan gets worse because it also delivers a
gut punch to the rest of the Medicaid Program--the part that predates
the ACA by decades. It does so by putting a cap on overall funding that
States can receive and then strictly limiting the growth in that cap.
This growth rate is deliberately set lower than the actual growth rate
in medical costs for Medicaid beneficiaries. Why? So Republicans can
cut the Federal Government's commitment to Medicaid without using the
word ``cut.''
I don't know if they think we are just too dumb to notice, but they
are cutting Medicaid. Of course, people will still get sick and will
still need medical care, so what the Republicans are doing is shifting
hundreds of billions of dollars in Medicaid costs to State governments,
which will struggle to pick up the tab, or shifting those costs to
hospitals and doctors, who will not get paid, or shifting it to the
families themselves, who will try to manage those bills.
Understand what that means. Right now, if you qualify for Medicaid
coverage, you get Medicaid coverage. That has been the law for decades,
but the Republicans want to change that. With the cap, if you qualify
for Medicaid coverage, you will get something. Nobody is really sure
what. All we know is that it will not cover your expected costs of
care. Think about the impact of that.
The reckless Republican plan will blow huge holes in State budgets.
The Republican plan will blow huge holes in rural hospitals' budgets
and in the budgets of opioid treatment centers and community health
centers all across this country.
Massachusetts is using some of its Medicaid funding right now to
fight the opioid crisis, but the Republican plan makes it harder to
wage that fight in Massachusetts and in every other State that is
battling this terrible epidemic.
The Republican plan will leave millions of people who have decent
Medicaid coverage holding the bag when they get sick. That is not
healthcare; that is a con job.
But it gets even worse. The bill cuts funding for Planned Parenthood,
which provides maternity care and birth control. It gives insurance
companies the green light to jack up costs for people over 50, blowing
up the limits that were established in the ACA to make sure seniors
could afford healthcare.
But there is one more very, very ugly reason the Republicans should
be ashamed, and that is because while they are gutting Medicaid,
slashing health coverage for sick Americans, and slapping penalties on
people who lose insurance through no fault of their own, Republicans
are also handing out hundreds of millions of dollars in tax cuts to
rich people and giving a special gift to insurance company CEOs.
The Republican plan repeals two Medicare taxes that apply only to
high-income taxpayers. Who benefits most from this repeal?
Millionaires. They get a full 80-percent of the tax cut. It is a
benefit that is worth an average of $50,000 each. That is right. The
tax cut that millionaires will get from the Republican plan to rip up
healthcare is more than many families make in a year.
The Republican plan also hurts Medicare by taking money away from the
Medicare trust fund, where it really belongs.
Right now, the law says insurance companies can deduct only $500,000
in executive compensation, but the Republicans think that is too hard
on insurance companies and their CEOs. So sad. So they have lifted the
cap to a full $1 million. The Republicans are determined to help boost
the pay of insurance company CEOs. No wonder the Republicans didn't
want to let anyone see this plan.
This is literally a backroom deal to strip away lifesaving healthcare
from babies, to drive the costs out of sight for seniors, to deny help
for people with disabilities, and to make insurance more expensive for
hard-working entrepreneurs. In exchange, insurance company CEOs and
millionaires get giant tax deductions. Unbelievable. Less health
insurance for people who need it; more tax cuts for wealthy insurance
company CEOs. This is the deal it took Republicans years to come up
with? They should be ashamed.
I have received letters and emails and calls from families in
Massachusetts who depend on Medicaid and the ACA. These families are
shouting as loudly as they can about how important Medicaid and the ACA
are to them. We need someone running the CMS who is listening and
someone who has their backs, who will tell Republican politicians that
their secret deals are terrible, who will tell them that their plans to
take away coverage will hurt people, who will tell them that their
recklessness will blow up State budgets.
Seema Verma has a deep knowledge of the Medicaid Program, having
worked at the State level to design and implement Medicaid waivers. Ms.
Verma says she wants to help States like Massachusetts invest in
innovative ways to improve care for Medicaid beneficiaries while
lowering costs--improve care and lower costs. That sounds great, but
she has also advocated for changes to Medicaid that violate the
fundamental principles of the program. She has designed Medicaid plans
that impose work requirements as a condition of receiving Medicaid
coverage even when they make no sense. She has sought to increase the
out-of-pocket costs that Medicaid beneficiaries must pay and has put in
place rules that lock people out of the program just at the moment they
most need coverage.
[[Page S1699]]
We need a CMS Administrator who will stand up to the backroom bullies
who are plotting to gut Medicaid, not one who wants to sneak cuts into
the very programs that need to be defended. For that reason, I oppose
Ms. Verma's nomination.
One of my constituents who receives Medicaid coverage in
Massachusetts, Lee from Holliston, wrote me to say: ``I just need to
know it is going to be okay.''
Lee, I wish I could tell you that it is going to be OK, but I cannot
tell you that. What I can tell you is that you are not alone. Americans
depend on the ACA and Medicaid to provide healthcare coverage. They
depend on it when they get sick, and they depend on it to stay alive.
Now that the Republican politicians have finally emerged from their
secret basement room and unveiled their ugly plans, I promise you I am
in this fight all the way. We need millions of people like you all
across this Nation to make their voices heard so that Republican
politicians do not destroy your healthcare.
In January, Senator Stabenow and I held a forum for the then-nominee
for Secretary of Health and Human Services, Tom Price. At this forum,
we heard from individuals who were concerned about the impact that cuts
to Medicare and Medicaid would have on their lives. I would like to
share some of my interactions with a few of these individuals back in
January by reading from the transcript Senator Stabenow introduced into
the record at Congressman Price's hearing before the Finance Committee.
I started by thanking everyone for being there and said this about
where we were:
Yesterday at the hearing for Congressman Price to be
Secretary of HHS, I asked him about the cuts that he has
proposed to Medicare and Medicaid. He's already proposed $449
billion in cuts to Medicare and over $1 trillion in cuts to
the Medicaid program. And so I asked him if he would commit
to follow through on Donald Trump's promise, ``I won't cut
Medicare or Medicaid.''
There was a lot of dancing back and forth, but the bottom line is
that no, he would not make that commitment, which I suppose should not
have been a surprise.
What I want to do as briefly as I can is to focus just a little bit
on down the line and put a face on that, what it means to put those
kinds of cuts into the system.
I started with Ms. Fleming, and here is what I asked her.
I said: ``You used to work at United Airlines. . . . How many years
did you pay into the Medicare system?''
Ms. Fleming said: ``Thirty-nine years.''
I asked: ``How long have you worked there?''
Ms. Fleming said: ``Thirty-nine years.''
I said: ``Thirty-nine years that you paid into the Medicare system.
Where else is it we need to spend $449 billion so that you can spend
more out-of-pocket? So that money can go somewhere else--like tax cuts
for rich people?''
I asked Ms. Jensen:
Just because I want to be clear about this, one of the
things that Medicaid does is make sure you get access to
mental health services. If you lose that access, what happens
in your life?
So I had asked Ms. Fleming about the Medicare cuts. Here is what Ms.
Jensen told me about the Medicaid cuts:
That would entirely change my life. I wouldn't be able to
afford the services I need. My medications alone, right now,
run about as much as my rent. And I know that weekly
counseling or therapy sessions would really be out of reach.
It would threaten not only the growth of my business but the
existence of my business.
She runs her own small business.
She said:
Basically: no Medicaid, no business. That would kind of be
the end of one of my dreams. And untreated disorders--my
untreated disorder--I know I would retreat from society. I
would retreat from my loved ones. I would not be a productive
citizen. I would probably get into trouble and cost the
taxpayers some money. Mental and behavioral health is no
joke. There are fatal consequences, and it's a matter of life
and death for a lot of people, including me.
Then I turned to the third of our witnesses, Ms. Serafin. She has
dealt with both systems--both Medicare and Medicaid--and I asked her to
focus just for a minute on the Medicaid part of that. She was taking
care of her elderly mother.
I said:
Your mother--after your father passed--your mother
declined, needed full time care. And she was supported by
Medicaid during that period of time. She was able to be in a
facility that could take care of her.
If Medicaid had not been available to you, if there had
been a trillion-dollar cut to Medicaid, what would have
happened to you and your husband?
Here is what Ms. Serafin said:
Well, physically, I could not take care of anyone else.
She had her own disabling medical problems. She said:
I can hardly take care of myself. So, we would have had to
hire someone, or we would have had to move because our home
was not accommodating for another person with a disability.
Secondly, the care my mother received in the nursing home
was so personally gratifying. I could sleep at night. My
mother was a really strong woman. She could have been a CEO.
She was born in the wrong era. But as a daughter--as mothers
and daughters often do--we didn't always see eye to eye on
everything!
The people in the nursing home loved her--they loved her
feisty manner, they loved the things she would say. And I
would think, ``Oh, God, I would never say that!'' But they
thought she was wonderful.
I made the point that my mother was a little like that too.
Ms. Serafin said:
I would sleep at night. I could feel good. Because I cannot
do things as it is for myself, and there were loving people
who would go to her and say, ``I love you, Anita,'' and it
just made my heart feel that wonderful feeling.
So that is the face of Medicaid.
We had one more witness, and this witness was Ms. Ornella, who had
her son Sam with her.
I said:
Sam is the happy face of Medicaid. Sam is a little boy who
was born with multiple difficulties and who flourishes and
who receives support from Medicaid.
So I asked:
If there's a trillion dollars in cuts to Medicaid, and Sam
is not able to get the help he needs through Medicaid, what
happens to Sam?
Ms. Ornella said:
We barely qualified for Medicaid as it was, so if there
were any cuts to it, we would have been in that group of
people who I believe wouldn't have qualified. Medicaid has
provided him to be able to go to his kidney doctors and keep
his status check on his kidneys, which is what we think his
long-term issues are going to be.
Medicaid has been there to cover tests for swallowing, for
swallowing functions, for all the different parts of his body
that are affected by his disorder. So my fear is, that if we
do get employer-based coverage, anything can happen in life--
what if my husband lost his job and then we didn't qualify
for Sam to get Medicaid anymore? How would we deal with that
double whammy of losing employer coverage and then not
qualifying for Medicaid for a medically complex child?
We heard from four people at this forum, and I am very grateful to
all four of them for putting a face on what Medicare and Medicaid
means. I suggested to Congressman Price that if he is confirmed to be
the head of HHS, that he cut out the statement that Donald Trump had
made, ``I will not cut Medicare or Medicaid,'' and that he tape it
above his desk and look at it every single day. Because that is what
the people at that hearing were all about.
They are the reason we must not cut Medicare and we must not cut
Medicaid, and I thanked them all for being with us.
Alice, Sam, Diane, and Ann really put a face on the importance of
Medicare and Medicaid at that forum.
I have heard from a number of hospitals, community health centers,
and behavioral health organizations in Massachusetts about the
importance of Medicaid to them for being able to provide essential
services to the people who need it most, and I want to share some of
the comments they have given to me.
John Nash, the CEO of Franciscan Children's Hospital, highlighted the
importance of Medicaid in providing healthcare coverage for our
children. Here is what he wrote to me:
Dear Senator Warren, at Franciscan Children's, our mission
is to provide a compassionate and positive environment where
children with complex medical, mental health, and educational
needs receive specialized care for people who are committed
to excellence, innovation, and family support, so that these
children can reach their fullest potential and live their
best lives. Located in the Boston metropolitan area, we are
one of four institutions in the country offering this unique
array of services to children with complex needs.
[[Page S1700]]
In Massachusetts, we are the only pediatric, post-acute
care provider that offers hospital-level care for children
with complex medical conditions. We are also one of the
largest pediatric mental health providers in Massachusetts,
offering a complete continuum of inpatient, residential, and
outpatient programming to ensure that children have access to
the services they desperately need.
Franciscan Children's is proud to be an independent,
unaffiliated provider that coordinates across the healthcare
system to deliver high-quality, low-cost, specialty services
to children who come to us from every major health system and
intensive care unit from across the State. Collectively
across our programs, we serve more than 12,000 children a
year.
Families who have had a child or children with special
needs often face tremendous financial burdens. Many
view hospitals like ours as a second home. Almost 60
percent of the families that we serve in our inpatient
medical program are on Medicaid.
In federal discussions about the Affordable Care Act, it is
crucial to realize that Medicaid is the most important health
coverage program for children. As many as 30 million children
nationally and 355,000 children in Massachusetts (29.6% of
the state population of children) are covered. Children
covered by Medicaid--compared with those who are uninsured--
generally go on to enjoy better health, lower rates of
mortality, and higher educational and economic outcomes as
they become adults.
Massachusetts is seeing the returns on investments made in
Medicaid. Our rate of uninsured children is at the lowest on
record. Cuts to Medicaid will have a negative impact on
children and may increase healthcare costs. Furthermore, any
cuts to the Medicaid program will threaten our institution's
long-term ability to serve children and their families who
may not receive care otherwise. As the population of children
with complex needs continues to grow at the rate of 5 percent
annually, these funds will be vital to our future and to
theirs.
We support the belief that access to affordable care is
essential for all individuals. Our families, whose resilience
and strength continues to inspire us every day, depend on
this principle being upheld. Our children deserve every
opportunity to reach their fullest potential and live their
best life.
This letter is just a reminder of who gets Medicaid and how Medicaid
changes the lives of the children who need it most and of their
families. We cannot cut this program without taking away the futures of
these children. This is an economic issue, but it is also a moral
issue.
I heard from the Behavioral and Health Network, a nonprofit community
behavioral health agency in Western Massachusetts, and they shared with
me an individual story they wanted to tell me about Tasha.
Tasha went from homelessness to addiction and then to recovery--
highlighting the importance of Medicaid funds in supporting individuals
who are dealing with substance abuse disorder. The behavioral health
network shared a story, and this is how they tell it:
Tasha M. recalls how her addiction started. She never
envisioned how and where it would end. As a teenager, she
remembers being homeless, her mom surrendering her to foster
care twice and living a dysfunctional life, leading to the
development of an eating disorder and hospitalization.
It was during that hospital stay where she was also
receiving treatment for an injured back, that she was
prescribed a bottle of painkillers. That started Tasha on the
road to addiction, and ultimately to BHN's, ``My Sister's
House''--and her eventual recovery.
Once addicted to pain pills she remembers ``hospital
hopping'' to feed the addiction. ``I felt so alone,'' she
said. Moving in with an aunt brought the prospect of turning
the page and leaving her addiction behind. Instead, Tasha
started to work as a bartender, ultimately succumbing to
alcohol and hitting bottom. Tasha says, ``I lost
everything.''
Moving back to Massachusetts, she ``tried to start anew.''
But instead she found herself back in the clubs and around
alcohol and, eventually, in a detox program through BHN's
Carlson Center. After that one-week stay, she entered Hope
Center, a BHN 30-day recovery addiction treatment program in
Springfield. Once released, the grip of addiction surfaced
again. ``I remember getting ready to go clubbing with my
boyfriend. We were in line to go into a club and I realized I
didn't have my ID. I went home and I found my ID lying on top
of my AA book. I thought, `wow, that's a sign'--and I need to
get back in the program.''
BHN assisted with entry into My Sister's House, a BHN
community-based program for women in recovery, where its
residents have daily therapy and support, peer meetings and
are connected to community resources.
It is also where Tasha met an intern who inspired her. ``I
remember I was one of her first clients. She said I couldn't
go back to my old ways . . . she really believed in me.''
Tasha's recovery has come full circle. After successful re-
entry into the community, she acquired a job as an
administrative assistant at a daycare center, and eventually
became a social worker helping mothers of children navigate
the complexities of parenting.
Tasha's story doesn't end there. Tasha was offered a
position at My Sister's House, where she assists other young
women who find themselves on the sometimes bumpy road to
recovery. ``For me, it's about giving back . . . I'm grateful
to them.''
About the new opportunity to help others at My Sister's
House, Tasha said: ``I always said to myself I was going to
come back to this House . . . this is my second home.''
Tasha's journey was supported by an organization whose
funding is 56 percent State and Federal contracts and 42
percent fees from Medicaid, Medicare and a small percentage
of private insurances. Clearly, the impact of affordable
insurance and funds from CMS and the State creates needed
access and opportunities for changing lives [like
Tasha's]. Individuals can embrace help, move beyond
despair and hardship, and establish meaningful life
experiences, employment and self-sufficiency. Without
affordable insurance, Medicaid and Federal and State
funds, that could not happen.
Thank you, Tasha, for telling your story. Thank you to the Behavioral
Network for sharing your story. Thank you for all of the amazing work
that you do every single day.
The Boston Medical Center, the State's largest safety net hospital,
also shared their perspective on how changes and cuts to Medicaid would
seriously impact the progress they have made in working to provide
high-quality, cost-effective care to their patients. Here is what
Boston Medical Center said:
At Boston Medical Center (BMC), our mission is to provide
Exceptional Care without Exception to all of our patients. As
the largest health safety net system in Massachusetts and in
New England, BMC and the patients we serve would be severely
impacted by major changes to the Affordable Care Act.
Massachusetts health care reform in 2008, and subsequently
the Affordable Care Act, supported our efforts to provide
high-quality, cost effective care to the many, formerly
uninsured, patients who became insured through Medicaid and
subsidized products. BMC has worked diligently with the
Commonwealth of Massachusetts and the Center for Medicare and
Medicaid Services (CMS) to transition the payment and
delivery of Medicaid services in a more cost effective
manner. With a strong understanding of the need to ensure
that the future of Medicaid is sustainable, our collective
efforts have begun to produce encouraging results.
Medicaid--and access to affordable, subsidized health care
insurance--is an important federal/state partnership that
allows the most vulnerable in our population to receive the
health care they need. At BMC, we see firsthand how it
affects the lives of our patients. In addition to providing
funding for important primary care services, it is a lifeline
for those with chronic diseases and mental health and
substance abuse needs.
BMC has used Medicaid funding to develop and implement a
number of very promising programs aimed at improving the
quality of care for our low-income population and doing it in
a manner that is the most cost effective. We aim to keep our
patients out of the hospital while giving them the care
necessary to lead fulfilling lives.
Some of these efforts include innovative programs for
pregnant women and babies both before and after delivery.
Post-partum depression is an all-too-common issue for new
mothers. BMC has designed a program that embeds necessary
behavioral health services into the OB/GYN visit setting,
thereby allowing them to receive the necessary mental health
care along with their medical visit.
At the same time, we have several successful programs
focusing on newborn infants--ranging from babies born
prematurely to those born addicted to drugs. As New England's
largest trauma center, we routinely treat large numbers of
patients who have been victims of violence. In an effort to
help break the trend of violence in the inner city, BMC
offers many programs that help those victims break that cycle
through counseling, education and support.
Boston, like many cities across the country, has seen an
unacceptable level of opioid related deaths. Probably our
most critical efforts today include programs that
successfully treat opioid and other drug addictions while
guiding patients toward prevention of future drug abuse and a
life where they can hold a job and maintain their
relationships with their families.
Working with the Commonwealth, BMC has also used Medicaid
funding to redesign how health care is provided in a manner
that ensures the highest quality patient care in the most
affordable, patient-centric manner. The groundwork has been
laid over the last several years with Medicaid waiver
funding. As we prepare for implementation of the Medicaid
waiver extension, we have just begun to roll-out our Medicaid
Accountable Care Organization, (ACO). The ACO structure
requires that we will be accountable for the full cost of
each Medicaid patient's health care, while it will allow the
flexibility to provide the right care that might not have
previously been covered (e.g. purchase of humidifier for an
asthmatic child that will help prevent hospitalizations).
Patients will benefit through further integration of care
across the delivery system continuum,
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while reimbursement for the cost of treating those patients
will be contained in a defined agreement.
These important Massachusetts efforts of transforming the
delivery and payment system for Medicaid will be dealt a
serious blow if the underlying Medicaid funding is changed.
Additionally, if Medicaid and subsidized healthcare
eligibility changes result in our patients losing access to
affordable health care, not only will the patient's quality
of life suffer, but the lack of funding will not allow [us]
to continue to provide those patients with many of these
critical services.
BMC is committed to maintaining the provision of
exceptional care without exception and it will require the
financial partnership with the federal and state government
to ensure that our low-income patients have access to that
care.
Boston Medical Center absolutely provides ``Exceptional Care without
Exception,'' and Medicaid helps them carry out that critical work.
The Boston Center for Independent Living shared with me a story from
a constituent named Ty who receives healthcare from One Care, a program
in Massachusetts that integrates care for beneficiaries who are dually
eligible for both Medicare and Medicaid. So I will tell a little bit
about Ty's story.
Ty Muto, a 39-year-old transgender man, was recovering from
colon surgery in 2014 when he stopped outside of his work and
was assaulted by three men yelling homophobic slurs. He
survived the attack with a traumatic brain injury and spinal
cord injury and is only alive thanks to several necessary,
timely medical interventions. A former mediator and American
Friends Service Committee volunteer, Ty is enrolled in One
Care with the Commonwealth Care Alliance. They provide
medical care, visiting nurse support, physical therapy, and
medical rides. His Care Manager helped him apply for Social
Security and find housing, which really improved his life! On
several occasions his visiting nurse has identified urgent
medical conditions and he has been able to take a medical
ride to the hospital where he receives care--avoiding lengthy
and expensive emergency room visits at local hospitals that
aren't equipped to care for his specific condition. Ty says
the only reason he's alive today is because of all of the
services and care he gets through One Care.
That is the work being done at the Boston Center for Independent
Living, and it can only be done because they receive the support of
Medicare and Medicaid.
The Boston Center for Independent Living also shared with me a story
from another constituent named Olivia.
Olivia Richards is a 33-year-old woman on One Care and, as
she emphasizes, a lifelong Bruins fan! Her plan with CCA
allows her to be an active member of the community and her
care coordinator assists her in managing her seizure
disorder, paraplegia, PTSD, and ADHD. Olivia grew up in the
foster care system and, after college, rather than move in
with an abusive family member, she tried to make it on her
own and she ended up homeless. Left without insurance--and
trying to keep up with her di-lanthin, ADHD and asthma
medications from seven- to fourteen-day sample packs from a
free clinic--she went on and off medication and eventually
ended up in a psychiatric hospital for a month.
If she had been making that transition in the post-
Romneycare age, she would have maintained her health
insurance and been able to stay on MassHealth. Olivia raves
about her coordinated care manager (CCA) and how she's helped
stabilize Olivia's health--recognizing issues before they
become emergencies. Prior to One Care, Olivia went to the
emergency room every few months with a severe UTI that landed
her in the hospital. Her care coordinator recommended she see
an infectious disease doctor, who prescribed a preventive
antibiotic--something none of the many doctors she'd seen had
put together. Olivia hasn't been to the hospital for a UTI
since.
This time around, when Olivia needed emergency care, her
care coordinator sent community medics to her apartment--
providing her with better care and avoiding an expensive
emergency room visit and other complications. Before One
Care, Olivia was using a third-hand wheelchair with a bent
frame and a wheel that she had to weld back together every
few months. Medicare and Medicaid kept dodging responsibility
for wheelchair repairs. Olivia's care coordinator helped her
get a new chair.
That is a real quality-of-life improvement for Olivia.
I want to say a special thank you to both Ty and to Olivia for
sharing their stories, for letting us make them public, and a very big
thanks to the Boston Center for Independent Living for all that you are
doing every single day to help the people of Massachusetts. We are all
deeply grateful for your work, and we want to continue to support it
here in Congress.
Many of my constituents have written to me, fearful of what changes
to Medicare or Medicaid might actually mean to them. Jeffrey, who is
from Gardner, wrote to me to share his constant worries about health
insurance coverage. This is what he wrote:
Dear Senator Warren,
I hope this message finds you well, and I want to thank you
for your continued fight for the rights of everyone in
Massachusetts & the nation.
Unfortunately, this election has left me with some constant
worry, as I'm sure it has many. I'm a graduate student and
have a year and a half left until I complete my masters
degree in counseling psychology.
Obviously because of this, I work part-time, and am not
offered health insurance through my employer. I have been on
MassHealth (Tufts Network Health, to be exact) since 2013
when I decided to make a career change.
I have some issues that require prescriptions and doctors
visits monthly. I'm not sure if they can be deemed as
preexisting conditions, but these are prescriptions I can
certainly not go without, nor could I go without insurance
for a year and a half.
Obviously I don't enjoy being on MassHealth, but for right
now it's what is necessary. My question may be a difficult
one to answer, due to the fact that no one truly knows what
will happen after inauguration day. I do know Massachusetts
is better protected than other states to keep its citizens
insured, and I know that you and Governor Baker have vowed to
fight for this right, as well as for many others--which I
could not be more thankful for!
If the new establishment has their way and repeals federal
funding to Medicaid, will people in Massachusetts such as
myself be thrown off their insurance? I know we rely heavily
on a waiver that was signed recently, and it's a ``wait and
see matter,'' but I suppose my question is, will I be
protected since I have documented needs for insurance already
in place? Or are my conditions going to be deemed ``not
severe enough?''
All I can say, Jeffrey, is we don't know yet, but I can promise you
that I am fighting to make sure you remain protected.
Elise from Scituate wrote to me about the importance of Medicare and
Medicaid funds in supporting nursing homes, adult day health programs,
and other needs of older adults. Here is what Elise had to say:
Dear Senator Warren,
I am writing to you because I am very concerned about the
direction of the incoming administration, President-Elect
Trump, and his cabinet choices. It was certainly a difficult
election period. The policies and direction of these
individuals is particularly troubling for those who are
older, or who may have mental illness, disabilities, or
developmental challenges.
As many are not aware, the federal rules, regulations, and
budget do affect the management of services in the states. As
a consultant in Massachusetts in both nursing homes and
adult day health programs, I see the strong need for
cooperative and supportive federal and state funding as
well as regulatory processes for ongoing care. Very few of
the individuals in these settings are paying privately.
Medicare and Medicaid--as well as the VA--are the major
funders for these programs.
In Massachusetts, we have 45,000 nursing home beds, or
approximately 400 skilled nursing facilities. Home care
incorporates adult day health, and we have roughly 14,600
participants in Massachusetts alone. Our population is aging,
and access to good services are critical to good care and
quality of life.
In addition, there are many programs that continue to need
commitment and funding to manage necessary services to
individuals. These include: housing (Section 8), elder and
those with disabilities home care, services to the blind, and
community mental health care--to name a few.
Changes in these benefits would jeopardize the delicate
balance of home and community care, rehabilitation, and
perhaps ultimately end up costing more for care. For example,
if we don't have resources to assist people to return to the
community, institutional care may be the only answer--and a
costly one.
The notion of having poor individuals pay for their
Medicaid benefits, and/or privatizing this to an insurance
base is ill-founded and often becomes costly to manage, as
well as lowers benefits. Aside from providing services to our
citizens, the reduction in these programs will drag the
overall economy down.
The healthcare industry (private enterprise) is dependent
upon a multitude of programs to generate profit. For example,
if Mr. X needs a wheel chair and Medicare does not pay for
one, Mr. X will not pay for a new wheel chair. He will either
borrow one, or purchase one used, or perhaps ``do without.''
This scenario, regardless of the product, will duplicate
itself throughout health care and service provision.
Companies that have dependency upon Medicare funds may have
to close or cut back. Service providers, such as Visiting
Nurses, will be facing similar results.
I have been in the older adult/health care/medical field
since 1969. I have seen changes over time to services from
government provisions to privatization. Privatization is the
one of the poor outcomes when government monies are used to
pay for services rendered. I remain a very strong advocate
for individuals and their families as they try to meet
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the challenges of obtaining just and fair services.
Thank you, Elise. I appreciate your writing. Medicare and Medicaid
provide critical funds to support nursing homes and senior citizens in
Massachusetts. I agree that we must fight to protect these programs.
I have many constituents writing in. My constituents are shouting as
loudly as they can about the need to protect Medicare and Medicaid. We
need a CMS Administrator who will stand up for Tasha and for other
individuals who are struggling with addiction, who will stand up for
those who are relying on Medicare to help with Parkinson's, who will
stand up for our hospitals and healthcare providers to ensure that they
have the resources they need to adequately serve their patients. I am
listening. I am fighting.
Republicans are trying to cut backroom deals to end these
protections. I promise you, I will do everything in my power to prevent
them from destroying your healthcare. That is why I am here.
____________________