Hearing of the Health Subcommittee of the House Energy and Commerce Committee - Setting Fiscal Priorities

Hearing

Today we have a hearing on the entitlement programs and the economy -- with the
implication we have to choose one or the other in setting "fiscal priorities." Unfortunately, in the name of fiscal responsibility and balancing the budget, we are often presented with what I believe is a false choice between securing our nation's fiscal health and ensuring the health of older, disabled, and low income Americans.

As this is one my last hearings while in Congress, I want to use this opportunity to
highlight my commitment to protecting our federal entitlement programs, namely the Medicare and Medicaid programs, and the vulnerable populations they serve.

There are different paths we can take to ensuring the long term fiscal health of Medicare and Medicaid. The Ryan Budget proposals and what my Republican colleagues and their witnesses propose in our hearing today are fundamental structural changes in the programs which, through premium support and privatization for Medicare and block grants for Medicaid, shift costs to beneficiaries, providers, and states. This path doesn't lower costs, it shifts costs in a way that undermines the programs' guarantee of access to care.

The alternative path that we began in 2010 with passage of the Affordable Care Act is to reform entitlement programs through delivery system reform that improves both efficiency and quality. The Affordable Care Act improves access to preventive care that saves dollars and lives. It includes incentives to reward physicians and other providers for better coordinating care and improving health. It also included policies to cut waste and inefficient care.

Health reform is entitlement reform. It is this kind of reform that builds a better health care system for all Americans at the same time it lowers costs and helps support the long term sustainability of our public health care programs.

Medicare and Medicaid are not ballooning out of control. These programs are amazingly efficient. Over the 2010 -- 2014 period, Medicare spending per beneficiary increased by well less than one percent per year. On the Medicaid side, CBO estimates of projected Medicaid spending dropped by $395 billion through 2020, and the CMS Actuary predicts spending will grow no faster per beneficiary than private insurance.

The problem is the numbers and the aging of our society. In the coming years we will see a growth in the number of people who need Medicare and Medicaid. For Medicare, it is because of the retirement of the baby boomers. And, many of these Medicare beneficiaries will also rely on Medicaid. Currently, dual eligibles are 15 percent of the Medicaid population, but account for nearly 40 percent of expenditures.

In Medicaid, millions of Americans who were previously shut out of having insurance--particularly the working poor-- now have access to coverage as of 2014. More people clearly means more costs -- but the solution should not and cannot be simply to shift costs to states and beneficiaries, but to continue our efforts to improve the value we get from our programs in a thoughtful and sensible way.

Rather than a serious effort at maintaining our commitment to help working Americans, the Republican budget slashes away at the programs that families need most. The Republican budget is built on a hoax. On the one hand, they say it balances in 10 years. On the other hand, they say they repeal Obamacare. The fact is, they repeal all the benefits of Obamacare -- including improvements to Medicare, like filling in the Medicare Part D donut hole and adding no-cost preventive services - the things that help provide affordable health care to millions more Americans. But then they turn around and keep the very Medicare cuts and taxes from the Affordable Care Act that Republicans campaigned against.

We need to have an honest conversation about where the opportunities are to improve quality and efficiency, and secure the financial integrity of these programs, while acknowledging the demographic realities ahead.

And to do that, revenues need to be on the table. I do not think most Americans would say -- well we know there are going to be 70 million more seniors in Medicare, but we hope you can make do with the dollars that supported only half that number.

Eviscerating programs for low and middle-income Americans while protecting tax perks for the wealthiest is unjust.

If history is any indicator of what lies ahead, today's hearing will be a one-sided
conversation, a simple-minded focus on slashing the safety net, rather than a robust discussion about how to take care of all Americans.

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