Senate Budget Committee holds hearing on the effect of Medicaid cuts

[0:00] Longer than normal, but I think it's an important, very important topic. [0:04] I'll tell you just right up front what prompted this hearing as our first hearing. [0:09] It was the CBO release of the first three-quarter spending in Medicaid. [0:16] And the result is year over year we're at $49 billion, [0:21] which is a 10% increase over what we spent in fiscal year 2025. [0:28] Now again, I'd like to be as cooperative as possible, [0:31] but one of the reasons I wanted to hold the hearing is I wanted to counter the false accusations [0:36] that the Republicans cut and slashed Medicaid to the bone. [0:39] It's simply not true. [0:42] So just a real quick history of Medicaid passed in 1965. [0:48] There were four designated groups of people that qualified to aid for families to depend on children qualified, [0:57] aid to the elderly, aid to the blind, aid to the permanently and totally disabled. [1:02] States could optionally cover people medically needed who had income levels above the threshold set [1:09] and also children less than 21 that weren't on AFDC. [1:13] So that was the core group of people that Medicaid was initially designed to cover. [1:19] Now through the 90s and a little bit again in early 2000s, [1:23] eligibility continued to expand, as did enrollment, as did the dollars and cents. [1:31] We're going to have a little bit of dueling charts here. [1:33] I think the committee should get used to my using of charts. [1:37] But let's, again, the problem-solving process always begins with you have to admit you have a problem. [1:44] Now my guess is we have two definitions of the problem on each side of the dais here. [1:49] Personally, I think Medicaid spending is out of control, and I will kind of prove that case. [1:55] My guess on the other side of the dais, we're probably not spending enough. [1:58] But anyways, set that aside. [2:00] The next step is you have to define the problem. [2:03] You have to agree on common facts. [2:05] And what I'd like today's hearing to be about is laying out the basic facts we can all agree on. [2:11] And once we do that, we can start doing root cause analysis. [2:14] We can start taking a look at what kind of policy changes are required for something I hope we all agree with, [2:21] is prevent the massive fraud we're starting to have been revealed here over the last few months. [2:27] But let's start with my, I'll call this a PowerPoint presentation. [2:32] Everybody at their seat has the final chart of this buildup. [2:35] But it starts with this chart, which just shows spending from 1990 to 1998. [2:40] Now, again, this is 33 years into the program. [2:44] We are spending less than $100 billion. [2:48] And there's about 32 million people enrolled, which is around 12% of the population. [2:54] Next chart. [2:56] I've been spending enough, talking an awful lot about different budget baselines. [3:02] You know, take actual expenditures, increase them by population inflation growth. [3:07] It's just a reasonable baseline control over, you know, what should we be spending. [3:12] Had we done that to 1998 spending under Clinton, this year, last year, 2025, we'd be spending $248 billion. [3:19] Okay, next chart. [3:22] This shows actual spending. [3:24] Then on top of that, those projections, not really projections, but again, the baseline, [3:29] through 2014, the first year that Obamacare kicked in and Medicaid expansion kicked in. [3:36] You know, we were growing under the Bush administration, [3:39] slightly higher than that population growth and inflation. [3:43] Under the Obama administration, those expenditures increased pretty significantly and above and beyond that. [3:48] And, of course, 2014, it really took off. [3:51] Next chart. [3:52] This is what we'd be spending if we took the 2014 spending, again, [3:57] which is already first year into Medicaid expansion, [4:01] and just increase that by population and inflation. [4:05] We'd be spending $441 billion in fiscal year 2025. [4:10] Next chart. [4:12] This shows, again, actual spending on top of that inflation and population growth [4:18] from 2014 through 2019, the year before the pandemic. [4:22] Again, we're running ahead of that baseline. [4:25] Next chart. [4:27] So let's say you take 2019 spending, increase that by population inflation. [4:33] This year, 2025, we'd be spending $536 billion. [4:38] Final chart. [4:40] It's one in front of you. [4:42] We're actually spending $668 billion. [4:45] So, again, that's just the financial facts. [4:49] Instead of spending $248 billion under a Clinton 1998 baseline, [4:54] or $441 billion under a Obama after Medicaid expansion was already instituted of $441, [5:00] or $536 from the pre-pandemic baseline, we're spending $668 billion. [5:07] I just think that indicates a program out of control. [5:11] You combine that with the fact that now we have the Nick Shirley videos of the outrageous fraud [5:19] uncovered in Minnesota with child leering centers and autism centers and transportation. [5:29] I mean, all these things are defrauding Medicaid. [5:31] And the problem with that is when you're spending billions of dollars on fraud, [5:37] those are billions of dollars that can't be spent on the people who actually need it. [5:41] I think we'll hear from witnesses today, too, that a lot of Medicaid expansion, let me back up. [5:50] Medicaid was initially established as a federal match to a state-administered program. [5:56] The states have a significant amount of skin in the game. [5:59] Currently, for every dollar the states spend on a disabled child, [6:02] they get about $1.33 in benefits from the federal government. [6:07] Obamacare changed that for single, working-age, able-bodied, childless adults. [6:13] And for every dollar the state spends on that category of individuals, [6:17] again, not disabled child, not blind, not elderly, states get $9 in funding. [6:22] I mean, we'll talk about it, but it makes no sense. [6:25] I would say a lot of that has fueled some of the fraud. [6:29] There's just no incentive for states to really be checking eligibility or really be investigating fraud. [6:34] So we'll talk about that. [6:36] But anyway, huge disparity in terms of the dollars spent. [6:40] We've seen now the fraud. [6:43] We talked, and this is generally Medicare, but 400 hospice centers in Los Angeles. [6:48] A third of all hospice centers apparently were in L.A. [6:51] Dr. Oz defunded 400 of them. [6:53] Not one of them complained. [6:55] So again, I hope we can get bipartisan agreement that we need to figure out how to eliminate this fraud. [7:01] I can't tell you how much it is. [7:03] We don't do a very good job tracking it. [7:04] We don't have the controls in place. [7:06] We designed these programs to really be out of control, which is what we've got. [7:10] Final charts just talk about the enrollment. [7:14] You can see it has skyrocketed. [7:16] It has different points in time when it's done it through the 90s, early 2000s, [7:21] but it really skyrocketed after Obamacare and Medicaid expansion. [7:27] And I think the last chart you also have in front of you, this is a similar type of depiction [7:34] as I've done in the other baselines. [7:37] If you took the 1998 enrollment, increase it only by population, [7:42] we'd be looking at about 40 million people on Medicaid. [7:47] It'd be about 12% of our population. [7:50] If you just take, again, 2014 after Medicaid expansion, [7:55] so you've already had one year of Medicaid expansion, [7:58] you'd be at about 70 million, about 20% of our population. [8:02] But in fact, we're at about 88.2, which is over a quarter of our population is on Medicaid. [8:08] Again, I don't think Medicaid was ever designed to cover 25% of our population, [8:13] but that's where we are today. [8:14] So, again, these are just the basic facts. [8:17] If we're going to solve a problem, again, I would hope on a bipartisan basis [8:20] we'd like to at least eliminate the fraud in the program, [8:24] make sure the dollars we spend are going to the people who truly need it. [8:29] We all want to provide that kind of help. [8:31] We can hopefully eliminate the fraud. [8:33] But, again, these are just the numbers that indicate something's amiss here that needs to be addressed. [8:37] With that, I'll turn it over to Senator Merkley. [8:39] Thank you very much, Mr. Chairman. [8:41] We're bringing different perspectives to bear, [8:44] and that's the beauty of having hearings and debate. [8:51] And the perspective that many Democrats are bringing to this, [8:56] and probably a few Republicans as well, [8:59] is that prior to 2009, we had a tremendous uninsured population in America. [9:08] Both because, essentially, there were a lot of holes in the Medicaid program as to who was covered, [9:16] and then there was a gap above the income qualification for Medicaid, [9:20] where people still couldn't afford insurance unless insurance came through their company. [9:26] And then you had folks above that who couldn't afford insurance either. [9:31] So, essentially, we did two things. [9:33] We said, let's expand Medicaid, fill in the holes, [9:38] address the still low, less affluent population above it, [9:42] and let's create tax credits to help people buy private insurance in a marketplace. [9:46] And in Oregon, I don't have the exact number in front of me, [9:51] but I think we had roughly 25% of the population without insurance before we made those changes, [9:57] and we were over 95% who had insurance afterwards. [10:02] So, the result of that is not only a big reduction in stress for families because they had insurance, [10:10] but we ended a lose-lose situation. [10:14] Folks without insurance simply would postpone getting treatment for medical problems [10:20] because they couldn't afford to pay the bill, [10:23] and then the problems become bigger and more expensive. [10:26] And that's a problem for their health, [10:28] but it's also a problem for the cost of the medical system. [10:31] And then when they did go to get medical help, [10:34] they went to the emergency room, [10:35] which is the least efficient and highest cost piece of the entire system. [10:41] And then, because they didn't have insurance, [10:43] they often couldn't pay the bill, [10:44] which meant there was no revenue to cover the provision of services. [10:49] So, here we are with this lose-lose-lose proposition [10:52] because we don't have comprehensive health care. [10:55] So, that's the vision that was undertaken. [10:58] What we will see and lay it out is essentially, [11:02] when we're looking at the rising costs in Medicaid, [11:04] it's essentially because of the rising costs of health care per person [11:09] in every aspect of health care, [11:12] that is, in individual insurance provided through Medicare [11:15] and also through private insurance. [11:19] Last year, the Republican majority used a bill that's a simple majority bill. [11:25] And so, they said, essentially, [11:28] we don't like this Medicaid program. [11:30] We're not all in on this vision of health insurance for less affluent families. [11:34] So, we're going to cut it. [11:36] And they slashed what will become more than a trillion from the health care system. [11:41] And it will kick more than 15 million Americans off health insurance. [11:45] And it will skyrocket the out-of-pocket costs for millions more. [11:49] And where was the savings applied to? [11:52] Tax breaks for billionaires. [11:54] It was a very simple proposition. [11:57] Less affluent families lose and billionaires win. [12:02] And that's not a philosophy that many of us share. [12:06] Many of us disagree with that philosophy. [12:08] We think we should have a foundation for families to thrive, [12:11] not a families lose, billionaires win strategy. [12:15] Now, I'll partner with anyone to tackle fraud. [12:19] Invest in audits? [12:20] Absolutely. [12:22] Uncover and stop fraudulent charges? [12:24] Have significant penalties for that? [12:26] Absolutely. [12:27] Stop up-coding? [12:29] You bet. [12:29] And I've introduced a bill on up-coding. [12:31] Up-coding is a huge fraudulent practice. [12:33] But where? [12:34] In Medicare Advantage. [12:36] But deliberately reducing health insurance coverage for less affluent families [12:41] isn't, that's not tackling fraud. [12:44] That's simply destroying health care for less affluent families. [12:47] It's back to where we were in a lose-lose-lose strategy for our nation. [12:54] Now, the Trump administration has proceeded to protect fraudsters. [12:59] How? [12:59] By cutting off funding for Medicaid fraud control units. [13:02] I would suggest, Mr. Chairman, we should have a hearing on that. [13:05] And by pardoning convicted fraudsters, including one executive [13:10] who generated $205 million in false Medicare claims. [13:14] We should have a hearing on that. [13:16] So I'm all in on tackling fraud. [13:21] But when the conversation about fraud is used as a strategy [13:24] to wipe out health insurance for families [13:28] and recreate a lose-lose-lose foundation in America, [13:32] that I'm not all in. [13:34] The vision of the red carpet for the rich and red tape for the poor [13:39] is a bad vision for America. [13:42] We've already wiped out, under what Trump called the Big Beautiful Bill [13:49] and we called the Big Ugly Betrayal, [13:52] health care for 2 million children and 8 million people. [13:58] And certainly, the 2 million children who have been booted off Medicaid [14:01] or the Children's Health Insurance Program, CHIP, [14:03] they weren't committing health care fraud. [14:08] But I'll tell you what they were doing. [14:10] They were going to the doctor when they needed medical treatment [14:13] and the clinic and the hospitals were getting paid. [14:16] That's a win-win. [14:18] So let's reject the lose-lose-lose strategy [14:21] and adopt the win-win strategy. [14:24] Without health insurance, people will delay getting care, [14:28] develop more serious health issues, [14:30] be more expensive to treat, [14:31] go to the most expensive part, the emergency room, [14:34] provide less revenue to our clinics and hospitals. [14:38] And when revenue drops, hospitals and clinics close, [14:42] reducing care for the entire community, [14:45] regardless of what type of insurance you have. [14:48] So proceeding to, well, [14:52] take away health insurance for the less affluent [14:55] actually has a profound impact [14:57] on everyone's ability to have health care treatment. [15:01] And you know where it's really scary? [15:03] Rural America. [15:05] If you wipe out the flow of revenue [15:08] for a clinic or hospital in urban America, [15:11] well, there's another clinic or hospital nearby. [15:14] But when you do it in a rural area [15:16] and the next clinic or hospital is 70 miles away [15:19] or 100 miles away, [15:20] that's certainly out west, [15:21] that's not uncommon at all, [15:23] then you're having a profound impact [15:26] on the health of the entire community. [15:28] If you have a health attack [15:31] or that is a heart attack or a stroke, [15:33] you don't have time to drive 100 miles [15:34] to see a doctor, get to a hospital, [15:37] get to emergency room. [15:38] As of April of this year, [15:41] 216 hospitals and clinics have already closed [15:44] due to the provisions [15:46] in the big, beautiful bill last year [15:48] or dramatically reduced services. [15:51] More than 1,000 hospitals, clinics, and nursing homes [15:55] are at risk of closing or cutting services [15:57] because of the cuts to Medicaid. [16:00] And here's more bad news. [16:03] There's even more devastating cuts coming in 2027, [16:07] cynically scheduled to kick in [16:09] after this November's election. [16:12] An independent analysis [16:13] by the nonpartisan Congressional Budget Office [16:16] shows that this law will end coverage [16:18] for 7.5 million Medicaid enrollees [16:20] by creating a thicket of red tape, [16:22] burdensome reporting requirements, [16:24] and extra costs, [16:25] like the $35 copays for Americans [16:27] who are already struggling [16:28] to afford the cost of gas and groceries. [16:31] It's just wrong. [16:33] Let's recognize that these cuts [16:35] hit rural America the hardest. [16:37] My state of Oregon is a big rural state. [16:41] In rural Malloyer County [16:42] in southeast Oregon, [16:43] 52% of residents are covered by Medicaid. [16:45] And if you compare the number of children [16:48] in rural Oregon [16:49] who are dependent on Medicaid, [16:51] the Oregon Health Plan, [16:52] compared to the rural, [16:53] it's much higher in the rural areas. [16:56] Compare that to folks in Washington County, [16:58] just west of Portland, [16:59] where only 25% of residents, [17:01] instead of 52%, [17:02] are covered by the Oregon Health Plan. [17:04] That is our version of Medicaid. [17:06] So again, [17:07] it really attacks rural Americans. [17:10] Now let's look at the numbers. [17:11] And I share an affection with the chair [17:13] of using numbers. [17:15] Let's put up the first chart. [17:18] Medicaid spending has grown slower [17:20] than overall U.S. health spending. [17:23] And you can see it from this chart. [17:25] The blue line is much flatter than the red line. [17:27] It's as simple as that. [17:29] Since 2007, [17:30] all health care spending has gone up. [17:32] But Medicaid spending has gone up [17:34] at a much lower rate. [17:37] And now let's look at a forecast going forward. [17:39] CMS forecasts that this year, [17:43] the per-person costs of private insurance [17:45] will increase more [17:46] than the per-person costs of Medicaid. [17:50] Not to mention that Medicaid makes up [17:52] just 18% of national health spending. [17:55] Between 2000 and 2023, [17:58] while Medicaid's enrollment roughly doubled, [18:01] Medicaid's share of national health spending [18:03] ticked up just three percentage points. [18:06] Three percentage points from 16% to 19%. [18:09] So the problem isn't Medicaid. [18:13] It's our overall health care system [18:15] driving up costs across the board. [18:16] You see it in private insurance. [18:18] You see it in Medicare. [18:19] And yes, you see it in Medicaid as well. [18:21] But you see it going up more slowly in Medicaid [18:24] than in these other arenas. [18:26] CBO has found that every additional dollar [18:29] we spend on children's Medicaid coverage today [18:32] reduces federal deficits [18:33] by roughly $2 in the future. [18:36] Why is that? [18:38] Because healthier kids grow into healthier adults, [18:41] reducing their demand on the health care system [18:43] while increasing their contributions and taxes. [18:46] Well, we're creating a better foundation [18:49] for children to thrive [18:50] by making sure that they have insurance. [18:53] That's critical to my state of Oregon [18:56] where nearly 60% of their kids [18:58] get their health care through Medicaid [19:00] or CHIP, [19:02] Children's Health Insurance Program. [19:03] But it's not just the kids [19:05] who are threatened by these cuts. [19:06] The big, ugly betrayal law [19:08] passed last year on a partisan basis [19:10] is also forcing states [19:12] to slash home and community-based services [19:14] for seniors and people with disability. [19:17] Here's how it's affecting real people. [19:19] In Minnesota, [19:20] an autism therapy provider [19:21] had to sell her cattle herd [19:22] and lay off staff [19:23] just to keep serving children [19:26] who have nowhere else to turn. [19:28] In California, [19:29] because of in-home support services, [19:31] a mother has been able to take care of her disabled son [19:33] instead of having to work an additional job. [19:36] And as she said, [19:37] and I quote, [19:38] without this, [19:38] people become homeless. [19:40] They lose their income. [19:41] They lose their stability. [19:42] Whatever tiny safety net they had is gone. [19:45] It's just cruel. [19:46] And of course, [19:46] I think everyone is familiar [19:48] that we're the only developed country [19:49] where people are still going bankrupt [19:51] because of the costs of health care. [19:54] We have failed to provide [19:55] the same firm foundation [19:56] provided in every other developed country. [19:58] In Oregon, [19:59] one of my constituents wrote to me [20:01] about her two 40-year-old sons [20:03] with disabilities [20:03] who since they were 18 [20:05] have lived in group homes [20:06] and attended day programs. [20:08] Her plea to us was simple. [20:09] Don't force families like hers [20:11] back towards institutionalization [20:13] by cutting Medicaid funding [20:14] for these programs. [20:16] And institutionalization [20:17] is always more expensive. [20:20] In her words, [20:21] it would be insane, [20:22] inhumane, [20:23] and a crime against humanity. [20:26] Insane is right. [20:27] This isn't about fraud. [20:28] If it was, [20:29] this hearing would be [20:29] about the president [20:30] pardoning convicted fraudsters, [20:32] encouraging fraud, [20:33] and cutting funding [20:34] for Medicaid fraud control units. [20:36] This hearing [20:37] is about the red carpet [20:38] for the rich [20:39] and red tape for the poor. [20:41] Health care is a right for all, [20:42] not a privilege for the wealthy. [20:44] Let's reject the strategy [20:45] of families lose [20:47] and billionaires win [20:48] and replace it [20:48] with a strategy [20:49] of a foundation [20:50] for every family to thrive, [20:52] and that includes health insurance. [20:55] Senator Merkley, [20:56] you might have missed [20:57] the fact that we provided [20:59] $50 billion [20:59] for a rural health care fund [21:01] in the reconciliation bill. [21:04] And I'll just remind everybody, [21:06] Medicaid spending [21:06] is up 10% this year. [21:08] I don't think [21:09] there's any projection [21:09] that shows Medicaid spending [21:11] being cut or declining at all. [21:13] So it's just going [21:15] through the roof. [21:16] But again, [21:17] appreciate your opening statement. [21:19] Now, [21:19] it is tradition [21:24] in this community [21:24] to swear on witnesses. [21:25] If you all stand, [21:26] raise your right hand. [21:31] You swear on the testimony [21:32] you will give [21:32] before this community [21:33] would be the truth, [21:33] the whole truth, [21:34] and nothing but the truth [21:35] to help you God. [21:36] Please be seated. [21:40] Our first witness [21:40] is Mr. Brian Blaze. [21:42] Mr. Blaze is the president [21:43] of Paragon Health Institute. [21:45] He was a special assistant [21:46] to the president [21:46] for economic policy [21:47] at the White House's [21:48] National Economic Council [21:49] from 2017 to 2019, [21:52] where he coordinated [21:52] the development and execution [21:53] of numerous health policies [21:55] and advised the president, [21:56] NEC director, [21:57] and senior officials. [21:58] After leaving the White House, [21:59] Mr. Blaze founded Blaze [22:00] Policy Strategies [22:01] and served as the CEO. [22:02] Mr. Blaze. [22:04] Chairman Johnson, [22:05] Ranking Member Merkley, [22:07] and members of the committee, [22:08] thank you for the opportunity [22:09] to testify. [22:11] Medicaid is an important [22:12] welfare program, [22:14] but too often [22:15] it fails the truly vulnerable. [22:17] Children, pregnant women, [22:19] seniors, [22:19] and people with disabilities. [22:21] The federal-state [22:22] Medicaid partnership [22:24] is broken. [22:26] Over the past dozen years, [22:28] states have shifted [22:29] hundreds of billions [22:30] of dollars of Medicaid costs [22:32] to the federal government. [22:35] Washington now pays [22:36] more than 70% [22:37] of Medicaid spending, [22:38] up from the historic 60%. [22:40] I will focus my remarks [22:42] on two major problems. [22:44] The Affordable Care Act's [22:45] expansion of Medicaid [22:47] to able-bodied working-age adults [22:49] and the legalized [22:50] money-laundering apparatus [22:52] that results in massive [22:54] corporate welfare [22:55] through Medicaid. [22:55] The ACA created [22:58] a powerful financial incentive [23:00] for states to prioritize [23:01] expansion enrollees [23:03] over traditional enrollees. [23:05] On average, [23:06] when a state spends [23:07] one dollar of its own money [23:08] on a traditional Medicaid [23:09] enrollee, [23:10] the federal government [23:11] contributes a dollar-33. [23:14] But for one dollar [23:15] of state spending [23:16] on an expansion enrollee, [23:18] the federal government [23:19] contributes nine dollars. [23:20] Thus, [23:22] Washington pays states [23:24] seven times more [23:25] for each state dollar [23:27] on expansion adults [23:28] than for people [23:29] Medicaid was created [23:30] to serve. [23:32] Multiple studies show [23:33] that Medicaid expansion [23:35] has made it harder [23:35] for traditional enrollees [23:37] to obtain physician appointments. [23:39] It's increased wait times [23:40] and forced more patients [23:42] to rely on emergency rooms [23:44] for routine care. [23:46] Medicaid should prioritize [23:47] the most vulnerable. [23:49] Instead, [23:49] its financing formula [23:50] discriminates against them. [23:53] The same misguided incentives [23:54] explain the surge [23:56] in improper Medicaid enrollment. [23:58] Yesterday, [23:59] Paragon released a study [24:01] by Liam Segoe [24:02] estimating that nearly half [24:04] of the 20 million [24:05] Medicaid expansion enrollees [24:07] were likely ineligible [24:08] in 2024. [24:10] This imposed roughly [24:11] $33 billion [24:13] in improper federal costs [24:15] with a major cost shift [24:17] from states [24:18] to the federal government. [24:20] A few states [24:20] like California [24:21] and New York [24:22] have exceptionally high [24:23] improper enrollment. [24:24] But the problem exists [24:25] in virtually every year. [24:26] Congress should end [24:29] the discrimination [24:30] against the most vulnerable [24:32] and equalize federal [24:33] reimbursement rates [24:34] for all enrollees [24:36] within each state. [24:38] President Obama [24:39] proposed equalizing [24:40] reimbursement rates [24:42] after the ACA [24:43] became law. [24:44] A second major problem [24:45] is Medicaid money laundering. [24:47] The clearest example [24:48] is provider taxes. [24:50] Former Oregon [24:51] State Representative [24:52] Mitch Greenlich [24:53] called these [24:54] quote, [24:54] dream taxes for states. [24:57] Quote, [24:58] we collect the tax [24:59] from the hospital, [25:00] we put it up [25:01] as a match [25:02] for federal money, [25:02] and then we give it [25:03] back to the hospitals. [25:05] To be clear, [25:06] this is not a tax. [25:07] It is legalized [25:08] money laundering mechanism [25:10] for shifting costs [25:11] from states [25:12] to Washington [25:13] while generating [25:14] windfalls [25:15] for politically powerful [25:16] providers. [25:17] In 2011, [25:18] then-Vice President [25:20] Joe Biden [25:20] called provider taxes [25:22] a quote, [25:22] scam [25:23] and said they should [25:24] be eliminated. [25:26] Senator Durbin [25:26] has called them [25:27] a charade. [25:28] The Simpson-Bowles [25:29] Commission, [25:30] set up by President Obama, [25:32] recommended ending them. [25:35] President Obama [25:35] proposed limiting [25:36] provider taxes, [25:38] and the one big, [25:39] beautiful bill [25:39] basically adopted [25:40] his proposal. [25:42] Broken Medicaid [25:43] incentives have led [25:44] to a new form [25:45] of corporate welfare, [25:47] state-directed payments. [25:49] Under the Biden [25:50] administration, [25:50] CMS allowed Medicaid [25:52] insurers to pay hospitals [25:53] up to average commercial rates [25:55] or more than [25:56] two-and-a-half times [25:57] Medicare rates. [25:58] Medicaid should not [25:59] pay hospitals [26:00] more than Medicare. [26:01] Such excessive [26:02] Medicaid payments [26:03] distort the program's purpose [26:05] and threaten [26:06] seniors' access to care. [26:08] In the one big, [26:09] beautiful bill, [26:10] Congress appropriately [26:11] limited Medicaid payments [26:13] through insurers [26:14] to Medicare rates. [26:16] Most Medicaid spending [26:17] now runs through [26:17] health insurance companies, [26:19] generating enormous revenues [26:20] for them. [26:21] Yet there is remarkably [26:22] little evidence [26:24] that Medicaid-managed care [26:25] has improved access, [26:27] health outcomes, [26:28] or reduced costs. [26:30] Increasingly, [26:30] Medicaid-managed care [26:32] functions as a [26:33] financing intermediary [26:34] for corporate welfare. [26:36] Medicaid's perverse [26:37] incentives have also [26:38] created a lucrative [26:39] consulting industry [26:41] devoted to helping [26:42] states maximize [26:43] federal reimbursement [26:44] by gaming Medicaid's [26:46] complicated financing rules. [26:48] This does not [26:48] improve patient care. [26:51] Medicaid is an [26:51] essential program, [26:52] but Congress must [26:54] improve the core incentives. [26:55] Reward states [26:56] for serving [26:57] the most vulnerable, [26:58] not for maximizing [26:59] federal reimbursement. [27:01] End the financial [27:02] discrimination [27:02] against the most vulnerable. [27:04] Eliminate the Medicaid [27:05] money laundering schemes [27:06] and root out [27:07] corporate welfare. [27:09] Those reforms [27:09] will help return [27:10] the balance [27:11] to the federal-state [27:12] Medicaid partnership [27:13] and improve Medicaid [27:15] for America's [27:16] most vulnerable citizens. [27:18] Thank you, [27:18] Mr. Blaze. [27:19] Our next witness [27:20] would be [27:20] Mr. Jonathan Ingram. [27:22] Mr. Ingram is [27:23] the Vice President [27:23] of Policy and Research [27:24] at the Foundation [27:25] for Government Accountability. [27:27] Prior to joining FGA, [27:29] Jonathan served [27:29] as Director of Health Policy [27:30] and Pension Reform [27:31] at the Illinois Policy Institute [27:33] and is Editor-in-Chief [27:34] of the Journal of Legal Medicine. [27:36] He holds a Bachelor of Science [27:37] in History and English, [27:38] an Executive Master [27:39] of Business Administration [27:40] and a Juris Doctor. [27:41] Mr. Ingram. [27:44] Chairman Johnson, [27:45] Ranking Member Merkley, [27:46] and members of the committee. [27:48] Jonathan Ingram, [27:48] Vice President of Policy [27:49] and Research [27:50] at the Foundation [27:50] for Government Accountability. [27:51] Criminals steal billions [27:54] from Medicaid every year. [27:56] Last summer, [27:57] prosecutors charged [27:58] a Russia-led crime syndicate [28:00] that stole the identities [28:01] of more than a million Americans [28:03] and then billed Medicare [28:05] and Medicaid [28:06] more than $10 billion. [28:08] In May, [28:09] prosecutors charged [28:10] 15 defendants in Minnesota [28:12] in the largest Medicaid [28:13] autism fraud case [28:15] in American history. [28:17] In Ohio, [28:18] fraudsters built networks [28:19] of shell home health companies, [28:21] billed Medicaid for care [28:23] that they never delivered, [28:24] and then posted videos [28:25] of themselves drinking champagne [28:27] on private jets. [28:29] Those cases made headlines [28:30] because prosecutors [28:31] could bring charges. [28:33] Many Medicaid losses [28:34] never get that far. [28:36] Bureaucrats wrote rules [28:38] that enroll people [28:39] without verifying eligibility [28:40] and pay providers [28:42] that nobody has screened. [28:44] It's fraud by design. [28:45] The fraud has two faces, [28:47] criminal syndicates [28:49] billing from overseas [28:50] and rules quietly manipulated [28:52] from cubicle. [28:54] But the victims are the same. [28:56] American families [28:57] pay their taxes, [28:58] trusting Congress [28:59] to spend their money carefully. [29:01] And the people this program [29:02] was built for, [29:04] senior citizens, [29:05] pregnant women, [29:07] children with disabilities, [29:08] are left competing [29:09] for resources [29:10] that were stolen [29:11] or diverted [29:12] by bureaucrats [29:13] before they ever arrived. [29:16] Start with the scale. [29:17] More than one in five [29:18] Medicaid dollars [29:19] is spent improperly. [29:20] And before the one [29:21] big beautiful bill, [29:23] taxpayers were on track [29:24] to lose more than [29:24] two trillion dollars [29:25] over the next decade. [29:27] More than 80% [29:28] of those improper payments [29:29] traced to eligibility errors. [29:32] Five policy choices [29:33] made that possible. [29:35] First, bureaucrats [29:36] stopped verifying applications. [29:38] More than 40 states [29:39] take an applicant's word [29:40] on residency. [29:42] More than a dozen [29:43] take their word [29:44] on income. [29:45] And officials [29:46] in at least 30 states now [29:48] want to take enrollees' word [29:51] on work requirement exemptions [29:52] and compliance. [29:54] Second, states stopped [29:56] rechecking eligibility. [29:58] Nationwide, [29:59] states renewed 69% [30:00] of recent cases [30:01] without asking enrollees [30:03] a single question. [30:05] North Carolina [30:06] renewed 99.5% [30:08] of their 2.2 million [30:10] cases this way. [30:12] Third, states let hospitals [30:14] enroll patients [30:15] before anyone [30:16] verifies eligibility. [30:18] In California, [30:19] hospitals deemed [30:21] nearly 500,000 people [30:22] presumptively eligible [30:24] for Medicaid. [30:25] When the state [30:26] finally completed [30:27] its full eligibility [30:28] reviews, [30:29] only 155,000 of those [30:31] actually qualified. [30:33] 30%. [30:33] Federal taxpayers [30:35] never got any [30:36] of those dollars back. [30:37] Fourth, bureaucrats [30:38] import errors [30:39] from other welfare programs, [30:41] enrolling people [30:42] in Medicaid [30:42] based on their [30:43] food stamp enrollment. [30:45] Bureaucrats have built [30:46] these one-door systems [30:47] that merge enrollment [30:48] across programs. [30:50] Minnesota brags [30:51] that it built [30:51] a single app [30:52] that signed someone up [30:54] for as many as [30:55] nine welfare programs [30:56] in under 15 minutes. [30:58] One wrong answer [30:59] cascades through [31:00] every program [31:02] at once. [31:03] And fifth, [31:04] bureaucrats built [31:05] an on-ramp [31:05] for illegal aliens. [31:07] States enroll applicants [31:08] while they verify [31:09] immigration status, [31:11] a grace period [31:11] meant to last 90 days. [31:13] Seven in ten [31:14] of those temporary cases [31:16] now last longer. [31:18] One Utah enrollee [31:19] has collected Medicaid [31:20] for 5,820 days. [31:23] 16 years [31:24] without ever proving [31:26] immigration status. [31:27] Enrollment through [31:28] this loophole [31:29] grew more than 400% [31:30] under the Biden administration. [31:33] The results [31:33] match the design. [31:35] Federal auditors [31:35] have flagged millions [31:36] of ineligible [31:37] and potentially [31:38] ineligible enrollees. [31:41] Providers get [31:41] the same free pass. [31:43] Federal law [31:43] requires states [31:44] to rescreen [31:45] every Medicaid provider [31:46] at regular intervals. [31:49] Illinois went [31:49] three years [31:50] without rescreening [31:51] a single one [31:52] and some providers [31:53] have gone 17 years [31:55] without a revalidation. [31:57] When CMS forced [31:58] Minnesota [31:58] to rescreen [31:59] nearly 6,000 [32:01] high-risk providers, [32:03] the state disenrolled [32:03] more than 62% of them. [32:06] They failed background checks, [32:07] they failed site visits, [32:09] and they refused [32:09] to turn over information. [32:12] And when investigators [32:13] do catch providers, [32:15] states keep paying [32:15] them anyway. [32:16] States are supposed [32:17] to suspend payments [32:18] to any provider [32:19] who's credibly accused [32:21] of fraud. [32:22] New York [32:23] issued waivers [32:24] to keep paying [32:24] 96% of them. [32:26] Massachusetts [32:27] suspended payments [32:28] for fewer than [32:29] 1 in 10. [32:30] So why do states [32:31] run their programs [32:32] this way? [32:33] It's the money. [32:34] Every dollar a state [32:35] spends on Medicaid [32:36] draws at least [32:37] one federal dollar. [32:38] And Obamacare [32:39] supercharged that math. [32:41] Washington pays [32:41] states $9 [32:43] for every dollar [32:44] they spend [32:44] on able-bodied adults. [32:46] As Dr. Blaze mentioned, [32:47] an average of $1.33 [32:48] on the truly needy. [32:50] Then states launder [32:51] the rest, [32:52] shifting more state costs [32:53] onto federal taxpayers. [32:54] So bureaucrats [32:56] treat federal dollars, [32:58] Medicaid, [32:58] as free stimulus. [33:00] They treat [33:00] stopping fraud [33:01] as budgetary malpractice. [33:03] Every dollar of fraud [33:04] that they stop [33:05] is a dollar less [33:06] of free federal money [33:07] coming into the state. [33:09] Many go further [33:10] and game the match [33:11] itself, [33:12] misclassifying enrollees [33:13] into Obamacare expansion [33:14] to claim the higher rate. [33:17] Bureaucrats designed [33:18] this fraud over decades, [33:19] but Congress can fix it. [33:21] Require states [33:22] to verify identity, [33:23] income, [33:24] immigration status [33:25] before enrollment, [33:27] not after. [33:28] Require eligibility reviews [33:30] and provide a re-screening [33:32] on schedules [33:32] that states cannot ignore [33:33] and end the funding formula [33:35] that pays states [33:36] more to cover [33:37] able-bodied adults [33:37] than children [33:38] with developmental disabilities. [33:40] Thank you. [33:43] Thank you, Mr. Ingram. [33:44] Our final witness [33:44] is Mr. Schneider. [33:46] Mr. Schneider [33:47] is a research professor [33:48] of the Practice Center [33:49] for Children and Families, [33:51] McCourt School of Public Policy [33:52] at Georgetown University. [33:54] Most recently, [33:55] he served under [33:55] the Obama administration [33:56] as a senior advisor [33:57] at the Centers for Medicare [33:58] and Medicaid Services, [34:00] where he focused [34:02] on program integrity issues [34:03] in Medicaid. [34:04] He is a graduate [34:05] of Princeton University [34:06] and the University [34:07] of Pennsylvania Law School. [34:08] Mr. Schneider. [34:10] Thank you, Chairman Johnson, [34:12] Ranking Member Merkley, [34:13] and members of the committee. [34:15] Appreciate the opportunity [34:16] to testify. [34:19] So, let me tell you [34:20] about CCF, [34:21] the Center for Children and Families. [34:22] It's an independent, [34:23] nonpartisan policy [34:24] and research center [34:25] founded in 2005 [34:27] with a mission [34:28] to expand and improve [34:29] high-quality, [34:30] affordable health care coverage [34:31] for America's children [34:32] and families. [34:34] As part of the McCourt School [34:35] of Public Policy [34:36] at Georgetown University, [34:37] we conduct research, [34:39] develop strategies, [34:40] and offer solutions [34:40] to improve the health [34:41] of America's children [34:42] and families, [34:43] particularly those [34:44] with low and moderate incomes. [34:46] CCF is responsible [34:48] for raising external funding [34:49] to conduct our work. [34:50] The full list [34:51] of our current funders [34:52] is available on our website. [34:54] CCF does not accept [34:55] any government, [34:56] foreign, [34:57] or corporate funding. [34:58] Our work is funded primarily [34:59] by philanthropies. [35:02] Testimony and views [35:03] I'm presenting today [35:04] are my own, [35:05] not those of Georgetown University [35:06] or the McCourt School. [35:09] Here's the reality of Medicaid. [35:11] It's a hugely important [35:12] health insurance program [35:13] for 67 million [35:15] low-income Americans. [35:16] It covers nearly 40% [35:18] of our nation's children, [35:19] nearly half of all children [35:20] with special health care needs, [35:22] and 40% of births. [35:24] It's also the largest payer [35:25] for long-term care services [35:27] and supports for people [35:28] with disabilities and seniors [35:30] accounts for three-fifths [35:31] of long-term care spending. [35:34] It's particularly important [35:35] to children and families [35:36] in rural America [35:37] and to hospitals and physicians [35:38] that serve them [35:39] in the communities [35:40] in which they live. [35:41] Non-elderly adults [35:42] and children in small towns [35:44] and rural areas [35:44] are more likely [35:45] than those living [35:46] in metro areas [35:47] to rely on Medicaid [35:48] for their health insurance. [35:51] Medicaid means access [35:52] to needed health [35:53] and long-term care services [35:54] as well as protection [35:56] from medical debt [35:57] for children and families [35:58] and for all the other [36:00] populations it serves. [36:02] So it comes as no surprise [36:03] that Medicaid is very popular [36:05] with the American people. [36:06] The January 2025 KFF tracking poll [36:09] found that 77% of voters [36:11] had very or somewhat favorable views [36:13] about Medicaid, [36:15] including 63% of Republicans [36:16] and 81% of independents. [36:19] In my written testimony, [36:21] I discussed the role of Medicaid [36:22] in our health care system. [36:23] It's important to children [36:24] and families, [36:25] the harm that last year's [36:26] budget reconciliation bill [36:27] will do to millions of Americans [36:29] who rely on Medicaid [36:30] for access to health care [36:32] and protection against [36:33] high health care costs, [36:34] and the reasons for federal [36:36] and state spending [36:37] why that spending is growing. [36:40] I also explained [36:41] that actually reducing fraud [36:42] against the Medicaid program [36:43] requires collaboration [36:45] between the federal government [36:46] and the states, [36:48] not withholding federal funds [36:49] or partisan attacks. [36:52] In closing, [36:52] I want to sound one alarm. [36:53] We at CCF closely monitor [36:57] child enrollment in Medicaid. [36:58] Our latest tracking, [37:00] updated as of last Friday, [37:02] finds that since January 2025, [37:05] the number of children [37:06] enrolled in Medicaid [37:07] has dropped by 2.3 million. [37:10] That's 2.3 million. [37:12] That's as many children [37:13] as in the states of Alaska, [37:15] Delaware, Maine, Montana, [37:17] New Hampshire, North Dakota, [37:19] Rhode Island, South Dakota, [37:21] Vermont, Wyoming, [37:22] and the District of Columbia combined. [37:25] This is a statistic [37:27] that should alarm [37:28] every policymaker [37:29] who cares about [37:30] the well-being of children. [37:31] We know that declines [37:32] in Medicaid coverage [37:33] mean increases [37:35] in the number [37:35] of uninsured children. [37:37] We know that uninsured children [37:38] are children without access [37:39] to preventive or primary care. [37:42] We know that their families [37:43] have no protection [37:44] against medical debt [37:45] if their children become sick [37:47] or injured [37:47] and need to go [37:48] to the emergency room. [37:50] At a minimum, [37:51] CMS should be working [37:52] with states [37:53] to understand [37:53] the root causes [37:54] for this trend [37:55] and take immediate steps [37:56] to reverse it. [37:58] Instead, [37:59] CMS leadership [37:59] seems laser-focused [38:01] on withholding federal funds [38:02] from California [38:03] and Minnesota, [38:05] 2.7 billion and counting [38:07] through repeated deferrals. [38:11] That is the reality [38:12] of Medicaid today, [38:13] and it does not have [38:14] to be this way. [38:15] I hope the members [38:16] of this committee [38:17] will work with CMS [38:17] to change course. [38:19] I look forward [38:19] to your questions. [38:21] Thank you, Mr. Schneider. [38:22] Mr. Blaze, [38:23] let's quick address [38:25] that issue [38:25] of the 2.3 million children [38:27] that have lost coverage [38:30] under Medicaid. [38:30] Can you explain that? [38:32] Yeah, it's a deeply [38:33] misleading statistic. [38:35] If you look at [38:36] combined Medicaid [38:37] and CHIP enrollment [38:39] from before the pandemic [38:40] to 2026, [38:42] there's actually [38:43] a higher percentage [38:44] of children [38:44] on Medicaid and CHIP [38:46] in the first part of 2026 [38:48] than before the pandemic. [38:49] One of the issues [38:50] is we have fewer [38:52] one year, [38:54] we have fewer bursts [38:55] in the U.S. [38:55] because of the [38:56] fertility decline [38:57] than we have children [38:58] who are moving [39:00] off the Medicaid program [39:01] because they age [39:02] off of it. [39:03] So when you account [39:04] for those factors [39:04] and you look at it [39:05] as a percentage [39:06] of all kids, [39:07] there's actually [39:07] a higher percentage [39:08] of kids enrolled [39:09] in Medicaid and CHIP [39:10] than before the pandemic. [39:11] I appreciate you [39:11] explaining that. [39:12] Mr. Schneider, [39:13] there were four primary [39:15] reforms in the first [39:17] reconciliation package. [39:19] The first one [39:19] was requiring states [39:22] to redetermine eligibility [39:23] every six months [39:24] rather than a year. [39:24] Do you have a real [39:25] problem with that? [39:27] Do you want people [39:28] who are ineligible [39:29] to be on these programs? [39:32] I believe that the program [39:33] should be only for people [39:35] who are eligible. [39:36] So is there anything wrong [39:37] with states rechecking, [39:40] redetermining eligibility? [39:41] Because a lot of states [39:41] obviously don't. [39:42] They haven't been. [39:44] I think the state [39:45] should have some flexibility [39:46] in how they administer [39:47] their programs. [39:49] The previous... [39:49] You're not answering [39:50] the question. [39:50] I mean, is there a problem [39:52] with rechecking eligibility? [39:55] There's nothing [39:55] There's nothing draconian [39:57] about that, correct? [39:59] There's not a problem [40:00] with rechecking eligibility. [40:01] Next. [40:03] Are provider taxes [40:04] and provider fees, [40:05] are those... [40:06] Is that health care? [40:09] States are sovereign [40:10] political entities. [40:11] Is provider... [40:12] Is that health care? [40:17] Health care is in part [40:18] how it gets paid for. [40:19] The answer is no. [40:21] Mr. Blaze, [40:23] so when states charge [40:24] a provider, [40:26] provider fees [40:27] and taxes, correct? [40:29] For a Medicaid recipient, [40:34] the provider gets [40:36] reimbursed that amount, right? [40:38] But again, [40:39] the states are charging [40:39] that for services [40:41] across the board, correct? [40:43] So isn't it true [40:44] then those provider fees [40:45] and taxes artificially [40:46] drive up the cost [40:47] of health care [40:48] for people on private insurance [40:49] or for people on Medicare? [40:51] They do. [40:52] We actually have a study [40:53] from looking at a tax [40:55] that California imposed [40:56] that it increased [40:57] commercial prices [40:59] by about 4%. [41:00] So isn't it true [41:01] that you said [41:02] in your testimony [41:03] President Biden [41:05] called that a scam. [41:07] President Obama [41:08] recommended doing [41:10] exactly what he did [41:11] in the One Big Beautiful Bill. [41:12] That's not cutting [41:12] and slashing Medicaid, right? [41:13] That's just actually [41:14] implementing what both [41:15] President Biden [41:16] and Obama recommended. [41:19] That's correct. [41:20] So that's the second reform, [41:21] the One Big Beautiful Bill. [41:23] State-directed payments. [41:24] This one is kind of baffling. [41:27] Can you describe [41:28] a little bit more [41:29] what that is [41:29] and intergovernmental transfers [41:31] where the states juice, [41:33] you know, [41:33] plump up what they charge [41:36] or reimburse, [41:37] like their ambulance, [41:38] their state-owned ambulance services? [41:40] I mean, can you describe that? [41:41] Yeah, so let me do [41:41] state-directed payments first. [41:43] On the fee-for-service side [41:45] of Medicaid, [41:46] there is a cap [41:47] at Medicare rates. [41:49] It's called [41:50] an upper payment limit. [41:51] That cap does not exist [41:53] on the managed care side. [41:55] So as states have moved [41:56] Medicaid enrollees [41:57] into coverage through insurers, [42:00] they've realized [42:01] that they can create [42:02] these provider tax [42:03] and financing gimmicks, [42:05] get the federal funds, [42:07] and then lavish [42:07] much higher payments [42:09] on the big hospital systems. [42:12] So what the One Big Beautiful Bill did [42:14] was extend the limits [42:16] that were on the fee-for-service side [42:18] of Medicaid [42:19] to the managed care side. [42:21] So, Mr. Schneider, [42:22] does it make any sense [42:23] to you whatsoever [42:24] that for every dollar [42:25] a state spends [42:26] on a disabled child [42:28] or blind elderly individual, [42:31] they get reimbursed, [42:32] again, in the federal match, [42:34] they get reimbursed $1.33. [42:37] But for every dollar [42:38] a state spends [42:38] on a single, childless, [42:41] working-age, able-bodied adult, [42:44] states get $9 in reimbursement [42:46] from a federal government [42:47] that's $40 trillion in debt. [42:49] Does that make any sense [42:50] at all that disparity [42:51] to $1.33 for a disabled child [42:53] but $9 for some of you [42:55] in many cases [42:56] should be working? [42:58] Does that make any sense [42:58] to you at all? [42:59] It's a policy choice [43:00] that Congress has made. [43:03] There's similarly, [43:04] there are differentials. [43:05] Again, that's not the question. [43:06] Does it make any sense to you? [43:10] It apparently didn't make any sense [43:11] to President Obama [43:12] because he recommended [43:13] equalizing that treatment, correct? [43:16] He did in a 2012 budget proposal [43:18] called the blended rate proposal. [43:20] He proposed equalizing [43:21] the match rates. [43:22] Now, would he increase [43:24] the reimbursement [43:26] for disabled children [43:27] or would he just drop that [43:29] to a reasonable level? [43:30] Like, no, [43:31] if we're going to reimburse [43:32] disabled children [43:33] for $1.33, [43:33] that's what we're reimbursed for? [43:35] So he had it as part [43:36] of a deficit reduction plan. [43:37] It would have brought up [43:39] the traditional federal reimbursements [43:41] for those traditional categories. [43:42] You know how much [43:43] from $1.33? [43:44] I don't recall. [43:45] Okay, so what I've got [43:47] for the time being, [43:48] Senator Merkley. [43:52] Yeah, thank you, [43:53] Mr. Chairman. [43:55] Can you tell us, [43:58] Mr. Blaz, [43:59] Blaz? [44:00] Mr. Blaz. [44:03] Blaz. [44:04] What is the federal poverty level [44:07] for a mother and two children? [44:08] The federal poverty level [44:11] for a household of three [44:14] is probably around $25,000 a year. [44:18] Yeah, that's approximately right. [44:22] And Mr. Schneider, [44:28] is it hard for a mother [44:29] and two children [44:29] to live on roughly $25,000? [44:32] It's slightly higher. [44:33] It's $27,000, [44:34] but close enough. [44:35] Is it difficult [44:36] for a mother and two children [44:37] to live on that? [44:40] So you're looking [44:41] at a monthly income [44:43] of $2,000 a month, [44:46] depending on the area [44:48] of the country [44:49] that the mother and child live in? [44:50] Yes. [44:51] I don't understand [44:52] how they make the ends meet. [44:53] Extremely difficult. [44:55] And there probably [44:57] aren't too many people [44:57] in this room [44:58] living at that level [45:00] and struggling. [45:01] And is it correct, [45:02] Mr. Schneider, [45:04] that when people [45:05] are at that income level, [45:06] it often varies tremendously [45:08] in the course of a year [45:09] because they get [45:09] another part-time job [45:11] or the boss [45:12] at one part-time job [45:13] has a scheduled arrangement [45:14] that doesn't work [45:15] with the other part-time job [45:16] or child care problems [45:18] intervene. [45:18] So changes, [45:20] is there a lot of fluctuation [45:21] in the level of income? [45:23] That's correct, Senator. [45:25] And am I correct [45:26] that Medicaid [45:27] for expanded Medicaid [45:30] covers 138% [45:32] of federal poverty level? [45:36] In states that have [45:38] accepted the option [45:39] for adults? [45:40] Yes. [45:40] Yes. [45:41] So that's 1.3 times [45:43] roughly $27,000 [45:44] or roughly $36,000, [45:47] still a very low income [45:49] for a mother [45:50] and two children. [45:52] The point I'm making here [45:53] is the chairman [45:55] asked a question [45:56] about reauthorizing [45:58] the income level [45:59] every six months. [46:00] I will tell you, [46:01] one of the enormous [46:02] stress factors [46:03] for very low income families [46:05] is the refiling paperwork [46:09] continuously [46:10] and the states [46:12] have estimated [46:12] that there's [46:13] a massive overhead [46:15] and essentially [46:16] people bump up, [46:18] bump down [46:18] with every little job [46:20] fluctuation. [46:22] And so I would say [46:23] to my colleague, [46:24] when you understand [46:25] the challenge [46:27] of less affluent families, [46:29] certifying it every year [46:30] might make sense. [46:31] You get more often [46:32] than that [46:32] and you're just catching [46:33] the fluctuations [46:34] and creating enormous [46:35] anxiety [46:37] of qualifying, [46:39] not qualifying, [46:40] qualifying, [46:40] not qualifying, [46:41] which doesn't serve [46:42] low income children [46:43] or their families well. [46:47] And I wanted to turn [46:50] to this question [46:51] of the impact [46:52] on rural America. [46:54] Is it correct, [46:55] Mr. Schneider, [46:56] that there are a lot [46:57] more folks on Medicaid [46:58] in rural America [46:59] than in urban America [47:00] in terms of the percent [47:03] of the population? [47:04] Yeah, in terms [47:04] of the coverage. [47:06] Yes, it's, yes. [47:07] And am I correct [47:08] that when you lose [47:09] revenue at a rural clinic [47:12] or hospital [47:12] and it shuts down [47:13] that it affects everyone [47:14] in the community [47:15] because there isn't often [47:17] another clinic [47:18] or another hospital? [47:20] That's correct, sir. [47:21] And therefore, [47:22] people might have [47:23] to go a long distance [47:24] to get health care [47:24] so they could have [47:25] great health insurance [47:26] but their health care [47:27] is still compromised? [47:29] That's correct. [47:30] Well, [47:30] and I wanted to understand [47:32] this question [47:34] about children. [47:36] You testified [47:38] that in a short period [47:39] of time, [47:39] 2.3 million children [47:42] have come off [47:43] of Medicaid [47:44] because of the big, [47:46] beautiful bill [47:47] or the big, [47:47] ugly betrayal [47:48] as better known [47:49] in most parts [47:50] of the country. [47:52] And yet, [47:54] we heard testimony [47:54] from someone else [47:55] saying, [47:55] oh, that's just an anomaly [47:57] because children [47:58] are graduating [47:59] out of the program [48:00] faster than they come [48:01] into it [48:01] because of low birth rates. [48:02] Is it just an anomaly [48:03] or did that bill [48:05] actually change [48:06] the program [48:07] in a fashion [48:07] that is greatly reduced [48:08] in the number [48:09] of children covered? [48:11] So, [48:13] let's separate two things. [48:16] We're looking, [48:18] when we track [48:18] child health enrollment, [48:21] we are looking [48:21] at current data [48:22] from CMS [48:24] plus what we can get [48:26] from the state agencies [48:28] because there's [48:28] a little data lag [48:29] between what the states [48:31] provide [48:31] and what CMS has. [48:33] So, [48:34] if you're just looking [48:35] at the CMS data [48:36] between January 2025 [48:38] and April 2026, [48:41] the Medicaid child [48:42] numbers enrollment [48:44] went down [48:45] from 30.1 million [48:46] to 28.2 million. [48:49] So, [48:49] that's a drop [48:50] of almost 2 million. [48:51] We say 2.3 million [48:53] because we have [48:54] some later data [48:54] from some states. [48:56] And that decline [48:57] is very, [48:59] very concerning. [49:00] We don't know [49:01] the reasons. [49:02] We don't know [49:02] the reasons [49:03] and we don't know [49:03] how many of those [49:04] 2.3 million [49:05] are going to end up [49:07] uninsured. [49:08] But we're very concerned [49:09] based on what has [49:09] happened historically [49:10] that when [49:11] the child enrollment [49:12] rate in Medicaid [49:13] goes down, [49:15] the uninsured rate [49:16] for children [49:16] goes up. [49:18] And we want to do [49:19] whatever we can [49:19] to avoid that. [49:21] So, [49:21] just one factual question [49:23] as I close out [49:23] because I'm out of time. [49:25] Am I correct? [49:26] Is Medicaid [49:27] the only health care program [49:29] where the federal spending [49:30] is shrinking [49:30] as a share of GDP? [49:35] Sir, [49:36] I assume so. [49:38] I don't have [49:38] that information. [49:39] I do have that. [49:40] And the answer is yes. [49:41] Thank you. [49:42] Thank you, [49:43] Senator Merkley. [49:43] The ranking member [49:44] mentioned a family [49:45] making $24,000. [49:48] Senator Phil Graham [49:48] has written extensively [49:49] about families [49:50] in that situation. [49:51] In the 2025 [49:52] Wall Street Journal column, [49:54] he pointed out [49:55] a single mother, [49:56] single parent, [49:57] with two school-aged [49:58] children making $11,000 [49:59] would qualify [50:01] for over $53,000 [50:02] in tax-free benefits [50:06] across the board. [50:08] Again, [50:08] $53,000 [50:09] tax-free. [50:11] So again, [50:13] we want to help people. [50:14] We want to help [50:15] single moms. [50:16] We want to see children [50:17] make sure they have [50:18] health care. [50:19] Let's, again, [50:20] talk about the facts. [50:21] There aren't [50:22] literally people [50:24] only living on $24,000 [50:25] who have access [50:27] to all kinds [50:28] of welfare benefits. [50:30] Again, [50:30] in this case, [50:30] $53,000 worth. [50:33] Senator Kennedy. [50:40] Dr. Blase, [50:42] before President Obama [50:43] expanded Medicaid [50:47] to include able-bodied [50:49] working adults, [50:53] traditional Medicaid [50:54] covered the poor, [50:58] pregnant women, [50:59] people with disabilities. [51:00] Is that correct? [51:01] That's correct, Senator. [51:02] And today, [51:03] those people are still covered, [51:04] are they not? [51:05] Correct. [51:06] And is it not the case [51:08] that for those folks [51:11] in traditional Medicaid, [51:13] for every $1 that, [51:18] this is an average, [51:19] for every $1 [51:20] that a state puts up, [51:23] the federal government [51:24] puts up $1.33. [51:26] Does that sound about right? [51:28] That's average [51:29] across the country, Senator. [51:30] All right. [51:30] Now, President Obama, [51:32] through Obamacare, [51:33] extended Medicaid [51:34] to able-bodied working adults. [51:38] Is that correct? [51:39] Correct. [51:40] And the, [51:41] on average, [51:43] the federal government, [51:44] for those, [51:46] I'll call them [51:47] Obamacare, [51:48] Medicaid, [51:49] expansion enrollees, [51:51] for every $1 [51:52] that the state puts up, [51:53] the federal government [51:55] puts up $9. [51:56] Is that correct? [51:57] That's correct. [51:58] Okay. [51:59] So if you're a governor, [52:01] for traditional Medicaid, [52:04] you can get $1.33. [52:07] For Obamacare expansion enrollees, [52:10] you can get $9. [52:12] That's the math that they face. [52:14] Right. [52:15] Now, [52:15] if you're a governor, [52:17] you're going to try to get [52:19] as many people on Medicaid [52:21] through Obamacare expansion, [52:23] are you not? [52:23] That is the incentive [52:26] that states have, [52:27] Senator Yesen. [52:27] Do some governors cheat? [52:30] There are definitely [52:31] some states [52:32] that have [52:33] a massive problem [52:35] of improper enrollment. [52:37] So people who would be- [52:38] Do some states cheat? [52:41] Yes. [52:41] Okay. [52:43] Many states cheat. [52:46] Now, [52:48] the states determine, [52:51] in accordance with federal rules, [52:54] who's eligible for Medicare. [52:56] Is that, [52:56] for Medicaid, [52:57] is that the case? [52:59] Yes. [52:59] Okay. [53:00] Now, [53:00] they have to do it [53:01] in compliance with federal rules, [53:03] right? [53:03] There's the federal eligibility rules [53:05] that the federal government [53:06] does a very poor job [53:08] of enforcing. [53:08] Do all states [53:09] follow the federal rules? [53:13] No, [53:13] they don't. [53:14] Some of them cheat, [53:15] don't they? [53:16] Many of them cheat. [53:17] Right. [53:18] Do some states [53:19] just accept [53:21] people's word [53:23] that they make [53:24] a certain amount of money [53:25] and therefore qualify [53:26] for Medicaid? [53:28] Yes, [53:28] Senator. [53:28] Do all states say, [53:31] listen, [53:32] we hear you [53:34] and we're not saying [53:34] you're lying, [53:35] but we're going to cross-check [53:38] your application [53:41] with our state income tax records. [53:43] Do all states do that? [53:45] Not all states do that. [53:46] Okay. [53:47] If they did, [53:48] they would find out [53:49] that some people are lying, [53:51] wouldn't they? [53:52] They would. [53:52] Now, [53:55] what's your best guess [53:56] as to how much per year [53:59] this cheating costs [54:04] the federal taxpayer? [54:06] We released a report [54:07] on this yesterday, [54:09] Senator, [54:09] and estimated [54:10] that it's $33 billion. [54:12] It was $33 billion [54:13] in 2024. [54:15] Okay. [54:16] And that's $33 billion [54:18] that is taken away [54:22] from the people [54:23] who really need Medicaid. [54:25] Is that right? [54:26] Yes. [54:27] Has anybody gone to jail [54:30] for doing this? [54:32] Not to my knowledge. [54:33] Don't you think [54:34] we ought to start [54:35] putting people in jail [54:36] for cheating? [54:37] I think that it's financial fraud [54:39] against the federal government, [54:40] yes. [54:42] Sir, [54:43] on the end, [54:44] I'm sorry, [54:44] I can't read your name. [54:47] Sir, [54:47] I'm sorry. [54:48] Don't you think [54:48] we ought to put people [54:49] in jail for cheating? [54:52] Senator, [54:53] I do not believe [54:55] states are cheating. [54:56] You don't believe they're cheating? [54:57] I do not believe that. [54:58] If they were cheating, [55:00] what planet [55:01] did you just parachute in from? [55:06] Sir? [55:06] Sir, [55:08] I've worked on this program [55:10] for a long time. [55:11] But I'm going to be sure [55:12] I understand, [55:12] you don't believe states [55:13] do not cheat. [55:14] You don't believe [55:14] states are cheating? [55:15] I do not believe [55:16] states are cheating. [55:17] Do you believe [55:17] in the tooth fairy? [55:21] Sir? [55:23] Do you believe [55:24] in the Easter bunny? [55:27] Do you believe [55:28] that Jimmy Hoffa [55:29] died of natural causes? [55:32] You're not answering. [55:34] I do not believe [55:34] states are cheating [55:35] in the administration [55:37] of the Medicaid program. [55:38] Okay. [55:40] I'm glad you have [55:45] some water [55:45] in front of you [55:46] because your pants [55:48] are on fire. [55:50] I'm going to go back [55:50] to Dr. Blaise. [55:53] Tell me in the 13 seconds [55:55] I have left, [55:57] other than putting [55:58] these people in jail, [56:00] both the people [56:01] who cheat [56:02] and the bureaucrats [56:03] who allow them to cheat, [56:05] how else you would [56:05] fix Medicaid? [56:07] So the key problem [56:08] with Medicaid [56:09] is that the more [56:10] states spend, [56:11] the more money they get [56:12] from the federal government. [56:13] So to set the certain amount [56:15] that states get [56:16] and all state spending [56:17] on top of that [56:18] comes from the state, [56:19] that would be [56:20] an ideal reform. [56:21] But I'd say [56:22] a first-order reform [56:24] is to end the discrimination [56:25] against the most vulnerable. [56:26] There shouldn't be [56:27] the federal government [56:29] incentivizing states [56:30] with seven times [56:31] more money [56:32] for the able-bodied [56:34] than traditional enrollees. [56:35] Sir, [56:35] to the gentleman [56:36] in the end, [56:36] I don't mean [56:38] to be rude to you, [56:39] but if you really believe [56:40] there's no cheating, [56:42] you need to put down [56:43] the bomb. [56:45] That's one of the most [56:47] extraordinary statements [56:49] I've ever heard [56:49] a witness make. [56:52] Thank you, Mr. Chairman. [56:53] We'll move on. [56:53] While we're on the topic, [56:54] I just want to quick ask [56:55] Mr. Blaze, [56:56] do all states comply [56:57] with the federal government [56:58] requirements [56:59] to provide information [57:00] to the federal government [57:01] to audit their results? [57:05] It's a very mixed bag. [57:07] I think the information [57:08] that states provide [57:09] is often incomplete, [57:11] and the federal government [57:12] needs to do a better job [57:13] of getting real-time [57:15] spending information [57:16] from states. [57:17] Which states are the worst [57:18] in terms of compliance? [57:21] Well, in terms of [57:22] improper enrollment [57:23] in the ACA... [57:24] No, I mean, [57:24] just in terms of not [57:25] providing federal government [57:26] information that's required [57:27] or requested. [57:29] That I don't know [57:29] the answer to. [57:30] Okay. [57:30] Senator. [57:31] Senator Cain. [57:34] Thank you, Mr. Chair, [57:35] and thanks for holding [57:35] this hearing. [57:36] You know, [57:36] this is an interesting one. [57:37] There's that old parable [57:39] about people with blindfolds [57:41] on touching an elephant [57:42] and all describing [57:43] something different, [57:44] and they're not [57:45] necessarily inaccurate, [57:47] but they're all describing [57:48] something different, [57:49] and I think there have been [57:50] a number of charts [57:51] that are probably accurate, [57:52] and there have been [57:54] a number of statements [57:54] that are accurate. [57:55] The two million decline [57:57] of kids in a year and a half [58:00] in Medicaid [58:01] is an accurate number. [58:03] I do believe some of that [58:04] might be related to fertility. [58:07] Some of that might be related [58:08] to more aging out [58:09] than being born. [58:10] I doubt that equates [58:11] to two million, [58:11] but that's probably a factor [58:13] we should get into. [58:14] Here's the chart [58:15] that I want to put up, [58:17] and it's a chart [58:19] of what's happening [58:19] in Virginia, [58:20] so I'm just going to spend [58:21] my time talking [58:22] about providers, [58:22] and I bet some of you [58:23] have a similar experience. [58:26] Since the reconciliation [58:27] bill passed, [58:29] 12 hospitals or clinics [58:32] in Virginia, [58:33] and they're denominated [58:34] in the red, [58:35] have announced, [58:36] not have announced, [58:37] they have closed [58:38] citing H.R. 1 [58:41] as the reason. [58:41] The Medicaid changes [58:43] in H.R. 1 [58:44] is the reason. [58:46] And so these are [58:47] the red dots on my map, [58:49] and they include [58:50] three primary care clinics [58:52] and six school-based clinics, [58:58] and then three hospital units, [59:00] a labor and delivery ward [59:02] in one hospital, [59:03] an observation ward [59:05] in another hospital, [59:06] and I think a mental health [59:07] observation, [59:08] mental health wing [59:09] in another hospital. [59:10] So 12 closures in Virginia [59:12] where they have announced [59:14] it is because of H.R. 1. [59:17] Now remember, [59:18] the Medicaid cuts in H.R. 1 [59:19] didn't go into effect [59:21] until late 26 or early 27, [59:24] but any institution [59:25] has to run a budget. [59:26] So they're going to run [59:27] the budget for the next year, [59:28] and they're going to look [59:29] at what percentage [59:30] of their patients [59:30] are Medicaid reimbursed, [59:32] and they're going to see [59:33] there's changes to Medicaid. [59:35] And so even in the advance [59:37] of these cuts being made, [59:40] we already have 12 closures. [59:42] The Virginia Joint Commission [59:45] on Health Care, [59:46] so this is not, you know, [59:48] some liberal think tank [59:49] or whatever, [59:49] it's the Joint Commission [59:50] on Health Care [59:51] has additionally come up [59:53] with a list of hospitals. [59:56] This is not hospitals [59:57] and clinics. [59:57] It's hospitals that are either [1:00:00] at immediate risk of closure [1:00:02] or at risk of closure, [1:00:04] and those are the yellow dots [1:00:05] on this chart. [1:00:06] And so we've got about 25 providers [1:00:11] in Virginia, [1:00:12] half of which have already closed, [1:00:14] and then the other half, [1:00:15] the Joint Health Care Mission, [1:00:16] says they are at risk [1:00:17] or immediate risk of closure [1:00:19] just because of the Medicaid [1:00:21] changes made in H.R.1. [1:00:23] There's actually a CMS reg [1:00:25] that's come out recently [1:00:26] that extends H.R.1's effect [1:00:28] on state-directed payment [1:00:29] beyond what was in the bill, [1:00:32] and my hospitals are coming to me [1:00:33] and saying this is going [1:00:34] to compound it. [1:00:35] So this issue is going [1:00:36] to get worse because it'll get worse [1:00:39] when the Medicaid cuts actually [1:00:40] factor in and if the CMS rule [1:00:42] on the SDP program comes in, [1:00:44] it'll get worse. [1:00:45] Now here's the reason I wanted [1:00:48] to bring this up, [1:00:49] and I suspect my colleagues [1:00:51] are seeing something similar. [1:00:52] Virginia's population is [1:00:54] about nine million. [1:00:56] Seventy percent [1:00:57] of the Virginia population lives [1:00:59] in something that we call [1:01:00] the Urban Crescent, [1:01:01] which is basically D.C. [1:01:05] to Richmond along I-95, [1:01:08] and then Williamsburg, [1:01:10] Newport News, Hampton, [1:01:11] Virginia Beach along I-64. [1:01:14] We call that the Urban Crescent [1:01:16] in Virginia. [1:01:17] Seventy percent of our population, [1:01:19] 5.5 million people, live there. [1:01:21] None of the closures, [1:01:24] none of the at-risks for closures [1:01:27] are in the Urban Crescent. [1:01:29] They're all in rural Virginia. [1:01:31] All of them. [1:01:32] Shenandoah Valley, Appalachia, [1:01:35] Southside, Northern Neck, [1:01:38] potentially the Eastern Shore. [1:01:41] And so this is what my providers [1:01:44] are telling me. [1:01:45] So that's data too. [1:01:47] You know, the overall growth [1:01:48] of the program is data, [1:01:50] but these are hospitals [1:01:52] that have already closed, [1:01:53] clinics that have already closed [1:01:54] and those that are threatened [1:01:55] to close, and all of them [1:01:56] are in rural Virginia [1:01:59] because as Mr. Schneider said, [1:02:00] rural populations tend to have [1:02:02] a higher Medicaid percentage [1:02:05] in the payer mix, [1:02:06] and they also tend to have [1:02:07] a lower patient volume. [1:02:09] So when you take, [1:02:10] we already have a low patient volume, [1:02:12] so we're sort of barely struggling, [1:02:14] and then you take the core [1:02:16] of our financial model [1:02:17] and you make changes to it, [1:02:18] that's why these closures [1:02:19] are in rural Virginia [1:02:20] and why they're likely to be. [1:02:21] And I suspect states around [1:02:23] the country are seeing [1:02:24] exactly the same thing. [1:02:25] The only real question [1:02:26] that I want to put on the table, [1:02:29] and I think it was Mr. Blaise, [1:02:30] you said, you know, [1:02:31] one of the reforms we should make [1:02:33] is have some uniformity [1:02:35] in the program [1:02:36] and then have any excess [1:02:39] that's spent, [1:02:40] that should be [1:02:41] on the state's shoulders. [1:02:43] So I know you're talking about, [1:02:44] here's a program where the feds [1:02:46] are, you know, [1:02:47] being charged by the state. [1:02:50] I mean, and your argument is [1:02:51] we should just have governors [1:02:53] do more state taxes [1:02:55] or mayors do more local taxes [1:02:58] to pick this up [1:02:59] because if these changes [1:03:01] are already leading [1:03:02] to all these rural closures, [1:03:04] I live in Richmond. [1:03:05] I'm going to get service. [1:03:07] But the 30% of Virginia [1:03:09] that lives in rural Virginia, [1:03:12] they're the ones seeing [1:03:13] the closures. [1:03:14] And if we were to do [1:03:15] what you suggest, [1:03:16] hey, you know, [1:03:17] forget all this federal money [1:03:19] in the state, [1:03:20] the SDP program, [1:03:22] just as you say, [1:03:23] put the excess costs [1:03:24] on the states, [1:03:25] then, you know, [1:03:27] I guess we could pat ourselves [1:03:28] on the back and say [1:03:29] we're bringing the cost curve down. [1:03:30] But if we're just forcing [1:03:31] states to increase taxes [1:03:33] or mayors to increase taxes, [1:03:35] I'm not really sure [1:03:36] we're reducing costs. [1:03:37] Instead, an awful lot [1:03:39] of the most rural states [1:03:41] where people are getting hurt [1:03:42] the most are also the states [1:03:44] that are probably least likely [1:03:46] to be able to raise revenue [1:03:48] at the state level [1:03:49] to support these providers. [1:03:51] So I'll just put my chart in [1:03:54] with the others [1:03:55] to say this tells me [1:03:57] we've got a huge problem. [1:03:59] If the closures [1:04:00] are all in rural Virginia, [1:04:01] and I suspect overwhelmingly [1:04:02] in rural America, [1:04:04] then as we're trying [1:04:05] to figure out [1:04:05] what the answer is, [1:04:06] we better come up [1:04:07] with an answer [1:04:07] that solves this. [1:04:08] Thank you, Mr. Chair. [1:04:09] I yield back. [1:04:10] Mr. Blase, [1:04:11] he mentioned you. [1:04:12] Do you want to quick [1:04:12] respond to this? [1:04:14] Yeah, Senator, [1:04:14] it's obviously [1:04:15] a complicated problem. [1:04:16] You had rural hospitals [1:04:17] that were struggling [1:04:18] before the reconciliation bill [1:04:21] last year was passed. [1:04:22] The Assistant Secretary [1:04:25] of Planning and Evaluation [1:04:26] at HHS did a study [1:04:28] looking at rural hospitals [1:04:29] that closed from 2011 [1:04:30] to 2023 [1:04:31] and found that their occupancy [1:04:34] was really low [1:04:35] and had been declining [1:04:36] and that the vast majority [1:04:38] of rural hospitals [1:04:39] that closed [1:04:40] were adjacent [1:04:40] to urban areas. [1:04:42] I think that from thinking [1:04:47] that your job [1:04:49] is to best spend [1:04:50] federal taxpayer dollars [1:04:51] and a lot of these programs, [1:04:53] the provider taxes, [1:04:54] the state-directed payments, [1:04:56] the beneficiaries of those [1:04:57] overwhelmingly [1:04:58] are wealthy, [1:05:00] big hospital systems. [1:05:01] That's not what [1:05:02] my rural hospitals [1:05:03] are telling me [1:05:04] about the SDP rule. [1:05:05] But I think [1:05:06] the savings that you get [1:05:08] from those broader reforms [1:05:10] allow you to make [1:05:11] targeted investments, [1:05:12] which is what the [1:05:13] Rural Health Transformation Fund is, [1:05:15] and that's $10 billion a year. [1:05:17] Yeah, but it's interesting. [1:05:18] These closures have happened [1:05:19] even though there was [1:05:20] a Rural Health Transformation Fund. [1:05:22] They closed [1:05:23] even though they knew [1:05:24] that Congress [1:05:25] had tried to provide [1:05:25] a little bit of money [1:05:27] to try to help bridge [1:05:28] this problem. [1:05:29] I mean, I think [1:05:30] the $10 billion a year [1:05:31] is a lot of money [1:05:33] given the financial exposure. [1:05:35] Not enough to stop [1:05:36] these hospitals from closing. [1:05:39] So, again, [1:05:40] I would never question [1:05:41] the veracity of, you know, [1:05:42] people who get federal dollars. [1:05:45] But I will point out [1:05:46] when we passed [1:05:47] one big beautiful bill, [1:05:48] Wisconsin went from [1:05:49] 1.8% to 6% [1:05:51] provider tax [1:05:52] because they wanted [1:05:53] to, you know, [1:05:54] be part of the deal too. [1:05:55] And it got lobbied by a hospital [1:05:57] and said, you know, [1:05:57] you've got to lobby Dr. Oz [1:05:59] to create a waiver [1:06:00] so we can get that 6% [1:06:01] provider tax [1:06:02] because if we do it, [1:06:05] we can charge [1:06:05] our patients $12 million [1:06:09] and we'll get reimbursed [1:06:10] for $18 million [1:06:11] and we'll make [1:06:12] a $6 million profit. [1:06:15] That was the rationale. [1:06:16] It wasn't like, [1:06:16] hey, if we can't do this, [1:06:17] we're going to go out of business. [1:06:18] No, this is a money-making [1:06:19] opportunity for us [1:06:20] and you've got to lobby Dr. Oz [1:06:22] to, you know, [1:06:23] allow us to make that [1:06:23] an extra $6 million. [1:06:24] So, again, [1:06:25] I would take [1:06:26] what these providers [1:06:28] who are getting [1:06:29] all this federal money [1:06:30] I'd take what they say [1:06:31] with a grain of salt. [1:06:32] Senator Marino. [1:06:33] Thank you, Mr. Chairman. [1:06:34] Thank you for having this hearing. [1:06:35] You know, [1:06:36] there's an expression [1:06:36] in sales that says [1:06:38] facts get in the way [1:06:39] of a good story. [1:06:40] And obviously, [1:06:41] the Democrats [1:06:41] want to stick with the story [1:06:43] that Republicans [1:06:44] are somehow [1:06:44] for billionaires [1:06:47] and they're [1:06:47] for the working class [1:06:48] but obviously, [1:06:49] the facts are completely [1:06:50] the opposite of that. [1:06:53] Talking about rural America, [1:06:55] they get wiped out [1:06:55] in rural America. [1:06:57] Rural American voters [1:06:58] reject Democrats [1:07:00] by wide margins. [1:07:01] You would think [1:07:02] that they would look at that [1:07:03] and go, [1:07:03] well, why is that? [1:07:04] So let me give you [1:07:04] a little bit of the answer. [1:07:06] Your policies have destroyed [1:07:07] American manufacturing. [1:07:09] You allowed these jobs [1:07:10] to get shipped overseas [1:07:11] to China, Mexico, [1:07:13] and our factories [1:07:15] and places in Ohio [1:07:16] got wiped out [1:07:18] because of those policies. [1:07:20] President Trump [1:07:20] has put tariffs in place [1:07:21] which have brought [1:07:22] these manufacturing facilities [1:07:23] back to the United States [1:07:24] of America [1:07:25] and yet they've fought [1:07:26] tooth and nail [1:07:27] every step of the way [1:07:29] on tariffs. [1:07:29] You allowed drugs [1:07:31] to come into our border [1:07:32] across our border [1:07:33] with impunity. [1:07:34] We had a completely [1:07:35] wide open border [1:07:36] and allowed tens of millions [1:07:38] of people to enter [1:07:38] this country. [1:07:39] Cheap labor. [1:07:40] That doesn't affect [1:07:41] billionaires. [1:07:42] I don't think billionaires [1:07:43] get replaced [1:07:44] by illegals crossing [1:07:45] our border [1:07:46] but working Americans do. [1:07:48] They see massive [1:07:49] wage suppression [1:07:50] and so those are the policies [1:07:52] that they've put in place [1:07:54] and they actually [1:07:54] shut down the government [1:07:55] and wanted, [1:07:57] one of the ransom notes [1:07:58] was to get rid [1:07:59] of the Rural Hospital [1:08:00] Opportunity Fund. [1:08:01] They wanted to eliminate it. [1:08:03] None of them voted for it [1:08:04] and they wanted to eliminate it. [1:08:05] Those are just facts. [1:08:08] The ranking member [1:08:08] talked about the mom [1:08:09] with two kids. [1:08:11] We're the party [1:08:12] that cares about [1:08:12] the mom with two kids. [1:08:14] We're the party [1:08:15] that gave that mom [1:08:16] a $2,000 child tax credit. [1:08:18] You voted against that. [1:08:20] We gave that mom [1:08:21] an $1,800 child tax credit. [1:08:23] You voted against that. [1:08:25] If that mom worked [1:08:26] for tips or overtime, [1:08:27] you voted against that. [1:08:29] You're the one [1:08:29] that wants to give [1:08:30] able-bodied adults [1:08:32] more money [1:08:33] than those kids [1:08:35] that that mom has. [1:08:36] I think a little [1:08:37] self-reflection on that [1:08:38] should be part [1:08:40] of the equation [1:08:40] that those two things, [1:08:44] just those two things, [1:08:45] the child tax credit [1:08:46] and the daycare credit [1:08:47] is $3,800 [1:08:48] for that mom [1:08:49] making $25,000 a year. [1:08:51] That's real money [1:08:53] that you guys [1:08:54] did not want [1:08:55] to give that mom. [1:08:56] That was just your votes [1:08:58] and those are just facts. [1:08:59] But when you did have [1:09:00] control of Congress [1:09:01] and the White House, [1:09:02] what did you do? [1:09:04] Did you help [1:09:05] working Americans? [1:09:06] No. [1:09:07] You passed a law [1:09:08] that gave $7,500 [1:09:11] to the wealthiest [1:09:13] 0.01% of Americans [1:09:15] to lease luxury electric vehicles. [1:09:20] So while the mom [1:09:21] with two kids [1:09:22] is making $25,000 a year [1:09:24] struggling, [1:09:25] the person making [1:09:26] tens of millions [1:09:27] of dollars a year [1:09:28] could go into [1:09:29] a Rolls-Royce dealership [1:09:30] and get $7,500 [1:09:31] thanks to each [1:09:32] and every one of you [1:09:33] to lease [1:09:34] a Rolls-Royce specter. [1:09:36] Congratulations [1:09:36] on that phenomenal policy. [1:09:41] Mr. Snyder, [1:09:42] if somebody's in this country [1:09:43] without permission, [1:09:45] should they be allowed [1:09:46] to get healthcare [1:09:47] on the backs [1:09:49] of the American taxpayer? [1:09:50] Yes or no? [1:09:54] My own view is [1:09:56] if people need healthcare, [1:09:58] they should receive it. [1:09:59] So you think [1:10:00] that somebody [1:10:00] who is here illegally [1:10:02] should have their healthcare [1:10:04] paid for [1:10:05] by the American taxpayer? [1:10:10] So we have a law [1:10:11] in this country. [1:10:12] No, I'm just asking you. [1:10:13] That's a simple [1:10:13] yes or no question. [1:10:14] Somebody's in this country? [1:10:15] I agree with... [1:10:16] Somebody's... [1:10:16] Somebody's... [1:10:17] Let me just restate it. [1:10:18] Yes, if they need [1:10:18] emergency care, yes. [1:10:20] So the taxpayer, [1:10:21] the United States of America, [1:10:23] should pay for the healthcare [1:10:25] of people who broke [1:10:26] into this country illegally? [1:10:27] That's what Congress [1:10:28] decided in 19... [1:10:29] No, no, no, no, no. [1:10:30] Congress never decided... [1:10:31] I don't know what Congress [1:10:32] you're talking about. [1:10:33] If you needed emergency healthcare [1:10:35] and you went to any other country [1:10:37] on earth, [1:10:38] would you get it for free? [1:10:41] Well, the countries [1:10:41] that I've gone to, yes. [1:10:43] You'd get healthcare for free [1:10:44] if you went into... [1:10:46] So, for example, [1:10:47] let's take Spain, [1:10:48] which has incredibly difficult [1:10:49] visa standards. [1:10:50] If you went to Spain [1:10:52] and needed heart surgery, [1:10:54] you think the Spanish government [1:10:55] would give it to you gratis? [1:10:56] I can't speak to Spain. [1:10:58] But do you think that's... [1:10:59] But it's interesting. [1:11:01] I wonder if my Democrat colleagues [1:11:03] would agree with that, [1:11:04] that if people who broke [1:11:05] into this country illegally [1:11:06] should get healthcare. [1:11:08] Mr. Schneider, [1:11:08] if somebody broke into your home, [1:11:10] would you make them dinner? [1:11:13] No, I would not. [1:11:14] Why not? [1:11:18] Why not? [1:11:19] Why wouldn't you? [1:11:21] They need help. [1:11:22] What if they're starving? [1:11:23] What if somebody broke [1:11:24] into your home who's hungry, [1:11:26] would you not feed them? [1:11:28] Or would you call the police [1:11:29] and get the heck out of the house? [1:11:32] If somebody was hungry [1:11:33] and needed to be fed, [1:11:34] I would feed them. [1:11:35] So if somebody broke [1:11:36] into your house, [1:11:37] you will feed them. [1:11:38] Don't give anybody your address. [1:11:42] Whatever you do, [1:11:43] I'm asking you just for your own personal sake, [1:11:45] do not release your address. [1:11:47] Can I answer the question? [1:11:48] You can, please. [1:11:49] Somebody breaks into my home [1:11:50] and they're hungry, [1:11:51] I'm going to forgive them [1:11:52] for breaking in, [1:11:53] I'm going to feed them, [1:11:54] and then we'll work out [1:11:56] accountability [1:11:57] for what they've done. [1:11:59] Okay. [1:11:59] Like I said, [1:12:00] don't release your address. [1:12:01] But on behalf of the American taxpayers, [1:12:03] especially the hardworking [1:12:04] men and women of this country, [1:12:06] no government benefits, [1:12:08] taxpayer dollars [1:12:09] should be absolutely [1:12:10] and exclusively [1:12:12] reserved for American citizens. [1:12:14] And so the party [1:12:15] that says they care [1:12:15] about working Americans, [1:12:16] this is why you keep losing [1:12:18] in rural America. [1:12:19] This is why you guys [1:12:20] get wiped out [1:12:21] in places like that. [1:12:22] Whether it's Virginia [1:12:23] or Oregon, [1:12:24] you do not win [1:12:25] in the rural parts [1:12:27] of your state. [1:12:27] You get absolutely crushed [1:12:29] because of that kind [1:12:31] of philosophy. [1:12:33] Senator Mercury, [1:12:34] would I like to make a comment? [1:12:37] Thank you. [1:12:37] Just for the record, [1:12:40] undocumented individuals [1:12:41] are not eligible [1:12:42] for Medicaid [1:12:43] unless they're in emergency, [1:12:45] going to emergency room [1:12:46] under very limited circumstances. [1:12:48] And yes, [1:12:49] those same services, [1:12:50] emergency, [1:12:51] are provided [1:12:51] by many other nations [1:12:53] if Americans [1:12:53] are traveling abroad [1:12:54] for an emergency service. [1:12:57] Mr. Blaise, [1:12:57] very quickly, [1:12:58] how many illegal immigrants [1:12:59] do you think are on Medicaid? [1:13:01] Not beyond, [1:13:02] beyond emergency services, [1:13:04] but on Medicaid. [1:13:06] Do you have any estimate [1:13:07] in California? [1:13:09] In California, [1:13:10] it's considerable. [1:13:13] California got one [1:13:14] of these provider tax schemes [1:13:16] approved, [1:13:16] and then the next, [1:13:17] got $10 billion [1:13:18] in federal funds [1:13:20] without any state contribution, [1:13:21] and the next year [1:13:22] expanded Medicaid [1:13:23] to all unauthorized immigrants [1:13:25] in the state. [1:13:27] Senator Lujan. [1:13:27] Thank you very much, [1:13:30] Mr. Chairman. [1:13:32] Coming into the hearing [1:13:34] at the moment that I did [1:13:35] really caught my attention [1:13:36] as my colleague departs. [1:13:38] You know, [1:13:38] some of us are Catholic, [1:13:41] and my colleague [1:13:42] went to Catholic high school, [1:13:43] I believe, [1:13:44] if I'm not mistaken, [1:13:44] someone that should understand [1:13:45] the lessons [1:13:46] that are taught to us every day. [1:13:48] I'd refer my colleague [1:13:50] from Ohio [1:13:50] to teachings [1:13:52] under St. Francis of Assisi [1:13:53] if he needs to learn [1:13:54] about what it means [1:13:56] to shelter those [1:13:57] that need some help [1:13:58] or provide food [1:13:59] to those that need some help [1:14:01] or care for those [1:14:02] that need some help. [1:14:03] I grew up in a rural community. [1:14:05] I didn't have [1:14:06] a Rolls-Royce dealership. [1:14:08] I still live on a small farm. [1:14:10] I put diesel in my tractor. [1:14:12] I turn dirt every day. [1:14:13] I fix fences. [1:14:14] When my neighbors [1:14:15] need help fixing a fence, [1:14:17] I go help them [1:14:18] put that fence up. [1:14:19] I don't ask if they're [1:14:20] Democrat, Republican, [1:14:21] whatever it may be. [1:14:22] We do it. [1:14:23] This lesson [1:14:25] about how the big, [1:14:28] beautiful bill, [1:14:29] a piece of legislation [1:14:30] that President Trump ran on [1:14:31] that my Republican colleagues [1:14:33] are trying to fleece [1:14:34] the American people [1:14:35] and convincing them [1:14:37] that this bill helps them. [1:14:40] A trillion dollars [1:14:41] was taken out of health care. [1:14:42] How the hell [1:14:43] does that help anybody? [1:14:44] I'm a stroke survivor. [1:14:46] Four years ago, [1:14:46] I had a stroke. [1:14:48] What I learned is [1:14:49] time is not on your side [1:14:50] if you have a stroke. [1:14:51] You need to get [1:14:52] to the doctor immediately. [1:14:54] Well, not in the case [1:14:57] of what happens [1:14:58] with the trillion dollar cuts [1:14:59] and Medicaid facilities [1:15:00] start closing [1:15:00] and rural clinics [1:15:01] start closing. [1:15:02] And if that was not enough, [1:15:03] then they went [1:15:04] and devastated food programs [1:15:05] in America, [1:15:06] kicking farmers and ranchers [1:15:07] in the teeth [1:15:08] and closing rural grocery stores. [1:15:10] That's the big, [1:15:12] beautiful bill. [1:15:12] They just voted on it. [1:15:14] It just facts are funny. [1:15:17] Anyhow, [1:15:18] this hearing is about Medicaid, [1:15:21] the realities around Medicaid. [1:15:23] If I'm not mistaken, [1:15:24] the big, beautiful bill [1:15:25] removed about a trillion dollars [1:15:27] from health care [1:15:28] with more than $800 billion [1:15:29] of federal Medicaid dollars. [1:15:32] And my Republican colleagues [1:15:34] profess that they did not cut. [1:15:37] They being Republicans [1:15:38] did not cut Medicaid. [1:15:39] They only transferred [1:15:40] the cost to states. [1:15:43] They eliminated a trillion dollars [1:15:45] in access to health care. [1:15:47] Medicaid programs [1:15:48] across the country, [1:15:49] we don't know [1:15:49] who's going to get care [1:15:50] or who's not going to get care. [1:15:52] I have constituents [1:15:53] writing to me every day [1:15:54] about a concern [1:15:55] of being able to pay bills, [1:15:57] trying to figure out [1:15:58] if they're going to be able [1:15:58] to get access to care or not. [1:16:02] Dina from Bernalillo County, [1:16:03] which is the largest county [1:16:05] in New Mexico, [1:16:06] populist-wise, [1:16:07] said, [1:16:08] as I was sitting [1:16:08] in urgent care this weekend, [1:16:10] I started to have serious anxiety [1:16:11] that next year [1:16:12] I might be without [1:16:13] my Medicaid insurance [1:16:14] and I may not be able [1:16:16] to go to urgent care [1:16:16] if I needed to. [1:16:18] Quinn, [1:16:19] the Affordable Care Act [1:16:20] was passed. [1:16:21] We had a Republican governor [1:16:23] in New Mexico [1:16:23] that did the right thing [1:16:25] and embraced Medicare, [1:16:26] Medicaid expansion. [1:16:28] It took New Mexico [1:16:29] from one of the most [1:16:29] uninsured states [1:16:30] in the country [1:16:31] to a state [1:16:32] that actually people [1:16:33] could get some coverage [1:16:34] and have some certainty [1:16:35] that care was going [1:16:36] to be there. [1:16:36] Democrats and Republicans [1:16:39] should be working together [1:16:40] in all these. [1:16:41] If we're going to talk [1:16:42] about reforms, [1:16:42] let's talk about smart reforms. [1:16:44] Let's talk about ways [1:16:45] that we can get care [1:16:46] to people [1:16:46] in the most effective manner [1:16:48] possible so that [1:16:49] if someone out there [1:16:50] has a stroke like I did, [1:16:52] they're going to live [1:16:53] and they're actually [1:16:53] going to recover [1:16:54] the way that I did [1:16:55] because my recovery [1:16:56] is also very unique. [1:16:58] I was very blessed [1:16:58] with that recovery, [1:17:00] but it's because [1:17:00] I had access to care. [1:17:02] Eight million Americans [1:17:03] have already lost [1:17:04] health care coverage, [1:17:05] including nearly four million [1:17:07] who lost Medicaid, [1:17:08] CHIP, [1:17:09] the Children's Health [1:17:10] Insurance Program. [1:17:12] Now, Professor Schneider, [1:17:14] are children protected [1:17:15] from Medicaid cuts [1:17:16] as my Republican colleagues [1:17:18] have suggested? [1:17:20] Over time, [1:17:22] the large withdrawal [1:17:23] of federal funding, [1:17:25] close to a trillion dollars [1:17:26] over the next 10 years [1:17:27] that's in H.R. 1, [1:17:30] everyone in the program [1:17:31] is at risk. [1:17:33] Children, [1:17:34] people with disabilities, [1:17:36] seniors, [1:17:37] people in rural areas, [1:17:39] people in urban areas, [1:17:41] the providers that serve them, [1:17:43] they're all at risk. [1:17:43] You anticipated my next question [1:17:45] about seniors. [1:17:46] I appreciate that response. [1:17:48] I did not hear you [1:17:50] specifically mention [1:17:51] people with disabilities. [1:17:53] I heard you say everyone, [1:17:54] but what about people [1:17:55] with disabilities? [1:17:57] Exactly the same situation. [1:18:01] The states were expecting [1:18:03] the resources [1:18:04] that had been in place [1:18:06] before H.R. 1 was enacted, [1:18:08] and over the next 10 years, [1:18:10] they're not going to have [1:18:11] those resources available. [1:18:13] Now, coming from [1:18:14] a rural community myself, [1:18:16] hearing the question [1:18:17] from my colleague [1:18:19] that was speaking before me, [1:18:21] are adults and children [1:18:23] in small towns [1:18:24] and rural areas [1:18:25] more likely than those [1:18:26] living in metro areas [1:18:28] to rely on Medicaid CHIP [1:18:30] for their health insurance? [1:18:32] Medicaid is a slightly [1:18:33] more important payer [1:18:34] for families and children [1:18:36] in rural areas [1:18:37] than in urban. [1:18:38] It's important in both, [1:18:39] but it's a little more [1:18:40] important in rural. [1:18:42] I appreciate it. [1:18:42] Well, this hearing [1:18:43] is not on SNAP. [1:18:43] The same holds true [1:18:44] for SNAP as well. [1:18:46] So, look, Mr. Chairman, [1:18:47] I certainly hope [1:18:48] as the budget reconciliation [1:18:50] debate is continuing [1:18:51] on budget reconciliation 3, [1:18:53] we're looking at access [1:18:54] to health care. [1:18:55] Costs are going up. [1:18:56] You know, some folks [1:18:57] try to refer to this [1:18:57] as affordability. [1:18:59] People just can't afford [1:19:00] to get services [1:19:01] and to get by [1:19:02] and that we should not forget [1:19:04] about Social Security. [1:19:05] I challenged my Republican [1:19:06] colleagues at the last hearing [1:19:07] we had on Social Security, [1:19:09] maybe in your next budget [1:19:10] reconciliation bill, [1:19:11] we'll actually see [1:19:12] some language in there [1:19:13] to make sure Social Security [1:19:14] is solvent [1:19:15] and it didn't happen. [1:19:16] Well, lo and behold, [1:19:17] there's another budget [1:19:18] reconciliation coming forward. [1:19:19] So, I look forward to seeing [1:19:20] how Republicans are going [1:19:22] to protect Social Security [1:19:23] and make sure [1:19:23] that it's going to be solvent [1:19:24] in the next budget [1:19:25] reconciliation package as well. [1:19:27] I appreciate all the panelists [1:19:28] and everyone here today [1:19:28] for the hearing. [1:19:30] So, a couple of comments. [1:19:31] Reconciliation can't touch [1:19:32] Social Security. [1:19:34] I've got to defend Lutherans. [1:19:35] We're pretty compassionate too. [1:19:37] And I would just remind [1:19:37] Senator Lujan, [1:19:38] take a look at the chart there. [1:19:39] In 2014, [1:19:41] the first year of Obamacare [1:19:42] Medicaid expansion, [1:19:43] we spent about $400 billion [1:19:45] on Medicaid. [1:19:46] 2019, we were spending, [1:19:50] actually, 2014, [1:19:51] spent $300 billion. [1:19:53] 2019, about $400 billion. [1:19:56] This year, we'll spend $668 billion [1:19:59] or 2025. [1:20:00] This year, we'll spend about $735. [1:20:04] So, it went from $300 billion [1:20:05] first year of Obamacare, [1:20:06] $400 billion right before the pandemic, [1:20:08] $668 billion last year, [1:20:11] $735 billion this year. [1:20:13] Again, I'm just not seeing [1:20:14] where we're taking [1:20:15] a trillion dollars out of Medicaid. [1:20:17] The costs of Medicaid [1:20:18] are exploding. [1:20:19] But with that, [1:20:20] we'll turn to Senator Scott. [1:20:21] Mr. Chairman, [1:20:21] can I respond to that? [1:20:22] I'd ask unanimous consent [1:20:25] to submit the analysis [1:20:26] of H.R.1 [1:20:27] from CBO into the record, [1:20:29] and that'll respond [1:20:30] to your questions [1:20:31] associated with [1:20:31] the trillion dollar tax cut. [1:20:32] Thank you. [1:20:33] I'm really high [1:20:33] on CBO projections. [1:20:35] Senator Scott. [1:20:36] All right. [1:20:37] Thank you, Chairman. [1:20:37] Thanks for holding this, [1:20:38] Dr. Blaze. [1:20:39] The Medicaid program [1:20:41] was originally set up [1:20:42] for seniors, children, [1:20:43] pregnant women, disabled, right? [1:20:45] Correct. [1:20:46] And the reason it was [1:20:47] set up the way it was [1:20:48] was that the federal government [1:20:49] would pay a portion [1:20:49] and the states would pay a portion, [1:20:51] and the states would pay a portion [1:20:52] out of their own taxes, right? [1:20:54] Correct. [1:20:55] Right. [1:20:56] And I guess, you know, [1:20:57] it goes from, what, [1:20:58] 50 to, depending on the income level [1:21:01] the states pay from 50% [1:21:04] to as little as, what, [1:21:05] 15% about? [1:21:07] Yeah. [1:21:07] So, for the traditional population, [1:21:09] wealthiest states, [1:21:10] they spend a dollar, [1:21:11] federal government contributes a dollar. [1:21:13] Poorest states, [1:21:14] they spend a dollar, [1:21:15] federal government contributes $3. [1:21:17] But for all states, [1:21:18] wealthy or not, [1:21:18] when they, [1:21:19] when Obamacare expanded [1:21:20] to able-bodied adults, [1:21:22] it was 90-10. [1:21:23] It was actually 100% [1:21:24] for the first three years, [1:21:26] and it's phased down, [1:21:27] and it's 90 to 10 now. [1:21:30] So, if you look at a state budget now, [1:21:32] there, have states used the, [1:21:34] have they gained the 90-10 match [1:21:36] to pay for things [1:21:38] that have nothing to do [1:21:39] with health care? [1:21:41] Yeah, I mean, [1:21:41] states get seven times more funding [1:21:44] when they spend a dollar [1:21:46] on the expansion population [1:21:47] than the traditional population, [1:21:49] and particularly given [1:21:50] that they can finance [1:21:51] their state share [1:21:52] with these legalized [1:21:53] money laundering tactics, [1:21:55] states use Medicaid [1:21:56] to fund other state projects, [1:21:59] and the ACA expansion, [1:22:01] the nine-to-one, [1:22:01] is a multiplier [1:22:02] on the money laundering apparatus. [1:22:05] So, have some states said, [1:22:07] okay, gone to a provider [1:22:08] and said, hey, [1:22:09] you'll pay us some money [1:22:10] so we can get extra money [1:22:10] from Medicaid? [1:22:12] Yeah, in any case, [1:22:13] the provider that goes [1:22:15] to the state [1:22:15] and says, [1:22:17] we've designed this scheme [1:22:18] that's just going to [1:22:19] plus us up [1:22:20] with federal tax dollars. [1:22:22] So, this concept [1:22:23] that the states [1:22:23] would put up a portion [1:22:24] to make sure [1:22:26] the dollars are spent wisely, [1:22:28] to make sure [1:22:28] the people are covered, [1:22:30] doesn't really work anymore? [1:22:31] That's deteriorated, yes. [1:22:33] So, I mean, [1:22:35] when you think about it, [1:22:36] if the federal government's goal [1:22:37] was to make sure [1:22:38] we take care of, [1:22:39] especially the, you know, [1:22:40] the pregnant women, [1:22:42] kids, disabled, [1:22:44] the states have lost focus [1:22:45] because there's so much money [1:22:46] and the providers have looked at it. [1:22:48] There's so much money [1:22:49] out here for the able-bodied adults. [1:22:51] The federal government [1:22:52] is encouraging states [1:22:53] to discriminate [1:22:54] against the most vulnerable. [1:22:56] Dr. Oz recently paused [1:22:58] payments to California [1:22:59] knowing that the [1:23:00] in-home supportive service program [1:23:01] has grown over 24% [1:23:03] over two years, [1:23:05] way more than [1:23:05] the national average. [1:23:07] What's noteworthy [1:23:07] is that the funding [1:23:08] of this program [1:23:09] is 55% federal, [1:23:10] about 35% [1:23:11] is intergovernmental transfers [1:23:13] leaves the state [1:23:14] only paying about 11%. [1:23:15] Okay? [1:23:16] So, now, [1:23:17] I thought they were supposed [1:23:18] to have a 50-50 match. [1:23:20] So, explain how that works. [1:23:23] So, intergovernmental transfers, [1:23:25] the problematic, [1:23:26] most problematic ones [1:23:27] are where you get [1:23:28] a local health facility [1:23:31] that transfers money [1:23:32] to the state. [1:23:33] The state then uses that, [1:23:36] has its payment, [1:23:37] back to the facility [1:23:38] and then leverages [1:23:39] the federal dollars. [1:23:40] So, it's a way for states [1:23:42] to use the Medicaid [1:23:44] financing system [1:23:45] to benefit [1:23:45] the government-owned providers [1:23:47] at the expense [1:23:48] of the taxpayer. [1:23:49] And you have some examples [1:23:50] where, like in California, [1:23:52] they do this [1:23:53] for their ambulances, too, [1:23:54] where they'll pay [1:23:55] the government [1:23:56] ambulance providers [1:23:57] more than three times [1:23:58] what they pay [1:23:59] the private ambulance providers [1:24:00] through the Medicaid program. [1:24:01] So, like that ambulance company [1:24:05] has no risk. [1:24:06] I mean, there's just extra money. [1:24:08] Yes. [1:24:08] They're just using [1:24:09] the federal tax dollar to pay [1:24:10] because we all, [1:24:11] we should expect our states [1:24:13] to be, have skin in the game. [1:24:14] And what you're saying is [1:24:15] what happens is [1:24:16] they don't actually [1:24:17] have skin in the game. [1:24:18] They don't have skin in the game [1:24:19] and they're lobbied. [1:24:21] Like, there is, [1:24:22] in the state capitals, [1:24:23] I mean, you know this [1:24:23] as a former governor [1:24:24] and former governors know this, [1:24:26] you're lobbied [1:24:26] by the special interests [1:24:28] to design programs this way [1:24:30] and take advantage [1:24:31] of the federal taxpayer. [1:24:33] Mr. Ingram, [1:24:34] the HHS Office [1:24:35] of the Inspector General [1:24:36] recently decertified [1:24:37] New York's Medicaid [1:24:38] Fraud Control Unit [1:24:39] due to a year-long failure [1:24:40] to do its job. [1:24:41] Despite receiving [1:24:42] over $60 million annually [1:24:44] and having a staff [1:24:45] of 270 people, [1:24:46] New York was the worst [1:24:47] performing unit [1:24:48] compared to other states. [1:24:49] This office was only able [1:24:50] to secure 85 fraud convictions [1:24:52] from 20 to 25 [1:24:53] when the newest, [1:24:55] next lowest-scoring state [1:24:56] had 237 convictions, [1:24:58] almost three times more. [1:25:00] New York had 49 criminal [1:25:01] fraud indictments [1:25:02] between 20 and 25, [1:25:03] which is less than 10 a year. [1:25:05] The next state had 268 [1:25:07] five times more. [1:25:08] It's not that fraud isn't there. [1:25:10] Indiana and Arizona [1:25:11] were able to secure [1:25:11] five and seven times [1:25:12] as many indictments [1:25:13] in 25 alone [1:25:14] compared to New York's seven. [1:25:16] How important is the [1:25:17] Medicaid Fraud Control Unit [1:25:18] program, [1:25:19] and what does it mean [1:25:19] when a state is run [1:25:21] so poorly like New York [1:25:22] that only one [1:25:23] conviction for patient abuse [1:25:25] in 2025 [1:25:26] despite having 2,000 [1:25:28] patient abuse referrals a year? [1:25:32] Well, New York's [1:25:34] fraud control unit [1:25:35] under AG Letitia James [1:25:37] has been horrendous, [1:25:38] as you noted. [1:25:39] It's one of the worst [1:25:40] in the country. [1:25:41] You mentioned Indiana [1:25:43] and Arizona. [1:25:45] Those are states [1:25:46] with programs, [1:25:47] you know, [1:25:47] one-fifth the size of New York. [1:25:50] They have about one-tenth [1:25:52] the staff, [1:25:53] one-tenth the budget, [1:25:54] and they're delivering, [1:25:55] you know, [1:25:55] five to seven times [1:25:56] more criminal indictments. [1:25:58] They're delivering [1:25:59] more convictions, [1:26:00] more civil recoveries. [1:26:03] New York had not [1:26:04] a single hospice [1:26:05] fraud investigation, [1:26:07] despite that being [1:26:08] sort of a hotbed [1:26:09] of fraud in New York. [1:26:11] It's not a new problem. [1:26:13] It's been ongoing [1:26:14] for years. [1:26:15] It definitely worsened [1:26:16] under President Biden. [1:26:18] States are getting [1:26:19] more funding [1:26:19] from taxpayers [1:26:20] than ever [1:26:22] for these units [1:26:23] units [1:26:23] and delivering [1:26:24] worse results. [1:26:25] Investigations are down, [1:26:26] indictments are down, [1:26:28] convictions are down, [1:26:28] recoveries are down. [1:26:30] Indictments in New York [1:26:31] have dropped 93% [1:26:33] since 2019. [1:26:36] Over a dozen [1:26:37] of these units [1:26:38] recover less fraudulent funds [1:26:40] than it costs [1:26:42] federal taxpayers [1:26:43] to operate them. [1:26:45] So, you know, [1:26:45] this is a longstanding problem. [1:26:46] Nobody really seemed [1:26:47] to care [1:26:47] until President Trump [1:26:49] came in. [1:26:51] He's doing something [1:26:51] about it. [1:26:52] You know, [1:26:52] New York was decertified, [1:26:54] Hawaii was decertified, [1:26:55] but a future administration [1:26:57] could go back [1:26:57] to the way things were [1:26:58] under President Biden. [1:26:59] So I would encourage [1:27:00] everyone to codify [1:27:02] stronger oversight [1:27:03] requirements for these [1:27:04] and really make them [1:27:06] effective. [1:27:07] Thank you. [1:27:08] Senator Whitehouse. [1:27:11] Thanks, Chairman. [1:27:13] We're here today [1:27:15] because the [1:27:15] billionaire's bill [1:27:17] will knock down [1:27:21] Medicaid spending [1:27:23] by somewhere [1:27:24] in the neighborhood [1:27:24] of a trillion dollars. [1:27:28] Some basic facts [1:27:29] are the Medicaid money [1:27:30] does not go [1:27:31] to the Medicaid recipient. [1:27:33] It goes to the people [1:27:33] who provide the health care. [1:27:35] It goes to hospitals. [1:27:36] It goes to nursing homes. [1:27:37] It goes to doctors. [1:27:38] It goes to pharmacists. [1:27:41] So when you drop [1:27:43] that kind of a spending cut [1:27:45] into our health care system, [1:27:46] you're going to see [1:27:47] real problems. [1:27:50] And I think, [1:27:51] knowing that, [1:27:53] Republicans set the grenade [1:27:54] to go off after the election [1:27:57] so that the damage [1:28:00] to individuals [1:28:01] was not front-page news [1:28:02] everywhere before the election. [1:28:06] But what we are seeing [1:28:07] is that the entities [1:28:10] that receive the Medicaid funding [1:28:11] are having to start [1:28:13] doing their budgeting [1:28:14] for the trillion-dollar cuts. [1:28:17] It's responsible [1:28:19] to look forward. [1:28:20] And as they're doing that, [1:28:22] they're starting to see, [1:28:22] oh, my God, [1:28:25] our numbers don't work anymore. [1:28:28] The financials now [1:28:29] for hospitals [1:28:30] are being affected [1:28:31] by the predicted cuts [1:28:34] to Medicaid. [1:28:36] The financials now [1:28:37] for doctor's practices [1:28:38] are being affected [1:28:39] by the predicted cuts [1:28:42] to Medicaid. [1:28:43] And nursing homes [1:28:44] have a particularly [1:28:45] bad vulnerability, [1:28:47] and they're starting [1:28:48] to see those cuts as well. [1:28:50] So we need to be paying attention [1:28:52] to the forewarnings [1:28:54] that the financial work [1:28:59] in these industries [1:29:00] are giving us [1:29:01] about what the hell [1:29:02] is coming at us. [1:29:04] Because the grenade [1:29:05] may be set to go off [1:29:06] after the election, [1:29:07] but it's still going to go off. [1:29:10] And that's why [1:29:10] we're living through [1:29:11] this narrative creation effort [1:29:14] to suggest that [1:29:16] the problems with Medicaid [1:29:17] are that it's riddled [1:29:19] with fraudsters, [1:29:21] people are crooked, [1:29:22] and, oh, folks, [1:29:23] it has nothing to do [1:29:25] with the billions and billions [1:29:26] and billions in tax cuts [1:29:28] that we gave in that bill [1:29:30] to the wealthiest [1:29:33] and highest-income people [1:29:36] in the country, [1:29:37] some of whom, as billionaires, [1:29:39] actually don't pay any taxes. [1:29:42] Actually don't. [1:29:44] That's, as Ms. Helmsley [1:29:47] famously said, [1:29:48] for the little people. [1:29:52] And this body is highly responsive [1:29:54] to those billionaires, [1:29:55] and so, of course, [1:29:57] out went the Medicaid spending, [1:29:59] in went the tax cuts [1:30:00] for billionaires, [1:30:01] and that's why we are [1:30:02] where we are. [1:30:03] The device [1:30:06] is employment reporting. [1:30:10] It's to create [1:30:11] a red tape bomb [1:30:12] that makes it [1:30:14] as difficult as possible [1:30:15] for people on Medicaid [1:30:16] to fill out [1:30:18] the requisite paperwork [1:30:19] so they can keep [1:30:19] their benefits. [1:30:22] That's the trick. [1:30:24] That's the stunt [1:30:24] that's being used [1:30:26] to knock people off Medicaid. [1:30:28] I don't know [1:30:29] how many of my colleagues [1:30:29] hang out with people [1:30:30] on Medicaid. [1:30:31] We're a pretty [1:30:32] high-end group here [1:30:35] around the Senate, [1:30:35] but I tell you [1:30:37] around Rhode Island, [1:30:38] who's on Medicaid? [1:30:39] It's people with [1:30:41] really significant [1:30:42] learning disabilities. [1:30:43] It's people with [1:30:45] mental health issues [1:30:48] that they're getting [1:30:49] treatment for. [1:30:49] It's people in [1:30:50] addiction recovery. [1:30:53] It's people with [1:30:54] really severe [1:30:55] health conditions [1:30:56] that interfere [1:30:58] with their ability [1:30:59] to earn a living. [1:31:01] It's people [1:31:01] who have multiple [1:31:02] health conditions, [1:31:03] so many that they can [1:31:04] barely keep track [1:31:05] of their multiple [1:31:06] health conditions. [1:31:07] And all of those people [1:31:08] with all those conditions [1:31:09] are now supposed [1:31:09] to be experts [1:31:11] at red tape [1:31:12] so that they don't [1:31:13] get pushed off [1:31:14] by employment [1:31:17] reporting requirements. [1:31:20] It's kind [1:31:21] of a dirty trick. [1:31:25] And the notion [1:31:26] that fraud is so [1:31:27] endemic in Medicaid [1:31:28] is a little bit [1:31:31] belied by the fact [1:31:32] that it's the only [1:31:34] program that has [1:31:37] a specifically dedicated [1:31:39] fraud detection [1:31:40] and prevention program. [1:31:43] I was the attorney [1:31:44] general of the state [1:31:45] of Rhode Island. [1:31:45] I ran our Medicaid [1:31:48] fraud control unit. [1:31:51] Everybody had one. [1:31:55] We didn't find [1:31:55] all that much, [1:31:57] Mr. Chairman, [1:31:57] because Rhode Island's [1:31:58] a small state. [1:31:59] It's hard to set up [1:32:00] a phony baloney [1:32:00] doctor's office [1:32:01] and run millions [1:32:02] of dollars in payments [1:32:03] through without somebody [1:32:04] catching on real quick. [1:32:07] But boy, [1:32:08] was Florida [1:32:09] a festival of fraud. [1:32:14] It has its own [1:32:15] Medicaid fraud [1:32:15] control unit. [1:32:16] They all do. [1:32:18] Other programs [1:32:19] don't have that discipline. [1:32:20] They're not policed [1:32:21] that way. [1:32:22] So the idea [1:32:23] that fraud is out [1:32:24] of control [1:32:24] in Medicaid [1:32:25] to me [1:32:27] is not credible. [1:32:28] What is credible [1:32:29] is how many people, [1:32:31] individuals [1:32:32] with significant disabilities, [1:32:37] very often addiction, [1:32:38] mental health, [1:32:39] learning, [1:32:40] so that they're [1:32:41] able-bodied [1:32:42] are going to get [1:32:46] clobbered [1:32:47] by the red tape bomb [1:32:49] that Republicans set [1:32:51] to go off [1:32:52] after the election. [1:32:54] And the tell [1:32:55] is the financials [1:32:57] of the providers [1:32:58] who are looking forward [1:33:00] to what their [1:33:02] financial world [1:33:03] looks like [1:33:03] when that grenade [1:33:04] goes off. [1:33:06] Thank you, Chairman. [1:33:07] I will point out [1:33:08] that Governor Walz [1:33:09] and Attorney General Ellison [1:33:10] didn't find much fraud [1:33:10] in Minnesota either. [1:33:12] And I'll also remind people [1:33:13] of just the basic facts, [1:33:14] and I'll repeat them again, [1:33:15] probably do it again. [1:33:17] 2014, the first year [1:33:18] of Obamacare's implementation, [1:33:20] Medicaid spent $300 billion. [1:33:23] 2019, before the pandemic, [1:33:25] spent $400 billion. [1:33:27] Last year, [1:33:28] we spent $668 billion, [1:33:30] more than double, [1:33:31] where we spent first year [1:33:33] of Medicaid expansion, [1:33:33] this year we'll spend $735 billion. [1:33:35] Again, I'm just not [1:33:36] seeing these cuts. [1:33:38] I can do math. [1:33:39] That is an out-of-control [1:33:40] increase in Medicaid spending. [1:33:43] Senator... [1:33:44] Mr. Chairman, [1:33:44] if you're going to argue [1:33:45] with each of us [1:33:46] after we've made our statements, [1:33:47] I think we're entitled [1:33:48] to reply. [1:33:50] And I think it's important [1:33:51] simply to reiterate [1:33:53] what I said. [1:33:54] There are a great number [1:33:55] of Medicaid patients [1:33:56] for whom keeping track [1:33:58] of the new red tape [1:34:01] employment requirements, [1:34:04] the new red tape bomb [1:34:05] that Republicans built [1:34:06] into the billionaire's bill [1:34:07] to specifically [1:34:09] to knock people off. [1:34:10] The test was [1:34:11] how many people [1:34:12] you could knock off Medicare. [1:34:13] How can you reduce the spending [1:34:14] by knocking those people [1:34:16] off Medicare? [1:34:17] And the selection [1:34:18] is going to be the people [1:34:19] who are most vulnerable, [1:34:20] who don't have the skills [1:34:22] to keep up with the paperwork [1:34:24] and red tape bomb [1:34:26] that's going to be set off [1:34:27] in their lives. [1:34:28] That's what we're dealing with. [1:34:30] We'd like to keep [1:34:31] immigrants off the Medicaid [1:34:32] rails. [1:34:33] Senator Van Hollen. [1:34:34] Mr. Chairman, [1:34:36] first, we should be clear [1:34:37] about this. [1:34:38] There's nobody in this room [1:34:39] that doesn't want to [1:34:41] crack down on waste, [1:34:43] fraud, or abuse. [1:34:45] Every one of us recognizes [1:34:46] that a dollar that goes [1:34:47] to fraud is a dollar [1:34:49] that is not going to somebody [1:34:51] who needs the help. [1:34:53] And I don't think [1:34:54] there's a person in this room [1:34:55] who disagrees with that statement. [1:34:57] I do have to question [1:34:58] why the Trump administration [1:34:59] in its very first days [1:35:03] eliminated the inspector generals [1:35:05] in a whole bunch [1:35:06] of departments, [1:35:08] including the inspector general [1:35:10] overseeing HHS. [1:35:13] If you were really interested [1:35:15] in going after fraud, [1:35:17] you wouldn't be firing [1:35:18] inspector generals [1:35:20] in the U.S. government, [1:35:21] which is exactly what they did. [1:35:23] So what this hearing [1:35:25] is all about [1:35:26] is let's pretend. [1:35:28] Let's pretend [1:35:29] that the $1 trillion [1:35:30] cut to Medicaid [1:35:32] that Republicans [1:35:35] here in Congress [1:35:36] and the President [1:35:36] of the United States [1:35:37] made in what they called [1:35:38] their big, beautiful bill, [1:35:39] let's pretend [1:35:40] that $1 million [1:35:40] was really going after fraud, [1:35:44] as opposed to hurting [1:35:46] tens of millions [1:35:47] of Americans. [1:35:48] I didn't make up the number. [1:35:50] The Congressional Budget Office, [1:35:51] the nonpartisan Congressional Budget Office, [1:35:53] told us that 7.5 million Americans [1:35:55] are going to lose access [1:35:57] to health care [1:35:57] because of the cuts to Medicaid. [1:36:00] There are another over 2 million [1:36:01] who are going to lose access [1:36:03] because Republicans [1:36:05] took away tax credits [1:36:07] for the Affordable Care Act. [1:36:09] Again, that's a CBO number. [1:36:12] And actually tells us [1:36:13] what their real goal here was, right? [1:36:16] Because as part of that [1:36:17] big, beautiful bill, [1:36:19] they gave billionaires [1:36:21] and very rich people [1:36:22] permanent tax cuts. [1:36:24] It was beautiful [1:36:26] if you're a billionaire. [1:36:28] I just want to show [1:36:29] what the distribution [1:36:30] of those tax cuts was right here. [1:36:32] If you look at the tax cuts, [1:36:34] 22% of the benefits [1:36:35] of the Republican bill [1:36:38] went to the top 22%. [1:36:41] 72% of the benefits [1:36:43] went to the wealthiest 20%. [1:36:46] And that number will get bigger [1:36:48] over time [1:36:48] because Republicans sunset [1:36:51] the few tax benefits [1:36:53] that went to working people. [1:36:55] just as they eliminated [1:36:57] the one tax credit [1:36:58] that was available [1:36:59] to middle-class folks [1:37:00] trying to afford their health care. [1:37:03] And despite the cuts to Medicaid, [1:37:05] they still had a $4.2 trillion deficit [1:37:08] over the next 10 years. [1:37:09] This is a budget committee. [1:37:11] I'm all for looking [1:37:12] at honest ways [1:37:13] for reducing our deficits. [1:37:15] You don't do that [1:37:16] by giving billionaires [1:37:17] and big corporations [1:37:18] huge tax cuts. [1:37:20] So let's look at these Medicaid cuts [1:37:24] because in addition [1:37:27] to the 7.5 million Americans [1:37:29] who are going to get hurt, [1:37:31] you're also going to have [1:37:33] a spillover effect [1:37:34] on probably every American. [1:37:37] Mr. Schneider, [1:37:38] maybe you could tell us [1:37:39] what happens [1:37:40] when somebody [1:37:41] who doesn't have Medicaid coverage [1:37:43] and doesn't have [1:37:44] preventative health care coverage [1:37:46] gets desperately sick, [1:37:49] waits until they have to go [1:37:50] to the emergency room. [1:37:51] Who ends up having [1:37:54] to cover the costs [1:37:55] of that uncompensated care [1:37:57] at the end of the day? [1:38:00] Well, what usually happens is [1:38:02] the patient ends up [1:38:05] getting a bill [1:38:06] that may throw the patient [1:38:08] into medical debt. [1:38:10] The hospital that's providing [1:38:12] the emergency care [1:38:13] has to cross-subsidize [1:38:15] that service [1:38:16] and it will find the money [1:38:18] for its operations [1:38:20] from other paying patients. [1:38:22] So, right, [1:38:23] let's unpack what you mean [1:38:24] by cross-subsidize, right? [1:38:25] What you mean is that [1:38:27] people who are not [1:38:29] on Medicaid, [1:38:29] people, for example, [1:38:31] who are on private insurance, [1:38:32] people who are paying [1:38:33] their premiums, [1:38:34] at the end of the day, [1:38:35] they're going to have [1:38:36] to pay more, [1:38:38] either in higher premiums [1:38:39] or co-pays, [1:38:39] in order to compensate [1:38:40] for the uncompensated care [1:38:42] that was the care [1:38:45] that was denied [1:38:46] to the person [1:38:46] who was on Medicaid. [1:38:47] Is that right? [1:38:48] That's correct. [1:38:49] Right. [1:38:49] So, I think it's important [1:38:50] to understand that [1:38:51] in order to provide [1:38:53] these tax cuts [1:38:54] to billionaires [1:38:55] and corporations, [1:38:57] Republicans not only [1:38:58] cut access to health care [1:39:00] for a million people, [1:39:03] excuse me, [1:39:03] 7.5 million people [1:39:05] in Medicaid, [1:39:05] but they're also going [1:39:07] to be pushing the costs [1:39:08] of that harmful action [1:39:11] onto everybody else. [1:39:13] And again, [1:39:14] all for the effort [1:39:16] to give these very rich people [1:39:17] a big tax cut. [1:39:18] And I will just say, [1:39:19] Mr. Chairman, [1:39:20] that the cuts to Medicaid [1:39:21] were very cynically timed. [1:39:24] Most of them, [1:39:25] if not all of them, [1:39:26] don't take place [1:39:26] until January of next year, [1:39:29] after the election. [1:39:30] I wonder why that is. [1:39:32] It's because the American people [1:39:34] are going to hate [1:39:35] what they see [1:39:36] and they're going to be feeling it [1:39:37] in their pocketbooks [1:39:38] and Republicans want to delay that [1:39:41] until after the election. [1:39:43] That's what that cynical timing [1:39:44] was all about. [1:39:46] Again, all in service [1:39:47] of giving very rich people [1:39:48] big tax cuts. [1:39:50] Thank you, Mr. Chairman. [1:39:51] So first of all, [1:39:53] the reconciliation bill [1:39:54] primarily prevented [1:39:55] a massive automatic tax increase. [1:40:00] We cut taxes [1:40:01] for virtually every American taxpayer [1:40:03] back in 2017, 2018. [1:40:05] When Democrats had House, [1:40:08] Senate, and the White House, [1:40:09] you could have reversed that. [1:40:11] You didn't. [1:40:13] You didn't increase people taxes. [1:40:15] Neither did we. [1:40:15] So again, [1:40:16] to call out a massive tax cut, [1:40:18] it wasn't. [1:40:18] We prevented a massive [1:40:20] automatic tax increase, [1:40:21] which would have been [1:40:22] devastating for our economy. [1:40:24] So again, [1:40:24] let's talk about it honestly [1:40:25] in terms of what [1:40:26] that reconciliation bill did. [1:40:28] There were some additional [1:40:29] tax cuts, yes, [1:40:30] but the trillions of dollars [1:40:32] was an automatic tax increase [1:40:34] would have impacted [1:40:35] every American. [1:40:36] And you didn't want to do it [1:40:38] and we didn't do it. [1:40:39] So that was kind of bipartisan. [1:40:40] We didn't want to increase taxes. [1:40:41] Mr. Chairman, [1:40:42] if I could just have [1:40:43] 30 seconds to reply. [1:40:45] Then I'll refute that. [1:40:45] First of all, [1:40:46] as you know, [1:40:46] Mr. Chairman, [1:40:47] when we passed [1:40:49] the Inflation Reduction Act, [1:40:50] we actually did close [1:40:51] a lot of tax loopholes [1:40:53] on very wealthy corporations [1:40:55] that were moving jobs overseas. [1:40:56] You didn't reverse [1:40:57] moving jobs overseas. [1:40:58] There was 2017 tax cuts. [1:41:00] With respect to the earlier tax cuts, [1:41:02] they were lapsing on their own. [1:41:04] They were going to go away [1:41:05] on their own. [1:41:07] And all of us [1:41:08] were prepared to have [1:41:10] those for very rich people [1:41:12] lapse on their own [1:41:14] as they should have. [1:41:15] So you saw the chart. [1:41:16] The overwhelming benefits [1:41:18] from those tax cuts [1:41:19] go to very wealthy people. [1:41:21] And we actually [1:41:21] specifically proposed [1:41:22] that they lapse [1:41:24] for those people. [1:41:24] I would say, [1:41:25] but not increasing tax [1:41:26] on the American economy [1:41:27] and benefits. [1:41:28] Well, these were tax cuts [1:41:29] that were put in place, [1:41:30] as you pointed out, [1:41:31] right, [1:41:31] during the first [1:41:32] Trump administration, [1:41:33] disproportionately helping [1:41:34] the very rich. [1:41:35] We wanted to allow [1:41:36] those to lapse. [1:41:37] Republicans didn't. [1:41:38] I mean, [1:41:38] that's the end of the story. [1:41:40] Okay. [1:41:40] Senator Murray. [1:41:41] Thank you, [1:41:43] Mr. Chairman. [1:41:43] I think we can all agree [1:41:45] we do need to crack down [1:41:47] on fraud, [1:41:48] especially in a program [1:41:49] like Medicaid [1:41:49] that so many Americans [1:41:51] really rely on. [1:41:52] So, Mr. Ingram, [1:41:52] let me just ask you [1:41:53] yes or no. [1:41:54] You agree [1:41:55] we do need to be [1:41:56] cracking down [1:41:57] on Medicaid fraud [1:41:58] and not letting criminals [1:41:59] off the hook, yes? [1:42:01] Yes. [1:42:02] Thank you. [1:42:03] So, I hope [1:42:04] my Republican colleagues [1:42:05] will use some part [1:42:07] of this hearing [1:42:08] to condemn [1:42:09] President Trump [1:42:10] for pardoning criminals [1:42:11] who were convicted [1:42:12] of major Medicaid fraud. [1:42:15] Trump pardoned [1:42:16] five former executives [1:42:18] from Florida [1:42:19] who committed [1:42:20] serious Medicaid fraud [1:42:21] to the tune [1:42:22] of tens of millions [1:42:24] of dollars. [1:42:25] That is pretty bad. [1:42:27] Following what was dubbed [1:42:28] quote, [1:42:28] the largest healthcare [1:42:30] fraud scheme [1:42:30] charged by the U.S. [1:42:32] Justice Department [1:42:32] valued at over [1:42:34] one billion [1:42:35] in Medicare [1:42:36] and Medicaid fraud, [1:42:37] Trump commuted, [1:42:39] commuted [1:42:40] the 20-year sentence [1:42:41] of a Florida nursing home [1:42:42] and assisted living [1:42:44] facility executive. [1:42:45] So, that's even worse. [1:42:46] So, look, [1:42:47] I'm all for major [1:42:48] crackdown fraud. [1:42:49] I think we all are, [1:42:50] but it looks like [1:42:51] we've got some [1:42:52] pretty good leads [1:42:52] starting in the White House. [1:42:54] Mr. Schneider, [1:42:55] I want to turn to you. [1:42:57] What single piece [1:42:58] of legislation [1:42:59] delivered the largest [1:43:00] cuts to Medicaid [1:43:01] in American history? [1:43:03] Last year's budget [1:43:04] reconciliation bill. [1:43:05] Yep. [1:43:05] So, everybody knows [1:43:07] Republicans' big ugly bill [1:43:09] passed more than [1:43:10] one trillion dollars [1:43:12] in healthcare cuts, [1:43:14] mostly to Medicaid. [1:43:15] Mr. Schneider, [1:43:16] how much in tax breaks [1:43:18] for the top one percent [1:43:19] did Trump's bill contain? [1:43:21] Approximately [1:43:22] one trillion dollars. [1:43:23] One trillion dollars [1:43:24] in tax cuts [1:43:24] to the top one percent. [1:43:26] Mr. Schneider, [1:43:27] how many Americans [1:43:28] are losing healthcare [1:43:29] because of Trump's [1:43:31] big ugly bill? [1:43:31] So, in terms [1:43:35] of the Medicaid cuts, [1:43:36] the latest estimates [1:43:37] are approximately [1:43:37] 11 million. [1:43:38] 11 million. [1:43:40] So, zero billionaires [1:43:42] lose their healthcare. [1:43:44] They do get [1:43:45] a trillion dollars [1:43:46] in tax cuts. [1:43:47] And then, [1:43:48] over 15 million Americans, [1:43:50] including the [1:43:50] extended ACA tax credits, [1:43:53] lose their healthcare [1:43:54] thanks to Republicans [1:43:55] passing one trillion [1:43:56] in cuts [1:43:57] for regular [1:43:58] working-class people. [1:43:59] That is the math, [1:44:01] and that is [1:44:02] out-and-out grift. [1:44:03] So, it seems to me [1:44:04] like the biggest [1:44:05] Medicaid theft [1:44:05] didn't happen [1:44:06] in a billing office [1:44:07] somewhere. [1:44:08] It actually happened [1:44:09] last year, [1:44:10] right here [1:44:10] in the United States [1:44:11] Capitol, [1:44:12] when Republicans [1:44:13] passed Trump's [1:44:14] big, ugly bill. [1:44:16] So, Mr. Chairman, [1:44:17] let me just say, [1:44:18] I find it pretty [1:44:19] astounding [1:44:19] that Republicans [1:44:20] are holding [1:44:21] an entire Senate [1:44:22] hearing on fraud [1:44:23] in Medicaid, [1:44:24] but they don't seem [1:44:25] to have anything [1:44:26] to say about the fraud [1:44:27] coming out of the White House. [1:44:28] I mean, look at [1:44:29] the crypto schemes [1:44:30] and the foreign gifts. [1:44:31] That's easily [1:44:33] the most corrupt [1:44:33] White House [1:44:34] and American history. [1:44:36] So, the President Trump [1:44:37] pardoned convicted [1:44:38] criminals who committed [1:44:39] Medicaid fraud. [1:44:42] This is outrageous [1:44:43] to me, [1:44:43] and it is what [1:44:44] we should be talking about. [1:44:45] But I also want to note [1:44:46] a really big difference [1:44:47] in terms of values [1:44:49] and beliefs right now, [1:44:50] because I am here, [1:44:51] and I know my colleagues [1:44:52] on this side are, [1:44:53] to fight for our [1:44:55] safety net programs, [1:44:56] but my colleagues [1:44:56] on the other side [1:44:57] of the aisle [1:44:57] are not with me [1:44:58] on that fight. [1:44:59] Chairman Johnson [1:45:00] has said repeatedly [1:45:02] he believes [1:45:02] Social Security [1:45:03] is a Ponzi scheme. [1:45:05] Last week, [1:45:06] another Republican [1:45:07] Senator was on the floor [1:45:08] saying Social Security [1:45:09] is a scam. [1:45:11] So, I wanted to make [1:45:12] really clear [1:45:13] at this hearing, [1:45:14] I cannot disagree [1:45:15] more strongly, [1:45:16] Mr. Chairman. [1:45:17] Social Security [1:45:18] is a program [1:45:19] that millions [1:45:20] of hardworking Americans [1:45:21] have paid [1:45:22] into their entire lives. [1:45:24] So, Republicans [1:45:25] might want to cut benefits [1:45:26] or privatize Social Security, [1:45:28] but I want you to know [1:45:29] I'm going to keep fighting [1:45:30] to save Social Security [1:45:32] and protect health care [1:45:33] for our Americans [1:45:35] now and long [1:45:36] into the future. [1:45:37] Thank you, [1:45:37] Mr. Chairman. [1:45:38] Correct the record, [1:45:39] I've said it's a legal [1:45:40] Ponzi scheme, [1:45:42] which is exactly [1:45:43] what it is. [1:45:43] I mean, [1:45:44] take a look at [1:45:44] what a Ponzi scheme is. [1:45:46] That's what Social Security [1:45:47] is. [1:45:47] It's been horribly mismanaged. [1:45:49] Those funds [1:45:50] were not invested [1:45:51] in something [1:45:51] that's valued [1:45:52] in the federal government's [1:45:52] government bonds. [1:45:54] I'm happy to, [1:45:55] and we'll probably [1:45:55] hold a hearing on this, [1:45:56] and I'll prove the case, [1:45:57] but it's a legal [1:45:58] Ponzi scheme, [1:45:59] and that's quite [1:46:00] honestly indisputable. [1:46:01] Mr. Chairman, [1:46:02] to respond. [1:46:03] Yes. [1:46:03] And welcome [1:46:04] to the chairmanship, [1:46:06] but I find that [1:46:07] you are turning this [1:46:08] into a debate committee, [1:46:09] not a budget committee. [1:46:10] That's fine. [1:46:11] I think it's important [1:46:12] the American people [1:46:13] see a civil exchange. [1:46:15] But go ahead. [1:46:15] I will respond. [1:46:16] Americans pay [1:46:18] for their Social Security. [1:46:19] They pay into it [1:46:20] for their lifetimes, [1:46:21] and they deserve to know [1:46:23] it's going to be there [1:46:23] in the future. [1:46:24] That's what we're focused on. [1:46:25] Yes, and they paid into it, [1:46:26] and the money was spent. [1:46:27] It's gone. [1:46:28] It's been horribly mismanaged. [1:46:29] And again, [1:46:30] you take a look [1:46:30] at the Social Security tables, [1:46:31] and some people [1:46:32] don't even get back [1:46:33] what they put into it. [1:46:34] Other people get up [1:46:35] to three times [1:46:36] what they put in. [1:46:36] So again, [1:46:37] we'll lay out the facts [1:46:38] for this. [1:46:39] That's all I'm trying. [1:46:39] I'm trying to lay out the facts. [1:46:40] This is a hearing [1:46:41] about laying out the facts, [1:46:43] and I'll go to Senator Wyden. [1:46:45] Mr. Chairman, [1:46:47] point of privilege. [1:46:49] It's customary [1:46:50] in a Senate committee [1:46:52] for each member [1:46:54] of the Senate [1:46:55] and each member [1:46:56] of the committee [1:46:56] to be able to ask [1:46:57] their questions [1:46:58] and make their points [1:46:59] without an intervening [1:47:02] rebuttal by the chair. [1:47:04] I'm not anticipating [1:47:06] doing an intervening rebuttal [1:47:08] of Republican members. [1:47:11] I'm not going to take up [1:47:12] the time for that. [1:47:13] I'm not going to ask for that. [1:47:15] I just think that, [1:47:17] and I did ask [1:47:18] if I could put in a point [1:47:19] for the record earlier, [1:47:20] and you allowed me [1:47:22] to do that, [1:47:22] clarifying that undocumented [1:47:24] individuals do not qualify [1:47:26] for federal benefits, [1:47:28] but I hope the point [1:47:31] my colleagues have made [1:47:33] is that that is a new norm, [1:47:37] but maybe not a great norm [1:47:38] for this committee. [1:47:40] I would disagree. [1:47:41] I think it makes the hearings [1:47:42] more interesting [1:47:42] and more informative. [1:47:43] Are you going to grant? [1:47:44] So again, I've allowed [1:47:46] an exchange back and forth. [1:47:47] Are you going to grant me [1:47:48] to intervene [1:47:49] after every Republican testimony [1:47:51] to point out how wrong they are [1:47:52] and how off-base they are? [1:47:53] Because that would be [1:47:54] the equivalent point. [1:47:55] Senator Wyden. [1:47:56] Thank you, Mr. Chairman, [1:47:58] and I certainly share [1:47:59] Senator Merkley's view [1:48:01] on this point, [1:48:02] and the reality is [1:48:03] on this side, [1:48:04] we have been trying [1:48:05] to work with Republicans [1:48:06] on fighting health care fraud [1:48:08] again and again. [1:48:10] You know, I went to the floor [1:48:11] repeatedly to point out, [1:48:12] for example, insurance broker fraud, [1:48:15] something that both of us [1:48:16] ought to come together, [1:48:17] no response from Republicans. [1:48:18] So today, we're looking [1:48:20] at yet another approach [1:48:23] that is ill-advised [1:48:24] because it primarily hurts people [1:48:26] and doesn't do anything [1:48:27] about reducing fraud [1:48:29] or anything like that, [1:48:30] and that's the administrative trap [1:48:32] designed to disenroll folks [1:48:34] who are eligible for Medicaid, [1:48:36] and the Trump administration [1:48:38] went forward to basically say [1:48:40] that they were going [1:48:41] to literally require people [1:48:43] to prove that they're sick enough [1:48:45] to deserve health care. [1:48:47] So today, Senator Warnock [1:48:49] and I are releasing a letter [1:48:51] signed by each Senate Democrat [1:48:54] urging the Trump administration [1:48:56] to pull back [1:48:57] on this disastrous rule [1:48:59] that would harm [1:49:00] so many vulnerable people. [1:49:02] So this, by the way, [1:49:04] is the same sort of approach [1:49:06] that House Democrats have taken [1:49:08] to raise the alarm [1:49:09] on this flawed and hurtful rule. [1:49:12] I can't remember the last time [1:49:13] that we had such unity [1:49:15] between the House and the Senate, [1:49:16] but I guess if the Republicans [1:49:18] are just going to keep hurting people, [1:49:19] you'll see it often in this session. [1:49:22] I'd like to ask, Mr. Chairman, [1:49:24] that these letters be entered [1:49:25] into the record. [1:49:26] Objection. [1:49:27] Thank you, Mr. Chairman. [1:49:28] Now, Andy Schneider may not be known [1:49:31] to everybody in this room, [1:49:33] but I sat next to Andy Schneider [1:49:35] when he was starting his career [1:49:37] in health care, [1:49:38] and he was fighting [1:49:39] for people who were vulnerable, [1:49:41] people who walked [1:49:42] an economic tightrope [1:49:43] and balanced the food bill [1:49:44] against the fuel bill [1:49:45] and the fuel bill [1:49:46] against the rent bill, [1:49:47] and he's still doing that. [1:49:49] My God, this is a man [1:49:51] who could probably go out [1:49:52] to any megacorporation [1:49:53] and pull down a gigantic salary, [1:49:56] but instead what he's doing [1:49:58] is putting his heart out there [1:49:59] once more for people [1:50:01] who are walking [1:50:02] that economic tightrope. [1:50:03] So before we wrap up, [1:50:05] I think it would be great [1:50:06] to have Andy Schneider [1:50:07] give us a real-world example [1:50:09] of the human cost [1:50:10] for the millions of Americans [1:50:12] who are losing their health care [1:50:14] as a result [1:50:15] of this bureaucratic razzmatazz. [1:50:17] That's the most complimentary thing [1:50:19] you can talk about [1:50:20] because it really is [1:50:22] bureaucratic unfairness, [1:50:24] but tell us what it means [1:50:25] to people who are, you know, [1:50:28] hurting and vulnerable [1:50:29] that you've been fighting for, [1:50:30] by my calculus, [1:50:32] for almost a half a century. [1:50:34] Half a century going to bat [1:50:35] for people who didn't have clout [1:50:36] and didn't have power. [1:50:40] Thank you, Senator. [1:50:41] I appreciate that. [1:50:43] And I fondly remember [1:50:44] our days in midnight basketball [1:50:47] in Portland. [1:50:48] Don't talk about [1:50:49] my Grey Panther days. [1:50:52] Okay, I withdraw that comment. [1:50:53] Thank you. [1:50:54] You had a great dunk, though. [1:50:55] So, let's take [1:51:02] what is the unfolding story here [1:51:04] of work reporting requirements [1:51:07] being imposed [1:51:09] on all Medicaid expansion states [1:51:11] for Medicaid expansion adults. [1:51:15] And one of the first states [1:51:16] out of the box is Nebraska. [1:51:19] And there was a piece yesterday [1:51:23] or the day before reporting [1:51:25] on some of the early administrative [1:51:29] red tape problems [1:51:34] that Medicaid beneficiaries [1:51:38] are going to face [1:51:39] as this unfolds. [1:51:40] It's a backdoor disenrollment program, [1:51:41] isn't it? [1:51:43] Well, I think that's [1:51:44] a fair characterization, yeah. [1:51:46] So, in this particular case, [1:51:51] a pregnant woman [1:51:52] was disenrolled [1:51:55] from the Nebraska Medicaid program [1:51:58] because the enrollment staff [1:52:03] didn't understand [1:52:04] that she was pregnant. [1:52:06] So, it eventually got sorted out, [1:52:08] as far as we can tell [1:52:09] from the reporting, [1:52:10] but these kinds of errors [1:52:12] are almost unavoidable [1:52:15] given the complexity [1:52:16] and cumbersomeness [1:52:19] of the new rules [1:52:20] that are about to go into effect. [1:52:24] Well, I thank you [1:52:25] for putting a human face on this. [1:52:27] We're going to be calling on you [1:52:28] in the Finance Committee [1:52:29] as well on the same point. [1:52:31] And before I close out my time, [1:52:33] Mr. Chairman, [1:52:33] Ranking Member [1:52:34] Merkley asked members [1:52:36] on the dais [1:52:36] to share stories [1:52:37] from our states, [1:52:38] from families [1:52:39] who rely on Medicaid. [1:52:40] I'd like to enter [1:52:41] into the record [1:52:42] the letter [1:52:42] from 11 U.S. senators [1:52:43] to Dr. Oz [1:52:45] that highlights families [1:52:46] all over the nation, [1:52:48] from one end of the country [1:52:49] to another, [1:52:50] who need help, [1:52:51] need assistance [1:52:52] with community-based services [1:52:54] and particularly need Medicaid. [1:52:56] I ask unanimous consent [1:52:57] that I close out [1:52:58] my remarks with that. [1:52:59] Without objection. [1:53:00] Thank you. [1:53:00] So, I think we'll bring [1:53:02] the hearing to a close. [1:53:03] I want to thank everybody, [1:53:04] all the witnesses, [1:53:05] everybody attending. [1:53:07] Listen, I'd like to have [1:53:09] a little bit more discussion. [1:53:10] I think we've, [1:53:11] I've been civil, [1:53:12] I'd like to maintain civility. [1:53:14] I think it's going to be [1:53:15] more interesting [1:53:15] for the American public [1:53:16] if we can exchange views. [1:53:18] Again, there's obviously [1:53:18] a big difference [1:53:20] in perspective on this thing. [1:53:21] That's fine. [1:53:22] But let's discuss it, okay? [1:53:24] And just the rigidity [1:53:25] of the standard hearing, [1:53:26] you know, this is said, [1:53:27] and again, [1:53:28] I think it is far more interesting. [1:53:31] I think it's far more beneficial [1:53:32] to let's have a discussion. [1:53:35] You know, [1:53:35] if there's something [1:53:35] that you want to challenge, [1:53:37] go ahead and challenge it [1:53:38] with civility. [1:53:39] So, again, [1:53:39] that's the way I intend [1:53:40] to do this. [1:53:41] I keep my comments [1:53:43] pretty short. [1:53:44] I don't filibuster. [1:53:45] Just take a look [1:53:46] at my opening statement. [1:53:46] I think it's pretty short. [1:53:49] But they're important points [1:53:50] to be made, [1:53:51] and I'll continue to do that. [1:53:53] So I hope it doesn't offend [1:53:54] my Democrat colleagues, [1:53:56] but that will continue [1:53:57] to be my intention here. [1:54:00] Mr. Chairman, [1:54:02] I'll just point out [1:54:03] that a discussion involves [1:54:04] other members having [1:54:05] an equal time [1:54:06] to provide rebuttal as well. [1:54:08] Otherwise, [1:54:09] it's just rebuttal. [1:54:10] And again, [1:54:10] when I rebutted, [1:54:12] I gave the Democrat member [1:54:14] time to rebut [1:54:15] what I said as well. [1:54:16] So, again, [1:54:17] I've been here 15 years. [1:54:19] I've seen chairman [1:54:19] handle different things, [1:54:20] including the esteemed [1:54:22] former chairman [1:54:22] of our finance committee. [1:54:23] So, again, [1:54:24] I think that's, you know. [1:54:25] Could I provide one fact [1:54:26] before we close? [1:54:28] Just a fact. [1:54:29] As long as I can rebut it. [1:54:30] You can. [1:54:31] You're most welcome. [1:54:32] You're most welcome to. [1:54:34] So, that family [1:54:35] of a mother [1:54:36] and two children, [1:54:37] that's only 100% [1:54:39] of federal poverty level, [1:54:40] that's $2,276 a month. [1:54:44] After payroll taxes, [1:54:46] the disposable income [1:54:47] is $2,100. [1:54:49] An average rent [1:54:49] for a two-bedroom apartment, [1:54:50] not even a three-bedroom, [1:54:51] children don't get [1:54:52] their own room, [1:54:53] is $1,700. [1:54:55] An average cost [1:54:56] for transportation, [1:54:57] around $500. [1:54:58] Already, [1:54:59] you're down to $0. [1:55:01] $0 for that family. [1:55:03] Now, you made reference [1:55:04] to $50,000 in benefits. [1:55:06] A family does qualify [1:55:08] at that level [1:55:08] for $785 for SNAP, [1:55:11] $0 for TANF, [1:55:13] and there's a massive [1:55:15] waiting list [1:55:15] for affordable housing. [1:55:16] So, that's the luck [1:55:17] of the draw, if you will. [1:55:18] So, most families [1:55:19] are in the situation [1:55:20] where they're completely [1:55:21] out of money [1:55:22] other than the assistance [1:55:24] to help them buy food. [1:55:25] They don't even have money [1:55:26] to add into that, [1:55:28] and this is before [1:55:29] we start looking at [1:55:31] a family has to buy utilities. [1:55:32] They have to put clothing. [1:55:34] They have to have [1:55:34] school supplies. [1:55:36] And so, [1:55:36] I just want to point out [1:55:38] that, as one colleague [1:55:40] observed, [1:55:41] very few people [1:55:42] in this room [1:55:42] have lived at that level [1:55:44] of really minimal resources. [1:55:49] And so, [1:55:50] having Medicaid available [1:55:52] as health insurance [1:55:54] to those families, [1:55:55] if we want that next generation [1:55:57] to thrive, [1:55:58] is essential. [1:55:58] Well, I will say, [1:56:00] people on this dais, [1:56:01] including myself, [1:56:02] came from very humble beginnings. [1:56:04] Senator Graham, [1:56:04] Senator Scott. [1:56:06] So, I think we understand this. [1:56:08] I was quoting [1:56:09] Senator Phil Graham, [1:56:10] who's also a pretty [1:56:11] noteworthy economist, [1:56:12] in his studies, [1:56:13] talking about $53,000 [1:56:14] in tax-free benefits [1:56:15] for a single parent [1:56:17] with two children, [1:56:18] making $11,000. [1:56:19] Again, I'm just quoting him, [1:56:21] so take a look [1:56:22] at his information. [1:56:23] But, you know, [1:56:26] facts are facts, [1:56:27] and I think that's [1:56:27] what we need to try and do, [1:56:28] is let's get the facts [1:56:29] on the table, [1:56:30] find out what [1:56:31] we all agree on, [1:56:33] common facts, [1:56:33] and then we can [1:56:34] kind of debate [1:56:35] the different perspectives. [1:56:36] But again, [1:56:36] I appreciate [1:56:37] everybody's involvement here. [1:56:39] The hearing record [1:56:39] will remain open [1:56:40] for 15 days [1:56:41] until August 19th [1:56:42] at 5 p.m. [1:56:42] for the submission [1:56:43] of statements [1:56:43] and questions for the record. [1:56:44] This hearing is adjourned.