Indian Health Care Improvement Act Amendments of 2007

Floor Speech

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Ms. KLOBUCHAR. Mr. President, I rise to speak in strong support of amendment No. 4023. This is the amendment my friend, Senator Mikulski, just spoke about. It is a bipartisan amendment. Cosponsors are myself, Senator Mikulski, Senator Coleman, and many other Senators from across this country.

This amendment would stop the administration from making drastic changes to its targeted case management system that would hurt those in our country who are most in need of assistance.

Targeted case management benefits children in foster care, kids and adults battling mental illness, and seniors and disabled people receiving institutional care. It exists to help those individuals to navigate the complicated web of available services, to help these men, women, and children overcome bureaucratic barriers in order to achieve independence. These services include transporting people with disabilities to and from doctor's appointments as well as managing pharmacy services for individuals with severe mental illness. These essential services are now threatened by a proposed rule change from the Centers for Medicare and Medicaid Services.

For 8 years, I served as the chief prosecutor and top lawyer for Minnesota's largest county, serving Minneapolis and 45 suburban communities, with a population of over 1 million people. In that role, I worked closely with our county child protection and adult protection agencies, with our hospital, which was the biggest emergency hospital in the State of Minnesota. So I saw firsthand what would happen if we did not prevent people from getting in trouble, what would happen when they would end up at the emergency room or when they would end up in the jail because they were not getting the necessary mental health care they needed. I know firsthand the vulnerability of these individuals, young and old, and the responsibility of Government to help them achieve as much independence, well-being, and dignity as possible.

When Congress passed the Deficit Reduction Act in 2005, it clarified exactly what services are eligible for payment under the Targeted Case Management Program. Senator Mikulski went through those important services.

Unfortunately, the Centers for Medicare and Medicaid Services has since come up with a rule that goes miles and miles beyond what Congress intended. That rule is scheduled to be implemented next month. This impending rule will have a devastating fiscal impact on States and local communities. It will endanger the well-being of vulnerable people who benefit the most from these crucial services.

Our States received over $2 billion in funding for targeted case management in 2005. If this rule is put into effect, that funding will be slashed in 2008.

I want to use one example; it is from a county in my State, Dakota County. Now, this is not exactly a sort of wild-eyed county; it tends to be a more conservative county in our State. But, like any other county in our State, they have needs for case management services for people who are mentally ill, seniors, young kids who need help. This county has made a practice of developing a cost-effective, community-based system of services that relies heavily on case management. Why did they do it? Well, they did it to save money.

Medicaid funding has been key to developing service alternatives in homes and in less expensive settings than in institutional settings. This is the kind of innovative, cost-effective approach we want to encourage from Government. Instead, with this sudden rule change, they are being punished. Even worse, the vulnerable individuals they serve are being punished.

I always believed this was a country where we wrapped our arms around the people who need the help. That is what America is about. That is what patriotism is about. But with this rule slash-and-burn of all these services, they are not wrapping their arms around these people, they are rejecting them for Dakota County, this suburban county in Minnesota.

For States such as California, Colorado, Maryland, New Jersey, New York, and North Dakota, pulling the plug on targeted case management will disrupt the lives of those served by these cost-effective efforts. Furthermore, in the end, it will just increase the total costs borne by State, local and Federal governments, which means all of us as taxpayers also pay more. It simply defies common sense.

Our amendment will postpone the Center for Medicaid and Medicare Services' rulemaking by 1 year. We need a year to examine exactly how badly this will hurt our States and local governments, especially the children, the disabled, and the seniors who need these services most.

I occupy the Senate seat once held by Hubert Humphrey. Some of my colleagues had the great privilege of serving in the Senate with him. Hubert Humphrey was someone who, of course, was never at a loss for words. Many of those words were memorable.

There is one statement in particular that I believe is very appropriate for this topic. Senator Humphrey once said this:

The moral test of Government is how that Government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadow of life, the needy, the sick, and the disabled.

I submit that this hasty, ill-considered action to cut essential services for the most vulnerable people fails that moral test of government. I believe we can and we must do better. That is why I strongly support our bipartisan amendment, an amendment focused on saving money in the long term by keeping people in settings that actually save taxpayers money, by not slashing funds to the most vulnerable in our society. That is why we support this amendment, and we ask our colleagues to vote with us.

I yield the floor.

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