[Congressional Record (Bound Edition), Volume 155 (2009), Part 18]
[Extensions of Remarks]
[Pages 24509-24510]
[From the U.S. Government Publishing Office, www.gpo.gov]




 GOVERNORS OF NEBRASKA, NORTH DAKOTA, NEVADA, AND RHODE ISLAND 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 Nebraska, North Dakota, Nevada and Rhode 
Island:

                                               September 16, 2009.
     Hon. Benjamin Nelson,
     U.S. Senator, Hart Building, Washington, DC.
     Hon. Mike Johanns,
     U.S. Senator, Russell Senate Office Building, Washington, DC.
       Dear Senator Nelson and Senator Johanns: I am writing to 
     alert you that the analysis provided by the staff to the 
     members of the NGA Health Care Reform Task Force indicates 
     that the Chairman's Mark released by Senator Baucus this 
     morning contains a new unfunded Medicaid mandate. Earlier 
     this year I wrote both of you expressing my concern that this 
     might occur as part of health care reform.
       I greatly appreciate the fact that both of you have 
     repeatedly expressed concerns about the negative impact that 
     health care reform could have on the Federal deficit and the 
     State budget. As former Governors you understand the impact 
     that Medicaid has on state spending. This new unfunded 
     federal Medicaid mandate could result in higher taxes on 
     Nebraskans or in cutting state aid to Nebraska's school 
     districts as well as state appropriations to our 
     universities, state colleges and community colleges. This 
     proposal is not in Nebraska's best interests.
       As we develop more specific information, I will be 
     providing you with our best estimates of the magnitude of the 
     impact on Nebraska. Thank you for your attention to this 
     matter.
           Sincerely,
                                                    Dave Heineman,
     Governor, Nebraska.
                                  ____

                                               September 30, 2009.
     Kathleen Sebelius,
     Secretary of Health and Human Services, Hubert H. Humphrey 
         Building, Washington DC.
       Dear Secretary Sebelius: As Congress and the Administration 
     work through the various versions of health care reform 
     currently moving through the legislative process, we ask that 
     you carefully consider the following issues.
       First, having served as chief executive of a state 
     yourself, I am sure you are mindful of the growing concern 
     among the nation's governors about the risk to states of 
     including unfunded mandates in national healthcare 
     legislation. States are constitutionally mandated to balance 
     their budgets, which means that any shortfalls caused by 
     unfunded federal mandates could force increases in taxes, a 
     reduction in services or both. This potential is especially 
     troubling at a time when states are financially struggling.
       We cannot be certain what form evolving legislation will 
     take, and what the impact of that final legislation will be 
     on state budgets. For that reason, we, along with the 
     National Governors Association, urge extreme caution in 
     moving forward with any plan that would commit the states, 
     without their express participation and consent, to 
     obligations that may financially bind them for decades into 
     the future.
       Second, it is important that any healthcare reform plan 
     passed by Congress and signed by the President reward the 
     states for good Medicare and Medicaid outcomes. North Dakota 
     health care providers, for example, consistently provide low-
     cost, high-quality healthcare, yet have the lowest 
     reimbursement rates in the nation. Any reform of the system 
     must have incentives for good performance and cost-
     effectiveness.
       Notwithstanding these issues, like Americans everywhere, we 
     too are concerned about rising healthcare costs and the need 
     to provide access to affordable, high-quality healthcare for 
     our citizens. Congress and the Administration should be 
     looking at a range of reforms chat can deliver meaningful and 
     almost immediate benefits for our healthcare system. These 
     include measures, among others, like tort reform for medical 
     liability; tax credits to help make insurance more 
     affordable; providing transparency in billing; ensuring 
     healthcare insurance portability; and limiting denials for 
     preexisting conditions.
       Clearly, healthcare reform is needed. On that matter there 
     is no disagreement, but it needs to be done right. To that 
     end, I do hope that you will keep in mind OUR concerns and 
     recommendations as you consider proposals to improve 
     America's healthcare system.
           Sincerely,
                                                      John Hoeven,
     Governor, North Dakota.
                                  ____

                                               September 11, 2009.
     Hon. Harry Reid,
     Senate Majority Leader, U.S. Senate, Washington, DC.
       Dear Senator Reid: It has been clear from the early days of 
     the 111th Congress that health insurance reform will be a top 
     priority for lawmakers this year. Comprehensive reform should 
     lower health care costs while increasing insured populations, 
     quality of care, and point-of service accessibility for all 
     Nevadans.
       One common thread appears throughout recent legislative 
     proposals: the expansion of Medicaid as a central ``reform'' 
     component. Simply put, the expansion of existing healthcare 
     programs is not authentic reform and further, places the cost 
     burden to the states at a time when states can ill afford it.
       It is essential that Congress take the time to examine all 
     possible options for health insurance reform in order to find 
     sustainable long-term solutions. Lowering healthcare costs 
     and reforming the healthcare system is possible without 
     unfunded mandates or Medicaid expansions forced on the 
     states. While certain changes to the current Medicaid program 
     could advance the overall function of health insurance 
     reform, expansion of the program without a permanent funding 
     mechanism is not something that any state can support, nor is 
     it a viable solution.
       As you know, unlike the United States Constitution, most 
     state constitutions require a balanced budget, including 
     Nevada. In Nevada, we will spend nearly $907,000,000 for 
     Medicaid programs in Fiscal Years 2010 and 2011. This 
     accounts for 13.8 percent of our General Fund budget. Any 
     further expansion of this program would be another great 
     example of Washington playing budget games by passing on 
     costs to the state--this is unrealistic in the current 
     economy and as a long term resolution.
       Additional expansions of the Medicaid program will force 
     Nevada into deep cuts in other programs and services which 
     are not federally mandated in order to balance our General 
     Fund. In the current fiscal year gaming revenues are down 
     12.5 percent, and sales tax revenues are down 20 percent. By 
     overriding my veto, the 2009 Nevada Legislature passed 
     substantial tax increases to burden our already beleaguered 
     citizens.
       Many current proposals also include significant cuts to the 
     Medicare program. Nevada's growing senior population is 
     frightened by the proposed $162,200,000 reductions which will 
     impact an estimated 11,000,000 seniors. Harmful and arbitrary 
     cuts to Medicare Advantage may result in plans dropping out 
     of the program, limiting beneficiary choice, and causing 
     millions of seniors to lose their current coverage. These 
     proposals must be stopped.
       Nevadans cannot afford more taxes. Now is not the time to 
     place unfunded Medicaid or other mandates on the states. By 
     expanding Medicaid programs, the United States Congress will 
     be forcing the State of Nevada into deep budget cuts in other 
     state programs. I do not believe that any child's education 
     should be placed on the chopping block to fund these new 
     programs, but we will face that dilemma if these proposals of 
     the Democratic Congress are enacted.
       Health insurance reform should be addressed in a 
     cooperative manner by both the federal and state governments. 
     If states are treated as partners--not pawns--we can work to 
     enact important reforms in concert with federal efforts. 
     State-enacted caps on medical malpractice lawsuits, for 
     example, would have a transformative impact on the health 
     care and health insurance industry in each state, cutting 
     costs for consumers without negatively affecting the 
     stability of our current health care industry.
       I am ready to work with my fellow Governors and the U.S. 
     Congress in order to support sensible, accountable, and 
     workable health insurance reform that helps, not hurts, 
     Nevadans.
           Sincerely,
                                                      Jim Gibbons,
     Governor, Nevada.
                                  ____

                                               September 25, 2009.
     Hon. Jack Reed,
     Senator, U.S. Senate, Hart Building, Washington, DC.
       Dear Senator Reed: I appreciate your work and that of your 
     colleagues in the Congress to craft legislation to reform the 
     health care system in America. As you know, Rhode Island took 
     on reform last year, albeit on a smaller scale, as we 
     developed and pursued approval of our groundbreaking Global 
     Consumer Choice Waiver.
       One of the primary reasons the State pursued the Global 
     Waiver is that federal Medicaid rules often limit the ability 
     of the

[[Page 24510]]

     states to adapt to fiscal realities and the complex and 
     changing needs of beneficiaries. It is difficult to deliver 
     vital services to the beneficiaries and be fair to all 
     taxpayers when the federal government denies us the 
     flexibility to effectively structure and manage a program 
     representing such a significant financial investment.
       I am extremely concerned that several of the health reform 
     initiatives recently introduced in Congress will prevent 
     Rhode Island from fulfilling the Global Waiver's promise. 
     Such initiatives will further strain the state's budget at a 
     time of great fiscal uncertainty and impose even more debt on 
     our children, grandchildren and great grandchildren.
       Therefore, I ask for your support and that of all members 
     of the Rhode Island Congressional Delegation, to preserve the 
     innovative health care initiatives now under way in Rhode 
     Island and in many other states. I ask that you reject any 
     reform proposals that impose additional financial burdens on 
     the states and the people and communities we serve or that 
     otherwise limit our capacity to meet our constituents' needs.
       As originally proposed, the Senate Finance bill required a 
     significant portion of the costs for covering the uninsured 
     through Medicaid to be paid by lower and middle income 
     taxpayers and the states. I am aware that changes in the 
     proposed legislation provide, at least temporarily, 
     additional funding for the required Medicaid expansions to 
     ``high need'' states like Rhode Island. However, full federal 
     funding will only be available for a limited period and would 
     cease at the very time population projections estimate we 
     will begin to see a surge in Medicaid eligibility for elders. 
     It is unclear how the state or federal government will be 
     able to sustain these Medicaid expansions in light of these 
     projections and at a time of decreasing revenues and sky-
     rocketing deficits. The House legislation imposes burdens on 
     state budgets and working Americans that are unacceptable.
       Likewise, there still remain Medicaid eligibility and 
     coverage mandates that will limit the flexibility of the 
     states to operate financially sound, sustainable programs. 
     Moreover, ongoing health reform efforts, such as those now 
     under way in Rhode Island, may be hampered as limited 
     administrative resources are diverted to finance the mandated 
     expansions. Federal oversight of the Medicaid program should 
     be streamlined, and allow for far greater innovation at the 
     state level.
       As a Governor, I am particularly concerned about the 
     prospect of additional ``short-term funded'' federal Medicaid 
     mandates. The Medicaid program itself is expensive, provider-
     centered, inefficient, slow to innovate and, as such, 
     ultimately unsustainable. For these reasons, the Medicaid 
     program is hardly the best and by no means the most 
     appropriate platform for expanding health coverage to tens-
     of-thousands of additional Rhode Islanders and millions of 
     other Americans.
       I hope you will ensure that any legislation enacted by 
     Congress does not include additional mandates on states, or 
     at the very least compensates states fully for those it does 
     impose, including the administrative costs associated with 
     expansion. Additionally, providing states with the 
     flexibility they need to implement the relevant provisions of 
     reform should be a top priority today and in the future.
       There are better ways to reform America's health care 
     system, and I hope that President Obama and Congress will 
     work with Governors, providers, consumers and others to bring 
     about sensible reforms that increase quality, contain costs 
     and ensure portability of health care.
           Sincerely,
                                               Donald L. Carcieri,
     Governor, Rhode Island.

                          ____________________