Mr. President, the budget conference report that is about to be voted on by the Senate decreases access to and affordability of needed health care through the Medicaid Program for low-income children, parents, seniors, and people with…
Mr. President, the budget conference report that is about to be voted on by the Senate decreases access to and affordability of needed health care through the Medicaid Program for low-income children, parents, seniors, and people with disabilities while protecting a $10 billion fund for Medicare private health plans that are already acknowledged to receive payments far in excess of Medicare fee-for-service.
Clearly, the conferees made the choice to protect private health plan overpayments in Medicare while cutting access to care for some of our most vulnerable citizens enrolled in the Medicaid Program.
The conference report permit States to cut back on benefits for nearly all of the 27 million low-income children enrolled in Medicaid, including allowing States to restrict and limit benefits even for those with little or no income. The language is ambiguous about whether Early Periodic Screening Diagnostic and Treatment, EPSDT, services, which are critical to ensuring that children have access to all medically necessary services they need, will continue to be provided. Benefits that could be lost include comprehensive developmental assessments, assessment and treatment for elevated blood lead levels, eyeglasses, dental care, hearing aids, wheelchairs and crutches, respiratory treatment, comprehensive mental health services, prescription drugs, and speech and therapy services.
While certain populations, like pregnant women, people with disabilities, dual eligibles, and people with long-term care needs, are explicitly protected from benefit reductions, all other children enrolled in Medicaid, with the exception of children in foster care, are no longer ensured such protections.
The conference report also permits, States to reduce Medicaid benefits for many low-income parents and some people with disabilities to something called a benchmark package, even if it is bare-bones coverage with minimal benefits. The Congressional Budget Office, CBO, had previously written that it expected a reduction in benefits by 15 percent to 35 percent due to this provision. The conference report estimates that over $6 billion in cuts will occur to benefits for low- income people in Medicaid.
The conference report also allows States to impose substantial cost- sharing charges upon Medicaid beneficiaries that will impact millions of low-income beneficiaries. Currently, States can generally charge no more than $3 for copayments per service or prescription drugs with groups like children entirely exempt. That is all changed by the conference report.
For very low-income people, the Secretary would increase the nominal copayments of $3 by the medical portion of the Consumer Price Index, or M-CPI, which rises twice as fast as inflation generally. Of course, it will result in sharp rises in cost-sharing for our Nation's most vulnerable citizens, which a large body of research indicates will result in having people forgo needed health care services and prescription drugs.
Meanwhile, beneficiaries with income between 100 and 150 percent of poverty could be charged copayments up to 10 percent, and beneficiaries with income over 150 percent of poverty could be charged copayments of up to 20 percent of the cost of medically necessary care.
Furthermore, providers are allowed to deny care to anyone that cannot afford such cost-sharing. There are not even protections for children facing life-threatening conditions and in dire need of medically necessary care, as the language states that it would be incumbent upon the provider to waive the copayment in this case and only if the State allows it.
It should be further noted that there really are no statutory limitations because even those protections or limitations on cost- sharing that I have cited may be waived by the Secretary under the conference report.
CBO estimates that the conference report will result in $10.1 billion in cuts over 10 years resulting from increases in beneficiary copayments and premiums and these reductions are about 90 percent of the size of the cuts in the House package that they previous analyzed. It is important to remind my colleagues what the CBO said about the House bill, as it so closely mirrors what came out of the conference.
As CBO's analysis of the House bill states, ``We estimate that the number of affected enrollees [due to increased cost-sharing requirements] would increase from 7 million in 2010 to 11 million by 2015, and that about half of those enrollees would be children.''
CBO added that, due to added premiums, ``about 70,000 enrollees would lose coverage in fiscal year 2010 and that 110,000 would lose coverage in fiscal year 2015 because of the imposition of premiums.''
In sharp contrast, the Senate bill had nothing that increased premiums or cost-sharing.
Without the Medicaid Program, the number of children without health insurance--8.3 million in 2004--would be substantially higher. In fact, the number of uninsured children has dropped by over 300,000 children over the past 4 years due in large part to Medicaid and the State Children's Health Insurance Program, or SCHIP. We should not at this time be taking steps backward by reducing coverage for low-income and vulnerable populations, including children.
Senators need to fully recognize, understand, and reject what the House of Representatives and conferees have done with respect to the health and well-being of children, seniors, and the disabled in their budget reconciliation bill. Our Nation's most vulnerable citizens should not be asked to bear the burden of billions of dollars in budget cuts--cuts that are not even being used to reduce the deficit but, rather, to help pay for tax cuts.
There is also the fact that the conference report will significantly restrict eligibility for nursing home care under Medicaid. The conference report adopts most of the punitive provisions in the House- passed bill to limit eligibility for long-term care services, but adds additional restrictions so that savings in this area would actually be 11 percent larger than the House bill and 7 times larger than the Senate bill.
There are numerous problems with the provisions in this section that I do not have time to address today, but I would like to ask unanimous consent to place into the Record a letter from AARP expressing concern about these provisions, that CBO estimates will cut $6.5 billion out of nursing home spending over the next 10 years. It should be noted that these figures are just Federal amounts and that if you add State cuts in spending that there are billions and billions more in cuts to eligibility and services to Medicaid beneficiaries.
In addition, I also want to raise another major problem that I asked conferees to address and was highlighted by my introduction of S. 2074, the Medicaid Indian Health Act. That legislation would have exempted American Indians and Alaska Natives, AI/ANs, and Indian health programs from those provisions and changes being proposed to Medicaid that will all have devastating consequences for Native Americans.
Unfortunately, the conference report failed mightily in this regard. In fact, there is not even a mention of Native Americans or Indian health program in the legislation despite the fact the Federal Government's responsibility for Indian health, the uniqueness of the Indian health care system, and the serious health problems of Indian people require that protection of access to health care services for Native Americans be reflected in Federal Medicaid
policy. Failure of the conferees to address this fact will have significant harmful consequences for American Indians and Alaska Natives.
For example, the budget conference report would allow States to impose cost-sharing on Medicaid beneficiaries similar to and at even higher levels than those allowed under the SCHIP program, with the stated policy objective of achieving more appropriate utilization of cored services. This objective, however, would not be achieved at Indian Health Service, IHS, or Indian tribal health facilities, as these programs do not charge their American Indian and Alaska Native patients for health care. Rather, imposition of premiums and copays would produce the following unintended--and very harmful impact--on the Indian health system:
Medicaid enrollment of AI/ANs who are eligible for coverage is already low, since the IHS user population receives health care without charge at IHS and tribal facilities. The financial barriers imposed by assessment of Medicaid premiums would further depress AI/AN enrollment. Decreases in Medicaid enrollment would deprive already-underfunded Indian health programs of vital Medicaid revenues on which they are heavily dependent.
The imposition of copayments will not change utilization habits of Indian Medicaid beneficiaries because IHS and tribal providers do not charge copays to their Indian patients. Copay amounts would be simply cost-shifted to the Indian health programs, causing a further reduction in the services they can offer, and reducing the resources they need to purchase contract health care.
These reductions in resources available to the Indian health system will decrease the health services they can provide and cause further decline in the health status of Indian populations. Everybody voting on today's package should be fully aware of that fact.
In addition, the budget reconciliation bill would, for the first time, allow States to offer different Medicaid benefit packages to ``individuals within one or more groups of individuals'' in the State by requiring enrollment in ``benchmark'' or ``benchmark-equivalent'' Medicaid coverage. This authority would allow a State to reduce the amount, duration and scope of Medicaid benefits to many beneficiaries. The Indian Health Service, which is now funded at less than 60% of need and is heavily dependent on Medicaid payments, would be decimated by any reductions in Medicaid-covered services.
While States receive 100% FMAP for Medicaid services provided in an IHS or tribal facility, those facilities have limited capabilities and are not able to directly supply all needed care. When the IHS or tribal facility must refer an Indian Medicaid beneficiary to a private or public provider, the State must pay the regular State Medicaid match. Thus, States would have an incentive to limit the benefits AI/ANs referred to outside providers could receive under the State Medicaid plan.
If Native Americans stay within the IHS system and the benefits are not covered, this is simply yet another cost shift to Indian health care programs.
As part of the Indian Health Care Improvement Act of 1976 report, the Congress said, ``The most basic human right must be the right to enjoy decent health. Certainly, any effort to fulfill Federal responsibilities to the Indian people must begin with the provision of health services. In fact, health services must be the cornerstone upon which rest all the other Federal programs for the benefit of Indians. Without a proper health status, the Indian people will be unable to fully avail themselves of the many economic, educational, and social programs already directed to them or which this Congress and future Congresses will provide them.''
The Federal Government has a ``Federal trust responsibility'' to Indian people that it is simply not fulfilling. This budget conference agreement is yet another example of this failure and should be rejected for this reason, as well as the negative consequences that it will have on low-income children, senior citizens, and people with disabilities across this Nation.
Finally, although I do not have the time today to talk at length about the problems with the Medicare provisions, I will say that I am very disappointed and deeply concerned about the $8.1 billion in home health cuts that have been included in the conference report. It is also disturbing that the conferees would choose to add a provision that was in neither the House nor Senate bills to cut $3 billion out of the Medicare disproportionate share hospital, DSH Program, which provides financial assistance to our Nation's safety net hospitals. These cuts will undoubtedly have negative consequences on safety net hospitals across the country. With 46 million uninsured people in our country, it makes little sense to be cutting our Nation's safety net providers at this time.
This is all about choices. The Senate reconciliation bill contained the same level of savings in Medicaid and Medicare without all of these provisions that will certainly have negative consequences on millions of people served by Medicaid and Medicare. The conferees had before them the choice of protecting vulnerable, low-income citizens or to do things such as protecting the interests of private health plans.
For example, such cuts were added in conference to help pay for decisions such as the dropping of savings that had been obtained in the Senate bill by such things as elimination of what is known as the health plan ``slush fund.'' This $10 billion fund was created in the Medicare prescription drug bill to encourage participation by private health plans, but the Medicare Payment Advisory Commission, MedPAC, almost unanimously recommended its elimination and the Senate bill had included such savings.
The dropping of such reasonable cost savings out of the conference report has clearly left low income people to pay the price through cost-sharing increases and benefit restrictions that will undoubtedly have negative consequences on the health and well-being of our Nation's most vulnerable citizens enrolled in Medicaid.
I would also like to express my opposition to section 1101 of this budget reconciliation conference report the Senate is now considering.
I am disappointed the budget reconciliation bill includes a 2-year extension of the Milk Income Loss Contract, or MILC, a wasteful subsidy that primarily benefits dairy farmers in only a few states. I helped lead the opposition in the Senate in 2002 when this new dairy subsidy program was created as part of the farm bill. The MILC program has already cost taxpayers over $2 billion. I strongly oppose extending it further.
The Milk Income Loss Contract Program expired on September 30, but this conference report extends it for 2 years at a cost to the taxpayers of almost $1 billion. I oppose the extension because I believe this MILC Program is basically unfair and unnecessary.
Since the subsidy payments began in 2002, almost half the MILC payments--about $950 million--has gone to producers in only four States, Wisconsin, New York, Pennsylvania, and Minnesota. In fact, 20 percent of the payments, over $410 million, went to producers in just a single state, Wisconsin. The other half of the Federal payments is shared among all the remaining 46 States.
California, on the other hand, by far the nation's largest dairy state, isn't even among the top four in Federal MILC payments. California's dairies produce 20 percent of the nation's milk but get only about 7 percent of the payments. Idaho is 4th in dairy production, but 12th in MILC payments. How can anyone say that is a fair and equitable use of the taxpayers' dollars? Dairy producers my State of New Mexico rank 7th in the Nation in milk production but are 28th in Federal MILC payments.
Some of the supporters of this $1 billion boondoggle say that dairy farmers need a safety net. However, I hope all Senators know dairy producers already have a safety net, one that has been in place for over 50 years. It's called the Federal Price Support Program, and it was extended in the 2002 farm bill. So this $1 billion program subsidy program is really just a case of some dairy farmers trying to double dip at the taxpayers' expense.
Another argument I have heard is that MILC helps the family farms. Nearly all dairies in this country, regardless of size, are family farms; that
is, owned and run by families. The families who run New Mexico's dairies are strongly opposed to extending MILC.
Finally, a recent study by the U.S. Department of Agriculture shows the MILC program actually lowers prices paid to diary farmers. This shouldn't be a surprise to anyone, it is just basic economics. Taxpayer subsidies invariable lead to excess production, which pushes prices down. In my opinion, this is a simple case of an unnecessary and counterproductive program that should have been left to die.
I understand President Bush made a campaign promise last year to support extending the MILC Program. But at hearing on October 27 in the Senate Finance Subcommittee on International Trade, where I am a member, the deputy trade representative, Ambassador Allgeier, stated the administration would prefer MILC not be extended because of the possible impact on the President's ongoing world trade negotiations. MILC is a huge trade-distorting subsidy, and extending it now sends the wrong signals to our trading partners.
I didn't sign the conference report, and I plan to vote against this budget reconciliation bill because I do believe this bill is a missed opportunity to establish spending priorities and deal with the nation's burgeoning deficit.
This bill sets aside $1 billion for an unnecessary subsidy to benefit mainly Northeast and Midwest dairy farmers, while at the same time making deep cuts to essential health care and housing initiatives. Agriculture spending for farmers and ranchers has had to be cut an extra $1 billion to pay for the MILC subsidy. Our country is in deep financial trouble which requires us to make difficult choices and set priorities. In my view, we have laid out the wrong priorities in this bill.
Decisions that cost the taxpayers a billion dollars shouldn't be made on the basis of partisan politics. Section 1101 in this reconciliation bill will cost taxpayers $1 billion over the next 3 years. That means $1 billion more that has to be borrowed; another $1 billion added to the deficit.
New Mexico's family-owned dairies are some of the most efficient in the Nation, and they should be free to compete without this costly and totally unnecessary subsidy program. I do believe it is bad policy to put an extra $1 billion of the taxpayers' money into this unnecessary MILC subsidy.
Groups that oppose this 2-year extension of the MILC subsidy include the International Dairy Foods Association, the American Conservative Union, Americans for Tax Reform, Citizens against Government Waste, Freedom Works, and the National Taxpayers Union.
In addition to the letter from AARP previously mentioned, I ask that letters expressing major concerns and opposition to the conference report from 35 organizations that are part of the Consortium for Citizens with Disabilities, the American Cancer Society, the National Council of La Raza, and an organization representing 2,500 police chiefs and other law enforcement leaders be printed in the Record.
I also ask unanimous consent that a recent article opposing extending MILC by Thomas Schatz, president of the Council for Citizens Against Government Waste, and John Berthoud, president of the National Taxpayers Union, be printed in the Record.