Sequester Replacement Reconciliation Act

Floor Speech

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Mr. MARKEY. Mr. Speaker, I rise in strong opposition to H.R. 5652, the Sequester Replacement Reconciliation Act of 2012.

As the Ranking Democrat on the House Natural Resources Committee, which has jurisdiction over the various insular territories of the United States, I wish to call the attention of my colleagues to the adverse impact of this bill on the 4.1 million Americans who live on the five U.S. territories--Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Marianas Islands.

Of all the cuts being proposed by this bill today, perhaps none is as cynical, thoughtless and irresponsible as the Republican proposal to repeal Section 1204 of the Health Care and Education Reconciliation Act of 2010, which finally mitigated the profoundly unjust treatment that these Americans in the five U.S. territories have always been subject to under the Medicaid program.

If this proposal is enacted, it would cut total federal funding for Medicaid in the territories by 65% over the next decade--a crippling blow that would devastate the territories' Medicaid programs and drastically restrict the ability of millions of Americans to receive care.

The territories' Medicaid programs are already vastly underfunded. By law, they are supposed to receive a 50% federal funding match, but they get nowhere near it. Unlike the 50 states and the District of Columbia, the amount that the federal government can contribute to their Medicaid programs is capped, and so Puerto Rico, for example, receives less than a 20% match.

The 50 states and the District of Columbia, on the other hand, receive up to an 80% match. Even the wealthiest states--which receive the lowest match rates--get 50%.

If the federal match for each of the territories was calculated the same way they are calculated for the states, each of the territories would have Federal Medical Assistance Percentages, (FMAP) in the 75% to 83% range based on their poverty levels.

The results of this chronic underfunding by the federal government are both devastating and predictable: too many patients in the territories receive inadequate care and too many providers in the territories are not adequately compensated for their services.

Because the treatment of the territories under Medicaid was a travesty from both a moral and public policy perspective, the Affordable Care Act (ACA) sought to partially redress this profound inequality. It provided $6.3 billion in additional Medicaid funding to the territories between the fourth quarter of Fiscal Year 2011 and Fiscal Year 2019.

The territories have already begun to use--and will continue to use--this new funding to increase the number of low-income individuals that can receive Medicaid coverage and to provide beneficiaries with essential health services. Prior to this funding increase, the territory governments could not afford to provide many basic services or to cover many of their neediest residents under Medicaid. Every penny of this money will be used.

H.R. 5652 cuts funding that would merely narrow the inequality gap between the states and the territories. It still would not come close to eliminating it.

It is important to remember that residents of the territories are Americans who, if they are not receiving adequate health care, can relocate to the states and become eligible for fully-funded Medicaid whenever they wish. Thus, treating territory residents like second-class citizens under Medicaid is extraordinarily short-sighted.

It is also important to remember that residents of the territories serve in disproportionate numbers in the U.S. military. Residents of the territories have made tens of thousands of deployments to Iraq, Afghanistan and the Horn of Africa since 2001, and nearly 170 service members from the territories have lost their lives.

The Republicans should explain to the hundreds of thousands of soldiers and veterans from the territories why they are ``American enough'' to defend our country in combat, but somehow not ``American enough'' to receive a modicum of fair treatment under critical health care programs.

I urge my colleagues to vote against this mean-spirited bill.

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