105th Congress: Democratic Perspectives House Committee on Energy and Commerce Democrats Welcome Page
We applaud the majority for rejecting the ill-conceived notion of a block grant for Medicaid. Since Medicaid is America's second largest health care program, covering almost as many Americans as Medicare, it would have been irresponsible for Congress to support a program that had virtually no protections for the 36.8 million poor senior citizens, disabled people, women, and children that rely on Medicaid for their health and long term care services. We believe that the Republicans have once again learned that the approach of the last Congress -- putting America's children, the elderly and disabled at risk -- was the wrong way to go.
This year's Medicaid proposal maintains a number of the existing protections of current law for these important and vulnerable beneficiaries including:
In addition, as the Republican proposal moved through the committee process several bi-partisan amendments adopted improved on the initial proposal: women will have direct access to their ob/gyn as their primary care provider; women and children will be guaranteed important quality standards for managed care plans; children who suffer from cerebral palsy, cystic fibrosis, cancer and a range of other debilitating diseases will have access to the specialized pediatric services they vitally need; and the public will have important fraud and abuse provisions for managed care plans in the areas of marketing and contract negotiations.
The minority is very disappointed, however, that the Republicans failed to live up to the budget agreement.
First, the budget agreement included an understanding that $1.5 billion would pay for premiums for low-income Medicare beneficiaries. This protection was vital to securing the over-all agreement that the costs of maintaining the Part B premium at 25% of program costs and the costs of switching home health to part B of Medicare would be phased into the premium payment. Because of these two provisions the part B premium for Seniors will increase by as much as $23.00 a month from 1997 to 2002. When this increase is added to the other increases incorporated into the budget agreement, the average elderly woman with an income less than $12,000 a year will see her Part B premium rise from $43.80 a month in 1997 to $66.70 a month in 2002. This extra cost of approximately $800 a year represents a substantial sum for those with incomes less than 150 percent of the poverty line. The committee included the savings from increasing the Part B premium, but did not include the agreed upon protections for low-income Seniors. Instead of providing $1.5 billion in protection, it provides only $600 million. To add insult to injury, the bill actually spends an additional $2.2 billion in Medicare funds on MSAs, which will hardly help low-income Seniors. Most MSAs include deductibles of up to $6,000, approximately half the annual income of a senior at 150 percent of poverty. The majority failed abjectly in this matter. The minority attempted several times in subcommittee and full committee to circumscribe this through amendments, and we intend to see that the terms of the agreement are honored as this legislation proceeds.
Second, the majority took direct action to refuse to provide health care services for disabled children eligible for SSI who were covered under terms of the agreement. At a time when the majority was attempting to proclaim that they were providing additional coverage to millions of uninsured children, they were at the same time taking away health insurance coverage from 20,000 disabled children. This is beyond our comprehension, and causes us to wonder whether the majority's idea is to provide insurance to the healthy but not the sick.
Finally, the majority repealed the so-called "Boren amendment," which provides payment protections for hospitals and nursing homes. The Boren amendment simply says that Governors must pay hospitals and nursing homes a "reasonable and adequate" payment to ensure the adequate provision of services. This provision is crucial to ensuring that we do not have a return to the disgraceful conditions that existed before our 1987 nursing home reforms when we found frail elderly and disabled individuals warehoused and abused in chronically substandard facilities. The Democratic minority worked successfully in subcommittee to restore this vital provision only to see it replaced by the Republicans in full committee with a meaningless public process.
For these reasons, the Medicaid provisions of budget reconciliation ultimately falls short in several key areas and fail to honor the terms of the budget agreement.
John D. Dingell
Sherrod Brown
Diana DeGette
Bobby L. Rush
Rick Boucher
Thomas J. Manton
Gene Green
Tom Sawyer
Anna G. Eshoo
Elizabeth Furse
Frank Pallone, Jr.
Peter Deutsch
Ron Klink
Edward J. Markey
Bart Gordon
Henry A. Waxman
Edolphus Towns
Ted Strickland
Karen McCarthy
Bart Stupak
105th Congress: Democratic Perspectives
House Committee on Energy and Commerce Democrats Welcome Page