About this transcript: This is a full AI-generated transcript of Senate convenes hearing on Medicaid as work requirements face scrutiny from The Hill, published August 5, 2026. The transcript contains 18,081 words with timestamps and was generated using Whisper AI.
"Longer than normal, but I think it's an important, very important topic. I'll tell you just right up front what prompted this hearing as our first hearing. It was the CBO release of the first three-quarter spending in Medicaid. And the result is year over year we're at $49 billion, which is a 10%..."
[0:00] Longer than normal, but I think it's an important, very important topic.
[0:04] I'll tell you just right up front what prompted this hearing as our first hearing.
[0:10] It was the CBO release of the first three-quarter spending in Medicaid.
[0:16] And the result is year over year we're at $49 billion, which is a 10% increase over what we spent in fiscal year 2025.
[0:27] Now, again, I'd like to be as cooperative as possible, but one of the reasons I wanted to hold the hearing is I wanted to counter the false accusations that Republicans cut and slashed Medicaid to the bone.
[0:40] It's simply not true.
[0:42] So just a real quick history of Medicaid passed in 1965.
[0:48] There were four designated groups of people that qualified to aid for families to depend on children qualified, aid to the elderly, aid to the blind.
[1:01] aid to the permanently and totally disabled.
[1:03] States could optionally cover people medically needed who had income levels above the threshold set and also children less than 21 that weren't on AFDC.
[1:12] And so that was the core group of people that Medicaid was initially designed to cover.
[1:19] Now, through the 90s and a little bit again in early 2000s, eligibility continued to expand, as did enrollment, as did the dollars and cents.
[1:30] We're going to have a little bit of dueling charts here.
[1:34] I think the committee should get used to my using of charts.
[1:38] But let's, again, the problem-solving process always begins with you have to admit you have a problem.
[1:45] Now, my guess is we have two definitions of the problem on each side of the dais here.
[1:51] Personally, I think Medicaid spending is out of control, and I will kind of prove that case.
[1:55] My guess on the other side of the dais, we're probably not spending enough.
[1:58] But anyways, set that aside.
[2:01] The next step is you have to define the problem.
[2:03] You have to agree on common facts.
[2:05] And what I'd like today's hearing to be about is laying out the basic facts we can all agree on.
[2:12] Once we do that, we can start doing root cause analysis.
[2:14] We can start taking a look at what kind of policy changes are required for something I hope we all agree with is prevent the massive fraud we're starting to, this has been revealed here over the last few months.
[2:27] But let's start with my, I'll call this a PowerPoint presentation.
[2:32] Everybody at their seat has the final chart of this buildup.
[2:36] But it starts with this chart, which just shows spending from 1990 to 1998.
[2:40] Now, again, this is 33 years into the program, we are spending less than $100 billion, and there's about 32 million people enrolled, which is around 12% of the population.
[2:54] Next chart.
[2:56] Now, I've been spending enough, talking an awful lot about different budget baselines, you know, take actual expenditures, increase them by population inflation growth.
[3:08] It's just a reasonable baseline control over, you know, what should we be spending.
[3:12] Had we done that to 1998 spending under Clinton, this year, last year, 2025, we'd be spending $248 billion.
[3:21] Okay, next chart.
[3:23] This shows actual spending, then on top of that, those projections, not really projections, but again, the baseline, through 2014, the first year that Obamacare kicked in and Medicaid expansion kicked in.
[3:36] You know, we were growing under the Bush administration, slightly higher than that, population growth and inflation.
[3:42] Under the Obama administration, those expenditures increased pretty significantly and above and beyond that, and of course, 2014, it really took off.
[3:51] Next chart.
[3:53] This is what we'd be spending if we took the 2014 spending, again, which is already first year into Medicaid expansion, and just increase that by population and inflation.
[4:05] We'd be spending $441 billion in fiscal year 2025.
[4:11] Next chart.
[4:13] This shows, again, actual spending on top of that inflation and population growth from 2014 through 2019, the year before the pandemic.
[4:22] Again, we're running ahead of that baseline.
[4:26] Next chart.
[4:28] So let's say you take 2019 spending, increase that by population inflation.
[4:34] This year, 2025, we'd be spending $536 billion.
[4:38] Final chart.
[4:40] This one in front of you.
[4:43] We're actually spending $668 billion.
[4:45] So again, that's just the financial facts.
[4:49] Instead of spending $248 billion under a Clinton 1998 baseline, or $441 billion under a Obama after Medicaid expansion was already instituted of $441,
[5:01] or $536 from the pre-pandemic baseline, we're spending $668 billion.
[5:07] I just think that indicates a program out of control.
[5:12] You combine that with the fact that now we have the Nick Shirley videos of the outrageous fraud uncovered in Minnesota with child leering centers and autism centers and transportation.
[5:29] I mean, all these things are defrauding Medicaid.
[5:31] And the problem with that is when you're spending billions of dollars on fraud, those are billions of dollars that can't be spent on the people who actually need it.
[5:42] And I think we'll hear from witnesses today, too, that a lot of Medicaid expansion, let me back up.
[5:49] Medicaid was initially established as a federal match to a state-administered program, where the states have a significant amount of skin in the game.
[5:59] Currently, for every dollar the states spend on a disabled child, they get about $1.33 in benefits from the federal government.
[6:07] Obamacare changed that for single, working-age, able-bodied, childless adults.
[6:13] And for every dollar the state spends on that category of individuals, again, not disabled child, not blind, not elderly, states get $9 in funding.
[6:23] I mean, we'll talk about it, but it makes no sense.
[6:26] I would say a lot of that has fueled some of the fraud.
[6:29] There's just no incentive for states to really be checking eligibility or really be investigating fraud.
[6:35] So we'll talk about that.
[6:37] But anyway, huge disparity in terms of the dollars spent.
[6:41] We've seen now the fraud, you know, we talked, and this is generally Medicare, but 400 hospice centers in Los Angeles.
[6:49] The third of all hospice centers apparently were in L.A.
[6:52] Dr. Oz defunded 400 of them, not one of them complained.
[6:56] So again, I hope we can get bipartisan agreement that we need to figure out how to eliminate this fraud.
[7:02] I can't tell you how much it is.
[7:03] We don't do a very good job tracking it.
[7:05] We don't have the controls in place.
[7:07] We designed these programs to really be out of control, which is what we've got.
[7:10] The final charts just talk about the enrollment.
[7:14] You can see it has skyrocketed.
[7:16] It has different, you know, points in time when it's done it through the 90s, early 2000s,
[7:21] but it really skyrocketed after Obamacare and Medicaid expansion.
[7:28] And I think the last chart you also have in front of you, this is a similar type of depiction as I've done in the other baselines.
[7:37] If you took the 1998 enrollment, increase it only by population, we'd be looking at about 40 million people on Medicaid.
[7:47] It'd be about 12% of our population.
[7:50] If you just take, again, 2014 after Medicaid expansion, so you've already had one year of Medicaid expansion.
[7:57] You'd be at about 70 million, about 20% of our population.
[8:02] But in fact, we're at about 88.2, which is over a quarter of our population is on Medicaid.
[8:08] Again, I don't think Medicaid was ever designed to cover 25% of our population, but that's where we are today.
[8:14] So again, these are just the basic facts.
[8:16] If we're going to solve a problem, again, I would hope on a bipartisan basis we'd like to at least eliminate the fraud in the program.
[8:24] Make sure the dollars we spend are going to the people who truly need it.
[8:29] We all want to provide that kind of help.
[8:32] We can hopefully eliminate the fraud.
[8:33] But again, these are just the numbers that indicate something's amiss here that needs to be addressed.
[8:38] With that, I'll turn it over to Senator Merkwik.
[8:40] Thank you very much, Mr. Chairman.
[8:41] And we're bringing different perspectives to bear, and that's the beauty of having hearings and debate.
[8:52] And the perspective that many Democrats are bringing to this, and probably a few Republicans as well,
[9:00] is that prior to 2009, we had a tremendous uninsured population in America,
[9:08] both because essentially there were a lot of holes in the Medicaid program as to who was covered,
[9:16] and then there was a gap above the income qualification for Medicaid,
[9:21] where people still couldn't afford insurance unless insurance came through their company.
[9:27] And then you had folks above that who couldn't afford insurance either.
[9:32] So essentially we did two things.
[9:33] We said, let's expand Medicaid, fill in the holes, address the still low, less affluent population above it,
[9:42] and let's create tax credits to help people buy private insurance in a marketplace.
[9:48] And in Oregon, I don't have the exact number in front of me,
[9:52] but I think we had roughly 25% of the population without insurance before we made those changes,
[9:58] and we were over 95% who had insurance afterwards.
[10:03] So the result of that is not only a big reduction in stress for families because they had insurance,
[10:11] but we ended a lose-lose situation.
[10:14] Folks without insurance simply would postpone getting treatment for medical problems
[10:20] because they couldn't afford to pay the bill,
[10:23] and then the problems become bigger and more expensive.
[10:26] And that's a problem for their health, but it's also a problem for the cost of the medical system.
[10:32] And then when they did go to get medical help, they went to the emergency room,
[10:35] which is the least efficient and highest cost piece of the entire system.
[10:41] And then because they didn't have insurance, they often couldn't pay the bill,
[10:44] which meant there was no revenue to cover the provision of services.
[10:49] So here we are with this lose-lose-lose proposition
[10:52] because we don't have comprehensive health care.
[10:55] So that's the vision that was undertaken.
[10:59] What we will see and lay it out is essentially when we're looking at the rising costs in Medicaid,
[11:05] it's essentially because the rising costs of health care per person in every aspect of health care,
[11:12] that is in individual insurance provided through Medicare and also through private insurance.
[11:19] Last year, the Republican majority used a bill that's a simple majority bill.
[11:26] And so they said essentially, we don't like this Medicaid program.
[11:31] We're not all in on this vision of health insurance for less affluent families,
[11:35] so we're going to cut it.
[11:37] And they slashed what will become more than a trillion from the health care system.
[11:41] And it will kick more than 15 million Americans off health insurance.
[11:46] And it will skyrocket the out-of-pocket costs for millions more.
[11:50] And where was the savings applied to?
[11:53] Tax breaks for billionaires.
[11:55] It was a very simple proposition.
[11:58] Less affluent families lose and billionaires win.
[12:02] And that's not a philosophy that many of us share.
[12:07] Many of us disagree with that philosophy.
[12:08] We think we should have a foundation for families to thrive,
[12:11] not a families-lose-billionaires-win strategy.
[12:17] Now, I'll partner with anyone to tackle fraud.
[12:19] Invest in audits?
[12:21] Absolutely.
[12:22] Uncover and stop fraudulent charges?
[12:24] Have significant penalties for that?
[12:27] Absolutely.
[12:27] Stop upcoding?
[12:29] You bet.
[12:30] And I've introduced a bill on upcoding.
[12:31] Upcoding a huge fraudulent practice.
[12:34] But we're in Medicare Advantage.
[12:37] But deliberately reducing health insurance coverage for less affluent families,
[12:42] that's not tackling fraud.
[12:44] That's simply destroying health care for less affluent families.
[12:48] It's back to where we were in a lose-lose-lose strategy for our nation.
[12:54] Now, the Trump administration has proceeded to protect fraudsters.
[12:59] How?
[13:00] By cutting off funding for Medicaid fraud control units.
[13:02] I would suggest, Mr. Chair, we should have a hearing on that.
[13:06] And by pardoning convicted fraudsters, including one executive who generated $205 million in false Medicare claims.
[13:15] We should have a hearing on that.
[13:16] So I'm all in on tackling fraud.
[13:21] But when the conversation about fraud is used as a strategy to wipe out health insurance for families
[13:28] and recreate a lose-lose-lose foundation in America, that I'm not all in.
[13:34] The vision of the red carpet for the rich and red tape for the poor is a bad vision for America.
[13:43] We've already wiped out, under what Trump called the Big Beautiful Bill,
[13:50] and we called the Big Ugly Betrayal, health care for 2 million children and 8 million people.
[13:57] And certainly, the 2 million children who have been booted off Medicaid or the Children's Health Insurance Program, CHIP,
[14:04] they weren't committing health care fraud.
[14:08] But I'll tell you what they were doing.
[14:10] They were going to the doctor when they needed medical treatment,
[14:13] and the clinic and the hospitals were getting paid.
[14:17] That's a win-win.
[14:18] So let's reject the lose-lose-lose strategy and adopt the win-win strategy.
[14:25] Without health insurance, people will delay getting care, develop more serious health issues,
[14:30] be more expensive to treat, go to the most expensive part, the emergency room,
[14:35] provide less revenue to our clinics and hospitals.
[14:39] And when revenue drops, hospitals and clinics close,
[14:43] reducing care for the entire community, regardless of what type of insurance you have.
[14:48] So proceeding to, well, take away health insurance for the less affluent
[14:55] actually has a profound impact on everyone's ability to have health care treatment.
[15:02] And you know where it's really scary?
[15:03] Rural America.
[15:06] If you wipe out the flow of revenue for a clinic or a hospital in urban America,
[15:12] well, there's another clinic or hospital nearby.
[15:15] But when you do it in a rural area,
[15:16] and the next clinic or hospital is 70 miles away or 100 miles away,
[15:21] that's certainly out west, that's not uncommon at all,
[15:24] then you're having a profound impact on the health of the entire community.
[15:29] If you have a health attack or that is a heart attack or a stroke,
[15:33] you don't have time to drive 100 miles to see a doctor,
[15:36] get to a hospital, get to emergency room.
[15:38] As of April of this year, 216 hospitals and clinics have already closed due to the provisions
[15:46] in the big, beautiful bill last year or dramatically reduced services.
[15:52] More than 1,000 hospitals, clinics, and nursing homes are at risk of closing or cutting services
[15:57] because of the cuts to Medicaid.
[15:59] And here's more bad news.
[16:03] There's even more devastating cuts coming in 2027, cynically scheduled to kick in after this November's election.
[16:12] An independent analysis by the nonpartisan Congressional Budget Office shows that this law will end coverage
[16:18] for 7.5 million Medicaid enrollees by creating a thicket of red tape, burdensome reporting requirements,
[16:24] and extra costs, like the $35 co-pays for Americans who are already struggling to afford the cost of gas and groceries.
[16:31] It's just wrong.
[16:32] Let's recognize that these cuts hit rural America the hardest.
[16:38] My state of Oregon is a big rural state.
[16:41] In rural Malloyer County and southeast Oregon, 52% of residents are covered by Medicaid.
[16:46] And if you compare the number of children in rural Oregon who are dependent on Medicaid,
[16:51] the Oregon Health Plan, compared to the rural, it's much higher in the rural areas.
[16:56] Compare that to folks in Washington County, just west of Portland,
[16:59] where only 25% of residents, instead of 52%, are covered by the Oregon Health Plan.
[17:04] That is our version of Medicaid.
[17:06] So again, it really attacks rural Americans.
[17:10] Now let's look at the numbers.
[17:12] And I share an affection with the chair of using numbers.
[17:16] Let's put up the first chart.
[17:18] Medicaid spending has grown slower than overall U.S. health spending.
[17:23] And you can see it from this chart.
[17:25] The blue line is much flatter than the red line.
[17:27] It's as simple as that.
[17:28] Since 2007, all health care spending has gone up.
[17:33] But Medicaid spending has gone up at a much lower rate.
[17:37] And now let's look at a forecast going forward.
[17:41] CMS forecasts that this year, the per-person costs of private insurance will increase more
[17:47] than the per-person costs of Medicaid.
[17:50] Not to mention that Medicaid makes up just 18% of national health spending.
[17:54] Between 2000 and 2023, while Medicaid's enrollment roughly doubled, Medicaid's share of national
[18:02] health spending ticked up just three percentage points.
[18:05] Three percentage points from 16% to 19%.
[18:10] So the problem isn't Medicaid.
[18:12] It's our overall health care system driving up costs across the board.
[18:17] You see it in private insurance.
[18:18] You see it in Medicare.
[18:19] And yes, you see it in Medicaid as well.
[18:21] But you see it going up more slowly in Medicaid than in these other arenas.
[18:26] CBO has found that every additional dollar we spend on children's Medicaid coverage today reduces
[18:33] federal deficits by roughly $2 in the future.
[18:36] Why is that?
[18:38] Because healthier kids grow into healthier adults, reducing their demand on the health care system
[18:43] while increasing their contributions and taxes.
[18:46] Well, we're creating a better foundation for children to thrive by making sure that they have insurance.
[18:53] That's critical to my state of Oregon, where nearly 60% of their kids get their health care
[18:59] through Medicaid or CHIP, Children's Health Insurance Program.
[19:03] But it's not just the kids who are threatened by these cuts.
[19:07] The big, ugly betrayal law passed last year on a partisan basis is also forcing states to slash home
[19:13] and community-based services for seniors and people with disability.
[19:16] Here's how it's affecting real people.
[19:19] In Minnesota, an autism therapy provider had to sell her cattle herd and lay off staff just to afford
[19:24] keep serving children who have nowhere else to turn.
[19:28] In California, because of in-home support services, a mother has been able to take care of her disabled son
[19:34] instead of having to work an additional job.
[19:36] And as she said, and I quote, without this, people become homeless.
[19:40] They lose their income.
[19:41] They lose their stability.
[19:42] Whatever tiny safety net they had is gone.
[19:45] It's just cruel.
[19:46] And of course, I think everyone is familiar that we're the only developed country where people
[19:50] are still going bankrupt because of the costs of health care.
[19:54] We have failed to provide the same firm foundation provided in every other developed country.
[19:59] In Oregon, one of my constituents wrote to me about her two 40-year-old sons with disabilities
[20:04] who, since they were 18, have lived in group homes and attended day programs.
[20:08] Her plea to us was simple.
[20:10] Don't force families like hers back towards institutionalization by cutting Medicaid funding
[20:15] for these programs.
[20:16] And institutionalization is always more expensive.
[20:20] In her words, it would be insane, inhumane, and a crime against humanity.
[20:26] Insane is right.
[20:27] This isn't about fraud.
[20:28] If it was, this hearing would be about the president pardoning convicted fraudsters, encouraging fraud,
[20:33] and cutting funding for Medicaid fraud control units.
[20:37] This hearing is about the red carpet for the rich and red tape for the poor.
[20:41] Health care is a right for all, not a privilege for the wealthy.
[20:44] Let's reject the strategy of families lose and billionaires win and replace it with a strategy
[20:50] of a foundation for every family to thrive.
[20:52] And that includes health insurance.
[20:56] Senator Merkley, you might have missed the fact that we provided $50 billion for a rural health care fund
[21:02] in the reconciliation bill.
[21:05] And I'll just remind everybody, Medicaid spending is up 10% this year.
[21:09] I don't think there's any projection that shows Medicaid spending being cut or declining at all.
[21:14] So, it's just going through the roof.
[21:16] But, again, appreciate your opening statement.
[21:20] Now, it is a tradition of this committee to swear on witnesses.
[21:26] If you all stand, raise your right hand.
[21:31] If you swear on the testimony you will give before this committee,
[21:33] it would be the truth, the whole truth, and nothing but the truth, so I'll help you God.
[21:37] Please be seated.
[21:38] Our first witness is Mr. Brian Blaze.
[21:42] Mr. Blaze is the president of Paragon Health Institute.
[21:45] He was a special assistant to the president for economic policy at the White House's National Economic Council
[21:49] from 2017 to 2019, where he coordinated the development and execution of numerous health policies
[21:55] and advised the president, NEC director, and senior officials.
[21:58] After leaving the White House, Mr. Blaze founded Blaze Policy Strategies and served as the CEO.
[22:03] Mr. Blaze.
[22:05] Chairman Johnson, Ranking Member Merkley, and members of the committee,
[22:08] thank you for the opportunity to testify.
[22:11] Medicaid is an important welfare program, but too often it fails the truly vulnerable.
[22:17] Children, pregnant women, seniors, and people with disabilities.
[22:22] The federal-state Medicaid partnership is broken.
[22:26] Over the past dozen years, states have shifted hundreds of billions of dollars of Medicaid costs
[22:33] to the federal government.
[22:35] Washington now pays more than 70 percent of Medicaid spending, up from the historic 60 percent.
[22:42] I will focus my remarks on two major problems.
[22:44] The Affordable Care Act's expansion of Medicaid to able-bodied working-age adults
[22:49] and the legalized money-laundering apparatus that results in massive corporate welfare through Medicaid.
[22:56] The ACA created a powerful financial incentive for states to prioritize expansion enrollees over traditional enrollees.
[23:04] On average, when a state spends $1 of its own money on a traditional Medicaid enrollee,
[23:10] the federal government contributes $1.33.
[23:14] But for $1 of state spending on an expansion enrollee, the federal government contributes $9.
[23:20] Thus, Washington pays states seven times more for each state dollar on expansion adults
[23:29] than for people Medicaid was created to serve.
[23:32] Multiple studies show that Medicaid expansion has made it harder for traditional enrollees
[23:37] to obtain physician appointments.
[23:39] It's increased wait times and forced more patients to rely on emergency rooms for routine care.
[23:45] Medicaid should prioritize the most vulnerable.
[23:49] Instead, its financing formula discriminates against them.
[23:53] The same misguided incentives explain the surge in improper Medicaid enrollment.
[23:59] Yesterday, Paragon released a study by Liam Segoe estimating that nearly half of the 20 million Medicaid expansion enrollees
[24:07] were likely ineligible in 2024.
[24:10] This imposed roughly $33 billion in improper federal costs, with a major cost shift from states to the federal government.
[24:20] A few states like California and New York have exceptionally high improper enrollment.
[24:25] But the problem exists in virtually every expansion state.
[24:28] Congress should end the discrimination against the most vulnerable
[24:32] and equalize federal reimbursement rates for all enrollees within each state.
[24:37] President Obama proposed equalizing reimbursement rates after the ACA became law.
[24:45] A second major problem is Medicaid money laundering.
[24:48] The clearest example is provider taxes.
[24:50] Former Oregon State Representative Mitch Greenlich called these, quote,
[24:55] dream taxes for states.
[24:58] Quote, we collect the tax from the hospital, we put it up as a match for federal money,
[25:03] and then we give it back to the hospitals.
[25:05] To be clear, this is not a tax.
[25:07] It has legalized money laundering mechanism for shifting costs from states to Washington
[25:13] while generating windfalls for politically powerful providers.
[25:18] In 2011, then-Vice President Joe Biden called provider taxes a, quote,
[25:23] scam and said they should be eliminated.
[25:26] Senator Durbin has called them a charade.
[25:29] The Simpson-Bowles Commission, set up by President Obama, recommended ending them.
[25:34] President Obama proposed limiting provider taxes, and the one big, beautiful bill basically adopted
[25:41] his proposal.
[25:43] Broken Medicaid incentives have led to a new form of corporate welfare, state-directed payments.
[25:49] Under the Biden administration, CMS allowed Medicaid insurers to pay hospitals up to average
[25:54] commercial rates, or more than two and a half times Medicare rates.
[25:59] Medicaid should not pay hospitals more than Medicare.
[26:01] Such excessive Medicaid payments distort the program's purpose and threaten seniors' access to care.
[26:08] In the one big, beautiful bill, Congress appropriately limited Medicaid payments through insurers to Medicare rates.
[26:16] Most Medicaid spending now runs through health insurance companies, generating enormous revenues for them.
[26:21] Yet there is remarkably little evidence that Medicaid-managed care has improved access, health outcomes, or reduced costs.
[26:30] Increasingly, Medicaid-managed care functions as a financing intermediary for corporate welfare.
[26:37] Medicaid's perverse incentives have also created a lucrative consulting industry devoted to helping states maximize federal reimbursement
[26:45] by gaining Medicaid's complicated financing rules.
[26:48] This does not improve patient care.
[26:51] Medicaid is an essential program.
[26:53] But Congress must improve the core incentives.
[26:56] Reward states for serving the most vulnerable, not for maximizing federal reimbursement.
[27:01] End the financial discrimination against the most vulnerable.
[27:04] Eliminate the Medicaid money laundering schemes and root out corporate welfare.
[27:09] Those reforms will help return the balance to the federal-state Medicaid partnership
[27:14] and improve Medicaid for America's most vulnerable citizens.
[27:18] Thank you, Mr. Blaze.
[27:19] Our next witness will be Mr. Jonathan Ingram.
[27:22] Mr. Ingram is the Vice President of Policy and Research at the Foundation for Government Accountability.
[27:27] Prior to joining FGA, Jonathan served as the Director of Health Policy and Pension Reform at the Illinois Policy Institute
[27:33] and is Editor-in-Chief of the Journal of Legal Medicine.
[27:36] He holds a Bachelor of Science in History and English, an Executive Master of Business Administration, and a Juris Doctor.
[27:42] Mr. Ingram.
[27:42] Chairman Johnson, Ranking Member Merkley, and members of the committee.
[27:48] Jonathan Ingram, Vice President of Policy and Research at the Foundation for Government Accountability.
[27:53] Criminals steal billions from Medicaid every year.
[27:57] Last summer, prosecutors charged a Russia-led crime syndicate that stole the identities of more than a million Americans
[28:03] and then billed Medicare and Medicaid more than $10 billion dollars.
[28:08] In May, prosecutors charged 15 defendants in Minnesota in the largest Medicaid autism fraud case in American history.
[28:16] In Ohio, fraudsters built networks of shell home health companies,
[28:21] billed Medicaid for care that they never delivered,
[28:25] and then posted videos of themselves drinking champagne on private jets.
[28:28] Those cases made headlines because prosecutors could bring charges.
[28:34] Many Medicaid losses never get that far.
[28:37] Bureaucrats wrote rules that enroll people without verifying eligibility
[28:41] and pay providers that nobody has screened.
[28:44] It's fraud by design.
[28:46] The fraud has two faces, criminal syndicates billing from overseas
[28:50] and rules quietly manipulated from cubicle.
[28:55] But the victims are the same.
[28:56] American families pay their taxes,
[28:59] trusting Congress to spend their money carefully.
[29:01] And the people this program was built for,
[29:04] senior citizens, pregnant women, children with disabilities,
[29:09] are left competing for resources that were stolen or diverted by bureaucrats before they ever arrived.
[29:16] Start with the scale.
[29:17] More than one in five Medicaid dollars is spent improperly.
[29:21] And before the one big beautiful bill,
[29:23] taxpayers were on track to lose more than $2 trillion over the next decade.
[29:28] More than 80% of those improper payments traced to eligibility errors.
[29:31] Five policy choices made that possible.
[29:35] First, bureaucrats stopped verifying applications.
[29:39] More than 40 states take an applicant's word on residency.
[29:42] More than a dozen take their word on income.
[29:46] And officials in at least 30 states now want to take enrollees' word on work requirement exemptions and compliance.
[29:54] Second, states stopped rechecking eligibility.
[29:58] Nationwide, states renewed 69% of recent cases without asking enrollees a single question.
[30:06] North Carolina renewed 99.5% of their 2.2 million cases this way.
[30:11] Third, states let hospitals enroll patients before anyone verifies eligibility.
[30:18] In California, hospitals deemed nearly 500,000 people presumptively eligible for Medicaid.
[30:26] When the state finally completed its full eligibility reviews, only 155,000 of those actually qualified.
[30:33] 30%.
[30:34] Federal taxpayers never got any of those dollars back.
[30:38] Fourth, bureaucrats import errors from other welfare programs,
[30:42] enrolling people in Medicaid based on their food stamp enrollment.
[30:45] Bureaucrats have built these one-door systems that merge enrollment across programs.
[30:50] Minnesota brags that it built a single app that signs someone up for as many as nine welfare programs in under 15 minutes.
[30:58] One wrong answer cascades through every program at once.
[31:03] And fifth, bureaucrats built an on-ramp for illegal aliens.
[31:08] States enroll applicants while they verify immigration status, a grace period meant to last 90 days.
[31:13] Seven in 10 of those temporary cases now last longer.
[31:18] One Utah enrollee has collected Medicaid for 5,820 days, 16 years, without ever proving immigration status.
[31:28] Enrollment through this loophole grew more than 400% under the Biden administration.
[31:33] The results match the design.
[31:35] Federal auditors have flagged millions of ineligible and potentially ineligible enrollees.
[31:41] Providers get the same free pass.
[31:43] Federal law requires states to rescreen every Medicaid provider at regular intervals.
[31:49] Illinois went three years without rescreening a single one, and some providers have gone 17 years without a revalidation.
[31:57] When CMS forced Minnesota to rescreen nearly 6,000 high-risk providers, the state disenrolled more than 62% of them.
[32:06] They failed background checks, they failed site visits, and they refused to turn over information.
[32:11] And when investigators do catch providers, states keep paying them anyway.
[32:17] States are supposed to suspend payments to any provider who's credibly accused of fraud.
[32:23] New York issued waivers to keep paying 96% of them.
[32:27] Massachusetts suspended payments for fewer than 1 in 10.
[32:31] So why do states run their programs this way?
[32:33] It's the money.
[32:35] Every dollar a state spends on Medicaid draws at least one federal dollar.
[32:39] And Obamacare supercharged that math.
[32:40] Washington pays states $9 for every dollar they spend on able-bodied adults.
[32:46] As Dr. Blaze mentioned, an average of $1.33 on the truly needy.
[32:51] Then states launder the rest, shifting more state costs onto federal taxpayers.
[32:56] So bureaucrats treat federal dollars, Medicaid, as free stimulus.
[33:00] They treat stopping fraud as budgetary malpractice.
[33:04] Every dollar of fraud that they stop is a dollar less of free federal money coming into the state.
[33:09] Many go further and game the match itself, misclassifying enrollees into Obamacare expansion to claim the higher rate.
[33:17] Bureaucrats designed this fraud over decades.
[33:20] But Congress can fix it.
[33:21] Require states to verify identity, income, immigration status before enrollment, not after.
[33:29] Require eligibility reviews.
[33:31] And provide a rescreening on schedules that states cannot ignore.
[33:34] And end the funding formula that pays states more to cover able-bodied adults than children with developmental disabilities.
[33:41] Thank you.
[33:43] Thank you, Mr. Ingram.
[33:44] Our final witness is Mr. Schneider.
[33:47] Mr. Schneider is a research professor of the Practice Center for Children and Families, McCourt School of Public Policy at Georgetown University.
[33:54] Most recently, he served under the Obama administration as a senior advisor at the Centers for Medicare and Medicaid Services,
[34:01] where he focused on program integrity issues in Medicaid.
[34:04] He is a graduate of Princeton University and the University of Pennsylvania Law School.
[34:08] Mr. Schneider.
[34:09] Thank you, Chairman Johnson, ranking member Merkley, and members of the committee.
[34:15] Appreciate the opportunity to testify.
[34:19] So, let me tell you about CCF, the Center for Children and Families.
[34:23] It's an independent, nonpartisan policy and research center found in 2005 with a mission to expand and improve high-quality,
[34:30] affordable health care coverage for Obamacare's children and families.
[34:33] As part of the McCourt School of Public Policy at Georgetown University, we conduct research, develop strategies,
[34:40] and offer solutions to improve the health of America's children and families, particularly those with low and moderate incomes.
[34:47] CCF is responsible for raising external funding to conduct our work.
[34:51] The full list of our current funders is available on our website.
[34:55] CCF does not accept any government, foreign, or corporate funding.
[34:58] Our work is funded primarily by full-out philanthropies.
[35:03] The testimony and views I'm presenting today are my own, not those of Georgetown University or the McCourt School.
[35:09] Here's the reality of Medicaid.
[35:12] It's a hugely important health insurance program for 67 million low-income Americans.
[35:17] It covers nearly 40% of our nation's children, nearly half of all children with special health care needs, and 40% of births.
[35:24] It's also the largest payer for long-term care services and supports for people with disabilities and seniors.
[35:30] It accounts for three-fifths of long-term care spending.
[35:34] It's particularly important to children and families in rural America and to hospitals and physicians that serve them and the communities in which they live.
[35:42] Non-elderly adults and children in small towns and rural areas are more likely than those living in metro areas to rely on Medicaid for their health insurance.
[35:50] Medicaid means access to needed health and long-term care services, as well as protection from medical debt, for children and families, and for all the other populations it serves.
[36:02] So it comes as no surprise that Medicaid is very popular with the American people.
[36:07] A January 2025 KFF tracking poll found that 77% of voters had very or somewhat favorable views about Medicaid, including 63% of Republicans and 81% of independents.
[36:19] In my written testimony, I discussed the role of Medicaid in our health care system, it's important to children and families, the harm that last year's budget reconciliation bill will do to millions of Americans who rely on Medicaid for access to health care and protection against high health care costs, and the reasons for federal and state spending, why that spending is growing.
[36:40] I also explained that actually reducing fraud against the Medicaid program requires collaboration between the federal government and the states, not withholding federal funds or partisan attacks.
[36:51] In closing, I want to sound one alarm.
[36:55] We at CCF closely monitor child enrollment in Medicaid.
[36:59] Our latest tracking, updated as of last Friday, finds that since January 2025, the number of children enrolled in Medicaid has dropped by 2.3 million.
[37:09] That's 2.3 million.
[37:13] That's as many children as in the states of Alaska, Delaware, Maine, Montana, New Hampshire, North Dakota, Rhode Island, South Dakota, Vermont, Wyoming, and the District of Columbia combined.
[37:25] This is a statistic that should alarm every policymaker who cares about the well-being of children.
[37:32] We know that declines in Medicaid coverage mean increases in the number of uninsured children.
[37:37] We know that uninsured children are children without access to preventive or primary care.
[37:42] We know that their families have no protection against medical debt if their children become sick or injured and need to go to the emergency room.
[37:50] At a minimum, CMS should be working with states to understand the root causes for this trend and take immediate steps to reverse it.
[37:58] Instead, CMS leadership seems laser-focused on withholding federal funds from California and Minnesota, 2.7 billion and counting, through repeated deferrals.
[38:10] That is the reality of Medicaid today, and it does not have to be this way.
[38:16] I hope the members of this committee will work with CMS to change course.
[38:19] I look forward to your questions.
[38:22] Thank you, Mr. Schneider.
[38:23] Mr. Blaze, let's quick address that issue of the 2.3 million children that have lost coverage under Medicaid.
[38:31] Can you explain that?
[38:32] Yeah, it's a deeply misleading statistic.
[38:35] If you look at combined Medicaid and CHIP enrollment from before the pandemic to 2026, there's actually a higher percentage of children on Medicaid and CHIP in the first part of 2026 than before the pandemic.
[38:49] One of the issues is we have fewer births in the U.S. because of the fertility decline than we have children who are moving off the Medicaid program because they age off of it.
[39:03] So when you account for those factors and you look at it as a percentage of all kids, there's actually a higher percentage of kids enrolled in Medicaid and CHIP than before the pandemic.
[39:11] Why don't you explain that?
[39:13] Mr. Schneider, there were four primary reforms in the first reconciliation package.
[39:19] The first one was requiring states to redetermine eligibility every six months rather than a year.
[39:25] Do you have a real problem with that?
[39:28] I mean, do you want people who are ineligible to be on these programs?
[39:32] I believe that the program should be only for people who are eligible.
[39:36] So is there anything wrong with states rechecking, redetermining eligibility?
[39:41] Because a lot of states obviously don't.
[39:43] They haven't been.
[39:44] I think the state should have some flexibility in how they administer their programs.
[39:49] The previous.
[39:50] You're not answering the question.
[39:51] I mean, is there a problem with rechecking eligibility?
[39:55] There's nothing draconian about that, correct?
[39:59] There's not a problem with rechecking eligibility.
[40:02] Next.
[40:04] Are provider taxes and provider fees, are those, is that health care?
[40:09] States are sovereign political entities.
[40:12] Is provider, does that, is that health care?
[40:18] Health care is in part how it gets paid for.
[40:20] The answer is no.
[40:20] So, Mr. Blaise, so when states charge a provider, provider fees and taxes, correct?
[40:29] For a Medicaid recipient, this, the provider gets reimbursed that amount, right?
[40:38] But again, the states are charging that for services across the board, correct?
[40:42] So, isn't it true, then, those provider fees and taxes artificially drive up the cost of health care for people on private insurance or for people on Medicare?
[40:51] They do.
[40:52] They do.
[40:52] We actually have a study from looking at a tax that California imposed that it increased commercial prices by about 4 percent.
[41:01] So, isn't it true that you said in your testimony, President Biden called that a scam.
[41:08] President Obama recommended doing exactly what we did in the One Big Beautiful Bill.
[41:12] That's not cutting and slashing Medicaid, right?
[41:14] That's just actually implementing what both President Biden and Obama recommended.
[41:19] That's correct.
[41:20] So, that's the second reform, the One Big Beautiful Bill.
[41:23] State-directed payments, and this one is kind of baffling.
[41:27] Can you describe a little bit more what that is, and intergovernmental transfers, where the states juice, you know, plump up what they charge or reimburse, like, their ambulance, their state-owned ambulance services?
[41:40] Can you describe that?
[41:41] Yeah.
[41:41] So, let me do state-directed payments first.
[41:44] On the fee-for-service side of Medicaid, there is a cap at Medicare rates.
[41:50] It's called an upper payment limit.
[41:52] That cap does not exist on the managed care side.
[41:55] So, as states have moved Medicaid enrollees into coverage through insurers, they've realized that they can create these provider tax and financing gimmicks,
[42:04] get the federal funds, and then lavish much higher payments on the big hospital systems.
[42:12] So, what the One Big Beautiful Bill did was extend the limits that were on the fee-for-service side of Medicaid to the managed care side.
[42:21] So, Mr. Schneider, does it make any sense to you whatsoever that for every dollar a state spends on a disabled child, a blind elderly individual,
[42:30] they get reimbursed, again, in the federal match, they get reimbursed $1.33.
[42:37] But for every dollar a state spends on a single, childless, working-age, able-bodied adult,
[42:45] states get $9 in reimbursement from a federal government that's $40 trillion in debt.
[42:49] Does that make any sense at all, that disparity to $1.33 for a disabled child, but $9 for a, some of you, in many cases, should be working?
[42:58] Does that make any sense to you at all?
[42:59] It's a policy choice that Congress has made.
[43:02] It's, there's, there's, similarly, there are differentials.
[43:06] Again, that's not the question.
[43:06] Does it make any sense to you?
[43:10] It, it, apparently, didn't make any sense to President Obama, because he, he recommended equalizing that treatment, correct?
[43:16] He did, in a 2012 budget proposal, uh, called the blended rate proposal.
[43:20] He proposed equalizing the match rates.
[43:23] Now, would he, would he, if he, would he increase the reimbursement for disabled children,
[43:28] or would he just drop that to a reasonable level?
[43:31] Like, no, if we're going to reimburse, uh, disabled children for $1.33, that's what we're reimbursed for-
[43:34] So, so he, so he had it as part of a deficit reduction plan, it would have, um, brought up the traditional, uh, federal reimbursements for those traditional categories.
[43:42] You know how, by how much from $1.33?
[43:44] I don't recall.
[43:45] Okay, okay, well, that's, uh, what I've got for the time being, uh, Senator Merkley.
[43:52] Yeah, thank you, uh, Mr. Chairman.
[43:54] Um, can you tell us, uh, Mr. Vlaz, Blaise?
[44:00] Mr. Blaise.
[44:03] Blaise.
[44:03] Uh, what is the federal poverty level for a mother and two children?
[44:10] The federal poverty level, um, for a household of three is probably around $25,000 a year.
[44:18] Yeah, that's approximately, uh, right, and, uh, Mr. Schneider, is it hard for a mother and two children to live on roughly $25,000?
[44:32] It's slightly higher, it's $27,000, but close enough.
[44:35] Is it difficult for a mother and two children to, to live on that?
[44:41] So, you're looking on, at a monthly income of $2,000 a month, depending on the, on the area of the country that the mother and child live in?
[44:51] Yes.
[44:52] I don't understand how they make ends meet.
[44:54] Extremely difficult, uh, and, uh, there probably aren't too many people in this room living at that level and struggling.
[45:01] And is it correct, Mr. Schneider, that when people are at that income level, it often varies tremendously in the course of a year because they get another part-time job,
[45:11] or the boss at one part-time job has a scheduled arrangement that doesn't work with the other part-time job,
[45:17] or child care problems intervene, so changes, a lot of fluctuation in the, in the, in the level of income?
[45:23] That's correct, Senator.
[45:24] And am I correct that Medicaid, for expanded Medicaid, covers 138% of federal poverty level?
[45:33] For, uh, in, in, in states that have accepted the option for adults?
[45:40] Yes.
[45:40] Yes.
[45:41] Yes, and...
[45:42] So, that's 1.3 times roughly $27,000, or roughly $36,000, still a very low income for a mother and two children.
[45:52] The point I'm making here is the, uh, the, uh, the chairman asked a question about reauthorizing the income level every six months.
[46:00] Uh, I will tell you, one of the enormous stress factors for very low income families is the refiling paperwork continuously,
[46:11] and the states have estimated that there's a massive, uh, uh, overhead, and essentially people bump up, bump down with every little job fluctuation.
[46:21] And so, I would say to my, my colleague, when you understand, uh, the challenge of less affluent families, uh, certifying it every year might make sense.
[46:31] You get more often than that, and you're just catching the fluctuations and creating enormous, uh, anxiety of, of, of qualifying, not qualifying, qualifying, not qualifying,
[46:42] which doesn't serve low income children or their, their families, uh, well.
[46:47] And, um, I wanted to turn to this question of the impact on rural America.
[46:54] Is it correct, Mr. Schneider, that there are a lot more folks on Medicaid in rural America than in urban America, in terms of the percent of the population?
[47:03] Yeah, in terms of the coverage. Yes, it's, yes.
[47:06] And am I correct that when you lose, uh, revenue at a rural clinic or hospital and it shuts down,
[47:13] that it affects everyone in the community because there isn't often another clinic or another hospital?
[47:19] That's correct, sir.
[47:21] And therefore, people might have to go a long distance to get healthcare, so they could have great health insurance,
[47:26] but their healthcare is still compromised?
[47:28] That's correct.
[47:29] Well, and I wanted to understand, uh, this, this question about children.
[47:35] Uh, you testified that in a short period of time, 2.3 million children have come off of, um, Medicaid because of the,
[47:45] the big, beautiful bill or the big, ugly betrayal as, as better known in most parts of the country.
[47:51] Uh, and, um, and yet we heard testimony from someone else saying,
[47:55] oh, that's just, uh, an anomaly because children are graduating out of the program faster than they come into it because of low birth rates.
[48:02] Is it just an anomaly or did that bill, uh, actually change the program in a fashion that is greatly reducing the number of children covered?
[48:12] So, let's separate two things.
[48:15] Um, we're looking, when we track child health enrollment, we are looking at current data from CMS,
[48:24] plus what we can get from the state agencies because there's a little data lag between what the states provide and what CMS has.
[48:33] So, if you're just looking at the CMS data, between January 2025 and April 2026,
[48:41] the Medicaid child numbers enrollment went down from 30.1 million to 28.2 million.
[48:48] So, that's a drop of almost 2 million.
[48:51] We say 2.3 million because we have some later data from some states.
[48:55] Okay.
[48:56] And that, that decline is very, very concerning.
[48:59] We don't know the reasons.
[49:01] We don't know the reasons, and we don't know how many of those 2.3 million, um, are going to end up uninsured.
[49:07] But we're very concerned based on what has happened historically,
[49:10] that when the child enrollment rate in Medicaid goes down, the uninsured rate for children goes up.
[49:17] Okay.
[49:18] And we want to do whatever we can to avoid that.
[49:20] So, just one factual question as I close out because I'm out of, out of time.
[49:25] Am I correct?
[49:26] Is Medicaid is the only health care program where the federal spending is shrinking as a share of GDP?
[49:32] Sir, I, I, I...
[49:36] You don't have the number.
[49:37] I assume so.
[49:38] I don't have that information.
[49:39] I apologize.
[49:40] I do have that.
[49:41] And that is, yeah, the answer is yes.
[49:42] Thank you.
[49:43] Thanks, Senator Merkley.
[49:44] The ranking member mentioned a family making $24,000.
[49:47] Uh, Senator Phil Graham has written extensively about families in that situation.
[49:51] In the 2025, uh, Wall Street Journal column, he pointed out a single mother, single parent,
[49:57] with two school-aged children making $11,000 would qualify for over $53,000 in tax-free benefits across the board.
[50:07] Again, $53,000 tax-free.
[50:11] So, again, we want to help people.
[50:14] We want to help single moms.
[50:15] And, you know, we, we want to see children make sure they have health care.
[50:18] Well, let's, again, talk about the facts.
[50:21] I mean, there aren't literally people only living on $24,000 who have, they have access to all kinds of welfare benefits.
[50:29] Again, in this case, $53,000 worth.
[50:32] Uh, Senator Kennedy.
[50:33] Senator Kennedy.
[50:40] Dr. Blaise.
[50:42] Uh, before President Obama expanded Medicaid to include able-bodied working adults,
[50:53] traditional Medicaid covered, uh, the poor, pregnant women, people with disabilities.
[51:00] Is that correct?
[51:01] That's correct, Senator.
[51:02] And today, those people are still covered, are they not?
[51:05] Correct.
[51:07] And is it not the case that, uh, for those folks in traditional Medicaid, um, for every $1 that, this is an average,
[51:19] for, for every $1 that, that, uh, a state puts up, the federal government puts up $1.33.
[51:27] Does that sound about right?
[51:28] That's, uh, average across the country, Senator.
[51:30] All right.
[51:31] Now, President Obama, through Obamacare, extended Medicaid to able-bodied working adults.
[51:38] Is that correct?
[51:39] Correct.
[51:40] Uh, and the, uh, on average, the federal government, for those, uh, I'll call them Obamacare, Medicaid,
[51:49] expansion enrollees, this, for every $1 that the state puts up, the federal government puts up $9.
[51:56] Is that correct?
[51:57] That's correct.
[51:58] Okay.
[51:59] So, if you're a governor, uh, for, for, for, for traditional Medicaid, you can get $1.33.
[52:06] For, uh, uh, Obamacare expansion enrollees, you can get $9.
[52:12] That's the math that they face.
[52:13] Right.
[52:14] Now, if you're a governor, you're going to try to get as many people on, uh, on Medicaid through Obamacare expansion, are you not?
[52:23] That is the incentive that states have, Senator, yes.
[52:27] Do some governors cheat?
[52:29] Uh, there are definitely some states that have a massive problem of improper enrollment.
[52:37] So people who would be-
[52:38] Do some, do, do some states cheat?
[52:40] Yes.
[52:41] Okay.
[52:42] Many states cheat.
[52:44] Now, the states determine, in accordance with federal rules, who's eligible for Medicare.
[52:55] Is that, for Medicaid, is that the case?
[52:58] Yes.
[53:00] Okay.
[53:01] Now, they have to do it in compliance with federal rules, right?
[53:03] There's, there's the federal eligibility rules that the federal government does a very poor job of enforcing.
[53:08] Do, do, do, do all, all, all states follow the, the federal rules?
[53:12] No, they don't.
[53:14] Some of them cheat, don't they?
[53:15] Many of them cheat.
[53:17] Right.
[53:18] Do some states just accept people's word that they make a certain amount of money and therefore qualify for Medicaid?
[53:28] Yes, Senator.
[53:30] Do all states say, listen, um, we hear you and we're not saying you're lying, but we're gonna cross-check, uh, your application with our state income tax records.
[53:43] Do all states do that?
[53:45] Uh, not all states do that.
[53:46] Okay.
[53:47] If they did, they would find out that some people are lying, wouldn't they?
[53:51] They would.
[53:52] Now, what's your best guess as to how much per year, um, this, this cheating costs the, the, the federal taxpayer?
[54:06] We released the report on this yesterday, Senator, and estimated that it's $33 billion.
[54:11] It was $33 billion in 2024.
[54:16] Okay.
[54:17] And that's $33 billion that is taken away from the people who really need Medicaid.
[54:25] Is that right?
[54:26] Yes.
[54:29] Has anybody gone to jail for doing this?
[54:31] Not to my knowledge.
[54:33] Don't you think we ought to start putting people in jail for cheating?
[54:37] Uh, I think that it's financial fraud against the federal government.
[54:40] Yes.
[54:41] Um, sir, on the end, I'm sorry, I can't read your name.
[54:45] Sir, I'm sorry.
[54:47] Don't you think we ought to put people in jail for cheating?
[54:50] Senator, I do not believe states are cheating.
[54:56] You don't believe they're cheating?
[54:57] I do not believe that.
[54:58] If they were cheating, what planet did you just parachute in from, sir?
[55:03] Sir, I've worked on this, I've worked on this program for a long time.
[55:11] It's not perfect, but states do not cheat.
[55:14] You don't believe states are cheating?
[55:16] I do not believe states are cheating.
[55:17] Do you believe in the tooth fairy, sir?
[55:19] Do you believe in the Easter bunny?
[55:24] Do you believe that Jimmy Hoffa died of natural causes?
[55:30] You're not answering.
[55:33] I do not believe states are cheating in the administration of the Medicaid program.
[55:37] Okay.
[55:38] Um, I'm glad you have some water in front of you because your pants are on fire.
[55:48] I'm gonna go back to Dr. Blaze.
[55:52] Tell me in the 13 seconds I have left, other than putting these people in jail, both the
[56:01] people who cheat and the bureaucrats who allow them to cheat, how else you would fix Medicaid?
[56:06] So the key problem with Medicaid is that the more states spend, um, the more money they
[56:12] get from the federal government.
[56:13] So to set the certain amount that states get and all state spending on top of that comes
[56:18] from the state, that would be an ideal reform.
[56:21] But, um, I'd say a first order reform is to end the discrimination against the most vulnerable.
[56:26] There shouldn't be, uh, uh, the federal government incentivizing states with seven times more money,
[56:32] uh, for the able-bodied than traditional enrollees.
[56:34] Sir, to the gentleman in the end, I, I, I don't mean to be rude to you, but if you really
[56:40] believe there's no cheating, you need to put down the bomb.
[56:44] That's the most, one of the most extraordinary statements I've ever heard a witness make.
[56:50] Okay.
[56:51] Thank you, Mr. Chairman.
[56:52] We'll move on.
[56:53] While we're on the topic, I just want to quick ask Mr. Blaze, do all states comply with
[56:57] the federal government requirements to provide information to the federal government to audit
[57:01] the results?
[57:02] Um, it's, it's a very mixed bag.
[57:07] Uh, I think the information that states provide is often incomplete, um, and the federal government
[57:12] needs to do a better job of getting real-time, uh, spending information from states.
[57:17] Which, which states are the worst in terms of compliance?
[57:20] Well, in terms of, uh, improper enrollment in the ACA.
[57:24] No, I mean, just in terms of not providing federal government information that's required
[57:27] or requested.
[57:28] That I don't know the answer to.
[57:30] Okay.
[57:31] Senator.
[57:32] Uh, Senator Cain.
[57:33] Senator Cain.
[57:35] Thank you, Mr. Chair.
[57:36] And thanks for holding this hearing.
[57:37] You know, this is an interesting one.
[57:38] There's that, that old parable about people with blindfolds on touching an elephant and
[57:43] all describing something different.
[57:45] And they're not necessarily inaccurate, but they're all describing something different.
[57:49] And I think there have been a number of charts that are probably accurate.
[57:52] Um, and there have been a number of statements that are accurate.
[57:56] The, the two million decline of kids in a year and a half in, in Medicaid is an accurate
[58:02] number.
[58:03] I do believe some of that might be related to fertility.
[58:07] Some of that might be related to more aging out than being born.
[58:10] I doubt that equates to two million, but that's probably a factor we should get into.
[58:15] Here's the chart that I want to put up.
[58:17] Um, and it's a chart of what's happening in Virginia.
[58:20] So I'm just going to spend my time talking about providers.
[58:23] And I bet some of you have a similar experience.
[58:26] Since the reconciliation bill passed, um, 12 hospitals or clinics in Virginia, and they're
[58:33] denominated in the red, have announced, not have announced, they have closed citing HR1
[58:41] and HR1 is the reason.
[58:42] The, the Medicaid changes in HR1 is the reason.
[58:46] And so these are the red dots on my map and they include three primary care clinics, um,
[58:54] and six school based clinics.
[58:58] And then three hospital units, a labor and delivery ward in one hospital and observation ward in
[59:05] another hospital.
[59:06] And I think a mental health observation, mental health wing in another hospital.
[59:10] So 12 closures in Virginia, where they have announced it is because of HR1.
[59:17] Now, remember the Medicaid cuts in HR1 didn't go into effect until late 26 or early 27, but
[59:24] any institution has to run a budget.
[59:26] So they're going to run the budget for the next year.
[59:28] And they're going to look at what percentage of their patients are Medicaid reimbursed.
[59:32] And they're going to see there's changes to Medicaid.
[59:35] And so even in the advance of these cuts being made, we already have 12 closures.
[59:41] The Virginia joint commission on healthcare.
[59:46] So this is not, you know, some liberal think tank or whatever.
[59:49] It's the joint commission on healthcare has additionally come up with a list of hospitals.
[59:56] This is not hospitals and clinics.
[59:58] It's hospitals that are either at immediate risk of closure or at risk of closure.
[1:00:04] And those are the yellow dots on this chart.
[1:00:06] And so we've got about 25 providers in Virginia, half of which have already closed.
[1:00:14] And then the other half, the joint healthcare mission says they are at risk or immediate risk of closure,
[1:00:19] just because of the Medicaid changes made in HR1.
[1:00:23] There's actually a CMS reg that's come out recently that extends HR1's effect on state-directed payment beyond what was in the bill.
[1:00:31] And my hospitals are coming to me and saying this is going to compound it.
[1:00:34] So this issue is going to get worse because it'll get worse when the Medicaid cuts actually factor in.
[1:00:41] And if the CMS rule on the SDP program comes in, it'll get worse.
[1:00:45] Now, here's the reason I wanted to bring this up.
[1:00:49] And I suspect my colleagues are seeing something similar.
[1:00:52] Virginia's population is about 9 million.
[1:00:56] 70% of the Virginia population lives in something that we call the Urban Crescent, which is basically D.C. to Richmond along I-95.
[1:01:08] And then Williamsburg, Newport News, Hampton, Virginia Beach along I-64.
[1:01:13] We call that the Urban Crescent in Virginia.
[1:01:16] 70% of our population, 5.5 million people live there.
[1:01:20] None of the closures, none of the at-risks for closures are in the Urban Crescent.
[1:01:29] They're all in rural Virginia.
[1:01:31] All of them.
[1:01:32] Shenandoah Valley, Appalachia, Southside, Northern Neck, potentially the Eastern Shore.
[1:01:39] And so this is what my providers are telling me.
[1:01:45] So that's data, too.
[1:01:47] You know, the overall growth of the program is data.
[1:01:50] But these are hospitals that have already closed, clinics that have already closed, and those that are threatened closed.
[1:01:56] And all of them are in rural Virginia because, as Mr. Schneider said, rural populations tend to have a higher Medicaid percentage in the payer mix.
[1:02:06] And they also tend to have a lower patient volume.
[1:02:09] So when you take, we already have a low patient volume, so we're sort of barely struggling.
[1:02:14] And then you take the core of our financial model and you make changes to it.
[1:02:18] That's why these closures are in rural Virginia and why they're likely to be.
[1:02:21] And I suspect states around the country are seeing exactly the same thing.
[1:02:25] The only real question that I want to put on the table, and I think it was, Mr. Blaze, you said, you know, one of the reforms we should make is have some uniformity in the program
[1:02:36] and then have any excess that's spent that should be on the state's shoulders.
[1:02:42] So I know you're talking about here's a program where the feds are, you know, being charged by the state.
[1:02:49] I mean, and your argument is we should just have governors do more state taxes or mayors do more local taxes to pick this up.
[1:02:58] Because if these changes are already leading to all these rural closures, I live in Richmond.
[1:03:05] I'm going to get service.
[1:03:06] But the 30 percent of Virginia that lives in rural Virginia, they're the ones seeing the closures.
[1:03:14] And if we were to do what you suggest, hey, you know, forget all this federal money in the state, the SDP program, just as you say, put the excess costs on the states,
[1:03:25] then, you know, I guess we could pat ourselves on the back and say we're bringing the cost curve down.
[1:03:31] But if we're just forcing states to increase taxes or mayors to increase taxes, I'm not really sure we're reducing costs.
[1:03:38] Instead, an awful lot of the most rural states where people are getting hurt the most are also the states that are probably least likely to be able to raise revenue at the state level to support these providers.
[1:03:52] So I'll just put my chart in with the others to say this tells me we got a huge problem.
[1:03:59] If the closures are all in rural Virginia, and I suspect overwhelmingly in rural America, then as we're trying to figure out what the answer is,
[1:04:07] we better come up with an answer that solves this. Thank you, Mr. Chair. I yield back to you.
[1:04:10] Mr. Blaise, he mentioned you. Do you want to quick respond to this?
[1:04:13] Yeah, Senator, and it's obviously it's complicated problem.
[1:04:16] You had rural hospitals that were struggling before the reconciliation bill last year was passed.
[1:04:22] The Assistant Secretary of Planning and Evaluation at HHS did a study looking at rural hospitals that closed from 2011 to 2023,
[1:04:32] and found that their occupancy was really low and had been declining,
[1:04:37] and that the vast majority of rural hospitals that closed were adjacent to urban areas.
[1:04:43] I think that from thinking that your job is to best spend federal taxpayer dollars,
[1:04:52] and a lot of these programs, the provider taxes, the state-directed payments,
[1:04:56] the beneficiaries of those overwhelmingly are wealthy, big hospital systems.
[1:05:02] That's not what my rural hospitals are telling me about the SDP rule.
[1:05:06] But I think the savings that you get from those broader reforms allow you to make targeted investments,
[1:05:13] which is what the Rural Health Transformation Fund is, and that's $10 billion a year.
[1:05:17] Yeah, but it's interesting. These closures have happened even though there was a Rural Health Transformation Fund.
[1:05:22] They closed even though they knew that Congress had tried to provide a little bit of money to try to help bridge this problem.
[1:05:29] I mean, I think the $10 billion a year is a lot of money given the financial exposure of rural hospitals.
[1:05:35] Not enough to stop these hospitals from closing.
[1:05:37] So, again, I would never question the veracity of, you know, people who get federal dollars.
[1:05:44] But I will point out when we passed one big, beautiful bill, Wisconsin went from 1.8% to 6% provider tax
[1:05:52] because they wanted to, you know, be part of the deal too.
[1:05:55] And it got lobbied by a hospital and said, you know, you've got to lobby Dr. Oz to create a waiver
[1:06:00] so we can get that 6% provider tax because if we do it, we can charge our patients $12 million
[1:06:09] and we'll get reimbursed for $18 million and we'll make a $6 million profit.
[1:06:15] That was the rationale.
[1:06:16] It wasn't like, hey, if we can't do this, we're going to go out of business.
[1:06:18] No, this is a money-making opportunity for us and you've got to lobby Dr. Oz to, you know,
[1:06:23] allow us to make that an extra $6 million.
[1:06:25] So, again, I would take what these providers who are getting all this federal money,
[1:06:30] I'd take what they say with a grain of salt.
[1:06:31] Senator Marino.
[1:06:32] Thank you, Mr. Chairman.
[1:06:34] Thank you for having this hearing.
[1:06:35] You know, there's an expression in sales that says facts get in the way of a good story.
[1:06:40] And obviously the Democrats want to stick with the story that Republicans are somehow for billionaires
[1:06:46] and they're for the working class, but obviously the facts are completely the opposite of that.
[1:06:52] Talking about rural America, they get wiped out in rural America.
[1:06:56] Rural American voters reject Democrats by wide margins.
[1:07:02] You would think that they would look at that and go, well, why is that?
[1:07:04] So let me give you a little bit of the answer.
[1:07:06] Your policies have destroyed American manufacturing.
[1:07:09] You allowed these jobs to get shipped overseas to China, Mexico,
[1:07:14] and our factories and places in Ohio got wiped out because of those policies.
[1:07:20] President Trump has put tariffs in place, which have brought these manufacturing facilities
[1:07:24] back to the United States of America.
[1:07:26] And yet they fought tooth and nail every step of the way on tariffs.
[1:07:30] You allowed drugs to come into our border, across our border with impunity.
[1:07:35] We had a completely wide open border and allowed tens of millions of people to enter this country.
[1:07:40] Cheap labor.
[1:07:41] That doesn't affect billionaires.
[1:07:43] I don't think billionaires get replaced by illegals crossing our border, but working Americans do.
[1:07:48] They see massive wage suppression.
[1:07:51] And so those are the policies that they've put in place.
[1:07:54] And they actually shut down the government and wanted one of the ransom notes was to get rid of the Rural Hospital Opportunity Fund.
[1:08:01] They wanted to eliminate it.
[1:08:03] None of them voted for it and they wanted to eliminate it.
[1:08:05] Those are just facts.
[1:08:07] The ranking member talked about the mom with two kids.
[1:08:10] We're the party that cares about the mom with two kids.
[1:08:13] We're the party that gave that mom a $2,000 child tax credit.
[1:08:18] You voted against that.
[1:08:19] We gave that mom an $1,800 child tax credit.
[1:08:24] You voted against that.
[1:08:25] If that mom worked for tips or overtime, you voted against that.
[1:08:29] You're the one that wants to give able-bodied adults more money than those kids that that mom has.
[1:08:36] I think a little self-reflection on that should be part of the equation.
[1:08:42] That those two things, just those two things, the child tax credit and the daycare credit is $3,800 for that mom making $25,000 a year.
[1:08:52] That's real money that you guys did not want to give that mom.
[1:08:56] That was just your votes and those are just facts.
[1:08:59] But when you did have control of Congress and the White House, what did you do?
[1:09:03] Did you help working Americans?
[1:09:06] No.
[1:09:07] You passed a law that gave $7,500 to the wealthiest 0.01% of Americans to lease luxury electric vehicles.
[1:09:20] So while the mom with two kids is making $25,000 a year struggling,
[1:09:26] the person making tens of millions of dollars a year could go into a Rolls-Royce dealership
[1:09:31] and get $7,500, thanks to each and every one of you, to lease a Rolls-Royce Spectre.
[1:09:36] Congratulations on that phenomenal policy.
[1:09:40] Mr. Snyder, if somebody's in this country without permission, should they be allowed to get healthcare on the backs of the American taxpayer?
[1:09:50] Yes or no?
[1:09:51] My own view is, if people need healthcare, they should receive it.
[1:09:59] So you think that somebody who is here illegally should have their healthcare paid for by the American taxpayer?
[1:10:06] So we have a law in this country.
[1:10:11] No, I'm just asking you, that's a simple yes or no question.
[1:10:13] Somebody's in this country?
[1:10:14] I agree with that.
[1:10:15] Somebody's, somebody's, let me just restate it.
[1:10:17] Yes, if they need emergency care, yes.
[1:10:19] So the taxpayer, the United States of America, should pay for the healthcare of people who broke into this country illegally?
[1:10:27] That's what Congress decided in 1980s.
[1:10:29] No, no, no, no, no, no.
[1:10:30] Congress never decided.
[1:10:31] I don't know what Congress you're talking about.
[1:10:33] If you needed emergency healthcare and you went to any other country on Earth, would you get it for free?
[1:10:39] Well, the countries that I've gone to, yes.
[1:10:42] You'd get healthcare for free if you went into, so for example, let's take Spain, which has incredibly difficult visa standards.
[1:10:50] If you went to Spain and needed heart surgery, you think the Spanish government would give it to you gratis?
[1:10:56] I can't speak to Spain.
[1:10:57] But do you think that's, that's, but it's interesting.
[1:11:01] I wonder if my Democrat colleagues would agree with that, that if people who broke into this country illegally should get healthcare.
[1:11:07] Mr. Snyder, if somebody broke into your home, would you make them dinner?
[1:11:12] No, I would not.
[1:11:14] Why not?
[1:11:15] Why not?
[1:11:19] Why wouldn't you?
[1:11:22] They need help.
[1:11:23] What if they're starving?
[1:11:24] What if somebody broke into your home who's hungry?
[1:11:27] Would you not feed them?
[1:11:28] Or would you call the police and get the heck out of the house?
[1:11:33] If somebody was hungry and needed to be fed, I would feed them.
[1:11:36] So if somebody broke into your house, you will feed them.
[1:11:39] Don't give anybody your address.
[1:11:42] Whatever you do, I'm asking you just for your own person's sake, do not release your address.
[1:11:47] Can I answer the question?
[1:11:48] You can, please.
[1:11:49] Somebody breaks into my home and they're hungry.
[1:11:51] I'm going to forgive them for breaking in.
[1:11:53] I'm going to feed them and then we'll work out accountability for what they've done.
[1:11:58] Okay.
[1:11:59] Like I said, don't release your address.
[1:12:01] But on behalf of the American taxpayers, especially the hardworking men and women of this country,
[1:12:06] no.
[1:12:07] Government benefits, taxpayer dollars should be absolutely and exclusively reserved for American citizens.
[1:12:14] And so the party that says they care about working Americans, this is why you keep losing in rural America.
[1:12:19] This is why you guys get wiped out in places like that.
[1:12:22] Whether it's Virginia or Oregon, you do not win in the rural parts of your state.
[1:12:27] You get absolutely crushed because of that kind of philosophy.
[1:12:31] Senator Mercury, would I like to make a comment?
[1:12:36] Thank you.
[1:12:38] Just for the record, undocumented individuals are not eligible for Medicaid unless they're in emergency, going to the emergency room under very limited circumstances.
[1:12:48] And yes, those same services emergency are provided by many other nations if Americans are traveling abroad for an emergency service.
[1:12:56] Mr. Blaise, very quickly, how many illegal immigrants do you think are on Medicaid?
[1:13:01] Not beyond, beyond emergency services, but on Medicaid.
[1:13:05] Do you have any estimate in California?
[1:13:09] In California, it's considerable.
[1:13:12] California got one of these provider tax schemes approved and then the next got $10 billion in federal funds without any state contribution.
[1:13:21] And the next year expanded Medicaid to all unauthorized immigrants in the state.
[1:13:27] Senator Lujan.
[1:13:28] Thank you very much, Mr. Chairman.
[1:13:32] Coming into the hearing at the moment that I did, it really caught my attention as my colleague departs.
[1:13:38] You know, some of us are Catholic.
[1:13:40] And my colleague went to Catholic high school, I believe, if I'm not mistaken, someone that should understand the lessons that are taught to us every day.
[1:13:48] I'd refer my colleague from Ohio to teachings under St. Francis of Assisi if he needs to learn about what it means to shelter those that need some help or provide food to those that need some help or care for those that need some help.
[1:14:03] I grew up in a rural community.
[1:14:05] I didn't have a Rolls-Royce dealership.
[1:14:07] I still live on a small farm.
[1:14:10] I put diesel in my tractor.
[1:14:11] I turn dirt every day.
[1:14:13] I fix fences.
[1:14:14] When my neighbors need help fixing a fence, I go help them put that fence up.
[1:14:19] I don't ask if they're Democrat, Republican, whatever it may be.
[1:14:21] We do it.
[1:14:22] This lesson about how the big, beautiful bill, a piece of legislation that President Trump ran on that my Republican colleagues are trying to fleece the American people in convincing them that this bill helps them.
[1:14:39] A trillion dollars was taken out of healthcare.
[1:14:43] How the hell does that help anybody?
[1:14:44] I'm a stroke survivor.
[1:14:46] Four years ago, I had a stroke.
[1:14:48] What I learned is time is not on your side if you have a stroke.
[1:14:51] You need to get to the doctor immediately.
[1:14:53] Well, not in the case of what happens with the trillion-dollar cuts and Medicaid facilities start closing and rural clinics start closing.
[1:15:02] And if that was not enough, then they went and devastated food programs in America, kicking farmers and ranchers in the teeth and closing rural grocery stores.
[1:15:10] That's the big, beautiful bill.
[1:15:13] They just voted on it.
[1:15:15] Facts are funny.
[1:15:18] Anyhow, this hearing is about Medicaid, the realities around Medicaid.
[1:15:23] If I'm not mistaken, the big, beautiful bill removed about a trillion dollars from healthcare, more than $800 billion of federal Medicaid dollars.
[1:15:32] And my Republican colleagues profess that they did not cut, they being Republicans, did not cut Medicaid.
[1:15:40] They only transferred the cost to states.
[1:15:42] They eliminated a trillion dollars in access to healthcare.
[1:15:46] Medicaid programs across the country, we don't know who's going to get care or who's not going to get care.
[1:15:52] I have constituents writing to me every day about a concern of being able to pay bills, trying to figure out if they're going to be able to get access to care or not.
[1:16:01] Dina from Bernalillo County, which is the largest county in New Mexico, populous wise, said, as I was sitting in urgent care this weekend, I started to have serious anxiety that next year I might be without my Medicaid insurance.
[1:16:14] And I may not be able to go to urgent care if I needed to.
[1:16:18] When the Affordable Care Act was passed, we had a Republican governor in New Mexico that did the right thing and embraced Medicaid expansion.
[1:16:28] It took New Mexico from one of the most uninsured states in the country to a state that actually people could get some coverage and have some certainty that care was going to be there.
[1:16:37] Democrats and Republicans should be working together in all these.
[1:16:41] If we're going to talk about reforms, let's talk about smart reforms.
[1:16:44] Let's talk about ways that we can get care to people in the most effective manner possible so that if someone out there has a stroke like I did, they're going to live and they're actually going to recover the way that I did.
[1:16:55] Because my recovery is also very unique.
[1:16:58] I was very blessed with that recovery, but it's because I had access to care.
[1:17:01] Eight million Americans have already lost health care coverage, including nearly four million who lost Medicaid CHIP, the Children's Health Insurance Program.
[1:17:11] Now, Professor Schneider, are children protected from Medicaid cuts, as my Republican colleagues have suggested?
[1:17:18] Over time, the large withdrawal of federal funding, close to a trillion dollars over the next 10 years, that's in H.R. 1, everyone in the program is at risk.
[1:17:31] Children, people with disabilities, seniors, people in rural areas, people in urban areas, the providers that serve them, they're all at risk.
[1:17:43] You anticipated my next question about seniors.
[1:17:46] I appreciate that response.
[1:17:48] I did not hear you specifically mention people with disabilities.
[1:17:53] I heard you say everyone, but what about people with disabilities?
[1:17:56] Exactly the same situation.
[1:17:59] The states were expecting the resources that had been in place before H.R. 1 was enacted, and over the next 10 years, they're not going to have those resources available.
[1:18:12] Now, coming from a rural community myself, hearing the question from my colleague that was speaking before me, are adults and children in small towns and rural areas more likely than those living in metro areas to rely on Medicaid CHIP for their health insurance?
[1:18:31] Medicaid is a slightly more important payer for families and children in rural areas than in urban.
[1:18:38] The same holds true.
[1:18:39] It's important in both, but it's a little more important in rural.
[1:18:42] I appreciate it.
[1:18:43] Well, this hearing is not on SNAP.
[1:18:44] The same holds true for SNAP as well.
[1:18:46] So, look, Mr. Chairman, I certainly hope as the budget reconciliation debate is continuing on budget reconciliation three, we're looking at access to health care.
[1:18:56] Costs are going up.
[1:18:57] You know, some folks try to refer to this as affordability.
[1:18:59] People just can't afford to get services and to get by, and that we should not forget about Social Security.
[1:19:05] I challenge my Republican colleagues at the last hearing we had on Social Security, maybe in your next budget reconciliation bill, we'll actually see some language in there to make sure Social Security is solvent.
[1:19:16] And it didn't happen.
[1:19:17] Well, lo and behold, there's another budget reconciliation coming forward.
[1:19:20] So I look forward to seeing how Republicans are going to protect Social Security and make sure that it's going to be solvent in the next budget reconciliation package as well.
[1:19:27] I appreciate all the panelists and everyone here today for the hearing.
[1:19:30] So a couple of comments.
[1:19:31] Reconciliation can't touch Social Security.
[1:19:33] I've got to defend Lutherans.
[1:19:35] We're pretty compassionate, too.
[1:19:36] And I would just remind Senator Lujan, take a look at the chart there.
[1:19:39] In 2014, the first year of Obamacare Medicaid expansion, we spent about $400 billion on Medicaid.
[1:19:47] 2019, we were spending, actually, 2014 spent a little $300 billion.
[1:19:53] 2019, about $400 billion.
[1:19:56] This year, we'll spend $668 billion, or 2025.
[1:20:02] This year, we'll spend about $735.
[1:20:04] So it went from $300 billion first year of Obamacare, $400 billion right before the pandemic, $668 billion last year, $735 billion this year.
[1:20:13] Again, I'm just not seeing where we're taking a trillion dollars out of Medicaid.
[1:20:17] The costs of Medicaid are exploding.
[1:20:19] But with that, we'll turn to Senator Scott.
[1:20:21] Mr. Chairman, could I respond to that?
[1:20:24] I would ask unanimous consent to submit the analysis of H.R.1 from CBO into the record.
[1:20:29] And that will respond to your questions associated with the trillion-dollar tax cut.
[1:20:32] Thank you.
[1:20:33] I'm really high on CBO projections.
[1:20:34] Senator Scott.
[1:20:35] All right.
[1:20:36] Thank you, Chairman.
[1:20:37] Thanks for holding this, Dr. Blaze.
[1:20:39] The Medicaid program was originally set up, what, for seniors, children, pregnant women, disabled, right?
[1:20:45] Correct.
[1:20:46] And the reason it was set up the way it was, was that the federal government would pay a portion, and the states would pay a portion.
[1:20:51] And the states would pay a portion out of their own taxes, right?
[1:20:54] Correct.
[1:20:55] Right.
[1:20:56] And I guess, you know, it goes from, what, 50 to, depending on the income level, the states pay from 50 percent to as little as, what, 15 percent about?
[1:21:07] Yeah.
[1:21:08] So for the traditional population, wealthiest states, they spend a dollar.
[1:21:11] Federal government contributes a dollar.
[1:21:13] Poorest states, they spend a dollar.
[1:21:15] Federal government contributes three dollars.
[1:21:17] But for all states, wealthy or not, when they, when Obamacare expanded to able-bodied adults, it was 90-10.
[1:21:24] It was actually 100 percent for the first three years, and it's phased down, and it's 90 to 10 now.
[1:21:30] So if you look at a state budget now, there, have states used the, have gained, have they gained the 90-10 match to, to pay for things that have nothing to do with healthcare?
[1:21:40] Yeah, I mean, states get seven times more funding when they spend a dollar on the expansion population than the traditional population.
[1:21:50] And particularly given that they can finance their state share with these legalized money laundering tactics, states use Medicaid to fund other state projects.
[1:21:59] And the ACA expansion, the 9 to 1, is a multiplier on the money laundering apparatus.
[1:22:05] So have some states said, okay, gone to a provider and said, hey, you'll pay us some money so we can get extra money for Medicaid?
[1:22:11] Yeah, in any case, Senator, it's the provider that goes to the state and says, we've designed this scheme that's just going to plus us up with federal tax dollars.
[1:22:22] So this concept that the states would put up a portion to make sure the dollars are spent wisely, to make sure the people are covered, doesn't really work anymore?
[1:22:31] That's deteriorated, yes.
[1:22:33] So, I mean, when you think about it, if the federal government's goal was to make sure we take care of, especially, you know, the pregnant women, kids, disabled,
[1:22:43] the states have lost focus because there's so much money, and the providers have looked at it, there's so much money out here for the able-bodied adults.
[1:22:51] The federal government is encouraging states to discriminate against the most vulnerable.
[1:22:56] Dr. Oz recently paused payments to California, knowing that the in-home supportive service program has grown over 24 percent over two years, way more than the national average.
[1:23:06] What's noteworthy is that the funding of this program is 55 percent federal, about 35 percent is intergovernment transfers, leaves the state only paying about 11 percent.
[1:23:15] Okay, so now they're supposed, I thought they were supposed to have a 50-50 match.
[1:23:20] So, explain how that works.
[1:23:22] So, intergovernmental transfers, the problematic, most problematic ones are where you get a local health facility that transfers money to the state.
[1:23:33] The state then uses that, has its payment back to the facility, and then leverages the federal dollars.
[1:23:40] So, it's a way for states to use the Medicaid financing system to benefit the government-owned providers at the expense of the taxpayer.
[1:23:49] And you have some examples where, like in California, they do this for their ambulances, too, where they'll pay the government ambulance providers more than three times what they pay the private ambulance providers through the Medicaid program.
[1:24:01] So, so that, like that ambulance company has no risk.
[1:24:06] I mean, there's just extra money.
[1:24:08] Yes.
[1:24:09] They're, they're just using the federal tax dollars to pay.
[1:24:11] Because we all, we should expect our states to be, have skin in the game.
[1:24:14] And what we're, what you're saying is what happens is they don't actually have skin in the game.
[1:24:18] They don't have skin in the game, and they're, and they're lobbied.
[1:24:21] Like there is, in the state capitals, I mean, you know this as a, as a former governor, and former governors know this.
[1:24:26] You're lobbied by the special interests to design programs this way and take advantage of the federal taxpayer.
[1:24:32] Mr. Mr. Ingram, the HHS Office of the Inspector General recently decertified New York's Medicaid Fraud Control Unit due to a year-long failure to do its job.
[1:24:41] Despite receiving over $60 million annually and having a staff of 270 people, New York was the worst performing unit compared to other states.
[1:24:49] This office was only able to secure 85 fraud convictions from 20 to 25, when the newest, next lowest scoring state had 237 convictions, almost three times more.
[1:24:59] New York had 49 criminal fraud indictments between 20 and 25, which is less than 10 a year.
[1:25:04] The next state had 268, five times more.
[1:25:08] It's not that fraud isn't there.
[1:25:10] Indiana and Arizona were able to secure five and seven times as many indictments in 25 alone compared to New York's seven.
[1:25:16] How important is the Medicaid Fraud Control Unit program, and what does it mean when a state is, that is run so poorly like New York,
[1:25:22] that only one conviction per, for patient abuse in 2025, despite having 2,000 patient abuse referrals a year?
[1:25:30] Well, New York's fraud control unit under AG Letitia James has been horrendous, as you noted.
[1:25:39] It's one of the worst in the countries.
[1:25:41] You mentioned Indiana and Arizona.
[1:25:44] Those are states with programs, you know, one fifth the size of New York.
[1:25:49] They have about one tenth the staff, one tenth the budget.
[1:25:53] And they're delivering, you know, five to seven times more criminal indictments.
[1:25:58] They're delivering more convictions, more civil recoveries.
[1:26:01] New York had not a single hospice fraud investigation, despite that being sort of a hotbed of fraud in New York.
[1:26:11] It's not a new problem. It's been ongoing for years.
[1:26:15] It definitely worsened under President Biden.
[1:26:18] States are getting more funding from taxpayers than ever for these units and delivering worse results.
[1:26:25] Investigations are down, indictments are down, convictions are down, recoveries are down.
[1:26:29] Indictments in New York have dropped 93 percent since 2019.
[1:26:34] Over a dozen of these units recover less fraudulent funds than it costs federal taxpayers to operate them.
[1:26:45] So, you know, this is a longstanding problem.
[1:26:47] Nobody really seemed to care until President Trump came in.
[1:26:51] He's doing something about it.
[1:26:53] You know, New York was decertified.
[1:26:54] Hawaii was decertified.
[1:26:55] But a future administration could go back to the way things were under President Biden.
[1:27:00] So I would encourage everyone to codify stronger oversight requirements for these and really make them effective.
[1:27:07] Thank you.
[1:27:08] Senator Whitehouse.
[1:27:09] Thanks, Chairman.
[1:27:12] We're here today because the billionaire's bill will knock down Medicaid spending by somewhere in the neighborhood of a trillion dollars.
[1:27:27] Some basic facts are the Medicaid money does not go to the Medicaid recipient.
[1:27:33] It goes to the people who provide the health care.
[1:27:35] It goes to hospitals.
[1:27:36] It goes to nursing homes.
[1:27:37] It goes to doctors.
[1:27:38] It goes to pharmacists.
[1:27:40] So when you drop that kind of a spending cut into our health care system, you're going to see real problems.
[1:27:49] And I think, knowing that, Republicans set the grenade to go off after the election so that the damage to individuals was not front page news everywhere before the election.
[1:28:05] But what we are seeing is that the entities that receive the Medicaid funding are having to start doing their budgeting for the trillion dollar cuts.
[1:28:16] It's responsible to look forward.
[1:28:20] And as they're doing that, they're starting to see, oh, my God, our numbers don't work anymore.
[1:28:28] The financials now for hospitals are being affected by the predicted cuts to Medicaid.
[1:28:36] The financials now for doctors practices are being affected by the predicted cuts to Medicaid.
[1:28:43] And nursing homes have a particularly bad vulnerability.
[1:28:47] And they're starting to see those cuts as well.
[1:28:50] So we need to be paying attention to the forewarnings that the financial work in these industries are giving us about what the hell is coming at us.
[1:29:04] Because the grenade may be set to go off after the election, but it's still going to go off.
[1:29:09] And that's why we're living through this narrative creation effort to suggest that the problems with Medicaid are that it's riddled with fraudsters.
[1:29:20] People are crooked.
[1:29:22] And, oh, folks, it has nothing to do with the billions and billions and billions in tax cuts that we gave in that bill to the wealthiest and highest income people in the country,
[1:29:37] some of whom, as billionaires, actually don't pay any taxes, actually don't.
[1:29:43] That's, as Ms. Helmsley famously said, for the little people.
[1:29:50] And this body is highly responsive to those billionaires.
[1:29:55] And so, of course, out went the Medicaid spending.
[1:29:59] In went the tax cuts for billionaires.
[1:30:01] And that's why we are where we are.
[1:30:04] The device is employment reporting.
[1:30:10] It's to create a red tape bomb that makes it as difficult as possible for people on Medicaid to fill out the requisite paperwork so they can keep their benefits.
[1:30:21] That's the trick.
[1:30:23] That's the stunt that's being used to knock people off Medicaid.
[1:30:28] I don't know how many of my colleagues hang out with people on Medicaid.
[1:30:31] We're a pretty high-end group here around the Senate.
[1:30:35] But I tell you around Rhode Island, who's on Medicaid?
[1:30:39] It's people with really significant learning disabilities.
[1:30:43] It's people with mental health issues that they're getting treatment for.
[1:30:49] It's people in addiction recovery.
[1:30:52] It's people with really severe health conditions that interfere with their ability to earn a living.
[1:31:01] It's people with multiple health conditions.
[1:31:03] So many they can barely keep track of their multiple health conditions.
[1:31:06] And all of those people with all those conditions are now supposed to be experts at red tape so that they don't get pushed off by employment reporting requirements.
[1:31:20] It's kind of a dirty trick.
[1:31:23] And the notion that fraud is so endemic in Medicaid is a little bit belied by the fact that it's the only program that has a specifically dedicated fraud detection and prevention program.
[1:31:42] I was the attorney general of the state of Rhode Island.
[1:31:45] I ran our Medicaid fraud control unit.
[1:31:50] Everybody had one.
[1:31:53] We didn't find all that much, Mr. Chairman, because Rhode Island's a small state.
[1:31:59] It's hard to set up a phony baloney doctor's office and run millions of dollars in payments through without somebody catching on real quick.
[1:32:06] But boy, was Florida a festival of fraud.
[1:32:10] It has its own Medicaid fraud control unit.
[1:32:17] They all do.
[1:32:18] Other programs don't have that discipline.
[1:32:20] They're not policed that way.
[1:32:22] So the idea that fraud is out of control in Medicaid to me is not credible.
[1:32:29] What is credible is how many people, individuals with significant disabilities, very often addiction, mental health, learning,
[1:32:41] so that they're able-bodied are going to get clobbered by the red tape bomb that Republicans set to go off after the election.
[1:32:54] And the tell is the financials of the providers who are looking forward to what their financial world looks like when that grenade goes off.
[1:33:06] Thank you, Chairman.
[1:33:07] I will point out that Governor Walz and Attorney General Ellison didn't find much fraud in Minnesota either.
[1:33:11] And I also remind people that just the basic facts, and I'll repeat them again, probably do it again.
[1:33:17] In 2014, the first year of Obamacare's implementation, Medicaid spent $300 billion.
[1:33:24] 2019, before the pandemic, spent $400 billion.
[1:33:27] Last year we spent $668 billion.
[1:33:30] More than double where we spent first year of Medicaid expansion.
[1:33:33] This year we'll spend $735 billion.
[1:33:35] Again, I'm just not seeing these cuts.
[1:33:37] You know, I can do math.
[1:33:39] That is an out-of-control increase in Medicaid spending.
[1:33:42] Senator...
[1:33:44] Mr. Chairman, if you're going to argue with each of us after we've made our statements, I think we're entitled to reply.
[1:33:49] And I think it's important simply to reiterate what I said.
[1:33:54] There are a great number of Medicaid patients for whom keeping track of the new red tape employment requirements,
[1:34:03] the new red tape bomb that Republicans built into the billionaire's bill to specifically to knock people off.
[1:34:10] The test was how many people you could knock off Medicare.
[1:34:13] How can you reduce the spending by knocking those people off Medicare?
[1:34:17] And the selection is going to be the people who are most vulnerable, who don't have the skills,
[1:34:22] to keep up with the paperwork and red tape bomb that's going to be set off in their lives.
[1:34:28] That's what we're dealing with.
[1:34:31] We'd like to keep immigrants off the Medicaid rails.
[1:34:33] Senator Van Hollen.
[1:34:35] Mr. Chairman, first we should be clear about this.
[1:34:38] There's nobody in this room that doesn't want to crack down on waste, fraud, or abuse.
[1:34:45] Every one of us recognizes that a dollar that goes to fraud is a dollar that is not going to somebody who needs the help.
[1:34:54] And I don't think there's a person in this room who disagrees with that statement.
[1:34:58] I do have to question why the Trump administration in its very first days eliminated the inspector generals
[1:35:05] and a whole bunch of departments, including the inspector general overseeing HHS.
[1:35:13] If you were really interested in going after fraud, you wouldn't be firing inspector generals in the U.S. government,
[1:35:21] which is exactly what they did.
[1:35:24] So what this hearing is all about is let's pretend.
[1:35:28] Let's pretend that the $1 trillion cut to Medicaid that Republicans here in Congress
[1:35:36] and the President of the United States made in what they called their big, beautiful bill,
[1:35:39] let's pretend that $1 million was really going after fraud,
[1:35:44] as opposed to hurting tens of millions of Americans.
[1:35:48] I didn't make up the number.
[1:35:49] The Congressional Budget Office, the nonpartisan Congressional Budget Office,
[1:35:52] told us that 7.5 million Americans are going to lose access to health care because of the cuts to Medicaid.
[1:35:59] There are another over 2 million who are going to lose access because Republicans took away tax credits for the Affordable Care Act.
[1:36:09] Again, that's a CBO number.
[1:36:12] And actually tells us what their real goal here was, right, because as part of that big, beautiful bill,
[1:36:18] they gave billionaires and very rich people permanent tax cuts.
[1:36:25] It was beautiful if you're a billionaire.
[1:36:28] I just want to show what the distribution of those tax cuts was right here.
[1:36:32] If you look at the tax cuts, 22 percent of the benefits of the Republican bill went to the top 22 percent.
[1:36:42] 72 percent of the benefits went to the wealthiest 20 percent.
[1:36:46] And that number will get bigger over time because Republicans sunset the few tax benefits that went to working people,
[1:36:55] just as they eliminated the one tax credit that was available to middle class folks trying to afford their health care.
[1:37:02] And despite the cuts to Medicaid, they still had a $4.2 trillion deficit over the next 10 years.
[1:37:10] This is a budget committee.
[1:37:11] I'm all for looking at honest ways for reducing our deficits.
[1:37:15] You don't do that by giving billionaires and big corporations huge tax cuts.
[1:37:20] So let's look at these Medicaid cuts, because in addition to the 7.5 million Americans who are going to get hurt,
[1:37:31] you're also going to have a spillover effect on probably every American.
[1:37:36] Mr. Schneider, maybe you could tell us what happens when somebody who doesn't have Medicaid coverage
[1:37:43] and doesn't have preventative health care coverage, gets desperately sick,
[1:37:49] waits until they have to go to the emergency room.
[1:37:51] Who ends up having to cover the costs of that uncompensated care at the end of the day?
[1:37:58] Well, what usually happens is the patient ends up getting a bill that may throw the patient into medical debt.
[1:38:10] The hospital that's providing the emergency care has to cross-subsidize that service,
[1:38:16] and it will find the money for its operations from other paying patients.
[1:38:22] So, right, let's unpack what you mean by cross-subsidize, right?
[1:38:26] What you mean is that people who are not on Medicaid, people, for example, who are on private insurance,
[1:38:32] people who are paying their premiums, at the end of the day, they're going to have to pay more,
[1:38:38] either in higher premiums or co-pays, in order to compensate for the uncompensated care,
[1:38:43] the care that was denied to the person who was on Medicaid. Is that right?
[1:38:47] That's correct.
[1:38:48] Right. So, I think it's important to understand that in order to provide these tax cuts to billionaires and corporations,
[1:38:56] Republicans not only cut access to health care for a million people, excuse me, 7.5 million people in Medicaid,
[1:39:05] but they're also going to be pushing the costs of that harmful action onto everybody else.
[1:39:13] And again, all for the effort to give these very rich people a big tax cut.
[1:39:18] And I will just say, Mr. Chairman, that the cuts to Medicaid were very cynically timed.
[1:39:23] Most of them, if not all of them, don't take place until January of next year.
[1:39:29] After the election, I wonder why that is.
[1:39:32] It's because the American people are going to hate what they see,
[1:39:36] and they're going to be feeling it in their pocketbooks,
[1:39:38] and Republicans want to delay that until after the election.
[1:39:43] That's what that cynical timing was all about.
[1:39:46] Again, all in service of giving very rich people big tax cuts.
[1:39:51] Thank you, Mr. Chairman.
[1:39:52] So, first of all, the reconciliation bill primarily prevented a massive automatic tax increase.
[1:40:00] We cut taxes for virtually every American taxpayer back in 2017, 2018.
[1:40:06] When Democrats had House, Senate, and the White House, you could have reversed that.
[1:40:11] You didn't.
[1:40:12] You didn't increase people taxes.
[1:40:14] Neither did we.
[1:40:15] So, again, to call it a massive tax cut, it wasn't.
[1:40:18] We prevented a massive automatic tax increase, which would have been devastating for our economy.
[1:40:24] So, again, let's talk about it honestly in terms of what that reconciliation bill did.
[1:40:28] There were some additional tax cuts, yes.
[1:40:30] But the trillions of dollars was an automatic tax increase would have impacted every American.
[1:40:36] And you didn't want to do it, and we didn't do it.
[1:40:39] So that was kind of bipartisan.
[1:40:40] We didn't want to increase taxes.
[1:40:41] Mr. Chairman, if I could just have 30 seconds to reply.
[1:40:45] First of all, as you know, Mr. Chairman, when we passed the Inflation Reduction Act, we actually did close a lot of tax loopholes on very wealthy corporations that were moving jobs overseas.
[1:40:58] You didn't reverse the 2017 tax cuts.
[1:41:00] With respect to the earlier tax cuts, they were lapsing on their own.
[1:41:04] They were going to go away on their own.
[1:41:06] And all of us were prepared to have those for very rich people lapse on their own as they should have.
[1:41:15] So you saw the chart.
[1:41:16] The overwhelming benefits from those tax cuts go to very wealthy people.
[1:41:20] And we actually specifically proposed that they lapse for those people.
[1:41:24] I would say, but not increasing tax on the American economy and benefits.
[1:41:27] Well, these were tax cuts that were put in place, as you pointed out.
[1:41:30] Right.
[1:41:31] During the first Trump administration, disproportionately helping the very rich.
[1:41:35] We wanted to allow those to lapse.
[1:41:37] Republicans didn't.
[1:41:38] I mean, that's the end of the story.
[1:41:39] Okay.
[1:41:40] Senator Murray.
[1:41:41] Thank you, Mr. Chairman.
[1:41:43] I think we can all agree we do need to crack down on fraud, especially in a program like Medicaid that so many Americans really rely on.
[1:41:52] So, Mr. Ingram, let me just ask you, yes or no.
[1:41:54] You agree we do need to be cracking down on Medicaid fraud and not letting criminals off the hook.
[1:42:00] Yes?
[1:42:02] Yes.
[1:42:03] Thank you.
[1:42:04] So, I hope my Republican colleagues will use some part of this hearing to condemn President Trump for pardoning criminals who were convicted of major Medicaid fraud.
[1:42:15] Trump pardoned five former executives from Florida who committed serious Medicaid fraud to the tune of tens of millions of dollars.
[1:42:25] That is pretty bad.
[1:42:27] Following what was dubbed, quote, the largest healthcare fraud scheme charged by the U.S. Justice Department, valued at over $1 billion in Medicare and Medicaid fraud, Trump commuted the 20-year sentence of a Florida nursing home and assisted living facility executive.
[1:42:45] So, that's even worse.
[1:42:46] So, look.
[1:42:47] I'm all for major crackdown fraud.
[1:42:49] I think we all are.
[1:42:50] But it looks like we've got some pretty good leads starting in the White House.
[1:42:54] Mr. Schneider, I want to turn to you.
[1:42:57] What single piece of legislation delivered the largest cuts to Medicaid in American history?
[1:43:03] Last year's budget reconciliation bill.
[1:43:05] Yep.
[1:43:06] So, everybody knows Republicans' big ugly bill passed more than $1 trillion in healthcare cuts mostly to Medicaid.
[1:43:16] Mr. Schneider, how much in tax breaks for the top 1% did Trump's bill contain?
[1:43:22] Approximately $1 trillion.
[1:43:23] $1 trillion in tax cuts to the top 1%.
[1:43:26] Mr. Schneider, how many Americans are losing healthcare because of Trump's big ugly bill?
[1:43:32] So, in terms of the Medicaid cuts, the latest estimates are approximately $11 million.
[1:43:38] $11 million.
[1:43:39] So, zero billionaires lose their healthcare.
[1:43:44] They do get a trillion dollars in tax cuts.
[1:43:47] And then over 15 million Americans, including the extended ACA tax credits, lose their healthcare thanks to Republicans passing $1 trillion in cuts for regular working class people.
[1:44:00] That is the math.
[1:44:01] And that is out and out grift.
[1:44:03] So, it seems to me like the biggest Medicaid theft didn't happen in a billing office somewhere.
[1:44:08] It actually happened last year right here in the United States Capitol when Republicans passed Trump's big ugly bill.
[1:44:15] So, Mr. Chairman, let me just say, I find it pretty astounding that Republicans are holding an entire Senate hearing on fraud in Medicaid, but they don't seem to have anything to say about the fraud coming out of the White House.
[1:44:28] I mean, look at the crypto schemes and the foreign gifts.
[1:44:31] That's easily the most corrupt White House in American history.
[1:44:35] So, the President Trump pardoned convicted criminals who committed Medicaid fraud.
[1:44:40] This is outrageous to me, and it is what we should be talking about.
[1:44:44] But I also want to note a really big difference in terms of values and beliefs right now, because I am here, and I know my colleagues on this side are, to fight for our safety net programs.
[1:44:55] But my colleagues on the other side of the aisle are not with me on that fight.
[1:44:59] Chairman Johnson has said repeatedly he believes Social Security is a Ponzi scheme.
[1:45:05] Last week, another Republican senator was on the floor saying Social Security is a scam.
[1:45:10] So, I wanted to make really clear at this hearing, I cannot disagree more strongly, Mr. Chairman.
[1:45:17] Social Security is a program that millions of hardworking Americans have paid into their entire lives.
[1:45:24] So, Republicans might want to cut benefits or privatize Social Security, but I want you to know I am going to keep fighting to save Social Security and protect healthcare for our Americans now and long into the future.
[1:45:37] Thank you, Mr. Chairman.
[1:45:39] To correct the record, I've said it's a legal Ponzi scheme, which is exactly what it is.
[1:45:44] I mean, take a look at what a Ponzi scheme is.
[1:45:46] That's what Social Security is.
[1:45:47] It's been horribly mismanaged.
[1:45:49] Those funds were not invested in something that's valued at the federal government's government bonds.
[1:45:54] I'm happy to, and we'll probably hold a hearing on this, and I'll prove the case, but it's a legal Ponzi scheme, and that's quite honestly indisputable.
[1:46:01] Mr. Chairman, to respond.
[1:46:03] Yes.
[1:46:04] And welcome to the chairmanship.
[1:46:06] Thanks.
[1:46:07] But I find that you are turning this into a debate committee, not a budget committee.
[1:46:10] That's fine.
[1:46:11] But let me just respond.
[1:46:12] I think it's important the American people see a civil exchange, but go ahead.
[1:46:15] Mr. Chairman, to chair, but I will respond.
[1:46:17] Americans pay for their Social Security.
[1:46:19] They pay into it for their lifetimes, and they deserve to know it's going to be there in the future.
[1:46:24] That's what we're focused on.
[1:46:25] Thank you.
[1:46:26] Yes, and they paid into it, and the money was spent.
[1:46:27] It's gone.
[1:46:28] It's been horribly mismanaged.
[1:46:29] And again, you take a look at the Social Security tables, and some people don't even get back what they put into it.
[1:46:34] Other people get up to three times what they put in.
[1:46:36] So again, we'll lay out the facts for this.
[1:46:39] I'm trying to lay out the facts.
[1:46:40] This is a hearing about laying out the facts, and I'll go to Senator Wyden.
[1:46:45] Mr. Chairman.
[1:46:46] Yes.
[1:46:48] Point of privilege.
[1:46:49] It's customary in a Senate committee for each member of the Senate and each member of the committee to be able to ask their questions and make their points without an intervening rebuttal by the chair.
[1:47:04] I'm not anticipating doing an intervening rebuttal of Republican members.
[1:47:11] I'm not going to take up the time for that.
[1:47:14] I'm not going to ask for that.
[1:47:15] I just think that, and I did ask if I could put in a point for the record earlier, and you allowed me to do that, clarifying that undocumented individuals do not qualify for federal benefits.
[1:47:28] But I hope the point my colleagues have made is that that is a new norm, but maybe not a great norm for this committee.
[1:47:39] Well, I would disagree.
[1:47:41] I think it makes the hearings more interesting and more informative.
[1:47:43] Are you going to grant?
[1:47:44] So again, I've allowed an exchange back and forth.
[1:47:47] Are you going to grant me to intervene after every Republican testimony to point out how wrong they are and how off-base they are?
[1:47:53] Because that would be the equivalent point.
[1:47:56] Senator Wyden.
[1:47:58] Thank you, Mr. Sherman.
[1:47:59] And I can certainly share Senator Merkley's view on this point.
[1:48:03] And the reality is, on this side, we have been trying to work with Republicans on fighting healthcare fraud again and again.
[1:48:10] And again, I went to the floor repeatedly to point out,
[1:48:13] for example, insurance broker fraud,
[1:48:15] something that both of us ought to come together,
[1:48:18] no response from Republicans.
[1:48:19] So today, we're looking at yet another approach
[1:48:24] that is ill-advised because it primarily hurts people
[1:48:27] and doesn't do anything about reducing fraud
[1:48:29] or anything like that, and that's the administrative trap
[1:48:33] designed to disenroll folks who are eligible for Medicaid.
[1:48:37] And the Trump administration went forward to basically say
[1:48:41] that they were going to literally require people
[1:48:44] to prove that they're sick enough to deserve healthcare.
[1:48:48] So today, Senator Warnock and I are releasing a letter
[1:48:52] signed by each Senate Democrat urging the Trump administration
[1:48:57] to pull back on this disastrous rule
[1:49:00] that would harm so many vulnerable people.
[1:49:03] So this, by the way, is the same sort of approach
[1:49:07] that House Democrats have taken to raise the alarm
[1:49:10] on this flawed and hurtful rule.
[1:49:12] I can't remember the last time that we had such unity
[1:49:15] between the House and the Senate,
[1:49:17] but I guess if the Republicans are just going
[1:49:19] to keep hurting people, you'll see it often in this session.
[1:49:22] I'd like to ask, Mr. Chairman,
[1:49:24] that these letters be entered into the record.
[1:49:27] Objection.
[1:49:28] Thank you, Mr. Chairman.
[1:49:29] Now, Andy Schneider may not be known to everybody
[1:49:33] in this room, but I sat next to Andy Schneider
[1:49:36] when he was starting his career in healthcare,
[1:49:38] and he was fighting for people who are vulnerable,
[1:49:41] people who walked an economic tightrope
[1:49:43] and balanced the food bill against the fuel bill
[1:49:46] and the fuel bill against the rent bill,
[1:49:47] and he's still doing that.
[1:49:49] My God, this is a man who could probably go out
[1:49:52] to any megacorporation and pull down a gigantic salary,
[1:49:56] but instead what he's doing is putting his heart out there
[1:50:00] once more for people who are walking
[1:50:02] that economic tightrope.
[1:50:04] So before we wrap up, I think it would be great
[1:50:06] to have Andy Schneider give us a real-world example
[1:50:10] of the human cost for the millions of Americans
[1:50:12] who are losing their healthcare as a result
[1:50:15] of this bureaucratic razzmatazz.
[1:50:18] That's the most complimentary thing you can talk about
[1:50:21] because it really is bureaucratic unfairness.
[1:50:24] But tell us what it means to people who are hurting
[1:50:29] and vulnerable that you've been fighting for,
[1:50:31] by my calculus, for almost a half a century,
[1:50:34] half a century going to bat for people
[1:50:36] who didn't have clout and didn't have power.
[1:50:40] Thank you, Senator.
[1:50:41] I appreciate that.
[1:50:44] And I fondly remember our days
[1:50:47] in midnight basketball in Portland.
[1:50:49] Don't talk about my Grey Panther days.
[1:50:52] Okay, I withdraw that comment.
[1:50:54] Thank you.
[1:50:55] You had a great dunk, though.
[1:50:58] So let's take what is the unfolding story here
[1:51:06] of work reporting requirements being imposed
[1:51:10] on all Medicaid expansion states
[1:51:12] for Medicaid expansion adults.
[1:51:15] And one of the first states out of the box is Nebraska.
[1:51:20] And there was a piece yesterday or the day before reporting
[1:51:26] on some of the early administrative red tape problems
[1:51:35] that Medicaid beneficiaries are going to face as this unfolds.
[1:51:40] It's a backdoor disenrollment program, isn't it?
[1:51:43] Well, I think that's a fair characterization, yeah.
[1:51:46] Yeah, so in this particular case, a pregnant woman was disenrolled
[1:51:55] from the Nebraska Medicaid program because the enrollment staff
[1:52:04] didn't understand that she was pregnant.
[1:52:06] So it eventually got sorted out, as far as we can tell
[1:52:09] from the reporting.
[1:52:10] But these kinds of errors are almost unavoidable given the complexity
[1:52:18] and cumbersomeness of the new rules that are about to go into effect.
[1:52:24] Well, I thank you for putting a human face on this.
[1:52:27] We're going to be calling on you in the Finance Committee as well
[1:52:30] on the same point.
[1:52:32] And before I close out my time, Mr. Chairman,
[1:52:34] Ranking Member Merkley asked members on the dais to share stories
[1:52:38] from our states, from families who rely on Medicaid, I'd like to enter
[1:52:41] into the record the letter from 11 U.S. Senators to Dr. Oz
[1:52:45] that highlights families all over the nation, from one end of the country
[1:52:49] to another, who need help, need assistance with community-based services
[1:52:55] and particularly need Medicaid.
[1:52:56] I'll ask unanimous consent that I close out my remarks with that.
[1:52:59] Without objection.
[1:53:00] So I think we'll bring the hearing to a close.
[1:53:03] I want to thank everybody, all the witnesses, everybody attending.
[1:53:06] Listen, I'd like to have a little bit more discussion.
[1:53:10] I think we've, you know, I've been civil.
[1:53:13] I'd like to maintain civility.
[1:53:15] I think it's going to be more interesting for the American public
[1:53:17] if we can exchange views.
[1:53:18] Again, there's obviously a big difference in perspective on this thing.
[1:53:22] That's fine, but let's discuss it, okay?
[1:53:24] And just the rigidity of the standard hearing, you know, this is said,
[1:53:27] and again, I think it is far more interesting.
[1:53:31] I think it's far more beneficial to let's have a discussion.
[1:53:35] You know, if there's something that you want to challenge,
[1:53:37] go ahead and challenge it with civility.
[1:53:40] So again, that's the way I intend to do this.
[1:53:41] You know, my, I keep my comments pretty short.
[1:53:44] I don't filibuster.
[1:53:46] Just take a look at my opening statement.
[1:53:47] I think it's pretty short.
[1:53:49] But there are important points to be made, and I'll continue to do that.
[1:53:54] So I hope it doesn't offend my Democrat colleagues,
[1:53:57] but that will continue to be my intention here.
[1:54:00] So Mr. Chairman, I'll just point out that a discussion involves other members
[1:54:05] having an equal time to provide rebuttal as well.
[1:54:09] Otherwise, it's just rebuttal.
[1:54:10] And again, I gave, you know, when I rebutted,
[1:54:12] I gave the Democrat member time to rebut what I said as well.
[1:54:16] So again, I've been here 15 years.
[1:54:19] I've seen Chairman handle different things, including the esteemed former
[1:54:22] Chairman of our Finance Committee, so again, I think that's, you know.
[1:54:26] Could I provide one fact before we close?
[1:54:29] Just a fact.
[1:54:30] As long as I can rebut it.
[1:54:31] You can, you're most welcome, you're most welcome to.
[1:54:35] So that family of a mother and two children,
[1:54:38] that's earning 100% of federal poverty level,
[1:54:41] that's 22,276 bucks a month.
[1:54:45] After payroll taxes, the disposable income is 2100.
[1:54:49] An average rent for a two bedroom apartment, not even a three bedroom,
[1:54:52] children don't get their own room, is 1700.
[1:54:55] An average cost for transportation around 500.
[1:54:59] Already, you're down to $0.
[1:55:02] $0 for that family.
[1:55:04] Now, you made reference to $50,000 in benefits.
[1:55:07] A family does qualify at that level for $785 for SNAP, $0 for TANF,
[1:55:14] and there's a massive waiting list for affordable housing.
[1:55:17] So that's the luck of the draw, if you will.
[1:55:19] So most families are in the situation where they're completely out of money,
[1:55:23] other than the assistance to help them buy food.
[1:55:26] They don't even have money to add in, into that.
[1:55:29] And this is before we start looking at a family has to buy utilities,
[1:55:33] they have to put clothing, they have to have school supplies.
[1:55:36] And so, I just want to point out that, as one colleague observed,
[1:55:41] very few people in this room have lived at that level of really minimal resources.
[1:55:50] And so, having Medicaid available as health insurance to those families,
[1:55:56] if we want that next generation to thrive, is essential.
[1:56:00] Well, I will say, people on this dais, including myself,
[1:56:02] came from very humble beginnings.
[1:56:04] Senator Graham, Senator Scott, so I think we understand this.
[1:56:08] You know, I was quoting Senator Phil Graham, who's also a pretty noteworthy economist,
[1:56:13] in his studies, talking about $53,000 in tax-free benefits
[1:56:16] for a single parent with two children, maybe $11,000.
[1:56:20] Again, I'm just quoting him, so take a look at his information.
[1:56:25] But, you know, facts are facts, and I think that's what we need to try and do,
[1:56:29] is let's get the facts on the table, find out what we all agree on, common facts,
[1:56:34] and then we can kind of debate the different perspectives.
[1:56:37] But again, I appreciate everybody's involvement here.
[1:56:39] The hearing record will remain open for 15 days until August 19th at 5 p.m.
[1:56:43] for the submission of statements and questions for the record.
[1:56:45] This hearing is adjourned.