The National Bipartisan Commission on Future of Medicaid

H.R. 4961 establishes a Commission to study Medicaid, modeled after the National Bipartisan Commission on the Future of Medicare. That former Commission was designed from the start to provide a predetermined result: privatize Medicare.

We do not wish to see a Medicare Commission process repeated, and for this reason offered an amendment in Committee to improve upon the politicized structure and mission statement of the Commission in the Republican bill.

This amendment diversified the membership of the Commission to include individuals with disabilities, low-income elderly or pregnant women -- populations for whom Medicaid plays a critical role. This amendment also added provider representation to the Commission. Each year Congress gives additional payments to Medicare providers, but almost never turns its attention to Medicaid. This is a serious problem, one that many members hear about frequently at home.

The General Accounting Office (GAO) in a September 2001 report wrote, "Nationally, low Medicaid physician fees and participation have been long-standing areas of concern. In a recent national survey, pediatricians cited low fees as one of the most important factors in their decision to limit participation."

As an example, New York only relatively recently increased fees for physician office visits from $7 to $30 -- the first such increase in 30 years. As we recognize from the concern voiced over physician reimbursement in Medicare, cuts in payment or inappropriately low payment translate directly into problems with access to care for beneficiaries. This same problem exists in Medicaid, only worse.

GAO also found in its September 2001 report that in the four states visited, "Medicaid fees were consistently lower than Medicare fees for the same preventive services... ." Adding provider representation to this Commission -- nursing homes, hospitals, federally qualified health centers and physicians -- will enable us to elevate this discussion about adequacy of payments and access to a level of attention it deserves.

The Commission is also flawed because its mission statement is unbalanced. The Republican bill has the Commission study virtually only cost containment, without looking at improvements in quality and access. To be balanced, any Commission studying Medicaid should also examine ensuring beneficiary access to the program, improving reimbursement to providers, protecting patients’ rights in managed care, improving patient safety in nursing homes, and improving provision of mental health and dental services.

We do need to look into the Medicaid program and we should take on this responsibility first in this Committee. Medicaid is a health insurance program of critical importance in this country. It covers as many people as the Medicare program; providing health insurance to more than one in seven Americans or about 40 million people. We can certainly make improvements in the program such as adding coverage of low-income legal immigrant families or improving provider reimbursement. This Committee has passed a number of such improvements in the past few years -- giving states new coverage options for women with breast or cervical cancer or working disabled.

We do not believe that a program of such importance to so many should be victimized by a Commission set to provide a predetermined result. Instead, we should ensure that the appropriate parties are represented on the Commission and that critical subjects like provider payment and beneficiary access to care get the consideration they deserve. The Commission created in the Republican bill does neither, so we oppose it.

John D. Dingell
Sherrod Brown
Henry A. Waxman
Rick Boucher
Edolphus Towns
Gene Green
Frank Pallone, Jr.
Mike Doyle
Karen McCarthy
Tom Barrett
Chris John
Bobby L. Rush
Ted Strickland
Anna G. Eshoo
Lois Capps
Peter Deutsch
Eliot L. Engel
Bart Stupak
Tom Sawyer
Diana DeGette
Bart Gordon