[Congressional Record (Bound Edition), Volume 148 (2002), Part 1]
[Senate]
[Pages 349-351]
[From the U.S. Government Publishing Office, www.gpo.gov]




                    HOPE FOR CHILDREN ACT--Continued


                           Amendment No. 2719

  Mr. HARKIN. Mr. President, as I understand it, the pending business 
before the floor is amendment No. 2719, offered yesterday by Senator 
Reid on this Senator's behalf. I rise to speak for a few minutes on 
that amendment.
  I thank the Senator from Montana for giving me the courtesy of going 
first because of the time schedule I have this afternoon.
  Senator Baucus and Senator Daschle have provided great leadership on 
this important issue of the stimulus. There is one part of the 
amendment that is before us that is vitally important to all of our 
States as we are facing this downturn in the economy. That part of the 
amendment deals with the Federal share for Medicaid recipients in the 
States. It is called FMAP, the Federal Match for Medicaid Program.
  Under the provision in the underlying Daschle amendment, and under 
the leadership of Senator Baucus, they did provide for three things. 
They provided a 1.5-percent increase to every State in their 2002 
Federal match for Medicaid. That would provide about $3.5 billion in 
additional Federal Medicaid payments to the States.
  I have a chart which shows what that would mean for every State and 
what my amendment would mean for every State. I ask unanimous consent 
that this chart be printed in the Record at the conclusion of my 
statement.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See exhibit 1.)
  Mr. HARKIN. Senator Baucus and Senator Daschle, by their amendment, 
put in a 1.5-percent increase to all States.
  The second part was, because of unemployment measures previously 
calculated, some States were scheduled to go down in 2002 in their 
Federal match.

[[Page 350]]

The amendment before us under Senator Baucus holds those States 
harmless. That is about 29 States that would have lost money this year. 
And under the Baucus amendment, they are held harmless.
  The third part is that States with high unemployment would receive an 
additional 1.5 percent in their 2002 Federal match. This would provide 
assistance to about 16 States that have very high rates of 
unemployment. This policy proposal is extremely important for the 
States.
  The pending amendment I have offered would only change one part of 
that. It would take the 1.5-percent increase for all States and 
increase it to 3 percent. In other words, it would add 1.5 percent to 
the Federal match for all States. I believe that is important because 
when the committee developed this bill and the stimulus package, the 
National Association of State Budget Officers had predicted a $15 
billion shortfall for the States for 2002. That was last fall. By the 
end of the year, the National Association of State Budget Officers had 
updated their prediction for the shortfalls in our State budgets to $38 
billion--in other words, double. I have heard from my Governor --and I 
know others have heard from their Governors and their legislatures--
about the cuts they are going to have to make in their State budgets.
  The problem is, one of the places where they have to cut, because 
that is the biggest pot for most States, is Medicaid. If a State cuts 
$1 out of their budget on Medicaid, they may lose $2 or $3 or $4 of 
Federal money. I don't know what it is for the Presiding Officer's 
State, and I don't know what the Medicaid match is there. I do know in 
Iowa it is about 3 to 1. So that for every dollar the State would not 
have in their budget for Medicaid, they would lose $3 of Federal money. 
It isn't only that the State cuts its Medicaid budget by $1 and hurts 
one Medicaid recipient. If it cuts Medicaid by $1, it is hurting three 
or four times as many people. It has that kind of a multiplier effect.
  While I am very supportive of what Chairman Baucus and Senator 
Daschle have done, we recognize now that these new projections of the 
shortfalls in our State budgets command us to put more into the program 
of reaching these States for their Federal match.
  On the other two aspects of the amendment, on the one that holds 
States harmless, that is still in my amendment. And on the other one 
that provides the 1.5-percent increase to the States with unusually 
high unemployment, that is there also. I wanted to make sure that every 
State received the amount of Federal matching money they need.
  Again, another reason why this is so important is because most States 
have a requirement in their Constitution that they have to balance 
their budgets. It is a constitutional requirement. They can't get 
around it. When they start cutting, if they do across-the-board cuts, 
which seems at first blush to be the most logical, they just do a 
straight percentage across-the-board cut, Medicaid, being the biggest 
part of the State budget, gets whacked the most. Then they lose the 
Federal dollars that come in as a match.
  I believe this is critically important for our States. I also believe 
State fiscal relief is one of the best ways to stimulate the economy. 
The Federal dollars we send out for Medicaid help to avert State budget 
cuts or tax increases that could be detrimental to the States in any 
economic recovery.
  People in my State of Iowa and all across the Nation have enough 
trouble finding affordable, quality health care. They need our help and 
support during this recession. When it comes to protecting the 
vulnerable in these difficult times and getting our economy back on 
track, putting Iowans and all Americans back to work, it is critically 
important that we make sure that those who are out of work--they may 
have lost their jobs; Medicaid may be the only source of health care 
for them and their kids during this period of time, and then looking at 
the States and facing the budget crunches they have--it became clear 
that we had to add a little bit more money to this effort.
  Again, I thank the chairman for focusing on this issue as he has done 
and for the work he has done in putting in that 1.5 percent. It has 
become clear in the last few weeks that the States are going to need 
more than 1.5 percent. That is why I have offered this amendment in a 
friendly manner to ensure that we meet our obligations to the States to 
get the money out there so that these people who are the most 
vulnerable don't fall through the cracks.
  Mr. President, I ask for the yeas and nays on my amendment.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The yeas and nays were ordered.
  Mr. HARKIN. I yield the floor.

                               Exhibit 1

       Comparison of Net FY2002 State Funds Impact of Senate and 
     House Provisions to Harkin Amendment. Harkin: 3% all + 1.5% 
     high unemployment + hold harmless.

                                        FMAP/TEMPORARY HEALTH ASSISTANCE
                          [Based on FFIS data/estimates, dollars in millions, rounded]
----------------------------------------------------------------------------------------------------------------
                                                                                               Harkin    Harkin
                             State                               Daschle    House    Harkin     minus     minus
                                                                  plan      plan      plan     Senate     House
----------------------------------------------------------------------------------------------------------------
Alabama.......................................................    $75.98    $14.99   $113.97    $37.99    $98.98
Alaska........................................................     30.14     13.61     39.24      9.10     25.63
Arizona.......................................................    114.87     24.01    162.93     48.06    138.92
Arkansas......................................................     65.23     10.45     95.05     29.82     84.60
California....................................................    821.54    234.55  1,188.31    366.77    953.76
Colorado......................................................     47.20     18.73     78.66     31.46     59.93
Connecticut...................................................     48.02     30.02     96.04     48.02     66.02
Delaware......................................................      8.98      5.17     17.96      8.98     12.79
DC............................................................     28.20      5.49     42.30     14.10     36.81
Florida.......................................................    253.55     71.73    390.93    137.38    319.20
Georgia.......................................................    101.92     48.69    178.59     76.67    129.90
Hawaii........................................................     19.97      5.60     29.95      9.98     24.35
Idaho.........................................................     24.54      3.77     36.81     12.27     33.04
Illinois......................................................    239.91     87.75    359.86    119.95    272.11
Indiana.......................................................     85.65     25.07    142.28     56.63    117.21
Iowa..........................................................     30.32     11.70     60.64     30.32     48.94
Kansas........................................................     26.02     10.86     51.84     25.82     40.98
Kentucky......................................................    112.16     24.87    161.00     48.84    136.13
Louisiana.....................................................    113.67     24.92    167.42     53.75    142.50
Maine.........................................................     22.78      7.56     44.26     21.48     36.70
Maryland......................................................     52.73     30.17    105.46     52.73     75.29
Massachusetts.................................................    122.11     60.98    244.22    122.11    183.24
Michigan......................................................    220.34     68.28    322.01    101.67    253.73
Minnesota.....................................................    100.45     56.98    165.52     65.07    108.54
Mississippi...................................................     88.20     13.23    125.49     37.29    112.26
Missouri......................................................     73.42     29.07    146.84     73.42    117.77
Montana.......................................................     10.31      2.77     19.67      9.36     16.90
Nebraska......................................................     27.05     12.77     46.20     19.15     33.43
Nevada........................................................     23.23      7.34     33.89     10.66     26.55
New Hampshire.................................................     12.08      7.74     24.16     12.08     16.42
New Jersey....................................................    106.70     57.94    213.40    106.70    155.46
New Mexico....................................................     59.43     10.56     84.45     25.02     73.89
New York......................................................  1,068.63    287.00  1,602.94    534.31  1,315.94
North Carolina................................................    232.62     72.97    325.71     93.09    252.74
North Dakota..................................................      8.99      2.68     15.88      6.89     13.20
Ohio..........................................................    146.40     68.42    276.88    130.48    208.46
Oklahoma......................................................     48.28     14.46     82.74     34.46     68.28
Oregon........................................................     92.56     29.03    131.23     38.67    102.20
Pennsylvania..................................................    352.78    103.02    529.17    176.39    426.15
Rhode Island..................................................     50.17     21.39     69.08     18.91     47.69
South Carolina................................................    116.22     29.06    161.93     45.71    132.87
South Dakota..................................................     18.23      6.79     26.06      7.83     19.27
Tennessee.....................................................     93.22     37.39    179.99     86.77    142.60
Texas.........................................................    394.12    115.32    570.67    176.55    455.35
Utah..........................................................     24.05      9.25     38.16     14.11     28.91
Vermont.......................................................     10.50      3.80     20.00      9.50     16.20
Virginia......................................................     77.22     32.64    136.04     58.82    103.40
Washington....................................................    174.83     54.78    253.52     78.69    198.74
West Virginia.................................................     47.44      7.69     70.60     23.16     62.91
Wisconsin.....................................................     73.05     38.56    125.70     52.65     87.14
Wyoming.......................................................      9.70      4.57     13.60      3.90      9.03
Puerto Rico...................................................      4.82      0.00      9.64      4.82      9.64
American Samoa................................................      0.10      0.00      0.20      0.10      0.20
Guam..........................................................      0.15      0.00      0.30      0.15      0.30
Northern Marianas.............................................      0.05      0.00      0.10      0.05      0.10
US Virgin Islands.............................................      0.15      0.00      0.30      0.15      0.30
                                                               -------------------------------------------------
    Total.....................................................     6,211     1,976     9,630     3.419     7,654
----------------------------------------------------------------------------------------------------------------

  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, I do not know if there are any Senators 
who wish to debate the current amendment. At the appropriate time, I 
will ask the Senator from Iowa to acknowledge there is no more debate 
so we can set aside his amendment and go to the regular order.
  The Senator raises a very important point that in the last 2 years, 
States' economies have generally deteriorated. As a consequence, there 
is more pressure on their Medicaid budgets. States are losing revenue. 
States are moving more toward deficit positions. They are not as 
healthy as they once were.
  When States begin to cut spending and cut services, there is a 
tendency to cut back a bit on Medicaid programs to balance the State 
budgets.
  The Senator is proposing a significant percentage increase in the 
matches the Federal Government make to States under Medicaid to make up 
that difference.
  That so-called difference, the drop, occurs for a second reason. We 
have very old data. The reimbursement to States under Medicaid is based 
on data up through the year 2000. States were doing pretty well in 1999 
and 2000. So there is a tendency for the reimbursement rate to be out 
of whack, out of

[[Page 351]]

sync with the current fiscal situation of the States; namely, tougher 
times, deteriorating surpluses, sometimes potential deficits. The 
amendment offered by the Senator from Iowa attempts to address that 
point.
  One might question whether the amendment is too rich or not rich 
enough. It is a question of degree. He essentially wants to add 3 
percent to all States' match and an extra 1.5 percent for States with 
particularly high unemployment. That is an approach I also took in an 
amendment I will be offering later today. Although the approach is the 
same, the total percentage amount is not quite as high.
  The percentages in the amendment I will be offering later hold States 
harmless. The percentages offered by the Senator from Iowa, it is my 
understanding, in the first year go slightly higher for well-intended 
reasons. I am not going to pass judgment on whether that is a good idea 
or not, but that is the practical effect of that amendment.
  I do not see anybody else wanting to speak on this amendment. The 
Senator might want to speak some more. Maybe he does not want to speak 
some more. If not, I ask unanimous consent that, whatever the 
appropriate order, the amendment be set aside and voted on at the 
appropriate time and that the pending business be the regular order.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BYRD. Mr. President, I will support the Harkin amendment, No. 
2719, in response to the numerous phone calls and letters I have 
received from my constituents in recent years regarding the increasing 
cost of health care. Nevertheless, I am concerned with increasing these 
kinds of mandatory expenditures that are able to bypass the 
consideration of the Appropriations Committees.
  While I believe that this Congress should address the rising cost of 
health care in the United States, we should avoid band-aid approaches 
and focus our efforts on more comprehensive solutions.
  The PRESIDING OFFICER. The Senator from Nevada.

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