‘The Most Corrupt White House…’: Senate Democrats Turn GOP Medicaid Fraud Hearing Against Trump

[0:00] i want to welcome everybody i certainly want to thank the witnesses for appearing appreciate your [0:03] testimony i've read it thoroughly uh longer than normal but i think it's an important very [0:10] important topic i'll tell you just right up front what prompted this hearing is as our first hearing [0:16] it was the cbo release of the first three quarter spending in medicaid and the result is [0:25] year over year we're at 49 billion dollars which is a 10 increase over what we spent in fiscal year [0:33] 2025. now again i'd like to be as cooperative as possible but one of the reasons i want to hold [0:39] the hearing is is i wanted to counter the false accusations that the republicans cut and slashed [0:45] medicaid to the bone it's simply not true so just a real quick history of medicaid passed in 1965. [0:53] uh there were four designated groups of people that qualified to uh aid to fit for families to [1:02] dependent children qualified um aid to the elderly aid to the blind aid to the permanently and totally [1:08] disabled states could actually cover people medically needed who had income levels above the threshold set [1:16] and also children less than 21 that weren't on afdc and so that was the the core group of people [1:22] uh that medicaid was initially designed to cover now through the 90s and a little bit again in the [1:28] in early 2000s eligibility continued to expand as did enrollment as did the dollars and cents uh we're [1:38] going to have a little bit of dueling charts here i think the committee should get used to my using of [1:43] charts but let's again the problem solving process always begins with you have to admit you have a problem [1:51] now now my guess is we have two definitions of the problem on each side of the dais here uh personally [1:58] i think medicaid spending is out of control and i will kind of prove that case my guess on the other [2:02] side of the dais we're probably not spending enough but anyways set that aside the next step is you have [2:08] to define the problem you have to agree on common facts and what i'd like today's hearing to be about [2:14] is laying out the basic facts we can all agree on once we do that we can start doing root cause [2:20] analysis we can start taking a look at what what kind of policy changes are required for something i [2:26] hope we all agree with is prevent the massive fraud we're starting to this been revealed here over the [2:32] last few months but let's start with my my i'll call this a powerpoint presentation uh everybody at [2:39] their seat has the final chart of this build up but it starts with this chart which just shows spending [2:45] from 1990 to 1998. now again this is 33 years into the program we are spending less than 100 billion [2:54] dollars and there's about 32 million people enrolled which is around 12 percent of the population [3:01] next chart now i've been spending enough talking an awful lot about uh uh different budget baselines you [3:09] know take what actual expenditures increase them by population inflation growth is just a reasonable [3:15] baseline control over you know what should we be spending had we done that to 1998 spending under [3:21] clinton this year last year 2025 we'd be spending 248 billion dollars okay next chart this shows actual [3:30] spending then on top of that those projections uh not really projections but again the baseline uh through [3:37] 2014 the first year that obamacare kicked in and medicaid expansion kicked in uh you know we were [3:43] we were growing under the bush administration slightly higher than that population growth and inflation [3:50] under the obama administration those expenditures increased pretty significantly and above beyond that [3:54] and of course 2014 it really took off next chart this is what we'd be spending [4:01] if we took the 2014 spending again which is already first year into medicaid expansion and just increase [4:09] that by population and inflation we'd be spending 441 billion dollars in fiscal year 2025. next chart [4:19] this shows again actual spending on top of that inflation population growth from 2014 through 2019 the [4:27] year before the pandemic again we're running ahead of that baseline next chart so so let's say you take [4:35] 2019 spending increase that by population inflation this year 2025 we'd be spending 536 billion dollars [4:46] final chart it's one in front of you we're actually spending 668 billion dollars so again that's just [4:53] the financial facts instead of two instead of spending 248 billion under a clinton 1998 baseline or 441 [5:02] billion under a obama after medicaid expansion was already instituted of 441 or 536 from the pre-pandemic [5:11] baseline we're spending 668 billion dollars i just think that indicates a program out of control you [5:18] combine that with the fact that now we have the nick shirley videos of the outrageous fraud uncovered in [5:27] minnesota with child leering centers and autism centers and transportation i mean all these things [5:36] are defrauding medicaid and and the problem with that is when you're spending billions of dollars on [5:43] fraud those are billions of dollars that can't be spent on the people who actually need it and i think [5:48] we'll hear from witnesses today too that a lot of the medicaid expansion the the let me back up medicaid [5:57] was initially established as a federal match to a state administered program you know where the [6:03] states has significant amount of skin in the game currently for every dollar the states spend on a [6:08] disabled child they get about a dollar 33 in benefits from the federal government obamacare changed [6:14] that for single working age able-bodied childless adults and for every dollar state spends on that [6:23] category individuals again not disabled child not blind not elderly states get nine dollars in [6:28] funding i mean we'll talk about it but it makes no sense i would say a lot of that has fueled some [6:35] of the fraud there's just no incentive for states to really be checking eligibility or really be [6:40] investigating fraud so we'll talk about that but anyway huge disparity in terms of the dollars [6:47] spent we've seen now the fraud uh you know we talked about this is generally medicare but uh 400 [6:53] hospice centers in los angeles the third of all hospice centers apparently were in la dr oz defunded [6:59] 400 of them not one of them complained so again i hope we can get bipartisan agreement that we need [7:05] to figure out how to eliminate this fraud i can't tell you how much it is we don't do a very good [7:10] job tracking we don't have the controls in place we designed these programs to really be out of control [7:15] which is what we've got uh final charts just talk about uh the enrollment uh you can see it's it's uh it [7:22] has skyrocketed it has different uh you know points in time when it's done it through the 90s early [7:27] 2000s but it really skyrocketed after uh obamacare and medicaid expansion uh and i think the last [7:35] chart you also have in front of you um this is a similar type of depiction as i've done to the other [7:43] baselines if you took the 1998 enrollment increase it only by population we'd be looking at about 40 [7:51] million people on on medicaid it'd be about 12 percent of our population uh if you just take [7:58] again 2014 after medicaid expansion so you've already had one year of medicaid expansion uh you'd [8:05] be at about 70 million about 20 percent of our population but in fact uh we're about 88.2 which is over [8:12] a quarter of our populations on medicaid again i don't think medicaid was ever designed to cover [8:18] 25 percent of our population but that's where we are today so again these are just the basic facts [8:23] um if we're going to solve a problem again i would hope on a bipartisan basis we'd like to at least [8:28] eliminate the fraud in the program make sure the dollars we spend are going to the people who are [8:33] truly that we truly need truly need it we all want to provide that kind of help we can hopefully [8:39] eliminate the fraud but again these are just the numbers that indicate something's a miss here that [8:43] needs to be addressed with that i'll turn over senator merckley uh thank you very much mr chairman and [8:48] we're we're bringing different perspectives to bear and that's the uh beauty of uh having hearings and [8:57] debate and the perspective that uh many democrats are bringing to this and i'm probably a few republicans as [9:05] well is that prior to 2009 we had a tremendous uninsured population in america both because uh [9:17] essentially there were a lot of holes in the medicaid program as to who is was covered and then there [9:23] was a gap above the qualified income qualification for medicaid where people still couldn't afford [9:29] insurance unless insurance came through their their company uh and then you had uh folks above that [9:36] who couldn't afford insurance either so essentially we did two things we said let's expand uh medicaid [9:43] fill in the holes address the still low less affluent population above it and let's create tax credits to [9:50] help people buy private insurance in a marketplace and in in oregon i don't have the exact number in front of me [9:58] but i think we had roughly 25 percent of the population without insurance before we made those changes [10:05] and we were over 95 percent who had insurance uh afterwards so the result of that is not only a big [10:14] reduction in stress for families because they had insurance but we ended a lose-lose situation folks [10:21] without insurance uh simply would postpone getting treatment for medical problems because they couldn't [10:28] afford to pay the bill and then the problems become bigger and more expensive and that's a problem [10:34] for their health but it's also a problem for the cost of the medical system and then when they did go [10:40] to get medical help they went to the emergency room which is the least efficient and highest cost [10:45] piece of the entire system and then because they didn't have insurance they often couldn't pay the bill [10:51] which meant there was no revenue to cover the the the provision of services so here we are with this [10:57] lose-lose-lose-lose proposition because we don't have comprehensive health care so that's the the vision [11:04] that was undertaken uh what we will see and laid out is essentially when we're looking at the rising [11:10] costs in medicaid is it's uh essentially because the rising costs of health care per person in every [11:16] aspect of of health care that is in individual insurance provided through medicare and and also through [11:23] uh private insurance last year the republican majority used a bill that's a simple majority bill [11:32] and so they said essentially we don't like this medicaid program we're not all in on this vision [11:39] of health insurance for less affluent families so we're going to cut it and they slashed what will [11:44] become more than a trillion from the health care system and it will kick more than 15 million americans [11:50] off health insurance and it will skyrocket the out-of-pocket costs for millions more [11:56] and where was the savings applied to tax breaks for billionaires it was a very simple proposition [12:04] less affluent families lose and billionaires win and that's not a philosophy that many of us uh share [12:13] many of us disagree with that philosophy we think we should have a foundation for families to thrive [12:17] not a families lose billionaires win uh strategy now i'll start partner with anyone to tackle fraud [12:26] invest in audits absolutely uncover and stop fraudulent charges have significant penalties for that [12:33] absolutely stop up coding you bet and i've introduced a bill on up coding up coding a huge fraudulent [12:39] practice but where in medicare uh advantage but deliberately reducing health insurance coverage for [12:47] less affluent families isn't that's not tackling fraud that's simply destroying health care for [12:52] less affluent families it's back to where we were in a lose lose lose strategy for our nation now the [13:01] trump administration has proceeded to protect fraudsters how by cutting off funding for medicaid fraud [13:08] control units i would suggest mr chairman we should have a hearing on on that and by pardoning convicted [13:15] fraudsters including one executive who generated 205 million dollars in false medicare claims we should [13:21] have a hearing on that so i'm all in on a tackling fraud but when the conversation about fraud is used as [13:31] a strategy to wipe out health insurance uh for families and recreate a lose lose lose uh foundation in america [13:38] uh that i'm not all all in the vision of the red carpet for the rich and red tape for the poor is a bad [13:47] vision for america we've already wiped out under what trump called the big beautiful bill and we called the [13:57] big ugly betrayal uh health care for two million children and eight million people and certainly the [14:05] two million children who have been booted off medicaid or the children's health insurance program chip [14:11] they weren't committing health care fraud but i'll tell you what they were doing they were going to [14:17] the doctor when they needed medical treatment and the clinic and the hospitals were getting paid [14:23] that's a win-win so let's reject the lose lose lose strategy and and adopt the win-win strategy without [14:32] health insurance people will delay getting care develop more serious health issues be more expensive to [14:38] treat go to the most expensive part the emergency room provide less revenue to our clinics and and [14:44] hospitals and when revenue drops hospitals and clinics close reducing care for the entire community [14:52] regardless of what type of insurance you have so proceeding to well uh take away health insurance for [15:01] the less affluent actually has a profound impact on everyone's ability to have health care treatment [15:07] and you know where it's really scary rural america if you wipe out the flow of revenue for a clinic or [15:16] hospital in urban america well there's another clinic or hospital nearby but when you do it in a rural area [15:23] and the next clinic or hospital is 70 miles away or 100 miles away that's certainly out west that's not uncommon [15:30] at all then you're having a profound impact on the health of the entire community if you have a health [15:36] attack or that is a heart attack or a stroke you don't have time to drive 100 miles to see a doctor [15:42] get to a hospital get to emergency room as of april of this year 216 hospitals and clinics have already [15:50] closed due to the provisions in the big beautiful bill last year or dramatically reduced services more than [15:59] 1 000 hospitals clinics and nursing homes are at risk of closing or cutting services because of the cuts to [16:05] to medicaid and here's more bad news there's even more devastating cuts coming in 2027 cynically [16:14] scheduled to kick in after this november's election an independent analysis by the nonpartisan [16:22] congressional budget office shows that this law will end coverage for 7.5 million medicaid [16:26] enrollees by creating a thicket of red tape burdensome reporting requirements and extra costs [16:32] like the 35 co-pays for americans who are already struggling to afford the cost of gas [16:37] and groceries it's just wrong let's recognize that these cuts hit rural america the hardest [16:44] my state of oregon is a big rural state in rural malliur county in southeast oregon 52 percent [16:50] of residents are covered by medicaid and if you compare the number of children in rural oregon [16:56] who are dependent on medicaid the oregon health plan compared to the rural it's much higher in the [17:01] rural areas compare that to folks in washington county just west of portland where only 25 percent [17:07] of residents instead of 52 percent are covered by the oregon health plan that is our version of medicaid [17:13] so again it really attacks rural americans now let's look at the numbers and i i share an affection [17:20] with the chair of of using numbers let's put up the first chart medicaid spending has grown slower than [17:27] overall u.s health spending and you can see it from this chart the blue line is much flatter than the [17:33] red line it's as simple as that since 2007 all health care spending has gone up but medicaid spending [17:40] has gone up at a much lower rate and now let's look at a forecast going forward cms forecast that this [17:49] year the per person cost of private insurance will increase more than the per person costs of medicaid [17:56] not to mention that medicaid makes up just 18 percent of national health spending between 2000 and 2023 [18:04] while medicaid's enrollment roughly doubled medicaid's share of national health spending ticked up just [18:10] three percentage points three percentage points from 16 percent to 19 percent so the problem isn't medicaid [18:20] it's our overall health care system driving across across the board you see it in private insurance you [18:25] see it in medicare and yes you see it medicaid as well but you see it up going up more slowly in medicaid [18:31] than in these other arenas cbo has found that every additional dollar we spend on children's medicaid [18:38] coverage today reduces federal deficits by roughly two dollars in the future why is that because healthier kids [18:46] grow into healthier adults reducing their demand on the health care system while increasing their [18:51] contributions and taxes well more creating a better foundation for children to thrive by making sure [18:58] that they have insurance that's critical to my state of oregon where nearly 60 percent of their kids get [19:05] their health care through medicaid or chip children's health insurance program but it's not just the kids [19:11] who are threatened by these cuts the big ugly betrayal law passed last year on a partisan basis is also [19:18] forcing states to slash home and community-based services for seniors and people with disability [19:23] here's how it's affecting real people in minnesota an autism therapy provider had to sell her cattle [19:29] herd and lay off staff just to afford keep serving children who have nowhere else to turn in california [19:36] because of in-home support services a mother has been able to take care of her disabled son instead of [19:41] having to work an additional job and as she said and i quote without this people become homeless they [19:47] lose their income they lose their stability whatever tiny safety net they had is gone it's just cruel [19:53] and of course i think everyone is familiar that we're the only developed country where people are [19:57] still going bankrupt because of the costs of health care we have failed to provide the same firm [20:02] foundation provided in every other developed country in oregon one of my constituents wrote to me about [20:08] her two 40 year old sons with disabilities who since they were 18 have lived in group homes and attended day [20:13] programs her plea to us was simple don't force families like hers back towards institutionalization [20:20] by cutting medicaid funding for these programs and institutionalization is always more expensive [20:26] in her words it would be insane inhumane and a crime against humanity insane is right this [20:34] isn't about fraud if it was this hearing would be about the president pardoning convicted fraudsters [20:39] encouraging fraud and cutting funding for medicaid fraud control units [20:43] this hearing is about the red carpet for the rich and red tape for the poor health care is a right [20:49] for all not a privilege for the wealthy let's reject the strategy of families lose and billionaires win [20:55] and replace it with a strategy of a foundation for every family to thrive and that includes health [21:00] insurance hey senator merckley you might have missed the fact that we provided 50 billion dollars for a rural [21:07] health care fund in the in the reconciliation bill and i'll just remind everybody medicaid spending [21:13] is up 10 percent this year i don't think there's any projection that shows medicaid spending being [21:19] cut or declining at all so it's just going through the roof but uh again appreciate your opening statement [21:25] uh now okay uh it is tradition this committee is swearing witnesses with all stand raise your right [21:33] hand you swear the testimony you will give before this committee would be the truth the whole truth [21:41] and nothing but the truth to help you god please be seated our first witness is mr brian blaze mr blaze [21:49] is the president of paragon health institute he was a special assistant to the president for economic [21:54] policy at the white house's national economic council from 2017 to 2019 where he coordinated the [21:59] development and execution of numerous health policies and advisor president nec director [22:04] and senior officials after leaving the white house mr blaze founded blaze policy strategies and [22:08] served as the ceo mr blaze chairman johnson ranking member merckley and members of the committee thank [22:15] you for the opportunity to testify medicaid is an important welfare program but too often it fails the [22:22] truly vulnerable children pregnant women seniors and people with disabilities the federal state medicaid [22:30] partnership is broken over the past dozen years states have shifted hundreds of billions of dollars [22:38] of medicaid costs to the federal government washington now pays more than 70 percent of medicaid spending [22:46] up from the historic 60 percent i will focus my remarks on two major problems the affordable care act [22:52] expansion of medicaid to able-bodied working age adults and the legalized money laundering apparatus that [23:00] results in massive corporate welfare through medicaid the aca created a powerful financial incentive [23:07] for states to prioritize expansion enrollees over traditional enrollees on average when a state spends [23:13] one dollar of its own money on a traditional medicaid enrollee the federal government contributes a [23:19] dollar 33 but for one dollar of state spending on an expansion enrollee the federal government contributes [23:26] nine dollars thus washington pays states seven times more for each state dollar on expansion adults [23:35] than for people medicaid was created to serve multiple studies show that medicaid expansion has made [23:42] it harder for traditional enrollees to obtain physician appointments it's increased wait times and forced [23:48] more patients to rely on emergency rooms for routine care medicaid should prioritize the most vulnerable [23:55] instead its financing formula discriminates against them the same misguided incentives explain the surge [24:03] in improper medicaid enrollment yesterday paragon released a study by liam segoe estimating that nearly [24:10] half of the 20 million medicaid expansion enrollees were likely ineligible in 2024 this imposed roughly [24:18] 33 billion dollars in improper federal costs with a major cost shift from states to the federal government [24:26] a few states like california and new york have exceptionally high improper enrollment but the [24:31] problem exists in virtually every expansion state congress should end the discrimination against the most [24:38] vulnerable and equalize federal reimbursement rates for all enrollees within each state president [24:45] obama proposed equalizing reimbursement rates after the aca became law a second major problem is medicaid [24:53] money laundering the clearest example is provider taxes former oregon state representative mitch greenlick [25:00] called these quote dream taxes for states quote we collect the tax from the hospital we put it up as a [25:08] match for federal money and then we give it back to the hospitals to be clear this is not a tax it is [25:14] legalized money laundering mechanism for shifting costs from states to washington while generating windfalls for [25:22] politically powerful providers in 2011 then vice president joe biden called provider taxes a quote scam [25:30] and said they should be eliminated senator durbin has called them a charade the simpson bowls commission [25:37] set up by president obama recommended ending them president obama proposed limiting provider taxes [25:45] and the one big beautiful bill basically adopted his proposal broken medicaid incentives have led to a new [25:52] form of corporate welfare state-directed payments under the biden administration cms allowed medicaid [25:58] insurers to pay hospitals up to average commercial rates or more than two and a half times medicare rates [26:05] medicaid should not pay hospitals more than medicare such excessive medicaid payments distort the [26:11] program's purpose and threaten seniors access to care in the one big beautiful bill congress appropriately [26:18] limited medicaid payments through insurers to medicare rates most medicaid spending now runs through [26:24] health insurance companies generating enormous revenues for them yet there is remarkably little [26:30] evidence that medicaid managed care has improved access health outcomes or reduced costs increasingly [26:37] medicaid managed care functions as a financing intermediary for corporate welfare medicaid's perverse [26:44] incentives have also created a lucrative consulting industry devoted to helping states maximize federal [26:51] reimbursement by gaming medicaid's complicated financing rules this does not improve patient care [26:57] medicaid is an essential program but congress must improve the core incentives reward states for [27:03] serving the most vulnerable not for maximizing federal reimbursement and the financial discrimination [27:09] against the most vulnerable eliminate the medicaid money laundering schemes and root out corporate [27:14] welfare those reforms will help return return the balance to the federal state medicaid partnership [27:20] and improve medicaid for america's most vulnerable citizens thank you mr blaze our next witness would [27:27] be mr jonathan ingram mr ingram is the vice president of policy and research at the foundation for [27:32] government accountability prior to joining fga jonathan served as the director of health policy and pension reform [27:38] at the illinois policy institute and is editor-in-chief of the journal of legal medicine he holds a bachelor of [27:43] science and history in english an executive master of business administration and a juris doctor mr ingram [27:51] chairman johnson ranking member merkeley and members of the committee um jonathan ingram vice [27:55] president of policy and research at the foundation for government accountability criminals steal billions [28:01] from medicaid every year last summer prosecutors charged a russian russia-led crime syndicate that [28:07] stole the identities more than a million americans and then billed medicare and medicaid more than 10 billion [28:14] dollars in may prosecutors charged 15 defendants in minnesota in the largest medicaid autism fraud [28:21] case in american history in ohio fraudsters built networks of shell home health companies [28:28] built medicaid for care that they never delivered and then posted videos of themselves drinking champagne [28:34] on private jets those cases made headlines because prosecutors could bring charges many medicaid losses never [28:42] get that far bureaucrats wrote rules that enroll people without verifying eligibility and pay providers [28:49] that nobody has screened it's fraud by design the fraud has two faces criminal syndicates billing from [28:56] overseas and rules quietly manipulated from cubicle but the victims are the same american families pay their [29:04] taxes trusting congress to spend their money carefully and the people this program was built for senior [29:11] citizens pregnant women children with disabilities are left competing for resources that were stolen or [29:19] diverted by bureaucrats before they ever arrived start with the scale more than one in five medicaid dollars [29:26] is spent improperly and before the one big beautiful bill taxpayers were on track to lose more than two [29:31] trillion dollars over the next decade more than 80 percent of those improper payments traced to eligibility [29:38] errors five policy choices made that possible first bureaucrats stopped verifying applications [29:45] more than 40 states take an applicant's word on residency more than a dozen take their word on income [29:52] and officials in at least 30 states now want to take enrollees word on work requirement exemptions [29:59] and compliance second states stopped rechecking eligibility nationwide states renewed 69 percent of recent [30:07] cases without asking enrollees a single question north carolina renewed 99.5 [30:14] percent of their 2.2 million cases this way third states let hospitals enroll patients [30:22] before anyone verifies eligibility in california hospitals deemed deemed nearly 500 000 people [30:30] presumptively eligible for medicaid when the state finally completed its full eligibility [30:35] reviews only 155 000 of those actually qualified 30 percent federal taxpayers never got any of those [30:43] dollars back fourth bureaucrats import errors from other welfare programs enrolling people in medicaid [30:49] based on their food stamp enrollment bureaucrats have built these one-door systems that merge enrollment [30:55] across programs minnesota brags that it built a single app that signs someone up for as many as nine [31:02] welfare programs in under 15 minutes one wrong answer cascades through the entire program through every [31:08] program at once and fifth bureaucrats built an on-ramp for illegal aliens states enroll applicants while [31:15] they verify immigration status a grace period meant to last 90 days seven and ten of those temporary cases [31:23] now last longer one utah enrollee has collected medicaid for five thousand eight hundred and twenty days [31:30] 16 years without ever proving immigration status enrollment through this loophole grew more than 400 [31:37] under the biden administration the results match the design federal auditors have flagged millions of [31:44] ineligible and potentially ineligible enrollees providers get the same free pass federal law requires [31:51] states to rescreen every medicaid provider at regular intervals illinois went three years without [31:58] rescreening a single one and some providers have gone 17 years without a revalidation when cms forced [32:04] minnesota to rescreen nearly 6 000 high-risk providers the state disenrolled more than 62 percent of them [32:12] they failed background checks they failed site visits and they refused to turn over information and when [32:19] investor investigators do catch providers states keep paying them anyway states are supposed to suspend [32:25] payments to any provider who's credibly accused of fraud new york issued waivers to keep paying 96 percent [32:32] of them massachusetts suspended payments for fewer than one in ten so why do states run their programs [32:39] this way it's the money every dollar a state spends on medicaid draws at least one federal dollar and obamacare [32:46] supercharged that math washington pays states nine dollars for every dollar they spend on able-bodied adults [32:52] as dr blaze mentioned an average of a dollar 33 on the truly needy then states launder the rest shifting more state [32:59] costs onto federal taxpayers so bureaucrats treat federal dollars medicaid as free stimulus they treat stopping [33:07] fraud as budgetary malpractice every dollar of fraud that they stop is a dollar less of free federal money [33:14] coming into the state many go further and game the match itself misclassifying enrollees into obamacare expansion [33:21] to claim the higher rate bureaucrats design this fraud over decades but congress can fix it require [33:28] states to verify identity income immigration status before enrollment not after require eligibility [33:36] reviews and provide a re-screening on schedules that states cannot ignore and in the funding formula that [33:42] pays states more to cover able-bodied adults than children with developmental disabilities thank you thank [33:50] you mr ingram our final witnesses uh mr schneider mr schneider is a research professor of the practice [33:56] center for children and families mccourt school of public policy at georgetown university most [34:01] recently he served under the obama administration as a senior advisor at the centers for medicare [34:05] and medicaid services which he focused where he focused on program integrity issues in medicaid [34:11] he's a graduate of princeton university and the university of pennsylvania law school mr schneider [34:16] thank you chairman johnson ranking member merckley and members of the committee appreciate the [34:22] opportunity to testify so let me tell you about ccf the center for children and families it's an [34:29] independent nonpartisan policy and research center found in 2005 with a mission to expand and improve [34:36] high quality affordable health care coverage for america's children and families as part of the [34:41] mccourt school of public policy at georgetown university we conduct research develop strategies and [34:47] offer solutions to improve the health of america's children and families particularly those with low and [34:51] moderate incomes ccf is responsible for raising external funding to conduct our work the full list [34:58] of our current funders is available on our website ccf does not accept any government foreign or corporate [35:04] funding our work is funded primarily by fill out philanthropies testimony and views i'm presenting [35:11] today are my own not those of georgetown university or the mccourt school here's the reality of medicaid [35:18] it's a hugely important health insurance program for 67 million low-income americans [35:23] it covers nearly 40 percent of our nation's children nearly half of all children with special [35:28] health care needs 40 percent of births it's also the largest payer for long-term care services and [35:34] supports for people with disabilities and seniors accounts for three-fifths of long-term care spending [35:41] it's particularly important to children and families in rural america and to hospitals and physicians [35:45] that serve them in the communities in which they live non-elderly adults and children in small towns [35:50] in rural areas are more likely than those living in metro areas to rely on medicaid for their health [35:56] insurance medicaid means access to needed health and long-term care services as well as protection [36:03] from medical debt for children and families and for all the other populations it serves so it comes [36:09] as no surprise that medicaid is very popular with the american people the january 2025 kff tracking poll [36:16] found that 77 percent of voters had very or somewhat favorable views about medicaid including 63 percent [36:22] of republicans and 81 percent of independents in my written testimony i discussed the role of medicaid [36:29] in our health care system it's important to children and families the harm that last year's budget [36:33] reconciliation bill will do to millions of americans who rely on medicaid for access to health care and [36:39] protection against high health care costs and the reasons for federal and state spending [36:45] why that spending is growing i also explained that actually reducing fraud against the medicaid program [36:51] requires collaboration between the federal government and the states not withholding federal funds [36:56] or partisan attacks in closing i want to sound one alarm we at ccf closely monitor child enrollment in [37:04] medicaid our latest tracking updated as of last friday finds that since january 2025 the number of children [37:13] enrolled in medicaid has dropped by 2.3 million that's 2.3 million that's as many children as in the [37:20] states of alaska delaware maine montana new hampshire north dakota rhode island south dakota vermont [37:28] wyoming and the district of columbia combined this is a statistic that should alarm every policymaker who [37:36] cares about the well-being of children we know that declines in medicaid coverage mean increases in the [37:42] number of uninsured children we know that uninsured children are children without access to preventive [37:47] or primary care we know that their families have no protection against medical debt [37:52] if their children become sick or injured and need to go to the emergency room at a minimum [37:58] cms should be working with states to understand the root causes for this trend and take immediate [38:03] steps to reverse it instead cms leadership seems laser focused on withholding federal funds from [38:09] california and minnesota 2.7 billion and counting through repeated deferrals that is the reality of [38:19] medicaid today and it does not have to be this way i hope the members of this committee will work with cms [38:24] to change course i look forward to your questions thank you mr schneider uh mr blaze let's quick address [38:31] that issue of the 2.3 million children that have lost coverage under medicaid can you explain that yeah [38:39] it's a deeply misleading uh statistic if you look at combined medicaid and chip enrollment from before [38:47] the pandemic to 2026 there's actually a higher percentage of children on medicaid and chip in the [38:53] first part of 2026 than before the pandemic one of the issues is we have fewer uh one year we have fewer [39:01] bursts in the u.s because of the fertility decline then we have children who are um moving off the medicaid [39:08] program because they they age off of it so when you account for those factors and you look at it as a [39:12] percentage of all kids there's actually a higher percentage of kids enrolled in medicaid and ship [39:17] appreciate you explaining that mr schneider there were four primary reforms in the first reconciliation [39:25] package the first one was uh requiring states to redetermine eligibility every six months rather than [39:31] years that do you have a real problem with that i mean do you want people who are ineligible to be on [39:36] these programs i believe that the program should be only for people who are eligible so is there [39:43] anything wrong with states rechecking redetermining eligibility because a lot of states obviously don't [39:49] they haven't been i think the state should have some flexibility in how they administer their programs [39:55] the previous you're not answering the question i mean do you is there a problem with rechecking [40:00] eligibility there's not a problem with there's nothing draconian about that correct there's not a problem [40:06] with rechecking eligibility next our provider taxes and provider fees are those is that health care [40:16] states are sovereign political is is provider our provider does that is that health care [40:24] health care is in part how it gets the answer is no mr blaze so when states charge a provider [40:33] provider fees and taxes correct for a medicaid recipient this the provider gets reimbursed that amount [40:44] right but again the states are charging that for services across the board correct so isn't it true [40:51] then those provider fees and taxes artificially drive up the cost of health care for people on private [40:55] insurance or for people on medicare they do we actually have a study from looking at a tax that [41:02] california imposed um that it increased uh commercial prices by about four percent so isn't it true that [41:08] you said in your testimony president biden called that a scam president obama recommended doing exactly what [41:17] we did in the one big beautiful beer that that's not cutting and slashing medicaid right that's just [41:21] actually implementing what both president biden and obama recommended that's correct so that's [41:27] the second reform the one big beautiful bill uh state directed payments and this one is is kind of [41:32] baffling uh can you describe a little bit more what that is and intergovernmental transfers where the [41:38] states juice you know plump up what they charge or reimburse like their ambulance their state-owned [41:46] ambulance services and can you describe that yeah so let me do state directed payments first [41:50] on the fee-for-service side of medicaid there is a cap at medicare rates it's called an upper payment [41:57] limit that cap does not exist on the managed care side so as states have moved medicaid enrollees [42:04] into coverage through insurers they've realized that they can create these provider tax and financing [42:10] gimmicks um get the federal funds and then lavish much higher payments um on the big hospital systems [42:19] so what the one big beautiful bill did was extend the limits that were on the fee-for-service side of [42:25] medicaid to the managed care side so mr schneider does it make any sense to you whatsoever for every dollar a [42:32] state spends on a disabled child or blind elderly individual they get reimbursed again in the in the [42:40] federal match they get reimbursed a dollar 33 but for every dollar a state spends on a single [42:47] childless working age able-bodied adult states get nine dollars in reimbursement from the federal [42:54] government that's 40 trillion dollars in debt does that make any sense at all that disparity to a buck 33 [42:59] for a disabled child but nine dollars for uh some of you in many cases should be working does that make [43:05] any sense to you at all it's a policy choice that congress has made it's there's there's similarly there [43:11] are different that's not the question does it make any sense to you it apparently didn't make any [43:18] sense to president obama because he he recommended equalizing that treatment correct he did in a 2012 [43:24] budget proposal uh called the blended rate proposal he proposed equalizing the match rates now would he [43:30] would he if he would if he increased their reimbursement for disabled children or we just [43:35] dropped that to a reasonable level like no if we're going to reimburse uh disabled children for [43:39] buck 33 that's what we're reimbursed for so he had it as part of a deficit reduction plan it would have [43:45] brought up the traditional uh federal reimbursements for those traditional categories you know by how [43:49] much from buck 33 i don't recall okay okay let's uh what i've got for the time being uh senator merckley [43:59] yeah thank you mr chairman um can you tell us uh mr blaze blaze mr blaze blaze uh what is the federal [44:13] poverty level for a mother and two children the federal poverty level um for a household of three [44:21] is probably around 25 000 a year yeah that's approximately uh right and uh mr schneider is it [44:35] hard for mother and two children to live on roughly 25 000 slightly higher it's 27 000 but close enough [44:42] is it difficult for a mother and two children to live on that so you're looking on at a monthly income [44:50] of 2000 a month depending on the area of the country that the mother and child live in yes [44:58] i don't understand how they make ends meet extremely difficult uh and uh there probably aren't too many [45:04] people in this room living at that level and struggling and is it correct mr schneider that when [45:11] people are at that income level it often varies tremendously in the course of a year because [45:16] they get another part-time job or the boss at one part-time job has a scheduled arrangement that [45:21] doesn't work with the other part-time job or child care problems intervene so changes a lot of fluctuation [45:28] in the in the in the level of income that's correct senator and am i correct that medicaid [45:35] for expanded medicaid covers 138 percent of federal poverty level for in in states that have accepted [45:45] the option for adults yes and so that's 1.3 times roughly 27 000 or roughly 36 000 still a very low income [45:56] for a mother and two children the point i'm making here is the uh the chairman asked the question about [46:03] reauthorizing the income level every six months uh i will tell you one of the enormous stress factors [46:10] for very low income families is the refiling paperwork continuously and the states have estimated that [46:19] there's a massive uh overhead and essentially people bump up bump down with every little job fluctuation [46:28] and so i would say to my my colleague when you understand uh the challenge of less affluent families [46:35] uh certifying it every year might make sense you get more often than that and you're just catching [46:40] the fluctuations and creating enormous uh anxiety of of qualifying not qualifying qualifying not [46:47] qualifying which doesn't serve low-income children or their their families uh well [46:53] and um i wanted to turn to this question of the impact on rural america is it correct mr schneider that [47:03] there are a lot more folks on medicaid in rural america than in urban america in terms of the percent [47:10] of the population yeah in terms of the coverage yes it's yes and am i correct that when you lose uh revenue [47:17] at a rural clinic or hospital and it shuts down that it affects everyone in the community because there isn't [47:23] often as another clinic or another hospital that's correct and therefore people might have to go a [47:30] long distance to get health care so they could have great health insurance but their health care is [47:34] still compromised and that's correct well and i wanted to understand uh this this question about [47:42] children uh you testified that in a short period of time 2.3 million children have come off of [47:50] uh medicaid because of the the big beautiful bill or the big ugly betrayal as as better known in most [47:56] parts of the country uh and um and yet we heard testimony from someone else saying oh that's just [48:03] uh an anomaly because children are graduating out of the program faster than they come into it because [48:08] of low birth rates is it just an anomaly or did that bill uh actually change the program in a fashion [48:14] that is greatly reducing the number of children covered so let's separate two things um we're [48:24] looking when we track child health enrollment we are looking at current data from cms plus what we can [48:32] get from the state agencies because there's a little data lag between what the states provide and what cms [48:40] has so if you're just looking at the cms data between january 2025 and april 2026 [48:48] the medicaid child numbers enrollment went down from 30.1 million to 28.2 million so that's a drop of [48:57] almost 2 million we say 2.3 million because we have some later data from some states and that that decline [49:05] is very very concerning we don't know the reasons we don't know the reasons we don't know how many of [49:10] those 2.3 million um are going to end up uninsured but we're very concerned based on what has happened [49:17] historically that when the child enrollment rate in medicaid goes down the uninsured rate for children [49:24] goes up okay and we want to do whatever we can to avoid that so just one factual question as i close [49:30] out because i'm out of out of time am i correct is medicaid is the only health care program where [49:36] the federal spending is shrinking as a share of gdp sir i i i you don't have i assume so i don't have [49:45] that information i do have that and that is yeah the answer is yes thank you thank you senator merckley [49:50] the ranking member mentioned a family making 24 000 uh senator phil graham has written extensively [49:56] about families in that situation in the 2025 wall street journal column he pointed out a single mother [50:03] single parent with two school-aged children making eleven thousand dollars would qualify for over 53 [50:09] thousand dollars in tax-free benefits across the board again fifty thousand dollars tax free so again [50:20] we want to help people we want to help single moms and you know we want to see children make sure they [50:24] have health care but let's again talk about the facts i mean there aren't literally people only [50:31] living on 24 000 who have x they have access to all kinds of welfare benefits again in this case 53 000 [50:38] worth uh senator kennedy dr blaze uh before president obama expanded medicaid to include able-bodied working [50:56] adults traditional medicaid covered uh the poor pregnant women people with disabilities is that [51:07] correct that's correct senator and today those people are still covered are they not correct and is [51:14] it not the case that uh for those folks in traditional medicaid um for every one dollar that this is an [51:26] average for for every one dollar that that a state puts up the federal government puts up one dollar and [51:32] thirty three cents that's uh that's uh average across the country senator all right now president obama [51:39] through obamacare extended medicaid to able-bodied working adults is that correct correct and the [51:48] on average the federal government for those uh i'll call them obamacare medicaid expansion [51:56] enrollees this for every one dollar that the state puts up the federal government puts up nine dollars [52:03] is that correct that's correct okay so if you're a governor uh for for for for traditional medicaid [52:11] you can get a buck 33 for uh obamacare expansion enrollees you can get nine dollars that's the math [52:20] that they face right now if you're a governor you're going to try to get as many people on on medicaid [52:28] through obamacare expansion are you not that is the incentive that states have senator do some governors [52:35] cheat uh there are definitely some states that have a massive problem of improper enrollment so [52:44] people who would be some do some states cheat yes okay many states cheat now the states determine [52:57] in accordance with federal rules who's eligible for medicare is that for medicaid is that the case [53:06] yes okay now they have to do it in compliance with federal rules right there's there's the federal [53:11] eligibility rules that the federal government does a very poor job of enforcing all states follow the [53:18] the federal rules no they don't some of them cheat don't they many of them cheat right do some states [53:27] just accept people's word that they make a certain amount of money and therefore qualify for medicaid [53:35] yes senator do all states say listen um we hear you and we're not saying you're lying but we're going [53:43] to cross check uh your application with our state income tax records do all states do that uh not all [53:52] states do that okay if they did they would find out that some people are lying wouldn't they they would [54:00] now what's your best guess as to how much per year um this this cheating costs the the federal taxpayer we [54:13] released the report on this yesterday senator and estimated that it's 33 billion dollars it was 33 [54:19] billion dollars in 2024. okay and that's 33 billion dollars that is taken away from the people who really [54:31] need medicaid is that right yes has anybody gone to jail for doing this not to my knowledge don't you [54:41] think we ought to start putting people in jail for cheating uh i think that it's financial fraud against [54:46] the federal government yes um sir on the end i'm sorry i can't read your name sir i'm sorry don't you [54:55] think we ought to put people in jail for cheating senator i do not believe states are cheating you don't [55:04] believe that i do not believe that if they were cheating what planet did you just parachute in from [55:13] sir sir you don't work on this i've worked on this program for a long time but i'm going to be sure [55:18] i understand you don't believe states do not believe states are cheating i do not believe states are [55:23] cheating do you believe in the tooth fairy sir do you believe in the easter bunny do you believe that [55:35] jimmy hoffa died of natural causes you're not answering i do not believe states are cheating [55:42] in our administration of the medicaid program okay um i'm glad you have some water in front of you [55:53] because your pants are on fire let me go back to dr blaze tell me in the 13 seconds i have left [56:03] other than putting these people in jail both the people who cheat and the bureaucrats who allow them to [56:11] cheat how else you would fix medicaid so the key problem with medicaid is that the more states spend [56:18] um the more money they get from the federal government so to set the certain amount that [56:22] states get and all state spending on top of that comes from the state that would be an ideal reform [56:28] but um i'd say a first order reform is to end the discrimination against the most vulnerable there [56:33] shouldn't be uh uh the federal government incentivizing states with seven times more money [56:39] uh for the able-bodied than traditional enrollees sir to the gentleman in the end i i i don't mean to be rude to [56:45] you but if you really believe there's no cheating you need to put down the bomb that's the mo one of [56:53] the most extraordinary statements i've ever heard a witness make okay thank you mr chairman we'll move [57:00] on while we're on the topic i just want to quick ask mr blaze do all states comply with the federal [57:05] government requirements to provide information to the federal government to audit the results um it's [57:12] it's a very mixed bag uh i think the information that states provide is often incomplete um and the [57:18] federal government needs to do a better job of getting real-time uh spending information from [57:23] which which states are the worst in terms of compliance well in terms of uh improper enrollment [57:30] in the i mean just in terms of not providing federal government information that's required or [57:34] requested that i don't know the answer to senator uh senator kane thank you mr chair and thanks for [57:42] holding this hearing you know this is an interesting one there's that that old parable about people [57:47] with blindfolds on touching an elephant and all describing something different and they're not [57:52] necessarily inaccurate but they're all describing something different and i think there have been a [57:57] number of charts that are probably accurate um and there have been a number of statements that are [58:02] accurate the the two million decline of kids in a year and a half in in medicaid is an accurate number [58:09] i do believe some of that might be related to fertility some of that might be related to more [58:15] aging out than being born i doubt that equates to two million but that's probably a factor we should [58:20] get into here's the chart that i want to put up um and it's a chart of what's happening in virginia [58:27] so i'm just going to spend my time talking about providers and i bet some of you have a similar [58:31] experience since the reconciliation bill passed um 12 hospitals or clinics in virginia and they're [58:40] denominated in the red have announced but not have announced they have closed citing hr1 as the reason [58:48] the the medicaid changes and hr1 is the reason and so these are the red dots on my map and they include [58:57] three primary care clinics um and six school-based clinics and then three hospital units a labor and [59:08] delivery ward in one hospital an observation ward in another hospital and i think a mental health [59:14] observation mental health wing in another hospital so 12 closures in virginia where they have announced [59:21] it is because of hr1 now remember the medicaid cuts in hr1 didn't go into effect until late 26 or early [59:30] 27 but any institution has to run a budget so they're going to run the budget for the next year and [59:35] they're going to look at what percentage of their patients are medicaid reimbursed and they're going to [59:39] see there's changes to medicaid and so even in the advance of these cuts being made we already have 12 closures [59:48] the virginia joint commission on health care so this is not you know some liberal think tank or whatever [59:56] it's the joint commission on health care has additionally come up with a list of hospitals this [1:00:03] is not hospitals and clinics it's hospitals that are either at immediate risk of closure or at risk of [1:00:10] closure and those are the yellow dots on this chart um and so we've got about 25 providers in virginia [1:00:19] half of which have already closed and then the other half the joint health care mission says they [1:00:24] are at risk or immediate risk of closure just because of the medicaid changes made in hr1 there's [1:00:30] actually a cms reg that's come out recently that extends hr1's effect on state directed payment [1:00:37] beyond what was in the bill and my hospitals are coming to me and saying this is going to compound it so [1:00:42] this issue is going to get worse because it'll get worse when the medicaid cuts actually factor in [1:00:48] and if the cms rule on the sdp program comes in it'll get worse now here's the the reason i wanted [1:00:55] to bring this up and and i suspect my colleagues are seeing something similar virginia's population is [1:01:00] about 9 million 70 percent of the virginia population lives in something that we call the urban crescent [1:01:08] which is basically dc to richmond along i-95 and then williamsburg newport news hampton virginia [1:01:19] beach along i-64 we call that the urban crescent in virginia 70 percent of our population 5.5 million [1:01:26] people live there none of the closures none of the at risks for closures are in the urban crescent they're [1:01:36] all in rural virginia all of them shanandoah valley appalachia south side northern neck potentially the [1:01:46] eastern shore and so this is what my providers are telling me so that that's data too the you know [1:01:54] the overall growth of the program is data but these are hospitals that have already closed clinics that [1:02:00] have already closed and those that are threatened to close and all of them are in rural virginia [1:02:05] because as mr schneider said rural populations tend to have a higher medicaid percentage in the payer mix [1:02:13] and they also tend to have a lower patient volume so when you take we're already have a low patient [1:02:18] volume so we're sort of barely struggling and then you take the core of our financial model and you [1:02:24] make changes to it that's why these closures are in rural virginia and why they're likely to be and i [1:02:28] suspect states around the country are seeing exactly the same thing the only real question that i want to [1:02:35] put on the table and i think it was mr blaze you said you know one of the reforms we should make [1:02:41] is have some uniformity in the program and then have any excess that's spent that should be on the [1:02:48] state's shoulders so i know you're talking about here's a program where the feds are you know being [1:02:55] charged by the state i mean and your argument is we should just have governors do more state taxes or [1:03:02] mayors do more local taxes to pick this up because if these changes are already leading to all these rural [1:03:10] closures i live in richmond i'm going to get service but but the 30 percent of virginia that lives in rural [1:03:18] virginia they're the ones seeing the closures and if we were to do what you suggest hey you know forget [1:03:24] all this federal money in the state the sdp program just as you say put the excess costs on the states [1:03:32] then you know i guess we could pat ourselves on the back and say we're bringing the cost curve down but if [1:03:37] we're just forcing states to increase taxes or mayors to increase taxes i'm not really sure we're [1:03:43] reducing costs instead an awful lot of the most rural states where people are getting hurt the most [1:03:50] are also the states that are probably least likely to be able to raise revenue at the state level to [1:03:56] support these providers so i'll just put my chart in with the others to say this tells me we got a huge [1:04:04] problem if the closures are all in rural virginia and i suspect overwhelmingly in rural america then [1:04:11] as we're trying to figure out what the answer is we better come up with an answer that solves this [1:04:15] thank you mr chair i yield back mr blaze he mentioned you do you want to quick respond to this uh yeah [1:04:21] senator and it's obviously it's a complicated problem uh you had rural hospitals uh that were struggling [1:04:25] before the reconciliation bill last year was passed um the assistant secretary of planning and [1:04:33] valuation at hhs did a study looking at rural hospitals that closed from 2011 to 2023 and found [1:04:40] that their occupancy was really low and had been declining and that the vast majority of rural [1:04:45] hospitals that closed were adjacent to urban areas um i think that from thinking that your job is to best [1:04:56] spend federal taxpayer dollars and a lot of these programs the provider taxes the state directed payments [1:05:03] the beneficiaries of those overwhelmingly are wealthy um big hospital systems that's not what my rural [1:05:10] hospitals are telling me about the sdp rule but i think the the savings that you get from those broader [1:05:17] reforms allow you to make targeted investments which is what the rural health transformation fund is [1:05:22] and that's 10 billion dollars a year yeah but it's interesting these closures have happened even though [1:05:26] there was a rural health transformation fund they closed even though they knew that congress had tried to [1:05:32] provide a little bit of uh money to try to help bridge this problem i mean i think the 10 billion [1:05:37] dollars a year is a lot of money given the financial exposure not enough to stop these hospitals from [1:05:44] closing so again i would never question the veracity of you know people who get federal dollars but i [1:05:52] will point out when we passed one big beautiful bill wisconsin went from 1.8 to six percent provider tax [1:05:59] because they wanted to you know be part of the deal too and i got a got lobbied by a hospital said you [1:06:04] know you you've got to lobby dr oz to create a waiver so we can get that six percent provider tax because [1:06:10] if we do it we can charge our patients 12 million dollars and we'll get reimbursed for 18 million [1:06:19] and we'll make a six million dollar profit that was the rationale wasn't like hey if we can't do this [1:06:24] we're gonna go out of business and say no it's this is a money-making opportunity for us and you've got to [1:06:28] lobby dr oz to you know allow us to make that an extra six million dollars so again i would take [1:06:34] what these providers uh who are getting all this federal money i'd take what they say with a grain [1:06:38] of salt senator marino thank you mr chairman thank you for having this hearing uh you know there's an [1:06:43] expression in sales that says uh facts get in the way of a good story and obviously the democrats want [1:06:49] to stick with the story that republicans are somehow uh for billionaires and they're for the working [1:06:55] class but obviously the facts are completely the opposite of that uh talking about rural america [1:07:01] they get wiped out in rural america rural american voters reject uh democrats by wide margins you would [1:07:09] think that they would look at that go why is that so let me give you a little bit of the answer [1:07:13] your policies have destroyed american manufacturing you allowed these jobs to get shipped overseas to china [1:07:19] mexico and our factories and places in ohio got wiped out because of those policies president trump [1:07:27] has put tariffs in place which have brought these manufacturing facilities back to the united states [1:07:31] of america and yet they fought tooth and nail every step of the way on tariffs you allow drugs to come [1:07:38] into our border across our border with impunity we had a completely wide open border and allowed tens of [1:07:44] millions of people to enter this country cheap labor that doesn't affect billionaires i don't think [1:07:49] billionaires get replaced by illegals crossing our border but working americans do they see massive [1:07:56] wage suppression and so those are the policies that they've put in place and they actually shut down [1:08:02] the government and wanted one of the ransom notes was to get rid of the rural hospital opportunity fund [1:08:08] they wanted to eliminate it none of them voted for it and they wanted to eliminate it those are just [1:08:13] facts the ranking member talked about the mom with two kids we're the party that cares about the mom [1:08:19] with two kids we're the party that gave that mom a two thousand dollar child tax credit you voted [1:08:25] against that we gave that mom an eighteen hundred dollar child tax credit you voted against that if [1:08:32] that mom worked for tips or overtime you voted against that you're the one that wants to give able-bodied [1:08:38] adults more money than those kids that that mom has i think a little self-reflection on that should be [1:08:46] part of the equation that those two things just those two things the child tax credit the daycare [1:08:53] credit is thirty eight hundred dollars for that mom making twenty five thousand dollars a year [1:08:58] that's real money that you guys did not want to give that mom that was just your votes and those are [1:09:05] just facts but when you did have control of congress and the white house what did you do did you help [1:09:11] working americans no you passed a law that gave seven thousand five hundred dollars to the wealthiest [1:09:20] point oh one percent of americans to buy luxury elect to lease luxury electric vehicles so while the [1:09:28] mom with two kids is making 25 grand a year struggling the person making tens of millions of dollars a [1:09:35] year could go into a rolls-royce dealership and get seventy five hundred dollars thanks to each and every one of you [1:09:40] the least a rolls-royce specter congratulations on that phenomenal policy mr schneider if somebody's [1:09:49] in this country without permission should they be allowed to get health care on the backs of the [1:09:56] american taxpayer yes or no my own view is if people need health care they should receive it so you think [1:10:07] that somebody who is here illegally should have their health care paid for by the american taxpayer so we [1:10:17] have a law in this country no i'm just asking that's a simple yes or no question somebody's in this [1:10:22] country i agree with somebody's somebody's let me just restate it so if they need emergency care yes [1:10:27] so the taxpayer the united states of america should pay for the health care of people who broke into [1:10:33] this country illegally that's what congress decided in 19 no no no no no congress never decided no what [1:10:39] congress you're talking about if you needed emergency health care and you went to any other country on earth [1:10:44] would you get it for free well the countries that i've gone to yes you'd get health care for free [1:10:51] if you went into so for example let's take spain which has incredibly difficult visa standards if you [1:10:58] went to spain and needed heart surgery you think the spanish government would give it to you gratis [1:11:03] i can't speak to spain but do you think that's that's but it's interesting i wonder if my democrat [1:11:09] colleagues would agree with that that if people who broke into this country illegally should get health [1:11:14] care mr schneider if somebody broke into your home would you make them dinner no i would not why not [1:11:25] why not why wouldn't you they need help but if they're starving what if somebody broke in your home [1:11:31] who's hungry would you not feed them or would you call the police and get the heck out of the house [1:11:37] somebody was hungry and needed to be fed i would feed them so somebody broke into your house you will [1:11:45] feed them don't give anybody your address so whatever you do i'm asking you just for your own [1:11:51] person's sake do not release your address can i answer the question please somebody breaks into my [1:11:57] home and they're hungry i'm going to forgive them for breaking in i'm going to feed them [1:12:01] and then we'll work out accountability for what they've done okay like i said don't release your [1:12:07] address but on behalf of the american taxpayers especially the hard-working men and women of this [1:12:12] country no government benefits taxpayer dollars should be absolutely and exclusively reserved for american [1:12:20] citizens and so the party that says they care about working americans this is why you keep losing in [1:12:25] rural america this is why you guys get wiped out in places like that whether it's virginia or oregon [1:12:31] you do not win in the rural parts of your state you get absolutely crushed because of that kind of philosophy [1:12:40] senator mercury would like to make a comment oh thank you just uh uh for the record uh undocumented [1:12:47] individuals are not eligible for medicaid unless they're in emergency going to the emergency room [1:12:52] under very limited circumstances and yes those same services emergency are provided by many other [1:12:59] nations if americans are traveling abroad for an emergency service mr blaze very quickly how many [1:13:05] illegal immigrants do you think are on medicaid not beyond uh beyond emergency services but on medicaid [1:13:13] do you have any estimate in california in california it's considerable um california got one of these [1:13:21] provider tax schemes approved and then the next got 10 billion dollars in federal funds without any [1:13:27] state contribution and the next year expanded medicaid to all unauthorized immigrants in the state [1:13:34] senator lujan thank you very much mr chairman um coming into the hearing at the moment that i did [1:13:42] uh really caught my attention as my colleague departs you know some of us are catholic and uh my colleague [1:13:49] went to catholic high school i believe if i'm not mistaken someone that should understand the lessons that [1:13:53] are taught to us every day um i'd refer my colleague from ohio to uh teachings under st francis of assisi if [1:14:00] he needs to learn about what it means to shelter those that need some help or provide food to those that [1:14:07] need some help or care for those that need some help i grew up in a rural community i didn't have [1:14:12] a rolls royce dealership um i still live on a small farm i put diesel in my tractor i turn dirt every [1:14:20] day i fix fences when my need my neighbors need help fixing a fence i go help them put that fence up i [1:14:26] don't ask if they're democrat republican whatever it may be we do it um this this this lesson about how [1:14:34] the big beautiful bill a piece of legislation that president trump ran on that my republican colleagues [1:14:40] are trying to fleece the american people in convincing them that this bill helps them a [1:14:47] trillion dollars was taken out of health care how the hell does that help anybody i'm a stroke survivor [1:14:52] four years ago i had a stroke what i learned is time is not on your side if you have a stroke you need [1:14:58] to get to the doctor immediately well not in the case of what happens with the trillion dollar cuts [1:15:05] and medicaid facilities start closing and rural clinics start closing and if that was not enough then [1:15:10] they went and devastated food programs in america kicking farmers and ranchers in the teeth and [1:15:15] closing rural grocery stores that's the big beautiful bill they just voted on it it just facts are funny [1:15:24] anyhow this hearing is about medicaid the realities around medicaid if i'm not mistaken the big beautiful [1:15:31] bill removed about a trillion dollars from health care with more than 800 billion dollars of federal medicaid [1:15:37] and my republican colleagues profess that they did not cut they being republicans did not cut medicaid [1:15:46] they only transferred the cost to states they eliminated a trillion dollars in access to health [1:15:52] care medicaid programs across the country we don't know who's going to get care who's not going to get [1:15:58] care i have constituents writing to me every day about a concern of being able to pay bills trying to [1:16:04] figure out if they're going to be able to get access to care or not dina from bernalillo county [1:16:10] which is the largest county in new mexico populace wise said as i was sitting in urgent care this [1:16:16] weekend i started to have serious anxiety that next year i might be without my medicaid insurance [1:16:21] and i may not be able to go to urgent care if i needed to quinn the affordable care act was passed we [1:16:28] had a republican governor in new mexico that did the right thing and embraced medicare medicaid expansion [1:16:35] it took new mexico from one of the most uninsured states in the country to a state that actually [1:16:39] people could get some coverage and have some certainty that care was going to be there um democrats [1:16:45] and republicans should be working together in all these if we're going to talk about reforms let's [1:16:49] talk about smart reforms let's talk about ways that we can get care to people in the most effective [1:16:54] manner possible so that if someone out there has a stroke like i did they're going to live and they're [1:17:00] actually going to recover the way that i did because my recovery is also very unique i was very [1:17:05] blessed with that recovery but it's because i had access to care eight million americans have [1:17:10] already lost health care coverage including nearly four million who lost medicaid chip the children [1:17:17] health insurance program now professor professor schneider are children protected from medicaid cuts [1:17:23] as my republican colleagues have suggested over time the large withdrawal of federal funding [1:17:32] close to a trillion dollars over the next 10 years that's in hr1 [1:17:37] everyone in the program is at risk children people with disabilities seniors people in rural areas [1:17:46] people in urban areas the providers that serve them they're all at risk you anticipated my next [1:17:51] question about seniors um i appreciate that response um i did not hear you specifically mention [1:17:58] the people with disabilities i heard you say everyone but what about people with disabilities exactly the [1:18:05] same situation the the states were expecting the resources that had been in place before hr1 was enacted [1:18:15] and over the next 10 years they're not going to have those resources available now coming from a rural [1:18:21] community myself um hearing the question uh from my colleague uh that was speaking before me are adults and [1:18:29] children in small towns and rural areas more likely than those living in metro areas to rely on medicaid chip for [1:18:37] their health insurance medicaid is a slightly more important payer for families and children in [1:18:43] rural areas than in urban this the same is important in both but it's a little more important in rural [1:18:48] i appreciate well this hearing is not on snap the same holds true for snap as well so look mr [1:18:54] chairman i certainly hope as the budget reconciliation debate is continuing on budget reconciliation three [1:19:00] we're looking at access to health care costs are going up you know some folks try to refer to this as [1:19:04] affordability people just can't afford to get services and to get by um and that we should not [1:19:10] forget about social security i challenge my republican colleagues at the last hearing we had on social [1:19:15] security maybe in your next budget reconciliation bill we'll actually see some language in there [1:19:20] to make sure social security is solvent and it didn't happen well lo and behold there's another [1:19:24] budget reconciliation coming forward so i look forward to seeing how republicans are going to protect [1:19:29] social security and make sure that it's going to be solvent in the next budget reconciliation package as well [1:19:34] i appreciate all the panelists and everyone here today for the hearing so a couple comments [1:19:38] reconciliation can't touch social security i've got to defend lutherans we're pretty compassionate too [1:19:43] and i would just remind us senator lujan take a look at the chart there and in 2014 the first year [1:19:48] of obamacare medicaid expansion we spent about 400 billion dollars on medicaid uh 2019 we were spending [1:19:57] actually 2014 spent a little 300 billion 2019 about 400 billion this year we'll spend 668 [1:20:06] billion dollars or 2025 next this year we'll spend about 735 so it went from 300 billion first year [1:20:12] of obamacare 400 billion right before the pandemic 668 billion last year 735 billion this year again i'm [1:20:20] just i'm just not seeing where we're taking a trillion dollars out of medicaid the costs of medicaid are [1:20:25] exploding but with that we'll turn to senator scott mr chairman could i respond to that i'd ask unanimous [1:20:31] consent is submit the analysis of hr1 uh from cbo into the record and that'll respond to your [1:20:37] questions associated with the trillion dollar tax cut thank you i'm really high in cbo uh projections [1:20:42] senator scott all right thank you chairman thanks for holding this dr blaze um the medicaid program [1:20:47] was released originally set up what for seniors children pregnant women disabled right correct and [1:20:52] the reason it was set up the way it was was that the federal government would pay a portion and the [1:20:56] states would pay a portion and they'd say with the states would pay a portion out of their own at their own [1:21:00] taxes right correct right and i guess you know it generally it goes from what 50 to depend on the [1:21:08] income level the state states pay from uh 50 to as little as what 15 about yeah so for the traditional [1:21:15] population wealthiest states they spend a dollar federal government contributes a dollar poor estates [1:21:20] they spend a dollar federal government contributes three dollars but for all states wealthy or not when [1:21:25] they when obamacare expanded to able-bodied adults it was 90-10 it was actually a hundred percent for [1:21:31] the first three years and it's phased down and it's not it's not 90 to 10 now so if you look at a state [1:21:37] budget now uh there have states used the have gained have they gained the 90-10 match to uh to pay for [1:21:44] things that have nothing to do with health care yeah i mean states get seven times more funding when they uh [1:21:52] spend a dollar on the expansion population than the traditional population and particularly given [1:21:57] that they can finance their state share with these legalized money laundering tactics states use medicaid [1:22:03] to fund other state projects and the aca expansion the nine to one is a multiplier on the money laundering [1:22:11] apparatus so have some states said okay gone to a provider and said hey you'll pay us some money so [1:22:16] we can get extra money from medicaid yeah in any cases uh centers the provider that goes to the state [1:22:22] and says we've designed this scheme um that's just going to plus us up with federal tax dollars so this [1:22:29] concept that the states would put up a portion um to make sure the dollars are spent wisely to make sure [1:22:35] the people are covered it doesn't really work anymore that's deteriorated yes so so i mean when you think [1:22:42] about it if the federal government's goal was to make sure we take care of especially the um you know the [1:22:48] pregnant women kids disabled they've the states have lost focus because there's so much money and the [1:22:53] providers have looked at there's so much money out here for uh the able-bodied adults the federal [1:22:58] government is encouraging states to discriminate against the most vulnerable dr oz recently paused [1:23:05] payments to california knowing that the in-home supportive service program has grown over 24 [1:23:10] percent over two years way more than the national average what's noteworthy is that the funding of this [1:23:15] program is 55 percent federal about 35 is intergovernmental transfers leaves the state only [1:23:21] paying about 11 percent okay so now they're supposed i thought they were supposed to have a 50 50 match [1:23:27] so to explain how that works so intergovernmental transfers the problematic most problematic ones are [1:23:34] where you get a um local health facility that transfers money to the state the state then uses that [1:23:42] has its payment back to the facility and then leverages the federal dollars so it's a way for [1:23:48] states um to use the medicaid financing system to benefit the government-owned providers at the expense [1:23:55] of the taxpayer and you have some examples where like in california they do this for their ambulances too [1:24:01] where they'll pay the government ambulance providers more than three times what they pay the private [1:24:06] ambulance providers through the medicaid program so so that like that ambulance company has no risk [1:24:13] i mean there's just extra money yes they're there's using the federal tax dollars to pay because [1:24:17] we all we should expect our states to be have skin in the game and what was what you're saying is what [1:24:22] happens is they don't actually have skin in the game they don't have skin in the game and they're and [1:24:27] they're lobbied like there is in the state capitals i mean you know this has a has a former governor and [1:24:31] former governors know this you're lobbied by the special interests to design programs this way and take it [1:24:37] advantage of the federal taxpayer mr mr ingerman the hss office of the inspector general recently [1:24:43] decertified new york's medicaid fraud control unit due to a year-long failure to do its job [1:24:48] despite receiving over 16 million dollars annually and having a staff of 270 people new york was the [1:24:54] worst performing unit compared to other states this office was only able to secure 85 fraud convictions [1:24:59] from 20 to 25 when the newest next lowest scoring state had 237 convictions almost three times more [1:25:06] new york had 49 criminal fraud indictments between 20 and 25 which is less than 10 a year [1:25:12] the next eight had 268 five times more it's not that fraud isn't there indiana and arizona were able [1:25:18] to secure five and seven times as many indictments in 25 alone compared to new york seven how important is [1:25:24] the medicaid fraud control unit program and what does it mean when a state is there is run so poorly like [1:25:29] new york had only one conviction per for patient abuse in 2025 despite having 2 000 patient abuse referrals [1:25:36] a year well new york's uh fraud control unit under uh ag letitia james has been horrendous as you noted [1:25:46] uh it's one of the worst in the countries uh you mentioned indiana and arizona those are states with [1:25:53] programs you know one-fifth the size of new york uh they have uh about one-tenth the staff one-tenth the [1:26:00] budget um and they're delivering you know five to seven times uh more criminal indictments they're [1:26:05] delivering more convictions more civil recoveries new york had not a single hospice fraud investigation [1:26:14] despite that being sort of a hotbed of fraud in new york it's not a new problem it's been ongoing for [1:26:21] years uh it definitely worsened under president biden uh states are getting more funding from [1:26:26] taxpayers than ever for these units uh and delivering worse results investigations are down indictments are [1:26:34] down convictions are down recoveries are down um indictments in new york have dropped 93 percent since [1:26:40] 2019. uh over a dozen of these units recover less fraudulent funds uh than it costs federal taxpayers to [1:26:50] operate them so you know this is a long-standing problem nobody really seemed to care until president [1:26:55] trump uh came in uh he's doing something about it you know new york was decertified hawaii was decertified [1:27:02] uh but a future administration could go back to the way things were under president biden um so i would [1:27:07] encourage everyone to uh codify stronger oversight requirements for these um and really make them [1:27:13] effective thank you senator whitehouse thanks chairman um we're here today because the uh billionaires bill [1:27:24] um will knock down medicaid spending by somewhere in the neighborhood of a trillion dollars uh some [1:27:35] basic facts are the medicaid money does not go to the medicaid recipient it goes to the people who provide [1:27:41] the health care it goes to hospitals it goes to nursing homes it goes to doctors it goes to uh pharmacists [1:27:48] so when you drop that kind of a spending cut into our health care system you're going to see [1:27:55] real problems and i think knowing that republicans set the grenade to go off after the election so that [1:28:06] the damage to individuals was not front page news everywhere before the election but what we are seeing [1:28:16] is that the entities that receive the medicaid funding are having to start doing their budgeting for [1:28:22] the trillion dollar cuts it's responsible to look forward and as they're doing that they're starting to [1:28:29] see oh my god our numbers don't work anymore the financials now for hospitals are being affected by the [1:28:39] predicted cuts to medicaid the financials now for doctors practices are being affected by the predicted [1:28:48] cuts to medicaid and nursing homes have a particularly bad vulnerability and they're starting to see those [1:28:56] cuts as well so we need to be paying attention to the forewarnings that the financial work in these [1:29:06] industries are giving us about what the hell is coming at us because the grenade may be set to go [1:29:13] off after the election but it's still going to go off and that's why we're living through this [1:29:19] narrative creation effort to suggest that the problems with medicaid are that it's riddled with [1:29:26] fraudsters people are crooked and oh folks it has nothing to do with the billions and billions [1:29:33] and billions in tax cuts that we gave in that bill to the wealthiest and highest income people in the [1:29:43] country some of whom as billionaires actually don't pay any taxes actually don't that's as [1:29:53] miss helmsley famously said for the little people and this body is highly responsive to those billionaires [1:30:01] and so of course out went the medicaid spending in went the tax cuts for billionaires and that's [1:30:08] why we are where we are the device is employment reporting it's to create a red tape bomb that makes [1:30:20] it as difficult as possible for people on medicaid to fill out the requisite paperwork so they can keep [1:30:27] their benefits that's the trick that's the stunt that's being used to knock people off medicaid [1:30:35] i don't know how many of my colleagues hang out with people on medicaid we're a pretty [1:30:40] high-end group here around the senate but i tell you around rhode island who who's on medicaid [1:30:47] it's people with really significant learning disabilities it's people with mental health [1:30:54] issues that they're getting treatment for it's people in addiction recovery it's people with really [1:31:01] severe health conditions that interfere with their ability to earn a living it's people have multiple [1:31:09] health conditions so many they can barely keep track of their multiple health conditions and all [1:31:14] of those people with all those conditions are now supposed to be experts at red tape so that they don't [1:31:20] get pushed off by employment reporting requirements it's kind of a dirty trick and the notion that fraud is so [1:31:33] endemic in medicaid is a little bit belied by the fact that it's the only program that has a specifically [1:31:44] dedicated fraud detection and prevention program i was the attorney general of the state of rhode [1:31:52] island i ran our medicaid fraud control unit everybody had one we didn't find all that much [1:32:03] mr chairman because rhode island's a small state it's hard to set up a phony baloney doctor's office [1:32:08] and run millions of dollars in payments through without somebody catching on real quick but boy was [1:32:15] florida a festival of fraud it has its own medicaid fraud control unit they all do other programs don't [1:32:26] have that discipline they're not policed that way so the idea that fraud is out of control in medicaid [1:32:33] to me is not credible what is credible is how many people individuals with significant disabilities [1:32:44] very often addiction mental health learning so that they're able-bodied are going to get clobbered [1:32:54] by the red tape bomb that republicans set to go off after the election and the tell is the financials [1:33:04] of the providers who are looking forward to what their financial world looks like when that grenade [1:33:11] goes off thank you chairman i will point out that governor walls and attorney general ellison didn't [1:33:17] find much fraud in minnesota either and also remind people just the basic facts and i'll repeat them [1:33:21] again probably do it again 2014 the first year of obamacare's implementation medicaid spent 300 billion [1:33:29] dollars 2019 before the pandemic spent 400 billion dollars last year we spent 668 billion dollars more than [1:33:37] double where we spent first year of medicaid expansion this year we'll spend 735 again i'm just not [1:33:43] seeing these cuts you know i can do math that is a out of control increase in medicaid spending uh senator mr [1:33:51] chairman if you're going to argue with each of us after we've made our statements i think we're entitled to [1:33:55] reply and i think it's important simply to reiterate what i said there are a great number of medicaid [1:34:03] patients for whom keeping track of the the new red tape employment requirements the new red tape bomb that [1:34:12] republicans built into the billionaire's bill to specifically to knock people off the test was how many people you [1:34:19] could knock off medicare how can you reduce the spending by knocking those people off medicare and [1:34:24] the selection is going to be the people who are most vulnerable who don't have the skills to keep up [1:34:30] with the paperwork and red tape bomb that's going to be set off in their lives that's what we're dealing [1:34:36] with we'd like to keep you immigrants off the medicaid rules senator van holland uh mr chairman first we [1:34:43] should be clear about this there's nobody in this room that doesn't want to crack down on waste fraud or [1:34:50] abuse every one of us recognizes that a dollar that goes to fraud is a dollar that is not going to [1:34:57] somebody who needs the help and i don't think there's a person in this room who disagrees with that [1:35:03] statement i do have to question why the trump administration in its very first days eliminated the [1:35:11] inspector generals and a whole bunch of departments including the inspector general overseeing hhs if [1:35:20] you were really interested in going after fraud you wouldn't be firing inspector generals in the us [1:35:27] government which is exactly what they did so what this hearing is all about is let's pretend let's [1:35:35] pretend that the one trillion dollar cut to medicaid that republicans here in congress and the [1:35:43] president united states made in what they called their big beautiful bill let's pretend that million [1:35:47] dollars was really going after fraud as opposed to hurting tens of millions of americans i didn't make [1:35:56] up the number the congressional budget office the non-partisan congressional budget office told us that [1:36:00] 7.5 million americans are going to lose access to health care because of the cuts to medicaid [1:36:06] there are another over 2 million who are going to lose access because republicans took away [1:36:13] tax credits for the affordable care act again that's a cbo number and actually tells us what their real goal [1:36:22] here was right because as part of that big beautiful bill they gave billionaires and very rich people [1:36:29] permanent tax cuts it was beautiful if you're a billionaire i just want to show what the distribution of [1:36:37] those tax cuts was right here if you look at the tax cuts 22 percent of the benefits of the republican bill [1:36:46] went to the top 22 percent 72 percent of the benefits went to the wealthiest 20 percent and that number [1:36:54] will get bigger over time because republicans sunset the few tax benefits that went to working people just as [1:37:03] they eliminated the one tax credit that was available to middle class folks trying to afford their [1:37:08] health care and despite the cuts to medicaid they still had a 4.2 trillion dollar deficit over next [1:37:16] 10 years this is a budget committee i'm all for looking at honest ways for reducing our deficits you don't [1:37:22] do that by giving billionaires and big corporations huge tax cuts so let's look at these medicaid cuts [1:37:31] uh because in addition to the 7.5 million americans who are going to get hurt you're also going to have [1:37:40] a spillover effect on probably every american uh mr schneider maybe you could tell us what happens when [1:37:47] somebody who doesn't have medicaid coverage and doesn't have preventative health care coverage [1:37:54] gets desperately sick waits until they have to go to the emergency room who ends up having to cover the [1:38:01] costs of that uncompensated care at the end of the day well what usually happens is um the patient [1:38:11] ends up getting a bill that may throw the patient into medical debt the hospital that's providing the [1:38:19] emergency care has to cross subsidize that service and it will find the money for its operations from [1:38:27] other paying patients so right let's let's unpack what you mean by cross subsidize right what you mean is [1:38:33] that people who are not on medicaid people for example who are on private insurance people who [1:38:39] are paying their premiums at the end of the day they're going to have to pay more either in higher [1:38:45] premiums or co-pays in order to compensate for the uncompensated care did not it was the care that [1:38:52] was denied to the person who was on medicaid is that right that's correct right so i think it's important [1:38:57] understand that um in order to provide these tax cuts to billionaires and corporations republicans not [1:39:05] only cut access to health care for a million people excuse me seven and a half million people in [1:39:11] medicaid but they're also going to be pushing the costs of that harmful action onto everybody else [1:39:20] and again all for the effort to give these very rich people a big tax cut and i will just say mr chairman [1:39:27] that the cuts to medicaid were very cynically timed most of them if not all of them don't take place [1:39:33] until january of next year after the election i wonder why that is it's because the american people [1:39:41] are going to hate what they see and they're going to be feeling it in their pocketbooks and republicans [1:39:46] want to delay that until after the election that's what that cynical timing was all about again all in [1:39:53] service of giving very rich people big tax cuts thank you mr chairman so first of all the reconciliation [1:40:01] bill primarily prevented a massive automatic tax increase we cut taxes for virtually every american [1:40:10] taxpayer back in 2017 2018 when democrats had house senate in the white house you could have reversed [1:40:18] that you didn't you didn't increase people taxes neither did we so again to call it a massive tax cut it [1:40:24] wasn't we prevented a massive automatic tax increase which which would have been devastating for [1:40:30] our economy so again let's talk about it honestly in terms of what that reconciliation bill did there [1:40:35] were some additional tax cuts yes but the the trillions of dollars was a automatic tax increase would [1:40:41] have impacted every american and you didn't want to do it and we didn't do it so that was kind of [1:40:46] bipartisan we didn't want to increase taxes mr chairman if i could just have uh go ahead 30 seconds to [1:40:51] reply then i'll refute first of all as you know mr chairman uh when we passed the inflation reduction [1:40:57] act we actually did close a lot of tax loopholes on very wealthy corporations that were moving you [1:41:03] didn't reverse moving jobs overseas tax cuts with with respect to the earlier tax cuts they were lapsing [1:41:10] on their own they were going to go away on their own and all of us were prepared to have those for very rich [1:41:19] people lapse on their own as they should have so you saw the chart the overwhelming benefits from [1:41:25] those tax cuts go to very wealthy people and we actually specifically proposed that they lapse for [1:41:31] those people obviously not not not increasing tax on the american economy and benefits well these were tax [1:41:36] cuts that were put in place as you pointed out right during the first trump administration [1:41:39] disproportionately helping the very rich we wanted to allow those to lapse republicans didn't i mean [1:41:45] that's the end of the story okay senator murray thank you mr chairman i i think we can all agree [1:41:53] we do need to crack down on fraud especially in a program like medicaid that so many americans [1:41:58] really rely on so mr ingram let me just ask you yes or no you agree we do need to be cracking down [1:42:04] on medicaid fraud and not letting criminals off the hook yes yes thank you so i hope my republican [1:42:12] colleagues will use some part of this hearing to condemn president trump for pardoning criminals [1:42:18] who were convicted of major medicaid fraud trump pardoned five former executives from florida who [1:42:26] committed serious medicaid fraud to the tune of tens of millions of dollars that is pretty bad following [1:42:34] what was dubbed quote the largest health care fraud scheme charged by the u.s justice department [1:42:40] valued at over one billion in medicare and medicaid fraud trump commuted commuted the 20-year sentence [1:42:48] of a florida nursing home and assisted living facility executive so that's even worse so look i'm all for [1:42:54] major crackdown fraud i think we all are but it looks like we've got some pretty good leads starting in [1:43:00] the white house mr schneider i want to turn to you what single piece of legislation delivered the largest [1:43:07] cuts to medicaid in american history last year's budget reconciliation bill yep so everybody knows [1:43:14] republicans big ugly bill passed more than one trillion dollars in health care cuts mostly to medicaid [1:43:22] mr schneider how much how much in tax breaks for the top one percent did trump's bill contain [1:43:28] approximately one trillion dollars one trillion dollars in tax cuts to the top one percent [1:43:33] mr schneider how many americans are losing health care because of trump's big ugly bill so in terms [1:43:41] of the medicaid cuts the latest estimates are approximately 11 million 11 million so zero [1:43:48] billionaires lose their health care they do get a trillion dollars in tax cuts and then over 15 [1:43:55] million americans including the extended aca tax credits lose their health care thanks to republicans [1:44:02] passing one trillion in cuts for regular working class people that is the math and that is out and [1:44:09] out grift so it seems to me like the biggest medicaid theft didn't happen in a billing office [1:44:14] somewhere it actually happened last year right here in the united states capitol when republicans passed [1:44:20] trump's big ugly bill so mr chairman let me just say i find it pretty astounding that republicans are [1:44:27] holding an entire senate hearing on fraud in medicaid but they don't seem to have anything to say [1:44:33] about the fraud coming out of the white house i mean look at the crypto schemes and the foreign gifts [1:44:38] that's that's easily the most corrupt white house in american history so the president trump pardoned [1:44:45] convicted criminals who committed medicaid fraud this is outrageous to me and it is what we should be [1:44:51] talking about but i also want to note a really big difference in terms of values and beliefs right now [1:44:57] because i am here and i know my colleagues on this side are to fight for our safety net programs but [1:45:03] my colleagues on the other side of the aisle are not with me on that fight chairman johnson has said [1:45:08] repeatedly he believes social security is a ponzi scheme last week another republican senator was on [1:45:14] the floor saying social security is a scam so i wanted to make really clear at this hearing i cannot disagree [1:45:22] more strongly mr chairman social security is a program that millions of hard-working americans have [1:45:29] paid into their entire lives so republicans might want to cut benefits or privatize social security but [1:45:35] i want you to know i'm going to keep fighting to save social security and protect health care for our [1:45:41] americans now and long into the future thank you mr chairman correct the record i've said it's a legal [1:45:48] ponzi scheme which is exactly what it is i mean take a look at what a ponzi scheme is that's what [1:45:53] social security is it's been horribly mismanaged those those funds were not invested in something [1:45:58] that's value the federal government's government bonds i'm happy to and we'll probably hold a hearing [1:46:02] on this and you know i'll prove the case but it's a legal ponzi scheme and that's quite honestly [1:46:07] indisputable mr chairman to respond yes and welcome to the chairmanship but i find that you are turning [1:46:14] this into a debate committee not a budget committee that's fine i think it's important the american [1:46:19] people see a civil exchange but i will respond americans pay for their social security they pay [1:46:26] into it for their lifetimes and they deserve to know it's going to be there in the future that's [1:46:31] what we're focused yes they paid into it and the money was spent it's gone it's been horribly mismanaged [1:46:36] and again there's you take a look at the social security tables and some people don't even get [1:46:40] back what they put into it other people get up to three times what they put in so again that's [1:46:44] again we'll lay out the facts for this that's all i'm trying i'm trying to lay out the facts this is [1:46:47] a hearing about laying out the facts and i'll go to senator wyden mr chairman yeah point of privilege [1:46:56] it's customary in a senate committee for each member of the senate and each member of the committee to [1:47:03] be able to ask their questions and make their points with without an intervening rebuttal by the chair [1:47:11] i'm not anticipating doing an intervening rebuttal of republican members i'm not going to take up the [1:47:19] time for that i'm not going to ask for that i just think that and i did ask if i could put in a point [1:47:26] for the record earlier and you you allowed me to do that clarifying uh that undocumented individuals do [1:47:32] not qualify uh for federal benefits but i i i hope the point my colleagues have made is is that that [1:47:42] that is a new norm but maybe not a great norm for this committee well i would disagree i think it [1:47:48] makes the hearings more interesting and more informative are you going to grant i've i've [1:47:53] allowed an exchange back and forth are you going to grant me to intervene after every republican [1:47:57] testimony to point out how wrong they are and how off-base they are because that would be the [1:48:01] equivalent point senator wyden thank you mr chairman and uh i certainly share senator merckley's [1:48:07] view on this point and the reality is on this side we have been trying to work with republicans on [1:48:13] fighting health care fraud again and again you know i went to the floor repeatedly to point out for [1:48:19] example insurance broker fraud something that both of us ought to come together no response from [1:48:25] republicans so today we're looking at yet another approach that is ill-advised because it primarily hurts [1:48:33] people and doesn't do anything about reducing fraud or anything like that and that's the administrative [1:48:38] trap designed to disenroll folks who are eligible for medicaid and the trump administration went forward [1:48:46] to basically say that they were going to literally require people to prove that they're sick enough to [1:48:52] deserve health care so today senator warnock and i are releasing a letter signed by each senate democrat [1:49:01] urging the trump administration to pull back on this disastrous rule that would harm so many [1:49:08] vulnerable people so this by the way is the same sort of approach that house democrats have taken [1:49:15] to raise the alarm on this flawed and hurtful rule i can't remember the last time that we had such unity [1:49:21] between the house and the senate but i guess if the republicans are just going to keep hurting people [1:49:26] you'll see it often in this session i'd like to ask mr chairman that these letters be entered into the [1:49:32] record objection thank you mr chairman now andy schneider may not be known to everybody in this room [1:49:40] but i sat next to andy schneider when he was starting his career in health care and he was fighting for [1:49:46] people who were vulnerable people who walked an economic tightrope and balanced the food bill against [1:49:51] the fuel bill and the fuel bill against a rent bill and he's still doing that my god this is a man who [1:49:57] could probably go out to any mega corporation and pull down a gigantic salary but instead what he's [1:50:04] doing is putting his heart out there once more for people who are walking that economic tightrope so [1:50:10] before we wrap up i think it would be great to have andy schneider give us a real world example of the [1:50:16] human cost for the millions of americans who are losing their health care as a result of this [1:50:22] bureaucratic razzmatazz that's the most complimentary thing you can talk about because it really is [1:50:29] bureaucratic unfairness but tell us what it means uh to uh to people who are you know hurting and [1:50:36] vulnerable that you've been fighting for by my calculus for almost a half a century half a century going [1:50:42] to bat for people who didn't have clout and didn't have power thank you senator i appreciate that [1:50:50] um and i fondly remember um our days in midnight basketball in portland don't don't talk about [1:50:56] my gray panther days okay i withdraw that comment thank you you had a great dunk though so um so let's [1:51:08] take what is the unfolding story here of work reporting requirements being imposed on all medicaid [1:51:17] expansion states for medicaid expansion adults and one of the first states out of the box is nebraska [1:51:26] and there was a piece yesterday or the day before uh reporting on um some of the early administrative [1:51:38] red tape problems that um medicaid beneficiaries are going to face as this unfolds [1:51:47] disenrollment program isn't it well i think that's a fair characterization yeah so um in this particular [1:51:56] case uh a pregnant woman um was disenrolled um from the nebraska medicaid program because the um enrollment [1:52:09] staff didn't understand that she was pregnant so it eventually got sorted out as far as we can tell from [1:52:16] the reporting but these kinds of of of errors are almost uh unavoidable given the complexity uh and [1:52:25] cumbersomeness of the new rules that are about to go into effect well i thank you for putting a human [1:52:33] face on this we're going to be calling on you in the finance committee as well on the same um point and [1:52:38] before i close out my time mr chairman ranking member merckley asked members on the dais to share [1:52:43] stories from our states from families who rely on medicaid i'd like to enter into the record the [1:52:48] letter from 11 u.s senators to dr oz that highlights families all over the nation from one end of the [1:52:55] country to another who need help need assistance with community-based services and particularly need [1:53:02] medicaid last unanimous consent that i close out my remarks with that without objection so i think we'll [1:53:08] bring the here into a close i want to thank everybody all the witnesses everybody attending [1:53:13] um listen i i i'd like to have a little bit more discussion i think we've i've been civil i'd like [1:53:19] to maintain civility i think it's going to be more interesting for the american public if we can [1:53:24] exchange views again there's obviously a a big difference in perspective on this thing that's fine [1:53:29] but but let's discuss it okay and just the rigidity of the standard hearing you know this is said and [1:53:34] again i i i think it is far more interesting i think it's more far more beneficial to [1:53:40] let's have a discussion you know if there's something that's you want to challenge go ahead [1:53:44] and challenge it with with civility so again that's the way i intend to do this you know my [1:53:48] i keep my comments pretty short i don't filibuster you just take a look at my opening statement i [1:53:53] think it's pretty short uh but i they're they're important points to make be made and and uh i'll [1:53:59] continue to do that so i hope it doesn't offend my my democrat colleagues but that'll continue to be my [1:54:04] my uh contention here mr chairman i'll just point out that a discussion involves other members having [1:54:12] an equal time to provide rebuttal as well otherwise it's just rebuttal and again i i gave you when i [1:54:18] rebutted i gave the the democrat member time to rebut what i said as well so okay yeah i've i've been [1:54:24] here 15 years i've seen chairman handle different things including the esteemed former chairman of our [1:54:29] finance committee so again i think that's you know could i provide one fact before we close uh just [1:54:36] a fact as long as i can rebut it you can you you're most welcome you're most welcome to uh so that family [1:54:42] of a mother and two children that's only 100 of federal poverty level that's 22 2276 bucks a month [1:54:51] after payroll taxes the disposable income is 2100 an average rent for a two-bedroom apartment not even a [1:54:58] three-bedroom children don't get their own room is 1700 average cost for transportation around 500 [1:55:05] already you're down to zero dollars zero dollars for that family now you made reference to fifty [1:55:12] thousand dollar in benefits a family does qualify at that level for seven hundred and eighty five dollars [1:55:17] for snap zero dollars for tana and there's a massive waiting list for affordable housing so that's [1:55:23] the luck of the draw if you will so most families are in the situation where they're completely out [1:55:28] of money other than the assistance to help them buy food they don't even have money to add in into that [1:55:35] and this is before we start looking at a family has to buy utilities they have to put clothing they have [1:55:41] to have school supplies and so i just want to point out that as one colleague observed very few people in [1:55:48] this room have lived at that level of um really uh uh minimal resources and so having medicaid [1:55:58] available as health insurance to those families if we want that next generation to thrive is essential [1:56:06] well i will say people on this dais including myself came from very humble beginnings senator graham [1:56:11] senator scott uh so i think we understand this you know i was quoting senator phil graham who's also a [1:56:17] pretty noteworthy economist in his studies talking about fifty three thousand dollars in tax-free benefits [1:56:22] for a single parent with two children maybe eleven thousand dollars again i'm i'm just quoting him [1:56:28] so to take a look at his information uh but you know facts are facts and i think that's what we need [1:56:34] to try and do is let's get the facts on the table uh find out what we all agree on common facts [1:56:40] and then we can kind of debate the different perspectives but again i appreciate uh everybody's [1:56:44] involvement here uh the hearing record will remain open for 15 days until august 19th at 5 p.m for [1:56:49] the submission of statements and questions for the record this hearing is adjourned