GOP Doctors Caucus

Floor Speech

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Mr. CASSIDY. Mr. Speaker, an issue tonight that is much more important to the American people than many realize is Medicaid. Now, for folks who don't understand this, and you really had no need to until this health care debate began, but, if you will, there are three types of coverage for folks who have insurance. One is Medicare. Medicare is the program for folks who are typically 65 and above. It is the program that all of us pay into, having a certain amount deducted from our paycheck, and it goes into this account. The second is private insurance. Ninety percent of Americans have their private insurance policy through their employer. And then the last group is Medicaid.

Now Medicaid is a program designed to support those of lower income as well as those who are elderly and, again, of lower income and long-term care--think nursing homes. And lastly, it supports the blind and disabled. The financing in Medicaid comes from your tax dollars, but it can be your tax dollars either funneled through the Federal Government paying a portion to the State, which is matched by what is called the State match, which is from the State itself.

So Medicaid is a program for lower income which receives about, on average, 57 percent of the money that goes towards it from the Federal Government and 43 percent on average from the State government. The State administers the program to take care of, again, low income for acute medical services, long-term care, think nursing homes for the elderly, and then the blind and disabled. Tonight's discussion will be about Medicaid.

Now, the importance of Medicaid is that 16 percent of the health care dollar in the United States goes towards Medicaid. So almost a little bit over one-eighth of the money our country spends is on this combined Federal-State program that provides health insurance, if you will, for the poor.

Additionally, Medicaid is important because right now Medicaid is consuming an ever larger portion of both the Federal Government's budget as well as the State government's budget. One example of this: the Simpson-Bowles bipartisan debt commission, which President Obama appointed to help give guidance as to how our country could get out of our indebtedness, pinpointed Medicaid as one of the drivers of our national debt. So first, we know that on a national level, Medicaid has been pinpointed as a driver of our national debt. On a State level, Medicaid is consuming an ever larger portion of State budgets.

Now, there are many examples of the importance of this, but as Medicaid is costing more and more, State dollars for other programs are less and less. Senator Lamar Alexandria from Tennessee said that the reason that tuition is increasing at universities in Tennessee is because there is less public support. More tax dollars are going to Medicaid, and so therefore, to make up the budget for the universities in Tennessee, they have to increase tuition.

One example of this, as well, for K-12 is that for the first time beginning around 2009, States spent more of their income upon Medicaid than on education. And so this is a chart from the National Association of State Budget Officers, and it shows how total State spending on Medicaid now surpasses K-12 education, and K-12 is kindergarten to 12th grade. So this is primary and secondary education. In this blue line you see funding for education, and you can see the percent of total State expenditures devoted to, in this case, education.

So in 2008 it peaked at around 22 percent, and now in 2011, it has decreased down to roughly 20 percent. Here you can see that in 2008, Medicaid expenditures were about 20.7 percent of the State budget, and they are rapidly rising. They are now up to almost 24 percent.

We are now spending more money providing Medicaid services for those who are eligible than we are educating our children. Now, it isn't as if this is something that is temporary, related to the recession; this is actually expected to continue to worsen. So Medicaid, again the program that both the Federal and State Governments--which means both taxpayers paying to the State and taxpayers paying to the Federal Government--finance, is growing so rapidly that it is cannibalizing the rest of the State budget.

An example of this is that expenditures for primary and secondary education now for the first time in history are lower than those expenditures for Medicaid. And this is expected to worsen.

So if you will, we have this program which is important. It's a safety net program. But under its current construction, it's costing more and more.

Now I'm joined by a couple of my colleagues, and I will first go to Dr. Nan Hayworth, who is an ophthalmologist--she held up a note earlier that my eyes are not good enough to read--an ophthalmologist from New York, and she can discuss how President Obama's health care plan expands Medicaid, a program which is rapidly expanding in cost but nonetheless will be further expanded in terms of those who benefit.

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Mr. CASSIDY. Federal and State Medicaid spending in billions of 2010 dollars by 2009. It's down here, the year. So 1993, 2009, going out to 2081. And so here is about $400 billion. This is combined Federal and State spending. By 2017, this rises to $750 billion. By 2025--obviously within our lifetime--that will rise close to $1 trillion. And projections are by 2081, it will be over $4.5 trillion.

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Mr. CASSIDY. So just to emphasize, Medicaid is an important safety net program for those folks without means. It was traditionally designed to take care of the blind and the disabled, the elderly and long-term care, and then oftentimes focused upon pregnant women and upon children. So the importance of making sure the program is sound is that we continue to care for these people.

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Mr. CASSIDY. If the gentlelady will yield, I'd like to bring in Dr. Harris, who is an anesthesiologist from Maryland, the Eastern Shore.

You just mentioned how Medicaid, as it attempts to expand and be all things to all people, becomes stressed and in that stress becomes less capable of being anything to anybody.

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Mr. CASSIDY. So the concern regarding a program which becomes, again, too stretched, too unfocused is that it becomes ineffective at its original mission.

Dr. Harris, I can leave this one or go to the next one.

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Mr. CASSIDY. I think the point being made is that not only will the safety net become tattered in and of itself, but, rather, even though tattered, it will destroy our ability to finance these other governmental functions.

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Mr. CASSIDY. Reclaiming my time, if you could elaborate. We know that under the President's health care proposal, Medicaid--a program which right now is driving Federal indebtedness and which is threatening to bankrupt States, despite that was greatly expanded under the President's health care proposal to include people up to 133 percent of Federal poverty level. So I'll yield back to the gentleman if he will just comment if this is what he is referring to regarding expansion, and if so, any further thoughts he has.

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Mr. CASSIDY. Now, if the gentleman will yield, I'll go to Dr. DesJarlais who joined us, who although he has a French last name and you would think he is from Louisiana is actually from Tennessee.

Now, Dr. DesJarlais, obviously, to you and me, but perhaps not to those who are listening, Tennessee experimented with using Medicaid as a safety net program back in the nineties and, if you will, extended it to many others. If I can yield to you, please, could you please comment as to the results of that.

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Mr. CASSIDY. I'll say, just out of pride of authorship, there's another alternative, a Republican Medicaid proposal, one that I and others are sponsoring, and it does, if you will, similar to the block grant, it readjusts as your population changes.

I'm from Louisiana. When Hurricane Katrina hit, we had lots of folks who moved to Atlanta and moved to Houston. If you will, the dollar would follow the patient. It wouldn't just stay in Louisiana. I love my State, and it would be nice to have the extra money. But it is more important that, where the patient is, have the money. It's a variation on the theme. But also part of it is that the State has flexibility, freeing them from the money-consuming regulations that the Federal Government puts on how those monies are applied.

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