Date: 2005-11-07
Speaker: GENE GREEN (democrat)
Chamber: H
State: Texas

Madam Speaker. I rise tonight to speak out against the budget reconciliation bill. which we will consider soon. The bill contains a number of harmful provisions. but. my primary opposition to this legislation stems from its $11.9 billion in cuts to the Medicaid program. This reconciliation process has been flawed from day one. The Energy and Commerce Committee was given an arbitrary budget number and was forced to mQld the policy to achieve that number. Without doubt. there are certainly ways that we can improve the Medicaid program. but sound public policy. not budget targets. must be the driving force behind any Medicaid reform. This quest to meet budget targets superseded Congresss responsibility to ensure that the Medicaid program continues to provide comprehensive and quality health care to our Nations most vulnerable. Unfortunately. the bill the House will consider takes away that assurance and further frays the safety net that Medicaid beneficiaries depend on. While the Senates bill largely shielded the beneficiaries from any cuts to Medicaid. the House bill places a bullseye squarely on the backs of Medicaid beneficiaries and aims Medicaid cuts directly at them. In fact. $8.8 billion of these cuts in this bill are achieved through costsharing and benefit reductions for beneficiaries. The increased costsharing allowed for in the bill exposes Medicaid beneficiaries to new premium requirements and copays that many beneficiaries simply cannot afford. The reason you are on Medicaid is because you are poor. What is more. Medicaid beneficiaries already pay a higher percentage of outofpqcket health care costs than high-. erincome individuals who can better afford outofpocket costs. In 2002. higherincome adults with private insurance paid 0.7 percent of their income on the outofpocket medical expenses. Yet during the same year lowincome. nondisabled adults on Medicaid spent more than three times as much. 2.4 percent of their income on outofpocket expenses. Lowincome disabled adults on Medicaid fared even worse. forced to spend 5.6 percent of their income on outofpocket medical expenses. Unfortunately. the growth of outofpocket health care spending is more than double that of the income for Medicaid adults. with income growing at 4.6 percent annually. outofpocket increases increasing by 9.4 percent annually. This bill is only going to make worse a problem we already know is occurring. Faced with increased outofpocket costs. Medicaid beneficiaries are less likely to seek health care. whith is exactly the result thit proponents of this bill are looking for. The problem is. health care conditions worsened. for these folks. and they will only seek CSare when their health problems reach emergency portions and the cost of care is exponentially greater. While we do not want to encourage overutilization. we also do not want to cut off our nose to spite our face by discouraging preventive care. To make matters worse. the bill takes an extremely heavyhanded approach tothe enforcement of those with costsharing measures. The bill will allow health care providers to refuse to treat sick Medicaid patients if they do not have the copay on hand. The State can. also drop Medicaid beneficiaries altogether if they cannot afford the premium for the Medicaid. A recent study of costsharing on Medicaid beneficiaries in Oregon fdreshadows what will happen under these circumstances. Less than a year after Oregon implemented premium increases through a waiver process. its Medicaid population decreased by onehalf. Make no mistake about it. the Medicaid progran is the health insurer of last resort. Without health insurance through Medicaid. it is safe to say that these folks in Oregon joined the growing ranks of the uninsured. a trend we will likely see continued if we enact this bill to allow every State in the Nation to follow Oregons lead. E 2015 Not only does the bill make Medicaid beneficiaries pay more for health care. it also reduces the health care benefits they receive under Medicaid. The bill allows States to reduce benefits as long as the Medicaid pabkage mirrors private coverage or SCHIP coverage. The flaw in thqt policy lies in the fact that the Medicaid l5rogram was always intended to provide benefits that lowincome individuals could not afford to purchase through private coverage. such as an array of benefits needed by disabled individuals. This reduction -in benefits flies in the face of the goal shared by Democrats and Republicans alike to remove the institutional bias inherent in the Medicaid program by providing the necessary tools to keep disabled individuals in the community. Without these benefits. lowincome disabled individuals will have no option other than to enter a nursing home setting. This bill also eliminates a benefit that .has long served as the cornerstone of the Medicaid programs approach toward childrens health. If Medicaid costs are truly growing at an unsustainable rate. there is no way increased costs canbe attributed to children. Health. cafe for pregnant women and children is arguably the most costbeneficial aspect of the Medicaid program. with pregnant women or children accounting for nearly 70 percent of all Medicaid enrollees. but only 30 percent of the programs costs. The bills elimination of the Early. Periodic. Screening. Detection " and Treatment program for children above the poverty level means that childhood illnesses will not be detected as early. and more lowincome children will lack the good health that puts them on the path of learning and productivity. According to the March of Dimes. the situation would be even more dire for children with significant physical and developmental conditions. Noveniber 7. 2005 In a recent analysis of Medicaid coverage in all 50 States. the March of Dimes found that each State would significantly restrict coverage for services needed by children with physical and developmental disabilities. States that were exempt from the mandates of the Early. Periodic. Screening. Detection and Treatment program. Unfortunately. this bill puts the wheels in motion for States to deny necessary health care benefits to disabled children. Madam Speaker. the light has been shined on this process. This is not a process to reduce the deficit. This is a process to finance additional tax cuts. There is no way to deny this fact when the same budget that protects $34.7 billion in decreased mandatory spending allows for $70 billion in tax cuts that will decrease revenues used to fund government programs. .It is inconceivable Congress would balance this budget on the backs of lowincome Americans. but to finance tax cuts on the backs of Americas most vulnerable. that is downright. shameful.