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Monday, 12/19/05
Today, Senator Charles Schumer and I called on the Commissioner of Health for the State of New York to put safeguards in place to protect New Yorkers who are in jeopardy of losing eligibility for health coverage as the new Medicare prescription drug program is implemented. Without action, New Yorkers dually eligible for Medicaid and Medicare and who also have employer-based retiree health coverage face a conflicting scenario in which any choice will result in termination of one type of health coverage.
Following is the text of our letter.
Dear Dr. Novello:
We are writing to express concern about a specific aspect of the implementation of the new Medicare prescription drug program. We understand that this new federal law has created many challenges for your Department, but need your help to ensure the continuation of Medicaid coverage for New Yorkers eligible for Medicare, Medicaid, and employer-based retiree health coverage.
As you know, the Centers for Medicare and Medicaid Services (CMS) have automatically enrolled individuals eligible for both Medicare and Medicaid (dual-eligibles) in a Medicare Part D prescription drug plan. It has issued guidance to states allowing them to condition Medicaid eligibility on enrollment in the Part D program, and New York is one of six states that has chosen to amend its state plan accordingly. Dual-eligible New Yorkers who are not enrolled in Medicare Part D as of January 1, 2006, will no longer be eligible for Medicaid.
However, through their employer subsidy program, CMS has also incentivized employers to condition health coverage for their retirees on disenrollment in the Part D program. For individuals who are eligible for all three types of coverage, this provides a conflicting scenario in which any choice will result in the termination of one type of health coverage: Medicaid if the dual-eligible disenrolls from Part D, and retiree health care if the individual stays enrolled in
Part D.
We have learned through discussions with your staff that the Department is aware of this contradiction and is working to address it. It is our utmost concern that dual-eligibles who disenroll from the Part D program in order to retain their employer-based retiree coverage do not experience any disruption in their Medicaid coverage. In addition, while CMS has primary responsibility for working with employers throughout New York State to ensure that retirees do not inadvertently and irrevocably lose their retiree health coverage because they choose or are auto-enrolled in the Part D program, we strongly encourage the Department to take an active roll in assisting CMS in protecting these dual-eligible retirees.
We urge you to act quickly to put safeguards into place that will protect dual-eligible New Yorkers from these scenarios. Dual-eligible New Yorkers should:
* be exempted from termination of Medicaid coverage if their enrollment in Part D would result in the loss of other creditable coverage;
* receive clear guidance explaining the steps they need to take to retain all of their coverage if they belong to employer-sponsored health plans;
* be notified well in advance of any termination of their Medicaid coverage; and
* be afforded with options to prove the existence of their creditable coverage other than coming to a Medicaid office in person, given the physical limitations that members of this population may be more likely to experience.
Thank you for your consideration, and we look forward to hearing from you.
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Sincerely yours,
Hillary Rodham Clinton
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12/21/05
Yesterday I spoke in the Senate chamber to express my strong
opposition to the Senate leadership's proposed budget bill that will
cut $39.7 billion from programs such as Medicare, Medicaid,
student loans, and child support enforcement that help working
families maintain their self sufficiency.
I have heard from many of you about the extreme consequences
this legislation, if passed, will have for New Yorkers, and I
appreciate your comments on this important matter. This morning
the Senate took a small step in the right direction by passing a
procedural motion - a budget point of order - to send the bill back
to the House of Representatives. While this vote did not defeat the
underlying bill, it did ensure that Members of Congress, advocates,
and the public will have more time to understand exactly what is in
this bill and to express opposition to it. Following is the statement
I delivered on the Senate floor yesterday.
Mrs. CLINTON. Mr. President, last week, I came to the floor to
speak against the proposed reconciliation bill, and I used the
analogy of the Grinch who stole Christmas. At that time, we did
not have a conference report yet before us, and I hoped that we
might make some significant changes in what would be sent to us
after the House acted.
Unfortunately, although there were some changes, the overall
impact of what has been sent to the Senate for action is
disappointing and deeply disturbing. While the Grinch stole the
gifts, the decorations, and even the Christmas tree, this budget
slashes hope. It slashes opportunity. It slashes support that the least
among us need in order to be as productive and healthy as possible.
This Republican budget slashes child support enforcement,
Medicaid benefits, student loans, and so much else.
Now, the story of the Grinch who stole Christmas actually has a
happy ending, because the Grinch, seeing the error of his ways,
returned what he had taken. Unfortunately, I fear the budget before
the Senate today does not have a happy ending. It represents a
monumental failure by the Republicans in Congress to recognize
the real priorities that the people of America--working families,
students, seniors, and particularly children--need.
The Republican priorities are crystal clear in this bill. The
Republican majority chose $2.6 billion in new tax breaks for oil
companies. I don't know how that is a priority. I don't even know
how that is understandable. The oil companies could not be doing
any better than they are doing, and we are still giving them more
tax breaks from hard-working American taxes. We still prohibit the
Government from negotiating for prescription drugs to lower the
cost to Medicare beneficiaries, which could save $100 billion for
taxpayers. The Republicans decided not to eliminate the $5.4
billion Medicare insurance company slush fund and, instead, chose
to cut home health care, hospital quality improvements, imaging
services, medical equipment, and hospital payments. And as usual,
with the Republican majority, they decided against cracking down
on abusive corporate tax shelters such as mailbox headquarters and
other loopholes.
We have heard a lot of this from the eloquent, persuasive
argumentation by the Democratic ranking member on the Budget
Committee, the Senator from North Dakota. We have heard from
others of our colleagues raising the alarm about this ill-conceived
budget. But one issue that has not yet been raised that I would like
to highlight is that I think this bill may very well increase the
number of unintended pregnancies and abortions in our country.
Why, you might ask? Today contraception and other family
planning services are provided as a matter of course under
Medicaid. We do this because it is good for women to have access
to such treatments and medications. It also prevents unintended
pregnancies and, therefore, prevents abortions and, therefore, saves
money. For every dollar Medicaid spends on family planning, the
Government saves $3. But this bill eliminates the guarantee.
I don't understand this. We obviously have very strong opinions
and deeply held convictions about abortion, but are we also
divided about contraception and family planning? Are we not in
this body committed to reducing the number of abortions?
Apparently, we are not because the provision in this
reconciliation budget that eliminates family planning for Medicaid
recipients makes it very clear that the majority opposes
contraception and family planning, which reduces unwanted
pregnancies and abortions.
It makes no sense to me. I thought we were working toward a
bipartisan agreement that we would try to prevent unwanted
pregnancies and, therefore, reduce the need for abortion. I sadly
predict that if this measure stays in the bill, which apparently it is
going to because we expect to vote on it in the next several hours,
the number of abortions will go up, the human and financial costs
will go up, and many women will really be out of luck.
The other piece that is so troubling to me is young people aging
out of foster care. These are young people for whom we try to
provide some support services by continuing their access to
Medicaid. They, too, will not have access to family planning.
This is all about misplaced priorities, choices that do not serve
our Nation's future and puts the burden of balancing the budget on
the backs of working families, college students, seniors, single
moms, and the middle class.
Consider who is bearing the costs because we know there are
winners and there are losers. Certainly, the winners will be oil
companies, drug companies, corporate freeloaders, and deadbeat
parents. That is a wonderful list of whom we are helping in this
Christmas season.
Despite rising medical expenses that burden middle-class and
low-income Americans, this bill cuts $6.9 billion from Medicaid
by slashing benefits and increasing costs to beneficiaries. We know
there is a considerable body of research from RAND to the Urban
Institute and many others that have found if you increase copays
and premium costs, beneficiaries will skip needed care and may
lose coverage entirely.
This bill also, for some reason, has it out for college students, the
very people we should encourage to get their education, to become
productive citizens, to have competitive jobs in a global economy.
The bill cuts over $12.7 billion from student loan programs,
resulting in higher payments for 472,000 New Yorkers today and
millions more in the years to come.
The bill also undermines the Direct Loan Program which has
been shown by every independent analysis to cost as much as 12
times less than the private loan program. So I guess we should put
the banks on the list of winners along with the corporate
freeloaders and the deadbeat parents and the oil companies.
As millions of seniors struggle with medical bills, this bill
slashes $6.4 billion from Medicare over the next 5 years, including
a $1.6 billion increase in Medicare Part B premiums, making it
more expensive for their seniors to visit their doctor this year
instead of last.
The thing I am still totally amazed by is cutting $4.9 billion in
child enforcement, eliminating $343 million from foster care
programs, undermining childcare for working families and TANF
that rewards and enables work.
I don't know, Mr. President, I guess there are different priorities
between us in this Chamber, and I am disappointed in that. Given
that 1.1 million more Americans fell into poverty last year, and
over 37 million Americans, including 13 million children, live in
poverty today, we are headed in the wrong direction.
I guess the Republican majority can brag about $2.6 billion in
new tax cuts for oil companies, $6.9 billion in Medicaid cuts, and
cuts to foster children, the most vulnerable of all of our citizens.
Corporate welfare was saved. Student loans were cut. I don't know
how you can, with a straight face, say that is the kind of priorities
we should be having at any time but particularly in the Christmas
season. But I suppose the folks who find these great big tax breaks under their tree are going to be grateful.
The ultimate irony is that this bill is being called deficit
reduction. We know how to do deficit reduction. We did it in the
1990s. We did it by making hard choices. We did it by making it
clear that nobody was going to get off scot-free, that everybody
would have to pay their fair share. Tough decisions would be made
on both the revenue and the spending side.
This bill doesn't reduce the deficit at all. In fact, it worsens the
deficit outlook by at least $30 billion. That is going to become
even more clear when we come back after the first of the year and
the Republicans give us $70 billion in additional tax cuts. Let's tell
everybody those tax cuts are, once again, going to help people who
have been helped already, quite substantially, over the last 5 years.
It is not doing much for the average American, it is not doing
anything for some of the poorest of Americans, other than telling
them they are on their own.
In a time of war, with the third largest budget shortfall in our
Nation's history, when we have rising poverty again, the call for
financial sacrifice by the White House and the Republican
Congress falls only on families struggling to make ends meet. It
falls on our children particularly, the poorest of our children, foster
care children, children whose parents are not providing support for
them. It doesn't fall on oil companies reaping record profits, not on
the drug companies, not on the corporate freeloaders, not on the
deadbeat parents.
This bill is not in keeping with the spirit of this season or the
priorities of the American people. I hope that we will do better
next year. I hope that people will realize, as the Grinch did, that we
don't need to act in a way that is playing to the lowest common
denominator, that takes care of the privileged at the expense of
everybody else. I do think it is fair to say that this bill is
unprecedented. Never has so much been done for so few who need
it so little.
This is a very sad day in the Senate. I hope we can do better in
the future on a bipartisan basis, and I hope that the real values of
America once again are put into action in the Congress.
Mr. President, I yield the floor.
Sincerely yours,
Hillary Rodham Clinton
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I'd say it's going to be a huge issue.
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