[Congressional Record Volume 167, Number 82 (Wednesday, May 12, 2021)]
[Senate]
[Pages S2465-S2467]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                                Medicaid

  Mr. CORNYN. Mr. President, more than 4 million Texans, including half 
of the children in my State, depend on the stability of the State's 
Medicaid Program to provide healthcare for themselves and their 
families. Everything from emergency room visits to mental health care, 
Medicaid funding

[[Page S2466]]

is vital to the health of our most vulnerable friends and neighbors. 
The same is true in virtually every State across the country.
  Unfortunately, a recent move by the Biden administration has put the 
healthcare of these vulnerable citizens in jeopardy. A few weeks ago, 
the Biden administration rescinded approval of Texas's 1115 waiver 
extension. I know that is an obscure reference to most folks, but, 
basically, here is the long and short of it. The previous 
administration reached an agreement with the State that will enable 
billions of dollars to flow to Texans in need. Now, for some reason, 
the Biden administration is trying to stop it.
  The real question is, Why? Why would the Biden administration try to 
jeopardize the healthcare for 4 million Texans, while the President has 
consistently talked about ensuring every American has access to quality 
healthcare. Just 2 weeks ago in his joint session to Congress, he said:

       Healthcare should be a right, not a privilege in America.

  So why would the administration take an unprecedented action to 
reduce access to healthcare for some of the most vulnerable people in 
my State?
  Well, the official answer from CMS is to correct an administrative 
error. But two Federal health officials did an unusual thing in 
Washington, DC, albeit anonymously. They told the truth. They told the 
Washington Post that this was done to ``push State officials toward 
accepting the Affordable Care Act's Medicaid expansion.'' It is pretty 
bold to admit that this was not about an administrative error at all 
but about forcing Medicaid expansion onto the State of Texas.

  Many people will recall that this was a portion of the Affordable 
Care Act which was held unconstitutional in an opinion written by Chief 
Justice Roberts. Chief Justice Roberts said that the Federal Government 
cannot put a gun to the head of the State and force it to accept the 
Medicaid expansion since it is a joint program between the Federal 
Government and the State. Now the administration is engaged in a game 
of political chicken, with 4 million Texans on the line, and the only 
ones who are getting hurt are the low-income and uninsured Texans whose 
healthcare relies on this safety net.
  This move by the administration would have been damaging during 
normal times, but it is even more damaging after this unprecedented 
year for our healthcare providers. In fact, it is downright reckless. 
Hospitals and providers in Texas have been pushed to the brink during 
the pandemic. On top of the additional expenses associated with COVID-
19, they have faced serious financial shortfalls from the pause on 
nonessential medical procedures as well as the hesitancy of patients to 
seek care because they have been worried about contracting the virus.
  Now, more than ever, hospitals and healthcare providers need reliable 
funding to plan ahead for their financial stability and uncompensated 
healthcare costs. If this funding stream goes away or is disrupted, it 
will directly threaten the healthcare for uninsured Texans and harm the 
livelihoods of healthcare providers as a whole.
  In rural areas and those that are already underserved, the 
consequences of this move could not be more dangerous. Let's say the 
Biden administration refuses to change course and Texas loses billions 
of dollars in Medicaid funding. If uninsured patients in small towns go 
only to local hospitals for emergency care, they will receive that 
emergency care because that is another Federal law, called EMTALA. But 
without the Federal funding to offset those costs, how would these 
hospitals make ends meet? If these patients aren't paying out of their 
pockets and the Federal Government is not helping to cover the costs, 
what will happen?
  It is pretty simple, actually. Without funding, the rural hospital 
will close.
  So those same uninsured patients will start visiting the second 
closest hospital. In my State--it is a big State--that is, maybe, 30 
minutes down the road. Maybe it is more than an hour away. Once again, 
without Federal funding to help cover the costs of treating rising 
numbers of uninsured patients, what will happen?
  Well, that hospital will close too. We will descend into a death 
spiral of hospitals and healthcare providers that close their doors 
because they can no longer afford to provide healthcare. The hardest 
hit patients won't be those with private health insurance; they will be 
those low-income and uninsured patients, especially in rural and 
underserved areas.
  So the consequences of this irresponsible move by the Biden 
administration could not be more serious, and they will be felt far and 
wide because this funding is vital to our healthcare system as a whole.
  It is not hyperbole to say that these are going to have life-and-
death consequences. While patients in Texas may be the first to get 
caught in the game of political chicken, they will not be the last. 
There are only four States that don't have approved or pending 1115 
waivers. Four--only four--don't have approved or pending 1115 waivers. 
Every other State could find itself in the same situation as my State 
in the coming months.
  Florida was granted a waiver around the same time as Texas. What will 
happen to vulnerable Floridians? Tennessee is already facing legal 
challenges to its waiver. Will its providers be in jeopardy too? North 
Carolina, South Carolina, Missouri, Idaho--the list of States that 
could be impacted by this life-or-death game of chicken goes on and on. 
The most vulnerable patients in States across the country could lose 
access to healthcare because of the Biden administration's 
irresponsible and reckless actions. Something must be done.
  To state the obvious, the nominee to lead the CMS, Ms. Brooks-LaSure, 
did not rescind the Texas Medicaid waiver approval. In fact, she has 
not been confirmed as yet, but before her nomination can advance, 
Members of the Senate deserve a commitment from the administration that 
it won't try to force the hand of States by putting the healthcare of 
millions on the line.
  If we don't step up now and push back against this reckless move, 
what State will be next? How far will the administration go--in the 
words of Chief Justice Roberts--to put a gun to the heads of the 
States, forcing them to dance to Washington's tune?
  I have asked the administration to work with Texas to ensure that 
millions of impacted individuals won't lose access to healthcare, but, 
so far, there has been zero progress. The administration has been 
unwilling to provide any assurance that an agreement with Texas could 
be reached before the end of this fiscal year--something that would 
have dire consequences for our providers, especially those in mental 
and behavioral health.

  As a reminder, the CMS said the only issue with the Texas waiver was 
an administrative error. Now it won't even commit to providing reliable 
care for these patients. This unprecedented action by the CMS threatens 
the security of the Texas Medicaid Program. It disrespects the 
continuity of this agreement, and it erodes the partnership between the 
State and the Federal Government.
  I think it also violates the constitutional authority of the States. 
The Federal Government is one of delegated powers, with the rest 
retained by the States and we the people. That was the basis upon which 
the Supreme Court of the United States struck down the compulsory 
Medicaid expansion under the Affordable Care Act. Yet now the 
administration seeks to do through the backdoor what it could not do 
through the front door. This sets a dangerous precedent of the 
administration's undoing of agreements, negotiated in good faith 
between the States and the Federal Government, for purely political 
reasons, and it could have cascading consequences across the country.
  I appreciate Ms. Brooks-LaSure's experience in working with States to 
develop these waivers as well as her willingness to talk to me about 
this issue, but she doesn't have any authority to force the Biden 
administration to undo its terrible and reckless mistake, at least not 
yet. Until Texas can receive a waiver and an assurance that this action 
will be rectified and the rug will not be pulled out from under our 
poorest patients, I cannot support this nomination.
  I urge my colleagues to stand up for the healthcare of their most 
vulnerable populations and push the administration to find an alternate 
path forward.

[[Page S2467]]

If they are willing to do this to my State, they will do it to your 
State and every other State in the country.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Padilla). The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. DURBIN. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The PRESIDING OFFICER (Mr. King). Without objection, it is so 
ordered.
  The Democratic whip.