[Congressional Record (Bound Edition), Volume 151 (2005), Part 17]
[House]
[Page 23607]
[From the U.S. Government Publishing Office, www.gpo.gov]




                            MEDICAID REFORM

  The SPEAKER pro tempore. Pursuant to the order of the House of 
January 4, 2005, the gentleman from Florida (Mr. Stearns) is recognized 
during morning hour debates for 5 minutes.
  Mr. STEARNS. Mr. Speaker, today the House Committee on Energy and 
Commerce will begin the long road to meaningful Medicaid reform and I 
am proud to be part of this effort. Think back just a decade ago when, 
together, the Republican-led Congress and then President Clinton, the 
Democrat President, enacted a successful welfare reform with a 
transformation of the program from a sixties-era program that became a 
way of life to a temporary assistance program, sort of a hand and not a 
handout. I believe we can do this together for Medicaid.
  The Medicaid program that is vitally sustaining for some people has 
become a leaking raft, carrying too many others whom we want to help 
obtain health care with options in competition and consumer choice. It 
is time to take a fresh look at Medicaid. Spending for Medicaid, 
Federal-State medical and long-term care for low-income families, 
elderly and the disabled, has risen very dramatically in the past 
decade. It has an annual growth of 7.9 percent, almost 8 percent. This 
is an unsustainable trend. As mandatory spending grows, obviously less 
money is available for other programs with high priorities, such as 
education, homeland security and National Institutes of Health 
research. This is true in the States also. In Florida, Medicaid 
represents nearly a quarter of the budget and is projected by 2015 to 
include almost 60 percent. Yet Medicaid does not well serve either the 
beneficiaries or the providers. It is unwieldy for States to oversee, 
unfortunately making it a program which attracts fraudulent practices. 
Finally, it does not provide opportunities and incentives for 
beneficiaries to take charge of their own health care. This is 
especially worrisome when some eligibility categories depend upon the 
Medicaid program, such as the developmentally disabled.
  Some points I would like to highlight include, one, cost-sharing. No 
one has said this better than Tennessee Governor Phil Bredesen, who 
delivered the national Democratic address on a Saturday in June: 
``Number one, everybody pays something. Imagine shopping at a store 
where nothing has a price tag and you never get a bill. You would spend 
a lot more than you do now. But this is exactly how Medicaid works 
today. Until there's a little economic tension, until everyone has a 
little skin in the game, the system will continue to be inefficient.''
  Also, I am encouraged to hear some forward-looking Governors, like 
Governor Jeb Bush of Florida, who has been discussing the role that 
beneficiary behavior change could play and has received Federal 
approval for a tidal change demonstration project in Medicaid. Last 
Wednesday, October 19, Health and Human Services Secretary Mike Leavitt 
approved an innovative Medicaid reform plan that will allow Florida 
beneficiaries to choose health care plans that best suit their needs, 
for the first time introducing competition and consumer choice to this 
government-funded health care program. Florida will begin the phase-in 
of this unprecedented demonstration in two counties, Broward and Duval, 
in July 2006. A statewide implementation plan will follow. The 
demonstration is approved to run through June 30, 2011.
  My colleagues, these are opportunities in Medicaid coverage where 
vast savings could be realized. More importantly, quality of life can 
be vastly improved if beneficiaries would make healthier, more 
responsible, more forward-looking choices. This could be implemented 
with a carrot, not a stick, strategy and it is not such a radical 
departure from other insurance models that we see today. The auto 
insurance industry has given safe driver discounts for years, and some 
health insurance plans give, quote, healthy life-style discounts for 
insurees who use a gym or stop smoking. Let's design a beneficiary-
empowering reward system to incentivize beneficiaries to lead healthy, 
fulfilling lives. Eat healthfully, drink in moderation, stop smoking, 
exercise, manage stress, purchase long-term care insurance when you are 
young and healthy, develop strong family and community ties as 
nurturing resources.
  Mr. Speaker, finally I am most hopeful about the prospect of making 
consumer direction in Medicaid a permanent option. For years there has 
been a proposed pilot project called ``cash and counseling'' in 
Medicaid in Arkansas, New Jersey and my home State of Florida. Since 
then it has been expanded to 11 new States who were impressed by its 
success. In the Medicare Prescription Drug and Modernization Act of 
2003, I included a provision creating an analogous demonstration and 
evaluation project in the Medicare program. And today I plan to 
introduce ``cash and counseling'' legislation to make it a permanent 
option so future States do not have to go through the bureaucratic 
waiver process for years to get on board. Besides the positive features 
of increasing choice, personal responsibility, and a sense of ownership 
over one's own health.
  Let's all take this opportunity to work together, Congress, 
Governors, beneficiaries, patient advocates, providers, on productive 
solutions.

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