Patient Protection And Affordable Care Act

Floor Speech

* Mrs. MALONEY. Madam Speaker, today we will cast a series of historic votes.

* The outcome of the votes will result in 32 million people without health insurance gaining coverage and 94 percent of Americans with guaranteed health care coverage.

* In New York State, close to 2.5 million people who are currently uninsured will have health care coverage once the day is over.

* To get to this point, the House had to first vote on the Senate passed health care bill and then vote on a bill that makes important changes that have been negotiated by the House to dramatically improve the Senate bill--this is called the reconciliation bill.

* Without a promise of these important fixes, like taking out several of these ``special deals'' I would not vote for the Senate bill. However, with the guarantee of these improvements, today I will cast my vote in favor of the Senate health care bill.

* I appreciate the opportunity to outline some of my concerns with the Senate passed health care reform bill.

* Most importantly, the Senate bill would have cost New York close to a billion of dollars in Medicaid funding. Unlike the House bill which saves New York billions, the Senate bill penalizes States like New York for its expanded coverage of its citizens under Medicaid. Under the Senate bill, States that have not significantly expanded their Medicaid programs would receive a large influx of Federal funding, but States like New York are penalized for doing the right thing. The House bill contained a more equitable solution to sharing the costs of Medicaid expansion under health care reform by providing increased Federal funding for Medicaid expansion regardless of existing State eligibility levels. FMAP provisions in the Senate bill would result in a significant loss to New York State as a significant number of uninsured New Yorkers who are eligible for Medicaid enroll, while the House bill fairly shares in the costs for currently enrolled and newly enrolled childless adults and parents. Fortunately, the reconciliation bill that we will be voting on, fixes this problem, and the distribution of Federal Medicaid funding is more equitable and saves money for New York.

* The Senate bill similarly penalized New York in terms of its treatment of payments to Disproportionate Share Hospitals, DSH. Historically, Medicaid hospital reimbursement rates, on average, have been lower than the cost of providing care, and DSH payments were instituted to cover reimbursement shortfalls and uncompensated care costs. The need for DSH reimbursement will remain even after health care reform is passed since there will millions of newly eligible individuals who will receive care through Medicaid.

* The Senate bill reduced Federal funding for Medicaid DSH payments by $19 billion and Medicare DSH payments by $24 billion over 10 years; reductions to DSH payments of this magnitude will jeopardize the stability and the services provided by our safety net system. The original House bill which I supported had included more reasonable reductions of $10 billion each from Medicaid and Medicare DSH and similarly, the reconciliation bill, while not as good as the original House bill, reduces the cuts that the Senate bill would have imposed.

* I am also opposed to the restrictive abortion language contained in the Senate bill. The Senate bill is significantly onerous, stigmatizing abortion services and creating obstacles for those consumers who would like to purchase this coverage and to those insurance companies would like to provide this coverage. Though I am strongly opposed to these restrictions, I am voting for the final bill because overall, reforming our current health care system dramatically and positively impacts women. As Chair of the Joint Economic Committee, I prepared a report that looked at the specific health care challenges facing women and how women would benefit from comprehensive health care reform. More than 2 million women have lost their health insurance since the recession began due to their own job loss or their spouse's job loss. 1.3 million women lost their health coverage when their spouse lost his job and an additional 800,000 women lost their health care as a result of their own job loss. More than 2 million women have faced the brutal double-whammy of a lost job and lost health care. While job losses

during this recession were much greater for men than women, women have fared worse than men in recent months. And this has had real consequences for women's health care coverage: in the last 6 months, the number of women losing health insurance benefits due to their own job losses has increased by nearly 50 percent. Over one quarter, 28 percent of women ages 19-24 have no health insurance at all. Part of that number is likely explained by the economic challenges facing young women. Young women have been hit hard in the recession, facing an unemployment rate of 13.1 percent, significantly higher than the national rate of 9.7 percent, and making it less likely that they will have job-based coverage. Health care reform will help us to overcome inequities at the center of the current system--where women pay more than men for the same coverage, or even, where women who are not smokers pay more for coverage than men who are smokers. My report and the reality is that the current health care system is serving women poorly, the recession has made the situation worse, and now more than ever, we need health care reform.

* I have been a strong supporter of the public option and voted for the House bill in large part because it contained a public option. I believed then and I believe now that a public insurance option will increase competition and reform our current system. Every day, 14,000 Americans lose their health care coverage. A public option would have brought down costs and expanded access. Unfortunately, the Senate was unable to pass a bill with a public option, though many Senators supported the provision. While I am disappointed that the final bill that will go to the President for signature will not include it, I feel confident that the end product will achieve the goals of covering the vast majority of Americans, reduce health care costs, and reduce our deficit by trillions of dollars.

* Madam Speaker, it is clear that the Senate bill had flaws and as passed was not as good of a bill for the State of New York as it should have been. If I was just casting one vote today, it would be a no vote on this bill. However, we are being given the opportunity to fix and improve the Senate bill with the upcoming reconciliation bill which is why I am able to vote in favor of this bill. With this vote, I am voting in favor of helping Americans gain affordable, quality health care they both need and deserve, I am voting in favor of dramatically reducing the Federal deficit by $143 billion in the first 10 years, and I am voting in favor of improving coverage by removing denials of coverage based on preexisting conditions or gender. I am voting in favor of a strong and healthy future for all Americans and for our great country.

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