Transcripts For CSPAN2 Hearing Focuses On Childrens Health Insurance Program And Outpatient Care... 20170623

The subcommittee on health will now come to order. The chair wishes to observe that this 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 and they continue to need our prayers as they fight to heal and recover and in the incoming days, join us again. Last weeks tragedy reminds us that what unites us is more of port and then 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 are Common Service to our fellow countrymen, that spirit of unity, pause for just a brief moment of quiet reflection for those, especially the member of the committee who is not able to be here today, but of course we still have other people who are recovering from their injuries. The chair will recognize himself or five minutes for an opening statement. In 2015, this committee passed the medicare act and chip reauthorization act. Youre welcome. Which extended funding for mending of the nation safety net programs, including the Community Health Center Funding and the state Childrens Health Insurance Program. With funding for both programs 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 longterm path to funding and reauthorization. The Community Health center fund plays an Important Role in supplementing the services the 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 Corporation which actually provide 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 were young and energetic and willing to work hard in some of the most medically underserved and challenging areas. The state Childrens Health Insurance Program provides healthcare coverage to over 8 million children across the nation through flexible capital lots allotment to state, they have 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 Health Centers and best maximize this investment. Exceeding in 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 Childrens Health Insurance Program, there are multiple points for consideration, as is the case with other federal Insurance Programs. There are considerable concerns regarding the longterm sustainability of the program, following the passage of the Affordable Care act the programs federal match rate rose an unprecedented 23 providing some states with as much as a one 100 federal match. This increase in funding has challenge the program by both shifting the nature of shared responsibility of the state Childrens 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 and elimination of the match rate would not impact coverage rates for children in the country while it 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 the cause. Todays hearing should focus on how to best perceiv proceed with the Affordable Care act increased funding for the state Childrens Health Insurance Program, the increased funding rate, and what it continuation of this funding would mean for taxpayers and what it would mean for children with these challenges before us i would like to welcome our witnesses and thank them again for joining us. Thank them for their forbearance at the hearing was rescheduled twice. On the chip front, we have jamie snyder who served as the associate commissioner in my home state of texas, and missing the man who served the administration as the administrator and director of the center for medicaid and Chip Services at the center for medicare and Medicaid Services from 2009 until 2014. I am interested in hearing how each of your expenses 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. Finally, mr. Michael holmes serves as the ceo of Cook Area Health Services which i believe is in minnesota, and is the treasurer for the National Association of Community Health centers, mr. Holmes, i look forward to your testimony on the role of Community Health has played in supporting your work. There is much to discuss today. I look forward to our conversation. They provide state and local opportunities to improve access to care in the united states. I yield back the balance of my time and recognize Ranking Member subcommittee mr. Green of texas, five minutes front opening statement. Thank you, mr. Chairman. Again, we appreciate the lawson injuries we have but i am glad he is progressing very well. The Childrens Health Insurance Program are critical components of our healthcare safety net. Funding for both expires at the end of this fiscal year and timely reauthorization is utterly critical. That said, we cannot talk about either without talking about medicaid and the elephant in the room. The American Healthcare act, or trump care gets medicaid, make structural changes that would inevitably lead to the rationing of care. After seeing the House Republicans bill to kick off 14 billion in rowleys on medicaid, cut 834 billion from programs, the senate plan to kick even more kids off medicaid overtime and makes deeper cuts somehow managing to be more mean than the hospital. In three years it will start the process of picking millions off their medicaid coverage. Then, as if that wasnt enough, starting in 2025, the plan managed even more medicaid cuts that every year becomes deeper than the year before. It was designed to set on top a strong Medicaid Program. Re authorizing it while simultaneously destroying medicaid is unacceptable. Trump care jeopardizes coverage for millions of kids with medicaid and chip in the trump budget doubled down on cuts that directly hurt kids. To make matters worse, the Trump Administration proposal it rolls back on states and cut support for kids over 250 of the federal poverty level. More than one third of all the children in the u. S. And half the kids under age six are covered by medicaid or chip. The vast majority of these children, more than 90 are covered by medicaid. I strongly support chip and will continue to urge my colleagues to fully extend the program for five years and ive long champion 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 and Health Insurance programs, clean extension of these two pillars of the healthcare safety net is of utmost importance. Again extending these programs without destroying medicaid is unacceptable. Chip stands on the shoulders of a strong Medicaid Program and in fiscal year 2016, medicaid provided more than 40 of the Community Health centers funding. They are tied together as three legs on a stool that help children get health care they need. No child should be left off course because the congress actions. With that 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. Thank you. Ladies and john, anyone who has welcome the child into this world knows that moment when you lock eyes with your son or daughter the first time. The promise that you make to protect them under any circumstance. You learn quickly that the matter how hard you try, nature will test the strength of the promise. Children are not immune to unexpected accident or lifethreatening diagnosis. We as a country in a community invest in their care through chip, medicaid and a ban on lifetime caps and a strong Community Health care center. It is our recognition that society are the Precious Resource that brings us together this morning. Trump care threatens the compassion for our kids. It segregates and stigmatizes children not just for their illness but the faith and fortune of their family. That is something 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. Thats why we have been working in a bipartisan way to make this country get closer to that goal. Ive worked on the very first chip bill in 1999, and because of the bipartisan collaboration, 95 of americans children have coverage. That is an alltime high. Why would Congress Pass this trump care bill which will take coverage away from over 3 million children. There would be an unprecedented 834 billion cut in medicaid which covers more than 35 million kids. Half of the 9 million children are in medicaid. Its hard for me to see how we can have a bipartisan reauthorization of chip by the end of september without a Strong Foundation of medicaid. I yield back. The gentleman of texas yields back. The chair thanks the gentleman recognizes the gentleman from oregon. Today marks a really important step forward in this committees worked. [inaudible] Congress Needs to renew funding for these important programs. The current funding streams will soon expire. We recognize chip plays a significant role in the safety net for millions of americans and pregnant women who are generally low to moderate income. 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 and they are our friends. My district alone there are 12 federally qualified Health Center organizations with 63 delivery site leveraging more than 41 million in federal money in order to serve over 240,000 patients. In many parts of oregon, they serve as the Main Healthcare provider and in some of my counties, there are no physicians and there are no hospitals. The Student Loan Repayment incentive offered through the National Health Service Corps also helps staff those centers to ensure patients in those communities can see a provider in a timely manner. Im glad to be here and join my colleagues, hopefully on both sides of the aisle, in moving this process forward. We are united in the effort to protect patients and support innovative Patient Centered Solutions at state and local levels. As a result there is strong bipartisan recognition that chip in the Health Center program play key rolls in our nations Healthcare 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 and deliver costeffective 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 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 trichip programs and Health Centers. We want to better understand of these programs face barriers to innovation. We want to hear Creative Strategies to deliver quality care and we seek your guidance on whats working and whats not. As we move forward, the committee face is considerations regarding funding for these programs. There are decisions to be made regarding how much funding should be provided and how long and how congress should pay for it as to not burden the next generation with additional debt. Particularly, the committee will closely examine the question of whether the 23 bump for a state match is appropriate as we look at funding questions but i have concerns that a 23 increase up ends the traditional state federal partnership. I know we all share the goals of reducing cost and ensuring patients have the peace of my making continued 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 aisle. Its important to know that chip is one of those programs that is a block grant through the state that seems to perform quite well when we rely on our partners. With that, i am happy to yield the balance of my time. There is a vote on the floor, there is still almost nine minutes left so with the committees permission, i will recognize the Ranking Member, mr. Pallone five minutes for an opening statement, after which we will recess for votes until votes have concluded on the floor. You recognize for five minutes. Thank you. A little over a month ago, House Republicans voted to repeal the Affordable Care act and got the Medicaid Program in order to give tax cuts to the rich and privileged few. The result, 23 Million People could lose Health Insurance. 3million of them children, and yesterday, Senate Republicans finally made public their bill where they proposed even steeper cuts to medicaid. Today republicans will talk about the importance of our safety net program, the Childrens Health Insurance Program chip and the Community Health center fund. I agree wholeheartedly with the importance of extending these programs, but what our republican colleagues seem to ignore is that our safety ne net is interconnected. To tear down medicaid which is supported by chip is misguided and hypocritical. Mr. Chairman, i believe we should judge a nation by how it treats its children. Chip covers 8. 9 million kids and 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 good healthcare. Every republican on this committee voted for a bill that capped coverage for kids in our communities. 3million children will lose their Health Insurance and thats simply not right. Today will have a conversation about Community Health centers to provide and serve our most vulnerable children. The Community Health center. Funds provides 75 of the funding for the 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 50000 clinician and other staff losing their jobs, and most importantly, 9 million patients losing access to care. I strongly believe in a swift reauthorization of the funding for Community Health centers. At the same time i remind my republican colleagues and medicaid is the largest single Funding Source for Community Health centers, providing more than 40 of their revenue. We cant ignore the devastating consequence that republican efforts to cut medicaid by 834 billion over the next ten years will have on Community Health centers and millions of americans. This includes four in ten children living in poverty nationwide who currently receive care at Community Health centers. Mr. Chairman, gop efforts to repeal the aca and jeopardize the Medicaid Program will harm children significantly. I urge my colleagues to immediately reverse course and stop the dismantling of the Medicaid Program. I yelled the remainder of my time split between ms. Castor. Thank you. We are at a remarkable place here in america, after decades of bipartisan work, the overwhelming number of American Children have Health Coverage. 95 . That is something to celebrate. I wanted to thank all of the policymakers and doctors and nurses, the folks in our local communities who have worked to achieve 95 coverage rate. This is smart policy. This makes america stronger. Kids are healthier, they do better in school, they missed less school, there likely to attend college and they earn higher wages. All of this progress is at risk because the gop has produced a bill that will rip coverage away from americans kids. All of the progress we have made is at risk. Why give massive tas tax cuts to massive corporate interests . We Work Together to make sure kids can be a doctor and get the care they need. What the bill does is the most radical, detrimental restructuring of Childrens Healthcare ever proposed under the 50 years of medicaid. It must be rejected. In fact, its wholly inconsistent for us to be talking about chip reauthorization because medicaid and chip are so closely interconnected. You cannot have chip reauthorization without a strong medicaid initiative. Lets Work Together to cover the remaining 5 the kids that dont have health care coverage. Im happy to yield the balance. Medicaid is the single Largest Health insurer for children. Because of medicaid, chip program, 95 of all children now have Health Coverage at an alltime high. Sadly, medicaid is in the crosshairs of our republican colleagues. You heard the numbers. 37million kids who depend on i it, the 3 million of the 23 Million People who will lose coverage our children. Its simple. A strong chip program depends on the strong Medicaid Program. You cant reach out with one hand in the guise of reauthorization while cutting a trillion dollars from medicaid with the other. You just cant have it both ways. I yield back. The gentleman from new jersey yields back. The chair thanks gentleman. They make a technical observation that chip is authorized until the end of fiscal year 2019. It was only funded through fiscal 2015. This is the second funding bridge that has had to occur because of the fiscal cliff that was built into the aca. We now stand adjourned until immediately, in recess until the last vote. Come on. [inaudible conversations] [inaudible conversations] [inaudible conversations] the hearing is in recess so members can cast vote on the house floor. This portion of the hearing and the entire event will be viewable after words on cspan. Org. The news from capitol hill, paul ryan speaking about tax reform. He tweeted, had another very productive meeting about tax reform with senate and white house leaders. We are going to get this done in 2017. The hill reporting this morning the Senate Health care bill had a rocky rollout yesterday as republican senators complained it doesnt do enough to repeal obamacare or lower healthcare costs. The blowback raised doubts over rather Mitch Mcconnell will be able to stick to his aggressive schedule of voting next week. He is at least two votes short of majority and maybe more. For conservative republican senators, rand paul and mike lee, ted cruz and ron johnson released a statement thursday afternoon announcing they dont support the legislation though they are open to negotiation. We will be back with more live coverage from the hearing when they return from the vote. Here is a portion of todays washington journal. We are back. On your screen, to members of the educational workforce committee, Glen Thompson a republican of pennsylvania and democrat of illinois, i want to thank you both for being here this morning to talk to us about this issue. I just want to begin with defining what is career and Technical Education. Mr. Thompson, if you want to go first. Sure. Career and Technical Education is an education path that may involve certification course, training, maybe an associate degree, it really is about opportunity. Its estimated by 2020 as many as 6 million jobs will be open because of the skills gap where individuals are not qualified or trained to be able to fill these positions. E these are great family sustaining positions but they are positions that also drive our economy. Without these positions, we are going to face some difficult economic times. Career and Technical Education is basically skills based education is maybe the easiest way to summarize it. You two came together for legislation and the past and the house yesterday. What would your legislation do. This legislation does a couple things. A it does many things, but a couple in particular worth noting, it really moves a lot of the authority for career and Technical Education fromto washington. I think thats important for high school and Community College districts. The skills that are being taught need to be consistent with the ones in need in the local areas. The second big change that i want to tell your viewers about is that it requires that local employers be consulteded when the local school