[Congressional Record (Bound Edition), Volume 151 (2005), Part 21]
[Senate]
[Pages 27952-27956]
[From the U.S. Government Publishing Office, www.gpo.gov]




                         BUDGET RECONCILIATION

  Mr. BAUCUS. Mr. President, at the appropriate time I will be sending 
a motion to instruct to the desk. I will be doing that at a later time. 
In the meantime, I rise to speak on that motion.
  The motion instructs the Senate conferees on the spending 
reconciliation bill not to bring back a conference report that hurts 
Medicaid beneficiaries. This is the item about which the Senator from 
New Mexico just spoke.
  Last month, the House passed such a bill, one that would hurt 
Medicaid beneficiaries. The House passed a bill that would cut health 
care for millions of seniors and lower income Americans who depend on 
Medicaid.
  I believe the Senate should reject these harmful cuts. In early 
November, the Senate voted by a thin margin to

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cut Medicaid, our Nation's safety net health program for low-income 
Americans. Many of us at that time objected to those cuts. That day, 
the Senate bill planted a seed of opportunity to make even more harmful 
cuts, hurting millions of low-income children, seniors, pregnant women, 
and individuals with disabilities. Just 2 weeks ago, the Senate 
reconciliation bill bore bitter fruit. Why? Because the Medicaid cuts 
in the House bill turned out to be substantial and, in fact, will hurt 
millions of the poorest and neediest among us.
  According to the Congressional Budget Office, most of the Medicaid 
savings in the House bill come from targeting our poorest citizens. CBO 
says three-quarters of the House bill's Medicaid savings come from 
provisions that increase costs, cut benefits, or impair access to 
services for low-income individuals. These cuts will affect millions of 
people. The CBO estimates that about 17 million Medicaid enrollees will 
pay more under the House bill, and half of those paying more will be 
children.
  Who will these cuts affect? Medicaid now serves more than 50 million 
low-income Americans. A quarter are children. A quarter are seniors and 
disabled. The rest are pregnant women, low-income parents, and 
individuals with serious medical needs.
  Many believe that all low-income Americans are eligible for Medicaid. 
That is not the case. Often only the very poor qualify. On average, a 
nonworking parent making about $150 per week for a family of three 
makes too much for Medicaid. Again, a nonworking parent of a family of 
three making about $150 a week makes too much for Medicaid. That is 
less than one-half the Federal poverty level.
  Eligibility levels for working parents are also low. On average, a 
working parent with a family of three earning more than $5.50 an hour 
also makes too much to qualify for Medicaid. So we are talking about 
the very poor.
  Under the House bill, these needy individuals will pay more for less. 
CBO estimates that about 80 percent of the savings from increasing cost 
sharing would come from decreased use of health care services. Some may 
say that increasing cost sharing will curb waste, abuse. I am not 
saying we cannot or should not look at reducing unnecessary treatments 
under Medicaid. Far from it. But increasing cost sharing is not the 
right way to do it.
  Increasing costs deters patients from seeking health care services, 
both good and bad services. If we really want to control overuse of 
services, we should be investing in care management strategies for 
expensive chronic diseases such as diabetes. These strategies have 
proven to lower cost while increasing the quality of care.
  Increasing enrollee cost sharing can also have unintended systemwide 
effects. Many States have already said they will deduct the new 
copayment fees from provider rates regardless of whether providers 
collect the fees. The result puts the new burden on doctors and clinics 
and hospitals serving our health safety net. Many of these providers 
will be forced to make up uncompensated care costs by increasing 
private market rates, which will drive up health care costs for all of 
us, leading to more uninsured and an even greater need for Medicaid.
  Even more troubling, the House bill's premium increases will result 
in tens of thousands of individuals losing Medicaid coverage. According 
to CBO, about a quarter of the savings from the premium increases are 
for individuals losing coverage. We don't need to rely on CBO to know 
that this will actually happen. Why? Because in the State of Oregon, 
this was tried, and the results were quite clear and disturbing. That 
State began to enforce nominal monthly premiums for higher income 
Medicaid beneficiaries. What happened? Oregon saw its enrollment drop 
by nearly one-half in 10 months. Nearly 50,000 individuals lost 
coverage.
  This increased cost sharing amounts to a tax on poor families now in 
Medicaid. For a family of three with income at 135 percent of poverty, 
annual cost sharing would be as high as $1,086 per year or, stated 
another way, about 60 percent of their annual Federal tax liability.
  Let me say that again. For a family of three, with income at 135 
percent of poverty, annual cost-sharing could be as high as over 
$1,000, which amounts to less than 60 percent of their annual Federal 
tax liability. In effect, it is a tax--a big tax, about 60 percent of 
their Federal tax. Add them together and it is about 160 percent of tax 
they are paying.
  Many of these poor individuals would also be forced to pay more to 
get less. How? Because the House allows States to cut Medicaid 
benefits.
  The Congressional Budget Office estimates that 5 million enrollees 
would see their benefits cut over the next 10 years. Half of those 
affected would be children. Higher income children would no longer have 
guaranteed access to medically necessary care under Medicaid.
  It is also unclear whether individuals with disabilities and chronic 
conditions would be protected. This could undermine access to more 
expensive treatments and services for those individuals who turn to 
Medicaid because the private market will not cover them.
  Shifting costs and cutting benefits for our poorest and least able to 
pay is not the smart way to preserve our Nation's safety net for future 
generations.
  In the Finance Committee, many of my colleagues on the other side of 
the aisle chose to support the Senate bill because it didn't include 
changes that would hurt Medicaid beneficiaries. My friend and 
colleague, Finance Chairman Grassley, praised the bill, saying it 
``protects Medicaid benefits for the most vulnerable in our society.''
  The Senator from Oregon, Mr. Smith, said that ``the reconciliation 
package we are considering today is not only fiscally responsible, but 
also morally defensible. This is a bill that protects the less 
fortunate among us. It takes pains to preserve the vital safety net 
programs that millions of Americans rely on.''
  And the junior Senator from Pennsylvania said during the committee 
markup:

       Let us set the record straight. We are not cutting health 
     care services to the beneficiary.

  So today I will offer this motion to set the record straight on 
Medicaid cuts. This motion instructs Senate conferees on the 
reconciliation bill to reject changes to Medicaid that would hurt 
Medicaid beneficiaries or undermine Medicaid's guarantee. Given the 
threat of the cuts passed in the House, the Senate must take a stand in 
support of the neediest among us.
  Let us ensure that we keep the record straight on Medicaid. Let us 
ensure that we do no harm to the vulnerable individuals whom Medicare 
serves. Let us pass this motion.
  Mr. President, at the appropriate time I will make the motion.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Rhode Island is recognized.
  Mr. REED. Mr. President, I, too, at the appropriate moment will offer 
a motion to instruct the conferees. I will offer the motion in 
conjunction with Senators Collins, Kennedy, Snowe, Lieberman, Leahy, 
Bingaman, Coleman, Salazar, Stabenow, Clinton, Lugar, Harkin, Levin, 
Smith, and Pryor.
  This motion to instruct conferees is about LIHEAP, the Low Income 
Heating Assistance Program. Each of us, at this point, is very familiar 
with the struggle that is taking place today. If you were in New 
England over the weekend, as I was, or in many other parts of the 
country, you understand that temperatures have fallen and many families 
are having to perform a juggling act with their budgets in order to 
heat their homes.
  According to EIA's most recent short-term energy outlook, released 
last week, energy costs for the average family using heating oil are 
estimated to hit $1,454 this winter, an increase of $255. That is a 21-
percent increase over last year's heating season. Natural gas prices 
could hit $1,024 for an average family using natural gas. That would be 
an increase of $282 or a 38-percent increase. For a family using 
propane, prices are projected to hit $1,269, an increase of $167 from 
last heating season, and that is a 15-percent increase.
  Despite these sharp increases in fuel costs, we sadly continue to 
fund

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LIHEAP--the one program that can provide sufficient help to these 
families--at the same level as last year, which in reality means an 
actual cut in the level of assistance we can provide low-income 
consumers this winter's heating season.
  The responsible thing for Congress to do is to fully fund LIHEAP at 
the full $5.1 billion authorized in the Energy Policy Act enacted 
earlier this year. Indeed, we have tried to do that on numerous 
occasions. Today marks the fifth time in the last 2 months that Senator 
Collins and I, along with some 30 other colleagues, have made an 
attempt to fully fund LIHEAP. We offered amendments to the Defense 
bill, the Transportation-Treasury-HUD bill, Labor-HHS bill and, most 
recently, the tax reconciliation bill. On each occasion, we reach 
across the aisle and across the country to provide more assistance for 
the LIHEAP program. While we did not reach the 60-vote margin needed to 
pass these amendments under the budget rules, in each instance, a 
majority of this body was on record supporting full funding for LIHEAP.
  My preference, of course, was to provide funding to fully fund LIHEAP 
on an emergency basis through an appropriations bill. Those 
opportunities have passed. Budget reconciliation is the last train that 
is leaving the station. That is why I come to the floor and will offer, 
at the appropriate time, a motion to instruct budget conferees to 
insist on a level of funding for LIHEAP that is sufficient to fully 
fund the program at its fully authorized level.
  The heat-or-eat dilemma is not just rhetoric. The RAND Corporation 
conducted a study and found that low-income households reduced food 
expenditures by roughly the same amount as increases in fuel 
expenditures. In some respects, this is a tidal wave not of rising 
water, like Katrina, but of rising energy prices.
  We have all had the opportunity to visit our constituents and get a 
firsthand glimpse of the struggle they are faced with. A few weeks ago, 
I visited with Mr. Aram Ohanian, an 88-year-old veteran of the U.S. 
Army in World War II, living on a $779-a-month Social Security check. 
Money is so tight that he sometimes has to eat with his children or go 
to a local soup kitchen. He also gets assistance from our Rhode Island 
food bank. These heating price increases to Mr. Ohanian will be very 
difficult. He received LIHEAP assistance last year, but that assistance 
will be relatively less this year because of rising prices and greater 
demand.
  Last month, the Social Security Administration announced that cost-
of-living adjustments for 2006, on average, are about $65. That $65 
increase to Mr. Ohanian is not going to take up the slack in terms of 
these tremendous increases in fuel prices.
  The motion to instruct conferees that we will submit at the 
appropriate moment calls for LIHEAP to be funded at the fully 
authorized level. Under the best-case scenario, if we fully fund 
LIHEAP, there would still be a significant number of Americans who 
qualify for the program but will not get any help. LIHEAP would still 
only serve about one-seventh of 35 million households that are poor 
enough to qualify for assistance. But at least we are taking a step by 
fully funding this important program.
  I urge my colleagues to support this motion when it comes to the 
floor for a vote.
  I yield back the remainder of my time.
  The PRESIDING OFFICER. The Senator from New Hampshire is recognized.
  Mr. GREGG. I ask for the regular order, Mr. President.
  The PRESIDING OFFICER. The Senate is in morning business with 10 
minutes for Senators.
  Mr. GREGG. Mr. President, we are trying, as the Senate and as a 
Congress, to wrap up the business for the Government this year. A major 
part of that effort is to complete the budget process. Included in the 
budget were two directions to the Congress, which were voted in by a 
majority of the Congress--regrettably, very few people from the other 
side of the aisle supported it--and one of the directions was, for the 
first time in 8 years, to attempt to bring under control the rate of 
growth of entitlement spending.
  Anybody who looks reasonably at the Federal Government--and let's 
take an independent view here and the view specifically of Chairman 
Greenspan, who recently gave a speech in London where he pointed out 
that the biggest concern he has from the standpoint of fiscal policy 
was the burgeoning costs of the Federal Government which were being 
driven by entitlement spending, and which would explode as the baby 
boom generation began to retire in 2008 and become an untenable burden 
for the children of the baby boom generation and their children as they 
have to pay the taxes or costs of supporting that retired generation 
which is so large.
  This bill, in what I consider to be the first act of fiscal 
responsibility of significance in the last 8 years, moved legislation 
that said the Congress, for the first time in 8 years, will address the 
issue of entitlements.
  Now, the savings being projected in the bill were not that dramatic 
and they continue to be not that dramatic. They are large numbers, 
obviously, but in the context of the total spending on entitlements, 
they are not that large.
  For example, the savings that are being projected in the area of 
Medicaid are about $10 billion over 5 years. But what you have to 
understand--and that is a big number--is over that period, Medicaid 
will be spending approximately $1.4 trillion--trillion dollars. So we 
are actually asking for less than a one-tenth of 1 percent reduction in 
the rate of growth in Medicaid, and Medicaid during that period will 
grow at 40 percent--a 40-percent growth rate over those 5 years, down 
from 41 percent, assuming we make the $10 billion reduction over the 10 
years in the rate of growth.
  The total deficit reduction bill was to be somewhere in the range of 
$35 billion to $50 billion, depending on which bill was taken from 
which House. It left the Senate at $39 billion and left the House of 
Representatives at about $50 billion, $51 billion, something like that; 
I am not sure. In any event, it is going to fall somewhere between 
those two numbers.
  We as a Congress hopefully can pass legislation that accomplishes 
that goal which starts to reduce the rate of growth of entitlements and 
reduces the debt of the Government to at least $40 billion--hopefully 
more than that, $45 billion, $46 billion over the next 5 years. This is 
the responsible thing to do, and it will be the first act of 
significant fiscal responsibility in which we have participated in a 
while around here as we continue to pass in the entitlement area--there 
has been significant fiscal responsibility in the nondefense 
discretionary area executed by the Appropriations Committee under, 
again, the budget which essentially froze nondefense discretionary 
spending and put in place what is known as caps so we can enforce them.
  Ironically, none of these proposals for fiscal responsibility put in 
place have received any significant support from the other side of the 
aisle. When the budget passed this Congress, I don't think any Members 
from the other side of the aisle voted for it. When the reconciliation 
bill passed this Congress, two Members from the other side of the 
aisle--I appreciate it very much--the Senator from Louisiana and the 
Senator from Nebraska voted for it, but other than that, no one else on 
the other side of the aisle voted for fiscal responsibility or an 
attempt to reduce the rate of growth of the Government. So this has 
become a lifting exercise in which, for all practical purposes, 
Republican Members of the Congress appear to be ready to participate.
  Yet today we are hearing from the other side of the aisle that they 
want to instruct the conferees of a bill, against which they voted--
they voted against the budget, which was the underlying bill--instruct 
the conferees how the conference should occur. I find that to be a 
touch inconsistent--to be kind, a touch inconsistent, a big touch 
inconsistent, to be honest. Here they are, folks who have not voted for 
any fiscal restraint and, in fact, as we moved through the 
appropriations

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process have suggested that we add $500 billion of new spending to the 
Federal Government under the appropriations process, which is not, by 
the way, impacted under this deficit reduction bill because this is 
entitlement activity, the two accounts being separate, appropriations 
being one-time annual expenditures of the Government, entitlements 
being programs which people have a right to and, therefore, they can go 
out and receive funding. They may be veterans, they may be low-income 
individuals, they may be students--they have a right to receive 
funding. It goes on independent of annual legislation.
  As I said, the other side of the aisle not only has not supported the 
efforts of fiscal responsibility by voting for either the budget or the 
vast majority, with the two exceptions I mentioned, not voting for a 
deficit reduction bill, but now come forward with a series of what are 
going to be instructions to the conferees as to how the conferees 
should act after they voted against passing the bill and moving forward 
with the legislation. Chutzpah is an understatement for that type of 
approach.
  Let's just take one or two examples and discuss them for a second. 
For example, the Senator from Rhode Island was talking about LIHEAP. 
There is significant irony in the position of the Senator from Rhode 
Island--significant irony. To begin with, he voted against the one 
proposal that we could have passed--which was funded--which would have 
funded LIHEAP to keep people protected from the increase in oil costs. 
It was paid for. That amendment was offered by myself. It was paid for 
with an across-the-board cut in the Labor-HHS bill. It would have fully 
funded the LIHEAP account at a level which would have held harmless 
everybody who receives LIHEAP money, low-income energy assistance, 
because we all realize the Low-Income Home Energy Assistance Program is 
a critical program and there is going to be significant stress, 
especially in the Northern States, as a result of the increased costs 
of the price of oil. And yet this was opposed.
  When this opportunity came along, it was opposed for political 
reasons, if nothing else, I suspect, because they wanted to make a 
claim that they were going to fund LIHEAP at a level that was 
significantly higher than what CBO and what the Energy Department and 
what everyone else said was needed, including the Health and Human 
Services Department, to hold the program harmless, to keep the people 
funded who needed to be funded.
  That increase, which was required, was a $1.2 billion increase. You 
don't have to listen to me to believe that. Take a look at the letter 
the Senator from Rhode Island sent out asking that the funding in 
LIHEAP be increased--it was signed by I think 44 Members of the 
Senate--be at a level that held harmless the system so people who 
receive money under LIHEAP would get the money they needed. What was 
the number in that letter? The number was $1.2 billion. But suddenly, 
in order to promote an agenda which had nothing to do with making sure 
the people were held harmless but had a lot to do with maybe headlines, 
we find the number being asked for is another $1.5 billion on top of 
that. It is not paid for, not offset. Just run up the debt and put 
money into an account far in excess of what that account needs to do 
the job right.
  In fact, as a result of the warm season in November in many of the 
Northern States and the result of the softening, to some degree, of oil 
prices, especially home heating oil prices, the number has now dropped. 
It is down below $1.2 billion, according to the estimates I have been 
seeing, to hold the system harmless. I am still willing to go to the 
$1.2 billion level and have it paid for. That is the way it should be 
done. You have to set priorities. You live in a household, and this is 
all about households trying to make ends meet. They set priorities.
  One of the priorities should be that the Federal Government should 
not pass the bills in an energy program today which pays for oil that 
is purchased today and given out today on to our children and our 
grandchildren to pay through debt. We should pay for it ourselves. We 
should be willing as a Congress to step up and say: Yes, this is an 
important program; yes, it should be funded at a level that holds 
everybody harmless and makes sure they get the support they need, but 
also it should be paid for by the generation that is going to benefit 
from it or at least the Government that is taking advantage of it. It 
should not be passed on to the next generation as a bill to our kids 
because our kids are also probably going to have cold winters, and they 
sure are going to have tough energy issues because we haven't solved 
any of those issues around here. We passed an energy bill that was 
filled with a lot of vertical subsidies but didn't have a whole lot of 
good energy policy in it; a little bit, a little bit of good energy 
policy and a lot of bad policy which was basically driven by interest 
groups around here, but it sure didn't do anything to make us more 
long-term solvent in the area of energy.
  One item that might address that is the issue of producing more 
energy for our country, and that, of course, is a big issue in this 
bill, and we will get into that in a later discussion.
  The point here is we are being asked to vote for the reconciliation 
bill when it comes out of conference. We are being asked to instruct 
the conferees to add another $2.9 billion of debt onto our children's 
backs rather than doing an appropriate action which is what I suspect 
the conference will do, which is increase the money in the Low-Income 
Home Energy Assistance Program by $1.2 billion, or something in that 
range, and have it paid for within the context of the entire deficit 
reduction bill, which is the fiscally responsible way to approach this 
issue.
  This will make a good press release, and it will obviously make a 
good political ad, but I hope there will be a followup statement and 
maybe even a followup political ad, maybe paid for by our kids or 
grandkids which says: Hey, why are you doing this to us? Why do you not 
take responsibility for your generations? Why are you giving us a bill 
for oil and heat for this year when we may have the same bills to deal 
with when we retire or when our children have to take care of us in 
retirement 10, 15 years from now?
  Let us do this the right way. Let us make this system solvent, not 
only solvent but make the system--put in the system the funds that are 
necessary to make sure that people who need the low-income energy 
assistance can get it under the higher oil prices, and then let us pay 
for it. Set a priority and say there are some things we can afford, 
some things we cannot afford, and in the Federal Government let us make 
the decisions to reduce the things we cannot afford and pay for the 
things we need, which specifically would be this proposal for low-
income energy assistance at $1.2 billion. But that is not the politics 
of this institution.
  So I do hope we will pass a reconciliation bill, otherwise known as a 
deficit reduction bill, and I do hope it will step forward and reduce 
the debt by somewhere around $45 billion or $46 billion, maybe more, 
and that in that process we will address the low-income energy 
assistance program and make sure that it is funded at a level that is 
necessary in order to make sure people are held harmless, and low-
income individuals who need energy can afford it to heat their homes 
and do not have to make difficult choices. But we should all do it 
within the context of prioritizing the responsibilities of the Federal 
Government today and not pass our responsibilities today on to our 
children and our children's children tomorrow by deficit-financing this 
event.
  So we are going to get these instructions. I guess there has been 
some unanimous consent agreement worked out. There are going to be 
about seven proposals, instructions to conferees. I just hope that as 
we go through these instructions people will have the intellectual 
integrity to ask the question, if they did not vote for the bill, if 
they did not vote for the budget which was trying to control spending, 
and they did not vote for the deficit reduction bill which is trying to 
control spending, why are they coming to the floor

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and suddenly telling the conferees how they should go about hitting 
their targets which are part of the bill, which they did not vote for, 
and they do not support? Maybe we will hear somebody preface their 
request for instructions with an explanation of that point.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.

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