The President and congressional leaders pledged to pay for "every dime" of new health spending during these days of soaring deficits. But ever since it was signed the game has been to point in horror to devices in the bill to satisfy that pledge (eg cutting Medicare doc fees by one-fifth) and tthen to try to"fix" them by hiding items in other bills. No wonder Americans have lost trust in government.

Jennifer Luray and Pete Stark point to items they say need to be added back to health programs or added to the legislation. Many would agree, though others might not. But there is surely a bottom line we can all agree on: If something is so vital that it must now be added, then something less vital should be removed. I'm sure both can offer a list of savings and then Mr Stark will gain the support of the Blue Dogs.

Extending Enhanced Medicaid Match Vital for Women’s Health

Jennifer Luray

President, Susan G. Komen for the Cure® Advocacy Alliance

When the so-called Tax Extender bill (H.R. 4213) moved through the House, the enhanced Medicaid match was removed. With the election approaching and voter anger over mounting budget deficits growing, it’s understandable that many in Congress are anxious about new spending. Yet, this enhanced Medicaid match is vital for the millions of women who depend on state-funded breast cancer screening programs. Congress has another chance to restore these life-saving funds.

We cannot stress this fact enough: early detection saves lives. The five-year survival rate when breast cancer is discovered early is 98 percent. It plummets to 23 percent when the cancer has spread to other parts of the body. For most women, access to routine screening mammograms is critical for early detection.

Women without private insurance rely on a patchwork of protection for their breast cancer screening and treatment. The access to screening depends upon a mixture of federal (CDC’s National Breast and Cervical Cancer Early Detection Program), state and non-profit funds. Susan G. Komen itself contributed $30 million towards CDC’s NBCCEDP programs last year. Yet, governors around the country are cutting back on these screening programs, leaving hundreds of thousands of women with nowhere else to go.

In California our grassroots have been working tirelessly to preserve state screening funding and the outcome is unclear. South Carolina has already cut $1 million in breast cancer screening funding and without the Medicaid extension will be forced to cut another $1 million, meaning 8,000 more underserved women will lose access to affordable breast cancer screening. Women in other states face similar fates.

It’s clear from governors, state legislators and our grassroots advocates on the ground that an extension of the enhanced Medicaid match will enable states to maintain these safety net services for uninsured, underinsured and low-income women. These women will not get regular screenings and instead face later diagnoses, more advanced cancers, and lower chances of survival. Of course, this also leads to higher costs for the government down the road. Women may also lose access to affordable breast cancer treatment like surgery, chemotherapy and radiation.

Extending the enhanced Medicaid match for six months will carry the benefit through the end of most states’ fiscal years, and will help promote economic stability at the state and local level. Most importantly, it will help states protect critical health care services like breast cancer screening for low-income, uninsured and underinsured women.

For more than a year our advocates have been working in states across the country to protect breast cancer screening programs. But the federal Medicaid extension is critical to these efforts. We’ve expressed this to Senate and House leadership and our grassroots advocates are right now reaching out to Capitol Hill. Congress must pass the enhanced Medicaid match — in this case, women’s lives are literally at stake.

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As of this time it looks like the continued Medicaid bailout has been added back into the so-called "tax-extenders" bill. The U.S. Chamber cannot support this bill because it significantly raises taxes. Therefore we also applaud Rep. Stark for his opposition!

From a health care perspective, perhaps we should ask ourselves - are we ready for Medicaid bailouts to become a permanent part of this entitlement?

Do we really want to give a sense of permanence to COBRA subsidies, turning that into an entitlement too? Even knowing that this hurts small businesses, who have to pay up front and get reimbursed by the government later? How many interest-free loans should Americans be forced to give the government?

How about, instead of funneling money into Medicaid and COBRA, we lower taxes, sign free-trade agreements, and take other actions laid out in the U.S. Chamber of Commerce's Strategy for New American Jobs? Then instead of needing to be impoverished or on COBRA to have health insurance, more Americans could acquire gainful employment and contribute to the economy.

Then again, this would be a counter-productive strategy if one's goal was to foster an environment where as many people as possible were dependent on the government...

This in an excerpt from my floor statement on the tax extenders bill May 28:

Three days ago I would have held my nose and supported this bill. I deplore many of the corporate tax breaks extended here, I don’t believe it goes far enough to close loopholes that encourage off-shoring, and I am angered that it fails to fully close the carried interest loophole. However, the bill did include other key provisions to protect working families and Medicare beneficiaries.

Unfortunately, "Blue Dog" Democrats insisted that many of those key provisions be removed. Rather than reforming Medicare’s physician payment system and creating several years of stability, the bill has a 19 month patch that is far less than what is needed. The bill eliminates the COBRA premium assistance program that enabled families to maintain their health insurance while they are between jobs. They even went so far as to remove emergency Medicaid funding for states that was the only hope to prevent states from dumping women, children and frail seniors off their Medicaid rolls.

What Congress does has consequences. When we choose to subsidize corporations through the tax code, rather than sustain Medicaid or the COBRA premium assistance program, our choice means people will lose health care. I was reminded of this sad reality yesterday when a constituent called to tell me he is getting laid off next month. Without COBRA assistance, which expires on Monday, he will be without health care. He was put in the difficult position of suggesting his employer terminate him earlier so his family could afford to remain insured. That isn’t a choice anyone should be forced to make.

I cannot vote for this bill knowing that we are cutting off health care to the unemployed, while continuing absurd tax breaks, such as the so-called Research and Development Tax Credit. GAO has found that this credit provides a windfall to huge corporations to engage in behavior they would have engaged in with or without the credit. Eliminating this credit and other wasteful corporate credits would allow us to pay for COBRA assistance. Unfortunately, Congress is choosing corporate interests over the interests of families and workers.