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Public Statements

Health Care

Floor Speech

Location: Washington, DC

Mr. KOHL. Mr. President, in an era when Congress is actively debating health care programs that are of enormous consequence to our economy and our collective future, it is important to acknowledge that today, Medicare and Medicaid play an essential role in ensuring access to health and long-term care services for nearly 100 million Americans. In fact, these programs are embedded in the daily lives of nearly one of every three Americans.

Medicaid is the program that currently pays for about half of all long-term care services in our country. Jointly financed and administered by states and the Federal Government, it is a program that all of us--taxpayers and beneficiaries and health care providers alike--have a major stake in seeing continue and succeed.

As chairman of the Senate Special Committee on Aging, I know that for millions of older and disabled Americans who are confronting the need for long-term care services, anxieties are often high. The costs associated with long-term care can be catastrophic, and many families turn to Medicaid for assistance.

In many parts of the country, Medicaid offers only limited choices of where and how to receive services. However, I am pleased and proud that a few States, Wisconsin among them, have developed Medicaid programs that are designed to offer beneficiaries real choices in where they will receive long-term care. The choices usually include nursing homes, assisted living residences, adult daycare, and personal care services delivered at home. Wisconsin and some other states are also increasingly offering beneficiaries the option to self-direct their care through programs that allow them to directly hire an aide--perhaps a family member or a friend--who can provide personal care within the confines of an approved individual budget.

Wisconsin's Medicaid managed care program that covers long-term services and supports is known as Family Care, and it is one that the state has worked to develop for many years under several administrations, starting with former Governor Tommy Thompson. Family Care is well ahead of where many States are in terms of offering older adults and those with disabilities a real choice of how and where they can receive long-term care services.

Today, one in five Wisconsin seniors and individuals with disabilities are enrolled in Medicaid. A similar proportion in six other States--California, Mississippi, Vermont, Louisiana, New York and Maine, as well as the District of Columbia, rely on the program. In every State, the number of older adults and individuals with disabilities who are enrolled in the program numbers is in the tens of thousands, hundreds of thousands, or millions. Last year, 321,700 seniors and individuals with disabilities in Wisconsin received coverage through Medicaid.

During the last several weeks, I have heard a great deal from constituents--beneficiaries, aging and disability organizations, and officials--who have expressed concern about recent developments in Family Care. It is my understanding that the state budget that was recently signed into law includes a provision to cap, or freeze, the number of individuals in the program, and thereby remove the ability of those who become eligible in the future to choose whether they wish to receive services in a nursing home, at home, or in a community-based setting such as an assisted living residence.

The State anticipates that the cap could save $265 million in the 2011-2013 budget. Yet predictions also abound that waiting lists for home and community-based services for newly eligible beneficiaries will begin to rapidly grow again, after a period of years in which the Family Care Program worked to eliminate delays in receiving services. Such delays could prove costly, because when appropriate and cost-effective interventions cannot be accessed by frail elders and individuals with disabilities, more medically intensive services are likely to be required later. Moreover, individuals who wish to receive lower cost in-home services--but who may find that institutionally based care is their only option--are predicted to wind up costing some counties significantly more.

This year, with the first cohort of boomers turning 65, we are launching our Nation's ``age wave.'' It is an exciting era for older adults, and it will be accompanied by new possibilities and challenges for our country. Wisconsin, which is aging more rapidly than many States, has a clear responsibility to continue to provide the best possible long-term care services to each and every one of its older and disabled citizens. In the coming weeks and months, I urge State and local officials to work closely and cooperatively with the Federal Government to keep Family Care strong. Over the last 12 years, Family Care has proven itself to be a valuable, popular, and cost-effective program--one that can be improved, yes, but one that also has a proven track record. It is my hope, and the hope of tens of thousands of beneficiaries of the program, that it will be preserved and carefully protected.

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