Mr. Chairman, I am pleased that we have an opportunity today to take a fresh look at reforming the Medicaid program. I commend you for holding this hearing, to continue our three-year discussion of Medicaid. During the last Congress, we disagreed strongly about turning the Medicaid program over to the states in the form of block grants. I am delighted to see no references to block grants in the Governors' testimony today. I hope this portends good things to come, and that it means we will work together to find the best way to address the Medicaid program.

Health insurance for children has become a focal point for bipartisan agreement in Congress this year. The President has proposed a number of initiatives to expand health insurance coverage for uninsured children, and members of both parties have embraced this concept. This is a good thing.

However, as we work toward this laudable objective, we must not lose sight of the fact that since its inception in 1965, Medicaid has been the sole source of health insurance coverage for millions of low-income seniors, people with disabilities, and women and children. Today, one out of every four children in America is insured through Medicaid. Any action we take in this Committee to reduce Medicaid expenditures or change the program under the guise of providing flexibility to states will affect access to health care services for twenty-five percent of our children. What we do about Medicaid could immediately undermine our shared goal of insuring more children. Indeed, rather than expanding health insurance coverage for children, we could inadvertently increase the number of uninsured children. While I support increasing health care coverage for children not currently eligible for Medicaid, we should not do it at the expense of the poorest and most vulnerable children.

As we have examined Medicaid reform, we have seen two recurring themes. First, we have been urged to reduce the federal commitment to basic health and nursing home care for people who depend on Medicaid, with reductions ranging from $7 to $26 billion. Today, we will hear the Governors express concern that this range of savings would force states to choose among cutting provider payments, reducing benefits, cutting back on eligibility, or slowing efforts to expand coverage for children. In fact, to quote from the Governors' testimony, "there is less room to squeeze additional savings without having a detrimental effect on the number of people served by Medicaid or on the range of benefits they receive." This was a theme I heralded often in the last Congress. I'm pleased to see the Governors and I finally agree.

Second, we have discussed giving states greater flexibility to administer the Medicaid program. In some areas, this may be appropriate. But, a few of these proposals bear greater scrutiny. For example, repeal of the so-called Boren Amendment has been suggested. This provision, of course, requires that states pay nursing homes "reasonable and adequate" rates. The testimony we will hear today projects that this change alone would save $6 to $8 billion in federal Medicaid spending over four years. Total State and federal Medicaid spending on nursing home care is estimated to drop between $10.5 and $14 billion over 4 years. I am very concerned that this form of so-called "flexibility" will only invite a return to the disgraceful conditions that existed before the 1987 nursing home reforms: frail elderly and disabled Americans warehoused and abused in chronically substandard facilities.

I look forward to hearing from the Governors today. I also urge you to afford all of us an opportunity at future hearings to hear from other beneficiaries of the Medicaid program, including representatives for children, seniors, people with disabilities, and pregnant women. We must be certain that as we look at reforming the Medicaid program, we also ensure that what we propose is not a wolf in sheep's clothing. A no-strings-attached block grant, even by any other name, is a dangerous concept, and we should be on our guard against it. We must not jeopardize a health insurance program, that is vital for many of the most vulnerable people in our country.

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