[Congressional Record (Bound Edition), Volume 150 (2004), Part 13]
[Extensions of Remarks]
[Pages 18230-18231]
[From the U.S. Government Publishing Office, www.gpo.gov]




  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
               RELATED AGENCIES APPROPRIATIONS ACT, 2005

                                 ______
                                 

                               speech of

                       HON. ENI F.H. FALEOMAVAEGA

                           of american samoa

                    in the house of representatives

       The House in Committee of the Whole House on the State of 
     the Union had under consideration the bill (H.R. 5006) making 
     appropriations for the Departments of Labor, Health and Human 
     Services, and Education, and related agencies for the fiscal 
     year ending September 30, 2005, and for other purposes:

  Mr. FALEOMAVAEGA. Mr. Chairman, I rise in support of the Bordallo-
Faleomavaega-Christiansen amendment to the Labor-HHS-Education 
Appropriations Act and I commend my colleagues, including Chairman Dan 
Burton of the Government Reform Committee, for their support.
  While I am sure my colleagues will address specific issues related to 
their constituencies, I would like to share with you my concerns about 
American Samoa's treatment under the Medicaid program. During the 108th 
Congress, I introduced H.R. 1188, a bill to amend the Social Security 
Act to provide for American Samoa treatment under the Medicaid Program 
similar to that provided to States.
  I introduced this legislation for two reasons. One, each year 
American Samoa's expenditures exceed its federal fiscal ceiling. Two, 
American Samoa, like every other insular area, pays a higher federal 
match than 40 other states.
  Each of these points deserves discussion and I would like to begin by 
addressing the issue of federal fiscal ceilings. In fiscal year 2003, 
more than 36,200 individuals in American Samoa were Medicaid eligible 
and American Samoa received $3.7 million in Medicaid reimbursement.
  However, in FY2003, American Samoa's Medicaid program cost $12.2 
million and if American Samoa were treated like a State, the federal 
government would have been responsible for $6.1 million (or half of the 
costs) and the American Samoa Government (ASG) would have been 
responsible for the other half, also $6.1 million.
  As it is, a federal ceiling is in place. For FY 2003, the federal 
ceiling for American Samoa was $3.7 million, meaning that the federal 
government only paid out $3.7 million of the $6.1 million to which we 
would have been entitled if we were treated like a State, leaving a 
difference of $2.4 million for American Samoa to pay for in addition to 
its own share of $6.1 million. In other words, American Samoa paid the 
$2.4 million which was over the federal ceiling plus its local share of 
$6.1 million for a total of $8.5 million in FY2003 Medicaid costs. The 
federal government paid $3.7 million.

[[Page 18231]]

  For FY2004, and as a result of our efforts to include provisions for 
the insular areas in the Tax Act of 2003, American Samoa will receive 
about a 5.9% increase or about $460,000 in Medicaid payments. But an 
increase of a half a million dollars is not enough. It is not enough 
for American Samoa and it is not enough for the other insular areas. 
Like American Samoa, all other insular areas including Guam, CNMI, the 
Virgin Islands, and Puerto Rico have federal ceilings in place that cap 
the amount of federal assistance they can receive under the Medicaid 
program. Although I have introduced legislation to specifically address 
American Samoa's needs, and although the other Territories have also 
asked Congress to intervene in their behalf, Congress has hesitated to 
assist us because of Puerto Rico's population.
  Puerto Rico has a population of almost 4 million. American Samoa, 
Guam, CNMI and the U.S. Virgin Islands have populations which range 
from 60,000 to 150,000. Federal costs to reduce the match and increase 
the Medicaid ceiling for Pacific Island Territories and the U.S. Virgin 
Islands would be minimal. However, to assist Puerto Rico, Congress 
would have to shell out millions of dollars per year in Medicaid 
reimbursements and this has been the problem.
  Time and time again, Congress has hesitated to assist the Pacific 
Island Territories and the U.S. Virgin Islands for fear this might open 
the door for increased Medicaid benefits to Puerto Rico. Quite frankly, 
I think we should all be treated fairly, including Puerto Rico, and I 
will continue to bring this matter to the attention of Congress until 
the matter is fairly resolved.
  With a per capita income of about $4,500 per year, more than 56 
percent of American Samoa's population lives below the poverty level 
and all on-island health care is provided by the LBJ Tropical Medical 
Center. The LBJ Tropical Medical Center is a semi-autonomous agency of 
the American Samoa Government.
  Construction of the LBJ Tropical Medical Center was completed in 
1967. The in-patient wards have not been renovated since this time. The 
patient wards have no air conditioning and many do not meet fire safety 
codes and ADA standards and requirements.
  While I am not asking for millions of dollars to address the inequity 
that currently exists in the way we provide for the healthcare needs of 
American Samoa, I am asking that the federal Medicaid ceiling be raised 
and the calculations used to determine the federal match for the States 
be applied to American Samoa.
  Until this matter can be fully resolved by Congress, I am hopeful 
that my colleagues, both Republican and Democrat, will support this 
amendment which minimally increases the Medicaid cap for American 
Samoa, Guam, the U.S. Virgin Islands and CNMI.
  Again, I thank my colleagues for their consideration of this 
amendment and I look forward to working with each of you to find a fair 
and reasonable approach to resolving health care disparities in the 
United States Pacific Island Territories.

                          ____________________