U. S. Troops Readiness, Veterans' Health, and Iraq Accountability Act, 2007

Floor Speech

U.S. TROOP READINESS, VETERANS' HEALTH, AND IRAQ ACCOUNTABILITY ACT, 2007 -- (Senate - March 28, 2007)

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Mr. DURBIN. Mr. President, will the Senator yield for a question?

Mr. WARNER. I am pleased to yield to the Senator.

Mr. DURBIN. I respect the Senator and his service to our country in uniform as well as the Secretary of the Navy and of course his service in the Senate. I ask him this question:

Let's assume that 120 days from now, the report comes back and says the Iraqi military is not prepared to stand and defend its own country. What responsibility then falls on our shoulders?

Mr. WARNER. Mr. President, it seems to me we have to face the reality of fact. Now, this would be an independent report. Obviously, I think the Department of Defense would come back and provide some rebuttal or some additional information, so we would have to take all the viewpoints and put them together. But what I say to my distinguished colleague from Illinois is we are still relying solely upon these reports that come on an annual basis. I read through them, and I encourage others to do so. It is very difficult to glean from these reports that sound, basic fact: Are they trained? Are they equipped? Are they ready? Most importantly, I say to the Senator, do they have the commitment in their hearts to take orders and fight on behalf of the Iraqi people? That is what concerns me because of the large amount of AWOL, absentees, and all the other types of things that are reflected in this report.

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Mr. DURBIN. Mr. President, earlier today, when I was at a hearing, my friend and colleague from Iowa, Senator Grassley, came to the floor to speak about a provision which I have added to this bill. I would like to address Senator Grassley's remarks.

Senator Grassley said that an amendment which I added in the Appropriations Committee, in his words, would ``lead to anarchy in the Medicaid financial arrangements.'' He said it would prevent CMS from taking any action relating to the rules related to Medicaid reimbursement and SCHIP reimbursement.

Senator Grassley recounted a time not that long ago when there was abuse of the Medicaid Program; where, in fact, States had figured ways to receive Medicaid funds and multiply them through accounting methods and use them in many instances for other purposes. In fact, Senator Grassley talked about the fact that under this behavior of the past, the money the States managed to multiply through accounting techniques could be used for roads or for stadium construction. That is true. I thought it was an outrage. As a result, there was a hue and cry on Capitol Hill for a change in the law or more enforcement and these abuses were rooted out. I am happy to say my State of Illinois did not participate in any of these scams. I am proud they did not. Other States did, and it stopped, as it should have.

Then there was a negotiation between the Federal Government and States about this Medicaid formula. It is extremely complex. I wish it were as easy as some would portray, but it is not. So many States had negotiated with the Federal Government to reduce the Medicaid payments or to adjust Medicaid payments to acceptable levels. Many provisions of Medicaid reimbursement that had been agreed to by the Federal Government were changed and amended. That happened. The Federal Government, through CMS, had the authority to do that, and they did.

There are still several States in negotiation about this reimbursement from the Federal Government. I am hoping that negotiation will end in a positive way, as others have in the past, and I think it will. In the meantime, the Department of Health and Human Services comes in with a rule, a proposed rule, and says: Well, we would like to change the law in terms of these Medicaid reimbursements. Unfortunately, this rule they proposed is so sweeping it would cut off in my State of Illinois some $600 million in reimbursement to Medicaid providers, primarily public hospitals serving poor people.

I want this negotiation to continue. Clearly the Federal Government has the authority to continue this negotiation. I will not stand and defend any misuse of Federal funds or fraud. My concern, and the reason I offered this amendment, was the rule is so sweeping it goes too far.

Senator Grassley has made a point, and others have backed him up, that this is probably the jurisdiction of the Finance Committee of the Senate, not the Appropriations Committee that brings this bill to the floor. I will acknowledge that point, but I also want to make it clear, this isn't the first time we have talked about this issue. In fact, it has been 2 years now when Senator Grassley was chairman of the Finance Committee that we appealed to him to have Congress take the initiative and work out this problem. Unfortunately, Senator Grassley couldn't schedule it in his busy schedule on the Finance Committee, and nothing was done.

The purpose of this amendment is simply to declare a moratorium on the new rule until we can put together this new approach through the Finance Committee. That is it. I am not standing here to defend any fraudulent practices. I don't want to take away from our Government any powers to enforce the law to stop any waste of taxpayers' dollars, but I want to make one point clear as well. When our State of Illinois entered into an agreement with the Federal Government about Medicaid reimbursement, it wasn't so we could use some backhanded accounting approach to build a road or a stadium. No. What we tried to do was to use accounting methods which would increase our opportunity to provide medical services to poor people and uninsured people. Our money we are receiving through Medicaid is used for health care and health care exclusively. This is the way it should be. It is a Medicaid program for health care. What we have done in Illinois with these funds is extend the reach of health care to uninsured people and provide services that otherwise would not be provided, such as specialized services many poor people never have a chance to receive.

I am proud our State has used this opportunity to expand care to people who need it: neonatal care for children who were born too soon and need the absolute best care immediately, and specialized care for those in every stage of life that otherwise wouldn't be available to them.

I say to my colleagues first, Senator Grassley is right, we should not tolerate fraud in any way in Medicaid. This amendment does not. Secondly, we should urge every State to negotiate their accounting standards so they are consistent with the Federal Government, and I think that is taking place and should continue. In addition, I think this rule needs to be stopped at this point in time. Let the Finance Committee step in. Let us come up with an approach that works. In the meantime, some States that could be affected by this rule are concerned. If there is a cutoff of funds from the Federal Government to treat poor people, we know what will happen. These people will fall between the cracks, they will come to an emergency room for charitable care if they are lucky, they won't have the preventive care they need to keep themselves and their families happy, and they will pay a price in their life in terms of the quality and length of their own lives that are at stake here.

I urge my colleagues: Let's keep this provision in this supplemental appropriations bill. I urge my colleague Senator Grassley, whom I dearly respect as a real leader here in the Senate, to work with Senator Baucus and others. Let us address this issue, not with this sword hanging over our heads about a rule that could come down and cut off hundreds of millions of dollars worth of funds for health care for poor people, but in a rational way that gives to each State what it is entitled to, and no more.

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AMENDMENT NO. 784

Mr. DURBIN. Mr. President, I also wish at this moment to mention an amendment I am going to offer to this supplemental appropriation to increase funding for international peacekeeping by $50 million. It is amendment No. 784, cosponsored by--I am not offering it at this time, but I will at a later time--Senators BIDEN, MENENDEZ, LEVIN, and others, to meet the urgent needs in Darfur, Sudan, and the surrounding region.

I believe these urgent peacekeeping needs constitute a true emergency by definition in this bill and should be funded. That was the amendment I originally filed and my colleagues joined in cosponsoring. I also recognize we are under severe budgetary pressure and I have been told I have to find an offset for the $50 million.

I do this with reluctance, but let me share with my colleagues a few numbers. The United States has spent $592 million in the construction of a gigantic Baghdad embassy--$592 million. For 2007 and 2008, the administration has requested $2.8 billion for mission operations in Iraq. To put this in perspective, the State Department's request for diplomatic and consular operations for the rest of the world for fiscal year 2008 is $5 billion. So $2.8 billion for Iraq, $5 billion for the world. This supplemental as passed out of the committee contains over $700 million for diplomatic and consular operations intended for Iraq.

This amendment, as I modified it, would shift $50 million from this sum to peacekeeping. Why do we need the peacekeeping? Because there are 7,000 African Union forces who are doing their best to protect hundreds of thousands, if not millions, of poor people in Darfur. I think this $50 million is not too much to ask. A slight trim, a little trim on the money that might be available for the $592 million Baghdad embassy, is not something that is unreasonable. They will have time to come back for more money if they need it.

At the appropriate moment I will offer this amendment. I hope my colleagues will join me in supporting it.

I yield the floor.

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