[Extensions of Remarks]
[Pages E2471-E2472]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

GOVERNORS OF IDAHO, INDIANA, AND LOUISIANA EXPRESS CONCERNS WITH
UNFUNDED MANDATES IN HEALTH REFORM

______

HON. MIKE ROGERS

of michigan

in the house of representatives

Wednesday, October 7, 2009

Mr. ROGERS of Michigan. Madam Speaker, I rise today to express
concerns regarding health reform proposals which would create unfunded
state mandates. Legislation currently before the House would
dramatically expand the Medicaid program and place over $35 billion in
new liabilities on state budgets over the next ten years. In addition,
these proposals would expand the federal government's role in
administering Medicaid, which would severely handcuff states' ability
to run their own programs and preempt state authority to manage
Medicaid eligibility and benefits.
Over the last several weeks, governors have expressed concerns over
these proposals. I would like to submit for the record the following
letters from the governors of Idaho, Indiana, Louisiana and Minnesota:

September 15, 2009.
Hon. Mike Crapo,
U.S. Senate, Dirksen Senate Office Building, Washington, DC.
Dear Senator Crapo: Idaho has a proud history of fiscal
responsibility, ensuring that our State government serves its
proper role for the people of Idaho while staying within
their financial means. As the United States Congress attempts
to address the healthcare challenges facing our nation, it is
important that we remain diligent in assessing the
implications of our decisions, always ensuring that we take
seriously our duty to safeguard the financial resources of
the American public, and allocating taxpayer money in an
efficient and effective manner.
As revised healthcare proposals continue appearing in
Congress, the full consequences of these reforms remain
unknown and we are uncertain of the possible negative impacts
on local businesses, families and senior citizens. However,
it is clear that these sweeping proposals would irresponsibly
shift a substantial and unmanageable financial burden to the
states. Like Idaho, many states already are functioning under
severely limited and strained budgets. It is certain that the
burden of these reforms would be placed upon the shoulders of
hardworking Americans.
The costs associated with these proposed reforms are
astounding. Conservative estimates from the Idaho Division of
Medicaid indicate that the bill's Medicaid eligibility
proposal would increase our state share of Medicaid and the
federal matching rate effective would drop in the middle of
fiscal year 2011, leaving Idaho struggling to fill the void.
Idaho's tax base could not support this large unfunded
mandate without resorting to tax increases, including a
possible increase in Idaho's already 6-percent sales tax--an
irresponsible action which would do serious harm to Idaho
taxpayers. The proposed reforms would impose an undue burden
on citizens already struggling in this difficult economy.
It has been estimated that combined federal-state Medicaid
costs in Idaho could increase by $501 million. In addition,
raising the Medicaid reimbursement rate to 110 percent of the
Medicare reimbursement rate would increase total federal-
state costs $50 million more.
This proposed change in the federal reimbursement rate
likely would reduce the number of plans that are offered to
persons on Medicare, resulting in increased premiums and
reduced services and access to service providers. Seniors in
rural Idaho already have trouble finding providers who accept
Medicare patients.
Should these changes be approved, that trend could continue
statewide--severely limiting access to medical care for some
of Idaho's most vulnerable residents. The people of Idaho
have entrusted us with a responsibility to use our government
resources wisely and efficiently. Imposing costly federal
mandates that cannot be sustained in the long run is an
irresponsible violation of this public trust. Quite simply,
these proposals are financially irresponsible and would not
adequately address the needs of senior citizens and other
vulnerable groups.
I encourage you to join me in opposing current health care
reform proposals. By ending these nonsensical debates and
stopping the proposed reforms, we can move forward in a more
positive, measured and reasonable direction, using common
sense to find a workable healthcare solution that benefits
all Americans.
As Always--Idaho ``Esto Perpetua'',
C.L. ``Butch'' Otter,
Governor, Idaho.
____

September 8, 2009.
Hon. Richard Lugar,
Hart Senate Office Building, Washington, DC.
Dear Senator Lugar: During your summer recess I am sure
that many, if not all of you heard from your constituents
regarding health care reform.
I have heard from them as well. In fact, over the past few
months, I have watched Americans come forward to passionately
express their anxieties about the legislation currently
making its way through Congress. Their worries are well-
founded.
There is no disputing the fact that aspects of American
health care, such as access and affordability, truly do need
to be restructured and improved. Yet, I have serious concerns
about Congress's proposed solutions to these problems. In
fact, I fear the current rush to overhaul the system will
ultimately

[[Page E2472]]

do more damage than good and create far more problems than it
solves.
And unfortunately, Indiana would bear the brunt of many of
the reckless policies being proposed. For example, our
Healthy Indiana Plan (HIP), an innovative and successful
state sponsored health insurance program for uninsured
citizens, would suffer greatly as Congress expands Medicaid
coverage, forcing many of the Hoosiers already enrolled in
HIP out of the plan and into a broken Medicaid program that
does not focus on prevention, healthy lifestyles, or personal
responsibility.
Additionally, states will likely have to pick up the tab
for this extension of Medicaid. We have estimated that the
price for Indiana could reach upwards of $724 million
annually. These additional costs will overwhelm our resources
and obliterate the reserves we have fought so hard to
protect.
While these reforms could do serious damage to our state, I
fear they will also have harmful consequences all across the
country by reducing the quality and quantity of available
medical care, stifling innovation, and further burdening
taxpayers.
There is another way. Americans from all walks of life and
every political stripe should work together with President
Obama and Congress to create a set of measured and sensible
reforms that bring down costs, increase access and
portability and stress the importance of innovative state-run
health insurance programs.
The majority of Americans do believe that health care
reform is needed, but do not believe that the legislation
currently on offer is the answer. I agree. And I will do
everything in my power to raise these concerns and work with
you to find a solution.
Sincerely,
Mitch Daniels,
Governor, Indiana.
____

September 30, 2009.
Hon. Steve Scalise,
Cannon House Office Building, Washington, DC.
Dear Congressman Scalise: I join many of my fellow
Republican and Democrat governors in expressing concern with
any health care legislation being signed into law that would
serve as an unfunded mandate to states.
Louisiana is similar to many other states around the
country in that we are attempting to address budgetary
deficits in large part by working to streamline government to
be more efficient and cost-effective. In short, we are trying
to emulate many of our working families, small businesses and
seniors by watching our spending, doing more with less, and
making every dollar count.
However, Louisiana's budgetary situation is uniquely
challenged due to an unprecedented FMAP rate drop from 72 to
63.1 percent beginning next fiscal year that will cost
Louisiana at least $700 million annually. This additional
cost will place significant pressures on our ability to
expand our economy, create new jobs and protect critical
services in our state.
Louisiana is proud of its commitment to its citizens'
health in the face of long-standing issues of extreme poverty
experienced in few other states. Our state is a national
model for insuring children with over a 95% rate of child
insurance and we were recently recognized for achieving the
2nd highest child immunization rates in the nation after an
intensive state-wide private-public effort.
My Department of Health & Hospitals has submitted a
Medicaid waiver to the US Department of Health & Human
Services that can help improve the cost and quality delivered
in the Medicaid program. This waiver proposes national best
practices of coordinated care, medical homes, provider
payment reform, electronic medical records, and consumer
incentives to manage cost and improve quality. This proposal
can help improve the efficiency in Medicaid and utilize those
savings, along with the shifting of DSH dollars from
expensive hospital based care to community based outpatient
care, to expand coverage through private insurance to tens of
thousands of adults in our state.
Again, I ask that you consider the budgetary pressures
being felt by Louisiana and many other states and avoid
passing any health care legislation that would serve as an
unfunded mandate to the states.
Best regards,
Bobby Jindal,
Governor, Louisiana.
____

[From the Washington Post, Aug. 3, 2009]

To Fix Health Care, Follow the States

(By Governor Tim Pawlenty of Minnesota)

If you tie money to results, you'll get better results.
Unfortunately, government often dumps money into programs
without regard to accountability and outcomes. This past
week, Democrats in Congress have been busy tinkering with a
Washington takeover of the health-care system, but perhaps
they should look instead to the states for models of market-
driven, patient-centered and quality-focused reform. Rather
than taking power away from states, federal health-care
reform should use the lessons we've learned tackling this
crisis in our back yards.
In Minnesota, our state employee health-care plan has
demonstrated incredible results by linking outcomes to value.
State employees in Minnesota can choose any clinic available
to them in the health-care network they've selected. However,
individuals who use more costly and less-efficient clinics
are required to pay more out-of-pocket. Not surprisingly,
informed health-care consumers vote wisely with their feet
and their wallets. Employees overwhelmingly selected
providers who deliver higher quality and lower costs as a
result of getting things right the first time. The payoff is
straightforward: For two of the past five years, we've had
zero percent premium increases in the state employee
insurance plan.
Minnesota has also implemented an innovative program called
QCARE, for Quality Care and Rewarding Excellence. QCARE
identifies quality measures, sets aggressive outcome targets
for providers, makes comparable measures transparent to the
public and changes the payment system to reward quality
rather than quantity. We must stop paying based on the number
of procedures and start paying based on results.
Instead of returning power to patients and rewarding
positive outcomes, many Democrats in Washington want a
government-run plan that would require states to comply with
dozens of new mandates and regulations. One study by the
Lewin Group recently concluded that an estimated 114 million
Americans could be displaced from their current coverage
under such a plan, and another study by House Republicans
said the plan could result in the loss of up to 5 million
jobs over the next 10 years.
In typical fashion, the self-proclaimed experts piecing
together this Democratic health-care legislation are focusing
on only one leg--access--of a three-legged stool that also
includes cost and quality. Expanding access to health care is
a worthwhile goal. But equal or greater focus should be
placed on containing costs for the vast majority of Americans
who already have insurance. Those costs will not be contained
by a massive expansion of federal programs.
Massachusetts's experience should caution Congress against
focusing primarily on access. While the Massachusetts plan
has reduced the number of uninsured people, costs have been
dramatically higher than expected. The result? Increased
taxes and fees. The Boston Globe has reported on a current
short-term funding gap and the need to obtain a new federal
bailout.
Imagine the scope of tax increases, or additional deficit
spending, if that approach is utilized for the entire
country.

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