Medicaid and the 2006 Budget 

By Carolynn Race 

During the month of March, Members of Congress, particularly Members of the House and Senate Budget Committees, spent a great deal of time working on budget resolutions for fiscal year 2006.  The budget resolutions are intended to guide appropriators' spending for the upcoming fiscal year.   

On March 17, 2005, the House and Senate passed their respective chambers' budget resolutions for fiscal year 2006.  The Senate budget resolution, S. Con. Res. 18, passed by a vote of 51-48, with all Democrats, Republican Senators Snowe (R-ME), DeWine (R-OH), Voinovich (R-OH), and Chafee (R-RI), and Independent Senator Jeffords (I-VT) voting against the resolution and the remainder of Republicans voting for the resolution.  The House resolution, H. Con. Res. 95, passed by a vote of 218-214.  Both resolutions will make steep cuts to programs that impact vulnerable populations.   The House version calls for $68.8 billion in cuts to mandatory spending programs over five years, while the Senate version was amended to strike $15 billion of the $32 billion in mandatory spending cuts over five years and to expand its tax cut proposal.  (Footnote:  April 4, 2005)  

Following their Easter recess, the House and Senate are expected to appoint conferees to iron out differences between the House and Senate resolutions and develop a bicameral conference report.  Both chambers of Congress must then vote on the conference report.  It does not need to be signed by the President.   

One major point of contention between the two budget resolutions is how to fund Medicaid, the nation's major public health program for low-income Americans.  Medicaid, which finances health and long-term care services for more than 50 million people, is a source of health insurance for 38 million low-income children and parents and a critical source of acute and long-term coverage for 12 million elderly and disabled individuals, including more than 6 million low-income Medicare beneficiaries.  

The House budget resolution includes a $20 billion cut that would apply largely to Medicaid, while the Senate version includes no Medicaid reductions.  During the Senate floor debate on the budget resolution, Senators voted, 52-48, for an amendment to strip from the Senate budget resolution instructions to the Finance Committee to cut $15 billion from programs under its jurisdiction.  It was assumed that about $14 billion of those cuts would have come from Medicaid.  The amendment, offered by Senators Smith (R-OR) and Bingaman (D-NM), was supported by the sponsors and all Democrats, Senator Jeffords (I-VT), Senator Snowe (R-ME), Collins (R-ME), Chafee (R-RI), Specter (R-PA), Coleman (R-MN), and DeWine (R-OH).  To see how your Senator voted, see the roll call vote below.   

Viewing the Federal Budget through a Moral Lens

Why are many Members of Congress so focused on cutting Medicaid and other entitlement programs?  The language heard around Capitol Hill revolves around the "fiscal deficit," which is currently $412 billion.  As was mentioned in the Health Care Outlook for 2005, politicians have promised to reduce the deficit.  During last November 's election, President Bush promised to cut the deficit in half over five years, while Senator Kerry (D-MA) said he would reduce the deficit — and would roll back tax cuts for the wealthiest Americans to fund expansions in federal programs, notably health care.   

But in claiming to reduce the deficit, both the House and Senate budget resolutions are putting an unfair burden on the least of these among us.  Additional tax cuts remain in both House and Senate budget resolutions, while programs that benefit people in and near poverty are being reduced.   

What happens when we view the federal budget through a moral lens?  As Jesus noted in the Gospel of Matthew, "Where our treasure is, there your heart will be also."  (Matthew 6:21).  How does the budget respond to the significant human needs deficits we have as a nation — and as a global community?   How is this year's budget resolution responding to the health care deficit — and the fact that over 45 million Americans are uninsured — and millions more are underinsured?  How is the budget resolution responding to the human needs' deficit — and the fact that over 36 million Americans live in poverty? 

Regarding health care, it is clear that the health care deficit would increase if cuts to Medicaid are included in this budget conference report.  Contact your Members of Congress and urge them not to include cuts to Medicaid and other vital human needs programs in the budget conference report.  

ACTION

First, thank Senators who voted for the Smith-Bingaman amendment to strip the Medicaid cuts from the Senate Budget Resolution.  A list of how your Senators voted is below. 

Second, urge all your Members of Congress to insist on a budget conference report without cuts to Medicaid and other vital human needs programs.  Tell them that you are a Presbyterian who is concerned about the impacts that cutbacks to Medicaid could have on the millions who rely on Medicaid for health care.  Call the Capitol switchboard at (202) 224-3121, and ask to be connected to your Senators or Representative. 

Conferees

The Senate budget conferees are:

Gregg (R-NH), Domenici (R-NM), Grassley (R-IA), Allard (R-CO), Conrad (D-ND), Sarbanes (D-MD), and Murray (D-WA). 

How Did Your Senators Vote?

Smith-Bingaman Amendment to Senate Budget Resolution:

Alabama: Sessions (R-AL), Nay Shelby (R-AL), Nay
Alaska: Murkowski (R-AK), Nay Stevens (R-AK), Nay
Arizona: Kyl (R-AZ), Nay McCain (R-AZ), Nay
Arkansas: Lincoln (D-AR), Yea Pryor (D-AR), Yea
California: Boxer (D-CA), Yea Feinstein (D-CA), Yea
Colorado: Allard (R-CO), Nay Salazar (D-CO), Yea
Connecticut: Dodd (D-CT), Yea Lieberman (D-CT), Yea
Delaware: Biden (D-DE), Yea Carper (D-DE), Yea
Florida: Martinez (R-FL), Nay Nelson (D-FL), Yea
Georgia: Chambliss (R-GA), Nay Isakson (R-GA), Nay
Hawaii: Akaka (D-HI), Yea Inouye (D-HI), Yea
Idaho: Craig (R-ID), Nay Crapo (R-ID), Nay
Illinois: Durbin (D-IL), Yea Obama (D-IL), Yea
Indiana: Bayh (D-IN), Yea Lugar (R-IN), Nay
Iowa: Grassley (R-IA), Nay Harkin (D-IA), Yea
Kansas: Brownback (R-KS), Nay Roberts (R-KS), Nay
Kentucky: Bunning (R-KY), Nay McConnell (R-KY), Nay
Louisiana: Landrieu (D-LA), Yea Vitter (R-LA), Nay
Maine: Collins (R-ME), Yea Snowe (R-ME), Yea
Maryland: Mikulski (D-MD), Yea Sarbanes (D-MD), Yea
Massachusetts: Kennedy (D-MA), Yea Kerry (D-MA), Yea
Michigan: Levin (D-MI), Yea Stabenow (D-MI), Yea
Minnesota: Coleman (R-MN), Yea Dayton (D-MN), Yea
Mississippi: Cochran (R-MS), Nay Lott (R-MS), Nay
Missouri: Bond (R-MO), Nay Talent (R-MO), Nay
Montana: Baucus (D-MT), Yea Burns (R-MT), Nay
Nebraska: Hagel (R-NE), Nay Nelson (D-NE), Yea
Nevada: Ensign (R-NV), Nay Reid (D-NV), Yea
New Hampshire: Gregg (R-NH), Nay Sununu (R-NH), Nay
New Jersey: Corzine (D-NJ), Yea Lautenberg (D-NJ), Yea
New Mexico: Bingaman (D-NM), Yea Domenici (R-NM), Nay
New York: Clinton (D-NY), Yea Schumer (D-NY), Yea
North Carolina: Burr (R-NC), Nay Dole (R-NC), Nay
North Dakota: Conrad (D-ND), Yea Dorgan (D-ND), Yea
Ohio: DeWine (R-OH), Yea Voinovich (R-OH), Nay
Oklahoma: Coburn (R-OK), Nay Inhofe (R-OK), Nay
Oregon: Smith (R-OR), Yea Wyden (D-OR), Yea
Pennsylvania: Santorum (R-PA), Nay Specter (R-PA), Yea
Rhode Island: Chafee (R-RI), Yea Reed (D-RI), Yea
South Carolina: DeMint (R-SC), Nay Graham (R-SC), Nay
South Dakota: Johnson (D-SD), Yea Thune (R-SD), Nay
Tennessee: Alexander (R-TN), Nay Frist (R-TN), Nay
Texas: Cornyn (R-TX), Nay Hutchison (R-TX), Nay
Utah: Bennett (R-UT), Nay Hatch (R-UT), Nay
Vermont: Jeffords (I-VT), Yea Leahy (D-VT), Yea
Virginia: Allen (R-VA), Nay Warner (R-VA), Nay
Washington: Cantwell (D-WA), Yea Murray (D-WA), Yea
West Virginia: Byrd (D-WV), Yea Rockefeller (D-WV), Yea
Wisconsin: Feingold (D-WI), Yea Kohl (D-WI), Yea
Wyoming: Enzi (R-WY), Nay Thomas (R-WY), Nay

Letter on Medicaid  

General Assembly Policy

Managed Care

[The 211th General Assembly (1999) of the Presbyterian Church (U.S.A.):]

(6)  Direct the Stated Clerk to communicate with the federal government by calling upon the United States Congress to do the following:

(a)Develop a national health plan designed to ensure access to medical care for all residents in the United States, with particular attention to the elderly, children, [people with physical, mental, and psychiatric disabilities.

(b)  Protect Medicare benefits.

(7)  Direct the Stated Clerk to communicate through electronic means to the elected and appointed officials in the legislative and executive branches of the federal and state governments calling them to do the following:

(a)   Protect uninsured persons, especially those with lower fixed incomes and those self-employed, from erosion of health-care benefits

(b)  Protect Medicaid benefits.

(c)  Protect the privacy and confidentiality rights of consumers.

(d)  Promote tort reforms to reduce the cost of health-care created by defensive medicine.

(e)  Protect the rights of the individual to choose the health-care providers of their choice.

(8) Direct the Washington Office to continue their advocacy efforts in support of the issues addressed in (6) and (7). (1999 Statement - PC(USA) pp. 341-342)

Washington Interreligious Staff Community Health Care Working Group 

"Speak out for those who cannot speak, for the rights of all the destitute. Champion the rights of the poor and needy" (Proverbs 31:8-9). 

February 3, 2005 

Dear Mr. President and Members of Congress,   

As people of diverse faith traditions, we share the core value of championing the rights of the poor and needy, including the right to health care. All human beings have the right to safe, affordable and high quality health care, and Medicaid is an important part of our nation's health care safety net. Therefore, we oppose Medicaid reform proposals that impose a cap on federal Medicaid spending, or eliminate the fundamental guarantee to Medicaid coverage for our nation's most vulnerable citizens, including low-income children and parents, pregnant women, people with disabilities and senior citizens.   

Since 1965, Medicaid has played a crucial role in providing health services to vulnerable populations; the program currently serves over 50 million people, about half of whom are children. A cap on federal funding--whether in the form of an allotment, an allocation or a block grant--would undermine our current federal commitment to populations whose health care needs would not disappear after the capped amount was reached.    

Arbitrary limits on federal Medicaid spending would fail to adjust automatically in response to economic recessions, demographic changes, health care inflation or natural disasters. No formula can account for the multitude of factors that affect Medicaid costs at different times in different parts of the country. Moreover, capped federal payments profoundly limit a state's ability to be innovative in responding to the 45 million people without health insurance in this country. Cutting Medicaid without real reform of the entire health care system will not address the health care crisis faced by our nation. 

The religious scriptures of our faith traditions speak with dramatic unanimity on the subject of responsibility to the most vulnerable in society. We believe that every human being is endowed with worth and dignity and created in the image of God. Reducing the deficit by cutting health care services for poor children, elderly sick people and the disabled undermines this dignity and is morally wrong. To ignore the uninsured in our nation, whose numbers are increasing even without the proposed caps on Medicaid, is not only negligent of those individuals, but also a violation of the core values under which our nation was founded.  

We in the religious community invite you to join us in advocating for the common good of our country by supporting policies that improve health coverage for all and enhance state flexibility without compromising the health and well-being of our nation's most vulnerable populations. 

Respectfully, 

American Baptist Churches USA
Anabaptist Center for Healthcare Ethics
The Association of Jewish Family and Children's Agencies
Call to Renewal
Central Conference of American Rabbis
Church of the Brethren Witness/Washington Office
Church Women United
Evangelical Lutheran Church in America
Fellowship of Reconciliation
Friends Committee on National Legislation
General Board of Church and Society of the United Methodist Church
Jewish Council for Public Affairs
Jewish Reconstructionist Federation
Mennonite Central Committee U.S. Washington Office
Mennonite Health Services Alliance
National Advocacy Center of the Sisters of the Good Shepherd
National Council of Churches USA
National Council of Jewish Women
NETWORK: A National Catholic Social Justice Lobby
Presbyterian Church (U.S.A.) Washington Office
The Rabbinical Assembly
Religious Action Center of Reform Judaism
Union for Reform Judaism
Unitarian Universalist Association of Congregations
United Church of Christ Justice and Witness Ministries
United Jewish Communities
United Synagogue of Conservative Judaism
Volunteers of America
Women of Reform Judaism 

cc: Mr. Joshua Bolten, Office of Management and Budget