Madam Speaker, I ask unanimous consent to take from the Speaker's table the concurrent resolution (H. Con. Res. 95) establishing the congressional budget for the United States Government for fiscal year 2006, revising appropriate budgetary…
Madam Speaker, I ask unanimous consent to take from the Speaker's table the concurrent resolution (H. Con. Res. 95) establishing the congressional budget for the United States Government for fiscal year 2006, revising appropriate budgetary levels for fiscal year 2005, and setting forth appropriate budgetary levels for fiscal years 2007 through 2010, with a Senate amendment thereto, disagree to the Senate amendment, and agree to the conference asked by the Senate.
Madam Speaker, I yield myself such time as I may consume.
Madam Speaker, this is a very interesting motion to instruct conferees. First of all, I am happy that we are at the point in time where we are able to go to the conference with the other body and complete our work on the Concurrent Budget Resolution for Fiscal Year 2006. This is never an easy road to travel when you are trying to accomplish so much, when you are trying to accomplish reforms in some very challenged programs that by anyone's estimation are unsustainable and are growing beyond the means not only of the Federal Government to fund but also State governments to fund.
It is always difficult when you have different ideas from different chairmen, different bodies, different leaders, different parties who want to come forward and make their mark on exactly what that spending blueprint should be. But I would like to acknowledge that I think we are all happy we are finally getting to a conference and the ability to work out our differences.
As such, I look at this motion to instruct conferees, and I am wondering what the controversy is. All of what the gentlewoman just said are comments that my colleagues on both sides, whether you are Republican or Democrat, have made throughout the entire debate over the budget.
We have an unsustainable program called Medicaid which is not serving the most vulnerable people in our society to the fullest extent that it should or that it must in order to meet not only the obligations that we have entrusted in the program but also to make sure that it is sustainable, not only in the short run of our budget, but also long term in our overall fiscal situation that our country faces and that many of our States face. So as I read the motion to instruct conferees, I am puzzled by what the controversy is.
It says we should recede to the following findings. Those findings are that Medicaid provides essential health care and long-term care services to more than 50 million low-income children, pregnant women, parents, probably grandparents as well and great grandparents of many of ours, individuals with disabilities and senior citizens; and that, B, Medicaid is a Federal guarantee that ensures the most vulnerable will have access to most needed medical services.
We all agree. There is nobody here that disagrees with that. That is what the program was set up for; and that is the reason why we are so intent on reforming it, so that it continues to meet that mission and continues to deliver quality health care services for our parents and our grandparents, children who may be of low-income families and people with disabilities and senior citizens. It is a guarantee. It is something that we all believe in. We are here to help people who cannot help themselves.
Unfortunately, this program in many instances in its current state, 40 years old now, you might not be surprised to hear that it needs a little bit of work, it needs a little bit of reforming. The Governors have figured that out, and they have come to Washington with proposals that find savings, not cuts. They are themselves proposing savings in the neighborhood of $8 billion to $9 billion, and that is just their first inception, that is just their first proposal, before we even go down that road.
Then I looked further at the motion to instruct conferees and it says: ``To strike reconciliation instructions to
the Committee on Energy and Commerce and recede to the Senate by including language declaring that a reconciliation bill shall not be reported that achieves spending reductions that would undermine the role the Medicaid program plays as a critical component of the health care system of the United States.''
I say again, there is no controversy in that. That is not the intent of the budget, that is not the intent of the conference, that certainly is not the intent of either reconciliation instruction. In fact, we think it is a pretty good idea to set up a conference and to set up an opportunity to take a look at this in some type forum, whether it is a task force, whether it is a working group, however you want to put it together, in order to come up with ideas and resolve this problem.
We want to invite the Governors to the table. Certainly they have the best perspective when it comes to how this program works in their individual States. Many of them have sought waivers in order to be able to reform the program on the ground in which they see it so that that program which delivers these essential services can be met and delivered in a more quality way to our seniors and to our citizens with disabilities, to our parents and grandparents, and to our most vulnerable who may be low income.
So I do not see the controversy. I understand that because, as the gentlewoman said, there are polls, there certainly is politics involved. Anytime that anyone wants to bring forward any kind of reform measure, the immediate thing is to rush breathlessly to the floor and claim that it is cutting funds for people, and it is cutting the most vulnerable and it is hurting people, and that is exactly what was said about the welfare reform bill when it came to the floor not 10 years ago, and it did not happen. It helped people. It unlocked from poverty thousands upon thousands of families and children in our society who all they needed was a hand up. For a while they may even have needed a handout. But because of the requirements that we passed in a bipartisan way, we were able to rise above the politics and the rhetoric and help people. That is what we want to do here.
There is not one Member who can come to the floor and say this Medicaid program is working in your State to its fullest extent, not one of you. Not one of you can say that. There is not one Member in the other body who can say that. There is, I dare say, not one Governor who can claim the Medicaid program in their State is working. So you are asking us here today in a political way, in a nonbinding motion to instruct, to do nothing.
Thankfully, that is not how you crafted technically your motion to instruct. You gave just a little bit of a backdoor, because you know as well as we do that this program needs attention, that it needs reformation, that it needs Governors and Congress and the administration to sit down and talk about the future of a program that is needed in order to deal with the most vulnerable in our society. So thank you for not crafting this in such a fail-safe way so that we had to vote against it and suggest that Medicaid should not be reformed, because, of course, it should.
I hope that is not what you are saying. If you are, say it. If you are saying do not reform Medicaid, do not touch it, do not change it, it is perfect, it is helping people, come to the floor and dare to say that. But if that is not what you are saying, then save that political rhetoric for some other time and let us work together to fix it.
That is what this ought to be about. Republican and Democrat Governors are certainly willing to do that. They are sitting down. I have got proposals here that add up to $8.6 billion of ideas that the Governors have already agreed to as a starting point. Now, are we claiming that those Governors are cutting? Are they gouging? Are they throwing people out on the street? Are they hurting seniors and people with disabilities?
Certainly that is not what we are saying. That is not what we would claim they are doing. They see a problem, they have come together to try to fix it, and that is what we should do as well. Reconciliation gives us that opportunity.
So I appreciate the gentlewoman's motion to instruct. It is crafted perfectly so that political points can be made. But there is just that little backdoor that says, you know what, even though we kind of like the Senate language, we like the fact that they are putting together ideas, we like the fact that the Governors are coming to the table, we heard all of that rhetoric, even though we want to make some political points today, there is a little bit of a backdoor so we can all vote for this and say that the Medicaid program, as most of our Governors would suggest, is unsustainable. It is unsustainable whether you are in the capital of your State or whether you are in Washington, D.C. And that is why we need to come together as Republicans and Democrats, in order to fix this.
So I appreciate the way the gentlewoman has crafted it. I am going to urge my colleagues to vote for the motion to instruct. I think it is well-crafted, to give everybody the opportunity to make the political points, to issue your press releases. I know you are going to do that. Knock yourselves out. I am sure they are already on the fax machine. But in the meantime, after all of the fax paper has cleared the air, let us sit down and talk about ways to fix this program so it actually does help people who are in need and were truly meant to be the focal point of this program when it was invented 40 years ago and which has rarely been changed from a Washington perspective ever since.
Madam Speaker, I reserve the balance of my time.
Madam Speaker, I yield myself 1\1/2\ minutes.
I want Members who are listening, maybe in their offices or here on the floor, and anyone else that is interested in listening to this debate today, listen for four things. Listen to whether you hear anyone come to the floor today and defend the Medicaid program as it stands today as perfect. My colleagues did not hear the gentleman from Maryland say that because, of course, he does not agree with that. Listen to hear if you hear any Member come to the floor and say, absolutely not, you cannot find a nickel's worth of savings in the program. You will not hear any Member come to the floor today and say that. I dare say the gentleman from Maryland would not say that.
Listen to this: Did the gentleman say he was against reform? Of course not. The gentleman from Maryland knows that in Maryland, as in Iowa, the program needs help if it is going to meet the needs of a changing world and meet the needs of its original mission. And listen to hear whether you hear any of them come forward and disagree with the bipartisan result of the Governors coming forth with savings. Not one Member will come today, I would dare say, and suggest that they are going to disagree with the Governors who come forth with ideas. My colleagues will not hear that.
So make your political points; even bring in Social Security. Did my colleagues hear that one? Social Security was even raised today. Boy, we are going to hear all sorts of great arguments, but we will not hear one that says we cannot find savings, this program is perfect, we are against reform, and we disagree with the Governors. We will not hear that. That is why we need to move forward with a reform of the Medicaid program ushered in by this budget.
Madam Speaker, I reserve the balance of my time.
Madam Speaker, I yield myself 15 seconds to just say I have a reform idea right here from the Governors that I would agree to right now.
Madam Speaker, reclaiming my time, the Committee on Energy and Commerce has jurisdiction. But be that as it may, I yield myself 15 more seconds to say that all I am suggesting is there are some good ideas that are out there, and the budget is a vehicle to accomplish a reform schedule. That is what we are trying to agree to, and I appreciate the fact the gentleman wrote the motion to instruct to give us the opportunity to meet that reform schedule in a bipartisan way, I hope.
Madam Speaker, I reserve the balance of my time.
Madam Speaker, I yield myself such time as I may consume just to respond and say, okay, I stand corrected. I thought no one was going to come to the floor and say do nothing. But I guess there are going to be a few Members who come to the floor and say do nothing. I am surprised by that. I think there will be a bipartisan vote today to do something, but doing nothing I really believe is not an option, and I guess I am surprised that there will be Members who will come to the floor today and do absolutely nothing to help improve the Medicaid program.
But I know someone who wants to do something.
Madam Speaker, I yield 3 minutes to the gentleman from Georgia (Mr. Deal), the very distinguished chairman from the Committee on Energy and Commerce.
Madam Speaker, I yield 4 minutes to the distinguished gentleman from Florida (Mr. Putnam), a member of the Budget Committee.
Madam Speaker, I yield myself as much time as I may consume.
I want to make sure people are, and Members are, listening to this debate and are reading the language, because again, if you want to come down here and vote politics again, you want to put out your press releases and fax machines are going whizzing around, hey, knock yourselves out.
But we have got a job to do down here, and we should read the language in front of us. And, again, it says that we should not report a reconciliation bill that achieves spending reductions. I just want to make sure people understand that, because I want to give you the actual numbers for Medicaid. If you are bored about numbers, turn down the sound because I am about to quote some numbers. But this is serious business.
I want to tell you what the Medicaid program is going to spend over the next 10 years. And I want you to listen to the numbers and the increases. This year we are going to spend $183 billion, which is almost a 4 percent increase from last year; $190 billion the next year, $202 billion. It goes up: $220. It goes up by 9 percent that year; $239 billion, goes up by almost 9 percent that year. $260 billion by 2010. By 2010, $260 billion. That is almost as much as we are spending on national defense right now. $282 billion, $304 billion. It goes up every single one of those years. Out of that $1.1 trillion or more, it is actually a little bit more than that I just quoted, we are saying in the House budget, even before we talk about a compromise with the other body, we are saying, instead of growing at an average rate of growth per year of 7\1/2\ percent, we want to grow at 7.3 percent.
We are going to grow every year. There are not spending reductions. Every single year of the House budget spending for Medicaid goes up. Every single year. Every year it goes up. There were no spending reductions.
Now, are we slowing down the growth?
Yes. And that is what the Governors have asked us to do. That is what they are coming here with proposals to accomplish. And their proposals that they have put forth, some have not even yet been scored, but the ones that have been scored by the Congressional Budget Office, which tries to add all that up and to find out what savings we have got, of the six main proposals that the bipartisan Governors have come forth with, they have already found $8.6 billion, and three of the proposals have not even yet been scored.
So to say there is no savings, to say that we are hurting the most vulnerable, to suggest that nobody wants reform, again, I would ask colleagues to listen to the debate.
Will there be political rhetoric today?
Yes. Unfortunately, that will be true. The same happened in the welfare reform debate. Members came to the floor saying we should not do anything. We should not make changes, we should not reform the program. Let us keep what we have got. We changed the program, and people were helped.
No Member is going to come to the floor today and say the Medicaid program is perfect. I dare say no Member would come to the floor and tell you that. No Member is going to come to the floor today and say we cannot find savings.
Actual cuts? I can understand why they might come to the floor. But that is not what is being proposed.
But can we find savings? Every Member will come to the floor today and say of course. If you look at a program long enough that is 40 years old and has never been changed, of course you can find savings, particularly one that in a bipartisan way every Governor is either asking to get out of through a waiver or is coming to Washington to suggest that we need to reform.
No Member is going to come to the floor today and say we should do absolutely nothing, with just a few exceptions. There may be a few Members who try and do that. And there will be no Members who come to the floor today and suggest that the Governors in a bipartisan way have put forth ideas that are not worthy of consideration. We need to consider it.
Again, I am very happy that the Members on the other side have given us a motion to instruct conferees with a fail-safe, with a trapdoor that allows us to keep the momentum of reform building and allows them to make their political points. That is what they are allowed to do, is to come to the floor and make their political points. But thank goodness we still have a process that says we have got to move forward.
This is an unsustainable growth rate, that every year the program grows and grows and grows. There are no cuts.
Are there savings that we suggest? Yes. That was true in welfare reform. It is true as we look at Medicaid. And we need to look for the savings, because without reform the program not only will bankrupt itself, but more important than all of the talk about numbers and budgets and all of those things, it will begin to hurt people who truly are the most vulnerable that this program endeavors to assist.
So the commission approach that the gentlewoman from New Mexico (Mrs. Wilson) has put forward is a good idea. She has many cosponsors. That is not something that the budget itself can accomplish. But, certainly, we endorse that kind of an approach to look for ways to bring all interested parties together to find reform.
And I hope that instead of just putting out your faxes, which you will do, and make out your political statements, that is fine. We understand
that. But you will also, after all of the dust settles, come forward with your ideas the way Democratic Governors and Republican Governors have done, so that we can begin to resolve this issue and not just have rhetoric. We need results, not just the rhetoric of today. And that is what this budget accomplishes.
Madam Speaker, I reserve the balance of my time.
Madam Speaker, who has the right to close?
Madam Speaker, I am the final speaker so I will reserve the balance of my time.
Madam Speaker, I yield myself the balance of my time.
Madam Speaker, those who actually administer the Medicaid program, our State Governors, have clearly told us in a bipartisan way that Medicaid must be reformed.
Wake up.
For those of you who are about to vote on this motion, this is a good motion. What it does is it says it is time to reform the program. It is time to consider the proposals that the Governors have put forth in a bipartisan way. They have clearly told us that their hands have been tied.
Their hands have been tied, Madam Speaker, by a program that is inefficient. It is ridiculously out of date, a health care delivery system that has not and will not under its current structure deal with the demands of the 21st century.
There is not one Governor that is suggesting do nothing. There is not one Member on the Republican side of the aisle that is suggesting do nothing. The 44 Members who signed the letter saying we are concerned about the future of Medicaid, they are not saying do nothing.
Everyone who is interested in the reform of this program understands that the budget this year gives us a schedule and an opportunity to finally get our arms around the Medicaid program.
I understand that there are going to be all sorts of political press releases put out about gouging and cutting and all sorts of things like that; but if anyone is interested in the actual technical language of the budget, they will discover that every single year the program under the House budget grows, every year.
What we are suggesting is that, with reform, it does not have to grow as much. Instead of growing at 7.5 percent, it can grow at a level a little lower, maybe 7.3 percent or 7.4 percent. Every year it should still grow because there are vulnerable people, there are senior citizens, there are people with disabilities who rely on this program. Our States rely on this program. We rely on this program in order to meet the needs of many people in this country who cannot help themselves.
Do not let anybody fool my colleagues. No one came to the floor today in support of this motion and said the program's perfect; the Governors are wrong; we do not like what they came up with; we do not think we should reform the program.
In fact, let us look at the reforms they have come up with. They have said let us restructure the pharmacy reimbursements to more closely align with the Medicaid pharmacy payments and pharmacy costs. That alone will save $5 billion. Bipartisan support from the Governors. I dare say we could support that here today.
Second proposal, revising what is called ``asset transfer.'' That will save the government $1.4 billion. Bipartisan support by the Governors.
Please do not come to the floor or issue press releases today that says do nothing. I understand my colleagues want to make a political point. That is fine. That is what motions to instruct conferees often do, but we are going to vote on a budget later on this week that says it is time to do something, it is time to reform the program, it is time to save a little bit of money and improve a program that is for our most deserved people, people who cannot help themselves. This is something we can do in a bipartisan way.
The same way Governors in a bipartisan way have come forward with their ideas, I would invite all Members to let their members of the Committee on Energy and Commerce know what their ideas are because we are going to go forward with reform. It is not going to actually cut any money. It is going to find savings. It is going to improve a program. It is going to reform it.
If the gentlewoman, who is the proponent of this motion, thinks the program is perfect, let her say so. If she thinks that we cannot find any savings, let her say so. If she thinks the Governors are wrong, let her say so. But no Member has come to the floor to say that yet today.
So that is why we should support this motion and move the budget forward to reform the Medicaid program and save some money as well.