[Congressional Record (Bound Edition), Volume 155 (2009), Part 18]
[Extensions of Remarks]
[Pages 24504-24505]
[From the U.S. Government Publishing Office, www.gpo.gov]




   GOVERNORS OF IDAHO, INDIANA, AND LOUISIANA EXPRESS CONCERNS WITH 
                   UNFUNDED MANDATES IN HEALTH REFORM

                                 ______
                                 

                            HON. MIKE ROGERS

                              of michigan

                    in the house of representatives

                       Wednesday, October 7, 2009

  Mr. ROGERS of Michigan. Madam Speaker, I rise today to express 
concerns regarding health reform proposals which would create unfunded 
state mandates. Legislation currently before the House would 
dramatically expand the Medicaid program and place over $35 billion in 
new liabilities on state budgets over the next ten years. In addition, 
these proposals would expand the federal government's role in 
administering Medicaid, which would severely handcuff states' ability 
to run their own programs and preempt state authority to manage 
Medicaid eligibility and benefits.
  Over the last several weeks, governors have expressed concerns over 
these proposals. I would like to submit for the Record the following 
letters from the governors of Idaho, Indiana, Louisiana and Minnesota:

                                               September 15, 2009.
     Hon. Mike Crapo,
     U.S. Senate, Dirksen Senate Office Building, Washington, DC.
       Dear Senator Crapo: Idaho has a proud history of fiscal 
     responsibility, ensuring that our State government serves its 
     proper role for the people of Idaho while staying within 
     their financial means. As the United States Congress attempts 
     to address the healthcare challenges facing our nation, it is 
     important that we remain diligent in assessing the 
     implications of our decisions, always ensuring that we take 
     seriously our duty to safeguard the financial resources of 
     the American public, and allocating taxpayer money in an 
     efficient and effective manner.
       As revised healthcare proposals continue appearing in 
     Congress, the full consequences of these reforms remain 
     unknown and we are uncertain of the possible negative impacts 
     on local businesses, families and senior citizens. However, 
     it is clear that these sweeping proposals would irresponsibly 
     shift a substantial and unmanageable financial burden to the 
     states. Like Idaho, many states already are functioning under 
     severely limited and strained budgets. It is certain that the 
     burden of these reforms would be placed upon the shoulders of 
     hardworking Americans.
       The costs associated with these proposed reforms are 
     astounding. Conservative estimates from the Idaho Division of 
     Medicaid indicate that the bill's Medicaid eligibility 
     proposal would increase our state share of Medicaid and the 
     federal matching rate effective would drop in the middle of 
     fiscal year 2011, leaving Idaho struggling to fill the void. 
     Idaho's tax base could not support this large unfunded 
     mandate without resorting to tax increases, including a 
     possible increase in Idaho's already 6-percent sales tax--an 
     irresponsible action which would do serious harm to Idaho 
     taxpayers. The proposed reforms would impose an undue burden 
     on citizens already struggling in this difficult economy.
       It has been estimated that combined federal-state Medicaid 
     costs in Idaho could increase by $501 million. In addition, 
     raising the Medicaid reimbursement rate to 110 percent of the 
     Medicare reimbursement rate would increase total federal-
     state costs $50 million more.
       This proposed change in the federal reimbursement rate 
     likely would reduce the number of plans that are offered to 
     persons on Medicare, resulting in increased premiums and 
     reduced services and access to service providers. Seniors in 
     rural Idaho already have trouble finding providers who accept 
     Medicare patients.
       Should these changes be approved, that trend could continue 
     statewide--severely limiting access to medical care for some 
     of Idaho's most vulnerable residents. The people of Idaho 
     have entrusted us with a responsibility to use our government 
     resources wisely and efficiently. Imposing costly federal 
     mandates that cannot be sustained in the long run is an 
     irresponsible violation of this public trust. Quite simply, 
     these proposals are financially irresponsible and would not 
     adequately address the needs of senior citizens and other 
     vulnerable groups.
       I encourage you to join me in opposing current health care 
     reform proposals. By ending these nonsensical debates and 
     stopping the proposed reforms, we can move forward in a more 
     positive, measured and reasonable direction, using common 
     sense to find a workable healthcare solution that benefits 
     all Americans.
           As Always--Idaho ``Esto Perpetua'',
                                             C.L. ``Butch'' Otter,
     Governor, Idaho.
                                  ____

                                                September 8, 2009.
     Hon. Richard Lugar,
     Hart Senate Office Building, Washington, DC.
       Dear Senator Lugar: During your summer recess I am sure 
     that many, if not all of you heard from your constituents 
     regarding health care reform.
       I have heard from them as well. In fact, over the past few 
     months, I have watched Americans come forward to passionately 
     express their anxieties about the legislation currently 
     making its way through Congress. Their worries are well-
     founded.
       There is no disputing the fact that aspects of American 
     health care, such as access and affordability, truly do need 
     to be restructured and improved. Yet, I have serious concerns 
     about Congress's proposed solutions to these problems. In 
     fact, I fear the current rush to overhaul the system will 
     ultimately do more damage than good and create far more 
     problems than it solves.
       And unfortunately, Indiana would bear the brunt of many of 
     the reckless policies being proposed. For example, our 
     Healthy Indiana Plan (HIP), an innovative and successful 
     state sponsored health insurance program for uninsured 
     citizens, would suffer greatly as Congress expands Medicaid 
     coverage, forcing many of the Hoosiers already enrolled in 
     HIP out of the plan and into a broken Medicaid program that 
     does not focus on prevention, healthy lifestyles, or personal 
     responsibility.
       Additionally, states will likely have to pick up the tab 
     for this extension of Medicaid. We have estimated that the 
     price for Indiana could reach upwards of $724 million 
     annually. These additional costs will overwhelm our resources 
     and obliterate the reserves we have fought so hard to 
     protect.
       While these reforms could do serious damage to our state, I 
     fear they will also have harmful consequences all across the 
     country by reducing the quality and quantity of available 
     medical care, stifling innovation, and further burdening 
     taxpayers.
       There is another way. Americans from all walks of life and 
     every political stripe should work together with President 
     Obama and Congress to create a set of measured and sensible 
     reforms that bring down costs, increase access and 
     portability and stress the importance of innovative state-run 
     health insurance programs.
       The majority of Americans do believe that health care 
     reform is needed, but do not believe that the legislation 
     currently on offer is the answer. I agree. And I will do 
     everything in my power to raise these concerns and work with 
     you to find a solution.
           Sincerely,
                                                    Mitch Daniels,
     Governor, Indiana.
                                  ____

                                               September 30, 2009.
     Hon. Steve Scalise,
     Cannon House Office Building, Washington, DC.
       Dear Congressman Scalise: I join many of my fellow 
     Republican and Democrat governors in expressing concern with 
     any health care legislation being signed into law that would 
     serve as an unfunded mandate to states.
       Louisiana is similar to many other states around the 
     country in that we are attempting to address budgetary 
     deficits in large part by working to streamline government to 
     be more efficient and cost-effective. In short, we are trying 
     to emulate many of our working families, small businesses and 
     seniors by watching our spending, doing more with less, and 
     making every dollar count.

[[Page 24505]]

       However, Louisiana's budgetary situation is uniquely 
     challenged due to an unprecedented FMAP rate drop from 72 to 
     63.1 percent beginning next fiscal year that will cost 
     Louisiana at least $700 million annually. This additional 
     cost will place significant pressures on our ability to 
     expand our economy, create new jobs and protect critical 
     services in our state.
       Louisiana is proud of its commitment to its citizens' 
     health in the face of long-standing issues of extreme poverty 
     experienced in few other states. Our state is a national 
     model for insuring children with over a 95% rate of child 
     insurance and we were recently recognized for achieving the 
     2nd highest child immunization rates in the nation after an 
     intensive state-wide private-public effort.
       My Department of Health & Hospitals has submitted a 
     Medicaid waiver to the US Department of Health & Human 
     Services that can help improve the cost and quality delivered 
     in the Medicaid program. This waiver proposes national best 
     practices of coordinated care, medical homes, provider 
     payment reform, electronic medical records, and consumer 
     incentives to manage cost and improve quality. This proposal 
     can help improve the efficiency in Medicaid and utilize those 
     savings, along with the shifting of DSH dollars from 
     expensive hospital based care to community based outpatient 
     care, to expand coverage through private insurance to tens of 
     thousands of adults in our state.
       Again, I ask that you consider the budgetary pressures 
     being felt by Louisiana and many other states and avoid 
     passing any health care legislation that would serve as an 
     unfunded mandate to the states.
           Best regards,
                                                     Bobby Jindal,
     Governor, Louisiana.
                                  ____


                [From the Washington Post, Aug. 3, 2009]

                 To Fix Health Care, Follow the States

                (By Governor Tim Pawlenty of Minnesota)

       If you tie money to results, you'll get better results. 
     Unfortunately, government often dumps money into programs 
     without regard to accountability and outcomes. This past 
     week, Democrats in Congress have been busy tinkering with a 
     Washington takeover of the health-care system, but perhaps 
     they should look instead to the states for models of market-
     driven, patient-centered and quality-focused reform. Rather 
     than taking power away from states, federal health-care 
     reform should use the lessons we've learned tackling this 
     crisis in our back yards.
       In Minnesota, our state employee health-care plan has 
     demonstrated incredible results by linking outcomes to value. 
     State employees in Minnesota can choose any clinic available 
     to them in the health-care network they've selected. However, 
     individuals who use more costly and less-efficient clinics 
     are required to pay more out-of-pocket. Not surprisingly, 
     informed health-care consumers vote wisely with their feet 
     and their wallets. Employees overwhelmingly selected 
     providers who deliver higher quality and lower costs as a 
     result of getting things right the first time. The payoff is 
     straightforward: For two of the past five years, we've had 
     zero percent premium increases in the state employee 
     insurance plan.
       Minnesota has also implemented an innovative program called 
     QCARE, for Quality Care and Rewarding Excellence. QCARE 
     identifies quality measures, sets aggressive outcome targets 
     for providers, makes comparable measures transparent to the 
     public and changes the payment system to reward quality 
     rather than quantity. We must stop paying based on the number 
     of procedures and start paying based on results.
       Instead of returning power to patients and rewarding 
     positive outcomes, many Democrats in Washington want a 
     government-run plan that would require states to comply with 
     dozens of new mandates and regulations. One study by the 
     Lewin Group recently concluded that an estimated 114 million 
     Americans could be displaced from their current coverage 
     under such a plan, and another study by House Republicans 
     said the plan could result in the loss of up to 5 million 
     jobs over the next 10 years.
       In typical fashion, the self-proclaimed experts piecing 
     together this Democratic health-care legislation are focusing 
     on only one leg--access--of a three-legged stool that also 
     includes cost and quality. Expanding access to health care is 
     a worthwhile goal. But equal or greater focus should be 
     placed on containing costs for the vast majority of Americans 
     who already have insurance. Those costs will not be contained 
     by a massive expansion of federal programs.
       Massachusetts's experience should caution Congress against 
     focusing primarily on access. While the Massachusetts plan 
     has reduced the number of uninsured people, costs have been 
     dramatically higher than expected. The result? Increased 
     taxes and fees. The Boston Globe has reported on a current 
     short-term funding gap and the need to obtain a new federal 
     bailout.
       Imagine the scope of tax increases, or additional deficit 
     spending, if that approach is utilized for the entire 
     country.

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