[Congressional Record (Bound Edition), Volume 160 (2014), Part 12]
[Extensions of Remarks]
[Pages 16613-16614]
[From the U.S. Government Publishing Office, www.gpo.gov]




    HISTORICAL RECORD ON PASSAGE OF AFFORDABLE CARE ACT AND RELATED 
                  HEALTHCARE FUNDING IN AMERICAN SAMOA

                                 ______
                                 

                      HON. ENI F. H. FALEOMAVAEGA

                           of american samoa

                    in the house of representatives

                      Wednesday, December 3, 2014

  Mr. FALEOMAVAEGA. Mr. Speaker, I rise today to include, for 
historical purposes, information on the passage of the Affordable Care 
Act and related healthcare funding in American Samoa.

                     [Press Release, Mar. 25, 2010]

    House Passes Final Version of Health Care Legislation, Includes 
 Increase in Medicaid and Health Insurance Exchange for American Samoa

       Congressman Faleomavaega announced today that by a vote of 
     220-207 the U.S. House of Representatives passed the final 
     version of H.R. 4872, the Health Care and Education 
     Reconciliation Act of 2010. The bill now goes to President 
     Obama for signature.
       ``As a result of this historic legislation, for the next 9 
     years American Samoa will receive an increase of $180 million 
     in its total Medicaid spending cap for a total of $285.5 
     million,'' Faleomavaega said. ``American Samoa will continue 
     to receive the 5% increase in its Federal Medical Assistance 
     Percentage (FMAP) that was signed into law by the President 
     this past Tuesday. This means that the American Samoa 
     Government (ASG) will pay 45% of the Medicaid costs while the 
     federal government pays 55%.''
       ``This legislation continues to provide $1 billion for the 
     Territories to participate in the Health Insurance Exchange 
     program. Each of the Territories will be afforded the option 
     to participate or transfer their allocation to their Medicaid 
     program. In this case, if American Samoa chooses not to 
     participate in the Exchange by 2014, the Territory will 
     receive an additional $18.75 million for its Medicaid 
     program.''
       ``Between 2004 and 2008, ASG has received an estimated $106 
     million in direct and indirect federal grant funding from the 
     U.S. Department of Health and Human Services. As you may 
     know, ASG receives an additional $23 million per year from 
     the federal government for the operations of its local 
     government. ASG continues to be the only State or Territory 
     that receives federal funding for the operation of its local 
     government and more than $7 million per year of these 
     operating funds, provided by the Department of Interior, are 
     allocated for LBJ and healthcare in the Territory.''
       ``With the hundreds of millions provided to ASG from the 
     federal government for healthcare in American Samoa, I have 
     every confidence that the Fono, together with the local 
     administration, will work to establish a solid program in 
     place for our residents who deserve affordable quality 
     healthcare under the law.''
       ``Again, I want to thank President Obama and those involved 
     for making health care affordable for all Americans and for 
     working with the Congressional Delegates to make certain that 
     the Territories were included in this historic legislation,'' 
     Faleomavaega concluded.
                                  ____


                     [Press Release, Apr. 30, 2012]

Faleomavaega Stands With Democratic Colleagues To Fight for Territory's 
                            Medicaid Funding

       Congressman Faleomavaega today announced that he will 
     continue to work with his Democratic colleagues in Congress 
     to ensure that critical funding for American Samoa's Medicaid 
     program is not affected by Republican proposals to 
     significantly reduce federal healthcare funding for the five 
     U.S. Territories.
       The Republican proposed cuts to American Samoa's Medicaid 
     program originated in the House Committee on Energy and 
     Commerce which oversees healthcare issues. The legislation, 
     put forward by Republican Chairman Fred Upton, seeks to 
     repeal a provision of Affordable Care Act (ACA) that provided 
     $6.3 billion in additional funding for Medicaid in the 
     territories from FY 2011 to FY 2019, and increased the 
     territories' Federal Medical Assistance Percentage (FMAP) 
     from 50% to 55%. The proposal follows the Republican's own 
     directive in the FY 2013 budget approved by the House last 
     month that required the Energy and Commerce Committee to 
     submit legislation to reduce the deficit by $96.76 billion 
     over the next decade.
       In a letter to Chairman Fred Upton, dated April 20, 2012, 
     Congressman Faleomavaega, along with his colleagues from the 
     U.S. Territories, Pedro Pierluisi (Puerto Rico), Donna 
     Christensen (U.S. Virgin Islands), Madeleine Bordallo (Guam), 
     and Gregorio ``Kilili'' Camacho Sablan (Commonwealth of the 
     Northern Mariana Islands), voiced their strong opposition to 
     the proposed cuts. Another letter to Chairman Upton, dated 
     April 25, 2012, from all Democratic members of the House 
     Natural Resources Committee, led by Ranking Member Edward 
     Markey and including Congressman Faleomavaega, denounced the 
     Republican proposed legislation. Furthermore, Representative 
     Donna Christensen of the U.S. Virgin Islands, a member of the 
     Energy and Commerce Committee, offered an amendment to block 
     the Republican proposal in the Committee. But the amendment 
     was defeated on a party-line vote of 30 to 21. The bill 
     passed in Committee on April 25, 2012 and is expected to be 
     considered by the full House in the coming weeks.
       ``While I understand the need for fiscal reform and the 
     important work we must do in Congress to reduce the deficit, 
     I do not believe that any budget alternative should be taken 
     out on America's most vulnerable populations,'' Congressman 
     Faleomavaega stated.
       ``The residents of the five U.S. Territories, numbering 
     more than 4 million, have historically received unequal 
     treatment under the Medicaid program in comparison to the 
     States. For example, some of the country's poorest states 
     receive upwards of 80 percent in their federal matching 
     requirement (FMAP) for Medicaid and do not have a mandated 
     funding cap on their Medicaid program. The Affordable Care 
     Act, passed in 2010 without a single Republican vote, sought 
     to address some of these disparities. While it did not fully 
     close the inequality gap, it did provide a major step forward 
     for the Territories. Out of the $6.3 billion in additional 
     funding to the Territories, the ACA increased American 
     Samoa's Medicaid funding to a total of $285.5 million over 
     the nine year period from FY 2011-FY 2019, compared to $105 
     million without the legislation.''
       ``The Affordable Care Act was a major step forward for 
     American Samoa and the U.S. Territories, but this Republican 
     bill only seeks to reverse our progress towards equality 
     under the Medicaid program. If this bill were to be enacted, 
     American Samoa's FY 2012 funding cap of approximately $28 
     million will revert back to a pre-ACA ceiling of 
     approximately $10.6 million next year,'' said Congressman 
     Faleomavaega.
       ``At this time, I, along with my fellow Territorial 
     delegates will continue to work hard to ensure that this bill 
     does not become law. It is highly unlikely that the Senate 
     will pass or the President will sign into law such a bill 
     that would repeal such important funding for our 
     Territories.''
       ``As stated in our joint Territorial letter to Chairman 
     Upton, this proposal has sent `a terrible message of 
     exclusion to our constituents' by proposing to cut every 
     single dollar of our new funding under the Affordable Care 
     Act. The President's Administration has offered several 
     alternatives to deficit reduction, and like my Democratic 
     colleagues from the Territories as well as our Territorial 
     governors, I do not believe that taking important funding 
     away from our needy healthcare systems in the Territories is 
     a good solution to the deficit.''
       ``I thank my colleagues for their tireless advocacy on 
     behalf of more than 4 million residents in the U.S. 
     Territories, and I ensure the people of American Samoa that 
     we

[[Page 16614]]

     will continue to fight hard to protect the Territory's 
     Medicaid funding,'' Faleomavaega concluded.

                     [Press Release, Jan. 13, 2014]

  Congressman Faleomavaega Applauds CMS Decision To Increase Medicaid 
                     FMAP for Eligible Territories

       Congressman Faleomavaega today issued the following 
     statement in response to a decision by the Centers for 
     Medicare and Medicaid Services (CMS) to increase the Federal 
     Medicaid Assistance Percentage (FMAP) for eligible U.S. 
     Territories.
       ``I am pleased to hear today of CMS' decision to offer each 
     US. Territory the opportunity to receive increases to the 
     federal Medicaid matching rate provided by the Affordable 
     Care Act (ACA). CMS' announcement today provides for each 
     eligible Territory to receive two increases to their FMAP. 
     CMS will send a letter to Medicaid directors in the five U.S. 
     Territories outlining the specific information needed to 
     determine the eligibility of each Territory. According to 
     CMS, one potential increase will be determined by whether a 
     Territory fulfills the requirements for an `expansion state' 
     matching rate. The other increase will be a temporary (2 
     year) 2.2 percentage point increase for all expenditures in 
     jurisdictions that do not claim any `newly eligible' matching 
     funds. CMS has also determined that both increases will be 
     available to Territories that meet the criteria for 
     `expansion state' designation. CMS will be reaching out to 
     each Territory similarly to each of the States and the 
     District of Columbia.
       ``From the outset of negotiations leading up to the passage 
     of the Affordable Care Act, one of the key issues for the 
     U.S. Territories was to increase the FMAP for each Territory. 
     Along with my colleagues from the U.S. Territories, I have 
     continuously voiced American Samoa's desire for state-like 
     treatment in which our FMAP is set according to per capita 
     income to reflect our true ability to share in financing 
     Medicaid services. The ACA increased the Territories' FMAP 
     from 50 to 55 percent federal share. The ACA also gave 
     American Samoa a $180 million increase in the Territory's 
     Medicaid statutory cap over a nine year period, from 2011 
     through 2019, lifting the overall cap to $285.5 million in 
     Medicaid funding. However, while the increase in funding caps 
     were a victory for the Territories, the fact of the matter 
     is, the ability of the Territories to draw down on this 
     additional federal funding is limited because of the required 
     FMAP.
       ``I thank Secretary Sebelius, Administrator Marilyn 
     Tavenner, and their team for their work and outreach to 
     American Samoa and our fellow Territories. While full parity 
     by statue is still a goal to be realized for the Territories, 
     I am pleased nonetheless that the most recent decision by CMS 
     will provide an opportunity for Territories to receive an 
     increased FMAP, pending eligibility.''

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