tv Hearing Focuses on Childrens Health Insurance Program and Outpatient Care... CSPAN July 1, 2017 4:01am-4:26am EDT
miles away. >> on sunday at 2:00 p.m. eastern on american history tv, we'll step inside an historic mansion built in 1914. the home belonged to the former owner and publisher of "the oregonian" newspaper. >> he was the one that kept it going. the owner was rather distracted with politics to the point that he owed henry a lot of back wages. in 1860, his employer, thomas dryer, decided to give the paper to henry in return for back pages that he was owed. henry turned the newspaper into a success, invested in real estate as the town grew and was able eventually to build a house as grand as this one. >> watch c-span cities tour of port planned, oregon, saturday at noon eastern on c-span's book tv and sunday at 2:00 p.m. on american history tv on c-span3, working with our cable
affiliates and visiting cities across the country. funding for the children's health insurance program known as c.h.i.p. is set to expire at the end of september. members of the house subcommittee recently looked at extending the program and how proposed changes to medicaid would affect it. witnesses include former state and federal health care officials. this hearing is 2 1/2 hours. >> the subcommittee on health will now come to order. the chair wishes to observe that today's hearing was originally scheduled to occur last wednesday morning. but on that wednesday morning, the capitol hill family and the
entire country was shocked and horrified to learn about an awful attack that took place against our own. this past week has been sobering and difficult for all of us in many different ways. a number of friends, indeed a member of this very committee, is still in the hospital. they continue to need our prayers and best wishes as they fight to heal, to recover, and in coming days, join us again. last week's awful tragedy reminds us that what unites us is more important than what divides us. we are not first democrats or republicans. we are americans. we love our country. we respect our colleagues. we are saddened but we are strong. we are troubled but we will unite around our common duty and our common service to our fellow countrymen in that spirit of unity. let us pause for a brief moment of quiet reflection for especially the member of the committee who is not able to be
here today. of course we have other people recovering from their injuries. the chair will recognize himself for five minutes for an opening statement. in 2015, this committee passed the medicaid access and c.h.i.p. reauthorization act. you're welcome. which extended funding for many of the nation's safety net programs, including the community health center funding and the state children's health insurance program. with funding for both the community health center fund and the s-chip program set to expire at the end of this fiscal year, our committee has the responsibility of taking a critical look at how these programs operate and setting out a long term path to funding and programs reauthorization. the community health center fund plays an important role in supplementing the services that federally qualified health centers are able to deliver to
underserved communities by providing care to all americans regardless of income, regardless of ability to pay. additionally, the community health center fund provides resources for the national health service corp., which actually provides scholarships and loans and loan repayment opportunities to new doctors willing to serve in medically underserved areas. this program has proven effective at placing providers, providers who are young and energetic and willing to work hard in some of the most medically underserved and challenging areas. the state children's health insurance program provides health care coverage to over 8 million children across the nation, through flexible capped allotments to states. the program has been able to successfully support children while providing states with opportunities to tailor their respective programs as to best meet the needs of their populations. however, the programs are not
without challenges. in regards to the community health center fund, we are interested in seeing how federally qualified health centers can best maximize this investment. succeeding in underserved areas can be difficult. and i look forward to learning more as to how the federally qualified health center can continue to deliver results and where improvements might be made. as for the state children's health insurance program, there are multiple points for consideration, as is the case with other federal insurance programs. there are considerable concerns regarding the long term sustainability of the program, following the passage of the affordable care act, the program's federal match rate rose an unprecedented 23%, providing some states with as much as a 100% federal match. this increase in funding has challenged the program by both shifting the nature of the shared responsibility of the
state children's health insurance program to the federal government and making states more dependent on federal dollars. the issue is further complicated by concerns raised by the congressional budget office on the efficacy of the enhanced match rate. according to the congressional budget office, an elimination of the enhanced match rate would basically not impact coverage rates for children in the country, while a continuation of the enhanced funding would add another $7.5 billion to the deficit over the next five years, if no other policies were undertaken to offset its cost. so today's hearing should focus on how best to proceed with the affordable care act's increased funding for the state children's health insurance program, the increased funding rate, and what a continuation of this funding would mean for taxpayers and what it would mean for covered children. with these challenges before us, i would like to welcome our witnesses and thank them again for joining us today. i thank them for their
forbearance as the hearing got rescheduled twice. on the c.h.i.p. front, we have ms. jami snyder who serves as the associate commissioner for medicaid and c.h.i.p. in my home state of texas, and ms. cindy mann, who served as the administrator and director of the center for medicaid and c.h.i.p. services at the center for medicare and medicaid services from 2009 to 2014. i am interested in hearing today how each of your experiences on both sides of this partnership has worked, and where you believe we can improve the ability of states to meet the needs of children in the program. and finally, mr. michael holmes serves as the ceo of cook area health services, which i believe is in minnesota, and as the treasurer for the national association of community health centers. mr. holmes, i look forward to
our conversation. both the community center fund and the state children's health insurance program provide state and local opportunities to improve access to care in the united states. i yield back the balance of my time and recognize the ranking member of the subcommittee, mr. green of texas, five minutes for an opening statement, please. >> thank you, mr. chairman. and again, we appreciate the loss we had, the injuries we had, and particularly to our committee member last week. but i'm glad he's progressing very well. the children's health insurance program, c.h.i.p., and federal qualified health centers, fqhcs, are critical components of our health safety net. funding for both expires at the end of this fiscal year and timely reauthorization is utterly critical. that said, we can't talk about either without talking about medicaid, literally the elephant in the room.
the american health care act or trumpcare guts medicaid and makes structural changes that would inevitably lead to the rationing of care. after seeing the house republican bill to kick off 14 million enrollees on medicaid, the senate plan to kick even more kids off of medicaid over time, and make even steeper cuts, somehow managing to be more mean than even the house bill. in three years, the senate bill will start the process of kicking millions off their medicaid coverage. and then, as if that wasn't enough, starting in 2025, the plan would institute even more medicaid cuts that every year becomes a deeper cut than the year before. c.h.i.p. was designed to sit on top of a strong medicaid program. and reauthorizing it while simultaneously destroying medicaid is simply unacceptable. trumpcare jeopardizes coverage for millions of kids with medicaid and c.h.i.p. and the trump budget doubles down on kits that directly hurt
kids. to make matters worse, the trump administration's budget proposes an additionally $610 billion in cuts to medicaid, rolls back the requirement on states to maintain current kids' eligibility in c.h.i.p. and cuts support for c.h.i.p. kids over 250% of the federal poverty level. more than one-third of all children in the u.s. and almost half of kids under age 6 are covered by medicaid or c.h.i.p. the vast majority of these children, more than 90%, are covered by medicaid. i strongly support c.h.i.p. and continue to urge my colleagues to fully extend the program for five years. i've long championed community health centers and want to see the health center fund extended for the same amount of time. without an extension of funding, the health center program will be decimated. given all the uncertainty my colleagues are introducing in the health insurance programs, a clean extension of these two pillars of the health care safety net is of utmost importance. again, extending these programs
without destroying medicaid is unacceptable. c.h.i.p. stands on the shoulders of a strong medicaid program. in 2016, medicaid provided more than 40% of the community health centers' funding. they're tied together as three legs on a stool that helps children get health care they need. no child should be left off worse because of congress's actions. with that, mr. chairman, i would like to yield one minute to my colleague from massachusetts, joe kennedy. and after congressman kennedy, i yield the remainder of my time to congresswoman degette. >> ladies and gentlemen, anybody who has welcomed a child into this world knows that moment when they see the world for the first time, the promise you make to protect them under any circumstance. no matter how hard you try, nature will test the strength of that promise because children are not immune to an unexpected
accident or life altering diagnosis. we as a country and a community invest in c.h.i.p., and to a strong community health program. it is that recognition that our children are society's most precious resource that brings us together here this morning. trumpcare threatens the fundamental guarantee of compassion for our kids. it stigmatizes children not only for their illness and that we should never accept. thank you, i yield back. >> thank you. we used to all agree in this country that every child, regardless of his or her parents' income, should have a chance at a healthy start. that's why we've been working in a bipartisan way to make this country get closer to that goal. i worked on the very first c.h.i.p. bill in 1999. and because of the by paipartis
collaboration, 95% of the america's children have coverage. that's an all-time high. so why would coverage pass this trumpcare bill that would take coverage away from 3 billion children? there would be an unprecedented cut in medicaid which covers more than 35 million kids. half of the 9 million children in c.h.i.p. are actually in medicaid. so mr. chairman, it's really hard for me to see how we can have a bipartisan reauthorization of c.h.i.p. by the end of september without a strong bedrock foundation of . medicaid. i yield back. >> the chair recognizes mr. walden for an opening statement. >> i thank the chairman. today marks a really important step forward in this committee's work to strengthen our health care safety net by examining the extension of two very important safety net programs.
both the children's health insurance program, c.h.i.p., and the community health center program, have enjoyed strong bipartisan support for many years. under current law, congress needs to renew funding for these programs since the current funding streams will soon expire. we recognize that c.h.i.p. and community health centers play a significant role in the nation's safety net for millions of americans. for millions of american children and pregnant women who are generally low to moderate income, and millions of individuals who may be medically underserved or face other barriers to care. individuals and families served by these programs are not just program enrollees. they are our neighbors. they are our friends. in my district alone, there are 12 federally qualified health center organizations with 63 delivery sites leveraging federal money to serve 240,000 patients. in many parts rural eastern oregon, a health center can serve as the main primary care
provider in a community that faces a shortage of private practice doctors. in three of my counties, there are no physicians and there are no hospitals. the student loan repayment incentive also helps staff those centers and ensure patients in those communities can see a provider in a timely manner. so i'm glad to be here, and join my colleagues hopefully on both sides of the aisle in moving this process forward. we're united in our desire to support patient centered solutions at state and local levels. as a result there is strong bipartisan recognition that c.h.i.p. and the health center program play key roles in our nation's health care delivery system by providing medical care for millions of low income americans. both programs have demonstrated successes in helping reduce costs for patients and families, improve health outcomes and deliver cost effective care. we view our state and local partners in these programs as key allies in the common cause of putting patients first.
this is a shared responsibility. in my state of oregon, our health centers partner would local providers and the patient community through coordinated care organizations that work to provide comprehensive services focusing on prevention, chronic disease management, and locally controlled patient centered care. today, we start our funding extension discussion by hearing from experts who have firsthand experience running c.h.i.p. programs and health centers. we want to better understand if these programs face barriers to innovation. we want to hear creative strategies to deliver quality care. we seek your guidance on what's working and what's not. as we move forward, this committee faces important considerations regarding extending funding for these programs. there are decisions to be made regarding how much funding should be provided, for how long, and how congress should pay for it. so as not to burden the next generation with additional debt. particularly, the committee will closely examine the question of whether the 23% bump for a
state's match for c.h.i.p. is appropriate to continue as we look at funding questions. i have concerns the 23% increase upends the traditional federal/state partnership. as we embark on this effort, i know we all share the goals of reducing costs and ensuring patients served by these programs have the peace of mind that they can continue to access timely, high quality care. it goes without saying this needs to be bipartisan. we look forward to working with our colleagues on the other side of the aislel. it's important to note as well that c.h.i.p. is one of those programs that's a block grant to the states that seems to perform quite well when we rely on our state partners. mr. chairman, i'm more than happy to yield back to get on with the hearing. >> the chair thanks the gentleman. the chair would observe there is a vote on the floor. there is still almost nine minutes left. so with the committee's permission, i'm going to recognize the ranking member of
the full committee, mr. pallone. >> thank you, mr. chairman. a little over a month ago, house republicans voted to repeal the affordable care act and gut the medicaid program in order to give tax cuts to the rich and privileged view. the result, 23 million people could lose health insurance. 3 million of them children. and then yesterday, senate republicans finally made public their bill where they proposed even steeper cuts to medicaid. and now today, republicans will talk about the importance of our safety net programs. the children's health insurance program, c.h.i.p., and the community health center fund. i agree wholeheartedly about the importance of extending these programs. but what our republican colleagues seem to ignore is that our safety net is interconnected. to tear down medicaid, which is supported by c.h.i.p. and community health centers, is misguided and hypocritical. mr. chairman, i believe we should judge a nation by how it treats its children.
c.h.i.p. covers 8.9 million kids. it stands on the shoulders of a strong medicaid program that covers 37.1 million more children. every single one of those kids deserves access to a doctor and access to good health care. yet every republican on this committee voted for a program that capped coverage. as a result of that vote, 3 million children would lose health insurance. that's simply not right. today we'll have a conversation about community health centers also. the providers that serve so many of our most vulnerable children. the community health center fund provides 70% of the funding for the health center program, which accounts for 20% of revenue for community health centers. according to estimates, failure to reauthorize this funding will result in the closure of approximately 2800 health centers and 50,000 clinicians and other staff losing their jobs. and most importantly, 9 million patients losing access to care. so i strongly believe in a swift
reauthorization of this funding for community health centers. at the same time, i will remind my republican colleagues again that medicaid is the largest single funding source for community health centers. providing more than 40% of their revenue during fiscal year 20 service. we can't ignore the devastating consequences that republican efforts to cut medicaid by $834 billion over the next ten years will have on community health centers and millions of americans. and this includes four in ten children living in poverty nationwide who currently receive care at community health centers. so mr. chairman, gop efforts to repeal the aca and jeopardize the medicaid program will harm children significantly. so i urge my colleagues to first immediately reverse course and stop the dismantling of the medicaid program. i yield the remainder of my time, split between ms. castor and mr. lujan. >> thank you, mr. pallone.
after decades of bipartisan work, the overwhelming number of american children have health coverage. 95%. that is something to celebrate. and i wanted to thank all of the policymakers, the doctors, the nurses, folks back in our local communities that have worked to achieve a 95% coverage rate. this is smart policy. this makes america stronger. kids are healthier. they do better in school. they misfew fewermiss fewer day. they're more likely to attend college. and they earn higher wages. but all of this progress is at risk, because the gop has produced bills, one here in the house, one that's even worse in the senate that came out yesterday, that will rip coverage away from america's kids. all of the progress we have made is at risk. why? just to give massive tax cuts to
wealthy special interests? those are not our values. our values are reflected in the fact that we work together in a bipartisan way to make sure that kids see a doctor and get the care they need. what the gop bills do is the most radical, detrimental restructuring of children's health care ever proposed under the 50 years of medicaid. and it must be rejected. and in fact, it's wholly inconsistent for us to be talking about c.h.i.p. reauthorization, because medicaid and c.h.i.p. are so closely interconnected. you cannot have a c.h.i.p. reauthorization without a strong medicaid initiative. so let's jettison those plans and work together to cover the ran remaining 5% of kids that don't have health care coverage. i'm happy to yield to mr. lujan. >> medicaid is the single largest health suinsurer for children. 95% of children now have health
coverage, an all-time high. sadly, medicaid is in the crosshairs of our republican colleagues. you've heard the numbers. 37 million kids who depend on medicaid nationwide, the 3 million of the 23 million people who will lose coverage are children. a strong c.h.i.p. program depends on a strong medicaid program. you can't reach out in the guise of reauthorizing c.h.i.p. while cutting a trillion dollars from medicaid with the other. you can't have it both ways. i yield back. >> the chair thanks the gentleman. the gentleman from new jersey yields back. the chair makes a technical observation that s-chip is authorized until the end of fiscal year 2019 as was accomplished in the affordable care act. it was only funded through year 2015. this is the second funding bridge that has had to occur because of the fiscal cliff that