Bob Graham

Mr. GRAHAM

Mr. GRAHAM. Mr. President, this reconciliation proposal is filled with risk--risk of the unknown, risks that have consequences that are beyond our ability to forecast. There is no area in this entire legislation that has a greater risk to the people of this country than the proposals in Medicaid. We are proposing to cut Medicaid by $187 billion--I repeat, a program which, last year, had a total Federal expenditure of $89 billion, we are going to cut, over 7 years, by $187 billion. It is at risk because we are proposing, for those funds that are left, to place them in an inflexible block grant, without Federal participation, in terms of dealing with unexpected circumstances, and we are freezing in many of the inequities that have made this program inappropriate in the past. Mr. President, we are putting at risk poor children, our elderly and, particularly, the States of America, as they are all being removed from the safety net that Medicaid has provided.

Mr. GRAHAM

Mr. GRAHAM. Mr. President, we have just heard a speech about change versus the status quo. This is one place in which we are all together. This is the status quo. This is deja vu all over again. We started this process of saying that we were going to meet deficit reduction targets and committed to the American people our frugality and our dedication to their attainment. We did it under what was called Gramm-Rudman. And in the years from 1986 to 1990, those 5 years, we had deficit-reduction targets for Gramm-Rudman that were supposed to bring us to a balanced budget early in this decade. What did it, in fact, bring us? More enormous deficits. And every year of Gramm-Rudman, from 1986 to 1990, we failed to meet the deficit reduction target. In fact, the total amount of our excess deficits, deficits beyond the target, was $201 billion over those 5 years. Did we change that pattern after President Bush went to Andrews Air Force Base and negotiated a new deficit-reduction plan? We did not--in 1991, 1992, 1993, again, failure to meet the deficit reduction targets in excess of $150 billion in just those 3 years. Mr. President, we delude ourselves, we repeat the status quo, not engage in change if we are saying that we are going to give ourselves this tax benefit before we demonstrate, first, that we have a serious, credible plan for balancing the Federal budget that is not just smoke, mirrors and ideas in the minds of a few people, but rather concrete law that has been passed, signed by the President and is a firm national contract and commitment to its attainment, and, second, a period of demonstrated fidelity to that plan and performance under that plan. I am the grandfather of eight young boys and girls. I know one thing about children: They like to eat their dessert before they will eat their spinach. That is what we are being asked here to do, is eat the cake and ice cream before we have the carrots and peas. I think we should not go down that path one more time.

Mr. GRAHAM

Mr. GRAHAM. Mr. President, I ask unanimous consent that statements from scores of organizations in opposition to the Republican plan and in support of the proposal that is before us be printed in the Record and that an analysis of the mandates which are contained in the Republican proposal also be printed in the Record.

Mr. GRAHAM. Thank you, Mr. President. Mr. President, it has been an illuminating debate but almost as illuminating by what has not been said as what has been said. What are some of the things that have been omitted? One of the major omissions is, how did the majority party arrive at the figure of $187 billion as the basis of its reduction in Medicaid expenditures by the Federal Government over the next 7 years? What was the source of that number? How was the calculation of the efficiencies and flexibilities that were going to be incorporated in this program used to derive the ultimate number of $187 billion? The reason that there has not been an answer to that question is because there is not an answer to that question. The $187 billion was derived, not by a rational assessment of what would be the needs of the program or what will be the per capita increase in costs in delivering health care, but rather as a means of deriving a set of dollars to fund a tax cut for the wealthiest of Americans. The fact is that the Medicaid Program has been operating at a per capita level of expenditure less than the national average in terms of all private sector health care spending, 7.1 percent in the private sector, 7 percent in Medicaid. This is what has been the level of Medicaid expenditure per capita. Under this bill, the proposal is to slash Medicaid from a 7 percent growth to a 1.4 percent growth. Mr. President, I would defy anyone to say that is not going to result in a significant collapse of the Medicaid system's ability to serve the most vulnerable population in our country. The second question that has not been discussed is, why has the Medicaid Program been growing at the rate that it has been growing? Let me suggest three reasons, one that we ought to be very proud of, and that is that we are doing as a Nation a much better job of helping the poorest and most at risk of our children. Infant mortality in the United States has dropped by over 21 percent in the last decade. Infant mortality in America has dropped by over 21 percent in the last decade. We ought to be proud about that, and it has occurred because in large part we have extended Medicaid coverage to more and more at-risk mothers, and we have provided the kind of appropriate health care immediately after birth. We should not be ashamed of that. Second, Medicaid has increased because of the aging of Americans. What has not been pointed out is that 60 percent of the Medicaid expenditures do not go to poor children and their mothers. Sixty percent of the expenditures go to the disabled and particularly to the frail elderly. In my State, 70 percent of Medicaid expenditures go to the disabled and the frail elderly. That happens to be the segment of our population which is growing at the fastest rate. In most States the fastest growing generational component of the population is people who are over the age of 80--the very population that is most likely to need Medicaid assistance for long-term care. The third reason for the increase in the number of persons on Medicaid has been the decline in private insurance coverage particularly for children. In 1977, 71 percent of the children of working Americans had their health care covered through their working parents. Today, in 1993, that number is down to 57 percent and projected in the year 2002 to be 47 percent. There has been almost a 1- to-1 increase in the poor children on Medicaid as there has been a decline in poor children covered through a parent's health care policy. Those are three basic reasons why Medicaid has been increasing over the last few years, not because of oppressive Federal regulations. Another thing that has not been discussed is the allocation formula. Would you like to see the allocation formula among the States? There it is. That is the arithmetic allocation formula contained in the Republicans' Medicaid proposal. This formula, when you get through all the algebra, says that those States which today are receiving 4 and 5 times as much per capita as other States will continue to receive 4 to 5 times as much. We are seeing a pattern. We saw it in welfare reform and now we are seeing it in Medicaid, and that is identify the problem, decry the status quo, and then retain the funding formula of the current program. We did it in welfare reform, and we are about to do it again in Medicaid. It would be like George Washington, after having won the American Revolution, saying, ``but we are going to continue to pay tribute to George III.'' The very reason that we fought the war would have been forgotten. Mr. President, we need to have a funding formula that treats all Americans fairly wherever they live. This bill of the Republicans continues basically the current funding formula into the indefinite future. What is going to be lost under the Republican proposal? We are going to lose the flexibility of an effective State-Federal partnership-- those States that experience growth, those States that experience economic decline, those States that experience a natural disaster. We had 12,000 people added to the Medicaid role in Florida within days after Hurricane Andrew because not only were their homes blown away, their jobs were blown away and they became eligible for Medicaid. And they needed it because of the disaster through which they just lived. That flexibility is going to be lost in this program. We are also going to lose the adequate funding of a Federal partner, and we are going to lose national standards particularly in the area of nursing homes. It is not surprising that President Reagan said that the Medicaid Program should not be turned over to the States but that the Medicaid Program should be federalized in order to have a national standard of health care. Where are the voices for President Reagan today? This great advocate of a strong national program to protect the health of our children needs to be heard today. I close by saying there is a better way. We are proposing in this motion, first, that we have a rational reduction in Medicaid. What we essentially are saying is that we will propose to restrain Medicaid to 1 percentage point less than the private sector rate of growth in health care spending. And with that 1 percent restraint, that is, that the per capita for Medicaid will be 6.1 percent per year over the next 7 years, we will save $62 billion. We think that we can make that kind of a change without ravaging the system, and we would distribute the money through a per capita cap. This maintains the individual entitlement to Medicaid coverage and creates incentives to maintain health care coverage. It provides for funding into each of the four categories of principal Medicaid populations, that is, poor children, their mothers, the disabled, and the frail elderly, so that we will not create what is, I believe, an inevitable result of the block grant approach which is going to be a war at the State level among those four groups of beneficiaries. We would also allow for a continuation of innovative programs such as the program in the State of Tennessee. We believe that the kinds of flexibility that we would provide, which would make it easier for States to move into managed care and easier for States to use community-based services to meet the needs of the elderly, will produce some real economies and therefore reduce the rates of expenditure over the next 7 years, an attainable goal without collapsing the system. It is interesting, Mr. President, that the proposal that I make today, the per capita cap alternative to block grants, is the proposal which was introduced in the Senate on June 29, 1994, by our distinguished majority leader, cosponsored by 39 Republican Members. A similar program was introduced by our colleague, the senior Senator from Texas, and the junior Senator from Rhode Island, also promoting a per capita cap on Medicaid as a means of reforming the system. Mr. President, I believe that we have a program that will achieve significant savings without sacrificing the safety net that Medicaid has represented. We can have these reforms while retaining a program that is vital to 37 million of our most vulnerable Americans. What we will sacrifice is a little piece of the tax break that we are about to give to the wealthiest of Americans in order to assure minimal health care standards for the poorest and most vulnerable of Americans.

Mr. GRAHAM. Mr. President, there is time we received, 3 minutes of general debate and 1 minute which was used by the Senator from Wisconsin. And I ask for the other 2 minutes, as well as the balance of our time on this amendment for my closing remarks.

Mr. GRAHAM. Mr. President, has the Senator from Michigan completed his presentation?

Mr. GRAHAM. Mr. President, I wish to reserve the balance of our time including the additional 2 minutes which were yielded for my close. I yield to the Senator from Michigan for any final debate in opposition to the motion. Mr. ABRAHAM addressed the Chair.

Mr. GRAHAM. Mr. President, I ask unanimous consent that off of the general debate on the bill there be 3 minutes yielded, one of which will be yielded to the Senator from Wisconsin as well as 1 minute for debate of this motion.

Mr. GRAHAM. Mr. President, I yield the Senator from Washington 2 minutes.

Mr. GRAHAM

Mr. GRAHAM. Mr. President, I yield 90 seconds to the Senator from Alabama.

Mr. GRAHAM. I yield 2 minutes to the Senator from California.

Mr. GRAHAM. Mr. President, I yield 2 minutes to the Senator from West Virginia.

Mr. GRAHAM. I yield 5 minutes to the Senator from Massachusetts.

Mr. GRAHAM. Mr. President, I yield 2 minutes to the Senator from Maryland.

Mr. GRAHAM. Thank you, Mr. President. I yield 5 minutes to the Senator from Minnesota.

Mr. GRAHAM. Mr. President, with those introductory comments, I send to the desk a motion to commit with instructions.

Mr. GRAHAM. I have not but I shall in a moment. This represents for most States 40 percent, or more, of all of their Federal grant in aid programs for highways, education, and law enforcement. Forty percent of all of the funds which come from the Federal Government to assist States in providing services to their people come through this one program of Medicaid. It is the safety net under our entire health care system. While it represents well under 10 percent of health care spending in terms of the Federal commitment to Medicaid, it represents the safety net for virtually 100 percent of our health care system. Yesterday, I heard some speakers talk about the fact that we are involved in this reform not just because we need to balance the Federal budget, which many of us, including this Senator, strongly support and have voted consistently for measures that will move toward the balanced budget and are very pleased at the report yesterday that for the third consecutive year we have reduced the degree of the Federal deficit, but beyond that goal of balancing the Federal budget, we need to rid ourselves of failures, of programs that were not functioning, that in some cases were even counterproductive. Mr. President, while I will suggest some areas in which I believe the Medicaid Program can be improved, I will state emphatically this program is by no definition a failure. In one very dramatic area, infant mortality, this program has contributed substantially to a dramatic reduction in infant mortality in virtually every State. It has resulted in more babies being born at term, at full birthweight, fully able to begin the developmental process, and then it has helped poor mothers to be able to continue the health care for those babies after they were birthed. This program is a program which has had flexibility to respond to changing circumstances which range in every degree from changes in population to changes in economic circumstances to natural disasters that impose unanticipated burdens upon a particular State. I will talk later about my concern of the proposals in this reconciliation bill for the severe cuts in the Medicaid program, cuts which will reduce the annual average increase to 1.4 percent in comparison to the private sector's estimate that over this 7 years, private sector health care will increase at 7.1 percent per American citizen over each of the next 7 years; that that kind of disparity represents not a fine tuning of the Medicaid Program but, frankly, a collapse of the Medicaid Program and its ability to serve as the safety net. And finally, that the allocation of funds among the 50 States in the rigid block grant formula is inequitable, perpetuating inequities in distribution which exist in the current law as well as rendering the program unable to respond to changes in circumstances among our 50 States. Motion to Commit

Mr. GRAHAM. Thank you, Mr. President. Mr. President, in light of the limitations under which we will debate this matter, I will make a few opening comments, and then yield 5 minutes to my colleague from Minnesota. Mr. President, one of the most significant but not adequately focused upon aspects of this debate is the impact which this reconciliation will have on the most important Federal-State partnership in existence, which is the Medicaid program. This program represents for most States----

Mr. GRAHAM. Mr. President, could I ask the ranking member a question? Is the 1 hour under the control of the Senator from Florida, or is it 1 hour equally divided?

Mr. GRAHAM

Mr. GRAHAM. Mr. President, I would like to take a few moments to speak on the Arctic National Wildlife Refuge. In their budget reconciliation package, Republican budget planners have mandated the oil exploration and drilling of the fragile coastal plain of the Arctic National Wildlife Refuge. This 125-mile stretch is the last protected area of the 1,100-mile Alaskan coastline. It is home to many precious species including caribou, polar bears, golden eagles, and grizzly bears. We have all seen the devastation wreaked by the drilling of the North Slope of Alaska and Prudhoe Bay. Before oil was discovered in the North Slope, it was part of the largest intact wilderness in the United States. The oil development of the North Slope has resulted in hundreds of open waste pits containing millions of gallons of oil industry waste and the destruction of thousands of acres of wildlife habitat. There is no reason to believe that the drilling of the coastal plain would produce any less devastating effects. The damage caused by the construction of oil rigs, roads, and pipelines and the inevitable oil and chemical spills are simply not worth the assumed revenues of this short term private gain induced pillaging. As stewards of our few remaining wildlife refuges, I believe that we have an obligation to protect them and the animals that seek shelter within them. Mr. President, I also ask that an editorial by Jessica Mathews, which appeared in the Washington Post on October 23, 1995, be printed in the Record. The article follows: [From the Washington Post, Oct. 23, 1995] Lusting After Black Gold (By Jessica Mathews) Alaskans think they have a terrible financial problem. To solve it they propose to ruin the last protected fragment of the arctic coastal plain--part of the Arctic National Wildlife Refuge (ANWR)--by opening it to oil drilling. Here's the problem. Alaska has no state income tax, no sales tax and the lowest fuel taxes in the nation. It has the highest per-capita income from the federal government of any state. State spending is twice the national average. And it has an $18 billion savings account, the Permanent Fund, that provides an annual Christmas-in-September check of a little less than $1,000 for every man, woman and child. You might think of it as Saudi Alaska. Here's the bad news. The North Slope oil revenues that underwrite this easy living are drying up, and the state now has a half-billion-dollar deficit that's heading skyward. One can still think offhand of about 49 governors who would love to have a fiscal problem like Alaska's. Solutions leap to the mind. Impose a small sales tax. Raise the fuel tax a bit. Cut the most egregious spending frills. Use some of the income from the oil-funded savings account for the purpose for which it was created instead of as a universal bonus entitlement. Alaskans have a different answer. Drill ANWR-- and hope that puts off the day of reckoning for a few more years. In an unguarded moment of honesty, Alaska's congressional delegation--Sens. Ted Stevens (R) and Frank Murkowski (R) and Rep. Don Young (R)--made the linkage explicit in a recent letter to constituents. The relevant passage says, in full: ``Oil revenue funds about 85 percent of the state's budget, but Prudhoe Bay is in decline. The administration is threatening to veto legislation to open the coastal plain.'' The other arguments for drilling in the refuge range from flimsy to specious. For years, a favorite has been that it would enhance national security by reducing the country's oil import dependence. That won't wash anymore since Congress and the administration have agreed to lift the 22-year-old ban on exporting Alaskan oil. If we need to reduce oil imports, why export our own? The best came Presidents Reagan and Bush could make for opening ANWR was that chances were one in two that its production would rise in a few years to 4 percent of U.S. oil use, dropping to one percent five years later and less thereafter. Not surprisingly, Congress didn't find that a compelling reason to make an irreversible sacrifice of the wilderness. If in some presently unimaginable future the nation absolutely required ANWR's oil it would still be there for the taking. Since then, the U.S. Geological Survey has slashed the expected find by more than half. An offshore well drilled in one of the most promising areas was a bust. Another hit oil but not in developable quantity, though the company, Atlantic Richfield, is still enthusiastic. Meanwhile, the expected market in which ANWR oil would have to compete, has turned from tight to squishy. Projected oil prices for the year 2000 are down from $38 to $19 per barrel. That turns the industry's five-year-old projection, which it is now shamelessly recycling, of 700,000 jobs created nationwide, from highly unlikely to laughable. The last-resort claim is that drilling won't make much difference to this narrow plain that is the biologically crucial part--the birthing, denning, feeding and nursery ground--of a much larger, fragle and unique arctic ecosystem. But no matter how environmentally sensitive the effort, 400 miles of roads, 11 production facilities, four airstrips, two ports, massive gravel mining and housing for several thousand, plus associated emissions and toxic wastes are not what most peole expect of wilderness. Neither will the plants and animals. What's left? A short-term fix that might or might not prolong the oil-welfare state. Not much there to arouse support, even in Washington. So the state's powerful congressional delegation, whose members chair both the House and Senate Natural Resources Committees, came up with a sweetener. They propose to give half of the hoped-for leasing revenue to Washington, which helps make the numbers work in the Republicans' deficit-reduction plan. If Congress counts on the money, however, it is playing a chump's game. The state has promised to sue for any split less than the 90 percent it believes is guaranteed by its Statehood Act. Alaska's congressmen want the name of the Arctic National Wildlife Refuge changed to the Arctic Oil Reserve. It's revealing that what's gone is not just wildlife, but the national interest as well. Until Congress acts, they unilaterally have adopted a new acronym, AOR. If the ANWR proposal does pass, the delegation has a lot more to follow, including develop in the Tongass National Forest and turning back 70 million acres of federal lands to the state. Instead, Congress should give the ANWR proposal the treatment it deserves. In the spirit of adopting new acronyms it could send along a message as well: GRA. Get Real, Alaska. The rest of us would trade for your troubles. Face the real choices now--ANWR isn't the answer.

Mr. GRAHAM

Mr. GRAHAM. Mr. President, I would like to articulate my deep sorrow as this week marks the anniversary of the senseless murder of Meredith Miller. Meredith, a native of Tampa, FL, graduated with honors from Princeton University where she majored in political science. After her graduation she came to Washington to further her studies at George Washington University and to work on the issues pertaining to women. On October 17, 1994, after returning from a study group, Meredith became the victim of a carjacking. The dream that Meredith held so dearly was to make a difference in the lives of others. Her fellow students at George Washington University would like Meredith's parents in Tampa to know that Meredith did make a difference in the lives of those fortunate enough to have known her and that their thoughts and prayers are with them today and always. Her friends miss her and learned much from her special outlook on life. She will always remain a vital part of their lives, in spirit. Mr. President, today let us not forget the contributions Meredith Miller made in her short time here with us, and let us be diligent in our efforts to find a solution to the ever-growing number of senseless violent crimes.

Mr. GRAHAM

Mr. GRAHAM. If I could use the remaining time of Senator Helms for the purpose of a couple of points. First, the current Cuban Democracy Act provides for limited travel under controlled circumstances to Cuba by three groups of Americans: those who are traveling for educational, religious, or humanitarian purposes. The President, within the last 2 weeks, has given greater definition to who will fall within those three categories and will receive authorization to travel to Cuba. The basic prohibition on general travel is a cornerstone of the United States' effort to isolate the dictatorship in Cuba while we were attempting to reach out to the people of Cuba with a hand of friendship. If we were to eliminate this prohibition on travel, we would be pouring dollars into Castro's thin coffers, dollars which would allow him to continue to operate the most repressive state security apparatus left in the world, one which has set new standards for human rights abuses. We would also prop up his regime against the inexorable forces which are leading toward its downfall. Mr. President, I urge the defeat of this amendment by adopting the motion that I will offer to table the Simon amendment.

Mr. GRAHAM. Mr. President, I move to table the Simon amendment and ask for the yeas and nays.

Mr. GRAHAM. Mr. President, I, too, rise in opposition to the amendments offered by our colleague from Connecticut. This proposal lays out a rational transition from the current authoritarian Communist regime to what we hope will soon be a democratic and marketplace political and economic system in Cuba. It is consistent with the provisions that were contained in the Cuban Democracy Act which was passed by this body by an overwhelming vote in 1993, but it continues the dual track of the United States providing pressure against the regime in Cuba while it opens up to the people of Cuba, including opening up with a clear statement of how we will assist the transition to democracy. Mr. President, I move to table the amendments of the Senator from Connecticut. I ask for the yeas and nays.

Mr. GRAHAM

Mr. GRAHAM. Mr. President, am I correct that the pending business is the amendment offered by Senator Dole as a substitute to H.R. 927?