▶ 0:16:11>> want to thank the witnesses for appearing. Longer than normal but I think it's important topic. I will tell you right up front what prompted this hearing as a first hearing. It was the cbo release of the first three quarters spending in medicaid. Year over year we are at $49 billion.
▶ 0:16:44Again, I would like to be as cooperative as possible. I want to counter the false accusations that the republicans cut medicaid to the bone. A quick history of medicaid, and
▶ 0:17:15To benefit children, elderly, blind, disabled. Children less than 21 that were not afdc. I was a core group of people medicaid was designed to cover.
▶ 0:17:39Through the 90's and 2000's eligibility continued to expand as did the enrollment, as did the dollars and cents. We will have a little bit of dueling charts here. The committee should get used to my using a chart. The problem-solving process always begins with you have to admit you have a problem. My guess is we have two definitions of problem on each side of the dais. Spending is out of control.
▶ 0:18:12My guess on the others, we are probably not spending enough. The next step is we have to define the problem and agree on common facts. What I would like today's hearing to be about is laying out the basic facts we could all agree on. Once we do that we can start doing analysis, what kind of policy changes are required.
▶ 0:18:36Something I hope we agree with his prevent the massive fraud that is being revealed the last few months. With start with I will call this a powerpoint presentation. Everybody at their seat has the final chart. It shows spending from 19 90 through 1998.
▶ 0:19:01We are spending less than $100 billion and there's about 32 million people enrolled, about 12% of the population. I have been talking an awful lot about different budget baselines, take the actual expenditures, increase them by population inflation growth. It is a baseline control over what should we be spending.
▶ 0:19:311998 spending under clinton, this year, last year. Next chart. This shows actual spending that on top of those projections, the baseline through 2014, the first year obamacare kicked in. We were growing under the bush administration slightly higher than that population growth and inflation.
▶ 0:20:01Those expenditures increased pretty significantly. 2014 it really took off. Next chart? This is what we would be spending if we took the 2014 spending and just increased that by population and inflation. We would be spending 441 billion dollars in fiscal year 2025.
▶ 0:20:29This shows again actual spending on top of that inflation population growth from 2014 32019, the year before the pandemic. We are running ahead of that baseline. Let's say you take 2019 spending , 2025 you will be spending $536 billion.
▶ 0:20:55Final chart is the one in front of you, we are spending $668 billion. That is just the financial facts. Instead of spending 248 billion under clinton in the 1990 a baseline or 441 billion, or 536 billion dollars from the pre-pandemic baseline we are spending $668 billion.
▶ 0:21:27I think that indicates a program out of control. You combine that with the outrageous fraud in minnesota with child rearing centers and autism centers and transportation. All of these things are defrauding medicaid. The problem is when you are spending billions of dollars on fraud, those are billions of dollars that can't be spent on the people who actually need it.
▶ 0:22:00A lot of the medicaid expansion, let me back up. Medicaid was initially established as a federal match to the state and district program. The state has a significant amount of skin in the game. Currently for every dollar the state spends on a disabled child they get about $1.33 in benefits from the federal government. Obamacare change that for single, working aged, able-bodied, childless adults.
▶ 0:22:30Every dollar the state spends, states get nine dollars in funding. We can talk about it but it makes no sense. A lot of that is fueled some of the fraud. No incentive for states to be checking eligibility. We will talk about that. Anyway, huge disparity in terms of dollars spent.
▶ 0:22:57We have seen the fraud, 400 hospice centers in los angeles. They were apparently in l.a., Dr. oz defunded 300 of them. Not one of them complain. I hope we could get bipartisan agreement that we can figure out how to eliminate this. We don't do a very good job tracking it.
▶ 0:23:22We designed these programs and they are out of control, which is what we got. The enrollment has skyrocketed. Different points in time done through the 90's, to thousands. It really skyrocketed after obamacare and medicaid expansion .
▶ 0:23:44I think the last chart you have in front of you, this is a similar type of depiction as I have done with the other baselines. If you took. 1998 enrollment, we are looking at 40 million people on medicaid.
▶ 0:24:06If you just take it again 2014 after medicaid expansion, you've already had one year of medicaid expansion you'd be at about $70 million, 20% of our population. I don't think medicaid was ever designed to cover 25% of the population. These are just a basic facts.
▶ 0:24:35I would hope on a bipartisan basis we would at least eliminate the fraud in the program. Make sure the dollars we spend are going to the people who truly need it. We want to provide that kind of help. We can hopefully eliminate the fraud. These are numbers that indicate this needs to be addressed.
▶ 0:24:59Sen. Merkley: We are bringing different perspectives. That is the beauty of having hearings and debate. The perspective that many democrats and probably a few republicans as well is that prior to 2000 I've we have a tremendous uninsured population in america both because essentially there are a lot of
▶ 0:25:29Sen. Merkley: Holes in the medicaid program as to who was covered and there was a gap above the income qualification by medicaid where people still couldn't afford insurance unless it came through their company. And then you had folks above that who couldn't afford insurance either. Let's expand medicaid, fill in the holes, address the less affluent population.
▶ 0:25:59Sen. Merkley: Create tax credits to help people by private insurance in a marketplace. In oregon, I don't have the exact number but we had roughly 25% of the population without insurance before we made those changes. The result is not only a big reduction in stress for families, they had insurance. We ended a lose lose situation.
▶ 0:26:32Sen. Merkley: Folks without insurance simply would postpone getting treatment for medical problems. They couldn't afford to pay the bill. The problems become bigger and more expensive. That is a problem for their health. Then when they did go to get medical health they went to the emergency room, the least efficient and highest cost piece of the entire system.
▶ 0:26:58Sen. Merkley: Because they didn't have insurance they often couldn't pay the bill which meant there was no revenue to cover the provision of services. Here we are with this lose, lose, lose proposition. That is the vision that was undertaken.
▶ 0:27:17Sen. Merkley: What we will see laid out looking at the rising costs of medicaid, essentially because the rising costs of health care per person in every aspect of health care, the individual insurance provided through medicare and private insurance. Last year the republican majority used a simple majority bill.
▶ 0:27:43Sen. Merkley: They said essentially we don't like this medicaid program, we are not all in on this vision of health insurance for less affluent families. We are going to cut it. It will kick more than 15 million americans off of health insurance. It will skyrocket the out-of-pocket cost for millions more. What was the savings applied to? Tax breaks for billionaires. It was a very simple proposition.
▶ 0:28:14Sen. Merkley: Less affluent families lose and billionaires win. That is not a philosophy many of us shared. Many of us disagree with that philosophy. We think we should have a philosophy for families to thrive, not families lose, billionaires win strategy. Invest in audits, absolutely. Uncovering fraudulent charges? We have significant penalties for that, absolutely.
▶ 0:28:45Sen. Merkley: I have introduced a bill on a huge fraudulent practice. Deliberately reducing health insurance coverage for less affluent families, that is not tackling fraud. That is destroying health care for less affluent families. It's back to where we were in a lose, lose, lose strategy for our nation.
▶ 0:29:12Sen. Merkley: The trump administration has proceeded to protect fraudsters, how? By cutting off medicaid control units. We should have a hearing on that. One executive who generated $205 million in false medicare claims . We should have a hearing on that. I'm all in on tackling fraud.
▶ 0:29:43Sen. Merkley: We will re-create this lose lose lose foundation in america. The vision of the red carpet from the rich and red tape for the poor is a bad vision for america. We have already wiped out under what trump called the big beautiful bill. Health care for 2 million children and 8 million people.
▶ 0:30:14Sen. Merkley: Certainly the 2 million children who have been booted off medicaid are the children's health -- health insurance program, we weren't committing health care fraud. But I will tell you what they were doing, they were going to the doctor when they needed medical treatment. The clinic at hospitals were getting paid. That is a win-win. Let's reject the lose, lose, lose strategy and adopt the win-win strategy.
▶ 0:30:43Sen. Merkley: People will delay getting care, develop more serious health issues, being more expensive to treat, provide less revenue to our clinics and hospitals. When revenue drops, hospitals and clinics close. Reducing care for the entire community. Regardless of what type of insurance you have.
▶ 0:31:07Sen. Merkley: Proceeding to take away health insurance for less affluent actually has found an impact on everyone's ability to have health care treatment. Do you know where it's really scary? Rural america. If you wipe out the flow of revenue for a clinic or hospital , there is another clinic or hospital nearby.
▶ 0:31:31Sen. Merkley: When you do it in a rural area and the next clinic or hospital is 70 miles or 100 miles away, out west that is not uncommon at all. You are having a profound impact on the entire community. If you have a heart attack or stroke, you don't have time to drive 100 miles to see a doctor, get to the emergency room.
▶ 0:31:55Sen. Merkley: As of april of this year, 216 hospitals and clinics have already closed due to the provisions in the big beautiful bill last year or dramatically reduced services. More than 1000 hospitals, clinics, nursing homes are at risk of losing or cutting services. Here is more bad news. There is even more devastating cuts coming in 2027.
▶ 0:32:24Sen. Merkley: Cynically scheduled to kick in after this november's election. Analysis by the nonpartisan congressional office shows it will end coverage for 7.5 million medicaid enrollees. The 35 dollars co-pays for americans already struggling to afford the cost of gas and groceries, it is wrong. Let's recognize these cuts hit rural america of the hardest.
▶ 0:32:54Sen. Merkley: My state of oregon is a big, rural state. 52% of residents are covered by medicaid. If you compare the number of children in rural oregon who are dependent on medicaid compared to rural, it is much higher in rural areas. Compare that to folks in washington county were only 25% of residents instead of 52% are covered by the health plan. It really attacks rural america.
▶ 0:33:27Sen. Merkley: Let's look captain numbers. Let's put up the first chart. Medicaid spending has grown slower than overall U.S. health spending. You could see it from this chart. The blue line is much wider than the red line. Since 2007, all health care spending has gone up. Medicare spending has gone up at a much lower rate.
▶ 0:33:53Sen. Merkley: Let's look at a forecast going forward. Cms forecasted this year the per person cost of private insurance will increase more than the per person cost of medicaid. Not to mention medicaid makes up just 18% of national health spending.
▶ 0:34:11Sen. Merkley: Between 2000 and 2020 three medicaid enrollment roughly doubled, the share of national health spending tipped up just three percentage points from 16% to 19%. The problem is in medicaid, it's our overall health care system driving up cost across the board. You see it in medicare and medicaid as well.
▶ 0:34:38Sen. Merkley: You see it going up more slowly in medicaid than these other arenas. They have found every additional dollar we spend on children's medicaid coverage today reduces federal deficits by roughly two dollars in the future, why is that? Reducing their demand on the health care system while increasing contributions in taxes.
▶ 0:35:04Sen. Merkley: We are putting a better foundation for children to thrive by making sure they have insurance. It's not just the kids who are threatened by these cuts. The big, ugly betrayal law is also forcing states to cut home and community-based services for seniors and people with disability.
▶ 0:35:34Sen. Merkley: Here's how it's affecting real people. An autism therapy provider to keep serving children who have nowhere else to turn. In california because of in-home support services a mother has been able to take care of her disabled son and as she said without this, people become homeless. Whatever tiny safety net they had is gone, it is just cruel.
▶ 0:36:03Sen. Merkley: Everyone is familiar we are the only developed country where people are still going bankrupt because of the cost of health care. We have failed to provide the same foundation provided in every other developed country. One of my constituents wrote to me about her 240-year-old sons -- two 40-year-old sons she pleaded don't force families like her back to institutionalization by cutting medicaid.
▶ 0:36:34Sen. Merkley: It is always more expensive. In her words, it would be insane, inhumane, a crime against humanity. Insane is right. This isn't about fraud. This hearing would be about the president convicting fraudsters. This hearing is about the red carpet for the rich and red tape for the poor. Health care is a right for all.
▶ 0:37:01Sen. Merkley: Let's reject the strategy of families lose and billionaires win. >> you might've missed the fact that we provided $50 million for a rural health care fund in the reconciliation bill. Medicaid spending is up 10% this year.
▶ 0:37:30Sen. Merkley: We are just going through the roof. Appreciate your opening statement. It is tradition this committee swears and witnesses. Raise your right hand. Do you swear the testimony you appear before this committee will be truthful, please be seated. Our first witness is Mr.
▶ 0:37:56Sen. Merkley: Brian blais, the president of paragon health institute. Special assistant to the president for economic policy of the national economic policy from 2000 17 through 2019 where he developed numerous health policies and advise the president and senior officials. He founded blais policy strategies after leaving the white house.
▶ 0:38:23Mr. Blase: Medicaid is an important welfare program. Too often it fails the truly vulnerable, children, pregnant women, seniors, people with disabilities. The federal state medicaid partnership is broken. After the past dozen years states have shifted hundreds of billions of dollars of medicaid costs to the federal government.
▶ 0:38:51Mr. Blase: Washington pays more than 70% of medicaid spending. Up from the historic 60%. I will focus my remarks on two major problems. The expansion of medicaid to able-bodied working age adults in the legalized money laundering apparatus that results in massive corporate welfare. The enrollees over traditional enrollees.
▶ 0:39:21Mr. Blase: On average when the state spends one dollar of its own money on traditional medicaid, the federal government contributes $1.33. For one dollar of state spending the federal government contributes nine dollars. Washington pays states seven times more for each state dollar on expansion adults then for people medicaid was created to serve.
▶ 0:39:49Mr. Blase: Multiple studies show medicaid expansion has made it harder for traditional enrollees to obtain appointments. It's increased wait times and forced patients to rely on emergency rooms for routine care. Medicaid should prioritize the most vulnerable. Its financing formula discriminates against them. The same misguided incentives explain the surge in improper medicaid enrollment.
▶ 0:40:17Mr. Blase: Yesterday, paragon released a study estimating nearly half of the 20 million medicaid expansion enrollees were likely ineligible in 2024. This opposed roughly 33 billion dollars in improper federal costs with a major cause shift from states to the federal government. If you states like california and new york have exceptionally high enrollment, it exists in every expansion state.
▶ 0:40:45Mr. Blase: Congress should expand the most vulnerable and have the enforcement rates for all enrollees within each state. President obama proposed rates after the aca became well. The second problem is money laundering. Former oregon state representative mitch greene link called these green taxes for states.
▶ 0:41:14Mr. Blase: We collect the tax from the hospital, we put it up as a match for federal money and then we give it back to the hospitals. This is not a tax, it is legalized money laundering for shifting costs from states to washington while generating windfalls for politically powerful providers. In 2011, then vice president joe biden called provider taxes a scam and said they should be eliminated.
▶ 0:41:43Mr. Blase: Senator durbin has called them a charade. The commission set up by president obama recommended ending them. President obama proposed limiting provider taxes and the one big beautiful bill basically adopted his proposal. Broken medicaid incentives have led to a new form of corporate welfare. State directed payments.
▶ 0:42:07Mr. Blase: Cms allowed medicaid insurers to pay hospitals up to average commercial rates or more than 2.5 times medicare rates. Such excessive medicaid payments distort the program's purpose and threaten seniors access to care. In the one big beautiful bill congress appropriately limited medicaid payments through insurers to medicare rates.
▶ 0:42:33Mr. Blase: Most spending runs through health insurance companies generating enormous revenues for them. There is remarkably little evidence that medicaid managed care has improved access, health outcomes, or reduced costs. Increasingly it manages as a financing intermediary for corporate welfare.
▶ 0:42:53Mr. Blase: Medicaid's incentives have also created a lucrative consulting industry devoted to helping states maximize federal reimbursement by gaining medicaid's complicated financing rules. This does not improve patient care. Medicaid is an essential program but congress must improve the core incentives, reward states were serving the most vulnerable, not for maximizing federal reimbursement.
▶ 0:43:20Mr. Blase: Eliminate the medicaid money laundering schemes and root out corporate welfare. Those reforms will help the balance with the federal and state medicaid partnership and improve medicaid for america's most vulnerable citizens.
▶ 0:43:34Chair Johnson: Our next witness will be Mr. jonathan ingram, vice president of policy and research at the foundation for government accountability. Jonathan served as the director for health policy for the illinois policy institute and is editor-in-chief with the journal of legal medicine. He holds an executive mastery of business administration and a juris doctor.
▶ 0:44:02Mr. Ingram: Criminals steal billions from medicaid every year. Last year they charged a russia lead crime syndicate and stole the identities of more than one million americans and build medicare and medicaid more than 10 billion dollars. In made prosecutors charged 15 defendants in minnesota in the largest medicaid autism fraud case in american history.
▶ 0:44:34Mr. Ingram: In ohio, fraudsters built networks of home health care companies, build medicare for kade then -- care they never delivered and posted videos of themselves drinking champagne on private jets. Those cases made headlines because prosecutors could bring charges. They pay providers that nobody has screened. It is fraud by design.
▶ 0:45:07Mr. Ingram: Billing from overseas and quietly manipulated. The victims are the same. American families pay their taxes, trust in congress to spend money carefully. The people the club was built for, senior citizens, pregnant women, children with disabilities, it was stolen or diverted by bureaucrats before they ever left. More than one in five medicaid dollars is spent improperly.
▶ 0:45:38Mr. Ingram: Before the one big beautiful bill taxpayers were on track to lose more than $2 trillion over the next decade. Five policy choices made that possible. First, bureaucrats stop verifying applications. More than 40 states take an applicant's word on residency. More than a dozen take their word on income.
▶ 0:46:03Mr. Ingram: Officials in at least 30 states now want to take the word on requirement exemptions. Second, states stopped rejecting eligibility. Nationwide states renewed 69% of recent cases without asking enrollees a single question. North carolina renewed 99.5 percent of their 2.2 million cases this way.
▶ 0:46:30Mr. Ingram: States let hospitals enroll patients before anyone verifies eligibility. Hospitals deemed nearly 500,000 people presumptively eligible for medicaid. When the state finally completed its full eligibility reviews only 155,000 of those actually qualified, 30%. Federal taxpayers never got any of those dollars back.
▶ 0:46:57Mr. Ingram: Enrolling people and medicaid based on their food stamp enrollment. Bureaucrats have built these one door systems that merge enrollment across programs. Minnesota brags it built a single app to sign someone up for as many as nine welfare programs. One wrong answer cascades the entire program at once. States enroll applicants while they verify immigration status.
▶ 0:47:27Mr. Ingram: The grace period meant to last 90 days. Seven in 10 of those temporary cases now last longer. One enrollee has collected medicaid for 5008 hundred 20 days, 16 years without ever updating immigration status. The results match the design.
▶ 0:47:50Mr. Ingram: Federal auditors flagged millions of ineligible and potentially ineligible enrollees. Providers get the same free pass. Federal law makes them re-screen every provider in regular intervals. They went three years without re-screening a single one. Some providers have gone 17 years without a revalidation.
▶ 0:48:15Mr. Ingram: When they forced minnesota to rescreen nearly 6000 high-risk providers, the state disenrolled 62% of them. They failed background checks, site visits, they refused to turn over information. When investigators do catch providers, states keep paying them anyway. They are supposed to suspend payments to any provider accused of fraud. New york issued waivers to keep paying 96% of them.
▶ 0:48:47Mr. Ingram: Why do states run their programs this way? It is the money. Every dollar a state to end -- spends on medicaid draws at least one federal dollar. Washington pays nine dollars for every one dollar they spend on able-bodied adults. States launder the rest, shifting more state cost on the federal taxpayers. Bureaucrats treat federal dollars, medicaid as free stimulus.
▶ 0:49:20Mr. Ingram: They treated as budgetary malpractice. It is a dollar less of free federal money coming into the state. Miss classifying enrollees into obamacare expansion to claim the higher rate. Bureaucrats designed this rod over decades. Require states to verify identity, income, immigration status before enrollment. Not after. Require eligibility reviews and provide a rescreening on schedules states cannot ignore.
▶ 0:49:51Mr. Ingram: End of the funding formula that pays that -- thank you.
▶ 0:49:58Chair Johnson: Our final witness is Mr. schneider, a research professor for children and families at the school of public policy at georgetown university. He served on the obama administration as the senior provider where he focused on integrity issues. He was a graduate of princeton university and the university of pennsylvania, Mr. schneider.
▶ 0:50:27Mr. Schneider: Appreciate the opportunity to testify. Let me tell you about ccf. It is an independent nonpartisan research center founded in 2005 for america's children and families. As a part of the public policy at georgetown university we conduct research, develop strategies, offer solutions.
▶ 0:51:01Mr. Schneider: Particularly those of low and moderate incomes. Ccf is responsible for raising external funding. The current list of our funders is available on our website. Ccf does not expect -- accept government or corporate funding. The testimony and views I'm presenting today are my own, not those of georgetown university or the mccourt school.
▶ 0:51:28Mr. Schneider: Medicaid is a hugely important health insurance program for 67 million low income americans. It covers 40% of our nation's children, half of our children special health care needs, it's also the largest payer for long-term care services for people with disabilities and seniors. It's particularly important to ensure families in rural america and those that serve them and the communities that they live.
▶ 0:52:00Mr. Schneider: They are more likely than those living in metro areas to rely on medicaid for their health insurance. Medicaid means access to long-term health and care services, for all the other populations it serves. It comes as no surprise that medicaid is very popular with the american people.
▶ 0:52:25Mr. Schneider: January, 20 25 tracking poll found that 27% of voters had somewhat favorable views about medicaid including 53% of republicans and 81% of independence. I discussed the written role of medicaid it is important to children and families, the harm the budget reconciliation bill will do to millions of americans who rely on medicaid for access to health care.
▶ 0:52:52Mr. Schneider: The reasons for federal and state spending and why that spending is growing. Actually reducing fraud against the medicaid program requires collaboration between the federal government and states, not withholding federal funds for partisan attacks. We at ccf closely monitored child enrollment in medicaid.
▶ 0:53:16Mr. Schneider: The latest tracking updated as of last friday finds that since january, 2025 the number of children enrolled in medicaid has dropped by 2.3 million. That is as many children as in the states of alaska, delaware, maine, montana, north dakota, rhode island, south dakota, vermont, wyoming, the district of columbia combined.
▶ 0:53:44Mr. Schneider: This is a statistic that should alarm every policymaker who cares about the well-being of children. We know uninsured children or children without access to preventative or primary care. We know their families have no protection against medical debt if their children become sick or injured. At a minimum, cms should be working with states to understand root causes and take immediate steps to reverse it.
▶ 0:54:16Mr. Schneider: Cms leadership seems laser focused on withholding federal funds from california and minnesota. 2.7 billion and counting to repeated deferrals. That is the reality of medicaid today. It does not have to be this way. I hope the members of this committee will work with cms to change course.
▶ 0:54:38Chair Johnson: Let's click address that issue. The 2.3 million children that have lost coverage under medicaid, could you explain that?
▶ 0:54:49Dr. Blase: It is a deeply misleading statistic. If you combined medicaid and chip enrollment from before the pandemic, there's a higher percentage of children on medicaid and chip. One of the issues as we have fewer bursts in the U.S.
▶ 0:55:09Dr. Blase: Because of that fertility decline because we have children who are moving off the medicare program -- medicaid program because they age off of it. When you look at it as a percentage of all kids there's a higher percentage of kids enrolled in medicaid.
▶ 0:55:26Chair Johnson: Mr. schneider, there were four primary reforms in the first reconciliation package. The first one was requiring states to re-determine eligibility, do you have a real problem with that? Did you want people who are now ineligible to be on these programs?
▶ 0:55:48Mr. Schneider: I believe the program should only be for people who are eligible.
▶ 0:55:53Chair Johnson: Is there anything wrong with states re-determining eligibility? A lot of states obviously don't.
▶ 0:55:59Mr. Schneider: I think the state should have some flexibility in how they administer their programs.
▶ 0:56:05Chair Johnson: Is there a problem with rechecking eligibility? There's nothing draconian about that, correct?
▶ 0:56:17Mr. Schneider: There is not a problem.
▶ 0:56:19Chair Johnson: Next. Our provider tax fees health care?
▶ 0:56:24Mr. Schneider: States are solvent political entities.
▶ 0:56:28Chair Johnson: Is that health care?
▶ 0:56:31Mr. Schneider: Health care is in part --
▶ 0:56:35Chair Johnson: The answer is no. When states charge a provider fees and taxes, correct? For medicaid recipient the provider gets reimbursed that amount. They are charging them for services across the board, correct?
▶ 0:57:00Chair Johnson: Isn't it true the provider fees and taxes artificially drive up the cost of health care for people on medicare?
▶ 0:57:06Dr. Blase: They do. We have a study from looking at a tax that california imposed that increased commercial prices by about 4%.
▶ 0:57:19Chair Johnson: President biden called that a scam. President obama recommended doing exactly what we did in the one big beautiful bill. That is just implementing what both president biden and obama recommended.
▶ 0:57:36Mr. Schneider: That is correct.
▶ 0:57:39Chair Johnson: This one is kind of baffling. Could you describe a little bit more what that is? The states juice, plump up what they charge or reimburse. Could you describe that?
▶ 0:57:58Dr. Blase: On the service side of medicaid there is a cap at medicare rates. It is called an upper payment limit. That does not exist on the managed-care side. States have moved medicaid enrollees through coverage for insurers. They realize they could create these provider tax and financing gimmicks, get the funds and lavish much higher payments on the big hospital systems.
▶ 0:58:29Dr. Blase: What the one big beautiful bill did was extend the limits on the service side of medicaid to the managed-care side.
▶ 0:58:36Chair Johnson: Does it make any sense for every dollar estate spends on a disabled child or a blind, elderly oat -- individual they get reimbursed $1.33. For every dollar the state spends on a single, childless, working aged able-bodied adult states get nine dollars in reimbursement from the federal government, does that make any sense at all?
▶ 0:59:11Chair Johnson: $1.33 for a child and nine dollars for someone that should be working? Does it make any sense to you? It apparently didn't make any sense to president obama. He recommended equalizing that treatment, correct?
▶ 0:59:33Dr. Blase: He did. He proposed equalizing the matrix.
▶ 0:59:38Chair Johnson: Would he have increased the reimbursement for disabled children or would he have dropped that to a reasonable level? If we are going to reimburse disabled children for $1.33?
▶ 0:59:52Dr. Blase: It would've brought up the traditional federal reimbursements.
▶ 0:59:57Chair Johnson: Do you know from how much?
▶ 1:00:00Dr. Blase: I don't recall.
▶ 1:00:02Chair Johnson: That's what I have for the time being.
▶ 1:00:07Sen. Merkley: Thank you. Can you tell us what is the federal poverty level for a mother and two children?
▶ 1:00:25Dr. Blase: The federal poverty level for a household of three is probably around $25,000 per year.
▶ 1:00:37Sen. Merkley: That is approximately right. Mr. schneider, is it hard for a mother and two children to live on $25,000? Is it difficult for a mother and children to live on that?
▶ 1:00:55Mr. Schneider: You are looking at a monthly income of $2000 per month. The area of the country that they live in, that is how they make ends meet.
▶ 1:01:14Sen. Merkley: There probably aren't too many people in this room at this level. When people are at that income level and often varies tremendously over the course of the year because they get another part-time job or their boss has a scheduled arrangement that doesn't work with the other part time job or childcare problems. It is a lot of fluctuation in the level of income.
▶ 1:01:41Sen. Merkley: Am I correct that medicaid for expanded medicaid covers 138% of federal poverty level?
▶ 1:01:52Mr. Schneider: In states that have accepted the option for adults, yes. >> that is 1.3 times or roughly 36,000 dollars. Still a very low income for a mother and two children. The point I'm making here is the chairman asks a question about authorized income level every six months.
▶ 1:02:17Mr. Schneider: I will tell you one of the enormous stress factors for a very low income family is the re-filing paperwork continuously and the states have estimated there is a massive overhead and essentially people bump up, bump down with every little job at fluctuation.
▶ 1:02:41Mr. Schneider: When you understand the challenge of less affluent families, you get more often than that and you are just catching fluctuations and creating enormous anxiety of qualifying, not qualifying. Which doesn't serve low income children or their families well. I wanted to turn to this question of the impact on rural america.
▶ 1:03:10Mr. Schneider: Is it correct that there are a lot more folks on medicaid in rural america? In terms of the percent of the population?
▶ 1:03:20Mr. Schneider: In terms of the coverage, yes.
▶ 1:03:26Sen. Merkley: When you lose revenue at a real clinic or hospital and it shuts down, it affects everyone in the community because there is often another clinic or hospital?
▶ 1:03:37Mr. Schneider: That is correct.
▶ 1:03:41Sen. Merkley: People could have great health insurance but there health care could still be compromised?
▶ 1:03:44Mr. Schneider: That is correct.
▶ 1:03:49Sen. Merkley: I wanted to understand this question about children. You testified that in a short period of time, 2.3 million children have come off of medicaid because of the big beautiful bill or the big ugly betrayal is it's better known in parts of the country. We heard testimony from someone else saying that is just an anomaly because children are graduating out of the program faster than they come into it.
▶ 1:04:19Sen. Merkley: Is it just an anomaly or did that bill change the program in a fashion that has greatly reduce the number of children covered?
▶ 1:04:27Mr. Schneider: Let separate two things. When we track child health enrollment we are looking at current data from cms plus what we could get from the state agencies. There is a little data lag between what the states provide and what cms has.
▶ 1:04:51Mr. Schneider: If you are just looking at the data between january, 2025 and april, 2026, the medicaid child numbers in rome down from 30.1 million to 28 .2 million. We say 2.3 million because we have some data from some states. That decline is very concerning. We don't know the reasons.
▶ 1:05:18Mr. Schneider: We don't know how many of those 2.3 million are going to end up on insured. We are very concerned based on what has happened historically that when the child enrollment rate goes down, the mutual rate goes up. We want to do whatever we can to avoid that.
▶ 1:05:38Sen. Merkley: One factual question as I close out, am I correct, medicaid is the only health care program where the federal spending is shrinking as a share of gdp?
▶ 1:05:53Mr. Schneider: I assume so. I don't have that information.
▶ 1:06:00Chair Johnson: The ranking member manchin day family making $25,000. He pointed out a single mother, single parent with two school-age children making $11,000 would qualify for $53,000 in tax-free benefits across the board. Tax-free. We want to help people.
▶ 1:06:31Chair Johnson: We want to help single moms and we want to see children. There are literally aren't people only living on $24,000 who have access to all kinds of welfare benefits. In this case 53 thousand dollars worth. Senator kennedy.
▶ 1:06:54Sen. Kennedy: Dr. blase, before president obama expanded medicaid to include able-bodied working adults, traditional medicaid covered the poor pregnant women, people with disabilities, is that correct?
▶ 1:07:17Dr. Blase: That is correct.
▶ 1:07:21Sen. Kennedy: Today they are still covered?
▶ 1:07:22Dr. Blase: That is correct.
▶ 1:07:25Sen. Kennedy: For those folks in traditional medicaid, for every one dollar, this is an average. For every one dollar that the state puts up, federal government puts up one dollar 33 cents. Does that sound about right?
▶ 1:07:44Dr. Blase: That is the average across the country.
▶ 1:07:50Sen. Kennedy: President obama extended medicaid to able-bodied working adults. Is that correct?
▶ 1:07:56Dr. Blase: Correct.
▶ 1:08:00Sen. Kennedy: On average the federal government for those obamacare expansion enrollees for every one dollar the state puts up, the federal government puts up nine dollars, is that correct?
▶ 1:08:14Dr. Blase: That is correct.
▶ 1:08:18Sen. Kennedy: If you are a governor for traditional medicaid if you get $1.33. For obamacare expansion enrollees you could get nine dollars. If you are a governor, you will try to get as many people on medicaid through obamacare expansion, are you not?
▶ 1:08:39Dr. Blase: That is the incentive states have.
▶ 1:08:44Sen. Kennedy: Some governors cheat?
▶ 1:08:46Dr. Blase: There are some states that have massive problem of improper enrollment.
▶ 1:08:56Sen. Kennedy: Do some states cheat?
▶ 1:08:57Dr. Blase: Yes. Many states cheat.
▶ 1:09:03Sen. Kennedy: The states determined in accordance with federal rules who is eligible for medicare -- medicaid, is that the case?
▶ 1:09:14Dr. Blase: Yes.
▶ 1:09:18Sen. Kennedy: They have to do it in compliance with federal rules?
▶ 1:09:20Dr. Blase: There is the rules that the federal government does a poor job enforcing.
▶ 1:09:27Sen. Kennedy: Do all states follow the federal rules?
▶ 1:09:29Dr. Blase: No they don't.
▶ 1:09:32Sen. Kennedy: Some cheat?
▶ 1:09:33Dr. Blase: Many of them cheat.
▶ 1:09:40Sen. Kennedy: Do they accept people's word that they make a certain amount of money and qualify for medicaid?
▶ 1:09:44Dr. Blase: Yes.
▶ 1:09:48Sen. Kennedy: Do allstate say listen, we hear you and we are not saying you are mine but we are going to cross check your application with our state income tax record, do all states do that?
▶ 1:10:01Dr. Blase: Not all states.
▶ 1:10:06Sen. Kennedy: If they did they would find out some people are lying. What is your best guess as to how much per year this cheating costs the federal taxpayer?
▶ 1:10:21Dr. Blase: We released a report on this yesterday and estimated its 33 billion dollars in 2024.
▶ 1:10:36Sen. Kennedy: That is $33 billion taken away from the people who really need medicaid, is that right?
▶ 1:10:44Dr. Blase: Yes.
▶ 1:10:47Sen. Kennedy: Has anybody gone to jail for doing this? Don't you think we should start putting people in jail for cheating?
▶ 1:10:54Dr. Blase: I think it is financial fraud against the federal government, yes.
▶ 1:11:03Sen. Kennedy: I'm sorry I can't read your name, don't you think we should put people in jail for cheating?
▶ 1:11:07Mr. Schneider: Senator, I do not believe states are cheating. I do not believe that.
▶ 1:11:16Sen. Kennedy: If you don't believe that what parachute -- what planet did you just parachuted in from?
▶ 1:11:23Mr. Schneider: I have worked on this program for a long time. The states do not cheat. I do not believe states are cheating.
▶ 1:11:34Sen. Kennedy: Do you believe in the tooth fairy? Sir? Do you believe in the easter bunny? Do you believe that jimmy hoffa died of natural causes? You are not answering.
▶ 1:11:49Mr. Schneider: I do not believe states are cheating in their administration of the medicaid program.
▶ 1:12:01Sen. Kennedy: I'm glad you have some water in front of you because your pants are on fire. I will go back to Dr. blase. Tell me in the 13 seconds I have left other than putting these people in jail both people who cheat in the bureaucrats who allowed them to cheat, how else should we fix medicaid?
▶ 1:12:24Dr. Blase: The more states spend, the more money they get from the federal government. The certain amount states get and all spending on top of that comes from the state would be ideal reform. That ends the discrimination against the most vulnerable. There are seven times more money for the able-bodied.
▶ 1:12:54Sen. Kennedy: I don't mean to be rude to you, if you don't believe there is cheating you need to put down the bottle. That is one of the most extraordinary statements I have ever heard a witness make. >> I just want to click asked you all states comply with the federal government requirements for auditing the results?
▶ 1:13:18Dr. Blase: It's a very mixed bag. I think the information states provide is often incomplete. The federal government needs to do a better job of getting real-time spending information.
▶ 1:13:32Chair Johnson: Which states are the worst in terms of compliance?
▶ 1:13:36Dr. Blase: In terms of improper enrollment --
▶ 1:13:40Chair Johnson: I mean providing the federal government information that is required or requested.
▶ 1:13:55Sen. Kaine: There's that old terrible about those with blindfolds on all describing something different. They are not inaccurate but they are all describing something different. There have been a number of charts that are probably accurate. There have been a number of statements that are accurate. The 2 million decline of kids over a year and a half and medicaid is an accurate number. I do believe some of that might be related to fertility.
▶ 1:14:23Sen. Kaine: Some of that might be related to more aging out than being born. I doubt that equates to 2 million but that is a factor we should get into. It is a chart of what is happening in virginia. I will spend my time talking about providers. I bet some of you have a similar experience.
▶ 1:14:46Sen. Kaine: Isn't reconciliation bill passed, 12 hospitals and clinics in virginia, denominated in the red, have announced, they have closed, citing h.r. 1 as the reason, the medicaid changes in h.r. 1 is the reason. So these are the red dots on my map, and they include three primary care clinics. And six school-based clinics.
▶ 1:15:13Sen. Kaine: And then three hospital units, a labor and delivery ward in one hospital, an observation ward in another hospital, and I think a mental health wing in another hospital. So 12 closures in virginia where they have announced it is because of h.r. 1. Now remember, the medicaid cuts in h.r.
▶ 1:15:33Sen. Kaine: 1 didn't go into effect until late 2016 or early 2027, but any institution has to run a budget, so they're going to run the budget for the next year, and they're going to look at what percentage of their patients are medicaid-reimbursed and see there's changes to medicaid, so even in the advance of these cuts being made, we already have 12 closures.
▶ 1:15:58Sen. Kaine: The virginia joint commission on healthcare, so this is not, you know, some liberal think tank or whatever, it's the joint commission on healthcare, has additionally come up with a list of hospitals, this is not hospitals and clinics, it's hospitals that are either at immediate risk of closure or at risk of closure. And those are the yellow dots on this chart.
▶ 1:16:24Sen. Kaine: So we've got about 25 providers in virginia, half of which have already closed, and then the other half, the joint healthcare commission says they are at immediate risk of closure, just because of the medicaid changes made in h.r. 1. There's actual a c.m.s.reg extends the effect on state-directed payment beyond what was in the bill, and hospitals are coming to me and saying this is going to compound it.
▶ 1:16:50Sen. Kaine: So this issue is going to get worse because it will get worse when the medicaid cuts actually factor in, and if the c.m.s. Program comes in, it will get worse. Now, here's the reason I wanted to bring this up, and I suspect my colleagues are seeing something similar. Virginia's population is about nine million. 70% of the virginia population lives in something that we call the urban crescent, which is basically D.C.
▶ 1:17:19Sen. Kaine: To richmond along I-95. And then waynesburg, newport news, hampton, virginia beach on I-64. We call that the urban crescent in virginia, 70% of our population, 5.5 million people, live there. None of the closures, none of the at risk for closures are in the urban crescent. They're all in rural virginia. All of them.
▶ 1:17:48Sen. Kaine: Shenandoah valley, appalachia, south side, northern neck, potentially the eastern shore. And so this is what my providers are telling me. So that's data, too. You know, the overall growth of the program is data, but these are hospitals that have already closed, clinics have already closed, and those that have threatened to close, and all of them are in rural virginia, because as Mr.
▶ 1:18:14Sen. Kaine: Schneider said, rural populations tend to have a higher medicaid percentage in the payer mix, and they also tend to have a lower patient volume. So when you take, we already have a low patient volume, so we're sort of barely struggling, and then you take the core of our financial model and you make changes to it, that's why these closures are in rural virginia and why they're likely to be. And I suspect states around the country are seeing exactly the same thing.
▶ 1:18:40Sen. Kaine: The only real question that I want to put on the table, and I think it was Mr. blase, you said one of the reforms we should make is have some uniformity in the program, and then have any excess that's spent, that should be on the states' shoulders. So I know you're talking about here's a program where the feds are being charged by the state.
▶ 1:19:05Sen. Kaine: Your argument is we should just have governors do more state taxes or mayors do more local taxes to pick this up. Because if these changes are already leading to all these rural closures, I live in richmond, I'm going to get service. But the 30% of virginia that lives in rural virginia, they're the ones seeing the closures.
▶ 1:19:29Sen. Kaine: And if we were to do what you suggest, hey, forget all this federal money and the state, the s.t.p. Program, just, as you say, put the excess costs on the states, then, you know, I guess we could pat ourselves on the back and say we're bringing costs down. But if we're just having states increase taxes or mayors, I'm not really sure we're reducing costs.
▶ 1:19:53Sen. Kaine: Instead, an awful lot of the most rural states where people are getting hurt the most are also the states that are probably least likely to be able to raise revenue at the state level to support these providers. I'll just put my chart in with the others to say this tells me we got a huge problem.
▶ 1:20:14Sen. Kaine: If the closures are all in virginia rural, I suspect overwhelming until rural america, as we're trying to figure out the answer, we better come up with an answer that solves this. Thank you, I yield back.
▶ 1:20:27Chair Johnson: Mr. blase, do you want to quick respond?
▶ 1:20:31Dr. Blase: It's a complicated problem. You have rural hospitals that were struggling before the reconciliation bill last year was passed. The assistant secretary of planning evaluation at h.h.s. Did a study looking at rural hospitals that closed from 2011 to 2023 and found that their occupancy was really low and had been declining and that the vast majority of rural hospitals that closed were adjacent to urban areas.
▶ 1:21:00Dr. Blase: I think from thinking -- your job is to best spend federal taxpayer dollars, and a lot of these programs, the provider taxes that disrupt the payments, the beneficiaries of those overwhelmingly are wealthy, big hospital systems.
▶ 1:21:18Sen. Kaine: That's not what my rural hospitals are telling me about the s.t.p. Rule.
▶ 1:21:23Dr. Blase: But I think the savings you get from broader reforms allow to you make target the investments, which is $10 billion a year.
▶ 1:21:31Sen. Kaine: It's interesting, these closures have happened even though there was a rural health transformation fund. They closed even though they knew that congress had tried to provide a little bit of money to try to help bridge this problem.
▶ 1:21:44Dr. Blase: I think the $10 billion a year is a lot of money given the financial exposure.
▶ 1:21:50Sen. Kaine: Not enough to stop these hospitals from closing.
▶ 1:21:53Chair Johnson: Again, I would never question the veracity of people who get federal dollars, but I will point out when we passed the one big beautiful bill, wisconsin went from 1.6 to 6% provider tax, because they wanted to be part of the deal too. Got a lot of hospitals said you got to lobby Dr.
▶ 1:22:12Chair Johnson: Oz to create a waiver so we can get that 6% provider tax, because if we do it, we can charge our patients $12 million, and we'll get reimbursed for $18 million, and we'll make a $6 million profit. That was the rationale. Hey, we can't do this, we're going to go out of business. No, this is a money-making opportunity for us, and you got to lobby Dr. oz to allow to us meet the extra $6 million.
▶ 1:22:41Chair Johnson: Again, I would take what these providers who are getting all this federal money, I take what they say with a grain of salt. Senator moreno.
▶ 1:22:49Sen. Moreno: There's an expression in sales that says facts get in the way of a good story. And obviously the democrats want to stick with the story that republicans are somehow for billionaires and they're for the working class, but obviously the facts are completely the opposite of that. Talking about rural america. They get wiped out in rural america. Rural american voters reject democrats by wide margins. You would think they go, why is that?
▶ 1:23:18Sen. Moreno: Let me give you a little bit of the answer. Your policies have destroyed american manufacturing. You allowed these jobs to get shipped overseas to china, mexico, and our factories and places in ohio got wiped out because of those policies. President trump has put tariffs in place, which have brought these manufacturing facilities back to the united states of america. And yet they fought tooth and nail every step of the way on tariffs. You allow drugs to come into our border with impunity.
▶ 1:23:48Sen. Moreno: I mean, completely wide-open border allowed tens of millions of people to enter this country. Cheap labor. That doesn't affect billionaires. I don't think bill union airs get replaced by illegals crossing our border, but working americans do. They see massive wage suppression. So those are the policies that they've put in place. And they actually shut down the government and wanted one of the ransom notes was to get rid of the rural hospital opportunity fund. They wanted to eliminate it.
▶ 1:24:17Sen. Moreno: None of them voted for it, and they wanted to eliminate it. Those are just facts. The ranking member talked about the mom with two kids. We're the party that cares about the mom with two kids. We're the party that gave that mom a $2,000 child tax credit. You voted against that. We gave that mom $1,800 child tax credit. You voted against that. If that mom worked for tips for overtime, you voted against that.
▶ 1:24:44Sen. Moreno: You're the one that wants to get able-bodied adults more money than those kids that that mom has. I think a little self-reflection on that should be part of the equation. Those two things, just those two things, the child tax credit and the daycare credit is $3,800 for that mom making $25,000 a year. That's real money that you guys did not want to give that mom. That was just your vote and those are just facts.
▶ 1:25:13Sen. Moreno: But when you did have control of congress and the white house, what did you do? Did you help working americans? No. You passed the law that gave $7,500 to the wealthiest .01% of americans to buy luxury, to lease luxury electric vehicles.
▶ 1:25:34Sen. Moreno: So while the mom with two kids is making $25,000 a year struggling, the person making tens of millions of dollars a year can go into a rolls royce dealership and get $7,500 thanks to each and every one of you to lease a rolls royce car. Congratulations on that phenomenal policy.
▶ 1:25:56Sen. Moreno: If somebody is in this country without permission, should they be allowed to get healthcare on the backs of the american taxpayer, yes or no?
▶ 1:26:08Mr. Schneider: My own view is if people need healthcare, they should receive it.
▶ 1:26:14Sen. Moreno: You think that somebody who is here illegally should have their healthcare paid for by the american taxpayer?
▶ 1:26:24Mr. Schneider: So we have a law in this country --
▶ 1:26:26Sen. Moreno: It's a simple yes or no question. Somebody, let me just restate it.
▶ 1:26:33Mr. Schneider: Emergency care, yes. Sen. moreno, the taxpayer of the united states of america should pay for the healthcare of people who broke into this country.
▶ 1:26:44Mr. Schneider: That's what congress decided.
▶ 1:26:46Sen. Moreno: I don't know what congress you're talking about. If you needed emergency healthcare and you went to any other country on earth, would you get it for free?
▶ 1:26:55Mr. Schneider: Well, the countries that I've gone to, yes.
▶ 1:26:58Sen. Moreno: You get healthcare for free? So for example, let's take spain, which has incredibly difficult visa standards. If you went to spain and needed heart surgery, the spanish government would give it to you?
▶ 1:27:11Mr. Schneider: I can't speak to spain.
▶ 1:27:13Sen. Moreno: It's interesting. I wonder, my democrat colleagues would agree with that. That if people who broke into this country illegally should get healthcare. Somebody broke into your home, would you make them there?
▶ 1:27:27Mr. Schneider: No, I would not.
▶ 1:27:29Sen. Moreno: Why not? Why not? Why wouldn't you? They need help. What if they're starving? What if somebody broke into your home who's hungry? Would you not feed them? Or would you call the police and get them the heck out of the house?
▶ 1:27:47Mr. Schneider: Somebody was hungry and needed to be fed, I would feed them.
▶ 1:27:51Sen. Moreno: Somebody broke into your house, you will feed them. Don't give anybody your address. Whatever you do. I'm asking you, just for your own sake --
▶ 1:28:00Mr. Schneider: I'd like to answer. Can I answer the question?
▶ 1:28:04Sen. Moreno: Please.
▶ 1:28:05Mr. Schneider: Somebody breaks into my home and they're hungry, I'm going to feed them, and then we'll work out accountability for what they've done.
▶ 1:28:14Sen. Moreno: Like I said, don't release your address, but on behalf of the american taxpayer, no, everyone with benefits, taxpayer dollars should be absolutely and exclusively reserved for american citizens. So the party that said they care about working americans, this is why you keep losing rural america. This is why you guys get wiped out in places like that. Whether it's virginia or oregon, you did not win the rural parts of your state.
▶ 1:28:42Sen. Moreno: You get absolutely crushed because of that kind of philosophy.
▶ 1:28:47Chair Johnson: Senator merkley would like to make a comment.
▶ 1:28:50Sen. Merkley: Just for the record, undocumented individuals are not eligible for medicaid unless there's an emergency, going to the emergency room under very limited circumstances. And yes, those same services in the emergency are provided by many other nations if americans are traveling abroad for emergency service.
▶ 1:29:11Chair Johnson: Very quickly, how many illegal immigrants do you think are on medicaid? Beyond emergency services, but on medicaid. Do you have any estimate? In california.
▶ 1:29:24Dr. Blase: In california, it's considerable. California got one of these provider tax schemes approved, and then got $10 billion in federal funds without any state contribution, and the next year expanded medicaid to all on unauthorized immigrants in the state.
▶ 1:29:43Chair Johnson: Senator lujan.
▶ 1:29:44Sen. Lujan: Thank you very much, Mr. chairman. Coming into the hearing at the moment that I did, really caught my attention, as my colleague departs. You know, some of us are catholic. And my colleague went to catholic high school, I believe, if I'm not mistaken. That's someone that should understood the lessons that are taught to us every day.
▶ 1:30:07Sen. Lujan: If he needs to learn about what it means to shelter those that need some help or provide food to those that need some help or care for those that need some help. I grew up in a rural community. I didn't have a roll royce dealership. I still live on a small farm. I put diesel in my tractor. I turn dirt every day. I fix fences. When my neighbors need help, I go help them put that fence up. I don't ask if they're democrat, republican, whatever. We do it.
▶ 1:30:40Sen. Lujan: This lesson about how the one big beautiful bill, a piece of legislation that president trump ran on, that my republican colleagues are trying to fleece the american people and convincing them that this bill helps them. A trillion dollars was taken out of healthcare. How the hell does that help anybody? I'm a stroke survivor. Four years ago I had a stroke. What I learned is time is not on your side if you have a stroke. You need to get to the doctor immediately.
▶ 1:31:10Sen. Lujan: Well, not in the case of what happens with the trillion dollar cut and medicaid facilities start closing and rural clinics start closing. And if that was not enough, then they devastate food programs in america, kicking farmers and ranchers in the teeth and closing rural grocery stores. That's the big beautiful bill. They just voted on it. Facts are funny. Anyhow, this hearing is about medicaid. The reality around medicaid.
▶ 1:31:37Sen. Lujan: If I'm not mistaken, the big beautiful bill removed about a trillion dollars from healthcare with more than $800 billion of federal medicaid dollars, and my republican colleagues profess that they did not cut, they being republicans, did not cut medicaid. They only transferred the costs to states. They eliminated a trillion dollars in access to healthcare. Medicaid programs across the country, we don't know who's going to get care or who's not going to get care.
▶ 1:32:08Sen. Lujan: I have constituents writing about a concern of being able to pay bills, trying to figure out if they're going to be able to get access to care or not. Dina from the largest county in new mexico said, as I was sitting in urgent care this weekend, I started to have serious anxiety that next year I might be without my medicaid insurance. I may not be able to go to urgent care if I needed to.
▶ 1:32:35Sen. Lujan: When the affordable care act was passed, we had a republican governor in new mexico that did the right thing and embraced medicaid expansion. It took new mexico from one of the most uninsured states in the country to a state that actually people could get some coverage and have some certainty that care was going to be there. Democrats and republicans should be working together in all these.
▶ 1:32:56Sen. Lujan: We're going to talk about reform, let's talk about smart reforms, ways that we can get care to people and the most effective manner possible so that if someone out there has a stroke like I did, they're going to live, and they're actually going to recover the way I did. Because my recovery is also very unique. I was very blessed with that recovery, but it's because I had access to care.
▶ 1:33:17Sen. Lujan: Eight million americans have already lost healthcare coverage, including nearly four million who lost medicaid chip, the children health insurance program. Professor schneider, are children protected from medicaid cuts as my republican colleagues have suggested?
▶ 1:33:35Mr. Schneider: Over time, the large withdrawal of federal funding, close to a trillion dollars over the next 10 years, that's in h.r. 1, everyone in the program is at risk, children, people with disabilities, seniors. People in rural areas. People in urban areas. The providers that serve them. They're all at risk.
▶ 1:33:58Sen. Lujan: You anticipated my next question about seniors. I appreciate that response. I did not hear you specifically mention people with disabilities. I heard you say everyone. What about people with disabilities?
▶ 1:34:11Mr. Schneider: Exactly the same situation. The states were expecting the resources that had been in place before h.r. 1 was enacted. And over the next 10 years, they're not going to have those resources available.
▶ 1:34:28Sen. Lujan: Coming from a rural community myself, hearing the question from my colleague that was speaking before me, are adults and children in small towns and rural areas more likely than those living in metro areas to rely on medicaid chip for their health insurance?
▶ 1:34:48Mr. Schneider: Medicaid is a slightly more important payer for families and children in rural areas than in urban. It's important in both, but a little more important in rural.
▶ 1:34:57Sen. Lujan: This hearing is not on snap. The same holds true for snap as well. So look, Mr. chairman, I certainly hope as the budget reconciliation debate is continuing on budget reconciliation bill 3, we're looking at access to healthcare, costs are going up. Some folks try to refer to this as affordability. People just can't afford to get services and to get by, and that we should not forget about social security.
▶ 1:35:19Sen. Lujan: I challenge my republican colleagues at the last hearing we had on social security, maybe in your next budget reconciliation bill bill, we'll actually see some language in there to make sure social security is solvent. And it didn't happen. Well, lo behold, there's another budget reconciliation coming forward. I look forward to seeing how republicans are going to protect social security and make sure it's going to be solvent in the next budget reconciliation package. I appreciate all the time.
▶ 1:35:44Chair Johnson: A couple of comments. Reconciliation can't touch social security. I've got to defend lutherans who are compassionate too. I will just remind senator lujan to look at the chart there. In 2014, the first year of obamacare, medicaid expansion, we spent about $400 billion on medicaid. 2019, we were spending, actually 2014, spent $300 billion. 2019, about $400 billion.
▶ 1:36:11Chair Johnson: This year we'll spend $668 billion. , 2025. This year we'll spend about $735 billion. From $300 billion first year of obamacare, $400 billion right before the pandemic, $6668 billion last year. Again, I'm not seeing where we're taking a trillion dollars out of medicaid. The costs of medicaid are exploding. With that, we'll turn to senator scott.
▶ 1:36:36Sen. Lujan: Could I respond to that? I ask unanimous consent to submit the analysis of h.r. 1 from c.b.o. Into the record, and that will respond to your questions.
▶ 1:36:46Chair Johnson: I'm really high on c.b.o. Projections. Senator scott.
▶ 1:36:51Sen. Scott: Thanks for holding this. The medicaid program was set up for seniors, children, pregnant women, disabled, right? The reason it was set up the way it was was that the federal government would pay a portion and the states would pay a portion. The state would pay a portion out of their own taxes, right?
▶ 1:37:11Dr. Blase: Correct.
▶ 1:37:12Sen. Scott: It goes from 50, depending on the income level of the state, states pay from 50% to as little as 15% about.
▶ 1:37:21Dr. Blase: Yeah, so for the traditional population, wealthiest states, they spend a dollar of federal government contributes a dollar. Poorer states, they spend a dollar, federal government contributes $3.
▶ 1:37:32Sen. Scott: For all states, when obamacare expanded to able-bodied adults, it was 90-10.
▶ 1:37:39Dr. Blase: It was actually 100% the first three years, and it's phased down. It's 90-10 now.
▶ 1:37:44Sen. Scott: If you look at a state budget now, states use, have they gained the 90-10 match to pay for things that have nothing to do with healthcare?
▶ 1:37:56Dr. Blase: States get seven times more funding when they spend a dollar on the expansion population than the traditional population. And particularly given that they can finance their state share with these legalized money laundering tactics, states use medicaid to fund other state projects, and the a.c.a. Expansion is a multiplier on the money laundering appear rap us.
▶ 1:38:20Sen. Scott: Have some states said they gone to a provider and said, hey, you pay money to get extra money for medicaid?
▶ 1:38:28Dr. Blase: It's the provider that goes to the state and says we've designed this scheme that's just going to plus us up with federal tax dollars.
▶ 1:38:37Sen. Scott: So this concept of the states with a portion to make sure dollars are spent wisely, to make sure the people are covered, doesn't really work anymore.
▶ 1:38:47Dr. Blase: That's deteriorated, yes.
▶ 1:38:49Sen. Scott: When you think about it, federal government's goal was to make sure we take care of, especially pregnant women, kids, disabled, the states have lost focus because there's so much money and the providers have looked at so much money out here for the able-bodied adults.
▶ 1:39:06Dr. Blase: The federal government is encouraging states to discriminate against the most vulnerable.
▶ 1:39:10Sen. Scott: Dr. oz recently paused payments to california, noting the in-home supportive program has grown over 24% over two years, way more than the national average. What's noteworthy the funding is 35% intergovernment transfers, and the state only paid about 11%. I thought they were supposed to have a 50-50 match. Explain how that works.
▶ 1:39:37Dr. Blase: So intergovernmental transfers, the most problematic ones are where you get a local health facility that transfers money to the state, the state then uses that as its payment back to the facility, and then leverages the federal dollars. So it's a way for states to use the medicaid financing system to benefit the government providers at the expense of the taxpayer.
▶ 1:40:04Dr. Blase: And you have some examples where, like in california, they do this for their ambulances too, where they'll pay the government ambulance providers more than three times what they pay the private ambulance providers through the medicaid program.
▶ 1:40:18Sen. Scott: The ambulance company has no risk? That's just extra money?
▶ 1:40:23Dr. Blase: Yes.
▶ 1:40:25Sen. Scott: We should expect our states to have skin in the game. What you're saying is what happens is they don't actually have skin in the game.
▶ 1:40:32Dr. Blase: They don't have skin in the game, and they're lobbied. In the state capitals, you know this as a former governor, you're lobbied by the special interests to design programs this way and take advantage of the federal taxpayer.
▶ 1:40:48Sen. Scott: Mr. ingram, the office of the inspector general declassified the new york unit. Despite receiving over $16 million annually, having a staff of 270 people, new york was the worst performing unit compared to other states. This office is only able to secure 85 fraud convictions from 2020 to 2025 when the next lowest scoring state had 327 convictions, almost three times more.
▶ 1:41:14Sen. Scott: New york had 49 criminal fraud indictments between 2020 and 2025, less than 10 a year. The next state had 268, five times more. It's not that fraud isn't there. In the end, arizona was able to secure more indictments in 2025 alone compared to new york's seven. How important does it make fraud unit control program, and what does it mean when a state runs so poorly like new york with only one conviction per patient abuse in 2025, despite having 2,000 patient referrals a year?
▶ 1:41:47Mr. Ingram: Well, new york's fraud control units has been horrendous, as you noted. It's one of the worst in the country. You mentioned indiana and arizona. Those are states with programs, 1/5 the size of new york. They have about 1/10 the staff, 1 clinton 10 the budget, and they're delivering five times more criminal indictments. They're delivering more convictions, more recoveries.
▶ 1:42:17Mr. Ingram: New york had not a single hospice fraud investigation, despite that being sort of a hotbed of fraud in new york. It's not a new problem. It's been ongoing for years. It definitely worsened under president biden. States are getting more funding from taxpayers than ever for these units and delivering worse results. Investigations are down. Indictments are down. Convictions are down. Recoveries are down. Indictments in new york have dropped 93% since 2019.
▶ 1:42:51Mr. Ingram: Over a dozen of these units recover less fraudulent funds than it costs federal taxpayers to operate them. This is a long-standing problem. Nobody seemed to care until president trump came in. He's doing something about it. New york was decertified. Hawaii was decertified. A future administration could go back to the way things were under president biden. So I would encourage everyone to codify stronger oversight requirements for these and really make them effective.
▶ 1:43:21Sen. Scott: Thank you.
▶ 1:43:23Chair Johnson: Senator whitehouse.
▶ 1:43:25Sen. Whitehouse: Thank you, chairman. We're here today because the billionaires bill will knock down medicaid spending by somewhere in the neighborhood of a trillion dollars. Some basic facts are the medicaid money does not go to medicaid recipient t. Goes to the people who provide the healthcare. It goes to hospitals. It goes to nursing homes t. Goes to doctors. It goes to pharmacists.
▶ 1:43:56Sen. Whitehouse: So when you drop that kind of a spending cut into our healthcare system, is you're going see real problems. And I think knowing that, republicans set the grenade to go off after the election. So that the damage to individuals was not front page news everywhere before the election.
▶ 1:44:21Sen. Whitehouse: But what we are seeing is that the entities that receive the medicaid funding are having to start doing their budgeting for the trillion dollar cuts. It's responsible to look forward. And as they're doing that, they're starting to see, oh, my god, our numbers don't work anymore.
▶ 1:44:44Sen. Whitehouse: The financial now for hospitals are being affected by the predicted cuts to medicaid, the financials now for doctor's practices are being affected by the predicted cuts to medicaid. And nursing homes have a particularly bad vulnerability, and they're starting to see those cuts as well.
▶ 1:45:05Sen. Whitehouse: So we need to be paying attention to the forewarnings that the financial work in these industries are giving us about what the hell is coming at us. Because the grenade may be set to go off after the election, but it's still going to go off.
▶ 1:45:24Sen. Whitehouse: And that's why we're living through this narrative creation effort to suggest that the problems with medicaid are that it's riddled with fraudsters, people are crooked, and oh, folks, it has nothing to do with the billions and billions and billions in tax cuts that we gave in that bill to the wealthiest highest income people in the country.
▶ 1:45:52Sen. Whitehouse: Some of whom as billionaires actually don't pay any taxes. Actually don't. That's for the little people. This body is highly responsive to those billionaires, so, of course, out went the medicaid spending, in went the tax cuts for billionaires, and that's why we are where we are.
▶ 1:46:22Sen. Whitehouse: The device is employment reporting. It's to create a red tape bomb that makes it as difficult as possible for people on medicaid to fill out the requisite paperwork so they can keep their benefits. That's the trick. That's the stunt that's being used to knock people off medicaid. I don't know how many of my colleagues hang out with people on medicaid. We're a pretty high-end group here around the senate.
▶ 1:46:51Sen. Whitehouse: But I tell you, around rhode island, who's on medicaid? It's people with really significant learning disabilities. It's people with mental health issues that they're getting treatment for. It's people in addiction recovery. It's people with really severe health conditions that interfere with their ability to earn a living.
▶ 1:47:16Sen. Whitehouse: It's people who have multiple health conditions, so many they can barely keep track of them and all of those people with all those conditions are now supposed to be experts at red tape so that they don't get pushed off by employment reporting requirements. It's kind of a dirty trick.
▶ 1:47:39Sen. Whitehouse: And the notion that fraud is so endemic in medicaid is a little bit belied by the fact that it's the only program that has a specifically dedicated fraud detection and prevention program. I was the attorney general of the state of rhode island. I ran our medicaid fraud control unit. Everybody had one.
▶ 1:48:10Sen. Whitehouse: We didn't find all that much, Mr. chairman, because rhode island is a small state. It's hard to set up a phony baloney doctor's office and run millions of dollars in payments through without somebody catching on real quick. But boy, was florida a festival of fraud. It has its own medicaid fraud control unit. They all do. Other programs don't have that discipline. They're not policed that way.
▶ 1:48:36Sen. Whitehouse: So the idea that fraud is out of control in medicaid to me is not credible. What is credible is how many people, individuals with significant disabilities, very often addiction, mental health, learning, so that they're able-bodied are going to get clobbered by the red tape bomb that republicans set to go off
▶ 1:49:07Sen. Whitehouse: After the election. And the tell is the financials of the providers who are looking forward to what the financial world looks like what that grenade goes off. Thank you, chairman.
▶ 1:49:22Chair Johnson: Governor walz and attorney general ellison didn't find much fraud in minnesota either. Basic facts, I'll repeat it again. 2014, the first year of obamacare's implementation, medicaid spent $300 billion. 2019, before the pandemic, spent $400 billion. Last year, we spent $668 billion, more than double what we spent the first year of medicaid expansion this year we'll spend $735 billion.
▶ 1:49:51Chair Johnson: Again, I'm not seeing these cuts. I can do math. That is an out of control increase in medicaid spending. >> if you're going to argue with each of us after we made our statements, I think we're entitled to a reply.
▶ 1:50:05Chair Johnson: Go ahead. >> I think it's important to reiterate what I said. There are a great number of medicaid payments for whom keeping track of the new red tape employment requirements, the new red tape bomb that republicans built into the billionaires bill to specifically knock people off the test was how many people you could knock off medicaid. How could you reduce spending? By knocking people off medicaid.
▶ 1:50:32Chair Johnson: The selection is the people who are most vulnerable who don't have the skills to keep up with the paperwork and red tape bomb that's going to be set off in their lives. That's what we're dealing with.
▶ 1:50:45Chair Johnson: We'd like to keep it off the medicaid rolls. Senator van hollen.
▶ 1:50:50Sen. Van Hollen: Mr. chairman, first we should be clear about this. There's nobody in this room that doesn't want to crack down on waste, fraud and abuse. Every one of us recognizes that a dollar that goes to fraud is a dollar that is not going to somebody who needs the help. And I don't think there's a person in this room who disagrees with that statement.
▶ 1:51:12Sen. Van Hollen: I do have to question why the trump administration, in its very first days, eliminated the inspector generals in a whole bunch of departments, including the in which for general -- inspector general overseeing h.h.s. If you're really interested in going after fraud, you wouldn't be firing inspector generals in the U.S. government, which is exactly what they did. So what this hearing is all about is let's pretend.
▶ 1:51:43Sen. Van Hollen: Let's pretend that the one trillion dollar cut to medicaid that republicans here in congress and the president of the united states made in what they called their big beautiful bill, let's pretend that dollars was really going after fraud, as opposed to hirdting tens of millions of americans. I didn't make up the number. The congressional budget office, the nonpartisan office told us that 7.5 million americans are going to lose access to healthcare because of the cuts to medicaid.
▶ 1:52:16Sen. Van Hollen: There are another over two million who are going to lose access because republicans took away tax credits for the affordable care act. Again, that's a c.b.o. Number. And it actually tells us what their real goal here was, because as parted of the big beautiful bill, they gave billionaires and very rich people permanent tax cuts. It was beautiful if you're a billionaire. I just want to show what the distribution of those tax cuts was right here.
▶ 1:52:46Sen. Van Hollen: If you look at the tax cuts, 22% of the benefits of the republican bill went to the top 22%. 72% of the benefits went to the wealthiest 20% and that number will get bigger over time, because republicans sunset the few tax benefits that went to working people. Just as they eliminated the one tax credit that was available to middle-class folks trying to afford their healthcare.
▶ 1:53:17Sen. Van Hollen: And despite the cuts to medicaid, they still had a $4.2 trillion deficit over the next 10 years. This is a budget committee. I'm all for looking at honest ways for reducing our deficits. You don't do that by giving billionaires and big corporations huge tax cuts. So let's look at these medicaid cuts.
▶ 1:53:41Sen. Van Hollen: Because in addition to the 7.5 million americans who are going to get hurt, you're also going to have a spillover effect on probably every american. Mr.
▶ 1:53:53Sen. Van Hollen: Schneider, maybe you can tell us what happens when somebody who doesn't have medicaid coverage and doesn't have preventive healthcare coverage gets desperately sick, waits until they have to go to the emergency room, who ends up having to cover the costs of that uncompensated care at the end of the day?
▶ 1:54:14Mr. Schneider: What usually happens is the patient ends up getting a bill that puts the patient in medical debt. The hospital who's providing the emergency care has to cross-subsidize that service, and it will find the money for its operations from other paying patients.
▶ 1:54:38Sen. Van Hollen: Let's unpack what you mean by that. What you mean is that people who are not on medicaid, people, for example, who are on private insurance, people who are paying their premiums, at the end of the day they're going to have to pay more, either higher premiums or co-pays, in order to compensate for the uncompensated care, the care that was denied to the person who was on medicaid. Is that right?
▶ 1:55:05Mr. Schneider: That's correct.
▶ 1:55:05Sen. Van Hollen: I think it's important to understand in order to provide these tax cuts to billionaires and corporations, republicans not only cut access to healthcare for a million people, excuse me, 7.5 million people in medicaid, but they're also going to be pushing the costs of that harmful action on to everybody else. And again, all for the effort to give these very rich people the big tax cut. And I will just say, Mr.
▶ 1:55:34Sen. Van Hollen: Chairman, that the cuts to medicaid were very cynically timed. Most of them, if not all of them, don't take place until january of next year, after the election. I wonder why that is. It's because the american people are going to hate what they see, and they're going to be feeling it in their pocketbooks, and republicans want to delay that until after the election. That's what that cynical timing was all about. Again, all in service of giving very rich people big tax cuts. Thank you, Mr. chairman.
▶ 1:56:06Chair Johnson: First of all, the reconciliation bill primary prevented a massive automatic tax increase. We cut taxes for virtually every american taxpayer back in 2017, 2018. When democrats had house, senate, and the white house, you could have reversed that. You didn't. You didn't increase people's taxes. Neither did we. So again, to call it a massive tax cut wasn't.
▶ 1:56:33Chair Johnson: We prevented a massive automatic tax increase, which would have been devastating for our economy. So again, let's talk about it honest until terms of what that reconciliation bill did. There were additional tax cuts, yes, but the trillions of dollars was an automatic tax increase that would have impacted every american, and you did not want to do it, and we didn't do it. So that was kind of bipartisan. We didn't want to increase taxes.
▶ 1:56:58Sen. Van Hollen: If I could 30 seconds to rebut. First of all, as you know, Mr. chairman, when we passed the inflakes rugs e reduction act, we actually did close a lot of tax loopholes on very wealthy corporations.
▶ 1:57:11Chair Johnson: You didn't reverse the tax cuts.
▶ 1:57:14Sen. Van Hollen: With respect to the earlier tax cuts, they were lapsing on their own. They were going to go away on their own. And all of us were prepared to have those for very rich people lapse on their own, as they should. So you saw the chart. The overwhelming benefits for those tax cuts go to very wealthy people and we actually specifically proceed poised that they lapse for those people.
▶ 1:57:40Chair Johnson: Not increasing tax on the american economy benefits --
▶ 1:57:44Sen. Van Hollen: These were tax cuts, as you pointed out, put in the first trump administration, helping the very rich. We wanted to allow those to lapse. Republicans didn't. I mean, that's the end of the story.
▶ 1:57:54Chair Johnson: Ok. Senator moreno? >> thank you, Mr. chairman. I think we can all agree we do need to crack down on fraud, especially ina program like medicaid that so many americans really rely on. Let me just ask you, yes or no. You agree we do need to be cracking down on medicaid fraud and not letting criminals off the hook, yes?
▶ 1:58:16Mr. Ingram: Yes. >> thank you. So I hope my republican colleagues will use some part of this hearing to condemn prime minister for pardoning criminals, who were convicted of major medicaid fraud. Trump pardoned five former executives from florida who committed serious medicaid fraud to the tune of tens of millions of dollars. That is pretty bad. Following what was dubbed "the largest healthcare fraud scheme charged by the U.S.
▶ 1:58:46Mr. Ingram: Justice department" valued at over $1 billion in medicaid and medicare fraud, trump commuted the 20-year sentence of a florida nursing home and assisted living facility executive. That's even worse. So look, I'm all for major crackdown fraud. I think we all are. But it looks like we've got some pretty good leads starting in the white house.
▶ 1:59:09Sen. Murray: Mr. schneid, I want to turn to you. What single piece of legislation delivered the largest cuts to medicaid in american history?
▶ 1:59:17Mr. Schneider: Last year's budget reconciliation bill.
▶ 1:59:20Sen. Murray: Yep. So everybody knows, republicans' big ugly bill passed more than $1 trillion in healthcare cuts mostly to medicaid. Mr. schneider, how much in tax breaks for the top 1% did trump's bill contain?
▶ 1:59:35Mr. Schneider: Roughly $1 trillion.
▶ 1:59:37Sen. Murray: $1 trillion in tax cuts for the top 1%. Mr. schneider, how many americans are losing healthcare because of trump's bill ugly bill?
▶ 1:59:49Mr. Schneider: In terms are the medicaid indicates, latest estimates are approximately 11 million.
▶ 1:59:54Sen. Murray: 11 million. So zero billionaires lose their healthcare. They do get a trillion dollars in tax cuts and then over 15 million americans, including the extended a.c.a. Tax credits, lose their healthcare thanks to republicans passing $1 trillion in cuts for regular working class people. That is the math. And that is out and out grift.
▶ 2:00:17Sen. Murray: So it seems to me like the biggest medicaid theft didn't happen in the billing office somewhere, it actually happened last year right near the united states capitol when republicans passed trump's big ugly bill. So Mr. chairman, let me just say, I find it pretty astounding that republicans are holding an entire senate hearing on fraud in medicaid, but they don't seem to have anything to say about the fraud coming out of the white house. I mean, look at the crypto schemes and the foreign gifts.
▶ 2:00:46Sen. Murray: That's easily the most corrupt white house in american history. So the president trump pardoned convicted criminals who committed medicaid fraud. This is outrageous to me. It is what we should be talking about. But I also want to note a really big difference in terms of values and beliefs right now. Because I am here, and I know my colleagues on this side are, to fight for our safety net programs. But my colleagues on the other side of the aisle are not with me on that fight.
▶ 2:01:14Sen. Murray: Chairman johnson has said repeatedly he believes social security is a ponzi scheme. Last week another republican senator was on the floor saying social security is a scam. So I wanted to make it really clear at this hearing I cannot disagree more strongly, Mr. chairman. Social security is a program that millions of hard-working americans have paid into their entire lives.
▶ 2:01:38Sen. Murray: So republicans might want to cut benefits or prioritize social security, but I want you to know, I'm going to keep fighting to save social security and protect healthcare for our americans, now and long into the future. Thank you.
▶ 2:01:52Chair Johnson: Correct the record, I've said it's illegal ponzi scheme, which is exactly what it is. Take a look at what a ponzi scheme is. That's what social security is. It's been horribly mismanaged. Those funds were not invested in something as value as bonds. I'm happy and will probably hold a hearing on this, and I'll prove the case, but it's an illegal ponzi scheme, and that's indisputable.
▶ 2:02:16Sen. Murray: Mr. chairman?
▶ 2:02:19Chair Warsh: Yes?
▶ 2:02:20Sen. Murray: Welcome to the chairmanship, but I find you are turning this into a debate committee.
▶ 2:02:27Chair Johnson: I think it's important the american people see a civil exchange, gut go ahead.
▶ 2:02:30Sen. Murray: I will respond americans pay to their social security. They pay into it for their lifetimes. And they deserve to know it's going to be there in the future. That's what we're focused on.
▶ 2:02:39Chair Johnson: Yes. They didn't do it, and the money was gone, been horribly miss managed. Take a look at the social security tables, and some people don't even get back what they put into it, and other people get up to three times what they put in. Again, we'll lay out the facts. I'm trying to lay out the facts. This is a hearing about laying out the facts. And I'll go to senator wyden.
▶ 2:03:01Sen. Wyden: Mr. chairman.
▶ 2:03:03Chair Johnson: Yes?
▶ 2:03:04Sen. Wyden: Point of privilege. It's customary in a senate committee for each member of the senate and each member of the committee to be able to ask their questions and make their points without an intervening rebuttal by the chair. I'm not anticipating doing an intervening rebuttal of republican members. I'm not going to take up the time for that. I'm not going to ask for that.
▶ 2:03:30Sen. Wyden: I just think that, and I did ask if I could put in a point for the record earlier, and you allowed me to do that, clarifying that undocumented individuals did not qualify for federal benefits. I hope the point my colleagues have made is that that is a new norm, but maybe not a great norm for this committee.
▶ 2:03:55Chair Johnson: I disagree. I think it makes the hearings more interesting and informative. Again, I've allowed an exchange back and forth.
▶ 2:04:04Sen. Merkley: Are you going to allow me to intervene after every republican testimony to allow me off base they are? That's the point.
▶ 2:04:10Chair Johnson: Senator wyden.
▶ 2:04:11Sen. Wyden: Thank you, Mr. chairman. I certainly share senator merkley's view on this point. The reality is, on this side, we have been trying to work with republicans on fighting healthcare fraud again and again, and I went to the floor repeatedly to point out, for example, insurance broker fraud, something that both of us ought to come together, no response from republicans.
▶ 2:04:35Sen. Wyden: So today we're looking at yet another approach that is ill advised because it primarily hurts people and doesn't do anything about reducing fraud or anything like that. And that's the administrative trap designed to disenroll folks who are eligible for medicaid. The trump administration went forward to basically say that they were going to literally require people to prove that they're sick enough to deserve healthcare.
▶ 2:05:03Sen. Wyden: So today, senator warnock and I are releasing a letter signed by each senate democrat urging the trump administration to pull back on this disastrous rule that would harm so many vulnerable people. So this, by the way, is the same sort of approach that house democrats have taken to raise the alarm on this flawed and hurtful rule. I can't remember the last time we had such united o unity between the house and senate.
▶ 2:05:32Sen. Wyden: But I guess if the republicans are going to keep hurting people, you'll see it often in the session. I'd like to ask the chairman that these letters be entered slew the record.
▶ 2:05:41Chaplain Kibben: No objection.
▶ 2:05:42Sen. Wyden: Thank you. Now, andy schneider may not be known to everybody in this room, but I sat next to him when he was starting hills career in healthcare and he was fighting for people who were vulnerable, people who walked an economic tightrope and the fuel bill against the rent bill, and he's still doing that. My god, this is a man who could probably go out to my mega corporation and pull down a gigantic salary.
▶ 2:06:12Sen. Wyden: But instead he's putting his heart out there once more for people who are walking that economic tightrope. So before we wrap up, I think it would be great to have andy schneider give us a real-world example of the human cost for the millions of americans who are losing their healthcare as a result of this bureaucratic razzmatazz, the most complimentary thing you can talk about, because it's bureaucratic unfairness, so tells what it means to people who are hurting
▶ 2:06:43Sen. Wyden: And vulnerable. You've been fighting for them, by my calculus, for almost half a century. Half a century going to batted for people who doesn't have clout and didn't have power.
▶ 2:06:53Mr. Schneider: Thank you, senator. Appreciate that. And I finally remember our days in midnight basketball in portland.
▶ 2:07:03Sen. Wyden: Don't talk about my great --
▶ 2:07:08Mr. Schneider: Ok, I withdraw that comment. You had a great dunk thousand. You had a great dunk though. So let's take what is the unfolding story here reporting requirements, being imposed on all medicaid expansion states for medicaid expansion adults. One of the first states out of the box is nebraska.
▶ 2:07:36Mr. Schneider: And there was a piece yesterday or the day before reporting on some of the early administrative red tape problems that medicaid bush airs are going to face as this unfolds.
▶ 2:07:55Sen. Wyden: It's an enrollment program, isn't it?
▶ 2:07:59Mr. Schneider: Well, I think that's a fair characterization, yeah. So in this particular case, a pregnant woman was disenrolled from the medicaid program because the enrollment staff didn't understand that she was pregnant.
▶ 2:08:21Mr. Schneider: So it eventually got sorted out as far as we can tell from the reporting, but these kinds of errors are almost unavoidable given the complexity and cumbersomeness of the new rules that are about to go into effect.
▶ 2:08:39Sen. Wyden: Well, thank you for putting a human face on this. We're going to call on you on the finance committee on the same point. Before I close out my time, ranking member merkley asked members on the dais to share stories from our states, families who rely on medicaid. I'd like to enter into the record the letter from 11 U.S. senators to Dr. oz that highlights families all over the nation.
▶ 2:09:02Sen. Wyden: From one end of the country to another, the need assistance of community-based services, particularly need medicaid. I close out my remarks.
▶ 2:09:13Chair Johnson: Without objection. I think we'll bring the hearing to a close. I want to thank everybody attending. I like to have a little bit more discussion. I think I've been civil. I'd like to maintain civility. I think it's going to be more interesting for the american people if we can exchange views. Again, there's obviously a big difference in perspective on this thing. That's fine. But let's discuss it, ok?
▶ 2:09:39Chair Johnson: Just the rigidity of the standard hearing, this is said, again, I think it is far more interesting, I think it's far more beneficial to let's have the discussion. You know, there's something that you want to challenge, go ahead and challenge it with civility. So again, that's the way I intend to do this, and I keep my comments pretty short. I don't filibuster. Take a look at my opening statement. It's pretty short. But they're important points to be made, and I'll continue to do that.
▶ 2:10:07Chair Johnson: So I hope it doesn't offend my democratic colleagues, but that will continue to be my contention here.
▶ 2:10:16Sen. Merkley: I'll just point out a discussion involves other members having equal time to provide rebuttal as well. Otherwise it's just rebuttal.
▶ 2:10:24Chair Johnson: And again, when I rebutted, I gave the democrat member time to rebut what I said as well. Again, I've been here 15 years. I've seen chairman have different things, including the former chairman of our finance committee. Again, I think that's --
▶ 2:10:40Sen. Merkley: Could I provide one fact before we close? Just a fact.
▶ 2:10:44Chair Johnson: As long as I can rebut it.
▶ 2:10:46Sen. Merkley: You're most welcome to. So that family of a mother and two children that's 100% of federal poverty level, that's $2,200 a month. After payroll taxes, the disposable income is $2,100. An average rent for a two-bedroom apartment, not even three bedroom, is $1,700. Average cost of transportation arounded ads hundred.
▶ 2:11:13Sen. Merkley: Already you're down to zero dollars. Zero dollars for that family. Now, you made reference to $50,000 benefits. A family does qualify at that level for $785 for snap. Zero dollars for tan. And there's a massive waiting list for affordable housing. That's the luck of the draw, full.
▶ 2:11:33Sen. Merkley: So most families are in a situation where they're completely out of money, other than the assistance to help them buy food, they don't even have money to add into that, and this is before we start looking at a family has to bayou tilts, clothing, school supplies.
▶ 2:11:52Sen. Merkley: So I just wanted to point out that as one colleague observed, very few people in this room have lived at that level of really minimal resources. So having medicaid available as health insurance to those families, if we want that next generation to thrive, it's essential.
▶ 2:12:14Chair Johnson: I will say, people on this dais, including myself, came from very humble beginnings. Senator graham, senator scott. So I think we understand this. I was quoting senator phil gray graham, a noteworthy economist, talking about 5 $53,000 in tax-free benefits for a single apparent with two children, $1,000. Again, I'm just quoting him. Take a look at his information. But facts are facts. And I think that's what we need to try to do.
▶ 2:12:43Chair Johnson: Let's get the facts on the table. Find out what we all agree on, common facts, and then we can kind of debate the different perspectives. But again, I appreciate everybody's involvement here. The hearing record will remain open for 15 days until august 19 for the submission of statements and questions for the record. This hearing is it this hearing is adjourned.