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Floor Speech

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Mr. GRASSLEY. Mr. President, Congress, 3 weeks ago, passed the One Big Beautiful Bill, and in that bill was a modest, cost-sharing requirement for able-bodied Medicaid expansion of adults that were making more than 100 percent of poverty.

The cost-sharing requirements would not apply to primary, prenatal, pediatric, mental, substance abuse disorder, emergency room care, or care provided by community health centers, certified behavioral health clinics, or rural health clinics.

Now, under the One Big Beautiful Bill, this cost sharing that is required for able-bodied Medicaid adults can't exceed $35 per visit, and there is an annual maximum limit of no more than 5 percent of an individual's income.

Well, you might ask: Why cost sharing? Having a modest cost sharing ensures consumers have skin in the game and thus, in turn, be responsible healthcare consumers.

Adults in Medicare earning between 100 and 133 percent of poverty are most likely to gain health insurance through the Federal marketplace or through an employer, where cost sharing is common. Despite fearmongering about cost-share requirements, establishing modest cost- sharing requirements in Medicaid is not anything brandnew. It has been around for quite a while.

So let me give you a little bit of history. The Obama administration approved a half dozen Medicaid waivers, including my home State of Iowa, to establish modest cost sharing for able-bodied Medicaid adults.

Congress, in addition, has enabled cost sharing before. Obama made that move. In the 2005 Deficit Reduction Act, which included my Family Opportunity Act, we expanded State flexibility in Medicaid to let States establish cost sharing up to 10 percent of the cost of services for those making over the poverty limit.

The law also lets hospitals impose cost sharing for nonemergency services provided in the emergency department. The cost-sharing policies had support from the Governors of both parties, from a National Governors Association working group. At a 2005 Finance Committee hearing that I chaired, Governors said modest Medicaid sharing ``[utilizes] market forces and personal responsibility to improve health care delivery.''

Another example is in the 1990s, Congress enabled cost sharing in the Children's Health Insurance Program. To this day, States are allowed and do impose cost sharing in that program. Even socialist proposals like Medicare for All have also included cost sharing.

So I want to make very clear: This is nothing new. Modest cost sharing is a commonsense policy for those benefitting from a government program and who have the means to pay for it.

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