My colleagues across the aisle speed of the committee will come to order. I now recognize mr. Rokita with the purpose of a motion. Thank you, madam chair. I have a motion at the desk is. The clerk will read the motion spin t motion offeredy mr. Ita, the committee on the budget direct its chairman to express the support of the Committee Prior to the consideration of the rule for the American Health care act for state disability in the design of the Medicaid Program. Mr. Rokita is recognized for gamers with one minute resort to close spirit i think the chairman. Ladies and gentlemen i want to commend the energy and Commerce Committee and the ways and Means Committee for bringing this bill to our attention today. However i want to address a glaring, the glaring absence of something that we as, as republicans come as a conference at work very hard on over the last several months. And that is to give to choice to the states when it comes to how they want to develop and implement and otherwise execute their Medicaid Program. And weve seen all of us really hold up this document, right away we call or come to describe to the American People come and visit before the election dated june 22, 2016, to describe to the American People what we wanted to do with regard to a lot of policy positions, including medicaid. What we decided at the time that federalism insisted that instead of a onesizefitsall Medicaid Program, we would have a choice as states, as governors, state legislators and as individual citizens on what kind of plan we wanted. And we coalesced around to make your choices a two medicaid block grant that gives the federal, largely if not altogether out of the business of medicaid including the energy and Commerce Committee, and per capita caps which puts caps on individuals and how much a state could be allotted for each individual. The linchpin per capita cap is that the federal government still decides for states and individuals who has to be covered. Instead of letting the governors, state legislative and local leaders decide who in their community is truly poor, is truly in need of services in terms of health care. Of the concept. I want to bring this to the committees attention, part of this instruction, have our budget chairman bring this to rules so it can be corrected. In that respect i want to introduce not only the better way plan. Without objection. A letter from the state of maines governor, paul lepage, said he would pick medical medicaid block grants over per capita caps any day of the weekend i am sure there are other governors as well as i would like to welcome into the record our last budget from fiscal year 2012 especially the line where it talks about the house of representatives that a whole adopted medicaid block grants, and treated fairly, at the top of t list in terms of services and helped us save the same amount of money if not more than per capita caps do for us. I would like to yield one moment to the chairman from alabama. One of the single greatest struggles over the last several years, managing the budget, medicaid. The lack of flexibility and lack of ability of the state of the program is what we have seen over the last few years is a growing drain on state budget, and the block grants gives the state ability to innovate, give state ability to make sure the Medicaid Services go to people who need them the most, the elderly and disabled, get us in a position where we can find out what works. With that, mister vice chairman i wholeheartedly support your motion. Gentleman from arkansas. The gentleman from indiana, thank you for yielding. Madam chairman as we work through this process, we had good enhancements to make and this lays the groundwork for the best enhancement and that is to create an option for a true blocgranfor states that would rather have that option. I would like to talk about what a block grant is not, not a program that maintains federal control over certain areas, states flexibility in areas approved by cms. A true block grant is total flexibility on the front end with an auditing function that makes certain funds are going to provide medical services in the state, and a block grant is not a global waiver, and the term waiver defines the block grant. And it asks permission of the federal government to do innovation in their program and true block grants does not have fluctuating rates that change the economy even though you could build in a growth factor for inflation or population. The premise behind a true block grant is a state assumes more responsibility in exchange for total flexibility. We have seen hints of the success of the block grant modal in the 10 of Program President clinton and the Republican Congress put in place. Although not a block grant the state of rhode island received a 5year global waiver in 2009s are tremendous benefits and Health Outcomes, saving 3 billion of the 12 billiondollar program they signed up for. In the state of maine the state had to go to court to get a sliver of flexibility but as a result they were able to create high risk that help their citizens lower costs and impred Health Outcomes because the state had that tiny bit of flexibility. We need to give states the true flex ability with a block grant. We have this option in a better way and need it in this bill. State, expansion and not expansion want the option for block grants. I look forward to working hard to help them have that option. We have been told by cbo they would not support block grants because they assume no state wants them. I would like to submit for the record a letter requesting the block grant option from paul lepage, the letter of maine, who is from a nonexpansion state. Without objection. I would also like to submit a letter requesting the block grant option from the honorable Asa Hutchinson from the great state of arkansas, which is an expansion state. This is a good motion. I hope we pass it in the rules committee will take it up and put the amendment in and i yelled back. They will be submitted for the record. Gentleman from missouri mister smith is recognized for the remainder of the time. I support this resolution wholeheartedly. As former state legislator i was constantly frustrated by the federal requirements that permitted us from running our own decayed program and tailoring it to missouris unique needs. I am encouraged by the motion because we havto give states the flex ability they need to administer the medicd program and provide care for lowincome individuals not how bureaucrats from washington say it should be done. Obamacare put washington in between patients and their doctors. Obamacare put washington in thrall. I support the mall for state block grant in designing the Medicaid Program because it will allow states to restore the doctorpatient relationship. Our bill creates a patient and states ability fund, responsibly scaledback obamacares medicare expansion and a fair funding formula strengthens medicaid for the long haul. Most and portly by yielding control to the states we assure medicaid will be used effectively to serve patients who are most in need. We have to get washington dc bureaucrats out, Thomas Jefferson said the government closest to the people serves the people best. I yield back. I recognize the opponents of the motion, Ranking Member, the only member of the committee from kentucky. I will yield 2 other members throughout the process which and in medicaid, states have amazing flexibility for eligibility, benefits, cost sharing and the Delivery System and to better tailor the program and in indiana, just wavered to change the program, flexibility is not what we are talking about. Cant do more with medicaid when cutting 900 billion from the program so when my republican colleagues say flexibly they mean doing less with less, if you are covered and fewer benefits people need. Kentucky is a prime example. Matt bevan has applied for medicaid waiver that by his own estimates would immediately take healthcare away from 17,000 kentuckians over a five your period, 75,000. Those that continue to receive medicaid, the most Vulnerable People in the commonwealth would see increased outofpocket costs and fewer benefits under his waiver. Kentucky has historically had the worst rate in the country when it comes to oral health and access to dental care. One in four kentuckians over the age of 65 have had all their natural teeth extracted. Prior to enactment of aca, medicaid eligible children had seen the dentist, 15 . Steve bashir expanded medicaid to 400,000 kentuckians as part of the aca which included coverage for oral care, the rate of dental visits, and double for children. That is what we are about to lose. Governor bevans waiver will cut dental coverage of the stated benefit for hundreds of thousands of kentuckians. That is not progress, it is a Public Health crisis. This is about improving care through flexibility, jeopardizing healthcare of millions of low income men, women and children. I now yield three minutes. This motion says state flexibly when it is really allowing states to rent medicaid coverage from those who need it most. Lets let states keep Medicaid Expansion. No question Medicaid Expansion is expanded from middleclass americans struggling to make ends meet, revealing expansion is dangerous and shortsighted. And the Healthcare Plan is to destabilize the Medicaid Program as a whole. And per capita state Medicaid Programs, and 8 billion in additional costs or begin rationing care. They plan to medicaid funding, will inevitably lead to waiting list address and healthcare with 6 people facing long delays and substantial barriers to the care they need, i heard care about this proposal from seattle childrens hospital, university of washington medicine, Skagit Valley hospital and Washington State medical association and so many others in my state. I ask unanimous consent to insert into the record a letter from our goverr and insuranc ission expressing deep and well thought out concerns with this bill. Ithout objection. It reads part,uote, 700,000 people in our state will be at risk of losing coverage unless we can find 2 billion by 2028 to continue medicaid coverage for 600,000 of these people, and unrealistic amount to raise in the first book the current fiscal climate. It also states, quote, if Medicaid Expansion were to end today, 20,000 people would have their cancer care disrupted and 30,000 would lose critical treatment for Substance Abuse disorder. Tens of thousands of people with mental illness, a recipe for disaster with outcomes. Everyone has delivered the same message to me, this would do irreparable harm to middleclass families in Washington State especially children. Just yesterday i heard from the university of washington and harvard you Medical Center that this bill means 518 million cut to their lifesaving work every year. It is staggering. I implore you to consider consequences before allowing this illadvised plan to move forward. Of my colleagues are truly concerned about states rights they should allow Medicaid Expansion to go forward uninhibited. In addition to regular doctor and hospital visits medicaid covers Longterm Services like Nursing Homes and home care allowing people with chronic conditions the ability and peace of mind to live independently. 31 states and the district of columbia have expanded medicaid so far. The expansion combined with acas of the reforms have lower the nations uninsured rate below 19 the lowest level ever recorded. States Like Washington have thrived under reforms like this which are helping millions of working families, seniors and children. States rights arguments only used when it is convenient. I urge a no vote and yield back. I think the gentlelady and yield two minutes to mister kautsky from illinois. Flexibility, flex ability, flex ability. Kicking billions of people off medicaid and threatening care to seniors and children and pregnant women and the disabled is not the same thing as flex ability. It is a fantasy to think you can cut 880 billion from medicaid and think nobody is going to get hurt. It is Common Knowledge states can use several waivers to design their Medicaid Program in ways that meet their needs as well as federal standards for coverage and benefit so those are not hard to get. What republicans mean when they talk about flex ability is drastically reducing funding for states for their programs, imposing a per capita and allowing states to impose regressive policies such as work requirements, blackouts, benefit cuts and enrollee costsharing that only serve to deny people access to medicaid who distantly need coverage. We heard from republican governors including my governor in the state of illinois, governor browner, and concerned about the effect of medicaid cuts. Brian sandoval in nevada said all along work with governors, it should be a governor led effort and for congress to rely on governors. He went on to say lost that. He went on to say nothing governors had recommended was actually put in place. Simply put, this would undermine the effectiveness of medicaid for thousands, millions of people, cutting budgets and punishing a vulnerable population. Yield the remainder of our time to Debbie Wasserman schultz of florida. I hear my republican colleagues asking flex ability for states but make no mistake that is good for deep cuts. Republican puzzles convert medicaid into a per Capita Program attended to achieve large growing cuts to medicaid spending shifting costs to the state. Considering the leeway state authority have in running their business under the gop will be only result flex ability will be further limiting enrollment, cutting benefits, low income americans for the what they need. Shifting is the billions of dollars of medicare costs to states will erode the progress the delivery of healthcare ing services to vulnerable populations. States like my home state of florida, 3. 7 Million People to receive healthcare coverage through medicaid cannot afford the cuts this budget proposes, three of 7 kids in our state they need to stay healthy thanks to medicaid, deserve better. If republicans spend more time learning about medicaid instead of investing meaningless catchphrases like flex ability they would know states can already do everything outlined in this motion. States already have likability to definedbenefit plans best for the residents, they have flicked ability on eligibility, and the delivery of payments of care. What is outlined, states cannot pursue today under existing flex ability standard states have improved the quality and delivery of care, flexibility the only way states have reception drugs, physical and Occupational Therapy and new Preventative Services to drive down the cost of care. The entire bills health care plan, nothing but huge taxcut for the rich, the expense of millions of hardworking American Families including millions of children, no matter medicaid flicked ability is going to change that. I yield back the balance of my time. The proponents of the motion is recognized. The reason i introduced the document entitled cbo scores of task grant proposal is to show that the savings of the block grant proposal generally matches per capita so there is no reason it should score 0, explicitly want to do. We could have that choice and it wouldnt change the cbo score, states would have per capita caps, block grants would not need the score and introducing the record a letter from mister price, former budget chairman. Without objection. Exhibit a. I got caught by my own. Agreeing to the motion, all those in favor signify by saying i. Those opposed no. In the opinion of the chair the eyes have it. Recorded vote, the clerk will call the role. [rollcall vote] [rollcall vote] [rollcall vote] [rollcall vote] [rollcall vote] [rollcall vote] [rollcall vote] are there any members who have not voted a wish to change their vote . If not a collection report. On that vote the is are 21 and the nays are 12. The eyes have it in the motion is 3 too. I now recognize mister gates from florida for the purpose of a motion. Have a motion. I have a motion at the desk. Clerk will read the motion. The motion offered by mister gates, mister gates moves the committee and budget director express support of the Committee Prior to consideration of the rule for the people on medicaid to 12 billion on medicaid products. They couldnt raise taxes fast enough to cover the focus on medicaid so what did they do . They cut reimbursement rates and when that happened provide is left the market and people couldnt get healthcare they ended up back in the emergency room. Medicaid expansion in many ways is a cruel joke. Gives people a car that tells people they have Health Insurance coverage when in reality access is illusory. It is not just california. In colorado there were Nursing Homes that are reductions in reimbursement rates. Think how irresponsible that is, thinning the soup in our Nursing Homes the consequence of these liberal policies. And illinois reimbursement rates were cut to hos