Medicaid

Floor Speech

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Mr. CORNYN. Mr. President, more than 4 million Texans, including half of the children in my State, depend on the stability of the State's Medicaid Program to provide healthcare for themselves and their families. Everything from emergency room visits to mental health care, Medicaid funding is vital to the health of our most vulnerable friends and neighbors. The same is true in virtually every State across the country.

Unfortunately, a recent move by the Biden administration has put the healthcare of these vulnerable citizens in jeopardy. A few weeks ago, the Biden administration rescinded approval of Texas's 1115 waiver extension. I know that is an obscure reference to most folks, but, basically, here is the long and short of it. The previous administration reached an agreement with the State that will enable billions of dollars to flow to Texans in need. Now, for some reason, the Biden administration is trying to stop it.

The real question is, Why? Why would the Biden administration try to jeopardize the healthcare for 4 million Texans, while the President has consistently talked about ensuring every American has access to quality healthcare. Just 2 weeks ago in his joint session to Congress, he said:

Healthcare should be a right, not a privilege in America.

So why would the administration take an unprecedented action to reduce access to healthcare for some of the most vulnerable people in my State?

Well, the official answer from CMS is to correct an administrative error. But two Federal health officials did an unusual thing in Washington, DC, albeit anonymously. They told the truth. They told the Washington Post that this was done to ``push State officials toward accepting the Affordable Care Act's Medicaid expansion.'' It is pretty bold to admit that this was not about an administrative error at all but about forcing Medicaid expansion onto the State of Texas.

Many people will recall that this was a portion of the Affordable Care Act which was held unconstitutional in an opinion written by Chief Justice Roberts. Chief Justice Roberts said that the Federal Government cannot put a gun to the head of the State and force it to accept the Medicaid expansion since it is a joint program between the Federal Government and the State. Now the administration is engaged in a game of political chicken, with 4 million Texans on the line, and the only ones who are getting hurt are the low-income and uninsured Texans whose healthcare relies on this safety net.

This move by the administration would have been damaging during normal times, but it is even more damaging after this unprecedented year for our healthcare providers. In fact, it is downright reckless. Hospitals and providers in Texas have been pushed to the brink during the pandemic. On top of the additional expenses associated with COVID- 19, they have faced serious financial shortfalls from the pause on nonessential medical procedures as well as the hesitancy of patients to seek care because they have been worried about contracting the virus.

Now, more than ever, hospitals and healthcare providers need reliable funding to plan ahead for their financial stability and uncompensated healthcare costs. If this funding stream goes away or is disrupted, it will directly threaten the healthcare for uninsured Texans and harm the livelihoods of healthcare providers as a whole.

In rural areas and those that are already underserved, the consequences of this move could not be more dangerous. Let's say the Biden administration refuses to change course and Texas loses billions of dollars in Medicaid funding. If uninsured patients in small towns go only to local hospitals for emergency care, they will receive that emergency care because that is another Federal law, called EMTALA. But without the Federal funding to offset those costs, how would these hospitals make ends meet? If these patients aren't paying out of their pockets and the Federal Government is not helping to cover the costs, what will happen?

It is pretty simple, actually. Without funding, the rural hospital will close.

So those same uninsured patients will start visiting the second closest hospital. In my State--it is a big State--that is, maybe, 30 minutes down the road. Maybe it is more than an hour away. Once again, without Federal funding to help cover the costs of treating rising numbers of uninsured patients, what will happen?

Well, that hospital will close too. We will descend into a death spiral of hospitals and healthcare providers that close their doors because they can no longer afford to provide healthcare. The hardest hit patients won't be those with private health insurance; they will be those low-income and uninsured patients, especially in rural and underserved areas.

So the consequences of this irresponsible move by the Biden administration could not be more serious, and they will be felt far and wide because this funding is vital to our healthcare system as a whole.

It is not hyperbole to say that these are going to have life-and- death consequences. While patients in Texas may be the first to get caught in the game of political chicken, they will not be the last. There are only four States that don't have approved or pending 1115 waivers. Four--only four--don't have approved or pending 1115 waivers. Every other State could find itself in the same situation as my State in the coming months.

Florida was granted a waiver around the same time as Texas. What will happen to vulnerable Floridians? Tennessee is already facing legal challenges to its waiver. Will its providers be in jeopardy too? North Carolina, South Carolina, Missouri, Idaho--the list of States that could be impacted by this life-or-death game of chicken goes on and on. The most vulnerable patients in States across the country could lose access to healthcare because of the Biden administration's irresponsible and reckless actions. Something must be done.

To state the obvious, the nominee to lead the CMS, Ms. Brooks-LaSure, did not rescind the Texas Medicaid waiver approval. In fact, she has not been confirmed as yet, but before her nomination can advance, Members of the Senate deserve a commitment from the administration that it won't try to force the hand of States by putting the healthcare of millions on the line.

If we don't step up now and push back against this reckless move, what State will be next? How far will the administration go--in the words of Chief Justice Roberts--to put a gun to the heads of the States, forcing them to dance to Washington's tune?

I have asked the administration to work with Texas to ensure that millions of impacted individuals won't lose access to healthcare, but, so far, there has been zero progress. The administration has been unwilling to provide any assurance that an agreement with Texas could be reached before the end of this fiscal year--something that would have dire consequences for our providers, especially those in mental and behavioral health.

As a reminder, the CMS said the only issue with the Texas waiver was an administrative error. Now it won't even commit to providing reliable care for these patients. This unprecedented action by the CMS threatens the security of the Texas Medicaid Program. It disrespects the continuity of this agreement, and it erodes the partnership between the State and the Federal Government.

I think it also violates the constitutional authority of the States. The Federal Government is one of delegated powers, with the rest retained by the States and we the people. That was the basis upon which the Supreme Court of the United States struck down the compulsory Medicaid expansion under the Affordable Care Act. Yet now the administration seeks to do through the backdoor what it could not do through the front door. This sets a dangerous precedent of the administration's undoing of agreements, negotiated in good faith between the States and the Federal Government, for purely political reasons, and it could have cascading consequences across the country.

I appreciate Ms. Brooks-LaSure's experience in working with States to develop these waivers as well as her willingness to talk to me about this issue, but she doesn't have any authority to force the Biden administration to undo its terrible and reckless mistake, at least not yet. Until Texas can receive a waiver and an assurance that this action will be rectified and the rug will not be pulled out from under our poorest patients, I cannot support this nomination.

I urge my colleagues to stand up for the healthcare of their most vulnerable populations and push the administration to find an alternate path forward. If they are willing to do this to my State, they will do it to your State and every other State in the country.

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