00:00:35.740 - 00:01:20.700

Oh. Mm. Okay. Mhm. Okay. Uh huh. Mhm. Trump. Yeah. Mm. Hello. I'm Lawton Child's and I want to welcome you to this month's edition of The Lawton Child's Update and our last program. We sort of stood in the doorway and looked at what goes on inside the Senate Budget Committee this month.

00:01:20.710 - 00:01:36.450

I want to invite you to take a much closer look at how the committee really combs through the president's budget in a systematic way. Unfortunately, it's not possible in the time we have to review the whole budget. This is just one of the seven books that explain the president's budget.

00:01:36.940 - 00:01:56.250

Even in its 992 pages, We can't unravel all the decisions that went into devising his financial plan for the coming year. So today we'll zero in on just one of the federal departments, the Department of Health and Human Services for a close up of how the Senate Budget Committee does its work.

00:01:57.540 - 00:02:19.660

HHS, as the department's call for short, is responsible for Medicare, Social Security, health research and a long list of other programs. The department itself has roots stretching back to the days of Republican Theodore Roosevelt when he used the creation of Children of the Children's Bureau to combat the exploitation of youngsters.

00:02:20.240 - 00:02:42.750

Later, in 1953 President Eisenhower signed legislation creating the Department of Health, Education and Welfare, the forerunner of the current HHS. With the department's long history and key programs, the budget Committee has to be very thorough when it analyzes the spending of this department. It's not enough to just rely on the cold numbers.

00:02:42.760 - 00:03:05.870

We've got to find out the reasoning behind those numbers. So we asked the department secretary to come and answer questions about the $200 billion plus budget. He's a former state governor. His name is Otis Bowen. He's a medical doctor by profession. As chairman of the Senate Budget Committee, I welcomed him and raise some of the issues that would get further attention during the course of the hearing.

00:03:05.990 - 00:03:21.250

It seems to me, Dr Bowen, we can only be competitive as a nation if we all contribute as a people, and we'd be wise to keep in mind that the measure of national excellence is not always who's the best, whether we're doing the best we can.

00:03:22.540 - 00:03:38.850

It's a race that sort of has a staggered start. Some begin with a broad field of opportunity in front of them, and others have hurdles that they have to across before they can even get to the starting line. Not everybody has the inside of the track.

00:03:39.540 - 00:03:58.360

When you look at our population, you can tell we're growing older. That doesn't have to be a handicap. It can be an opportunity. As our people grow older, they want to continue to grow as individuals and I elderly have talents that they're more than willing to share if they're helping our young people gain a step.

00:03:59.090 - 00:04:18.860

In recent years, a good many programs at HHS have taken deep spending cuts. This year, the budget proposed more reductions. Obviously, with the deficit on one side, but so many people in need on the other, there's some major choices to make. It's something I raised with Dr Bowen just before his testimony.

00:04:19.240 - 00:04:49.630

Few people are more aware than the members of this committee of the constraints imposed by the federal budget. We can't do everything that we'd like to do as quickly as we'd like to do it, but we know we must do better, and we must be more creative and thoughtful than some of the courses prescribed by your budget During the course of the hearing today and the days and weeks that followed, I hope we can begin the kind of constructive examination and it turns the disappointments into progress turns, barriers and opportunities.

00:04:50.240 - 00:05:07.490

If we listen to one another and work together, we may yet discover the will to find that way. When Dr Bowen spoke, he explained the main components of the budget for the Department of Health and Human Services. He described how money was divided among the chief areas his department serves.

00:05:08.540 - 00:05:33.260

Federal entitlements make up the overwhelming share of the HHS budget. Foremost among these are the social security programmes, with benefits amounting to more than $200 billion and accounting for almost 61% of the dollar outlays. Next in magnitude is Medicare, with an allocation of $73 billion approximately 20% of the budget.

00:05:34.540 - 00:06:04.970

Then comes Medicaid, with an allocation of $27 billion or 7%. Other entitlement programs account for $27 billion or another 7%. Discretionary programs amount to almost $15 billion and are a mere 4% of the budget. Once Dr Bowen's opening statement was finished, senators started in on the main reasons the committee holds these meetings to ask why, why certain program was cut or cancelled.

00:06:05.080 - 00:06:22.960

Why was another left untouched? Whether it's the Department of Defense, the Treasury, the Department of Agriculture or, in this case, the Department of Health and Human Services, the committee members want information and explanation. And our hearing, one of the first issues to come up was Medicare.

00:06:23.620 - 00:07:03.960

Once again, the numbers don't always tell the full story. Both Senator Sasser of Tennessee and I wanted to hear about the cuts firsthand from the official responsible for the recommendations. The administration is proposing to increase out of pocket beneficiary expenses on Medicare for new beneficiaries. Now that comes on top of out of pocket increases over the last six years of 89% in Part B coverage, 169% in charges to beneficiaries for Part B co insurance and 100 and 71% in charge.

00:07:03.960 - 00:07:31.270

Deductions passed on to beneficiaries for unassigned claims. And when I go into my state and talk to the elderly citizens there, they are wringing their hands about Medicare and the expense. And when we look at the statistics, we're now saying that the average elderly American is paying more out of his or her own pocket for medical expenses.

00:07:31.270 - 00:08:01.660

And then they did years ago, before the advent of Medicare. So from that standpoint, Mr Secretary, from a practical standpoint, does the administration really expect the Congress to pass these proposals? Or does your departure seriously expect this Congress and this budget committee to make what, in my estimation, are cuts in, uh, benefits going to Medicare beneficiaries?

00:08:01.660 - 00:08:31.250

Are we simply filling the technical requirements of the budget law and not proposing what this senator would consider a serious budget? Well, it's sort of difficult to answer, but I would say that we have tried to use our own best judgment as to how to allocate the various resources that we have in light of the current budgetary pressures.

00:08:31.840 - 00:09:11.560

And I think if you were sitting, I doubt that you could come up with something that everybody would agree with two. But we have done our best to do that. Now, As to the Medicare increases that you talk about again, I would state that 4% of those are do our our would affect the beneficiaries, whereas 57% would affect the hospitals as providers and 17% in fact positions UH, 18% would affect the third party payers.

00:09:11.570 - 00:09:34.960

Wonder if you give us the dollar values of those You've given us a kind of percent of the recommendations, but, uh, sometimes that doesn't equate to where the dollars are given. The total Medicare budget is $73 billion. Yeah, but the savings that you expect to come out of that you've given us only 4% of the recommendations in fact, affect beneficiaries.

00:09:34.970 - 00:10:17.750

How much savings come from that? This is the savings from the hospitals would be the 57% would amount to three point oh, $3 billion. That's that's one year D 88 the totals for 88 through 91 would be 28,000,000,426. 28 billion right or physicians dollars in 1988 would be 919 million, and over the period, 2 93 91 would be five billion, 416 million.

00:10:19.140 - 00:10:50.750

For the other providers, the savings in 88 would be 205 million and over a five year period, two billion, 220 million third party payers. It would be 947 million for the first year in 88 6.9 billion through 91. For the beneficiaries would be 237 million, or 4% and 88 over the long period.

00:10:50.750 - 00:11:25.960

It would be 12 billion 799 12 million right over the five year period. Yeah, the total Medicare outlays over the five years would be about $530 billion so it's 12 billion out of your proposed total savings over the five years would be, UH 62 is 85 was be about 23%.

00:11:26.840 - 00:11:45.260

So 25 year period, 23%. Even though it's 4% of your recommendations, those numbers again, they sound like something from a bank statement. But behind those numbers of the realities of the way people live, and those are the issues that we have to raise all the time.

00:11:45.930 - 00:12:03.460

Medicare is crucial to us in Florida. In 1985 Medicare paid out $4 billion to roughly 21 million claimants. But recently the claims haven't been paid on time. Early last year, complaints about the delays started coming into my office at a rate of about 100 a week.

00:12:04.140 - 00:12:18.980

That was up from about 20 for the whole preceding year. The growing delays led me to hold a separate hearing on the issue last year in Jacksonville to find out what was holding things up. And at our budget hearing this month, I put the issue to Dr Boy.

00:12:18.990 - 00:12:38.760

I want to ask you what the department's intent is on the prompt pay legislation. I'm confused about your intentions regarding implementation of the new Medicare pump. Prompt pay legislation. As you know, we had some problems last year when we had complaints from thousands of Medicare beneficiaries that their claims were not paid.

00:12:39.440 - 00:12:58.860

When we looked into it, we found that Medicare contractors had been told the whole claims so that they would not be paid before 30 days. The idea was to keep that money and the Medicare trust fund longer so it would earn more interest. We had the typical sort of statement that you don't pay your hardware store for 30 days.

00:12:58.860 - 00:13:17.860

So why should the government pay its bills? A lot of us in the Congress felt that if anyone was going to get paid interest, it ought to be the beneficiaries who couldn't pay their bills because they couldn't get their their Medicare. We passed a law to prohibit a slowdown in claims.

00:13:18.640 - 00:13:36.060

All clean claims had to be paid within 30 days this year in 26 days next year. Our intent was that most of those claims should be continued to be paid as fast as possible. Uh, it wasn't long before, rather than it be paid as fast as possible.

00:13:36.070 - 00:14:00.180

And that 30 days was again, uh, finally, granted, we started off with about 22 days, I think, with the legislation that I was interested in, but they kept saying, For some of these, it'll take us longer. Give us this longer period of time. We didn't get away from here, and we found out that that give us, uh, this extra period of time became the outside limit, and again the instructions were going down.

00:14:00.190 - 00:14:28.230

Wait at least the maximum period of time rather than pay things as quick as we could And another water order went out and said, Forget that 28 day wait and ah, all right, and pay sooner than that. Now we find that, uh, I think your budget says you you don't want to implement the proper pay provision.

00:14:28.480 - 00:14:51.810

So we're getting another signal. What's the signal that goes out there to the that the people that are supposed to be doing this as to whether they're supposed to be paying these claims or not? Our present policy and I emphasize present is that there will be How long will that present lab do we have till noon today?

00:14:51.810 - 00:15:23.760

I mean, or what do we have any? That there will be no mandatory holding or delay of claim of? We stated that in a letter to several congressmen as of December 23rd, 1986 I would have to say that if the policy changes due to the budgetary matters of what would be known to you wrap, please.

00:15:24.140 - 00:15:40.650

Well, I I think I got one of those letters with other people, but of that no unnecessary delay. But then when I talked to the the third party payers that are responsible for the people that are responsible for paying this the Blue Cross blue Shield people and all.

00:15:40.660 - 00:16:00.060

They tell me that their order said pay as rapidly as you can within their operating budgets. Now that's a that's another sort of level. And then when I look and see, uh, I don't think you've approved any contractors budgets yet. So all money for this year is now being held since October.

00:16:00.540 - 00:16:26.160

So if you hadn't improved any budgets Hey, is it this, uh, sort of another signal that's out there? If you're to pay within your operating budget? Well, our contractors, uh, will be permitted to pay claims faster than 30 days, if possible, within their operating budgets. But But if you ain't letting them have the money to operate on, what I'm saying is, they're not gonna be able to pay.

00:16:26.710 - 00:16:57.570

Sometimes the questioning gets a little rugged, but it's not nearly as rugged for senators or the head of HHS as it's been for people on Medicare who have to pay their doctors bills for some time. We've been concerned in Florida about the ability of Social Security officials to provide the quick and cordial service that beneficiaries should expect During the course of the hearing, I released a General Accounting Office report that raised serious questions about the lack of progress in modernizing Social Security computers.

00:16:57.940 - 00:17:25.000

Yeah, Social Security Administration has indefinitely deferred the modernization of computer software, or 94% of transactions for beneficiaries. The completion date for the remaining portion of the software development plan is now unknown, according to the S S, a project manager. Implementation of key aspects of this effort can't even begin until January of 1988.

00:17:25.840 - 00:17:54.460

Pilot testing in the new software system has not included evaluation of its impact on services to the public, and the Social Security Administration has no plan to do such an evaluation in the future. Ignoring GOS previous recommendations, the Social Security Administration has purchased 22,000 computer terminals in September, even though the software that goes with these terminals is way behind schedule.

00:17:55.440 - 00:18:17.860

Uh J. O now warns in this particular report that based on the past trends and the technological innovations of such equipment, it's entirely possible that this equipment will become obsolete before it's fully utilized. So S s a has failed to adopt standards for testing or documenting and validating its computer software.

00:18:18.540 - 00:18:39.050

And without these G s. A. Warns that future modifications to improve the systems are too implement. Legislative requirements could be difficult and costly. The point here is that the Social Security Administration went out and bought 22,000 computer terminals with no assurance the software would get the job done.

00:18:39.440 - 00:19:03.060

My concern over the problems in trying to modernize the computers was matched by a worry over projected cutbacks in Social Security personnel. It sounded to me like the administration was saying there were employees they didn't need because computers could do the work instead. But the computers we found are not ready to do the work so the beneficiary will suffer if we don't stop the cuts.

00:19:04.440 - 00:19:33.460

Your budget calls for a reduction of 4000 to 5000 more staff in 1988 on top of the reductions of many thousands that have already Rickard, the budget proposes to eliminate 17,000 positions about 1990 and 20,000 totaled by 1992. The rationalization for these large percentage of staffing cuts has been software computer modernization.

00:19:34.240 - 00:19:59.470

Remaining cuts have been largely unjustified altogether. Using this rationalization, though, S s A has argued that service to the public would not be impaired by such cuts. Congress has repeatedly talked about this service Thing is repeatedly asked essay whether this could be done now in view of the G A O report showing a huge delays in the computer software modernization.

00:20:00.240 - 00:20:21.460

It's inconceivable to me that such staffing cuts can be made without disrupting service to the elderly and disabled Social Security applicants and beneficiaries. If anything, it looks like your need for staff has increased because of new responsibilities for using Social Security numbers that are now mandated by the immigrant.

00:20:22.140 - 00:20:44.670

Ah, immigration and the tax reform legislation. We'll be right back. Hello and welcome to our special guest, handsomely dressed in a raincoat, a fellow who truly leads a dog's life. Meet McGruff the crime dog. Thanks, Dick. It may be a dog's life, but I'm helping people take a bite out of crime.

00:20:44.680 - 00:20:59.440

Indeed you are. Now, do I understand that neighborhood watch programs have reduced crime in some areas as much as 50%? Ah, that's right. But there's more to be done. Well, tell me about it, which I'm sure he will. You better make sure your neighborhood has plenty of lights.

00:20:59.450 - 00:21:12.830

Leave one on in your house at night and remember, light a light to stop a thief. Shady characters prefer the dark. You got it. Also start a volunteer escort service for older folks. Ha ha! Good news for the old folks at home. What about the young folks?

00:21:12.900 - 00:21:44.250

Start McGruff houses, which are houses kids conduct into in case of trouble. Terrific. Anything else? Yeah, that's a nice jacket, Dick. Thanks, McGruff. Hey, thanks for all you're doing. For more information, write to this address and help help take a bite out of crime. This Social Security issue illustrates another reason for the budget committees persistence in looking behind the budget numbers, we want to know if the deeds and promises are matched by the numbers and the performance.

00:21:44.290 - 00:22:04.460

A further example came when Senator Dodd of Connecticut asked Dr Boeing about how things have been moving since Congress passed last year's landmark drug bill about three or four months ago. I guess most would agree that the major issue of the 1986 presidential campaign, or rather, senatorial congressional campaigns, are there were drug abuse.

00:22:04.940 - 00:22:22.360

We had everyone taking drug tests from the president on down. We had a major bill in Congress, a major bill out of the administration. Quote the president, uh prior to the November 4th election, he says. The total commit the American people and their government to fight the evils of drugs.

00:22:23.740 - 00:22:40.460

And yet in this budget, you cut. They're supposed to cut $913 million in drug related programs, including 225 million grants to states and cities. After we urged to get involved in this program and told them they could count on the federal government to be involved. Have we reneged on that commitment in this budget?

00:22:42.040 - 00:23:17.060

Well, in my judgment, we have not reneged on it. We are not, uh, cutting back on efforts. There's no one that aboard the drug addiction and drug abuse any more than we do, I suspect you are getting after the fact that we are plan to implement the new funding over a two year period, rather than as we've been criticized already for not having added more new money to the program.

00:23:17.540 - 00:23:41.530

The exchange between Dr Bowen and Senator Dodd represents the legislative process in its watchdog capacity when Congress passes a law. The work doesn't stop there. We try to go in and make sure the decisions enacted into law are carried out. According to congressional intent. In the case of the drug bill, the intentions appeared to be jeopardized by later budget decisions made inside the administration.

00:23:41.540 - 00:23:59.670

You realize, of course, when this real effort got underway last year, a lot of state legislatures weren't even in session. They've just begun, uh, again, the fact that 20 states have in that time frame is rather remarkable, and I appreciate your comments, but it seems to me this is a far cry from the rhetoric we heard only a few short months ago.

00:24:00.040 - 00:24:17.700

The concerns of many of us that we were really looking at something more of it wasn't quite the commitment. We were fearful that it was an election, and I say that I might, but I'm not asking to comment on this, but, uh and I appreciate your trying to drape this thing, and it is attractive clothing as possible.

00:24:17.710 - 00:24:35.150

But the fact of the matter is, it's a significant production, and a lot of our mayors and governors across this country are deeply disappointed. Democrats and Republicans, Given the height and the level of rhetoric rhetorical commitment to this program of only a few weeks ago and then to find in this budget as it has submitted kind of cuts.

00:24:35.480 - 00:24:59.270

The concern about funding changes in the drug bill were genuine. But we were equally concerned about another key issue. Catastrophic health insurance. It's a known fact that the greatest problem that our seniors worry about is that illness that will wipe out their savings. And it's a real worry because they've seen it happened to their loved ones, and they've seen it happen to their neighbors.

00:24:59.740 - 00:25:14.460

There's an indisputable need to do something about that, but we need to have a program that we know that we'll be able to pay for. I told Dr Bowen we were ready and willing to tackle the problem, but we had to have a realistic view of what's involved.

00:25:15.240 - 00:25:39.860

Secretary. We want to work with you for a sound catastrophic coverage plan. We'll have to be very clear about what the funding sources that are going to be. It's been a generation since Medicare began, and we're still dealing with funding problems in that program. So let's begin the search for better health coverage by identifying what we need to do and how the administration is prepared to pay for it.

00:25:40.740 - 00:25:58.950

That demonstrates still another one of the reasons why those of us on the budget Committee spends so much time asking questions. Although the deficits a tremendous problem, there are still things we need to do. So it's essential that any time we plan to do something, we've got to find a dependable way to pay for it.

00:26:00.240 - 00:26:19.550

One of the things we've simply got to do is a much better job of making sure our newborn babies have a chance to survive. It's an area where too many tragedies have taken place. A recent report showed. There's a lot to do. We fall into 20th place in the community of nations in the fight against infant mortality.

00:26:20.440 - 00:26:46.900

Just last year, Congress approved my proposal for an organized fight to save our infants. But the administration's budget decided to pay for the effort by cutting funds out of another key program. That one was to combat the growing problem of teenage pregnancy. Well, you talked about infant mortality and case management makes a lot of sense to me that was included in the legislation that we or that could be included in the legislation.

00:26:46.900 - 00:27:07.210

We fast. But I'd like to know your rationale. Why? We, uh we put this initiative in, and we're gonna pay for it out of family planning money A. You know that just we're going to reduce a one device that we have that tries to keep young teens from getting pregnant.

00:27:07.520 - 00:27:30.270

And we're going to put the money in to take care of once they get pregnant of helping the infant mortality Initiative. I What's the rationale for that? The family planning money, as I recall, is a 90% matching rate and that would not be removed entirely would be reduced to 50% rate.

00:27:30.840 - 00:28:08.170

And with those funds, uh, and it would not interfere with the services. With those funds that would amount to $85 million we would have demonstration initiatives launched in 1988 to identify the better ways to manage the prenatal services. Throughout the hearings with Dr Bowen, more questions came up questions about proposed cuts in Medicaid and reductions in research grants at the National Institute of Health.

00:28:08.900 - 00:28:28.330

Sometimes the hearings sound like it's a matter of one side against the other. That's not really the case. The Congress and the president shared the responsibility for cutting the federal deficit, but we also share the responsibility for addressing important national needs. Now the Budget Committee is where those competing demands come into focus.

00:28:28.940 - 00:28:45.860

Our scrutiny of the president's proposals began in the first week of January, and they continued right into March. That was the time for questions. What comes next is much harder. That's when we try to put together fresh approaches to balance what people need with what we can afford.

00:28:46.450 - 00:29:08.050

The budget Committee continues to meet during the spring and try and arrive at a budget proposal to send to the full Senate for debate. It won't be easy. It never is. But on the next program will have a progress report on where we stand. Until then, this is Lawton Child's Please join us again next time for another edition of the Lawton Child's update.

00:29:14.340 - 00:30:20.850

Yeah, Oh, mhm! Wow! Yeah, yeah, yeah! Medicare paid out more than $4 billion on 21 million claims to Floridians last year, and Medicare is just a part of the gigantic $200 billion plus budget for the federal Department of Health and Human Services. We'll examine that budget and see how it affects each of us on the Lawton child's up there.

00:30:21.440 - 00:30:55.850

I'm Senator Lawton Child's. I hope you'll join us. Medicare paid out more than $4 billion on 21 million claims to Floridians last year, and Medicare is just a part of the gigantic $200 billion plus budget for the federal Department of Health and Human Services. We'll examine that budget and see how it affects each of us on the Lawton Child's update.

00:30:56.440 - 00:30:59.120

I'm Senator Lawton Child's. I hope you'll join us.