[Congressional Record Volume 171, Number 123 (Thursday, July 17, 2025)]
[Senate]
[Pages S4433-S4434]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
Medicaid
Mr. THUNE. Mr. President, the Democrat hysteria over Republicans' One
Big Beautiful Bill is in full swing, and Democrats seem to have fixated
on the bill's Medicaid provisions as a useful tool, they hope, to
attack Republicans. And they decided that a good talking point is to
blame rural hospital closures, including current rural hospital
closures, on our bill's Medicaid provisions.
Well, there is only one little problem. The provisions of our bill
the Democrats would like you to believe threaten rural hospitals, those
provisions don't even go into effect until 2028, 2\1/2\ years from now.
Suggesting that those provisions are responsible for rural hospitals
closing this month is the height of absurdity.
I said there was one little problem with Democrats' argument, but, in
fact, there are a whole lot of problems with Democrats' arguments,
starting with the fact that rural hospital closures are a longstanding
problem, not something that is suddenly being triggered by our bill.
Under President Biden, Medicaid spending soared, and yet rural
hospitals still closed. Why? Because rural hospitals have to deal with
a lot of challenges that hospitals in major metropolitan areas don't
have to deal with. Despite those challenges, many rural hospitals are
finding ways to adjust to keep their doors open and to serve their
communities, and we have taken steps with our bill to ensure that they
can continue to do so with a $50 billion fund for vulnerable providers
like rural hospitals--a fund that goes into effect this year.
Our goal with this fund is to give rural hospitals and other
vulnerable providers the time and resources to find solutions to some
of the challenges they are facing and to give State governments the
time to look at their budgets and develop ways of assisting rural
hospitals that don't involve pushing State responsibilities onto
Federal taxpayers.
Now, hopefully, what I have said so far brings some much needed
clarity and accuracy to this discussion. But I want to step back for a
minute and discuss the overall scope of what we are doing with the
Medicaid provisions in our bill.
We are restoring Medicaid to what it was originally intended to be--a
Federal-State partnership to support the most vulnerable Americans. Let
me just repeat that. We are restoring Medicaid to what it was
originally intended
[[Page S4434]]
to be--a Federal-State partnership to support the most vulnerable
Americans.
There has been drift on both of those in the past few years. We have
drifted from a Federal-State partnership to a situation where the
Federal Government picks up more and more--sometimes close to all--of
the tab. And we have drifted from a focus on the most vulnerable
Americans.
Medicaid was created to serve the most vulnerable populations: the
elderly poor, the disabled, pregnant women, and children in need. But
in 2010, President Obama and Democrats allowed States to expand
Medicaid to include able-bodied adults earning up to 138 percent of the
Federal poverty level. They gave States an incentive to do so by
promising that the Federal Government would pick up almost all of the
tab.
Now combine that with the Biden administration's Medicaid rules and
waivers, and both the Medicaid population and Federal spending on
Medicaid have exploded.
Medicaid spending has grown by more than 50 percent since 2019--50
percent since 2019. That is utterly unsustainable, and it threatens the
stability of the program for the most vulnerable populations.
So Republicans implemented several commonsense measures to slow the
rate of Medicaid growth and refocus the program on Americans most in
need. Know what I said--slow the rate of Medicaid growth.
We are not cutting Medicaid. We are simply slowing the rate of
growth.
As Senate Finance Committee Chairman Crapo noted, only in
Washington--only in Washington--is a smaller increase in spending
considered a cut.
So what did we do in our bill? We implemented measures to remove
noncitizens from the Medicaid rolls. We implemented an extremely mild
work requirement, just 20 hours per week for able-bodied, working-age
adults without young children. We overturned Biden-era regulations that
made it difficult to remove individuals who don't qualify for Medicaid,
and we took aim at rampant abuse of the provider tax loophole.
Now, use of this loophole, which sees States inflate Medicaid service
prices in order to garner a larger reimbursement from the Federal
Government, has been a problem for quite a while now.
In fact, President Obama proposed multiple budgets featuring measures
to rein in abuse of the provider tax. But States continued to take
advantage of the gimmick; and thanks to waivers that the Biden
administration issued to California and other blue States last year
allowing them to further exploit a similar loophole, taxpayers were on
the hook for tens of billions of dollars in new spending.
So we took action to rein things in. We are not eliminating States'
ability to use the provider tax loophole, but we are instituting
limits--the identical limits, in fact, that President Obama proposed
imposing.
We are making States take responsibility for their Medicaid
decisions--States like California, which chooses to spend State funds
to have its Medicaid program cover illegal immigrants. They should not
be able to, in effect, have the Federal Government bail them out for
their reckless spending decisions.
Resources are not unlimited, and States need to shoulder their share
of the Federal-State Medicaid partnership rather than pushing off their
costs onto Federal taxpayers.
The net effect of all of these measures--like removing ineligible
individuals and individuals who refuse to work from the Medicaid rolls
and restraining State abuse of the provider tax loophole--will be able
to put Medicaid on a more sustainable fiscal footing going forward and
put a renewed emphasis on the vulnerable individuals this program was
actually created to serve.
Vulnerable individuals will also be helped by the major investment
our bill makes in expanding home and community-based services for
individuals with developmental disabilities. This will reduce multiyear
waiting lists for services and allow individuals with disabilities to
access the care that they need at home or in their communities.
The One Big Beautiful Bill Act was developed to make hard-working
Americans safer, stronger, and more secure. And the Medicaid provisions
of the bill fit right in with that mandate. By refocusing available
Medicaid dollars on those this program was originally intended to
serve, we will make vulnerable Americans more secure and ensure that
this program will continue to be available to Americans in need long
into the future.
Mr. President, that sounds like a good day's work.
I yield the floor.
I suggest the absence of a quorum.
The ACTING PRESIDENT pro tempore. The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. SCHUMER. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.