[Congressional Record Volume 171, Number 129 (Monday, July 28, 2025)]
[Senate]
[Pages S4757-S4758]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                                Medicaid

  Mr. GRASSLEY. Mr. President, Congress, 3 weeks ago, passed the One 
Big Beautiful Bill, and in that bill was a modest, cost-sharing 
requirement for able-bodied Medicaid expansion of adults that were 
making more than 100 percent of poverty.
  The cost-sharing requirements would not apply to primary, prenatal, 
pediatric, mental, substance abuse disorder, emergency room care, or 
care provided by community health centers, certified behavioral health 
clinics, or rural health clinics.
  Now, under the One Big Beautiful Bill, this cost sharing that is 
required for able-bodied Medicaid adults can't exceed $35 per visit, 
and there is an annual maximum limit of no more than 5 percent of an 
individual's income.
  Well, you might ask: Why cost sharing? Having a modest cost sharing 
ensures consumers have skin in the game and thus, in turn, be 
responsible healthcare consumers.
  Adults in Medicare earning between 100 and 133 percent of poverty are 
most likely to gain health insurance through the Federal marketplace or 
through an employer, where cost sharing is common. Despite 
fearmongering about cost-share requirements, establishing modest cost-
sharing requirements in Medicaid is not anything brandnew. It has been 
around for quite a while.
  So let me give you a little bit of history. The Obama administration 
approved a half dozen Medicaid waivers, including my home State of 
Iowa, to establish modest cost sharing for able-bodied Medicaid adults.
  Congress, in addition, has enabled cost sharing before. Obama made 
that move. In the 2005 Deficit Reduction Act, which included my Family 
Opportunity Act, we expanded State flexibility in Medicaid to let 
States establish cost sharing up to 10 percent of the cost of services 
for those making over the poverty limit.
  The law also lets hospitals impose cost sharing for nonemergency 
services provided in the emergency department. The cost-sharing 
policies had support from the Governors of both parties, from a 
National Governors Association working group. At a 2005 Finance 
Committee hearing that I chaired, Governors said modest Medicaid 
sharing ``[utilizes] market forces and personal responsibility to 
improve health care delivery.''

[[Page S4758]]

  Another example is in the 1990s, Congress enabled cost sharing in the 
Children's Health Insurance Program. To this day, States are allowed 
and do impose cost sharing in that program. Even socialist proposals 
like Medicare for All have also included cost sharing.
  So I want to make very clear: This is nothing new. Modest cost 
sharing is a commonsense policy for those benefitting from a government 
program and who have the means to pay for it.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant executive clerk proceeded to call the roll.
  Mr. THUNE. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.