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Delegate, Territorial Governors Fight Medicaid Cuts

Delegate Donna M. Christensen tried unsuccessfully Wednesday to get Republicans to remove steep Medicaid funding cuts to the territories from legislation the party is trying to enact in the House of Representatives to undo part of the Affordable Care Act.

Republicans prevailed on a party line voice vote that did not support Christensen’s amendment. The Committee voted it down 21-30 on a roll call vote along party lines, according to a statement from Christensen’s office.

Legislation in the House Committee on Energy and Commerce right now would repeal a section of the Health Care and Education Reconciliation Act of 2010 that increased Medicaid funding to the territories. If the House measure becomes law, it would cut total federal funding for Medicaid in the territories by 65 percent over the next decade, according to a statement from Christensen’s office.

Republicans control the House of Representatives, while Democrats control the Senate and presidency, both of which would have to cooperate for the cuts envisioned by House Republicans to take effect. Thus, Republicans cannot implement these cuts without support from Democrats as well.

“This cut targets the territories, is irresponsible, unprincipled, unjustified and unnecessary,” Christensen said as she introduced her amendment, “and if implemented would deal the territories a crippling blow.”

Ranking committee member Henry Waxman and Rep. Charles Gonzales (D-TX) supported Christensen’s position with statements of their own.

Meanwhile lobbying from outside of Congress, Gov. John deJongh Jr. and four other territorial governors have sent a letter to members of the House of Representatives defending the Affordable Care Act’s new funding for Medicaid programs in the U.S. insular territories.

The letter urges Rep. Frederick Upton (R-Mich.), the Energy and Commerce Committee chairman of the House Committee on Energy and Commerce, and his fellow House Republicans to abandon plans to deny the new Medicaid funding to the territories.

In addition to deJongh, the letter was signed by Puerto Rico Governor Luis Fortuno, Guam Governor Eddie Baza Calvo, the Northern Marianas Islands Governor Benigno Fitial and American Samoa Governor Tulafono Togiola.

The Affordable Care Act addressed, but did not correct, the traditional discriminatory treatment received by the territories with regard to Medicaid, Christensen said. “The federal government pays at least 50 percent of the Medicaid program’s cost in each of the states and around 80 percent in the poorest states,” she said in her testimony to the committee.

“By contrast, federal law imposes an annual cap on funding in the territories. Historically, the territories’ caps were shockingly low," she said. Along with these spending caps, the federal contribution, or FMAP, for each of the territories was artificially set by statute at 50 percent, even though each of the territories should have an FMAP in the 75 percent to 83 percent range based on their poverty levels, according to Christensen.

A June 2005 General Accounting Office report "brought this problem into sharp relief," Christensen said. The GAO found annual per capita federal Medicaid spending in the territories was only $50, compared to $565 in the U.S. as a whole and over $800 in our poorest states, she testified.

In her comments to the committee, Christensen tried to address concerns raised about the territories’ ability to handle the new money. The Center for Medicaid and Medicaid Services shows that Puerto Rico, American Samoa and the CNMI have not had any trouble spending either the 30 percent increase to the spending caps that the territories received in the 2010 federal stimulus act, or their portion of the $6.3 billion provided in the Affordable Care Act. These three territories, together, represent 92 percent of the territory funding—that is, $5.8 billion of the $6.3 billion provided in the bill according to Christensen.

“The two remaining territories—Guam and the territory I am proud to represent, the U.S. Virgin Islands—together represent only 8 percent of the $6.3 billion—or $500 million,” she said. These two territories have struggled to draw down their ACA funds, but it is critical to understand why that it is the case, she said.

“My territory is in the midst of a severe economic crisis,” she said. “Government workers have had an across-the-board, 8 percent cut in salaries; over 500 government workers have been laid off; our largest private employer has shut down operations; and—while we are making great strides to address it—our households and businesses are being crushed by the cost of electricity, which is the highest in the nation at 45 cents per kilowatt/hour,” Christensen said.

“All of this makes it very difficult for the (territory) to meet the onerous 45 percent match—which has also stymied Guam’s ability to spend down their funds as well. However, this, too, is being addressed, because we intend to spend all of this money, which will for the first time allow us to provide coverage to all of our citizens at and below the federal poverty level," she said.

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