Blanche Lambert Lincoln

Emergency Health Care Relief Package - Oct. 30, 2005

Blanche Lambert Lincoln
October 30, 2005— U.S. Senate, Washington, DC
Congressional floor speech
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Mr. President, I come to the floor today to join my colleagues in what we hope to be an opportunity to bring about an awareness of the dire need , not only of the evacuees , of those individuals in the affected States who have received such incredible, devastating natural disasters, but also the other Americans who are involved in this circumstance, the other Americans who have opened their hearts and their homes, their hospitals and clinics, their pharmacies and their community centers, their church basements--these communities who have recognized what it means to be an American. They have recognized what it means to be fellow Americans. They have recognized what it means to be a good neighbor--I was, I guess--tongue in cheek--perhaps I was criticized being a little overpassionate on this issue, so I will resume my good, soft-spoken, and commonsense approach to what I think to be a very real problem--to have deeper roots, in terms of what are the values we as Americans do profess and for which we are willing to put our money where our mouth is when we speak of these values to really talk about not the immediate impact but also the long-term impact of the decisions that we make or we fail to make in a timely way.

I will come at it from a different perspective. Maybe keeping my compassion down a little bit will be helpful, but it is hard when we look out and see the kind of compassion in the faces of the incredible constituents that we serve, that we represent, that we have the privilege of coming to this floor to represent each and every day.

We also look out at the private sector, for which we also can be proud, our Nation's health care providers and States that have been there, at a time when vulnerable Americans need them the most.

The moment that Hurricane Katrina hit the gulf coast--now about a month ago--they jumped into action. They didn't have to be asked. They didn't have to be told what their job was. Medical, professional, and community leaders knew what their job was. Their job was to reach out to their neighbors, to their fellow Americans, and to their fellow human beings, who were in unbelievably devastating circumstances.

Cities and States all around the country opened their doors to welcome Katrina survivors from throughout the gulf coast region. Hospitals evacuated those who needed immediate attention. Doctors, nurses, and other health care providers have come together to provide health care to thousands of victims of this horrific natural disaster in the gulf coast. And they did all of it with no questions asked. They didn't ask: Who is going pay for this? Who is going to reimburse us? Who is going to take care of us? When the high numbers of Medicaid patients jump way beyond a survivable number, who is going to make us whole?

They did not ask those questions because they believed in this country. They believed in who we are in this body as Americans, who know our responsibility as neighbors. I happen to be somewhat of a neighbor of the President in the chair today. When my family is here and we are in session, northern Virginia provides an incredible neighborhood for us, just like our neighborhood in Little Rock.

We reach out to our fellow neighbors out there, as we do our neighbors in Arkansas.

It is what we are about in this country. It is being there for our fellow man. That is what these providers have done. Now it is our time.

We have an opportunity in this body to demonstrate that we understand what that means, we understand what it means to be a good American, to be a good neighbor and to provide to our fellow man who is in the neediest time in his life the kind of care and love and support that he needs--he or she--at that time without asking questions.

We could pass the Emergency Health Care Relief Act that Senator Baucus and Senator Grassley have worked so hard, in a bipartisan way, to bring about. I offered an amendment a month ago. I could see from my providers, those doctors and nurses, those pharmacists who worked 24-7, who spent their entire Labor Day weekend taking care of their neighbors from Mississippi and Louisiana, who didn't ask questions, I could see that there was going to be a tremendous need down the road to provide them piece of mind--that not only they were doing the right thing in helping those neighbors but also that they could continue to do the good job in providing services to the constituency, the community, and the neighbors they have known all of their lives.

Many of our communities in east Arkansas, particularly in the Delta region, are already disproportionately poverty counties. Hospitals and clinics, community health centers before Katrina were already disproportionately Medicaid and Medicare facilities. They were already heavily dependent.

Tomorrow, they are going to take a cut. To save money in this country, to look at where we are going to save money, we are going to reduce the Federal share of their Medicaid reimbursement as of October 1. Out of the 29 States that are going to see a cut in their Medicaid reimbursement, the most affected 7 States in the country by this natural disaster will see a cut tomorrow in their reimbursement for the neediest, those who depend on the health care safety net of this country because we are so trapped, so paralyzed in the redtape that we want to create in this body.

We do have an opportunity , though, to not only provide for Katrina survivors and victims of such an incredible natural disaster, but to also prove to the private industry of this Nation that we can react without the unbelievable web of redtape that leaves them hanging, that leaves them holding the bag for the cost of something that we should be held accountable for--not just held accountable because we are the Government but held accountable because we are the institution that wraps its arms around the American people when they are most in need . We can do so in an efficient and effective way.

To my colleagues on the other side who are so desperately worried about the cost of what we are doing, who are so afraid of helping one too many needy people, I say to you: Look at what we have become.

We have worked hard to keep the costs down. We have made it temporary so it wouldn't explode or overexpand--yes--an already very expansive program.

These people are not going home tomorrow.

I saw a piece in my hometown of Helena about a couple that left in haste out of New Orleans. They went to Jackson and could find no help. They went to Memphis and were sent to Tunica, MS. In Tunica, at the Red Cross facility, they were told there was already overcapacity, and they were simply sent away. They went to the next bridge that crossed the great Mississippi River and into my hometown, remembering someone they had grown up with in their childhood from Chicago, and called him hoping that he would be there. He was. He was a pastor of a church. He had opened his church doors and his home. He and his wife opened their home and welcomed them in, as well as other families that were already living there. They reached out to one of the most poverty-stricken counties already in the country--reached out to a small health care foundation that this community had managed to put together over the last several years to try to reinvigorate their health care infrastructure because they know how important it is as a component of rebuilding the vitality of their community and creating jobs for those who want to get into a more independent situation.

But who locates businesses, or factories, or jobs in an area where you don't have the necessary health care to begin with?

So you have a small nonprofit health care foundation paying for this couple's health care because the providers have no earthly idea whether their Federal Government is going to be there for them.

We are bigger than that. We are not talking about an open-ended payment.

We are talking about a temporary ability to give peace of mind to the people who, since day one when this disaster struck, have not asked questions, have put their full faith and hope in this Federal Government--that for once it will disregard the redtape, look wisely at something that we already have in place, and look wisely at past experience such as 9/11, when we were able to temporarily offer a health care safety net to survivors, and expect that we could come up with the wisdom and the courage in this body to provide them the peace of mind that what they have done for their fellow man was the right thing to do.

We are talking about ensuring full Federal funding within the area where medical care has been provided for victims of the hurricane.

Medicaid is our health care safety net in this country. I think this crisis itself has shown us how important this safety net is to our Nation.

We have to make sure it does not unravel in the face of this national emergency.

Do we have concerns about Medicaid? Do we feel as though there are places where we could be more efficient and effective in that program? You bet there are places we can be more efficient and effective.

Chairman Grassley has suggested some in terms of the cost of prescription drugs through Medicaid that can be negotiated in a better, more efficient way, to provide more cost-effective drugs in that program and hopefully lead the way to seeing us provide more cost-effective pharmaceuticals for all other programs, as we do with the Veterans' Administration. We can do that when we work together.

To scrap a program designed as a safety net for people who are in the most devastating circumstances is not the way to do that.

The administration promised they wanted to make whole financially the States that were providing health coverage to evacuees. They say there is no need for the Grassley-Baucus initiative to provide full Federal funding for Medicaid because they want to use waiver policy. What they did not say is there is no Federal funding, no Federal dollars in providing that waiver policy. There are no dollars that they will put behind that.

They have asked Louisiana, Mississippi, and Alabama, the affected States, to sign memorandums of understanding to agree to be on the hook financially for a portion of the Medicaid costs of the survivors. How humiliating to go to a State that has been devastated and say: We are going to put you on the hook right here and now for the costs of what your neighbors want to provide. And we, as a nation, supposedly the wealthiest nation in the world, should be able to care for our American citizens.

We know those States are in no position financially to incur that kind of cost. Those three Governors testified before the Committee on Finance earlier this week. One of the Governors mentioned she did not even have the resources through her State legislature to overcome the increase in costs they were going to see because of the loss of Federal dollars they are going to experience tomorrow when their Federal matching portion of Medicaid is cut. That was before Katrina ever hit. Before this devastation hit, they could not find the resources in their State--with a disproportionate share of low income, dependent on that safety net--to be able to cover that. That was before the disaster.

Those Governors were highly concerned. They expressed it in their testimony and in their questions and comments about making sure the Federal Government would be there for them to make them whole, to extend help to their States--Louisiana, Mississippi, and Alabama--when they were unable to deal with that under their current budgets.

For Arkansas, what does it mean? Does it mean we are left holding the bag due to budgetary issues, due to the fact that there are a few people in the Senate that are more worried about the temporary spending to help the neediest of this devastation than they were about the $62 billion we vetted for FEMA? Nobody objected to that. I have no objections for taking the money from that. FEMA will probably come back and ask for more money anyway.

If it were your mother or your sister or brother or niece or nephew, uncle or parents or grandparents who had been displaced, who found themselves in a strange community with a chronic illness--whether it was heart disease, diabetes, perhaps cancer patients in need of treatment, perhaps it was a child who needed health care--can you imagine the fear of thinking you would not be able to access it? Or to find the provider that was providing it for you was scared to death that it was going to push them over the edge; that if they helped enough of the people without any assurance or piece of mind, eventually their doors would be closed and they would no longer be able to provide that kind of care.

As I toured the evacuee camps, there was an unbelievable feeling of gratitude among those displaced at a time when they had to have been devastated. A woman was about to get married who had lost her wedding dress in New Orleans. But the people in our community in Arkansas provided a wedding dress and a wedding for people who had been displaced who did not know where their other family members were, who were separated, yet who were still so grateful for the food, the warmth, the hospitality, the love and the arms that enveloped them in the evacuee camps where they found themselves. Some of them have dispersed and gone to stay with cousins, aunts or uncles, sisters or brothers in other States. That is one of the reasons we want the expansion.

We do not want it just for the State of Arkansas. We know we have already sent many evacuees to Pennsylvania, West Virginia, North Carolina, Iowa, Utah. They too are going to need health care because they do not know when they will be able to go back, and they do not know what they will be going back to. They do not know what happened to their jobs, the health care they may have had which is provided for in this bill to keep private insurance still in the go-along to make sure we make it whole as well, that we put as few people as possible into that Federal safety net.

We have an opportunity. I hope as a nation we can realize spending more and more time to try to bring up convoluted waivers--and our State Medicaid directors know that most of what is in the waivers is an empty promise. Last night in Arkansas, we got a waiver from HHS, but it certainly has contributed only to more redtape in addition to what has already been created. It provides more questions than answers. There is no money attached to it so it really is an empty promise that they will do something about that.

The survivors, the health care providers in the States, have received no relief, no legitimate help. They are out there doing this without any assurance of from where it will come.

We do not know in the waivers what services will be cut. How do we expect providers to know what they can provide and what they can't? Most of them were given the assurances from their State: Don't worry, we are part of a great Nation.

When you treated those people over the weekend on Labor Day, we are going to ask them to go back in their minds 4 months and fill out the kind of paperwork to ensure they can get reimbursed for a tetanus shot or for a procedure, whatever it might have been. They, in good faith, have filled out what the State has asked them to fill out to make sure they are accountable for the services they have provided. Yet through the waiver processes, there is yet one more piece of redtape, one more form to be filled out, one more web of Washington bureaucracy they will have to deal with, without any guarantee that there is money behind it, that there are resources to actually pay for that.

As we look at the waivers that have been offered, they create uncertainty about reimbursement. The administration has suggested creating a new uncompensated care pool to reimburse health care providers. When we asked where was the money going to come from, that is what they told us--a new uncompensated care pool. Why wouldn't we use something that already exists, that already has fraud and abuse stipulations and cautions? Why wouldn't we use a system that we can continually improve on? But we will create a new uncompensated care pool. We will not know where the money will come from.

I question my colleagues who are looking at fiscal responsibility. A new uncompensated care pool does not have any parameters to it, it does not have any protections from fraud and abuse.

Health care providers receive no guarantee about which services and how much care will actually be reimbursed through this uncompensated care pool. I go back to the story I used in committee the other day about the woman who survived on top of her refrigerator. She was reported in The Economist. She survived on her refrigerator for 3 days and was able to finally get out. She made it as far as Baton Rouge. She was a diabetic and quite in need of care. She went to seek out health care and was told she was categorically incorrect and could not get care.

That is the kind of redtape we will perpetuate if we do not look at the reasonable proposal that Senator Grassley and Senator Baucus have come together to produce.

Does it go as far as I would like it to go? It does not. I have been out there and have seen what the people are up against--both the providers and the evacuees. I see what their families are going through--not just the lack of care, the lack of essentials or the communities that are trying to provide for them, but the dignity they want to maintain while finding themselves without a home, without any possessions, dislocated from their family, their neighbors, the people who care for them and love them, finding themselves in strange places with people who are trying desperately to give them that sense of dignity and care.

In my soft-spoken and commonsense way, I appeal to my colleagues. We can be fiscally responsible. We can look for ways we can provide care and peace of mind to those who need the health care and to those who, without reservation, are providing it to some of the neediest, most destitute of Americans at this time in our country. I ask my colleagues: Please, do not put this off for yet another week. Don't send us home to our States to tell our providers, to tell the Americans that have evacuated the gulf coast, that they are not important enough for Congress to deal with this issue in a more timely fashion.

I compliment my friend from Montana for his and Senator Grassley's attempt to work through this issue and to bring about something that is not only practical and common sense-oriented, that is limited in its timeframe, but that is also compassionate toward our fellow Americans.