WASHINGTON – U.S. Senator Bill Cassidy, M.D. (R-LA), ranking member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, delivered remarks during today’s markup of health care reauthorizations.
Click here to watch the markup live.
Cassidy’s speech as prepared for delivery can be found below:
Thank you, Chair Sanders.
You know, we can agree with the diagnosis and disagree with the prescription.
Because I accept everything you said about the crisis in health care. The Obamacare expansion of Medicaid has been unsuccessful at expanding access to primary care. Dental services are paid for by Medicaid for the poor. But they're paid so poorly that dentists cannot keep their doors open.
So we can acknowledge a failure of that policy. On the other hand, it isn't important what I think about this. If we're talking about increasing the number of primary care physicians, talking about how do we better serve, talking about workforce, what is probably more important is what stakeholders say. I'll refer to this later, but let me just take an excerpt from America's Essential Hospitals. America’s Essential Hospitals mission means they shoulder a disproportionate share of unreimbursed care. And I can give you more.
These hospitals are concerned that these experts in providing culturally competent care to their marginalized communities will be harmed by this bill.
That's important. That isn't Bill Cassidy. Those are the people that are frontline in addressing those who are marginalized.
Well, let's talk about workforce. Here is from the American Hospital Association. Put another way, provisions in this legislation to cut hospitals and health systems are cuts to the health care workforce, as more than half of the hospital's expenses reimburse nurses, physicians, technicians and other team members. That's something about the workforce provision.
And then let's talk about the Association of American Medical Colleges. If we're doing something good for your health, for medical training, maybe the AAMC would have something to weigh in on:
“I write today, however, to express deep concern that counterproductive measures included in the legislation jeopardize patient access to care, etc.”
Now, it is important the bill says it's important with the people who are frontline say, and they do not care for this legislation.
Since becoming Ranking Member, I worked in good faith to reauthorize the Community Health Center Fund, National Health Service Corps, and Teaching Health Centers Graduate Medical Education program before they expire in a manner that could secure broad, bipartisan support on the Senate floor.
Republicans care about community health centers. As the Chair likes to say, President Bush pledged during his campaign to fund 1,200 new health centers. He exceeded his promise during his eight years in office, working with Congress to double the size of the program through discretionary investments.
The Community Health Center Fund now provides an additional mandatory funding stream to those centers. I understand the Chair’s passion for the Fund. He created it in the Affordable Care Act – somewhat of a consolation prize of sorts at the time, since Senate Democrats weren’t ready to support single payer. It is now a bipartisan priority. We have reauthorized the Chair’s Fund on a bipartisan basis three times. It isn’t easy, because mandatory funding presents logistical and practical challenges, but we have always gotten there.
Every reauthorization has been short. We always fight for longer funding cycles and more certainty for community health centers, but we can never find the money. Bipartisan offsets are scarce. The biggest pot of mandatory funding in HELP’s jurisdiction is student loans. What a lightning rod. When we did Surprise Billing in 2020, it was practically a miracle. We never thought we’d have that kind of mandatory savings in the HELP Committee, and we used those savings for a three-year extension of the Community Health Center Fund.
With that context in mind, I was open to a funding increase when the Chair and I began discussing reauthorization. My goal was to reauthorize the Fund on time, which Congress had failed to do in 2017 and 2019 to great detriment. We need to fully offset our spending, and we need comprehensive Hyde protections. Those aren’t big asks. Every single reauthorization has met those parameters.
So how did we get where we are now? We’re marking up a new proposal six legislative days before the program expires. We have no time to align with House counterparts, guaranteeing that we’ll have to do at least a short-term, flat-funded patch. Not a good outcome for community health centers, who wished to have certainty and were scheduled to receive an increase in funding from the House bill.
The Chair first proposed increasing the Community Health Center Fund more than 500 percent, to more than $130 billion dollars. He kept telling me I needed to come closer to his $130 billion dollars. I proposed a variety of funding increases, all of which I knew we could offset on a bipartisan basis, which were within HELP’s jurisdiction. The Chair responded to every offer I made with the same $130 plus billion dollar proposal – but with each response he added new policies, like pilot projects and expansions of other workforce programs.
We were not going forward, and our deadline loomed. Ultimately, I introduced a bill that provides two years of increased funding for Community Health Centers. It’s a five percent bump – nothing to sneeze at. It passed the House Energy and Commerce Committee with a unanimous 49-0 vote. That is bipartisan consensus in a House which typically does not have any consensus. We should have marked up that bill in July and built on its success. We could have used August to pre-conference any Senate-adopted amendments with our House counterparts and had something ready to go before September 30.
Now we have the plan that Chair Sanders has just spoken of. But you know what he didn’t answer, which HHS can’t answer, is how many new providers and access points the funding would support for all this money we are pumping into primary care slots? We know that states are doing their part to address health professional shortages, does this proposal make it so that these efforts are better or worse?
I feel like this is so typical of Washington, DC. We don't think through a problem. We just throw money at it and feel good because we've thrown money at it. There is nothing here that is evidence that throwing money is actually going to help. It might, we don't know. But that's because we didn't have hearings on it. We didn't pursue.
By the way, this proposal is not close to being paid for. We don’t have a CBO score. The Chair acknowledges we have to rely on other Committees to close a multi-billion dollar gap. And the Chair says oh, don't worry, trust me, I'll get the money Finance always steps in to contribute the offsets. But you know, this has to be bicameral and bipartisan. And as a senior member of the Finance Committee, I can tell you there is not a lot of money to go around. We have so many priorities in Finance. So, if you've been told that Finance is coming to the rescue, get it in writing because right now we cannot believe it. If you think, anybody who's going to vote for this, that this is going to be paid for out of Finance, let me repeat. We have gotten no guarantees on that. So, are we going to be responsible or are we going to be aspirational?
Now, by the way, this is inside baseball. If you are watching on CSPAN, you’re probably not following. But it is important context. We can report anything we want out of Committee. But the requirement for attaching Committee-reported bills to a government funding vehicle is extremely high. If you haven’t noticed, it’s hard to fund the government. Controversial amendments are off the table.
Generally, the threshold is that Chairs and Ranking Members for every Committee of jurisdiction in the House and the Senate, plus bipartisan, bicameral Leadership must sign off on authorizing bills trying to hitch a ride on a funding vehicle. That includes offsets. You can’t just go to CBO’s website and copy and paste someone else’s legislation until you’ve offset the amounts you want to spend.
Other Chairs have their own goals and priorities to spend money on. What about their Ranking Members and House counterparts? If you’re lucky enough to spend someone else’s money on a goal, they have to be more than just meritorious. It is usually the kind of consensus-driven effort that a President pushes for in a State of the Union speech.
This legislation actually circumvents a recent high-profile effort reflecting months of negotiation between the President and House Republicans and was broadly supported by Senate Democrats. The so-called “lockbox” the Chair creates transfers money between Treasury accounts and directs the Appropriations Committee to spend money on HELP’s behalf. This spending does not show up on anyone’s balance sheet, unlike a traditional mandatory funding stream. I know Senator Braun wants this to be paid for. This isn’t paid for, it is laundered. It is taking money that should be discretionary and making it into mandatory spending. Contributing to our problem of mandatory spending, driving our nation's indebtedness, and Congress not taking responsibility for otherwise developing the resources. By the way, it doesn’t hit the appropriators’ caps either.
And so the beauty of this is that it pretends to be paid for, but it’s not paid for. It's one of those games we play in Washington to assume we’re being fiscally responsible to the people back home on a press release. But it's really not.
I didn’t vote for the Fiscal Responsibility Act, that what I’m describing. The Chair didn’t either. But it is the law. What’s the point of passing laws if all we do is navigate around them? We are $33 trillion in debt and supposedly we’re committed to addressing that.
If you ask me if I think the Chair wants to increase health care access, I do. But this isn’t legislating. If you want to do something positive for patients, then actually do the work to find the offsets on a bipartisan, bicameral basis. Don’t just say someone else will figure it out. If you don’t pay for it, then all you have is a messaging bill. That is cynical. It is manipulative. You're trying to tell the voters you're doing something when you know at the get-go it’s not going to happen. And that’s one of the worst things about Washington. That’s why people distrust what happens here.
The lack of commitment to deadlines, offsets; it’s not glamorous but it’s indispensable. The lack of commitment means that we wasted critical time when we could have been reaching consensus on realistic funding increases for these important programs. Aspirations cannot become law. To still be stuck at this step in the legislative process on September 21st does not help patients. Instead, Community Health Centers are going to be flat funded at least for several months and maybe for the next year. A failure to reach and build consensus, develop viable offsets, and reach agreement across the Capitol hurts the very people the Chair wishes to help.