Date: 2009-11-07
Speaker: HERSETH SANDLIN (democrat)
Chamber: H

Mr. Speaker. I believe its critical that we control rising health care costs. increase quality and value within our health care system. and that we improve access to health care and affordable health care insurance coverage. H.R. 3962. the Affordable Health Care for America Act. represents one of the most important votes of the year. on an issue that has been a priority for me since I first was given the honor of representing South Dakotans in Congress. I have long believed that the strength of our communities in South Dakota depends on the health of our people and that. unfortunately. quality. affordable care remains out of reach for far too many South Dakotans. I am convinced this Congress and the President will achieve fundamental reform because our country must fix whats broken in our health care system. The status quo is unsustainable. There is simply too much at stake for South Dakotas families and businesses. who have either seen their premiums rise sharply year after year. or who still have no access to an affordable plan. Done right. health care reform will both ensure that more people have access to quality health care. and. just as critically. make the commonsense reforms that are necessary to fix an unsustainable system that threatens our fiscal future. These twin goals of addressing access. quality and costs on the one hand. and solidifying our fiscal future on the other are not mutually exclusive. In fact. they are complementary. Unfortunately. the House bill misses this critical opportunity. While it does include many good provisions. it is not the right answer for South Dakota. it could threaten existing access to health care in our state. and it does not include nearly enough costcontainment and deficit reduction measures. I am concerned by the projected impact of the bills Medicaid provisions on South Dakotas state budget. and the reductions in payments for longterm care under Medicare. I have recently discussed the states budgetary situation with Governor Rounds. along with a number of community leaders. business people and others across South Dakota. and we must take this situation very seriously. The growth in the state Medicaid program due to the recession will produce a projected 25 to 30 million dollar deficit in the state Medicaid program in 2010. and. after the expiration of the Recovery Act enhancement in the FMAP rate. a 50 to 60 million dollar deficit in FY2011. Early analysis suggests that the House bill Medicaid provisions would impose at least $87.6 million more in new Medicaid costs on the state than the Senate Finance Committee bill. Given that budgetary impact. we have to consider the likelihood that dramatic service cuts would be the end result in South Dakota if the House bill were implemented. and that is a source of serious concern for me. It should be for every South Dakotan. I have discussed the longterm care provisions of the House bill with a number of longterm care providers in South Dakota and have serious concerns about how the House bill would affect the future of care in our state for our seniors. While the original House legislation again has been improved in this respect by the addition of some incentive payments under Medicaid. overall. I am concerned that the cuts under Medicare to longterm care are unsustainable. and put undue financial pressure on this essential part of the health care infrastructure of South Dakota. Nursing homes will not derive the same benefit from universal coverage that hospitals will. so this is another issue that needs to be addressed as the process continues. Another of my top priorities is the Indian Health Care Improvement Act reauthorization that has been incorporated into the broader bill. Together with the nine sovereign Native Tribes I represent. I have worked hard to advance the Indian Health Care reauthorization in the House of Representatives. I share the concerns of the Great Plains Tribal Chairmans Association (GPTCA) regarding aspects of the current version of that legislation. The GPTCA is comprised by the elected leaders of the sovereign Indian Tribes and Nations of the Great Plains. including South Dakota. I have consulted closely with the Tribes I represent. For years. the Tribes and the GPTCA have supported the Indian Health reauthorization and have been disappointed at the great length of time it has taken to bring the legislation to this point in the House. The GPTCA has reviewed the current version of the Indian Health reauthorization contained in the broader health reform bill and has serious concerns about certain provisions in the bill. principally the fact that urban Indian nonprofit organizations are. in various sections outside of Title V of the reauthorization. treated on a par with federallyrecognized tribes. The federal government has a unique relationship with the 562 federallyrecognized American Indian and Alaska Native tribes. This governmenttogovernment relationship is established by our founders in the U.S. Constitution. recognized through. hundreds of treaties. and reaffirmed through executive orders. judicial decisions. and congressional action. Fundamentally. this relationship establishes the responsibilities to be carried out by one sovereign to the other. That is why these requests by nine sovereign Sioux tribes located in South Dakota are essential. I will continue to provide my full support to GPTCAs requests to improve the reauthorization in conference with the Senate. and to properly fund Indian health services. Turning again to the broader House health care reform bill. underlying my concerns relating to Medicaid and longterm care and other issues is a fundamental concern about the effect of broader House health care reform bill on the nations longterm deficit. and more specifically. my view that it doesnt do enough to start bringing down the deficit and health care costs in the long term. As President Obama noted earlier this year: "If we do nothing to slow these skyrocketing costs. we will eventually be spending more on Medicare and Medicaid than every other government program combined. Put simply. our health care problem is our deficit problem. Nothing else even comes close." Hes right. Skyrocketing longterm costs will bankrupt the Medicare trust fund by 2017and thats just part of the problem we need to fix. But when it comes to the net change in the federal budgetary commitment to health care. the House bill is seven times greater in budgetary commitment of dollars than the Senate Finance Committee bill. while falling far short of the longterm cost containment in the Senate bill. In my view. any bill with such a significant increase should have a similar commitment to cost containment. Otherwise. well find ourselves in the same situation we find ourselves in with Medicarean essential program for South Dakotans that is going broke because we cant make the tough choices now and are putting those choices off until we face an immediate crisis. Thats not reformthats a recipe for fiscal disaster. Now. the House bill does include a number of good provisions on which the vast majority of South Dakotans I have talked to agree. For instance. I strongly support provisions in this bill to require insurance companies to cover people with preexisting conditions. and to end the insurance companies ability to cancel coverage when someone becomes sick. These practices must end. I was surprised and dismayed to see that the House Republican proposal that we also will vote on refuses to end the unconscionable practice of denying coverage for preexisting conditions. The Congress will ultimately agree on a bill that ends this practice. In addition. I support establishing health insurance exchanges to provide a transparent and competitive marketplace for individuals and businesses to buy more affordable health care plans. Unfortunately. in my view the House bill has not come far enough from where it started. and the bill does not yet represent the right formula for South Dakota. Nonetheless. I am very optimistic that. with the House and Senate working together with the President. we will achieve a good bill for South Dakota during this Congress. because the time has come for fundamental reform. AgainI believe the Congress has a responsibility to pass health care reform legislation that is deficit neutral. that ensures access. fairness and affordability of coverage for South Dakotans. and that takes a responsible approach to longterm costs with a focus on achieving higher quality health care outcomes. This bill meets some of these goals but not all. and I cant support it. I remain steadfastly committed to improving this legislation and I am optimistic that through the legislative process we will achieve what South Dakotans deserve. which is a fiscally responsible and sustainable reform of the health care system that will dramatically improve coverage and quality for all.