Hearing of the House Committee on Oversight and Government Reform - Lack of Hospital Emergency Capacity: Will the Administration's Medicaid Regulation Make it Worse --Day Two
Statement
Hearing of the House Committee on Oversight and Government Reform - Lack of Hospital Emergency Capacity: Will the Administration's Medicaid Regulation Make it Worse --Day Two
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REP. CHRISTOPHER S. MURPHY (D-CT): Thank you very much, Mr. Chairman.
Welcome, Secretary Leavitt, Secretary Chertoff.
For the last four years before I came to Congress, I was the chairman of Connecticut's Public Health Committee in our legislature, charged with this very issue -- making sure that we had appropriate surge capacity and everyday capacity in our hospitals.
Mr. Leavitt, I was reading through your testimony and it's dazzling at some level, the amount of bureaucracy and commissions that we've created around this issue -- ACD, NBSB, ECCC, ASPR, NRF. And I'm sure these are worthy commissions. I'm sure they're looking at important questions. But as somebody who was doing this on the ground floor, this is all new to me. As a state policymaker, we knew that Medicaid was not just about supporting people, it was about supporting institutions as well. They're one and the same. You can't help people unless you have institutions that are there and willing to do the work. And so the distinction, I guess, is a little bit troubling to me.
But we also didn't know too much about these grants that were coming to us, because we really knew that in order to keep these hospitals up and running, in order to keep capacity working, we needed Medicaid. We couldn't do it with grants alone.
Mr. Leavitt, Mr. Chertoff, if the staff has it ready, I'd like to just draw your attention to a chart, and this, I think, gets at -- I think this gets at Chairman Waxman's question about the amount of money that is going to hospital preparedness grants. This is I think a fair representation of, over the last several years, the amount of money that has been going into hospital preparedness grants starting at ($)498 million in 2003, dropping now to a proposed ($)362 million in the proposed budget for the coming fiscal year -- a pretty sharp decrease. And ($)362 million over 50 states spreads pretty thin.
The real, I think, rub here is when you compare it to the Medicaid cuts.
You can put that chart up now.
Now, this is the grant money that states are getting -- ($)362 million proposed in the next year -- compared to the impact of the Medicaid cuts. Now, this is the state Medicaid director's estimates.
If you take the CBO estimates, you're still talking about five times the amount of Medicaid cuts as you're talking in grant money to hospitals. And I think every state appreciates that grant money, but it's a drop in the bucket compared to what hospitals are going to face with regard to these Medicaid cuts.
Do you have -- I guess I ask this to you, Secretary Leavitt -- do you have concerns that these grants, dwindling year by year, are going to be dwarfed by the size of these cuts? And though those cuts are going to obviously see their way through the entirety of a hospital's operation, no doubt much of it is going to end up in the emergency room. Do you have a concern that these cuts, these Medicaid cuts -- you say they're to support individuals; they inevitably have to support institutions in order to support the individuals -- are going to dwarf those grants?
SEC. LEAVITT: Mr. Murphy, the distinction on institutions and people is not one that we have arbitrarily made. It's in the statutes. Over time, states have inappropriately claimed Medicaid dollars in a number of categories which had the direct impact -- I know you know this as a state legislature (sic) -- of crowding out all of the other activities, including the development of public health and emergency systems.
Medicaid was not designed, nor is it intended, to support institutions. Money should be directed to people. We support people. We support poor people, pregnant mothers and the disabled. This is not intended to be a hospital entitlement. Now, I understand that they have come to rely on it in some cases. That's precisely the reason that we are pushing back to the fee-based consultants who are driving this on the basis of they're getting a piece of the action to push Medicaid into every area of state government. It's not just emergency preparedness. It's in schools. It's in child welfare. It's in all the places that the states are not adequately funding. They're trying to get a garden hose into the Medicaid fund.
REP. MURPHY: But we're not talking about those places today. We're talking about institutions that are indisputably linked to health care, which are hospitals, and the fact is is that you say it's about supporting individuals, but the money doesn't go to individuals; it goes to institutions; it goes to doctors; it goes to hospitals; it goes to outpatient clinics because we know we need those places up and running.
And so let me just shift to a related question, and this is building off of Mr. Sarbanes' question.
You talk about the fact that ultimately this isn't going to happen in emergency rooms. If something enormous happens, you're going to have to build something outside of the emergency room. But doesn't that capacity, whether it exists in the physical confines of the emergency room or not, rely on the assets that exist right now in those emergency rooms? If we are gutting the capacity of hospital emergency delivery systems -- in terms of equipment, in terms of personnel, in terms of expertise -- it seems to me, Mr. Leavitt and Mr. Chertoff, that this directly impacts your ability to then move that capacity off site even if it isn't on site of the hospital grounds.
SEC. LEAVITT: Again, a very important point, Mr. Murphy. We're bringing capacity in. In the first 24 hours of an emergency, we're dependent upon local assets, and that's where you clear out the emergency room, you take anyone who's nonessential or out of the hospital, you make capacity. Within 24 hours, we have the NDMS system there; we have as many as 6,000 beds we can bring from all over the country. We then go to another phase where we start taking patients into capacity. At any given moment, we know how many hospital beds are available in the area. We are not dependent upon the hospital facilities except for that 24-hour period. And that's why we exercise and train for all of the other aspects on surge capacity.
REP. MURPHY: And I appreciate that. I know enough about how these things work to know that they still do draw upon local resources, they still do draw upon other hospitals, upon other capacity within the system. And, as Mr. Sarbanes and others have suggested here today, we have maxed out both the emergency and nonemergency capacity of our health care systems to the point that that extra capacity, even in the 48- and 72-hour window, simply doesn't exist.
Now, you can fly it in from all over the country, but I think this problem exists across the board. Our emergency medical technicians or emergency medical personnel are working 24/7 just to handle existing capacities right now, never mind being able to move over to emergency when it does happen.
My time has expired, Mr. Chairman.
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