Cantwell Floor Remarks on House Republican Plan to Repeal the Affordable Care Act, Cap Medicaid

Cantwell: "The House bill is literally a war on Medicaid"

WASHINGTON, D.C. - U.S. Senator Maria Cantwell (D-WA) today delivered remarks on the Senate floor on House Republicans’ health care plan to repeal the Affordable Care Act, cap Medicaid and eliminate Medicaid Expansion.

Madam President, I would like to come to the floor to discuss the proposed House Medicaid changes that are part of what they are proposing to the Affordable Care Act. This is so important because, as many people know, Medicaid has been a bedrock of how individuals get access to health care in our country. And in many parts of our state, at least in the state of Washington, Medicaid has been a lifeline in rural communities, in urban areas, and we've heard much from various people that it is actually helping stabilize health care costs so they are not rising as fast and giving people access to care in the most serious situations where we are trying to fight opioids or trying to fight for more efficiency in our health care system.

So, first of all, I think the house bill is literally a war on Medicaid. I say that because it is a capitation of health care costs. The federal government, according to one budget analyst, the Center on Budget and Policy Priorities, would shift the costs to the states by more than $500 billion over the next 10 years. That would mean that millions of people would lose coverage and be affected by this kind of repeal.

Now, many people talked about they might block grant Medicaid. I also thought that was a horrible idea because, really, it becomes nothing but a budget mechanism to reduce the federal partnership that exists between the federal government and the states on Medicaid. But the house chose not to do exactly do block granting. They said, instead, we have going to have a budget cap at the federal level on how much money they are going to spend on Medicaid and then work towards the repeal of the Medicaid expansion.

This is a very bad idea. The actual per capita cut -- I know my colleagues like to come out here and talk about a patient-centered relationship, which is exactly what getting off of fee-for-service and going to managed care does. But a per capita cost is nothing but a budget mechanism to cap the federal responsibility to Medicaid and cut cost and basically shift the pain on to states. I've been on various meeting tours in the state of Washington, talking to my constituents about this in Seattle, Spokane, and Olympia. I met with hospitals, women’s health, local officials, civic leaders, civil rights organizations, and I heard many things. I basically heard hospitals say there's evidence that Medicaid is actually lowering the commercial insurance premiums because of less uncompensated care, and I heard a safety net hospital in Spokane tell me that the population is 70% Medicaid/Medicare and that there is no way they could absorb this kind of a cut to the Medicaid program and it would mean that health care costs would rise in the future. I heard a hospital in Seattle tell me that this kind of attempt is nothing but a budget trigger. It is not reform of the system. It is simply a way to cut the budget.

What we believe is that Medicaid is a key part of our health care delivery system. The expansion has worked well and we should continue to move to ways to innovate Medicaid to save costs. Unfortunately, right now many people misunderstand how important Medicaid is in the mental health and addiction area. Basically, when you take what we've tried to do to address the opioid epidemic, those individuals who are working through the bills that we just recently passed to try to become patients in an emergency room or psychiatric care or trying to deal with this grave problem we have in the United States, getting rid of Medicaid for those individuals, you might as well roll back all of the assistance that we just provided as part of the CURES and other legislation. Why? Because these individuals will not be able to access the type of care that they need without this support. I do believe what we need to do is innovate instead.

There are many examples of innovation in our health care delivery system. One example, as I have mentioned on the floor several times, is going from nursing home care to community-based care. Medicaid is going to equal long-term care. So many Americans are not going to be ready to deal with their long-term health care issues, and when they are not, they are going to use Medicaid for their long-term care. We showed in the state of Washington, over more than a decade’s period of time, that we could save $2.7 billion by shifting our Medicaid population to community-based care instead of nursing home care. If we would do that same kind of innovation at the federal level, we would save more than this $500 billion that's being talked about right now as far as our costs. The issue here is that innovation in our delivery system, not a budget cap -- innovation, not a budget cap -- is what is going to help us with our health care needs for the future when it comes to the Medicaid population. So I urge my colleagues to speak loudly against this proposal to try to cap Medicaid, to try to shift the burden to states and local providers, to county governments, to jails, to all of those individuals who are going to see that population when and if they don't have Medicaid coverage and instead work together on expanding the innovation in Medicaid and coming up with a savings that we need to take care and provide health insurance and coverage to so many Americans. So with that, Madam President, I yield the floor and suggest the absence of a quorum.


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