Congressional Budget For The United States Government For The Fiscal Year 2006
Mr. President, I thank my colleague for yielding. I send the amendment to the desk. Mr. President, I ask unanimous consent that reading of the amendment be dispensed with. Mr. President, this amendment is being proposed by Senator Smith…
Mr. President, I thank my colleague for yielding. I send the amendment to the desk.
Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.
Mr. President, this amendment is being proposed by Senator Smith and myself, Senator Coleman, Senator Baucus, and other cosponsors who are listed on the amendment.
I wanted to start by commending my colleague from Oregon for his leadership on this very important issue. He has made the exact, right points. I will be brief in my comments because other Senators are here wishing to speak as well. I want to give them an opportunity to do so.
Medicaid is the most important program that pays for health care coverage in my State today. There are over 400,000 people in the State of New Mexico who receive health care because of the Medicaid Program. As he pointed out, these are the people who are most in need of that care, who are least able to cover their own health care costs.
There are 53 million of our Nation's most vulnerable children, disabled, and elderly citizens that rely on Medicaid for their well- being and livelihood. And there are 45 million Americans without health insurance coverage.
The President offered a budget proposal that added $140 billion for health care spending. Even with the proposed reductions in Medicaid spending, he was proposing a net increase of $80 billion for health care.
In contrast, the budget before us provides no spending for the uninsured and a cut in Medicaid of $15 billion over 5 years. This is important because the administration only got a scored savings of $7.6 billion in Medicaid. So, it is $140 billion short of the President's proposal on the uninsured and the cut for Medicaid is scored at twice the level of the President's budget, according to CBO.
This budget is seeking to reduce the deficit, but sadly at the expense of the uninsured and our Nation's most vulnerable children, elderly, and disabled citizens that rely on the Medicaid program.
As a result, I am pleased to be here today with my colleague Senator Smith in support of the bipartisan Smith-Bingaman-Coleman-Baucus amendment to strike the Medicaid cuts and to replace it with a bipartisan Medicaid Commission.
Senator Smith and I strongly believe that Medicaid needs reform and improvement. For years, Medicaid has been neglected. Democrats are often trying to push for universal coverage and neglect fixing issues with Medicaid. Meanwhile, Republicans have proposed block granting the Medicaid program without addressing reform. Just 2 years ago, that proposal was defeated on the Senate floor.
Sadly, we are here again with a proposal to cut Medicaid, but no thoughts
about how to reform and improve the Medicaid program. We are imposing cuts on Medicaid at twice the level the President proposed, as scored by CBO, with little more guidance than rhetoric about cutting ``waste and fraud in the system.''
According to the Budget Committee staff document, ``at least 34 States are estimated to be receiving up to $6 billion a year in Federal Medicaid dollars inappropriately.''
Which States? I think we all deserve to know who they are and what they are doing before voting to cut funding to them. In the Senate Finance Committee, a bipartisan group of Senators asked the Secretary for that list and we still do not have it.
However, anybody that asks is being assured not to worry because their State is not the problem. How can we cut $15 billion to the States without it seriously impacting any State or any of the 53 million people served by Medicaid? Even the best circus elephant or donkey cannot pull off such a feat.
To get scored savings, the Finance Committee will be forced to make major cuts in funding to the States. Let me emphasize, no State is protected.
Also, while some of the proposals have so little detail that we have no idea about the impact on individual States, we do know the budget assumes saving $1.5 billion by dropping the matching rate for targeted case management in Medicaid from the current matching rate to 50 percent Federal and 50 percent State. Again, there is nothing about reform here. It is simply about cutting Federal funding to States. And, in this case, we do know which States, and they are the poorest States in this country.
It may come as somewhat of a shock to some in the Senate, but the cuts would fall disproportionately on the 28 States of Mississippi, Montana, Arkansas, West Virginia, New Mexico, Utah, Idaho, Louisiana, Alabama, South Carolina, Kentucky, Oklahoma, Arizona, North Dakota, South Dakota, Tennessee, Iowa, North Carolina, Indiana, Maine, Missouri, Oregon, Texas, Georgia, Kansas, Ohio, Nebraska, and Florida. President Bush carried 26 of the 28 States and those States have 43 Republican Senators and 13 Democratic Senators.
Simple mathematics tells us that will not fly in the Senate. So, two of the largest proposals for savings truly have nothing to do with Medicaid reform and one does not have enough details to allow CBO to provide scored savings and the other has enough detail that we know it will never be enacted.
So, what we have here are proposed Medicaid budget cuts in search of a policy.
It is with that in mind that Senator Smith and I come to the floor today to actually attempt to reform and improve the Medicaid program in a systematic way. Our proposal is to strike the arbitrary cuts in the budget before us and replace them with the establishment of a bipartisan medicaid commission.
Why a Commission? Just like Social Security, just like the 9/11 Commission which examined the intelligence system, and just like Medicare, we believe that Medicaid deserves a comprehensive and thorough examination of what is working and what is not by all stakeholders--federal officials, state and local government officials, providers, consumer representatives, and experts.
Medicaid is a very complicated program. In fact, it is not one program. It is really four programs.
First, it is a program that provides health insurance for 25 million low-income children.
Second, it provides a safety net of coverage to 14 million adults, primarily low-income working families that play by the rules and work but do not have access to or cannot afford health insurance.
Third, 42 percent of Medicaid spending is actually for what are known as ``dual eligibles,'' which are over 7 million elderly and disabled citizens that have both Medicare and Medicaid coverage. Therefore, Medicaid fills the holes in both Medicare and private insurance by providing acute and long-term care services that neither Medicare or the private sector is able or willing to cover.
And fourth, Medicaid serves as a critical payment system for our Nation's safety net, including payments to disproportionate share hospitals for indigent care or to community health centers and other safety net providers. Without that funding, many of these critical community services would end.
Medicaid is a critically important health care safety net of four different programs that provides services to over 50 million of our Nation's most vulnerable children, pregnant women, the elderly, and people with disabilities.
In New Mexico, Medicaid is, in fact, the single largest payor for health care. All told, Medicaid covers the health care costs of more than 300,000 New Mexicans--nearly one-quarter of our State's population.
It is why I believe firmly we need to make sure that we do whatever we do right rather than quick. Medicaid is the back-stop to Medicare, the back-stop to private insurance, and the major funding source for our Nation's safety net providers. Medicaid is, as Health Affairs has called it, ``the glue that holds our Nation's health care system together.'' Therefore, we must make sure reform is done right and systematically, rather than quickly and without being thought through.
I would like to take a few moments to emphasize the importance of Medicaid to our Nation's children. Again, over 25 million children receive health care services through Medicaid. This includes an estimated 42 percent of our Nation's black children and 36 percent of our Nation's Hispanic children.
Children covered by Medicaid are far less likely than uninsured children to lack a usual source of medical care or have an unmet medical, dental, or prescription drug need.
During the last presidential election, the President recognized that 9 million children lacked health care coverage and made a proposal that he called ``Cover The Kids.''
In his own words:
We'll keep our commitment to America's children by helping
them get a healthy start in life. I'll work with governors
and community leaders and religious leaders to make sure
every eligible child is enrolled in our government's low-
income health insurance program. We will not allow a lack of
attention, or information, to stand between millions of
children and the health care they need.
The President put that proposal into his budget, but I do not see it in this budget. We should not be going backwards on children's health, but we will in this budget unless this amendment we offer today passed.
We should take time and ``first do not harm'' to our Nation's health care safety net. We have tried to enact reform quickly before and it has created many problems. For example, in the Balanced Budget Act of 1997, Congress cut funding for disproportionate share hospitals and Medicare physician payments in rather indiscriminate ways. As a result, the Congress has come back in 1999, 2000, 2001, and 2003 to make what are known as ``provider give-backs.''
The cumulative pages of legislation to correct the Medicare and Medicaid changes from 1997 now far exceed the original legislation, the problems continue and, in some cases, even grow. In fact, we have a crisis with Medicare physician payments that everybody acknowledges will now cost billions and billions of dollars to correct.
Unfortunately, these ``fixes'' are not reflected in this budget, but we all know that the Congress will have to address the problem. I fear the budget, as currently proposed, will create more problems that need fixing rather than correcting the current problems.
Therefore, Senator Smith and I call for a process by which we can enact reforms to Medicaid but do it correctly, rationally, and in a bipartisan fashion. For example, we should ensure that people have more access to home- and community-based care in Medicaid. Doing so would provide care in more cost-effective and appropriate settings for many Medicaid patients.
However, despite a lot of rhetoric about how this is one of the reasons Medicaid needs reform, the budget proposal before us does not address this problem.
There are those that believe Medicaid is ``flawed and inefficient'' and that costs are spiraling out of control so the program needs overhaul. On the other hand, there are those who believe there is absolutely nothing wrong with Medicaid. I firmly believe neither point of view is correct.
First, Medicaid is far from broken. The cost per person in Medicaid rose just 4.5 percent from 2000 to 2004. That compares to just over 7 percent in Medicare and 12.6 percent in monthly premiums for employer- sponsored insurance. If that is the comparison, Medicaid seems to be about the most efficient health care program around, even more so than Medicare.
The overall cost of Medicaid is going up largely, not because the program is inefficient, but because more and more people find themselves depending on this safety net program for their health care during a recession. While nearly 5 million people lost employer coverage between 2000 and 2003, Medicaid added nearly 6 million to its program. Costs rose in Medicaid precisely because it is working--and working well--as our Nation's safety net health program.
Consequently, Medicaid now provides care to 53 million low-income Americans, including nearly one-quarter of all New Mexicans.
On the other hand, it is also not true that Medicaid is not in need of improvement. The administration is rightly concerned about certain State efforts to ``maximize Medicaid revenues'' via ``enhanced payments'' to certain institutional providers. Secretary Leavitt, in a speech to the World Health Care Congress on February 1, 2005, referred to State efforts to maximize Federal funding as ``the Seven Harmful Habits of Highly Desperate States.'' As a result, he called for ``an uncomfortable, but necessary, conversation with our funding partners, the States.''
I would agree. However, Medicaid cuts driven by a budget reconciliation process is not a dialogue or conversation. It is a one- way mechanism for the Federal Government to impose budget cuts on the States. The administration's budget calls for $60 billion in cuts to Medicaid over 10 years, including $34-40 billion that would directly harm States.
Where is the conversation in that? In fact, I believe the States would have quite a lot to say to the Federal Government in such a conversation. While I do not speak for the National Governors' Association, the National Conference of State Legislatures, or the National Association of Counties, some of their grievances are rather obvious and I share them.
For one, these cuts are merely a cost-shift to State and local governments that simply force State Medicaid programs to enact cuts in coverage to our Nation's most vulnerable populations or require tax increases to make up for the loss of Federal funding. It is pretty simple. If the Federal Government cuts $15 billion out of Medicaid, New Mexico will likely lose over $100 million in Federal funding for Medicaid. Either some of our State's most vulnerable citizens will lose coverage or benefits, or taxpayers will be asked to pay more.
Governor Richardson is a pretty impressive guy, but he cannot magically produce the $100 million that the Federal Government would cut to our State under this budget proposal.
Second, as figures from the Kaiser Family Foundation indicate, 42 percent of the costs in Medicaid are a result of services delivered to Medicare beneficiaries. These dual eligibles are also a major driver of health costs in Medicare and this is a prime example of where the Federal Government pushes costs on to Medicaid. Instead, better coordination between Medicare and Medicaid could improve both programs and delivery of care to ``dual eligibles.'' States have been calling for better coordination for years to no avail.
Third, for all the rhetoric about being concerned about what States are doing in drawing down Federal funding, we should acknowledge that the Federal Government passes the buck on to States in other ways. For example, in the Medicare prescription drug bill that was passed by the Congress in 2003, the Federal Government imposed what is referred to as a ``clawback'' mechanism which forces the states to help pay for the federally-passed Medicare prescription drug benefit. Although States were expected to derive a financial windfall from the prescription drug bill, they are now finding that it will cost them millions of dollars more annually through what is referred to as the ``clawback provision'' than if the bill had never passed.
Furthermore, CBO estimated that States had $5.8 billion in added enrollment of dual eligibles in Medicaid due to what they refer to as a ``woodworking'' effect on dual eligibles trying to sign up for the low- income drug benefit discovering they are also eligible for Medicaid benefits. CBO further estimated that States had $3.1 billion in new administrative and other costs added by the prescription drug legislation.
States have no ability to ``have a conversation'' with the Federal Government about the imposition of such costs on them, but they should and will have that ability in our bipartisan commission on Medicaid.
Furthermore, due to a recent rebenchmarking done by the Department of Commerce's Bureau of Economic Affairs with respect to the calculation of per capita income in the States and the application of that data by the Centers for Medicare and Medicaid Services, or CMS, the Medicaid Federal Medical Assistance Percentage, or FMAP, many States, including New Mexico, will see a rather dramatic decline in their Federal Medicaid matching percentage. In fact, due to the rebenchmarking and other factors, 29 States will lose Medicaid funding in 2006 by an amount of in excess of $800 million. Again, this occurred with no dialogue or conversation.
I agree with Secretary Leavitt that there should be a conversation among all the stakeholders about the future of Medicaid and about what are the fair division of responsibilities between the Federal Government, States, local governments, providers, and the over 50 million people served by Medicaid. It is for this reason that the bipartisan commission on Medicaid includes all of those stakeholders at the table to have a full discussion and debate about the future of Medicaid.
It is our intent that the recommendations would not only be focused on spending inefficiencies but about improving health care delivery to our Nation's most vulnerable citizens. However, they are not mutually exclusive. In fact, both can and should be done.
Before closing, I thank Senator Smith for his leadership on this issue and the over 100 organizations--State and local governments, providers, and consumer groups that have endorsed this amendment. We have the attention and support of all these groups to come to the table to make Medicaid more efficient and effective in the delivery of care to our Nation's most vulnerable citizens. We should not pass up that opportunity.
The policy needs to drive the budget.
As Senator Smith said, and as Senator Coleman said, we cannot just take a figure out of the air and say we are going to cut Medicaid because we need to make up some money in the budget in order to get to the number that we predetermined we ought to get to. That kind of arbitrary cut in Medicaid, when we are doing nothing to constrain the growth of Medicare, when we are doing nothing to constrain the growth of spending in a lot of other areas, would be irresponsible. Exactly as Senator Smith pointed out, it is important that we do this right, that we do this fast.
This first chart I wanted to point to shows the States in red which are going to suffer these cuts. There is $4 billion proposed for cuts in these States that are depicted in red on this map. It turns out that most of those are the States that supported the President's reelection in large numbers.
We have a couple of other charts which I very briefly would like to point out. One is a chart that points out that Medicaid is not the great inefficient program that everyone is pointing to. Medicaid has grown 4.5 percent per year the last few years. Medicare has grown over 7 percent. The private sector health care expenses have grown over 12 percent. There is enormous growth in Medicaid because more and more people are depending on Medicaid. That is the simple point.
This last chart points out that 42 percent of the cost of Medicaid is because of the ``dual eligibles.'' These are people who are covered by Medicare, but Medicaid is having to pick up a substantial portion.
We need to understand these programs better before we begin cutting them. The Senator from Oregon has provided a real service to us in the Senate by focusing attention on this.
I hope my colleagues will support this amendment.
I yield the floor.