[Congressional Record (Bound Edition), Volume 147 (2001), Part 9]
[House]
[Page 12157]
[From the U.S. Government Publishing Office, www.gpo.gov]



                 LIFT MEDICAID CAPS IN U.S. TERRITORIES

  The SPEAKER pro tempore (Mr. Kennedy of Minnesota). Under a previous 
order of the House, the gentleman from Guam (Mr. Underwood) is 
recognized for 5 minutes.
  Mr. UNDERWOOD. Mr. Speaker, a couple of speakers this evening have 
talked about the need to improve health care for all American citizens, 
the most recent speaker talking about prescription drugs, and earlier 
my colleague talking about a real Patients' Bill of Rights.
  This evening I would like to raise another issue, and that is lifting 
of the Medicaid caps for the Territories of the United States, 
including my home Island of Guam.
  At the start of this Congress, I, along with other territorial 
delegates from the Virgin Islands, America Samoa, and the Resident 
Commissioner of Puerto Rico, introduced a bill, H.R. 48, to remove caps 
on Medicaid payments to the U.S. territories and adjust the statutory 
matching rate. H.R. 48 is authored by my esteem colleague, the 
gentlewoman from the Virgin Islands (Mrs. Christensen), formerly a 
practicing physician there.
  When this bill was first introduced during the 106th Congress, we 
reported that Medicaid allotments fell far short of meeting the needs 
of indigent populations in the Territories, and because of depressed 
economic conditions, high unemployment rates and the rising health care 
needs of growing indigent populations, the reliance on Medicaid 
assistance continues to surge way beyond the Federal cap and beyond the 
Territorial Government's ability to match Federal funds.
  In Guam, for example, for fiscal year 2000, Medicaid assistance was 
capped at $5.4 million. However, the Government of Guam, because of the 
emerging population, spent approximately 3 times that amount to serve 
the medical needs of the people of Guam. For fiscal year 2001, the 
Medicaid ceiling is capped at an additional $200,000 at $5.6 million. 
However, the estimated cost to provide medical care to Guam's needy 
today is approximately $27 million over that amount, resulting in a 
dramatic overmatch for the Government of Guam, way beyond any match 
that is expected of any State jurisdiction.
  I fear the squeeze will even be greater as the Government of Guam 
implements the President's tax cut plan which has a deep impact on the 
economies of Guam and the Virgin Islands. These two U.S. jurisdictions 
have tax systems which mirror the Internal Revenue Code of the United 
States, which means whatever tax policies are implemented on the 
Federal level automatically take effect at the local level, even 
without consulting us. The Government of Guam has no surplus to cover 
the anticipated $30 million shortfall in revenues which will occur 
resulting from this tax cut.
  Thus, the struggle to provide medical services to Guam's needy will 
be more than the local economy can bear. Lifting the Medicaid caps for 
territories and changing the Federal Territorial matching rate 
currently set at 50-50 would provide relief to the neediest populations 
of the Territories.
  This legislation proposes that the Federal Territorial matching share 
be set at the share of the poorest State, which is currently a 77 to 23 
Federal-State match. Congress must consider the reality that 
Territorial Governments have not shared in the same economic prosperity 
which has been experienced in the U.S. mainland, and should recognize 
this by changing the matching rate.
  I stand here this evening to urge my colleagues to join in support of 
H.R. 48. Health care is an issue of importance to every American, 
whether they reside in the 50 States or the U.S. Territories. Resolving 
Medicaid issues in the Territories is a step in the right direction 
towards providing much needed health care relief for Americans, no 
matter where they live. We are all one country when it comes to 
responsibilities like service to our country. We should all be one 
country when it comes to realizing benefits and services like health 
care.

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