Conference Report on S. 1932, Deficit Reduction Act of 2005

CONFERENCE REPORT ON S. 1932, DEFICIT REDUCTION ACT OF 2005 -- (House of Representatives - December 18, 2005)

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Ms. SCHAKOWSKY. Mr. Speaker, I want to raise my concerns about the Medicaid provisions in the House-passed budget reconciliation bill and, in particular, the provision that imposes new documentation requirements on individuals and on states.

There are many, many problems with the Medicaid bill. It would shift costs and take away benefits from those who need assistance the most: children, pregnant women, people with disabilities and frail senior citizens. The House-passed bill would do real harm--30 million Americans could face higher cost-sharing, 2 million children could lose coverage altogether, and 26 million individuals could lose benefits according to an analysis by the American Progress Action Fund.

One of the most disturbing provisions in the bill--Section 3145--would impose strict new documentation requirements on Medicaid applicants. Instead of allowing self-declaration of citizenship--as 47 states do today--applicants have to show documentation of citizenship status--such as a birth certificate or a passport. The authors are Section 3145 are apparently concerned that some ineligible immigrant pregnant woman, children or seniors--will slip through the cracks and get health care. Out of that unjustified and undocumented concern, they have created a provision that will actually penalize citizens and state Medicaid programs.

First, there is no reason for Section 3145. It is a measure that seeks to address an illusory problem. Eligible immigrants already have to provide proof of their legal status when they apply for Medicaid, and states take steps to verify that status. Current law is working.

The Office of the Inspector General (OIG) looked at this issue and reported last July that they found no substantial evidence that immigrants are falsely claiming citizenship to qualify for Medicaid. OIG did not recommend eliminating the opportunity for self-declarations. The Centers for Medicare and Medicaid Services has found no evidence that there is a problem and state Medicaid administrators have ``not seen a problem with self-declaration of citizenship'' based on the results of their quality control review systems.

Second, Section 3145 would have a disastrous effect by erecting Medicaid barriers for U.S. citizens. These new requirements will mean that those who have no money to obtain these documents or no time to wait for care will be unable to receive medical services. The Center on Budget and Policy Priorities has concluded that the ``bulk'' of the $735 million, 10-year savings from Section 3145 would come from reducing or delaying enrollment for U.S. citizens.

Many citizens--particularly low-income citizens--do not have birth certificates in their possession and do not have passports. And getting those documents is neither easy nor cheap. Getting a birth certificate can take weeks and cost up to $23. People born at home may not even have a birth certificate--a particular problem for people in some rural areas and elderly African Americans. According to information reported in Population Studies, as many as one-fifth of African Americans born around 1940 don't have a birth certificate. Getting a passport is even more expensive and takes even longer. Passports cost about $90. Just think about how these provisions will affect older women, living alone, possibly cognitively-impaired.

Third, at a time when we are cutting federal Medicaid funds and states are struggling to pay their share of Medicaid costs, Section 3145 would impose a brand new and costly administrative burden on them. The OIG surveyed state Medicaid directors who allow self-declaration. Twenty-five said that they were encouraged by the Centers for Medicare and Medicaid Services to simplify their application processes in order to reduce barriers to health care access. 28 said the requirement for documentations would delay eligibility determinations, twenty-five said it would increase personnel costs, and 21 said it would be burdensome and expensive for applicants.

This provision is not necessary but it is dangerous. It should be rejected.

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