April 16,2008

Grassley Floor Statement on Medicaid Moratoriums Legislation Moving in the House of Representatives

Floor Statement of U.S. Senator Chuck Grassley of Iowa
Ranking Member of the Committee on Finance
Medicaid Moratoriums Bill Moving in the House
Wednesday, April 16, 2008

Today the House Energy & Commerce Committee is taking up consideration of HR5613.This bill seeks to place a moratorium on seven Medicaid regulations until the nextAdministration. I know some people have concerns with the CMS Medicaid regulations.

Let me be clear: I’m not her to argue the regulations are perfect. I have issues with someof them I’d like to see addressed. However, the regulations do address areas where there are realproblems in Medicaid.

Mr. President, Medicaid is a federal-state partnership that provides a crucial health caresafety net for some very vulnerable populations – low-income seniors, the disabled, pregnantwomen, and children. They depend on Medicaid, and it does generally serve them well.Medicaid is also a program with a checkered history of financial challenges. That’s thegentle way of putting it. A more severe way of putting it would be that Medicaid has a history ofstates abusively pushing the limits of what should be allowed to maximize federal dollars sent tothem.

I’m not going to devote time in my remarks today to issues of fraud and abuse inMedicaid. I’ll probably be back to do more on that later. Instead, I want to focus on a verysimple concept: Medicaid program integrity depends on CMS and the states and providers andultimately, beneficiaries having a clear understanding of the rules of the road. When states don’thave clear guidance, they could be inappropriately spending taxpayer dollars. Improperpayments and wasteful spending only increase the financial pressure on the safety net.

Mr. President, the Medicaid regulations HR5613 attempts to halt are efforts by CMS toprovide clearer rules of the road in critical areas where there have been well documentedproblems. During the recent debate on the budget resolution, I entered into the record a CRSmemo that showed some of the issues that exist under current law. I’m not going to go into themin detail today, but when CMS doesn’t know how a state is billing for a service and states don’thave clear guidance for how they should bill, neither Medicaid beneficiaries nor the taxpayersare well served.

We should be talking about fixing the regulations so they better address real problems inMedicaid, but instead the House is trying to kick the can to next year.

So what does that mean for the taxpayer? HR5613 spends $1.7 billion to placemoratoriums on the regulations. This is only to delay the regulations until the end of March ofnext year. I know supporters hope that the next administration will completely cancel theregulations. What would it cost if we tried to completely prevent these regulations from evertaking effect? Not $1.7 billion that’s for sure. It would actually cost the taxpayers almost $20billion over the next five years and almost $50 billion over the next ten years.

It is an absolute farce for anyone to argue that all of those dollars are being appropriatelyspent and that Congress ought to just walk away from these issues. But that’s what HR5613does. Now I know supporters of that bill will say they just need more time. They say theyhaven’t had enough time to study the regulations and respond.

That argument is starting to strain credibility. The public provider rule was proposedwell over a year ago. The rehabilitation services rule was proposed nine months ago. Supportersof the bill have had plenty of time, if they wanted to make new policy. But it is obvious by theiractions, their only real interest is making the regulations go away. This is unfortunate Mr.President, because finding solutions is what we should be doing. When we start talking aboutthe integrity of the Medicaid program, clarity is what is most needed between CMS and thestates. If you don’t like the rules, fine. But there are ten of billions of taxpayer dollars involved.

Roll up your sleeves and get to work solving the problems the regulations try to solve.Mr. President, that’s what we should be doing for the taxpayers. Putting moratoriums onall of the Medicaid regulations issues by CMS is not the right answer.