Mr. President, I rise today to address a growing problem in my home state of Hawaii and the nation, individuals that do not have health insurance. The total number of uninsured people in the United States reached 43.6 million in 2002. Since 2000, the total number of uninsured has increased by 3.8 million. In the State of Hawaii, it is estimated that there are approximately 120,000 people that do not have health insurance.
Mr. President, the uninsured delay seeking medical treatment, which is likely to lead to more significant and more costly problems later on than if they had sought earlier, preventative treatment or proper disease management. Health insurance is essential to making sure that individuals can access health care services and properly manage their chronic diseases, such as diabetes. A tremendous amount of needless pain and suffering can be eliminated by ensuring that health insurance is universally available.
Everyone should have access to affordable health insurance. We must expand Medicaid and the State Children's Health Insurance Program (SCHIP) to provide essential access to health care for more people. In addition, we must take steps to help rein in health care costs in an attempt to keep coverage affordable. Providing additional resources for disease management programs and primary health care services will lead to long-term savings and benefits. Also, meaningful prescription drug patent law reforms need to be made to ensure that generic drugs can be brought to market in a timely manner.
Mr. President, we are also obligated to help provide support to health care providers that provide uncompensated care for the uninsured. In Hawaii, it is estimated that hospitals lost $95 million for uncompensated care in 2002. However, while other states benefit from Medicaid disproportionate share hospital (DSH) payments designed to provide additional support to hospitals that treat large numbers of Medicaid and uninsured patients, Hawaii is left out of this important program.
The Balanced Budget Act of 1997 (BBA) created specific DSH allotments for each state based on their actual DSH expenditures for fiscal year 1995. In 1994, the State of Hawaii implemented the QUEST demonstration program that was designed to reduce the number of uninsured and improve access to health care. The prior Medicaid DSH program was incorporated into QUEST. As a result of the demonstration program, Hawaii did not have DSH expenditures in 1995 and was not provided a DSH allotment.
The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 made further changes to the DSH program, which included the establishment of a floor for DSH allotments. However, states without allotments were again left out. Other states that have obtained waivers similar to Hawaii's have retained their DSH allotments. Only two states, Hawaii and Tennessee, do not have DSH allotments. I was disappointed that language similar to an amendment that I had offered, which was accepted as part of the manager's package for the Senate's prescription drug bill was not included in the conference report for H.R. 1, the Medicare Prescription Drug and Modernization Act of 2003. The language that was finally included prevents Hawaii from obtaining its DSH allotment as long as the QUEST program remains in place.
Medicaid DSH funding is needed because our hospitals in Hawaii are struggling to meet the elevated demands placed upon them by the increasing number of uninsured people. DSH payments will help Hawaii hospitals meet the rising health care needs of our communities and reinforce our health care safety net. All fifty states need to have access to Medicaid DSH support.
While Hawaii continues to be denied this assistance, many states fail to fully utilize their DSH allotments. For FY 1999, more than $1.2 billion was returned to the Treasury because states failed to draw down their full Medicaid DSH allotments. More than $800 million was returned to the Treasury for FY 2000. It is unfair that while certain states are declining to use their full allocation, states with no or small allotments are being denied the use of these resources. A viable option to provide relief for Hawaii and other low-DSH states is to redistribute funding that other states have returned to the Treasury. It is not fair that states that either lack any DSH funding or have low-DSH allotments cannot have an opportunity to apply for these excess funds to help bolster their public health safety net.
I appreciate all of the work done by my colleague from New Mexico, Senator Bingaman, to help provide relief to low-DSH states. I look forward to continuing to work with my colleagues to help restore Medicaid DSH payments to Hawaii. Also, we must continue our efforts to improve access to health care so that everyone can obtain affordable, comprehensive, and quality health care coverage.
Thank you, Mr. President.
