[Pages S12206-S12235]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CHILDREN'S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT OF 2007
The PRESIDING OFFICER. Under the previous order, there will now be 2
minutes of debate equally divided prior to a vote on the motion to
invoke cloture on the motion to concur in the House amendments to the
Senate amendments to H.R. 976, the Children's Health Insurance Act of
2007.
Pending:
Reid motion to concur in the amendments of the House to the
amendments of the Senate to the bill.
Reid Amendment No. 3071 (to the House amendment to Senate
amendment to the text of H.R. 976), to change the enactment
date.
Reid Amendment No. 3072 (to Amendment No. 3071), of a
perfecting nature.
The PRESIDING OFFICER. Who yields time?
Mr. ALLARD. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. REID. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. REID. Mr. President, what is the matter before the Senate?
The PRESIDING OFFICER. Each side has 1 minute of debate on the
children's health insurance amendment.
Mr. REID. Mr. President, we yield back the remainder of our time.
The PRESIDING OFFICER. Who yields time?
Mr. GRASSLEY. We yield back the remainder of our time.
Cloture Motion
The PRESIDING OFFICER. Under the previous order and pursuant to rule
XXII, the Chair lays before the Senate the pending cloture motion,
which the clerk will state.
The legislative clerk read as follows:
Cloture Motion
We, the undersigned Senators, in accordance with the
provisions of rule XXII of the Standing Rules of the Senate,
do hereby move to bring to a close debate on the motion to
concur in the House amendments to the Senate amendments to
H.R. 976, SCHIP.
Max Baucus, Ted Kennedy, Jeff Bingaman, Patty Murray,
Barbara Boxer, Tom Carper, Patrick J. Leahy, Charles
Schumer, Maria Cantwell, Dick Durbin, Blanche L.
Lincoln, Robert P. Casey, Jr., Debbie Stabenow, Jack
Reed, B.A. Mikulski, Tom Harkin, Harry Reid.
The PRESIDING OFFICER. By unanimous consent, the mandatory quorum
call has been waived.
The question is, Is it the sense of the Senate that the debate on the
motion of the Senator from Nevada, Mr. Reid, to concur in the House
amendment to H.R. 976, the Children's Health Insurance Act of 2007,
shall be brought to a close?
The yeas and nays are mandatory under the rule.
The clerk will call the roll.
The bill clerk called the roll.
Mr. LOTT. The following Senator is necessarily absent: the Senator
from Arizona (Mr. McCain).
The PRESIDING OFFICER (Mr. Tester). Are there any other Senators in
the Chamber desiring to vote?
The result was announced--yeas 69, nays 30, as follows:
[Rollcall Vote No. 352 Leg.]
YEAS--69
Akaka
Alexander
Baucus
Bayh
Biden
Bingaman
Bond
Boxer
Brown
Byrd
Cantwell
Cardin
Carper
Casey
Clinton
Coleman
Collins
Conrad
Corker
Dodd
Domenici
Dorgan
Durbin
Feingold
Feinstein
Grassley
Harkin
Hatch
Hutchison
Inouye
Johnson
Kennedy
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
Lugar
McCaskill
Menendez
Mikulski
Murkowski
Murray
Nelson (FL)
Nelson (NE)
Obama
Pryor
Reed
Reid
Roberts
Rockefeller
Salazar
Sanders
Schumer
Smith
Snowe
Specter
Stabenow
Stevens
Sununu
Tester
Warner
Webb
Whitehouse
Wyden
[[Page S12207]]
NAYS--30
Allard
Barrasso
Bennett
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Cornyn
Craig
Crapo
DeMint
Dole
Ensign
Enzi
Graham
Gregg
Hagel
Inhofe
Isakson
Kyl
Lott
Martinez
McConnell
Sessions
Shelby
Thune
Vitter
Voinovich
NOT VOTING--1
McCain
The PRESIDING OFFICER. On this vote, the yeas are 69, the nays are
30. Three-fifths of the Senators duly chosen and sworn having voted in
the affirmative, the motion is agreed to.
The PRESIDING OFFICER. The Senator from Nevada is recognized.
Unanimous Consent Request
Mr. ENSIGN. Mr. President, I ask unanimous consent to be recognized
for 5 minutes to make a quick statement, and then I will make a
unanimous consent request, to which there will be an objection on the
other side.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
The Senator from Nevada is recognized.
Mr. ENSIGN. Mr. President, let me make it clear. I support the
electronic filing by Senators in the underlying bill that Senator
Feinstein brought forward. There is an issue I want to raise on an
amendment I wish to add to the bill.
We have a problem going on in the Senate where there are anonymous
outside groups who are filing ethics complaints, and they are doing it
for purely political reasons. As often is the case, this can be fixed
with transparency.
If someone files an ethics complaint against a Senator from the
outside, then they would have to disclose their donors under my
amendment. Right now in the Senate, there is no such requirement for
filing a complaint. The complaints do not have to be sworn, signed, or
even identified, and they can be submitted by a person or an unnamed
group no one will ever know.
The complaints do not have to be submitted in a formal manner. They
can be on a beverage napkin or written in crayon. However, this is not
the case in the other Chamber. In the House of Representatives, they
have very formal, rigorous requirements to file complaints. The
complaints must be sworn to and filed by a Member of Congress. With no
requirements in the Senate, the result is that people create shell
organizations in order to register purely political complaints.
Some say my amendment will prevent people from filing complaints.
This is simply not true. My amendment will make the complaint process
transparent and similar to the FEC process. Has there ever been a
shortage of complaints at the FEC?
If these complaints are being filed purely for political reasons,
then we will find that out because we can see who the donors are. We
need to protect this institution. We need to protect individual
Senators from purely politically motivated ethics complaints that come
against us.
If it is done purely for partisan reasons, we need to know that, and
transparency is, once again, the best way to find that out. All I am
asking is for an up-or-down vote so the Senate can decide if it wants
transparency. It has been said that this bill is unrelated to the
electronic filing bill. I disagree. They are both about transparency.
They are both about the political process. We need to have this
amendment agreed to.
I ask unanimous consent that at a time to be determined by the
majority leader, in consultation with the Republican leader, the Senate
proceed to Calendar No. 96, S. 223, under the following limitations:
that the committee-reported amendment be agreed to, and that the only
other amendment in order be an Ensign amendment related to transparency
and disclosure, with 20 minutes of debate equally divided in the usual
form on the bill and the amendment to run concurrently, and that
following the use or yielding back of time, that the Senate proceed to
vote in relation to the Ensign amendment, and that the bill, as
amended, be read a third time and the Senate proceed to a vote on
passage of the bill, with no intervening action or debate.
The PRESIDING OFFICER (Mrs. McCaskill). Is there objection?
Mr. BAUCUS. I object.
Mr. ENSIGN. Madam President, I yield the floor.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Madam President, what is the regular order?
The PRESIDING OFFICER. The regular order is the motion to concur with
the House amendments to the Senate amendments on SCHIP.
Mr. BAUCUS. Madam President, we are awaiting the arrival of the
Senator from Kentucky. I do not see him yet so I will begin.
Nearly every American schoolchild knows the story told in Parson
Weems' 1800 biography ``The Life of Washington.'' That is our first
President. According to Weems, young George used his new hatchet to
chop down his father's cherry tree. His father asked George what
happened. George was tempted to make up a story, but then in Weems'
famous account, young George ``bravely cried out, `I cannot tell a lie.
I did cut it with my hatchet.'''
I wish all public servants kept the same standard of truthfulness,
especially in this debate. Regrettably, many of today's public servants
appear all too tempted to make up a story. Many are failing to tell the
truth about the Children's Health Insurance Program.
Let me set the record straight.
President Bush has said that our bill ``would result in taking a
program meant to help poor children and turning it into one that covers
children in households with incomes of up to $83,000 a year.'' That is
what our President said. That is not true. There is nothing in the
Children's Health Insurance Program bill that would change current law
and allow States to cover children in families making $83,000 a year.
There is nothing in the current bill that would let that happen.
Nothing in current law; nothing.
On income eligibility levels, the bill maintains current law. It
doesn't change current law, it maintains current law on income
eligibility levels. Current law limits CHIP to the higher of 200
percent of poverty or 50 percent above the State's prior Medicaid
levels. Any State that wants to increase eligibility for CHIP above
those levels has to get approval from the Secretary of Health and Human
Services. That is current law, and that is the law under the CHIP bill
before us today. It is unchanged.
In fact, our bill actually includes new policies to discourage States
from increasing eligibility for kids above 300 percent of poverty.
Under our bill, States that increase eligibility above 300 percent--
again, they have to get approval from HHS to get a waiver--under our
bill, those States that increase eligibility, if they get a waiver
granted by the Bush administration or not, would get the lower Medicaid
Federal match payment for higher income children. Our bill would
decrease the incentive to cover higher income children relative to
current law. It decreases incentives relative to current law.
Our bill also includes new policies requiring any States covering
children above 300 percent to meet a target enrollment level for
covering their lowest income children below 200 percent of poverty.
That is new. States that don't meet the target by 2010 risk losing all
Federal reimbursement for their higher income children. So our bill has
an even greater focus on low-income kids compared with current law.
Our bill will benefit low-income children. The Urban Institute found
that 70 to 80 percent of children helped by our bill are low-income
children with family incomes below 200 percent of poverty. Our bill is
targeted to help exactly the low-income children for which we created
the CHIP program in the first place. Our bill continues that mission
for the next 5 years.
The administration has also said our bill would move too many
children from private insurance into CHIP. Once again, that is not
true. According to Congressional Budget Office Director Peter Orszag--
he is the top person in the independent Congressional Budget Office.
His job is to independently assess what we do. There is no partisanship
at all. He said there is always some ``crowdout'' or substitution of
public coverage for private coverage whenever we create a new
Government subsidy to help people. It always happens to some degree.
[[Page S12208]]
A few years ago--this is important for everybody to remember,
especially the President--when we considered the Medicare prescription
drug bill, the so-called MMA, CBO then said about two-thirds of those
getting the new Government help would already have private coverage.
Two-thirds already had private coverage. I don't remember the
administration complaining about the crowdout then, complaining about
people who might leave private coverage to go to Medicare Part D.
When we enacted the CHIP program 10 years ago, the Congressional
Budget Office projected there would be about a 40-percent crowdout
rate, not two-thirds as the case in the Medicare Part D but about 40
percent. What happened? Our bill has a lower crowdout. It is about 40
percent lower than CBO projected would happen in the program 10 years
ago.
In fact, CBO Director Orszag said this year's Senate bill, which is
very similar to the final bill we are considering, was ``pretty much as
efficient as you can possibly get for new dollar spent to get a
reduction of roughly 4 million uninsured children.''
We went to CBO and said we want to reduce the so-called crowdout as
much as we can; how do we do it. We talked back and forth. And his
assessment is the final bill is ``pretty much as efficient as you can
possibly get,'' lower than any other major crowdout results.
The President also said he has a better plan to help uninsured
children. If he does, he is keeping it under wraps.
The President talked about both his plan to reauthorize CHIP and his
plan to promote private coverage through tax credits. But independent
analyses of both plans suggest that under them, American children would
fare far worse.
For the Children's Health Insurance Program, the President is
proposing a $5 billion increase in Federal funds over the next 5 years.
That is his proposal. The President says that will be enough. The
Congressional Budget Office disagrees. The analysis of the
Congressional Budget Office, again, an independent analysis of the
President's plans, indicates it would not even maintain coverage for
children currently enrolled in CHIP today. it would not even maintain
it. In fact, CBO projects that under the President's plan, 1.4 million
children would actually lose coverage.
The President's tax credit plan does not do much better. The
Congressional Budget Office has estimated only about 500,000 children
will gain new coverage under that plan. If we take CBO's estimates for
these plans together, over 5 years, there would still be a net loss
coverage for a million children--a net loss coverage for a million
children compared with current law.
Causing a million children to lose health insurance is not a better
plan to help uninsured children--not in my book, and I don't think it
is in anybody else's book either.
I am not the only one who thinks what the administration is saying is
essentially not true--in fact, not at all true. Go to the Annenberg
Political Fact Check, a nonprofit media accuracy organization funded by
the Annenberg Political Fund. Go to their Web site: www.factcheck.org.
At the end of the day, our current President named George has a
simple choice. He can bring health coverage to 3.8 million low-income
uninsured children who have no insurance today or he can cut it with
his hatchet, cutting coverage for at least a million children who would
otherwise get the doctor visits and medicines they need through CHIP.
The right choice is to stand bravely with America's children.
I urge my colleagues to join me in making the right choice. Support
the CHIP program. Call on the President to sign this important
legislation.
Support the CHIP bill because the truth is our bill focuses benefits
on low-income children. It is that simple. That is what the bill is, no
more. The truth is, in terms of preserving private coverage, our bill
is ``pretty much as efficient as you can possibly get.'' And the truth
is, the administration does not have a credible alternative.
I urge my colleagues to join me in making the right choice because in
the end, this bill is about helping those who can least afford health
insurance now. This bill is about helping Americas parents who truly
want the best for their children. And as much as some may be tempted to
make up a story to say it is about something else, the truth is, this
bill is about kids.
I yield to the Senator from Kansas.
Mr. ROBERTS. I asked for 20 minutes. I thought the leader was going
to come down and propose a unanimous consent request to lock in time.
He agreed to provide me 20 minutes.
Mr. BAUCUS. There is no time limit. We have 6 hours allocated
generally to this bill. The Senator can seek recognition.
Mr. ROBERTS. Madam President, I ask to be recognized for 20 minutes.
The PRESIDING OFFICER. The Senator from Kansas.
Mr. ROBERTS. Madam President, I rise today to express my support for
the SCHIP compromise bill. I believe this agreement represents a good
balance and continues the historic bipartisan support for this program.
On Tuesday, the House passed this bill with wide bipartisan support,
and I expect the Senate to do the same. I also rise today, Madam
President, to ask and to strongly recommend that the administration
rethink the threat to veto this important legislation. Simply put, this
bill should not be vetoed.
Here in Washington, we often talk about the programs that directly
affect our constituents back home. The State Children's Health
Insurance Program, or SCHIP is the acronym, is truly one of those
programs. SCHIP has long enjoyed bipartisan support, and I am glad we
have come to a strong bipartisan agreement on a program that is
critical for our low-income children.
In Kansas, our SCHIP is called HealthWave, and it supports over
35,000 Kansas children. It is a critical tool for our hard-working
families who would otherwise struggle to provide health care for their
children. Renewing this program has been a top priority of mine for the
110th Congress. While our Kansas HealthWave Program has made great
strides in providing health care to low-income children, unfortunately
we still have 50,000 uninsured children in Kansas--50,000. There are
35,000 now covered by the program but 50,000 who are not covered.
Many of these children are currently eligible for SCHIP but are not
enrolled because of the lack of resources in the program. We can
clearly do better. The bill before us would provide the necessary
resources to Kansas and other States in order to reach these low-income
children and finally provide them with the health care coverage they
need.
Unfortunately, instead of talking about achieving rare bipartisan
progress for these hard-working families and their children, this bill
and this debate has turned into a political showdown. And,
unfortunately, low-income children will be the ones to ultimately pay
the price.
I am very disappointed that before the administration even received
the final language their minds were apparently made up, and a line was
drawn in the sand opposing this compromise. Again, this was even before
the final language was in their hands. And, to my knowledge, there has
been little, if any, willingness to come to the negotiating table to
find the solution. I think this is unfortunate, and I think this is
irresponsible.
The administration is now threatening to veto this bill because of
``excessive spending'' and their belief this bill is a step toward
federalization of health care. Now, I agree with those concerns. I
agree with those concerns. I am not for excessive spending, and I
strongly oppose the federalization of health care. And if the
administration's concerns with this bill were accurate, I would support
a veto. But, bluntly put, they are not.
I do not believe the bill we are debating represents irresponsible
spending. Instead, this bill provides necessary funding to States to
cover children who should already be covered under the program. And I
know there are some who believe this bill is too expensive, but there
are also others who believe this bill doesn't go far enough. Many of my
friends on the other side of the aisle wanted a $50 billion to $75
billion expansion of SCHIP. Many in my caucus would have preferred a $5
billion increase. As a result, we had to try to find middle ground, and
we did just that. What we are debating today is something that is often
hard to come
[[Page S12209]]
by these days in Washington. It is called a bipartisan, bicameral
compromise.
Now, the agreement provides $35 billion in new funding for SCHIP and
targets the program back to its original focus--low-income children.
Let me repeat that. This bill targets the program back to its original
focus--low-income children. We should all understand that despite the
partisan bickering and the rhetoric that has poisoned the Halls of both
the House and Senate, bipartisanship and compromise are absolutely
necessary to achieve--to achieve--good policy. And I know President
Bush understands this. In fact, the administration has been successful
in working with my friends on the other side of the aisle on many
issues during these two terms to achieve good legislation. One good
example is the historic tax relief we were able to achieve. Obviously,
that final compromise required give and take from both sides of the
aisle, and this tax relief is now putting money back into the
pocketbooks of our constituents back home.
I was a conferee on the No Child Left Behind legislation and know how
closely the administration and Senator Kennedy and Congressman Miller
and others had to work to find any common ground. That bill was
certainly a great testament to bipartisanship, and we are trying to fix
some of the problems in that bill on a bipartisan basis.
The SCHIP bill is yet another example of hard work to come together
and find common ground. Of course, I am not pleased with everything in
the bill, and I know my colleagues on both sides of the aisle feel the
same. However, this bill represents a good bipartisan compromise, with
the ultimate goal of providing health care coverage to low-income
children. The alternative that is proposed by the administration is
threatening a veto and insisting upon a larger health care reform
debate.
I appreciate the administration's passion and persistence on having a
broader health care debate. However, holding a children's health
insurance bill hostage is not the right way to achieve this goal. I
support the goals of reforming the Tax Code to promote the purchase of
private health insurance. Let me repeat that, Madam President. I
support the goals of reforming the Tax Code to promote the purchase of
private health insurance. But I have yet to see a plan from the
administration that can actually pass the Congress.
In fact, I have yet to see an actual plan from the administration. I
have yet to see bullet points from the administration. I have yet to
see any plan that can be articulated in some fashion to sell to the
American public or to the Members of this body. We don't even have an
acronym for this plan. My word, you can't do anything around here
without an acronym.
The administration has also raised concerns that this bill is a march
toward the federalization of health care. I would argue that is simply
not true. I would never support a bill to federalize health care. I
remember that battle a decade ago. There is no way I want to go down
that road again.
I think it is important to point out what I think is a paradox of
enormous irony in regard to the claim that this bill is a step toward
the federalization of health care. In reality, this administration has
approved waivers--approved waivers--to cover adults under a children's
health care insurance program. Let me repeat that. Under this
administration's watch, we now have 14 States covering adults under the
Children's Health Insurance Program.
Now, this administration and others expressed grave concern that
SCHIP is the next step to universal health care. Yet this very same
administration is approving waivers to cover adults under a children's
health program. And, unfortunately, a number of these States are
covering more adults through their SCHIP program than they do children,
even while high rates of uninsured children still remain. This is not
fair. This is not right. It is wrong.
I don't mean to pick on other States, but let's take a look at a few
examples. New Jersey now covers individuals up to 350 percent of the
Federal poverty level and spends over 40 percent of its SCHIP funds on
adults. This is even while over 100,000 low-income children in the
State remain uninsured. This isn't right.
Earlier this year, Congress had to pass a stopgap funding measure to
plug 14 State SCHIP shortfalls. Of the 14 States that got this
emergency funding, five--five--cover adults. One of these States was
Illinois, which spends over 50 percent of its SCHIP funds on adults.
Wisconsin covers more adults than children under SCHIP--75 percent to
be exact. And the administration just approved an extension of their
waiver to cover adults. Minnesota covers more adults on their SCHIP
program than they do children. The same is true for Michigan, and the
same is true for Arizona.
Now, I am not trying to pick on these States. I can go on and on
because, again, there are currently 14 that cover adults on a program
that was meant for children. And how are these States able to cover
adults under the Children's Health Insurance Program? Again, through
waivers approved by this administration. This is certainly not fair to
States such as Kansas that have been playing by the rules and targeting
our programs to low-income children. I am beginning to wonder if we
have the wrong name for the State Children's Health Insurance Program.
I don't think it was intended to be the adult health care insurance
program.
The greatest paradox of enormous irony, however, is that this bill
actually stops the waivers this administration has been so generously
granting to States to cover adults by not allowing more adult waivers
to be approved. Let me say that again. The greatest paradox of enormous
irony is that this bill actually stops the waivers this administration
has been so generously granting the States to cover adults by not
allowing more adult waivers to be approved. This means future
administrations that may want to use SCHIP as a means to expand
government health care to adults will be prevented by law from doing
so. As a result, this bill ensures that the Children's Health Insurance
Program remains just that--a program for low-income children.
This bill also phases out childless adults currently being covered
with SCHIP funds and lowers the Federal matching rate for States that
currently have waivers to cover parents and now must meet certain
benchmarks in covering low-income children. As a result, this bill
brings excessive spending on adult populations in check.
The Congressional Budget Office has estimated that spending on adults
would be over $1 billion higher under current law over the next 5 years
than it would be under this compromise. This bill is more fiscally
responsible than the administration's approach or an extension of this
program by $1 billion.
Most importantly, this bill ensures that we are putting kids first
and returns the program to its original purpose--providing health care
coverage to low-income children.
Now, on the income eligibility front, the administration
unfortunately is claiming this bill does things that the bill simply
does not do. It is sort of an ``SCHIP In Wonderland.'' For example, the
President claimed in a speech last week that this bill expands SCHIP
coverage to families making over $80,000 a year.
I just have to ask the speech writer for the President, are you
reading the same bill I am reading? Are you reading the same bill that
we are discussing on the floor of the Senate? You can twist the facts,
but facts are stubborn things, Madam President.
In fact, this bill reduces the matching payment incentives that
States have had for so long to cover individuals at higher income
levels. In addition, by the year 2010, this bill--this bill--denies
Federal matching payments to States that cover children above 300
percent of the poverty level if the State cannot meet a certain target
in covering low-income children in either public or private insurance
plans. And let me emphasize private insurance plans.
I think it is important to remind the administration that a State can
only cover children above 200 percent of the poverty level if the
administration approves the State's application or waiver. I repeat: A
State can only cover children above 200 percent of the poverty level if
the administration or any administration approves that State's
application or waiver. This is current law and this bill does not
change that.
[[Page S12210]]
More importantly, this bill actually provides incentives and bonus
payments for States to cover children under 200 percent of the poverty
level in order to truly put the focus of this program back on low-
income children.
The bill also addresses the importance of including the private
market in the SCHIP program. Let me repeat that for all those who want
a private approach in regard to private markets, in regard to
insurance: The bill addresses the importance of including the private
market in the SCHIP program. In fact, the American Health Insurance
Plans, also known as AHIP--that is their acronym--on Monday announced
their support for this compromise bill. AHIP is the national trade
organization which represents over 1,300 private health insurance
companies.
The compromise makes it easier for States to provide premium
assistance for children to get health care coverage through the private
market--that is the goal of the administration and that should be our
goal as well--rather than relying on SCHIP. That is in this bill. This
is an important choice for families who would prefer a private choice
in health care.
This bill also requires the GAO and the Institute of Medicine to
produce analyses in the most accurate and reliable way to measure the
rate of public and private insurance coverage and on best practices for
States in addressing the issue of something called ``crowdout.'' That
means children switching from private health insurance to SCHIP. So we
have a study to determine exactly how we fix that.
In the ultimate paradox of enormous irony, it seems the
administration is threatening to veto a bill which does exactly what
they want us to do in focusing SCHIP on low-income children and making
sure the program does not become the vehicle for universal health care.
This bill gets adults off the program. It targets it to low-income
children. It ensures appropriate steps are taken to discourage crowdout
and it encourages private market participation.
I am proud to support this important bill, and I hope those who have
concerns can instead focus on the positive benefits this bill will
bring our low-income children and their hard-working families. I
especially thank our chairman, Chairman Baucus, Ranking Member
Grassley, Senator Hatch, all of our House colleagues for their tireless
work on getting this bill together.
At the start of these negotiations I made a commitment to work with
my colleagues to find a bipartisan solution to renew this important
program. I am holding to that commitment today and am pleased to
support this bill.
I also state to the administration I will lend my support to override
the President's veto if he chooses to wield his veto pen. However, I
hope--I hope--I hope the President heeds our advice and makes the right
decision for our children by signing this bill into law.
I yield the remainder of my time.
The PRESIDING OFFICER. The Senator from Montana is recognized.
Mr. BAUCUS. I ask unanimous consent that following the cloture vote
on the motion to concur in the House amendments to the Senate
amendments to H.R. 976, there be 6 hours 10 minutes for debate with
respect to that motion and that the time so far consumed, frankly, be
taken out of that total time; the time divided and controlled as
follows: 2 hours under the control of Senator Baucus or his designee,
and 4 hours 10 minutes under the control of Senator Grassley or his
designee; that upon the use or yielding back of time, the matter be
temporarily set aside and the Senate then proceed to the consideration
of H.J. Res. 43, the debt limit increase; that be 90 minutes of debate
equally divided and controlled between the leaders or their designees,
with no amendment in order; and upon the use or yielding back of time,
the joint resolution be read a third time and set aside; and that the
Senate then resume the message on H.R. 976; that the motion to concur
with amendments be withdrawn, and without further intervening action or
debate, the Senate proceed to vote on the motion to concur; that upon
disposition of H.R. 976, the Senate resume H.J. Res. 43 and vote on
passage of the joint resolution, without intervening action; and that
upon the conclusion of that vote, the motion to reconsider be
considered made and laid upon the table, and the Senate then proceed to
H.J. Res. 52, the continuing resolution; that no amendments be in
order, the joint resolution be read a third time, and the Senate,
without intervening action or debate, proceed to vote on passage of the
joint resolution; that upon passage, the motion to reconsider be
considered made and laid upon the table; that after the first vote in
this sequence, the vote time be limited to 10 minutes.
I also ask consent that the ``without intervening action or debate''
be stricken.
The PRESIDING OFFICER. Is there objection?
Mr. McCONNELL. Reserving the right to object, and I am not going to
object, I wish further to lock in the time to each Senator on my side
within the Republican time designated in the consent agreement the
distinguished chairman of the Finance Committee has just propounded, as
follows: Senator DeMint, 10 minutes; Senator Bunning, 15 minutes;
Senator Lott, 10 minutes; Senator Grassley, 45 minutes--it is my
understanding the Roberts time under the consent agreement would
already be counted. I will leave that out--Senator Hatch, 30 minutes;
Senator Vitter, 10 minutes; Senator Coburn, 15 minutes; Senator Corker,
10 minutes; Senator Smith, 10 minutes; Senator Snowe, 15 minutes;
Senator Murkowski, 15 minutes; Senator Burr, 10 minutes; Senator Thune,
10; and Senator Cornyn, 10.
The PRESIDING OFFICER. Is there objection to the request as modified?
Mr. BAUCUS. I ask the distinguished Senator from Kentucky, I assume
that is all within the time allocated.
Mr. McCONNELL. I confidently assure my friend that is my desire and I
think I expressed that to the Chair.
The PRESIDING OFFICER. Without objection, it is so ordered.
The minority leader is recognized.
Mr. McCONNELL. Madam President, I am going to proceed in my leader
time to speak on the SCHIP bill.
The PRESIDING OFFICER. The minority leader is recognized.
Mr. McCONNELL. Madam President, 10 years ago a Republican Congress
created a program that had a worthy and straightforward goal: health
insurance for kids whose parents made too little to afford private
coverage but too much to qualify for Government help. Millions of
children were caught between rich and poor, we wanted to help, and
thanks to the State Children's Health Insurance Program, we did.
The program has been a success. Since SCHIP's creation, the uninsured
rate for children in families earning between about $20,000 and $40,000
a year has dropped by 25 percent. Last year it covered more than 6 \1/
2\ million kids. Today the number of uninsured children within the
income group we originally targeted is down to about one million
nationwide.
Republicans were ready to finish the good work we started with SCHIP,
and we approached its reauthorization this year as an opportunity to do
just that, to reach out to the kids in our original target area who
should be covered by SCHIP but weren't.
Meanwhile, our friends on the other side had another idea: following
the lead of a number of State Governors, they decided to expand SCHIP
beyond its original mandate and bring us down the path of Government-
run healthcare for everyone.
These Governors started with adults and children from middle and
upper middle-income families. Taking SCHIP funds that were originally
meant for children from poor families, they spent it on these other
populations instead. Then they turned around and said they didn't have
enough money to cover the poor children in their States. Which is
absurd. This is a capped entitlement. The dollar amount is fixed. If
you are spending it on adults, you have already decided not to spend it
on the children who need it most. And that is wrong.
New Jersey, under the leadership of one of our former Senate
colleagues, helped lead the way. Rejecting a rule that limits SCHIP
funds to the poor children, New Jersey now uses SCHIP for adults, and
for children in families that earn as much as $72,275 a year.
For millions of hard-working Americans who have to pay for their
insurance, it doesn't seem right that they should have to subsidize the
families in New Jersey who can and should be paying for their own. And
a lot of poor
[[Page S12211]]
families in New Jersey are also right to wonder why Trenton is suddenly
enrolling middle-class families for SCHIP when their kids still lack
coverage--about 120,000 of them by one count.
This is the kind of SCHIP expansion that Democrats want in all 50
States. They want to continue to expand it, pulling more and more
middle-income children and adults off the private market and onto
public coverage, driving private insurance costs up, driving the
overall quality of health care down.
Not every State is abusing the rules. Kentucky runs its version of
SCHIP, KCHIP, in a financially responsible way. We even have money left
over from years past. But under the Democrats' reauthorization plan,
Washington would take those extra funds and send them to States like
New York and New Jersey that spend more than they get. As a result,
even the expanded SCHIP program would leave Kentuckians with less SCHIP
funding in the coming fiscal year.
Kentuckians don't want the money they have targeted for poor children
going to adults and middle-class families in other states that can
afford insurance on its own. KCHIP's money goes where it should be
going: to low-income kids who need it most.
Right now, KCHIP serves about 50,000 kids in Kentucky, but there are
a lot more who could be covered and aren't. We need to focus on them
before expanding SCHIP program to new populations. And the Republican
proposal I cosponsored with the other Republican leaders would do just
that.
Until this year, SCHIP had been a bipartisan program and a bipartisan
success. But in yet another sign that no good deed goes unpoliticized
by Democrats in the 110th Congress, our Democratic friends accuse
Republicans who want to reauthorize SCHIP of shortchanging it, of
shortchanging children. Which is also absurd. We want to improve the
program we have got, not expand it into areas it was never meant to go.
Of course some of the news organizations are running with the story.
They seem to have forgotten that basic rule of politics that anytime
somebody accuses you of opposing children they've either run out of
arguments or they are trying to distract you from what they are really
up to. And what our friends on the others side are up to is clear: they
have taken SCHIP hostage, and what they want in exchange is Republican
support for Government-run healthcare courtesy of Washington.
They tried that about 15 years ago, the American people loudly
rejected it when they realized it would nationalize about a seventh of
the economy, and they don't like Government health care any better now.
The first priority for Senate Republicans is reauthorizing SCHIP for
the kids who need it. And we have demonstrated that commitment. Early
last month, the Republican leadership proposed the Kids First Act,
which allocates new funds for outreach and enrollment so SCHIP can
reach 1.3 million more children than it already does. Our bill also
pays for this outreach, without gimmicks and without raising taxes.
When Democrats rejected Kids First, Republicans introduced a bill to
extend the current program to cover kids at risk of losing coverage
until the debate over its future is resolved. While our friends on the
other side were issuing press releases and playing politics,
Republicans were looking for ways to make sure SCHIP funds didn't run
out.
When this bill is vetoed, no one should feign surprise. They have
known since July the President would veto any proposal that shifted
SCHIP's original purpose of targeting health care dollars to low-income
children who need them most.
Our Democratic colleagues have no excuse for bringing us to this
point. But then again, this is the game they have played all year:
neglect the real business of Government in favor of the political shot.
Dozens of votes on Iraq that everyone knows won't lead to a change in
policy. Three hundred investigations into the executive branch. And
what is the result? We have less than 100 hours left in the current
fiscal year, and Democrats haven't sent a single appropriations bill to
the President's desk. This ought to put the 110th Congress into the Do-
Nothing Hall of Fame.
Less than 100 hours before a health insurance program for poor
children expires, and Democrats are counting down the hours so they can
tee up the election ads saying Republicans don't like kids. Meanwhile,
they are using SCHIP as a Trojan horse to sneak Government-run health
care into the States.
This isn't just a Republican hunch. According to the nonpartisan
Congressional Budget Office, families that have private insurance are
switching over to SCHIP in States that allow it. The junior Senator
from New York has proposed a plan that would raise the eligibility rate
to families of four that earn $82,600 a year--this, despite the fact
that roughly nine out of ten children in these families have private
health insurance already.
But of course that is not the point. The point is pursuit of a
nationalized Government-run health care controlled by a Washington
bureaucracy. Some Democrats have admitted what this is all about. The
chairman of the Finance Committee recently put it this way: ``We're the
only country in the industrialized world that does not have universal
coverage,'' he said. ``I think the Children's Health Insurance Program
is another step to move toward universal coverage.''
While Democrats are busy looking for ways to shift this program away
from its original target, the deadline for reauthorization looms.
Republicans have made this reauthorization a top priority. If Democrats
want to expand Government-run health care, they should do it in the
light of day, without seeking cover under a bill that was meant for
poor children, and without the politics. Republicans can take the
shots. But the poor kids who we were originally trying to help
shouldn't be caught in the middle.
I yield the floor.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Madam President, I have a couple of points. I don't want
to prolong the debate. My good friend from Kentucky made a couple
points I wish to clarify.
I did say I think our country should move toward universal health
coverage. I think we should. In fact, our President, President Bush,
has said the same thing. He said we should have universal coverage of
health care in America. I think most Americans think we should have
universal coverage. What does that mean? That means everyone should
have health insurance. I did not say and do not mean we should have a
single-payer system like Canada. I think we should have universal
coverage with an appropriate mix of public and private coverage so that
every American has coverage.
So I think for the Senator from Kentucky to make a charge that we are
for universal coverage, I am, as is our President. Most Americans want
universal coverage. My point is, what form and what way?
I think it is important to remember one thing. What does this CHIP
bill do compared to current law? The charge is that it expands
eligibility, it goes to upper income kids, and so on and so forth, it
is another step in Government health care. That is the charge.
That is not the fact. This bill is more restrictive than current
law--more restrictive than current law. Essentially, eligibility is,
under current law, determined by States and the Federal Government.
States determine eligibility--that is current law--and the
administration either does or does not grant a waiver. This Republican
administration has granted several waivers. In fact, one was to the
Republican Governor of New Jersey, Christine Todd Whitman, when a major
waiver was granted. So this bill does not change current law.
Basically, it provides and uses the purse to discourage States from
going to higher coverage by lowering the match rate. Nothing in this
bill expands eligibility--nothing. So the charge that this is
increasing eligibility to people other than children is just not
accurate.
Madam President, I yield the floor.
I see the Senator from West Virginia is seeking recognition.
The PRESIDING OFFICER. The Senator from West Virginia.
Mr. ROCKEFELLER. I thank the chairman of the Finance Committee. I am
very happy that the chairman of the Finance Committee made the comments
he just did because I was absolutely bowled over by the comments
[[Page S12212]]
which preceded him from the other side of the aisle. It is sort of
basic when you say the word ``universal.'' It means everybody, but it
does not necessarily mean it has to be run by the Federal Government,
and anybody who makes that kind of an error is either really playing
politics or really needs to go to grad school.
In any event, this program is totally optional. And there is nothing
about it which--in fact, several of the previous speakers said that
States could do this and States could do that, but on the other hand it
was all Government run, so therefore how could the States do it on
their own? It is sort of a sad argument.
Several months ago, four Senators--two Republicans and two
Democrats--stood in a room, shook hands, and made a promise to each
other. It was a wonderful moment. It was a wonderful moment. We vowed
not only to reauthorize the Children's Health Insurance Program for
millions of kids who rely on it for basic medical care but also to
reach out to millions more children. Today, these many months later, we
are one step closer to making the promise into a reality for nearly 10
million children. I am very proud to be working with those Senators,
grandfathers and fathers themselves, Senators Baucus, Grassley, Hatch,
and others, and what they have accomplished in the Senate on the CHIP
bill.
The legislation before us today is the result of months of some of
the most bipartisan working by both the Senators and the staff of the
Senators that I have ever seen. It went on for months, night and day.
Every day, the four Senators involved in this met for 2 hours so that
we could work out differences and make sure it was bipartisan, and I am
so happy to say that it is.
Many Members of the House and Senate had hoped for something
different in this bill. Obviously, some wanted more, some wanted less.
Some wanted to simply reauthorize the status quo, some wanted to even
decrease the children's health insurance funding, and others wanted to
add benefits. That is not necessarily evil. Because you did something
10 years ago does not mean it has to stand written in stone forever,
such as eye exams. Some wanted to restore coverage to the children of
legal immigrants. Some wanted to increase funding to $50 billion.
Individually, we all believed what we proposed was the right thing to
do, but ultimately we did not do those things because we compromised
because we were determined to be bipartisan and we wanted this bill to
pass for the sake of 10 million children. So the promise of the
handshake brought us back to the table each and every time and to the
common ground we walk today.
Each of us knows the statistics in our own State. I am proud that
nearly 40,000 West Virginians were enrolled in our Children's Health
Insurance Program last year. These kids can see a doctor when they get
sick, they can receive necessary immunizations, and they can get
preventive screenings. In fact, at the very beginning, it was very hard
to get preventive screenings. Now they can. They will be able to, so
they can get a healthy start in life because of this important program.
The passage of this bill means thousands more of West Virginia's
children will have affordable and stable health insurance, including
access to basic care.
A personal comment. This is all incredibly important to me. Four
decades ago, or more, I came to West Virginia as a VISTA volunteer. I
did not plan to stay; went to a community where nobody had any health
insurance, any job, any water, any sewer, any schoolbus. That was an
experience which turned me around, gave meaning to my life. It was a
small mining community in southern West Virginia where I learned just
exactly how important health care can be in the lives of people who
work hard every day to raise a family and to do right by their children
and how painful it is when they don't have it. That experience has had
a profound influence on me, has influenced me every day of my public
service career since.
Providing children, especially those who are in the grips of poverty,
with health care is moral. It is a moral obligation. It speaks to our
deepest humanity and to the better angels of our Nation's character. It
was a promise that got started, in fact, with the recommendations of
the National Commission on Children, which I was proud to chair and
have since worked to implement its recommendations, many of which,
including the earned-income tax credit and others, are in effect.
It was, as some remember, a very different time in 1997 when this
CHIP program was begun. A decade ago when the debates on CHIP took
place, there was a genuine frustration that we could not solve broader
problems plaguing America's health care system. We were, in fact, the
wisdom was, at the breaking point. That is when a bipartisan group of
equally committed Senators at that time were in the finance executive
room with no staff and worked long into the morning to develop a CHIP
program. It was one of the most glorious moments I can remember. People
who had never spoken about children suddenly rose, because we were all
by ourselves around a table, and spoke about the importance of doing
health insurance for children. It was moving. Some people actually
stood as they spoke. We were all around a table and there was no need
to stand, but their feelings were so deep and they poured forth because
there we were, by ourselves, with our consciences, with the future of
children in our hands. We knew we could not solve the entire problem,
but we committed to trying to do our best by putting children first.
The time has come for Congress once again to put our children first,
and the bill before us today does exactly that.
So having said what it exactly does, I want to say what it exactly
does not do, this bill.
To start with, we keep our promise that all those currently enrolled
will keep their health insurance by investing $35 billion over the next
5 years.
We give States the resources to reach out and enroll millions more
kids, which, in fact, sounds very easy, but in rural areas--and I
think, of course, of Appalachia--it is a very hard thing to do where,
in fact, many parents of children, and therefore the children
themselves, are scared of health care, scared of doctors, scared of
clinics, scared of hospitals, and want to stay as far away from health
care as possible. So it is a very difficult thing to get them to join,
but we are determined to do that.
We have included, yes, expanded access to dentists and mental health
counselors. All of the history of health care shows those things are
incredibly important for children. In fact, even as baby teeth come in,
they determine what mature teeth will be, and if you do not tend to
them early, the children are in for terrible problems. I have seen so
much of that.
We have made it easier for States to identify those children who are
eligible but not enrolled in CHIP by reviewing food stamp records,
school lunch programs, WIC programs, and all kinds of things that
States will decide to do, every State being different, parts of States
being different. So there are people--the Governors and those running
these programs as they do, not the Federal Government, but the
Governors of the States will decide how to do this.
We have maintained the unique public-private partnership that has
been the hallmark of the CHIP program which has been universally
recognized as the most cost-effective and efficient way of reaching all
those children who desperately need access to something sacred called
basic medical care.
Most importantly, we have preserved the State flexibility, so the
program fits the needs in every State--different in one State as
opposed to another.
Now, let me be equally clear about what the bill does not do. It does
not raise eligibility limits to families making $83,000 dollars a year.
It simply does not do that. I challenge anybody to come on the floor
and say otherwise. Our bill does not encourage people to give up
private insurance to enroll in CHIP. It does not do that. It does not
unfairly raise taxes on the poor and middle class to pay for CHIP. In
fact, throughout, both looking backward and looking forward to the
passage of this bill and hopefully the signing of this bill, 91 percent
of all the children who are covered by the Children's Health Insurance
Program will be at 200 percent of poverty or below. That is not wealth.
They go out in the private market, and in some places it can be $12,000
dollars, and in others, $9,000. Families cannot afford that. This bill
is incredibly important to them.
[[Page S12213]]
This bill does not cover illegal immigrants. It does not expand
coverage to adults. In fact, it cuts adults off the program over the
next several years. It does not turn CHIP into some massive Government-
run health care program. The President knows this. He should know this.
He is a former Governor. And he has spoken about this favorably. So he
should understand this.
So what is the President's plan for children's health care? For
starters, provide a bare minimum of Federal funding to keep CHIP on
life support and at the same time throw 1.6 million kids currently in
the program out of the program. And what is his answer to those kids
and the 721,000 who joined the ranks of the uninsured last year? Go to
the emergency room. That is the worst increase of health care known in
this country. So sit for hours to see a doctor, only to be prescribed
medicine that your parents cannot afford. It is not American. That is
not American.
Adding to the Nation's growing health care crisis is not a solution.
If anything, it would lead to the one thing the President is accusing
us of: shifting the burden of paying for health care to taxpayers. We
do not do that.
Threatening to veto our bill is a mistake. The majority of Americans
believe we need to live up to our obligations to provide children with
health care.
How many people wandering around the streets of Washington or any
other place in this country would ask: Don't you agree with me that
children shouldn't have health care, children who can't afford it, that
only the rich should have it? You wouldn't get any takers on that.
People care about children. They know they are the future. They want
them to have health care. So it is a moral obligation for our children,
and the President is squarely on the wrong side of the issue.
All of us here, I know, will do the right thing by our Nation's
children. I sincerely hope the President will look deep into his heart
and do the same.
I yield the floor and thank the Chair.
The PRESIDING OFFICER. The Senator from Maine.
Ms. SNOWE. Madam President, I rise today to voice my strong support
for the reauthorization of the State Children's Health Insurance
Program. I want to extend my heartfelt congratulations to Chairman
Baucus and Ranking Member Grassley as well as to the chairman and
ranking member of the Health Subcommittee, Senators Rockefeller and
Hatch, for their vital and resolute spirit of bipartisan cooperation
and tireless perseverance in crafting an agreement with House
negotiators that will maintain health insurance coverage for 6 million
children and reach nearly four million more. Their work demonstrates
what we can accomplish when we set aside philosophical differences in
order to do the right thing for children and their families. I am
pleased that we reached a veto-proof majority with the previous cloture
vote, which shows strong support for extending and building upon this
landmark legislation.
As we all know, the problem of the uninsured touches communities all
across our country. Thankfully, we have made tremendous strides in
dramatically lowering the number of uninsured children through SCHIP
which, time and again, has proved to be both a successful program and a
saving grace for millions of American families who otherwise simply
could not afford to pay for their children's health care. The stakes
could not be more monumental. The quality of the health care that one
receives as a child can have dramatic implications later in life. And
there is not a family in America who does not want to provide the most
comprehensive health coverage possible for its children.
While some may mistakenly characterize SCHIP coverage as a welfare
benefit, what they may not realize is that nearly 90 percent of
uninsured children come from families where at least one parent is
working. Today, fewer than half of parents in families earning less
than $40,000 a year are offered health insurance through their
employer--a 9 percent drop since 1997. And for many working families
struggling to obtain health care, if benefits are even accessible to
them, the costs continue to rise, moving further out of their reach. In
my own State of Maine, a family of four can expect to pay $24,000 on
the individual market for its coverage. For most families, taking this
path is unrealistic and unworkable, especially when factoring the cost
of mortgages, heating bills, and myriad other financial pressures.
That is why I am pleased that the compromise provides a significant
increase in federal commitment into the SCHIP program. With lives
literally hanging in the balance, we ought to be building on what
works. As we move to reauthorize the SCHIP program, states not only
require sufficient Federal funding to ensure that children currently
enrolled in SCHIP do not lose coverage and become uninsured, they also
require additional funding to enroll more uninsured children--
particularly the 11,000 children in Maine who are eligible but
unenrolled.
I am particularly heartened that the House and Senate negotiators
recognized that dental care is not a ``luxury'' benefit--but one that
is paramount to the healthy development of children. A guaranteed
dental benefit was included in S. 1224, the Children's Health Insurance
Program Reauthorization Act, legislation I introduced with Senator
Rockefeller in April.
In addition, as members of the Finance Committee, Senator Jeff
Bingaman and I sought to improve the quality of dental care through the
provision of an assured dental benefit for all SCHIP-covered children
during the committee process. Chairman Baucus was instrumental in the
inclusion of a $200 million dental grant program as a first step
towards meeting our goal during the Finance Committee process. And I am
pleased that we were ultimately able to see such a strong dental
benefit in the package we are considering today.
Most dental disease is preventable with proper care up front, but
when a parent cannot access routine care for a child, taking that child
to the emergency room is often their only recourse. Yet that option
costs at least four times as much as seeing a dentist. Plus, the health
care a child receives in the emergency room does not even resolve the
underlying problem--they generally provide only pain relief and
antibiotics for infection. The bill before us today provides States the
choice to either provide a dental benefit as contained in the SCHIP
statute or choose among three other coverage options--dental coverage
equivalent to the coverage offered by the Federal Employee Health
Benefit Plan, FEHBP, dental option--the largest dental plan in the
State--or the State employees dental plan with the largest enrollment
of children.
The compromise package also replaces the policy announced by the
Centers for Medicare and Medicaid Services last month that would
essentially prevent state SCHIP programs from enrolling uninsured
children from families with household incomes above 250 percent of the
federal poverty level. To put this into better perspective, 250 percent
of the federal poverty level for a family of four is $51,625. As I
illustrated before, families in Maine faced with purchasing a policy on
the individual market could face a cost well in excess of $24,000 a
year. If States such as mine were prevented from expanding eligibility
over 250 percent of poverty, families with a clear, demonstrable need
could be shut out.
Families could potentially spend nearly half their income on health
coverage yet still not qualify for assistance. That's why 2 weeks ago,
Senators Kennedy, Smith, Rockefeller, and I introduced legislation to
nullify these new restrictions. This compromise will rightfully block
efforts to impose onerous and unreasonable restrictions on the States'
efforts to reach every child requiring assistance--while at the same
time making sure States with more generous income-eligibility levels
are meeting their commitment to lower income children.
I also want to speak briefly about the offset contained in this bill.
Though some may vigorously disagree, I find that an increase in the
tobacco tax is an appropriate avenue to help finance health coverage
for low-income children. The health complications caused by smoking--
for instance, the increased risk of lung cancer and heart disease as
well as the clear relationship between the number of cigarettes smoked
during pregnancy and low birth weight babies--could not be more
evident. It is clear to me that investing in children's health, while
at the same
[[Page S12214]]
time discouraging children from starting to smoke in the first place,
is the best form of cost-effective, preventative medicine.
Regrettably, this week we will hear a litany of reasons why we
shouldn't cover more children through SCHIP. Some will express concerns
about the size and cost of the package. I would respond that it should
inject a dose of reality on the magnitude of the problem. States have
responded to the call of families who are struggling every day with the
cost of health insurance and are assuming a tremendous burden in the
absence of Federal action.
In addition, we should bear in mind that this bill is $15 billion
below the amount we provided for in the budget resolution. Again, this
bill is the product of compromise. Some of us wanted to go further.
Senator Rockefeller and I introduced legislation to reauthorize the
program at the full $50 billion--a bill that garnered 22 bipartisan
cosponsors.
Although there were compromises made along the way on various policy
positions, one point is not up for discussion--simply maintaining the
status quo of current levels of coverage is unacceptable. And while the
Congress and the White House argue over philosophical differences,
children are either going without coverage, or their parents are
financing their care on credit cards, hoping they can stay on top of
their debt.
We are the wealthiest Nation on earth, and if we are unable to
provide health insurance and medical care to our young people, then
what does that say about our values? Some of my colleagues will contend
that the SCHIP reauthorization we are considering is the first step
toward government-run health care and that we will substitute public
coverage for private insurance. The fact is that this SCHIP program
came into being ten years ago. We haven't seen that evolve from the
SCHIP program. We didn't see it materializing into a government-run
health care program, as many have alleged here today. It absolutely
hasn't happened. What we did was identify a need and address it in a
bipartisan manner.
These claims ignore the fact that today, 73 percent of the children
enrolled in Medicaid received most or all of their health care services
through a managed care plan. In fact, America's Health Insurance Plans,
AHIP, a national association representing nearly 1,300 member
companies, has recently endorsed this legislation, stating ``it repairs
the safety net and is a major movement toward addressing the problems
that States and Governors have been trying to address, which is how to
get access for children.'' The bill also helps shore up employer-based
coverage by granting states the option to subsidize employer-sponsored
group health coverage for families that find the coverage beyond their
financial means.
Some have argued that SCHIP should reduce coverage for adults,
especially childless adults. While I believe that coverage for adults
can have a clear benefit for children, both in terms of enrollment of
children as well as the simple fact that health problems for a working
parent can lead to economic insecurity for the family, this approach
represents an area where we had to compromise. But I find it
contradictory that the administration, which has been so vocal in its
opposition to the cost and scope of the compromise package, granted the
majority of the 14 adult coverage waivers granted over the past ten
years and renewed a waiver for adult coverage in May!
Some will argue that reauthorization should be attached to a larger
initiative on the uninsured. We must acknowledge forthrightly that
working families are having a difficult, if not wrenching, time finding
affordable, meaningful coverage--coverage not just in name only. Access
to affordable, quality health care is the No. 1 one domestic priority
of Americans, and the public will hold us all--Republicans and
Democrats alike--accountable on delivering that goal. That is why I
have been engaged with my colleagues in an effort to address the
critical issues of extending coverage, reducing costs, and
revolutionizing care delivery. But while I agree with many of my
colleagues that legislative action to solve the problem of the
uninsured is long-overdue, children should not be kept waiting. We
cannot defer the urgency of providing health insurance for our children
while we continue to procrastinate on the issue of the uninsured.
Frankly, I am outraged by the news that the President is considering
a veto of this legislation. I believe this seriously misjudges the
genuine concern Americans have about access to care, particularly for
children. In a March New York Times/CBS News poll, 84 percent of those
polled said they supported expanding SCHIP to cover all uninsured
children. A similar majority said they thought the lack of health
insurance for many children was a ``very serious'' problem for the
country.
SCHIP has been the most significant achievement of the Congress over
the past decade in legislative efforts to assure access to affordable
health coverage to every American. Today, as we consider this
reauthorization, we must not undermine the demonstrated success of this
program over the past decade. Compromise on both sides of the aisle
helped us create this program ten years ago and hopefully a renewed
sense bipartisan commitment will help us successfully reauthorize this
vital program.
I would strongly encourage the President to reconsider his short-
sighted veto threat and work hand-in-hand with Congress to extend
health insurance to countless, deserving children. I urge my colleagues
to support this legislation.
I yield the floor.
The PRESIDING OFFICER. The Senator from Florida.
Mr. NELSON of Florida. Madam President, on behalf of Senator Baucus,
I yield myself 10 minutes.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. NELSON of Florida. Madam President, this Children's Health
Insurance Program is universally acknowledged as having reduced the
number of uninsured children in America. As the Senator from Maine has
just said, we can be very proud we have seen a landmark compromise
between Republicans and Democrats. With the talks going on between the
House and the Senate, this compromise legislation is going to allow us
to continue coverage for millions of low-income children and to expand
the coverage to millions more.
It is so popular because if we can attack poor health at a child's
age, ultimately, not only is it going to benefit the quality of life of
that individual, but it is going to be less of a cost to society in the
long run, if you can get at their root problems of health while they
are young. This is a simple economic fact, preventive health care.
In my previous life as the elected State treasurer and insurance
commissioner in Florida, I chaired the board of directors of the
Healthy Kids Corporation. It was Florida's pioneering effort to insure
low-income children well before this Children's Health Insurance
Program started at the Federal level. We did it through the schools. We
had tremendous success. It works.
So there is a collective sigh of disappointment that the President is
going to refuse to accept this compromise, which is what reflects the
general will, as expressed by that tremendous vote we just had a few
minutes ago, allowing the bill to continue to go forward in this
legislative process. The President's looming veto threat calls into
sharp relief all of those who stand to lose in the absence of fully
reauthorizing and expanding this CHIP program.
Think back 10 years ago and what has happened since. The number of
uninsured adults has increased, while the rate of low-income, uninsured
children has decreased, and decreased not by a little but by a third
largely due to this program we are going to pass today.
These children have been afforded better access to primary and
preventive care and a better quality of care. This reauthorization is
going to provide $35 billion of additional funding over the next 5
years.
Now, of course, that is a bone of contention for some people. If you
are going out and finding $35 billion extra to fund something--at a
time there is not that money out there, particularly when we are going
to have a supplemental request for Iraq of some $200 billion--under
that circumstance, that context, where are you going to get 35 billion
new dollars over 5 years to fund a program such as this? The tobacco
tax.
There are those who do not want to tax tobacco. But where else would
you
[[Page S12215]]
like to get it? You cannot make it up. You cannot go and print the
money. You have to get it from some legitimate place. This is the place
that can withstand that additional tax. So there will be some who will
vote against this program because they do not want to tax tobacco.
Well, let their record be clear why they oppose this popular program.
The added investment in children's health is not only necessary, it
is fruitful. It is common sense. Healthy children are more likely to
stay healthy as they move into adulthood. Certainly, if they are
healthy, they are going to have more productive lives. On top of all
this, don't we have a moral imperative to ensure that children,
regardless of their parents' income, are able to have a healthy life?
I think that is what makes up our moral fiber, our fabric, all of our
teachings, our traditions. Our values say we want to have health care
for children regardless of their parents' ability to pay.
The President has argued that this expansion is going to take the
CHIP program beyond its original intent of just helping poor children.
Some people say it is going to be helping adults. Do I think that
pregnant women--pregnant adult women--ought to be helped? I would think
common sense would say yes.
I believe this program would deepen and expand that initial promise
which is helping those American families that struggle with those
health care costs that are rising much faster than their wages.
Can you imagine being a parent and watching your child have a health
problem and you cannot do anything about it because you do not have the
financial means to take away the pain of that health problem of your
own child? Parents would get out and scrap and scrape, they would dig
ditches, they would clean latrines, they would do anything for their
child. But, sadly, because of the low income of some families, those
children do not have that health care. Well, we can address that and
correct that today.
The President has also said this expansion is going to bring us down
a path toward the federalization of health care. Well, that is simply
not so. There is wide latitude in this law to give that latitude to the
States. I believe, simply, children are too precious to be held hostage
to an ideological debate. This program is more important than the
rhetoric about government-run health care.
By virtue of me telling you my background, obviously, this bill is
very important for my State of Florida, where over 700,000 children
alone are uninsured. This legislation is the best opportunity to expand
that coverage to a significant portion of those 700,000 children and
certainly across the land to millions of children.
We have seen the success. We are aware of how many more children need
to participate. I humbly urge the President to reconsider his veto
threat. It is rare we have a chance to pass legislation that is so
overwhelmingly positive, so completely necessary, and so morally
unquestionable.
I am certainly going to cast my vote in favor. I hope a resounding
percentage of this Senate will do likewise so we can send a very strong
message of support.
I yield the floor.
The PRESIDING OFFICER (Mr. Salazar). The Senator from Ohio.
Mr. BROWN. Mr. President, I would like to follow on the comments of
my colleague from Florida, Senator Nelson, in support of the Children's
Health Insurance Program bill.
This week, the House of Representatives passed the bill
overwhelmingly, 265 to 159. Of my 18 Ohio House colleagues, about two-
thirds of them voted for this bill. It is clearly something we know
works in my State.
The Children's Health Insurance Program was passed 10 years ago in
the House of Representatives and the Senate. It was established.
President Clinton, a Democrat, with a Republican House and a Republican
Senate, supported that issue, and it has clearly worked.
We have some 6 million children in this country now who benefit from
the Children's Health Insurance Program. In my State, it is around
200,000 children. We also know this legislation will mean about 4
million more children in the United States will benefit from this
health care program.
These are sons and daughters of working families. These are not
people living in the lap of luxury. They are families making $20,000,
$30,000, and $40,000 a year. They are families where they are working
hard, playing by the rules, but they are not making enough money to buy
insurance. Their employers do not offer insurance. So this is what we
need to do.
Now, the President says he plans to veto this bill for two reasons
that I can understand. One of them, he said, is the cost. This is $35
billion over 5 years; $7 billion a year. But just make the contrast: We
are spending $2.5 billion a week--$2.5 billion a week--on the war in
Iraq. Yet the President does not want to spend $7 billion a year to
insure 4 million children. That is his first reason--the cost.
The second reason, the President says: I want private insurance to
take care of these children. Well, so do I. So does Senator Grassley,
who has been a major leader on this issue in the Senate on the other
side of the aisle. We all do. But the fact is, private insurance is not
taking care of these children. Again, they are sons and daughters of
people with jobs paying $20,000, $30,000, $40,000, $50,000 a year,
people without insurance and without the financial wherewithal to be
able to take care of these children.
The President came to Cleveland a few months ago and said everybody
has health care in this country. They can get it at the emergency room.
I want children in this country to get preventive care in their family
doctor's office, not acute care in the emergency room.
Before the President makes his decision, I would like him to meet
three families in Ohio, people who really speak to this whole issue.
I want him to know about Dawn and Glenn Snyder and their son Cody,
living in Bloomingdale, near Steubenville, near the Ohio River in
eastern Ohio. Dawn works in a doctor's office, and Glenn works
temporary jobs. Cody is 3 years old and has cerebral palsy. Until he
was a year old, Cody had bleeding in his brain and seizures. Sometimes
Glenn has insurance and sometimes he doesn't. It depends on where he is
working. Dawn is going to lose the coverage for her family that she has
gotten because they can no longer afford to buy it.
So even though Cody needs regular medical care from a neurologist and
an eye doctor, as well as routine preventive care that all children
need, he is in danger of having no access to health insurance. However,
the Snyders will have coverage if this bill is signed into law.
If this bill passes, Cody will likely qualify for care under Ohio's
new Children's Health Insurance Program. I would add also, on a
bipartisan note, Governor Strickland, the new Governor of Ohio, with a
resounding bipartisan vote out of the legislature, moved the
eligibility to 300 percent of poverty so families making up to about
$50,000 or $55,000 a year will have coverage.
If this bill passes, it means the Snyders will have a safety net for
Cody's coverage and will be able to live with the security of knowing
their son will receive the care he needs.
Then there is the story of Evan Brannon. Evan is a 1-year-old from
Dayton in southwest Ohio. His dad Kenneth is currently not working,
after losing his job as a repairman for a telephone company. Angela,
Evan's mother, stays at home with him and has a baby on the way.
Evan was diagnosed with a congenital hernia of his diaphragm and is
on a feeding tube, and he also receives medicine through a tube. He
receives physical, occupational, and speech therapy. His parents looked
into private coverage and learned they would never qualify for it
because of Evan's preexisting condition. The family is faced with
$5,000 to $6,000 a month in medical expenses. Angela can't go back to
work. Kenneth is looking for a job but can't get a position over a
certain income level or Evan will lose medical coverage. How is this
family ever supposed to get ahead if they have to make sure not to make
too much money out of fear of losing health insurance for their
children? What kind of incentive is that to build into the system?
Passing this bill will fix that. This is just one way in which
America's families' opportunities are limited by our
[[Page S12216]]
country's inability to provide the insurance the children's health
insurance will provide.
One more story. David Kelley is a 13-year-old living in Erie County,
right next door to where I live. He lives with his mother Heather and
his stepfather Timothy. David has been diagnosed as bipolar, mildly
autistic, and suffers from Asperger's syndrome. He also has a rare form
of asthma. David was born 2 months premature. His doctors believe that
a lack of oxygen and other complications may have caused the conditions
he has coped with daily for 13 years, although the causes are not
completely known.
David's health conditions require him to regularly visit a
psychiatrist, a psychologist, and a primary care physician. His
medications cost $2,000 each month, and Medicaid covers it. His mother
Heather has said her greatest fear in life is of David losing his
medical coverage. She herself has multiple sclerosis and is unable to
work. No private insurance plan will ever cover David because of those
preexisting conditions. Heather has made navigating the Medicaid and
social service systems a nearly full-time job just to maintain David's
benefits. Here is another family in need of help from the Senate.
I hope our President will not leave the Kelleys, the Brannons, or the
Snyders behind, without the health coverage their children so
desperately need. I hope he can have compassion for those families
struggling so hard to make ends meet and whose greatest wish is to
provide the most basic of needs for their children: housing, food, and
health care. I hope the President can see what a sound investment this
is. This isn't spending $7 billion a year; this is investing $7 billion
a year in the future of our families, the future of our children, and
the future of our country. Four million American children will receive
health insurance if the President signs this bill. He must sign it into
law. Too many people are counting on it.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The Senator from Texas is recognized.
Mr. CORNYN. Mr. President, there is no doubt in anyone's mind that
the SCHIP program will continue. That is a certainty, as certain as
anything can be. The question is whether the SCHIP program, the State
children's insurance program, will remain true to its targeted
population which was contemplated by Congress in 1997 when it passed
with strong bipartisan support or whether it will expand into a new
burgeoning Federal program that has lost sight of its original mission
and which, in the minds of some, represents another incremental step
toward a Federal Government takeover of our health care system in
America.
Let there be no doubt about it, a Federal, Washington-run health care
system would be bad for the children and the people of this country.
There are at least three things you can guarantee if Washington takes
control of our health care. One is it will be incredibly expensive. In
other words, taxes will have to go up to pay for it. Two, it will be
incredibly bureaucratic, and some bureaucrat with a green eyeshade will
decide what kind of health care you or your family gets. Three, there
will be rationing of health care. That same Government bureaucrat will
decide whether you get a diagnostic test, whether you can be scheduled
for an operation when you need it, or what other kinds of health care
decisions you can make. In fact, the choices will be taken from
individuals and be given to the Government. That is a bad idea,
although there are some who have advocated this for many years,
including the leading Democratic contender for President of the United
States, who has advocated a government-run health care system since the
early 1990s.
This cannot be an expansion of a wildly successful program that has
lost its focus on the poor children of America, and how in the world
could I possibly say that? Well, this bill we are debating now raises
spending by 140 percent--140 percent--at a time when my constituents
tell me they are very concerned that the Federal Government has lost
its way when it comes to spending and are worried that they will see
consequential increases in their tax burden as a result of out-of-
control Federal spending.
Along with virtually everyone else in Congress, I strongly believe
the SCHIP program should be renewed, and it will be renewed. I voted
for a renewal bill called Kids First that provided $10 billion in
addition to the $35 billion over 5 years and which would enroll 1.3
million new children in SCHIP. But the majority has rejected that as
too miserly.
Whom do they want to cover with the State Children's Health Insurance
Program? Well, No. 1, they want to cover adults in 14 States, and in
New York City they want to be able to cover up to 400 percent of
poverty. A family making $82,000 a year would be--half of whom would be
displaced from their private health insurance to get government-funded
health insurance at the courtesy of the beleaguered American taxpayer.
That is wrong.
The other inadvertent consequence of this will be because government
doesn't know how to control health care costs except to ration access
to health care, we are going to see more and more people now who will
be displaced from private health insurance to go on to government
insurance who will find low reimbursement rates--close the doors to
access to health care providers. In the city of Austin recently, there
was a story written that said only 18 percent of physicians accept new
Medicare patients--18 percent. The question was, Why? Well, the Federal
Government Medicare reimbursement rate is so low, doctors can't
continue to accept new Medicare patients and keep their doors open. In
a similar fashion, the SCHIP rate is regulated by the Federal
Government, as is the Medicaid rate. The only way many physicians and
health care providers keep their doors open is to have a mix of
government-subsidized health coverage and private health insurance. We
all know private health insurance carries the cost to allow many health
care providers to keep their doors open.
It is not conspiracy theories, it is not an exaggeration to say this
is an incremental step toward that single-payer, Washington-controlled
health care system. Right now, the Federal Government pays 50 percent
of the health care costs in America today.
I think it is a bad idea to lose sight of the original target for
SCHIP, which is children whose families make up to 200 percent of the
poverty level, who have more money than they can make and still qualify
for Medicaid. But we should do everything in our power to recommit to
those children that we are going to make sure the money Congress
appropriates, takes out of the pocket of the taxpayer and provides in
terms of health benefits to them, is true to the vision Congress
originally intended and that that money which could go to expanding
health care coverage to these kids who come from relatively modest
incomes is not taken and provided for adult coverage or middle-income
coverage in places such as New York for up to 400 percent of the
poverty level.
So there is a lot of misinformation and, indeed, downright
demagoguery going on in the media and elsewhere with regard to what is
happening here. I hope we will make one thing clear: that every Member
of the Congress--certainly this Senator--supports a continuation and
reauthorization of SCHIP. It is a canard to suggest that anyone is
denying access to health care to the children who have benefited
historically and should benefit from SCHIP. But it is simply a Trojan
horse to suggest that we are merely reauthorizing this legislation
because what is happening is we are seeing a dramatic expansion of
Federal spending, losing sight of the targeted population, and taking
another incremental step toward a disastrous Washington-controlled and
-run health care system which will be expensive to the American
taxpayer, which will be incredibly bureaucratic, and which will result
in rationing of health care, which is something that is not in the best
interest of the American people.
I thank the Chair, and I yield the floor.
The PRESIDING OFFICER. The Senator from Tennessee is recognized for
10 minutes.
Mr. CORKER. Mr. President, I thank the Chair. I will try to use less
time. I know we have a lot of business today. I rise also to talk about
the SCHIP bill we just voted on for cloture, and hopefully, later this
evening, we will have the opportunity to vote on final passage.
[[Page S12217]]
I have been here a short amount of time, and I continue to be amazed
at some of the rhetoric that ends up circling much of the legislation
we discuss in the Senate. I do not think the SCHIP bill is perfect. I
am going to vote for the SCHIP bill. I haven't been in the Senate long
enough in 8\1/2\ months to have actually ever voted for a perfect bill.
Chances are I may never vote for a perfect bill in the Senate. I know
this bill has been threatened to be vetoed. Again, I think about the
irony of a bill such as this being vetoed by the administration.
The most recent health care legislation that I remember passing out
of this body that was a large bill was Medicare Part D. As I remember,
that was a bill where nothing was paid for. We added $700 billion to
$800 billion in deficits. There was no attempt whatsoever for that to
be paid for. It also created coverage for individuals who did not need
coverage. It didn't matter. We passed a massive bill. I was not here
during that time, but it passed several years ago.
The uniqueness of this bill is that there has been an attempt to
actually pay for it--something unique in recent times as it relates to
health care coverage. Secondly, it actually is health care for people
who need it, which is also very different from some of the things we
have focused on in the past. So I find it very ironic that this
administration has chosen this bill to veto.
I have heard a lot of comments about the frailties of this, and one
of the most recent red herrings regarding this bill was that it would
allow illegal immigrants to receive health care. That is absolutely not
true. But based on the standard of this argument that was put forth
recently, we certainly need to ensure that immediately we would do away
with Social Security, Medicare, and Medicaid because they would be
held, of course, to a standard that cannot be met. That is an argument
which obviously is not true.
I also heard that this bill had earmarks in it. I have looked and I
can't find any earmarks in this bill. There is a hospital in Tennessee,
down on the Mississippi-Arkansas border, and it happens to deal with
low-income citizens who come there from Mississippi and Arkansas. So
this bill allows that hospital to be paid Medicaid reimbursement for
the patients it sees from Mississippi and Arkansas. If that is the new
standard for earmarks in this body, then I suppose every comment or
statement we make will now become an earmark.
I have also heard the comment that this is the backdoor to socialized
medicine. I really think that one is maybe the most humorous I have
heard. I do wish to bring this body's attention to the fact that the
Bush administration--the Bush administration--since it has been in
office has approved these waivers and state plan amendments: in June of
2004 to California, allowing them to go to 300 percent of poverty,
again above the intent of the original SCHIP bill; in Hawaii, in
January of 2006, allowed the State, through executive prerogative, to
go to 300 percent; in Massachusetts, in July of 2006, this
administration allowed that State to go to 300 percent; in Missouri, in
August of 2003, this administration allowed them to go to 300 percent;
in New York, in July of 2001, this administration allowed them to go to
250 percent; in Pennsylvania, in February of 2007, just a few months
ago, to 300 percent; in West Virginia, in December of 2006, to 220
percent. But the one I have left is the one that is most recent.
This administration, without any legislative involvement, in March of
2007--a few months ago--agreed to let the District of Columbia go to
300 percent of the poverty level. So for those people to say this bill
is a back door to socialized medicine, it seems to me they have not
taken into account the front door of the Bush administration, which all
along has allowed nine states to expand their programs beyond the
original intent of the SCHIP program. This bill actually causes this
out-of-control process that has been ongoing during the Bush
administration to actually be reformed. It actually causes reforms to
take place so this bill will more fully embrace its original intent.
So I rise to say there is a lot of rhetoric that is being used in
this SCHIP bill. This bill is not perfect. I know my colleagues on the
other side of the aisle would like to see changes in this bill. I would
like to see changes in this bill. I think it could have had a more
credible debate had the administration initially funded this in their
budget with an appropriate amount of money to even allow the program as
it is to continue.
I will vote for this bill. I am not going to argue to any of my
colleagues as to what they should do. I will vote for this bill because
I believe it focuses on those most in need--children--mostly poor
children in our country.
What is actually moving our country toward socialized medicine is the
fact that none of us in this body have yet taken the steps to make sure
that those most in need have access to private, affordable health care.
I know there are a number of bills that have looked at that. I have
offered a bill--again, it is not perfect--and I hope Members of this
body will actually cause it to be improved by adding amendments. But
the fact of the matter is, what will move our country toward socialized
medicine is not this SCHIP bill, which focuses on poor children in
America, but it will be the lack of action in this body to create
methodologies, which we could do, to allow people in need to have
access to private, affordable health care.
Ms. STABENOW. Will my colleague yield for a question?
Mr. CORKER. Yes.
Ms. STABENOW. First, I thank the Senator for his comments on the
floor of the Senate, debunking what has been inaccurate statements that
have been made and also for laying out the realities of what is true
about this proposal. I think the Senator has done it in a wonderful
way. I appreciate the Senator's willingness to stand up and talk about
what is real, important, and the fact that this is such a strong
bipartisan bill.
I wonder if the Senator might comment on the fact that aren't we
talking about working families, low-income working families, trying
every day to keep things together for their family, and they want to
know that the children have health care? Isn't that what this is all
about?
Mr. CORKER. That is exactly what the bill is about. There is no
doubt--and I think we should all acknowledge this--that there are some
cases in some States where there has been an aggressiveness to actually
cause some adults to be covered who should not be covered. In this
bill, focusing toward 2010, there is an effort to reform that, to cause
the focus to return back to children.
Also, there is no question that this administration, which offers the
fact that they are going to veto this bill, has done more to change the
dynamics of SCHIP than any legislation that we could pass.
I yield the floor.
The PRESIDING OFFICER. The Senator from Oregon is recognized.
Mr. SMITH. Mr. President, today is a momentous day. We have the
opportunity to extend health insurance coverage to 10 million low-
income children, 4 million of whom, without this bill, simply would
continue to be a statistic in the ranks of the uninsured. In Oregon
alone, we estimate that at least 60,000 new young people will receive
health insurance and possibly even more.
Because of the outstanding work of my colleagues, Senators Baucus,
Grassley, Hatch, and Rockefeller, and because of their work, we have
before us a proposal that will garner wide, bipartisan support. I
commend them for their efforts and thank them for their willingness to
work with me to incorporate a number of important policies not only to
Oregon but to millions of young Americans across this country.
When I first arrived in the Senate in 1997, I had the opportunity to
learn about an outstanding idea launched by two great colleagues,
Senators Kennedy and Hatch. That idea was known as the State Children's
Health Insurance Program. When they described the details to me, I
recognized in it many of the features I had worked on as an Oregon
State Senator in the development of the Oregon health plan. I told them
to sign me up and let me know how a junior Senator on the Budget
Committee could help them. It was my privilege to do that with an
amendment on that year's budget.
But here we are, 11 years later; now I serve on the Finance
Committee, and I have had the opportunity to help craft
[[Page S12218]]
a bill that will provide the authority and funding needed to continue
SCHIP for another 5 years. It is a responsibility I took seriously then
and still. I am pleased to have an opportunity today to renew it and
improve it.
As I think of the work we have done to advance this bill, I wish to
take a moment to highlight a number of critical policies I have worked
hard to advance and which are now included in the bill before us.
First, and perhaps most important, I am pleased we will continue to
utilize a 60 cent increase in the tobacco products excise tax to pay
for SCHIP reauthorization. Looking back on the debate over the budget
this past March, I didn't know, but I hoped at the time, my amendment
to do this would garner the support necessary. It has done so. That
support has held, and it is now the funding source for keeping the
promise of SCHIP.
However, in my opinion, there is no better means to provide funding
for children's health care. I know some don't like this. It is,
frankly, the only tax increase I enthusiastically support and for which
I have ever consciously voted. Not only can we extend health insurance
to 10 million low-income children, we can do so while discouraging
other young people from smoking. Studies show America's youth is
strongly discouraged from smoking if the price of the tobacco product
is increased. I am hopeful we will discourage thousands of kids from
smoking, which will improve and perhaps save their lives. I see it as a
``twofer,'' to discourage smoking, and you can connect the habit of
tobacco with all the public health care costs it imposes. It is a sad
statistic that 20 percent of Oregonians who die each year die from
tobacco-related illnesses.
I am also pleased to have been able to secure mental health parity in
SCHIP. According to a report by the Urban Institute entitled ``Access
to Children's Mental Health Services Under Medicaid and SCHIP,'' the
highest prevalence of mental health problems among all children, ages 6
to 17, is observed among Medicaid and SCHIP-eligible children at a rate
significantly higher than for other insured children and uninsured
children. Now, today, the Senate has taken a remarkable step forward to
ensuring that SCHIP treats ailments of the mind on the same level as it
treats ailments of the body. That is a notable achievement.
We are, as a Senate body, advancing the cause of mental health care
as it has needed to be for some time but now hopefully soon. In this
bill, and in the mental health parity bill earlier passed, we put
mental health on parity with physical health.
This bill also reverses the harmful policy recently implemented by
the administration. While I understand the President has some authority
to help guide the development of Federal programs, in this instance,
the policy released by the Centers for Medicare and Medicaid Services
to restrict coverage of children with incomes over 250 percent of
poverty simply goes too far.
Therefore, I strongly support the language in the bill that
reinforces the Senate's position that States will be allowed to cover
children with family incomes up to 300 percent of poverty. I also
support the proposal to create a tracking system to more accurately
determine who does and doesn't have insurance. This is vital as we
continue to work to extend health insurance to all Americans.
Finally, I wish to note how pleased I am to see that States will be
able to extend coverage to pregnant women through SCHIP. This makes
sense. Prenatal care, when you are talking about children, is truly the
point at which they can get the healthier start. Their mothers deserve
this if we are serious about the children they bear. According to the
National Committee for Quality Assurance, every dollar spent on
prenatal care results in a 300-percent savings in postnatal care costs
and an almost 500-percent savings in long-term morbidity costs. This is
an investment we need to make, and it is well worth making.
Ten years after SCHIP became law, we now have a chance to support a
bill that will cover 4 million new children who are already eligible
for this program. This is not an expansion, though. This is simply
keeping the promise of SCHIP with those children who are currently
eligible but for whom we have not had the resources, the dollars, to
fully fund this program.
While some have alleged we are expanding the program, expanding
government-run health care, that rhetoric could not be further from the
truth. We are not expanding the program, we are simply putting our
money where our mouths have been. We are taking a step forward to give
States the money they need to cover the children who already are
qualified for SCHIP but, for one reason or another, are not enrolled.
We also are not expanding government-run health care. SCHIP is a
program that is delivered by private insurance companies. It is a
program that requires families to pay premiums and copayments based on
their income levels. It is for these reasons that SCHIP will garner
strong, bipartisan support today.
In closing, I know there has been a great deal of rhetoric back and
forth between the White House and the Hill. In this instance, with
health care for millions of American children on the line, I urge my
friend, President Bush, to take a fresh look at the details of this
package and realize it is worthy of his support. I urge him to put
aside the differences of this debate and sign this bill into law for
the sake of our children, America's children.
I yield the floor.
The PRESIDING OFFICER. The Senator from Louisiana. The Senator is
recognized for 10 minutes.
Mr. VITTER. Mr. President, I rise today to speak about a very
important amendment I have filed to the SCHIP legislation that passed
the House and was sent back to the Senate. Unfortunately, the majority
leader has decided not to allow any Republican amendments to this very
important legislation. But I wish to take the opportunity,
nevertheless, to discuss my amendment which is filed which is at the
desk. It is very straightforward.
It simply says American citizens only are eligible for SCHIP and that
no funds will be used to expand health care benefits in SCHIP to
illegal immigrants and others.
The legislation we are considering, as written, will do just that. It
will expand the program enormously without any regard for focusing on
American citizens, and it is very clear that in that expansion, the
benefit would go to many illegal aliens because of glaring loopholes
that exist in present law and in this legislation.
Congressman Jim McCrery of Louisiana has been looking into this issue
for several weeks. On September 21, he wrote the Commissioner of the
Social Security Administration.
Mr. President, I ask unanimous consent to have printed in the Record
Congressman McCrery's letter to the Social Security Administration.
There being no objection, the material was ordered to be printed in
the Record, as follows:
House of Representatives,
Committee on Ways and Means,
Washington, DC, September 21, 2007.
Commissioner Michael J. Astrue,
Social Security Administration, Office of the Commissioner,
Baltimore, MD.
Dear Commissioner Astrue: As Congress prepares to debate
the reauthorization of the State Children's Health Insurance
Program (SCHIP), I am writing to request your assistance in
clarifying an issue raised by a provision in the Senate
passed bill. Specifically, I would request that the Social
Security Administration provide technical assistance to
explain the impact of Section 301 of H.R. 976, which was
passed by the Senate on August 2, 2007.
Concerns have been raised that the implementation of this
provision could make it easier for illegal aliens to qualify
for government funded healthcare programs including SCHIP and
Medicaid. In order to better assess the accuracy of these
claims, I would request that you provide answers to the
following questions by no later than the evening of Monday,
September 24, 2007.
1. If implemented as written, would the name and Social
Security number verification process in section 301 of the
Senate SCHIP bill allow the Social Security Administration
(SSA) to verify whether someone is a naturalized citizen?
2. Would Section 301 require SSA to perform any
verification of a person's status as a naturalized citizen?
3. Would the implementation of this provision detect and/or
prevent a legal alien who is not a naturalized citizen (and
therefore generally ineligible for Medicaid), from receiving
Medicaid?
4. Would the name and Social Security number verification
system in Section 301 verify that the person submitting the
name and Social Security number is who they say they are?
5. Would the name and Social Security number verification
system in Section 301
[[Page S12219]]
prevent an illegal alien from fraudulently using another
person's valid name and matching Social Security number to
obtain Medicaid or SCHIP benefits?
6. Would the name and Social Security number verification
system in Section 301 prevent an individual who has illegally
overstayed a work visa permit from qualifying for Medicaid or
SCHIP?
7. Based on the accuracy of your database, please comment
as to the volume of false positives or false negatives that
could occur under the Social Security number verification
process in section 301 of the Senate SCHIP bill.
Thank you for your prompt attention to this matter. If you
should have questions about any of the requests in this
letter, please contact Chuck Clapton of the Ways and Means
Committee Republican staff.
Sincerely,
Jim McCrery,
Ranking Member.
Mr. VITTER. Mr. President, Congressman McCrery laid out seven very
simple and straightforward questions that go exactly to this point: Is
there any reliable way to ensure that this program is reserved for
American citizens, not illegal aliens in the country?
Unfortunately, the answers--all seven of them--came back: No, no, no,
no, no, no, no.
Mr. President, I ask unanimous consent to have printed in the Record
the Administrator's responses.
There being no objection, the material was ordered to be printed in
the Record, as follows:
If implemented as written, would the name and Social
Security number verification process in Section 301 of the
Senate SCHIP bill allow SSA to verify whether someone is a
naturalized citizen?
No, the name/SSN verification process only indicates
whether this information matches SSA's records. Our
understanding of Section 301 is that it would provide States
with the option of using a match as a conclusive presumption
that someone is a citizen, whether naturalized or not. Since
we have no data specific to this particular population, we
have no basis for estimating how many noncitizens would match
if this language were passed by Congress.
2. Would Section 301 require SSA to perform any
verification of a person's status as a naturalized citizen?
Section 301 would not provide for verification of
citizenship but would create a conclusive presumption based
on less reliable data that a person is a citizen. As we read
Section 301, it would not require use of DHS data to make a
verification of citizenship.
3. Would the implementation of this provision detect and/or
prevent a legal alien who is not a naturalized citizen (and
therefore generally ineligible for Medicaid), from receiving
Medicaid?
No. Our current name/SSN verification procedures will not
detect legal aliens who are not naturalized citizens.
4. Would the name and Social Security number verification
system in Section 301 verify that the person submitting the
name and Social Security number is who they say they are?
No.
5. Would the name and Social Security Number verification
system in Section 301 prevent an illegal alien from
fraudulently using another person's valid name and matching
SSN to obtain Medicaid or SCHIP benefits?
No.
6. Would the name and Social Security number verification
system in Section 301 prevent an individual who has illegally
overstayed a work visa permit from qualifying for Medicaid or
SCHIP?
The name/SSN verification system in Section 301 would not
identify individuals who have illegally overstayed a work
visa permit.
7. Based on the accuracy of your database, please comment
as to the volume of false positives or false negatives that
could occur under the Social Security number verification
process in section 301 of the Senate SCHIP bill.
Due to a lack of data specific to this particular
population defined in section 301, we have no basis for
projecting how many ``false negatives'' or ``false
positives'' would be produced by enactment of Section 301,
but they will occur.
Mr. VITTER. Mr. President, the responses are very clear:
. . . we have no basis for estimating how many noncitizens
would match if this language were passed by Congress.
Section 301 would not provide for verification of
citizenship. . . .
Our current name/SSN verification procedures will not
detect legal aliens who are not naturalized citizens.
They will not detect illegal aliens who have gotten Social Security
numbers fraudulently.
The . . . verification system in Section 301 would not
identify individuals who have illegally overstayed a work
Visa permit,
And on and on.
The record is perfectly clear, including from the Social Security
Administration Commissioner, that there is nothing in the SCHIP
legislation to prevent this fraud, to prevent these very significant
costly benefits coming from the Federal taxpayers from going to illegal
aliens in the country.
Again, this is a glaring problem with this legislation. It is a
glaring problem with many existing Federal benefits that we should
address head on. Absent a solution to look at this carefully in the
context of this legislation, I do not think it should move forward.
Again, it is truly unfortunate that we have no ability to vote on
this amendment on the Senate floor. This is a significant issue, this
is a significant bill, and yet no Republican amendments, either this
amendment or any other, can be considered on the Senate floor given the
procedures the majority leader has used to shut out debate, shut out
amendments, move forward, ignore a very serious concern of the American
people. I think that is unfortunate. I also think it is reason not to
move forward in passing this SCHIP legislation--one significant reason
among others.
Mr. President, I yield the floor and suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mrs. CLINTON. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mrs. CLINTON. Mr. President, today, in this Chamber, we are
considering three critical issues that go to the heart of values we
have as a nation, three pieces of legislation that seek to honor these
values by putting them into action. We have passed and I am proud to
support a bill to strengthen our capacity to stop hate crimes by
supporting local law enforcement. We will be passing the largest
expansion of health care for children since we created the Children's
Health Insurance Program during the Clinton administration. Finally,
included in this Children's Health Insurance Program legislation is a
provision I sponsored and authored with Senator Dodd to support injured
servicemembers by giving their families more time off under the Family
and Medical Leave Act. This is a banner day for the Senate and the
Congress, and I am proud to join a bipartisan coalition in tackling
these challenges, from children without health insurance to military
families without the support they need.
We will pass the CHIP legislation by a wide margin, and so the choice
will then fall squarely on the shoulders of the President. Will he join
us in helping injured servicemembers and in providing health care to
3.8 million children who right now don't have it or will he put
ideology ahead of military families and vulnerable children? We in this
Chamber know what the right choice is. The American people also know
what the right choice is. I hope our President will put progress over
partisanship and join the bipartisan majority and the vast majority of
Americans in believing we can no longer treat these challenges and the
people who face them as though they were invisible.
I believe every child deserves health care. Yet far too many children
in our Nation--more than 9 million--do not have access to quality,
affordable health care. That is a moral crisis which should be
impelling us to act, and this Congress has done so.
A few weeks ago, I met Amy McCutchin, who was struggling to find
health insurance for her 2-year-old daughter Pascale--a healthy, lively
2\1/2\ year old. Amy works as a contractor while also going to school
for her master's degree. She is divorced. She lost her insurance
because of the divorce. She is not offered insurance through her
employer because she does freelance work. Unfortunately, Pascale and
her mom are among the millions for whom the Children's Health Insurance
Program is currently unavailable.
When I met Amy, she stressed she is trying to do the right thing. She
works hard. She is what we would call barely middle class. In fact, she
can't miss a day of work or she doesn't get paid. But she is also going
to school full time, and she has to balance that with her work and the
care of her daughter. She is falling through the cracks, and so is
little Pascale.
This is a story which is being told 9 million times every day by the
parents
[[Page S12220]]
of the children without health insurance. Today, we can tell a
different story and create a different outcome.
I was proud to help create the State Children's Health Insurance
Program during the Clinton administration. I worked on that legislation
during my time as First Lady. In fact, after the bill was passed into
law--a bipartisan majority in this Congress made that happen--I helped
to get the word out to tell parents that help was on the way and to
sign up children for the program in the first few years. In the Senate,
I have continued that effort, fighting to ensure health care for
children has the priority in our budget it deserves, and I am proud of
the progress we have made.
The CHIP program provides health insurance for 6 million children. In
New York alone, almost 400,000 kids benefit from CHIP every month. With
this strong bipartisan, bicameral agreement, hammered out in this
Chamber by Chairman Baucus and Senators Grassley, Rockefeller, and
Hatch, an additional 72,000 children in New York will have access to
health care coverage.
It will also help enroll many of the almost 300,000 children in New
York who live in families who are already eligible for CHIP or for
Medicaid because they make less than $52,000 a year, which is 250
percent of the poverty level for a family of four. Now, I know that
sounds like a lot of money to some people around the country, but it
doesn't go very far in New York, and it is one of the reasons why so
many children in New York don't have access to health care and why we
are fighting so hard in New York to extend health care to those who
need it and can't yet afford it.
According to the Congressional Budget Office, 3.8 million children
who are uninsured nationwide will gain coverage. That will reduce the
number of uninsured children by one-third over the next 5 years. Now,
if we can afford tax breaks for companies that ship jobs overseas and
tax cuts for oil companies making record profits, I think we ought to
be able to find it in our hearts and in our budget to cover the
millions of children who deserve a healthy start.
I want to be very clear. If the President vetoes this bill, as he has
threatened, he will be vetoing health care for almost 4 million
children and he will be putting ideology, not children, first.
Earlier this year, I was proud to introduce legislation with Chairman
John Dingell from the House of Representatives to reauthorize and
expand CHIP, and I am very pleased that a number of the ideas in our
bill are included in this legislation, such as cutting the redtape and
bolstering incentives to get eligible children into the program. The
legislation also improves access to private coverage and expands access
to benefits such as mental health and dental coverage.
Some of my colleagues have heard me tell the story about the young
boy living in Maryland whose mother wasn't on Medicaid, wasn't on CHIP,
and was struggling to get some kind of health care coverage for her
children when her 12-year-old son came down with a toothache. Medicaid
and CHIP don't cover dental care in many cases, anyway, so even though
she eventually got coverage, she couldn't find a dentist who was
available to actually provide the dental care. Her son continued to
complain, the toothache turned into an abscess, the abscess broke, and
the next thing you know, the little boy is in the emergency room and
being admitted to the hospital. But because the poison had already
spread into his bloodstream, he had to be put on life support, and
Demonte didn't make it. So for the lack of a visit to a dentist, which
might have cost $80, $85, a little boy lost his life. And this is why
expanding access to mental health and dental coverage is absolutely
critical.
I also commend the authors of this bipartisan agreement for their
work and for bringing forward a practical, fiscally responsible
compromise. It represents the culmination of a lot of hard work. I see
some of the staff from the Finance Committee here on the floor, and I
thank them because I know how much they did to make this possible.
I am also pleased that the conference report includes the support for
the Injured Service Members Act of 2007, legislation Senator Dodd and I
introduced to provide up to 6 months of job-protected leave for
spouses, children, parents, or next of kin of service members who
suffer from combat-related injuries or illness.
This amendment implements a key recommendation of the Dole-Shalala
Commission, chaired by former Senator Dole, who served with great
distinction in this Chamber, and Secretary Shalala, who served for 8
years under the Clinton administration as the Secretary of Health and
Human Services. Their Commission on Care for America's Returning
Wounded Warriors came up with a number of recommendations, and those
recommendations are supported by a broad bipartisan coalition in
Congress.
The families of our service men and women face extraordinary demands
in caring for loved ones who are injured while serving our Nation.
Currently, the spouses, parents, and children receive only the 12 weeks
of unpaid leave under the Family and Medical Leave Act. But, as the
Dole-Shalala Commission found, all too often that is just not enough
time. An injured servicemember usually grapples with not only the
physical injuries but having been, just a few weeks or months before, a
healthy, fit young person and now, with the loss of a limb or being
blinded or burned, having to come to grips with all of that. That takes
time as well as medical care.
These new injuries our service members are suffering--the traumatic
brain injuries--that we are only now focusing on are especially
difficult.
I remember being at Walter Reed a few months ago, and I met a young
Army captain who had been in a convoy hit by one of those improvised
explosive devices, resulting in the loss of his right arm and the ring
finger on his left hand because he had his wedding band on his finger
and the explosion had caused his wedding band to melt into his finger,
unfortunately causing him to lose that finger.
I asked him: Captain, how are you doing?
He said: Oh, Senator, I am making progress. Folks are helping me get
used to the prosthetic, and I am learning how to use it. But where do I
go to get my brain back? I never had to ask people for help before. Now
my wife has to make a list for me, telling me where I have to go to
meet my appointments and what I have to do when I am there. Where do I
go to get my brain back?
Well, these wounds--some that you can see, some that you can't--are
extremely serious and require family members to be available. The
language included in the bill expands leave to 6 months. It is a step
we can take immediately that will make a real difference in the lives
of these wounded warriors and their families, and I hope the President
will think about that before he vetoes this bill.
Now, I am disappointed that the CHIP bill doesn't include the Legal
Immigrant Children's Health Improvement Act, which I introduced with
Senator Snowe and have been working on with her for a number of years.
This bipartisan bill would give States the flexibility to provide
Medicaid and CHIP coverage to low-income legal immigrant children and
pregnant women. I want to underscore that. We are talking about legal
immigrant children and pregnant women.
The current restrictions prevent thousands of legal immigrant
children and pregnant women from receiving preventive health services
and treatment for minor illnesses before they become serious. Families
who are unable to access care for their children have little choice but
to turn to emergency rooms. This hurts children, plain and simple, and
I think it costs us money. A legal pregnant woman who cannot get
prenatal care may have a premature baby, who ends up in a neonatal
intensive care unit, which ends up costing us hundreds of thousands of
dollars. So I hope we are going to be able to lift this ban and make it
possible for States to access Medicaid and CHIP for legal immigrant
children and pregnant women.
But I could not be more proud that the Senate is voting on expanding
health care to 3.8 million children. There is no debating the
importance of this and the way the Senate has come together in order to
produce this result.
Finally, I am proud to support the bipartisan legislation which we
have passed to strengthen our tools against crimes motivated by hate on
the basis
[[Page S12221]]
of a victim's race, ethnic background, religion, gender, sexual
orientation, disability, and gender identity. These are crimes not just
against an individual but against a community. What we have done by
moving this legislation forward means we are taking a stand on behalf
of those individuals and communities affected.
Hate crimes are an affront to the core values that bind us one to the
other in our country. We should dedicate the resources needed to
prosecute these crimes to the fullest extent of the law. I am very
proud of our country. I think we rightly hold ourselves up as a model
for the ideals of equality, tolerance, and mutual understanding. But we
cannot rest. We have to continue to fight hate-motivated violence in
America. With today's vote, the Senate is proclaiming loudly that the
American people will not tolerate crimes motivated by bigotry and
hatred, that we will punish such crimes and the bigotry they represent.
I commend Judy and Dennis Shepherd for their extraordinary dedication
and leadership when it comes to the prosecution of hate crimes. The
murder of their son Matthew was a tragic event for a family, but a
motivating cause was created. No parent should ever have to bear what
the Shepards have borne, but their grace and their grit in going
forward is inspirational. The Matthew Shepard Local Law Enforcement
Hate Crimes Prevention Act is a step toward honoring their son's
memory, and honoring everyone who has ever been afflicted by hate-
motivated violence and harassment.
I commend my colleague Senator Kennedy for his long-time leadership
on this important matter.
The Matthew Shepard Law Enforcement Hate Crimes Prevention Act
condemns the abhorrent practice of victimizing people and authorizes
the Justice Department to help State and local governments investigate
and prosecute these appalling offenses. I commend my colleague and
friend Senator Hatch.
Today is a good day for the Senate. We are doing good work. It may be
at a glacial pace in the eyes of some of us, but I have faith in our
system and I have the utmost respect for this body. It is an honor to
be part of it, especially on a day such as today when we make progress
on behalf of the values America stands for.
I yield the floor.
The PRESIDING OFFICER. The Senator from Utah.
Mr. HATCH. Mr. President, I remember it so vividly.
I remember it as if it were yesterday.
But it was 10 years ago that Senator Kennedy and I stood outside this
great building, we stood on the Capitol lawn under a great oak tree,
and announced final passage of the Children's Health Insurance Program
legislation.
History was made that day, and it has been made every day since.
A true, bipartisan partnership--forged on the strength of good
intentions, motivated by a simple desire to help our country's most
vulnerable citizens, and nurtured in a politics-free atmosphere--led to
enactment of CHIP, arguably the most significant advancement in
children's health in this modern era.
Ten years ago, Senator John Chafee and Senator Rockefeller, Senator
Kennedy and I, began a partnership that led to the Children's Health
Insurance Program. That legislation, enacted in under 5 months--to show
you its potency--was founded on a very basic premise: that we needed to
provide incentives to States to help them design plans to provide
health insurance to the poorest of the poor families not eligible for
Medicaid.
Senators Rockefeller and Chafee argued for a Medicaid expansion.
Senator Kennedy and I argued for a State-directed block grant. The
final law was an innovative, workable blend of the two.
Since that time, almost 6 million children have become insured under
CHIP. They are leading healthier, more productive lives.
Their parents can sleep at night, resting easy that their children
will be taken care of if they become ill.
That peace of mind, that giant step toward a healthier population, is
the mark of a compassionate, caring Congress. It was a mark toward
reassuring the American people that the Government hears their concerns
loud and clear and stands ready to act.
Let us hear that same message today and let us provide our
constituents with that same measure of reassurance as we consider this
bipartisan agreement to extend CHIP for another 5 years.
This year, as Finance Committee Chairman Max Baucus, Ranking
Republican Chuck Grassley, Subcommittee Chairman Jay Rockefeller, HELP
Committee Chairman Kennedy, and I began our discussions of the Child
Health Insurance Program Reauthorization Act--or CHIPRA--we agreed
there were several key principles that must be embodied in any
extension of the original act.
The bill we consider today is built on those principles.
First, we agreed that the proposal must be fully financed or else it
would be irresponsible for us to legislate.
Next, it must retain the original character of CHIP--that is, it must
be a flexible, State-directed program. Senator Kennedy talked about
that this morning.
We worked to see the budget resolution provide $25 billion in its
baseline to extend the current levels of coverage, and up to $50
billion more if it were fully financed.
Indeed, this bill is fully financed.
The costs above the budget baseline have been certified by Joint Tax
to be covered by an increase in the tobacco excise tax.
We agreed that we wanted to continue coverage for those who are
currently eligible, but also to conduct extensive outreach to enroll
those who may be eligible but aren't enrolled.
Our bill provides health coverage to almost 4 million low-income,
uninsured children through incentives to states to enroll these
uninsured children in their programs.
We agreed that coverage of childless adults--a policy Senator Kennedy
and I never intended nor envisioned when we wrote our original
proposal--we agreed that policy needed to stop.
Under our bill, childless adults currently covered under CHIP will be
phased out of the program and transitioned into Medicaid.
I cannot emphasize this enough. Today, 6 million children receive
health care through the CHIP program--25,095 of these children are from
Utah.
That would not have happened absent congressional action in 1997.
In addition, there are an added 6 million children in families with
income under 200 percent of the Federal poverty level--or FPL--who are
uninsured and eligible for either CHIP or Medicaid.
According to the Congressional Budget Office, the bipartisan,
compromise bill covers close to 4 million of these children--3.7
million to be precise--a significant step by any measure. This is a
crucial, crucial part of the bill, an achievement that, while
expensive, really goes to the heart of what we are trying to achieve
with the original CHIP, and now CHIPRA.
For several weeks now, we have heard a crescendo of opposition to our
legislation from officials at the White House, and most recently, our
President.
Needless to say, this is disheartening for me. It is difficult for me
to be against a man I care for, my own personal President, on such an
important bill. I have been and will continue to be one of the
President's strongest supporters in the Congress. He is a good man. He
means well, but he does have to listen to his staff--or at least does
listen to his staff, and I believe he has listened to them in a way
that throws barriers up to this bill.
I wish I had had an opportunity to persuade him on the merits of this
bill before he issued a veto threat. I did send messages down there,
talked to top people in the administration, but I wish I had had a
greater opportunity.
Indeed, I am sympathetic to many of the concerns he raises.
When he says that we need to be careful about creating a one-size-
fits-all health plan for our children, I believe he is right. When we
wrote this program in 1997, we wrote it based on the foundation of
giving States the flexibility to design their own CHIP programs. Each
State is different--what is good for Utah may not be good for
California or Massachusetts.
It is important for States, not the Federal Government, to determine
which benefits should be covered. After
[[Page S12222]]
all, CHIP is a State block grant program, not a Federal entitlement.
That is why we are debating its reauthorization today.
The President has also raised concerns about the Federal dollars that
our bill spends on the CHIP program over the next 5 years.
I agree that $60 billion is a lot of money. But in comparison to what
the House passed bill proposed earlier this year--they started at $100
billion and came down to $75 billion--it is much more reasonable.
And, as the Congressional Budget Office has told us, it is relatively
more expensive to find and cover the low-income children who still do
not have health coverage compared to those who are enrolled today.
That is why I was able to agree with the Senate number of $35
billion, in addition to the $25 billion already built in the budget
baseline for CHIP--although, to be fair, it is higher than I would have
liked. But this is a classic compromise and friends in the House wanted
more. Some of them.
It is unfortunate that the President has chosen to be on what--to
me--is clearly the wrong side of the issue.
Indeed, this is not the bill I would have written if I had full
license to draft. That is true for the original SCHIP law as well.
But, it is hard to envision any major law being written by one person
and enacted without change. That is not how good legislation is made.
Indeed, 10 years ago, Senator Kennedy and I spent many, many hours
proposing, arguing, compromising, and refining, in drafting session
after drafting session.
Some days it seemed we disagreed more than we agreed.
It was hard, hard work.
But it was a labor of love.
We had a full discussion. We explored all the issues together.
We found compromises where we needed to.
That is how good legislation is made. Sometimes even bad legislation,
but this is good legislation.
It pains me that we did not have this full discourse with the
administration on CHIPRA.
It pains me that some have been slow to recognize the realities of
this new Congress.
Indeed, what some political pundits termed The Trifecta--a Republican
House, Senate, and Presidency, is no more.
I thought I should point out this fact for those in this body who may
not have noticed.
And so it is no secret, no surprise, that a Democrat-led Congress
would seek a more expansive program.
Yet it is to the great credit of our Democratic leaders that they
recognize our country's fiscal realities and that they held the line at
the additional $35 billion figure.
To be sure, I would have been comfortable with a lower number, just
as Speaker Pelosi and Chairman Rangel and Chairman Dingell and Chairman
Baucus and Chairman Rockefeller advocated for a much higher number.
So, again, we have that spirit of compromise which was the hallmark
of CHIP in 1997.
I must say it has also been difficult to conflict with my good friend
from Utah, Health and Human Services Secretary Mike Leavitt.
He was an expert in health care policy when he was Governor of Utah,
and he is even more of a leader on the national level now.
I know the concerns he expressed to me about the CHIP bill in 1997.
I recall our many conversations when he advocated for a greater
Federal role in health coverage for needy children. And I also recall
his admonitions that we could do better by the children and their
parents if we were to provide the States with much-needed flexibility.
The final CHIP block grant reflected that flexibility I believe, and
Mike Leavitt's good counsel helped us improve the law. I hear Secretary
Leavitt's concerns when he says that he is concerned about paying for
the reauthorization of this program through tobacco taxes. I am not
comfortable with raising taxes either. However, when we first created
the CHIP program in 1997, we believed that it was entirely fitting that
the bill be funded through incentives to decrease the use of tobacco, a
leading killer of Americans young and old. And, therefore, I am
comfortable with raising tobacco taxes to pay for our CHIP program.
I understand his concerns about crowd-out and higher income children
dropping their private health coverage in order to be covered through
CHIP when CHIP was created to provide health care for low-income
children.
And I agree with him 100 percent when he says that we are only fixing
part of the problem by reauthorizing CHIP and not addressing what's
wrong with the entire health care system.
He and I have visited on several occasions on these issues. I have
benefited by that guidance, and I sincerely regret that ultimately we
disagree on this bill. But I am willing to work with him to try to come
up with an overall health care plan that will work.
I might add that I believe we have had an honest misunderstanding
which has not only been raised by Secretary Leavitt but the President
as well. They say that our legislation allows families with annual
incomes of $83,000 to be covered under a State CHIP plan.
Let me be clear. Our legislation does not permit a State to cover
these families unless the Secretary of Health and Human Services
approves the State's application to cover individuals at that income
level.
We do not change current law and put Congress in charge. We leave
that decision in the hands of the Secretary.
We do not take away the Secretary's authority to make that decision.
I hope that point is clear.
At this point, it may be helpful for me to outline for my colleagues
exactly what this bill does.
As I stated earlier, CHIPRA is a 5-year reauthorization which spends
an additional $35 billion in Federal dollars on the CHIP program, in
addition to the $25 billion in Federal dollars already built into the
budget baseline.
So, in total, we are spending $60 billion in Federal dollars over the
next 5 years on the CHIP program.
And I know that sounds very expensive, especially to my Republican
colleagues. In contrast, the bill passed by the House in August would
have spent an additional $50 billion on CHIP on top of the $25 billion
in the budget baseline for a grand total of $75 billion.
As this chart indicates, we spend far more Federal money on Federal
health programs then we are suggesting that we spend on the CHIP
program over the next 5 years.
This chart compares projected spending in Medicare, Medicaid and the
National Institutes of Health to the spending that we authorize for the
CHIP program from fiscal year 2008 to fiscal year 2012.
For the Medicare Program, CBO projects that the Federal Government
will spend $2.6 trillion, yes, trillion dollars over the next 5 years.
For the Medicaid Program, CBO projects that the Federal Government
will spend $1.22 trillion over the next 5 years.
For the NIH, we project that the Federal Government will spend
approximately $150 billion over the next 5 years.
In contrast, our bill authorizes $60 billion over the next 5 years. I
think these numbers speak for themselves. We can spend billions, even
trillions of dollars on programs for the elderly, disabled, very poor
and for medical research but spending $60 billion to provide health
care for the children of the working poor causes the President to issue
a veto threat? Something here just doesn't add up, especially when you
look at these numbers on this chart. The spending for the CHIP program
hardly shows up on this chart compared to the other three programs.
Let me remind my colleagues that this legislation is built on
compromise.
Is it perfect?
Far from it.
But does it cover more CHIP-eligible kids, our ultimate goal?
Absolutely.
And that's why I am a strong advocate for this bill and urge my
colleagues to support it.
This is a good compromise.
It is a $35 billion bill--not a $50 billion bill. The House
ultimately agreed with the Senate on this issue. I do not blame them.
They are very sincere in thinking you can just throw money at these
things and you will do more good.
It does not include Medicare provisions. The House also dropped its
insistence on this issue, even though
[[Page S12223]]
there was tremendous pressure to include Medicare provisions such as a
fix for the sustainable growth rate formula flaw, which is the
physician reimbursement rate, in 2008.
But let me be clear, all of us agree that these important Medicare
issues must be addressed by the end of this year. Just not in this
bill.
Before I continue, I would like to note that both the $35 billion
limit and agreement not to include Medicare provisions were huge
concessions by the House of Representatives.
Honestly, I never thought that the House leadership would agree to
those terms; and, trust me, those were the two conditions that were
nonnegotiable as far as I was concerned.
The moderation on the part of House leaders is a true indication that
they are serious about getting a bipartisan CHIP reauthorization bill
signed into law.
Key provisions of this legislation are the tools and resources it
provides to enroll more of the CHIP-eligible children. As I previously
stated, in addition to the 6 million children already covered by CHIP,
this bipartisan compromise bill would provide coverage to almost 4
million more uninsured, low-income children.
The bill no longer allows new State waivers for adults to receive
their health care through CHIP. Childless adults will be phased out of
CHIP and will be covered through Medicaid.
States that currently cover parents may continue to do so; but after
a transition period, States will no longer receive the enhanced CHIP
match rate for covering parents.
The legislation rewards States for covering more low-income children
by establishing a CHIP performance bonus payment for States that exceed
their child enrollment targets.
We worked hard to make certain there will be no funding shortfalls
with this legislation.
The bill provides States adequate money in their CHIP allotments so
they will not experience funding shortfalls in their CHIP program.
As a safeguard, we created a Child enrollment contingency fund for
States that experience a funding shortfall as a result of enrolling
more low-income children.
Shortfalls have been a serious problem. They are something we want to
avoid.
In addition, the proposal clarifies that States will only have 2
years to spend their CHIP allotments. Today, States have 3 years to
spend their CHIP allotments.
It gives States a new option to provide coverage to pregnant women.
Today, pregnant women are only covered in CHIP if the State has been
granted a waiver to cover pregnant women or through the
Administration's unborn child policy.
This is a proposal Senator Kennedy and I seriously considered
including in 1997. We ultimately concluded that the cost of childbirth
hospitalization was so expensive, then, about $4,000 a birth, that the
greater public good could be achieved if we focused those resources on
providing more insurance policies to needy children.
It was not a policy we undertook with great comfort. Indeed, Senator
Kennedy argued strongly for coverage of pregnant women. But ultimately,
we chose to advocate for the policy that covered the most children.
Today, we are both satisfied that the bill embodies the correct
policy, if I may speak for the Senator from Massachusetts on this
point.
CHIPRA provides beneficiaries and their families with coverage
choices. If the State provides premium assistance through its CHIP
program, CHIP beneficiaries may choose to be covered through the State
CHIP program or receive premium assistance to receive health care
through a private health plan. And States like Utah that already have
premium assistance programs for their CHIP beneficiaries would have
their programs grandfathered in, in other words, their programs would
continue to exist.
It also provides CHIP beneficiaries with dental benefits, states will
have a choice of four dental benchmark plans to provide to their CHIP
beneficiaries, the dental benefits included in the House-passed bill; a
benefit package equivalent to the federal employee health plan dental
benefit that covers the most children; a benefit package equivalent to
the State employee dental plan that covers the most children; or a
benefit package equivalent to the most popular commercial dental plan
that covers the most children.
As my colleagues are aware, I have a long record of advocating for
better dental care for children. It alleviates so many health problems
in the future.
In fact, in 2000, I introduced the Early Childhood Oral Health
Improvement Act, which created grant programs to improve the oral
health of children under 6 years of age. This bill was included in the
Children's Health Act which was signed into law on October 17, 2000.
So, I know how important dental health is for children.
At the same time, it is fair to say that I have been concerned about
mandating that States provide dental coverage for two basic reasons.
First, the inherent nature of CHIP, and a primary reason it could be
enacted in a Republican-led Congress, is that it was a State block
grant.
Mandates move us away from that important framework.
Second, the dental coverage that some advocated be included in this
bill is more generous than most private-sector policies. Thus,
including such coverage would be a giant incentive for crowd-out, that
is, dropping private coverage in order to seek a more generous public
coverage.
Ten years ago we called it substitution. Today, we call it crowd out.
But it is the same thing.
I will not sugar coat it. It is a problem. It is a concern. And, we
should take every step we can to keep it from occurring.
I think the dental policy we adopted was a good compromise, and I
appreciate my colleagues agreeing to my suggestion for this coverage.
Our legislation also limits the Federal matching rate that States
will receive for covering individuals with family incomes over 300
percent of FPL in their CHIP plans.
It clarifies the Administration's policy on crowd-out and provides
States with guidance on how to ensure that their low-income children
are covered through the CHIP plan before expanding coverage to higher
income children.
Another key element of this bill is that it provides States with
funds for outreach and enrollment.
It gives States a time-limited option to speed up enrollment in CHIP
and Medicaid by using eligibility information from designated express
lane agencies.
The bill gives States the option of verifying citizenship for both
Medicaid and CHIP by submitting names and Social Security numbers to
the Commissioner of Social Security.
It creates a new quality initiative through the Secretary of Health
and Human Services, in consultation with the States, to develop
evidence-based pediatric quality measures in order to evaluate the
quality of care for children.
I introduced legislation to develop pediatric quality measures with
Senators Bayh and Lincoln and much of our bill is incorporated in this
bipartisan compromise legislation.
The proposal includes mental health parity in the state CHIP programs
so that if a State offers mental health coverage in its CHIP plan, it
must be on par with limits for medical and surgical services.
Senator Gordon Smith has done a stellar job bringing awareness about
the need for mental health benefits for children and this provision is
modeled after legislation that he introduced with Senator John Kerry of
Massachusetts.
At this point, I would also like to refute some of the inaccurate
statements that I have heard the last few days regarding our bill.
First, some have alleged that our bill allows the Federal Government
to continue covering childless adults and parents through CHIP.
Our bill puts the emphasis back on low-income, uninsured children.
Simply put, our bill puts an immediate stop to States being granted
future waivers to cover nonpregnant adults. In fact, the provisions
included in the Senate-passed CHIP bill were included in the
compromise, bipartisan CHIP bill.
At the beginning of fiscal year 2009, States will receive lower
Federal matching rates for childless adults and
[[Page S12224]]
in fiscal year 2010, childless adults will not be covered under CHIP,
they will be transitioned into Medicaid.
At the beginning of fiscal year 2010, only States with significant
outreach efforts for low-income uninsured children will receive
enhanced match rates for parents; others will receive the lower
Medicaid match rate FMAP for adults.
Starting in fiscal year 2011, all States will receive a lower Federal
match rate for parents. Those States covering more lower income kids or
with significant outreach efforts will receive a Federal matching rate
for parents covered under CHIP which is a midpoint between the Federal
CHIP matching rate and the lower Medicaid matching rate. Other States
will receive the lower Medicaid Federal matching rate, known as FMAP,
for CHIP parents. Simply put, beginning in fiscal year 2011, States
will no longer receive the higher CHIP matching rate for covering
parents.
Second, some criticize our bill and say it allows higher income
children to be covered under the CHIP program.
Today, States may receive an enhanced Federal matching rate for their
CHIP program through waivers for all income levels. Our bill
discourages States from covering higher income individuals in the CHIP
program.
After enactment of our bill, States with new waivers approved to
cover those with family incomes over 300 percent of FPL would only
receive the lower FMAP payment for these higher income individuals.
In addition, States that cover individuals with incomes over 300
percent of FPL in their CHIP plans will have to submit a State plan to
the HHS Secretary to show how it is addressing crowd-out for higher
income children covered under CHIP.
The State plan must be approved by the HHS Secretary before October
1, 2010; otherwise, the State will no longer receive Federal matching
dollars for covering those over 300 percent of FPL in their CHIP plans.
Third, some say our bill makes CHIP an entitlement program and almost
doubles the Federal dollars spent on CHIP over the last 10 years.
CHIP is not an entitlement program, it is a capped, block grant
program, where States are given flexibility to cover their low-income,
uninsured children.
I admit that it works so well, nobody wants to abolish it, including
the President and most everyone in this body. As to its cost, as I
noted earlier, the 6 million children who are already covered by CHIP
were easier to find that the current 6 million, low-income, uninsured
children under 200 percent of FPL.
CBO has explained it is much more expensive to find these uncovered
children. That is why our bill gives States bonus payments for
enrolling them. I hope their prediction does not prove true. If it
doesn't, we will save money in the program. But if their prediction
does prove true, there is still no excuse for enrolling these kids.
I also believe it is important to note that, according to the Centers
for Medicare and Medicaid Services, in 2005, we spent a total $1.98
trillion on our Nation's health care system.
Private expenditures were $1.08 trillion and Federal spending was
$900 billion.
Total Medicare spending was $342 billion in 2005 and Medicaid was
$177 billion in Federal dollars.
Our bill today funds CHIP at $60 billion over five years--a fraction
of the cost to provide care for low-income, uninsured children.
Covering these children is worth every cent.
Another common criticism is the myth that our bill allows States to
cover children from families with annual incomes of $83,000.
I have addressed this before, but it bears repeating.
Our bill neither prevents, nor requires, States' coverage of families
at higher income levels. Only the Secretary of Health and Human
Services decides whether a State may cover families with incomes up to
$83,000 per year under their State CHIP program, not Congress.
Many have suggested, in error, that our bill allows illegal
immigrants to be covered under CHIP.
In fact, during the House debate, I heard some state incorrectly that
our bill provides benefits to illegal immigrants and opens the door for
CHIP and Medicaid benefits for illegal immigrants by substantially
weakening a requirement that persons applying for such services show
proof of citizenship.
Nothing could be further from the truth.
In fact, our legislation has specific language stating that no
illegal immigrants will be covered under CHIP.
For those who still don't believe me, it can be found under section
605, entitled No Federal Funding for Illegal Aliens.
Let me just read what it says: ``Nothing in this Act allows Federal
payment for individuals who are not legal residents.''
Finally, much has been said about the Centers for Medicare and
Medicaid Services' recent guidance on crowd out.
I will include for the Record a letter dated August 17, 2007, to the
State Medicaid Directors from Dennis Smith, the director of the Center
for Medicaid and State Operations for CMS.
The purpose of this letter was to give the State Medicaid Directors
guidance on how CMS will review state plan amendments or waivers to
raise income eligibility limits under the CHIP program in the future.
In this letter, CMS made it perfectly clear that the agency was very
concerned about crowd-out and wanted States to target low-income,
uninsured children under 200 percent of poverty before covering higher
income children under CHIP.
So in order for States to cover higher income children, CMS made it
clear that States must cover 95 percent of their children under 200
percent of poverty before expanding coverage to higher income children.
While I agree with the thrust of what the administration intended to
achieve, I am not certain what Mr. Smith asks the States to do can be
achieved.
States have told us it is virtually impossible for them to determine
how many of those low-income children are currently covered.
Currently, good, solid data on the uninsured simply do not exist. So
it is almost impossible to find good, solid numbers on the uninsured.
On top of that, currently, States do not have to report income data to
CMS.
Therefore, we knew that it would be impossible for States to
determine how many low-income, uninsured children live in their States
and whether or not those children were receiving health coverage.
We heard the States and we addressed their valid concerns in the bill
by requiring that two studies will be conducted to study crowdout and
figure out what States are doing to successfully cover low-income,
uninsured children. Once the data are available, States covering
individuals over 300 percent of poverty in their CHIP plans must submit
to the HHS Secretary their plans for covering low-income children and
reducing crowdout. If its plan is not approved by a certain date, a
state would no longer receive CHIP money for covering those over 300
percent FPL with limited exception. To me, that sends a very clear
message to all 50 States about the intention of the CHIP program--to
cover low-income, uninsured children.
Let me conclude by emphasizing to my colleagues that passing this
legislation is the right thing to do.
When we first wrote CHIP in 1997, our goal was to cover the several
million children who had no health insurance coverage. These children
were in a no-win situation--their family incomes were too high to
qualify for Medicaid, but their families did not have enough money to
purchase private health insurance.
When Senator Kennedy, Senator Chafee, Senator Rockefeller and I
worked on the original legislation in 1997, our goal was to cover the
several million children who had no health insurance.
Coverage of these uninsured children is still our top priority, and I
believe our bipartisan CHIP bill will make a dramatic difference by
covering almost 4 million additional low-income children.
The bill we are considering is very similar to the Senate-passed CHIP
bill and captures the true essence of the 1997 law.
It is the true essence of bipartisan compromise.
To be fair, it does not make any of us Republicans comfortable to
face a veto threat from our President.
[[Page S12225]]
It does not make me comfortable to face a veto threat issued by my
colleague and good friend from Utah, Secretary Leavitt.
However, as Senator Kennedy and I have been fond of saying to each
other over the years, if neither side is totally comfortable, we must
have done a good job.
This is a good bill. It accomplishes what we have set out to do--to
cover low-income children without health coverage.
Yes, I admit, it is expensive. However, this is necessary spending
when I think of the 6 million American children who are leading
healthier lives because of our vision and commitment.
And when I compare $60 billion to the trillions of dollars our
Government will spend on health care, I believe it is a worthwhile
benefit.
We should not let the opportunity pass us by to build on that solid
foundation and do even better for the children, our future.
I will add one more point that I want my Republican colleagues to
take to heart. This is a bipartisan compromise bill. It is not the
House-passed CHIP bill that would spend $75 billion over the next 5
years on CHIP.
In my opinion, the $50 billion CHIP legislation before the Senate is
the better deal for the low-income children and the American people. It
is my hope that my colleagues who disagree with me will take one more
look at this legislation.
On the House side, I would like to recognize the hard work of my
House colleagues: Energy and Commerce Committee Chairman John Dingell;
House Energy and Commerce Health Subcommittee Chairman Frank Pallone;
House Ways and Means Committee Chairman Charlie Rangel; House Committee
on Oversight and Reform Chairman Henry Waxman; and of course, the
Speaker of the House, Nancy Pelosi.
I also want to commend my Utah Governor, Jon Huntsman, Jr., for his
continued support of legislation to reauthorize the CHIP program. In
April, Governor Huntsman presented me with a proclamation expressing
his and the Utah State Legislature's strong support for the CHIP
program, which I greatly appreciated. In fact, Governor Huntsman and
his staff have provided me with invaluable advice throughout this
process. Utah's program, which covers 25,095 children, provides well-
child exams; immunizations; doctor visits; hospital and emergency care;
prescriptions; hearing and eye exams; mental health services; and
dental care.
Finally, I must commend my good friends and colleagues from the
Senate: Finance Committee Chairman Max Baucus; Ranking Republican
Member Chuck Grassley; Finance Health Subcommittee Chairman Jay
Rockefeller; and the Senate Majority Leader Harry Reid.
I would also like to mention all of the staff who put many hours into
this bill and gave up time with their families to work on this bill--
Pattie DeLoatche, Patricia Knight, Karen LaMontagne, Peter Carr, Jared
Whitley, Hanns Kuttner, Becky Shipp, Rodney Whitlock, Mark Hayes, Alice
Weiss, Michelle Easton, David Schwartz, Jocelyn Moore, Ellen Doneski,
Ruth Ernst, Kate Leone, Bridgett Taylor, Amy Hall, Bobby Clark, Karen
Nelson, Andy Schneider, Wendell Primus, Ed Grossman and Jessica
Shapiro.
I would be remiss if I didn't mention some of the staff who laid the
groundwork on the original CHIP law in 1997, particularly Patricia
Knight, Rob Foreman, Bruce Artim, Nick Littlefield, David Nexon, Laurie
Rubiner, Lisa Layman, Michael Iskowitz, Cybele Bjorklund and Mary Ella
Payne.
Mr. President, I remember so vividly 10 years ago when Senator
Kennedy and I stood on this floor to argue for enactment of SCHIP. We
had two posters.
We had one of a little boy named Joey.
And we had one of Joe Camel, the mascot for one manufacturer of
cigarettes.
We asked our colleagues, whom do you support? Joe Camel or Joey?
It is somewhat ironic, even amazing, or even more--a reflection of
history repeating itself--that I stand here today to pose the same
question to my colleagues.
Whom do you support: Joe Camel or Joey?
Joey? He's now almost 20.
The Camel? Haven't seen him for a while, have we?
So, we are making progress.
But there is much to do.
This bill represents the congressional commitment to one of the most
important goals we can strive for: a healthy population.
We must start with the kids, and that is what H.R. 976 does.
I would like to close by reading an excerpt from a letter written by
Karen Henage, the parent of children are covered by the Utah CHIP
program. Kim Henage writes, ``I firmly believe the CHIP Program gave
our family the financial assistance and more so the emotional security
(peace of mind) to survive our new start, so that we were able to make
it make it through. We are a success story because of this assistance.
I cannot express in mere words how much this meant to us. When we
needed it, it was there for us. I wholeheartedly request your support
of the continuation of this valuable program, that other families might
survive as we did.''
I think Kim's letter says it all--we must pass this bill today so
more families without health insurance will be able to become a CHIP
success story like the Henages.
I ask unanimous consent to print the above-referenced letter from CMS
in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Department of Health &
Human Services,
Baltimore, MD, August 17, 2007.
Dear State Health Official: This letter clarifies how the
Centers for Medicare & Medicaid Services (CMS) applies
existing statutory and regulatory requirements in reviewing
State requests to extend eligibility under the State
Children's Health Insurance Program (SCHIP) to children in
families with effective family income levels above 250
percent of the Federal poverty level (FPL). These
requirements ensure that extension of eligibility to children
at these higher effective income levels do not interfere with
the effective and efficient provision of child health
assistance coordinated with other sources of health benefits
coverage to the core SCHIP population of uninsured targeted
low income children.
Section 2101(a) of the Social Security Act describes the
purpose of the SCHIP statute ``to initiate and expand the
provision of child health assistance to uninsured, low-income
children in an effective and efficient manner that is
coordinated with other sources of health benefits coverage.''
Section 2102(b)(3)(C) of the Act, and implementing
regulations at 42 CFR Part 457, Subpart H, require that State
child health plans include procedures to ensure that SCHIP
coverage does not substitute for coverage under group health
plans (known as ``crowd-out'' procedures). In addition
section 2102(c) of the Act requires that State child health
plans include procedures for outreach and coordination with
other public and private health insurance programs.
Existing regulations at 42 CFR. 457.805 provide that States
must have ``reasonable procedures'' to prevent substitution
of public SCHIP coverage for private coverage. In issuing
these regulations, CMS indicated that, for States that expand
eligibility above an effective level of 250 percent of the
FPL, these reasonable crowd-out procedures would include
identifying specific strategies to prevent substitution. Over
time, States have adopted one or more of the following five
crowd-out strategies: Imposing waiting periods between
dropping private coverage and enrollment; imposing cost
sharing in approximation to the cost of private coverage;
monitoring health insurance status at time of application;
verifying family insurance status through insurance
databases; and/or preventing employers from changing
dependent coverage policies that would favor a shift to
public coverage.
As CMS has developed more experience and information from
the operation of SCHIP programs, it has become clear that the
potential for crowd-out is greater for higher income
beneficiaries. Therefore, we are clarifying that the
reasonable procedures adopted by States to prevent crowd-out
pursuant to 42 CFR. 457.805 should include the above five
general crowd-out strategies with certain important
components. As a result, we will expect that, for States that
expand eligibility above an effective level of 250 percent of
the FPL, the specific crowd-out strategies identified in the
State child health plan to include all five of the above
crowd-out strategies, which incorporate the following
components as part of those strategies: The cost sharing
requirement under the State plan compared to the cost
sharing required by competing private plans must not be
more favorable to the public plan by more than one percent
of the family income, unless the public plan's cost
sharing is set at the five percent family cap; the State
must establish a minimum of a one year period of
[[Page S12226]]
uninsurance for individuals prior to receiving coverage;
and monitoring and verification must include information
regarding coverage provided by a noncustodial parent.
In addition, to ensure that expansion to higher income
populations does not interfere with the effective and
efficient provision of child health assistance coordinated
with other sources of health benefits coverage, and to
prevent substitution of SCHIP coverage for coverage under
group health plans, we will ask for such a State to make the
following assurances: Assurance that the State has enrolled
at least 95 percent of the children in the State below 200
percent of the FPL who are eligible for either SCHIP or
Medicaid (including a description of the steps the State
takes to enroll these eligible children); assurance that the
number of children in the target population insured through
private employers has not decreased by more than two
percentage points over the prior five year period; and
assurance that the State is current with all reporting
requirements in SCHIP and Medicaid and reports on a monthly
basis data relating to the crowd-out requirements.
We will continue to review all State monitoring plans,
including those States whose upper eligibility levels are
below an effective level of 250 percent of the FPL, to
determine whether the monitoring plans are being followed and
whether the crowd-out procedures specified in the SCHIP state
plans are reasonable and effective in preventing crowd-out.
CMS will apply this review strategy to SCHIP state plans
and section 1115 demonstration waivers that include SCHIP
populations, and will work with States that currently provide
services to children with effective family incomes over 250
percent of the FPL. We expect affected States to amend their
SCHIP state plan (or 1115 demonstration) in accordance with
this review strategy within 12 months, or CMS may pursue
corrective action. We would not expect any effect on current
enrollees from this review strategy, and anticipate that the
entire program will be strengthened by the focus on effective
and efficient operation of the program for the core uninsured
targeted low-income population. We appreciate your efforts
and share your goal of providing health care to low-income,
uninsured children through title XXI.
If you have questions regarding this guidance, please
contact Ms. Jean Sheil, Director, Family and Children's
Health Programs.
Sincerely,
Dennis G. Smith,
Director, Center for Medicaid
and State Operations.
Mr. HATCH. I yield the floor.
The PRESIDING OFFICER. The Senator from Pennsylvania.
Mr. CASEY. Mr. President, I commend the Senator from Utah for his
remarks today, for his work on this bill, his work many months ago when
this work began in the Senate, and for his leadership 10 years ago in
1997, when at that time, as today, we had bipartisan agreement on
children's health insurance. I commend him and his colleague, Senator
Grassley.
On the Democratic side we have a lot of great leaders: Senator Jay
Rockefeller and Senator Max Baucus, working mightily with Senator
Kennedy and so many others to get this done. We still have a long way
to go. We know we had a resounding 69 votes in the Senate today, but we
still have one impediment to getting this done. That impediment is the
President of the United States.
I want to talk about some numbers today, but I want to focus
initially on the benefits of this program. We are going to continue to
have debates within this body and with the President about this issue.
I will get to that. But let's step back for a minute and think about
what this program means to one single child or what it means to one
single family. Here is what it means. I come from Pennsylvania. We have
some big cities in Pennsylvania: obviously, Pittsburgh and
Philadelphia. But what if this child is born in a rural area. I come
from a State where a huge percentage of our population is, in
statistical categories, considered rural. The breadth of Pennsylvania,
right through the middle of the State, out toward western Pennsylvania,
we have a lot of people who live in rural areas. We know the benefits
of this program help a lot of our children in cities and towns and also
in rural areas. In fact, one-third of rural children get their health
care from Medicaid or the Children's Health Insurance Program.
We also know a lot of African-American and Latino children have
benefited tremendously in the 10 years this has been part of our law.
Let's think about those children. No matter where they live, let's
think about what this means to them. It means they can get well-child
visits to the doctor during a year. The experts tell us you need at
least six of those in your first year of life to be healthy. We ought
to make sure every child in America can have six well-child visits in a
year, but millions don't get that.
What happens to that child? That child would not grow. Their brains
and cognitive development would not proceed as it should. They can't
learn as fast. They can't read as quickly. They don't do as well in
school. Down the road when they become part of the workforce, they have
been shortchanged, if we don't do our job. It also means immunizations
in the dawn of their lives and all of the preventative care a child
should receive.
We should be doing everything we can in this body, not just with
children's health insurance but with early learning opportunities and
other programs we have to help our children to do a number of things,
but principally to make sure children are healthy enough to learn. We
know if they learn more in the dawn of their lives, they will earn more
down the road. We have to make those investments. I don't see this as
just a program, something that we are giving to people.
That is not what it is. The distinguished Senator from Utah said a
couple moments ago, this is a capped block grant program and a good
investment in that child and his or her future. But it is also an
investment in our economic future. We can do a lot with this program to
help families. But let's think about a mother. What does every mother
want for their child, especially when they are very young? They want to
nurture the child. They want to make sure the child has some kind of
health care, has nutrition, and they want to shower that child with all
the love and care a mother can provide.
One of the benefits to reauthorizing this program and getting the job
done is that we can help a mother as she is trying to provide
everything she can for her child, whether she lives in a farming
community in central Pennsylvania or whether she lives in one of our
towns in Pennsylvania or across the country or whether she lives in the
inner city. Make no mistake, this comes down to a very simple
question--maybe a couple, but one basic question--which is, does the
President want to cover 10 million American children? There is only one
answer to that question, only one answer we can justify. There is only
one answer for which we can go back to our States and say we did the
right thing. That answer is, absolutely, the President should want to
cover 10 million American children because if he vetoes this and his
point of view prevails, 10 million children will not have health
insurance. By signing this legislation we are about to send to him, he
can make sure 10 million American children have health insurance.
What upsets me about the President--I have been very critical of him,
and I will continue to be so when it is warranted--is not just his
position on this issue, not just his threat of a veto--that is bad
enough. What upsets me and a lot of Americans, frankly, is the
President had month after month after month to come to the Congress and
say: I think we should have a $5 billion increase over 5 years. That is
what he says. There is an overwhelming consensus now in the Congress
that it should be a $35 billion increase. When you consider it over 5
years, that is only a billion a year. We spend $7 billion a year on a
lot of things. But let's consider what he said. If he was going to take
that position all those months ago, why didn't he come to the Congress?
If health care for children is such a priority, why didn't he come to
the Congress and say: We are far apart. The Congress is at $35 billion,
and I am at $5 billion. We will work together.
He didn't do that. He just laid down his number and then he began,
frankly, to misrepresent the facts. That has made this argument an
unfortunate episode in the debate.
I have another question for the President. The question about 10
million children is very important, but I have a question for the
President. What is the choice you are making? You are saying on the one
hand, Mr. President, that 10 million American children should not have
health insurance at the same time that in 2000 we will give away $100
billion to wealthy Americans. Is that right? I don't think so. That is
immoral in my judgment, to give $100 billion to wealthy Americans
[[Page S12227]]
and say children who could benefit from this program, 4 million more,
that they don't get health insurance.
It is equally immoral when the President of the United States and
every Senator and every House Member gets their health insurance paid
for. Yet some people say: No, we are going to wait on those children.
Those 4 million children will have to wait, even though every Senator
gets health care and this President gets health care every day of the
week. I think that is immoral. He should recognize that.
This is about numbers and budgets and a program. We will talk about
that a lot. That is important. I can justify every one of those
numbers. OK. I know a lot about cutting out waste and fraud. I did that
for 10 years in State government. I know that subject very well.
But this is a program that works. We have had a 10-year experiment
with it, and it works, and everyone here knows that. It works very well
to make sure we cover our children. All these other arguments about why
we should not do it comes down to politics. The people who are
supporting the President on this should answer the questions I posed.
Why shouldn't 10 million children get health care? Why do you get
health care in the Senate and those children do not get health care,
according to your point of view? They should answer that question when
they are supporting this President. Why should every Member of the
Senate get health care and these 4 million children--plus the 6.5
million or so we can cover--why shouldn't they get health care? Why
should millionaires and multimillionaires and billionaires get tax cuts
in 2008 and 2009 and on into the future and these children should not
have health insurance?
So when you come to the floor to talk about this program, and when
the President goes on television and preaches to us about why we should
not do that, I hope you would be honest enough--I hope the President
and every Member of this body would have the integrity to stand up and
justify why 10 million kids should not have health insurance, why they,
as a Member of the Senate, should have their health care paid for, and
why all those wealthy Americans should get their tax cut--tens of
billions this year--and these kids should not have health insurance.
I yield the floor.
The PRESIDING OFFICER (Mr. Salazar). The Senator from Oklahoma.
Mr. COBURN. Mr. President, I thank the leaders of this bill for the
time to speak.
I am kind of flabbergasted at the last talk. I am one of the
physicians in this country who has cared for kids on Medicaid. I have
actually delivered over 2,000 babies on Medicaid. I have actually done
well-child exams.
We have the Senate lecturing the President, and we should be
lecturing ourselves. The debate on this bill is not about children.
There is not anybody in the Senate who does not want to cover and
continue the present SCHIP.
What this debate is about is how do we move toward national health
care. That is what this debate is. So immoral? Is it immoral to spend
$3,000 to buy $1,500 worth of care, like we are going to do in this
bill? Is it immoral for the Senate to say it only costs $35 billion and
then totally take a program that is costing $12 billion a year 5 years
from now and cut it down to $700 million and say we met the budget
rules, when in fact we did not? That is immoral. What about the
children who are going to pay for the deficit associated with this
bill?
I have actually cared for these kids. My practice has been a
Medicaid-based practice and a SCHIP-based practice. The holier-than-
thou attitude that if you oppose this bill, you do not care about
children is completely disrespectful to those of us who happen to
disagree, who maybe think a better way to cover children would be the
Burr-Corker bill, which gives a tax credit to every kid in this country
that covers enough to give them insurance and takes that Medicaid stamp
off their head, since only 40 percent of the doctors in this country
will cover SCHIP kids and Medicaid kids.
So the debate is not about the President being immoral. It is not
about tax cuts. The real immoral fact of this bill is we are winking
and nodding again to the American people that we are going to spend
$121 billion over the next 10 years--not $60 billion over the next 5
years--$121 billion, and we have no way to pay for that. We had a $444
billion deficit last year. We could have paid for the war and decreased
the deficit if this body would have had the courage to eliminate
duplicative and fraudulent programs. There is no holier-than-thou
attitude to go after those programs because they have an interest. As
politicians, we do not want to upset anybody.
So it is easy--the greatest pleasure in the world is to spend
somebody else's money and to claim it is in the name of children. I
have been on the ground with children. I have taken care of the poorest
of the poor. We have a pregnancy component in this bill. Title 19 now
is at 300 percent of the poverty level in this country. We have people
dropping their insurance to qualify for title 19. We do not need
pregnancy covered in the SCHIP bill. It is already covered. But we
claim that to rationalize to make the bill better.
I have no disrespect for people in this body who claim they want
national health care, government-run national health care. Well,
American public--guess what--if you think health care is expensive now,
wait till it is free. Wait till it is free. That is exactly what we are
doing with this bill.
We can reauthorize SCHIP, and we can make it higher than a $5 billion
increase to truly cover those kids who need it. This body rejected an
insurance contribution component amendment I offered that would
actually expand further the number of kids.
The other point that is not being made is, for every kid you cover
who does not have health insurance today, you are going to drop another
kid from health insurance that is being paid for by their parents, and
they are getting no benefit in terms of a reduction of their health
insurance. So what we are doing is shifting taxes to those same parents
to pay for a program, twice as much money for the benefit we will get
for the kids.
I am not against well-child exams. I am not against immunizations. I
give them out of my pocket of my own practice now for free. They cost
me an average of $146 a kid.
The claim of superiority that somehow if you do not want to have this
bill you do not care for children is gobbledygook. What about the kids
in the future who are going to pay for the mistakes we are making? What
about the kids who are born today who owe $400,000 on our unfunded
liabilities? We have done that. If we care so much about kids, why
aren't we fixing that problem? They are never going to get a college
education or own a home, and they are never going to have health
coverage because we will have bankrupt this country by the way we do
not control how we spend money.
So to be lectured and lecturing the President because, finally, he is
exhibiting some fiscal responsibility into the future, and us to play
games on the true cost of this program, that is what is immoral. It is
not the President being immoral. The fact is it is not our money, it is
the money of the people of this country, and we are going to decide we
are going to spend money and not tell them what it is really going to
cost because that is what this bill does in the outyears, the 6th
through the 11th year of this bill if we cut this program to $700
million a year.
Now, nobody in their right mind will honestly say we are going to let
that happen. So if we are not going to let that happen, how about being
honest with the American people about the true cost of what we are
doing? It is $121 billion. It is not $60 billion. Even the staff admits
that. Both the Democratic and Republican staff admit that.
For us to sit up here and claim it is only a $35 billion increase--
well, only a $35 billion increase is a 120-percent increase in the
program, just a 120-percent increase in the program.
We ought to have a debate about national health care and how we solve
the problems of health care in this country. There is a way to solve
it. It is to make sure everybody in this country has access and give
them the freedom and the power to choose what is best for them rather
than us tell them what they have to have. That is the debate we ought
to have.
This is a farce. This debate is a farce. It is a farce about saying
we want to
[[Page S12228]]
cover more children, when we are really taking children who are already
covered and putting them under a government program and then charging
those children's kids for the cost of the program. That is what we are
doing. It is not about caring for kids. It is about lying to the
American public about what this program does.
So I do not have any hard feelings about the fact that people want to
have national health care and a government-run program, but let's have
the debate about what it really is and not have a debate demeaning the
President when he finally stands up and says we have an obligation, for
the next few generations, to start doing it right, and finally he is
starting to do it right. And now we are saying he is immoral. Of the 10
million kids, 5 million already have coverage. We are going to ask the
American taxpayer--in spite of what we are doing, in spite of the fact
we borrowed $434 billion--we are going to load that on them.
They already have coverage. They already have immunization. They
already have well-child care, and we are going to add that cost to the
American taxpayer. Do you know who that taxpayer is? That is that
child's child because we are not going to pay for it. We are going to
refuse to be responsible. We played the game of pay-go on this, the
great pay-go rule, where we now bastardize our own ethics to say we
paid for something, knowing we did not. Because nobody in this body
believes this is going to go to $700 million 5 years from now. Nobody
believes that. Everybody knows that. So everybody knows we are telling
an untruth to the American people about the true cost of this program.
I care a ton about my patients. But I also care enough about this
country to be able to speak the truth about what we are doing. And what
we are doing is absolutely untruthful in how we characterize the
spending on this program. You can debate that. I will debate that all
day with anybody up here. This body knows I know our numbers, and the
numbers on this bill are untruthful.
So what we ought to say is, we think we ought to expand the SCHIP
program, and it costs $121 billion. Let's have a debate about what it
really costs. That is why the President says we should not do it. And
we should not go to 300 percent, and we should not have adults on a
program where in many States it consumes 75 percent of the dollars.
I will readily grant you, we have a big problem with health care in
this country. One of the major reasons we have a big problem with
health care in this country is government-run health care programs that
drive the cost and the overutilization in many areas where we cannot
function properly.
What is happening today in our country with quality of care is
because we have so much government run. We have physicians trying to
see too many patients. The one thing we are taught in medical school
is, if you will listen to your patients, they will tell you what is
wrong. Right now, 8 percent of the cost of health care in this country
is associated with tests we order that no patient needs. It is because
this body will not look at the malpractice situation we have in this
country and the liability situation and fix it to where it truly
represents a system where people who are injured are taken care of.
What we have is a system that games it. So consequently we are all
paying 8 percent more for health care because providers have to order
tests to cover their backside.
The other thing we know is another 3 percent of the cost of health
care is associated with tests that doctors are ordering because they
are not listening well--$50 billion worth of tests that people do not
need because we will not take the time to listen to them.
I will summarize and finish my point with this: Washington has an 11-
percent approval rating for a very good reason. Because we do not
deserve to be trusted, because we do exactly what we are doing on this
bill. We are lying to the American people about what it costs, who it
will cover, and how it will be delivered.
Now, some other details of the bill are debatable, but those facts
are not debatable, and the American people, hopefully soon, are going
to wake up to the dishonesty and the farce that we perpetrate on them
as we debate those issues.
Let's have a debate about national health care. Let's really debate
it. Let's look at the options. Our bill, in several other places--the
Burr-Corker bill, the Universal Health Care Choice and Access Act--
gives everybody in this country an equal tax credit. Everybody gets
treated the same. You want to punish the millionaires? Take away some
of their tremendous excess tax benefits from health care. But we would
not do that. We do not have one person who will come forward and say:
Let's equalize the Tax Code on the other side. Let's equalize the Tax
Code so everybody has the same shot. Let's let a market help us access
that. Let's make sure it is 100 percent access. If you do not have
access, you cannot have care.
This bill is not going to provide that much access. Fifty percent of
what it does has to do with people who already have access. Those are
not my numbers. Those are Congressional Budget Office numbers.
So let's be honest about what we are doing. Let's talk about health
care. If we want to go to national health care, if we have the votes to
do it, then let's do it. But let's do not, under the guise of helping
children, expand national health care. This Senator will vote to
reauthorize a higher level of funding for SCHIP to cover kids who are
truly poor--those who don't have access. I will help anytime, any way
to do that. That has been my practice. That has been my heritage. That
has been my history in caring for poor folks in Oklahoma. But I am not
about to go along with a lie, that what we are doing is something
different than what we say we are doing.
With that, I yield the floor.
The PRESIDING OFFICER. The Senator from West Virginia is recognized.
Veto Threats
Mr. BYRD. Mr. President, with 3 days to go before the start of the
new fiscal year, there is much inside-the-beltway chatter about
continuing resolutions, omnibuses, minibuses, budget showdowns, and
Government shutdowns.
Nowhere is that chatter louder than that which is coming from the
other end of Pennsylvania Avenue. The President has threatened almost
daily that he will veto any appropriations bill that exceeds his budget
request. These veto threats include all of the spending bills that
provide funding for our domestic programs--programs that, in one way or
another, benefit each American and every American. These bills help to
educate our children, help to secure our homeland, help to support
rural America, and help to promote a competitive economy. These
domestic spending bills provide the essential building blocks for the
foundation of our great country.
On the one hand, the President is seeking over $190 billion in
emergency appropriations to fight the wars in Iraq and Afghanistan.
That is $190 billion for the cost of the wars for 1 year--1 year--1
year. At the same time, the President wants to veto critical domestic
spending bills because they total $22 billion above his, the
President's, budget request--less than 1 percent of our entire budget,
and about what we spend in 2 months' time fighting an unpopular war in
Iraq. All the chatter from the White House even asserts that the $22
billion for programs here in America means increasing taxes and putting
America's economic growth at risk.
This, of course, begs the question of the economic impact of the
almost $450 billion we have spent on the war in Iraq, a war which I
oppose.
The President characterizes the $22 billion above his request as
``increased'' spending. In fact, $19 billion of the $22 billion
``increase'' simply represents restorations of the President's--the
President's--the President's relentless attempts to savage important
domestic initiatives.
This week, the FBI announced that violent crime is on the rise for
the second straight year. Yet the President proposes to cut State and
local law enforcement funding by $1.5 billion.
Hurricane Katrina proved that the Government is not prepared to
handle major disasters, be they natural disasters or terrorist attacks.
Yet the President--our President--has proposed to cut first responder
grants by $1.2 billion. Those grants equip and train our police, our
fire and emergency medical personnel to respond to a disaster.
[[Page S12229]]
The President--our President--proposes over $3 billion in cuts for
education programs, including special education, safe and drug-free
schools, and improving teacher quality.
Despite an aging population in this country, the President proposes a
cut of $279 million for studying cancer, diabetes, and heart disease at
the National Institutes of Health. Under the President's budget, the
National Institutes of Health would have to eliminate 700 research
grants that could lead to cures for treatments for cancer, diabetes,
Alzheimer's, and other diseases.
The President also proposes to cut $2.7 billion for elderly and
disabled housing and community development grants.
When the Interstate 35 bridge collapsed into the Mississippi River,
it focused the Nation on the need to invest in our crumbling
infrastructure. Yet the President proposes to cut over $3 billion from
infrastructure programs, such as highway and transit funding, bridge
repairs, rural wastewater grants, levees and dams, clean water grants,
and airport safety and improvements. The President--our President--even
proposes to reduce funding for the highway and transit levels that are
guaranteed in the highway law that he, the President--our President--
signed in 2005.
The President proposed cuts of $1 billion from health programs such
as rural health, preventive health, and mental health grants, as well
as over $300 million from the Low-Income Home Energy Assistance
Program.
Between 1998 and 2004, disease outbreaks in food produce have almost
doubled. In 2003, there were 870 food inspectors at the FDA. In 2006,
there were 640. The FDA lost 230 inspectors in less than 4 years. So it
is no surprise food inspection dropped by nearly half during that time.
Yet the President--our President--does not propose to restore those
reductions in the number of inspectors.
All of these foolish cuts have been restored in the bipartisan bills
that were approved by the Senate Appropriations Committee by nearly
unanimous votes and, regrettably, that the President--our President--
has said he will veto. In the 12 bills that have been reported from the
committee, we have significantly reduced funding used for
congressionally directed spending, and we have added unprecedented
transparency and accountability.
As one can clearly see, this White House standoff is not over some
irresponsible plan for an expansion of Government or pork-barrel
projects. Rather, it is the President's--our President's--effort to
prevent cancellation of his ill-conceived and poorly justified proposed
budget cuts. Congress wants to support vital core missions of
Government, such as the Federal Emergency Management Agency, the Food
and Drug Administration, and the Customs and Border Protection Agency.
Congress wants to make reasonable choices and set important priorities
for our Nation.
There are consequences--yes, consequences--for failing to invest in
America's safety and in America's future. Hurricane Katrina proved
that. The collapse of the I-35 bridge proved that. Increases in violent
crime prove that. Increases in food-borne illnesses prove that. Every
headline about unsafe products being imported into this country proves
that.
Americans rightly expect their Government to work.
Regrettably, rather than recognizing the consequences of his budget,
the President--our President--is spoiling for a political fight. He
refuses to recognize the facts, even as those facts evolve in a
changing world.
According to the administration's latest National Intelligence
Estimate:
We judge the U.S. homeland will face a persistent and
evolving terrorist threat over the next three years. The main
threat comes from Islamic terrorist groups and cells,
especially al-Qaida, driven by their undiminished intent to
attack the United States.
Yet the President threatens to veto the Homeland Security bill that
passed the Senate 89 to 4 because it is $2.2 billion above his request,
with increases for first responder grants, for border security, and for
enforcing our immigration laws.
The President--our President--is determined to veto 8 of our 12
appropriations bills over $22 billion. Some have argued that $22
billion is not a lot of money. I don't share that view; $22 billion is
a lot of money. That is why we are fighting for the additional funding
above the President's inadequate request. This fight is about
priorities.
This Congress passed a budget resolution that balances the budget by
2012 and provides for the increase above the President's request for
domestic programs.
Consistent with the budget resolution, the Appropriations Committee
has reported all 12 bills. Four have passed the Senate, and with
passage of the continuing resolution, we will continue to press for
passage of the remaining bills. The President's veto threats
inevitably--yes, the President's veto threats inevitably slow this
process.
In the 12 bills that have been reported by the Appropriations
Committee, we invest the $22 billion in America's future. By
comparison:
In fiscal year 2008, the total cost of President Bush's tax cuts is
$252 billion--11 times the amount of spending in question.
In fiscal year 2008, the cost of the tax cuts for the wealthiest 1
percent of taxpayers is almost $70 billion--three times the amount of
spending in question.
In fiscal year 2008, special interest tax expenditures will cost $1
trillion--45 times the amount of spending in question. Corporate tax
expenditures will cost $91 billion--over four times the amount of
spending in question.
So $22 billion is, in fact, a lot of money; money that, if well
spent, can help to make America be a safer, healthier, more prosperous
country. We are committed to making those careful choices. We will root
out waste. We will cut or eliminate ineffective programs. We will make
careful choices.
When President Bush came to town almost 7 years ago, he vowed to
reach across the aisle for the common good of our Nation. Now is his
chance. This is the President's chance to make good on that pledge. He
can continue his purely partisan fight over $22 billion in needed
spending, or the President can work with the Congress to confront
problems that face Americans here at home.
It is my fervent hope the President will put away his veto pen so we
can get on with the business of adequately funding programs that
contribute to a safe and prosperous United States of America.
God bless America always.
The PRESIDING OFFICER. Who yields time?
The Senator from New Jersey is recognized.
Mr. MENENDEZ. Mr. President, I rise today, as I did when we started
this whole debate on children's health insurance, on behalf of the
Nation's children and working families. I wasn't intending to come to
the floor, but as I have listened to the debate over the last several
days, I am amazed we have to defend a program that I cannot believe
actually needs defending.
Today, we rise to protect the Nation's children. In this great
Chamber, I often hear Members say our children are our greatest asset,
and they most certainly are, but they are also our most fragile asset.
And nothing is more important in preserving that asset than preserving
their health so they can fulfill their God-given potential.
The issue before us today is a matter of values. It is not just about
a law or about a program, it is also about a matter of values. Do we
value our children sufficiently to ensure that those who otherwise do
not have the ability to insure themselves will have the ability to have
health care coverage so no child in America goes to sleep at night
worried that they not get ill because their parents cannot afford to
take care of them? That is the issue before the Senate, the issue
before the country, and the issue that will be before the President.
If our values match our action, then this bill needs to be passed by
the Senate and signed into law by the President.
This is common sense to me. The bill before us today will keep 6
million children insured and will cover an additional 4 million
children who presently go to sleep at night and, because they have no
health care coverage, their parents worry over them; and if they get
ill, what happens? They wait longer and their illness gets worse. What
do they do? They go to an emergency
[[Page S12230]]
room, which is far more costly to their lives, as well as to our
collective economic consequence. The deal the Senate has before it is
to save children's lives and keep children healthy. Bottom line: It is
a deal that will keep millions of American children and families from
being pushed into the ranks of the uninsured.
I find it interesting that my colleagues talk about fiscal
responsibility--now we are going to be fiscally responsible--when we
have supplementals that keep coming here without payment for them and
without any limitation whatsoever--a blank check. But now we are going
to be fiscally responsible on the backs of children.
I want to take a moment to look at the families who are actually
affected by the Children's Health Insurance Program. We are not talking
about the poor, because if you are poor in this country, you get
Medicaid. If you are wealthy, of course, you have the wherewithal to
pay for the insurance. We are talking about children whose families
work in some of the toughest jobs this country has. They work at jobs
that offer no health care, and they certainly don't make enough money
to afford private health care coverage. This program is their last
resort. I have been watching the floor this week and I have noticed
that my State of New Jersey has quite unfairly become the punching bag
by some Members of this body for our successful Children's Health
Insurance Program. On behalf of New Jersey families, I simply cannot
let that go unnoticed. On behalf of the families that the opponents of
this legislation say don't deserve to have a doctor or receive medical
attention, I am insulted. On behalf of children who are asking for an
eyeglass to see a blackboard or get an immunization shot to ward off
illness, I am offended.
I will tell you about one of these families in Keyport, NJ. They earn
just over $50,000 a year and they have a 16-year-old daughter. They
cannot afford private health insurance coverage in New Jersey, but
through the Children's Health Insurance Program they can provide their
daughter with the much needed health care--health care that protected
her when she came down with a flu that would not go away, and care that
provides relief to her parents, who don't have to worry about medical
bills if their child gets sick.
Even on New Jersey FamilyCare they pay a premium of $74 a month
because they are higher on the Federal poverty level. But that is far
less than private insurance would cost them, which they could not
possibly afford on that $50,000 income for that family of three.
Talking about premiums, let me take a moment to talk about families
at 350 percent of the Federal poverty level in New Jersey, since that
is a particular point of contention in this debate. Families at 350
percent of the Federal poverty level in New Jersey earn about $60,000
for a family of three. These families, under New Jersey FamilyCare, are
paying $125 each month in premiums and between $5 and $35 in copays. It
is not a free ride. In fact, most federally elected officials,
including my colleagues in the Senate, pay about $190 each month in
premiums for their family coverage and their earnings are well above
350 percent of the Federal poverty level. It is hard to see how it is
OK for Members of this body but it is not OK for children in this
country.
If the President made the decision, it seems he would say ``tough
luck'' to these families, ``go ahead and roll the dice on your
daughter's health care.'' That is not an action that I think is
dignified by a compassionate conservative. The President doesn't want
to cover families above 200 percent of the Federal poverty level--this
child and so many others like her. I believe that is disgraceful and it
should be embarrassing to even threaten a veto of this bill.
Here is my question to those who oppose this bill: Is the greatest
Nation on the Earth going to permit its children to have no health
coverage?
The President gets some of the best health care coverage in the
world, paid by the taxpayers of this country. He can go, as Members of
this body can, to Bethesda Naval Hospital, or Walter Reed, or, in the
case of the Members of this body, to the Capitol doctor. That is
subsidized by the taxpayer. Talk about socialized medicine. It is good
enough for Members of this Chamber but not for these children. The
President gets the best health care coverage in the world. He deserves
to have it, but so do the children of this country.
When you think about using your veto pen, Mr. President, think about
your health care coverage that we all pay for as taxpayers. Do these
children deserve less?
In New Jersey there are 130,000 children depending on this program
for their health coverage. They, along with 6 million children
nationwide, depend on this program to stay healthy and, in some cases,
stay alive. Proper coverage is often the difference between life and
death, between health and sickness, between compassion and
heartlessness.
I urge my colleagues to act wisely as this is not a political game,
nor is it time to make a point. This is about one thing only: the
health of our Nation's children.
What troubles me is that the President is prepared to turn his back
and close the doors but, simply put, if his priorities were different,
we could provide health care to all children in this country. If we
were to take what we spend in Iraq in one day--$300 million--and spend
that on children's health care, we could cover 245,000 children. In the
past 41 days, we have spent over $12 billion on the war, and what
changed in Iraq during that time? But I can tell you what we can do in
the lives of children in this country.
Finally, I bristle when colleagues come to this floor and still bring
up the red herring of immigrant children being covered who should not
have the right. The law has been clear--the law that exists, the law we
are renewing. Undocumented immigrants have never--I underline
``never''--been eligible for regular Medicaid or the Children's Health
Insurance Program. This bill maintains that prohibition. It maintains
that. So to continue to come to the floor and bring the bogeyman of
those who are coming because they want the health care coverage that
this program would provide, it is not permitted under the law, has not
been, and is not under this law, and won't be under this law.
I will tell you what is incredibly remarkable. During the immigration
debate, we heard a great deal that we should differentiate between
those who follow law and the rules and came here legally, and did the
right thing and are living legally as permanent residents of the United
States versus those who do not. Guess what. We don't even cover the
children of those legal permanent residents of the United States who
have obeyed the law, followed the rules, and ultimately are working
hard in our country. Many of them, by the way--over 70,000--are serving
in the Armed Forces of the United States. So to say that children are
getting covered who are not legal and who are not permitted under the
law, that is outrageous. This bill doesn't do it, but we should cover
those children of legal permanent residents who have obeyed the law and
the rules and are contributing to our society. But we don't do that
either. So I hope we stop using children, whether they be those who
cannot afford, because of their status in life and because of their
parents' hard work but they don't make enough money, to have insurance
and ultimately don't get it at their workplace, or those children who,
through no fault of their own, find themselves in this country but who
are not covered under this provision anyhow under the law--stop using
all of these images to try to undermine the very essence of what this
bill is all about.
You either stand with children in this country who, through no fault
of their own, have no health care coverage whatsoever, or you stand
against them. You stand for the proposition that no child in America
should go to sleep at night without health care coverage; you stand for
the proposition that it is in the societal interest of this country to
ensure that the greatest asset we always talk about, our children--they
are also the most fragile asset--can be protected; you stand for the
proposition that in this great country of ours, among the high and
mighty here, who have great health care coverage, well over 350 percent
of the Federal poverty level, that we deserve no more than children in
this country do.
That is what this debate and vote is all about.
Before I close, there is one part of this bill that is missing and it
leaves
[[Page S12231]]
this entire bill and mission to increase children's health care
unfulfilled. And that is the lack of language to provide health care
for legal immigrant children and pregnant women in this bill.
I am a proud cosponsor of the bipartisan Legal Immigrant Chidren's
Health Improvement Act, also known as ICHIA, which would have repealed
the morally objectionable law that prohibits new legal immigrants from
accessing Medicaid and SCHIP until they have lived in the United States
for 5 years. This bill today should have included a provision that
would have given States the flexibility to provide coverage to this
population.
I am proud of my home State of New Jersey. They have taken it upon
themselves to use 100 percent State funds to cover over 8,000 legal
immigrant pregnant women and children--at a cost of over $22 million.
My State has temporarily fixed the problem but it is up to Congress to
pass the solution into law.
How can you tell a 7-year-old child with an ear infection he has to
wait 5 years to see a doctor? We cannot bar these families from
accessing our health care system simply because they haven't lived here
long enough.
During the immigration debate, our colleagues emphasized the
difference between those here legally and those here illegally, so it
is appalling to me that a legal immigrant child, whose family waited
their time, came here legally and obeyed the law, are still subject to
republican criticism and are denied health care.
These fully legal, taxpaying pregnant women and their children
deserve to be covered under our children's health program. I am
disheartened that we could not agree to include this language but you
have my promise that I will work to pass ICHIA in coming months. This
is not a question of if but a question of when it will pass.
In conclusion, a great Republican, Abe Lincoln, once said:
A child is a person who is going to carry on what you have
started. They are going to sit where you are sitting, and
when you are gone; attend to those things, which you think
are important. The fate of humanity is in their hands. So it
might be well to pay them some attention.
I ask my colleagues to now pay attention to our children and support
this important bill. I ask this for our children, for our families and
for the well-being of our country.
The PRESIDING OFFICER. The Senator from Kentucky.
Mr. BUNNING. Mr. President, I wish to talk about the Children's
Health Insurance Program, known as SCHIP. In Kentucky, it is known as
KCHIP.
Several weeks ago, the Senate debated a bill that would reauthorize
this program. Now we are debating a bill that looks very much like the
last bill. I did not support the Senate-passed bill and, unfortunately,
I cannot support this version presently on the floor.
The tobacco tax funding mechanism is an irresponsible way to pay for
children's health care. The increased tax is fundamentally unfair,
particularly to my State and the States that surround Kentucky.
It pays for a government program intended for low-income kids--one
that I support and continue to support--by raising taxes. The bill
expands its coverage to middle-income adults and some illegal
immigrants in other States. It redistributes income from low-income
smokers to States with the highest per capita incomes. It could be
called Robin Hood in reverse.
I have a chart that illustrates what this bill really does. It is
compiled from data drawn from a CDC database on tobacco consumption and
projections by Family USA concerning SCHIP spending.
As we can see, the States in red will pay more in tobacco tax over
the next 5 years than they will receive. In my State of Kentucky, we
will pay $602 million more in tobacco taxes than we will receive in
SCHIP money under the same 5 years.
Virginians, our good friends from Virginia, will pay $576 million
more, and the citizens of Florida, our good friends down in the
panhandle, will pay $703 million more than they receive.
California, our good friends out on the left coast, will receive a
net benefit--in other words, more than they pay--of $2.5 billion. How
fair is this?
New taxes paid by low-income smokers in my State will go to pay for
an extravagant expansion of SCHIP in California, New York, Texas, and
all the States in light and dark green, and that includes New Jersey,
New Mexico, Arizona, California, New York, and many others.
Many people predict that the new Federal tobacco tax needed to pay
for this expansion of SCHIP is likely to cause the States to increase
their own tax cigarette taxes to avoid State revenue shortfalls. This
will lead to artificially high-priced cigarettes that are irresistible
targets for foreign cigarette counterfeiters and bootleggers in the
United States.
This is not just somebody's dream. There is new evidence of the
absolute folly of this plan to increase tobacco taxes by over 150
percent. We will not see the revenue projected, but you can be sure
organized crime will profit from this situation.
In August of this year, the New York Police Department and Federal
authorities found 600,000 cartons of counterfeit cigarettes made in
China in a warehouse in Queens. In the same raid, the NYPD found
125,000 phony revenue stamps. The counterfeiters planned to use these
phony stamps to evade taxes in Virginia, New York, and Kentucky,
passing them off as real stamps so that cigarettes can be sold in
ordinary stores.
This was not an isolated incident. There are many other similar
incidents of fake cigarettes in the United States from countries such
as China and Russia.
If you are concerned about lead in toys made in China, you should
also be concerned about this SCHIP bill because it will almost
certainly expose smokers, including some children, to the toxic
substance in counterfeit Chinese and Russian cigarettes.
According to an article last week in the New York Times, chemical
studies of counterfeit cigarettes have shown that they contain high
levels of lead. Unlike the lead paint on toys, this lead will certainly
be consumed by smokers. It is much more dangerous. So much for
improving health care.
In addition to all the other problems, this new tax is a poor
foundation for the proposed expansion of SCHIP. We are matching a
declining source of revenue with a growing Federal program. It doesn't
make any fiscal sense.
If we were honest and truly wanted to fully fund SCHIP spending with
a tobacco tax, the Federal Government would have to encourage people to
smoke. As a matter of fact, the Federal Government would possibly need
an additional 22.4 million smokers by the year 2017 to pay for this
bill.
Expanding SCHIP to cover adults, as well as kids, will lead to even
more tax increases in future years because no one will pay these
tobacco taxes if smuggled cigarettes and cigarettes from Internet Web
sites are freely available.
I also don't believe this bill focuses on those who need health care
insurance the most. When richer families are made eligible for SCHIP,
kids will move from private coverage to Government health care. In
fact, the Congressional Budget Office tells us that this bill will
result in 2 million children moving off private coverage. It is absurd
to me that children above the 300 percent poverty level will be added
to this program.
New York still has the possibility of covering families that will
make over $82,000 a year. It is not a fact, it is a possibility. These
are families paying AMT taxes, a tax which is supposedly only affecting
the wealthy. This expansion of the bill is a push for Government-funded
national health care which is not the original intent of SCHIP.
The way the bill is funded also should raise great concerns to anyone
if they care about fiscal responsibility. The budget gimmick used to
fund it is irresponsible. It jeopardizes coverage under the program and
basically guarantees another tax increase 5 years from today or when we
pass this bill.
Under the bill, SCHIP spending from 2008 to 2012 totals over $27
billion. However, for 2013, spending drops to $2.3 billion and falls to
negative amounts in each year after that until 2017, representing
projected cuts--I say that again, projected cuts--to the SCHIP program.
So what we have here is a 10-year tax for a 5-year program. Does
anybody really think we will kick millions of kids off this program in
2013 to accommodate this lowered spending? Of course we won't. However,
we will have
[[Page S12232]]
to find a new way to pay for it. If a private company ran its books
like this, the CEO would be fired or end up in the big house, in jail.
Another stunning example of how this bill undermines the original
purpose of SCHIP is that it makes it easier for illegal aliens to get
health care intended for poor children. This bill guts existing
protections put in place to stop illegal immigrants from getting
taxpayer-funded SCHIP and Medicaid benefits. Earlier this year, we
spent nearly a month debating immigration reform. This bill is a step
backwards, and it certainly sends the wrong message. It takes money
that is supposed to go to our poor children and gives it to others who
have come to this country illegally.
Let me make it clear that I want to see the SCHIP program continued
as it is, and I want to see it reauthorized. However, I want to see it
done responsibly. This bill does not do that. So I must oppose it and
urge my colleagues to do the same.
I yield the floor.
The PRESIDING OFFICER. Who yields time?
The Senator from Pennsylvania.
Mr. CASEY. Mr. President, I rise for a few moments because I know
there are other people in this Chamber who have worked for many years
on this bill who wish to speak. Senator Kennedy is here. I wish to take
a few moments to rebut what was said about a half an hour ago. Our
colleague from Oklahoma was making some arguments, and I want to rebut
some of them. I know this has been a long debate, but it is important.
He and others have made the claim about government-run health
insurance over and over, and I think that is a White House talking
point. I understand where they get the line. This is a program which
uses private insurance carriers to provide the services especially to
do the administration. So that argument really does not make a lot of
sense.
Secondly, he talked about shifting costs and people paying more
taxes. It is very clear, just as the argument of our colleague from
Kentucky made clear, that the increase in this program, the $35 billion
to cover 4 million more children, comes from tobacco tax increases. We
can have debates about whether it is right or wrong, but most people in
America support an increase in the tobacco tax to pay for this
legislation. We are not talking about an income tax or any other kind
of tax.
Thirdly, fiscal responsibility. We heard people talk about that issue
today. No one on this side of the aisle needs a lecture from that side
of the aisle or anywhere else about fiscal responsibility. This
administration is the administration that brought us to a $9 trillion
debt level and huge deficits. I think that is disingenuous.
I want to read a quotation from a recognized expert from MIT,
Professor Jonathan Gruber, on private versus public:
I have undertaken a number of analyses to compare public
sector costs of public sector expansions such as SCHIP to
alternatives such as tax credits. I find that the public
sector provides much more insurance coverage at a much lower
cost under SCHIP than these alternatives. Tax subsidies
mostly operate to ``buy out the base'' of insured without
providing much new coverage.
That quote is from a recognized expert.
We heard discussions about the cost over 5 years. This is a 5-year
reauthorization. The cost is not, as it was alleged before, some lie.
The cost over 5 years is very simple: $25 billion is in the program
now. We want to add $35 billion, so it is a $60 billion cost over 5
years. It makes all the sense in the world to spend $12 billion a year
on health insurance when billionaires get $100 million in 1 year, or I
should say over $200,000 of income. They get $100 million a year if
they make that kind of money.
My last point is, he and others talked about this being a debate
about national health insurance. We can have that debate. We agreed on
that. That is one thing we all agree on, both sides of the aisle. We
should have a debate about health insurance. This is not national
health insurance. This is not the debate about health insurance
generally. This is a very focused debate about whether the President of
the United States is in favor of providing health care for 10 million
children and whether he is going to make that commitment. It is very
simple. If you are supporting the President, then you are supporting a
policy which will lead to the failure of this country to provide health
care for 10 million children, and that would be a terrible mistake for
those kids, for their communities, but especially, over the long term,
for our economic future. We can't compete around the world unless our
kids are healthy and they learn more now and earn more in the future.
Mr. AKAKA. Mr. President, I support the Children's Health Insurance
Program Reauthorization Act of 2007.
The Children's Health Insurance Program is a successful program that
has improved the quality of life for our Nation's children. According
to the Center on Budget and Policy Priorities, the Children's Health
Insurance Program has reduced the number of uninsured children by one-
third since its enactment in 1997.
The Children's Health Insurance Program Reauthorization Act will
preserve the access of health care for the 6.6 million children
currently enrolled in the Children's Health Insurance Program. It will
also expand health care access to an estimated 4 million children.
An estimated 5 percent of children in Hawaii do not have health
insurance. This is approximately 16,000 children. My home State of
Hawaii has continued to develop innovative programs to increase access
to health insurance. The Hawaii State Legislature established the Keiki
Care Program this year. The Keiki Care Program is a public-private
partnership intended to make sure that every child in Hawaii has access
to health care.
It would be irresponsible to reduce Federal resources to States for
children's health care. Without access to insurance, children will not
be able to learn, be active, and grow into healthy adults.
I greatly appreciate the inclusion of a provision to restore Medicaid
disproportionate share hospital, DSH, allotments for Hawaii and
Tennessee. Medicaid DSH payments are designed to provide additional
support to hospitals that treat large numbers of Medicaid and uninsured
patients.
I developed this provision as an amendment with my colleagues,
Senators Alexander, Inouye, and Corker. I am proud that we were able to
have this bipartisan amendment included in the Children's Health
Insurance Program Reauthorization Act. Hawaii would be provided with a
$10 million Medicaid DSH allotment for fiscal year 2008. For fiscal
year 2009 and beyond, Hawaii's allotment would increase with annual
inflation updates just like other low DSH States.
We must enact this legislation so that Hawaii and Tennessee can
receive Medicaid DSH allotments in fiscal year 2008 and beyond. In The
Tax Relief and Health Care Act of 2006, DSH allotments were provided
for Hawaii and Tennessee for 2007. The act included $10 million for a
Hawaii Medicaid DSH allotment. The Hawaii State Legislature enacted
legislation to provide the necessary matching funds required to utilize
the Federal resources.
Hawaii and Tennessee are the only two States that do not have DSH
allotments. I will explain some of the history behind the lack of the
DSH allotment for Hawaii and why it is so important that this
legislation be enacted. The Balanced Budget Act of 1997, BBA, created
specific DSH allotments for each State based on their actual DSH
expenditures for fiscal year 1995. In 1994, Hawaii implemented the
QUEST demonstration program that was designed to reduce the number of
uninsured and improve access to health care. The prior Medicaid DSH
program was incorporated into QUEST. As a result of the demonstration
program, Hawaii did not have DSH expenditures in 1995 and was not
provided a DSH allotment.
The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection
Act of 2000 made further changes to the DSH program, which included the
establishment of a floor for DSH allotments. However, States without
allotments were again left out.
The Medicare Prescription Drug, Improvement, and Modernization Act of
2003 made additional changes in the DSH program. This included an
increase in DSH allotments for low DSH States. Again, States without
allotments were left out.
Hawaii and Tennessee should be treated like other extremely low DSH
[[Page S12233]]
States and be provided with Medicaid DSH allotments every year. Other
States that have obtained waivers similar to Hawaii's have retained
their DSH allotments.
Hospitals in Hawaii are struggling to meet the elevated demands
placed on them by the increasing number of uninsured people. DSH
payments will help Hawaii hospitals meet the rising health care needs
of our communities and reinforce our health care safety net. All States
need to have access to resources to ensure that hospitals can continue
to provide services for uninsured and low-income residents.
The President's expected veto of this legislation is detrimental to
the health of our Nation's children. It also will be very harmful to
Hawaii. The resources necessary to ensure that children have access to
health care.
This administration fails to understand the health care needs of the
country and especially Hawaii. This legislation will help the State of
Hawaii provide essential health care access to children that currently
lack health insurance. It will also provide much needed assistance to
our hospitals that care for Medicaid beneficiaries and uninsured
patients.
Mr. LEVIN. Mr. President, I strongly support the Children's Health
Insurance Program Reauthorization Act of 2007, a bipartisan bill that
would provide health care insurance to millions of children who are not
now covered.
I hope the President will reconsider his position and sign the
bipartisan compromise when it reaches his desk.
Currently, 6.6 million children are enrolled in CHIP. There are still
9 million uninsured children nationwide, 6 million of which are
eligible for either Medicaid or CHIP. In Michigan, while 55,000
children are covered under CHIP, 90,000 Michigan children are currently
eligible for Medicaid or MIChild, Michigan's CHIP program, but are not
receiving services. In addition, according to the Robert Wood Johnson
Foundation, the recent decline in employer-sponsored health care
coverage is threatening the access to private health care coverage for
many more children. In fact, the Census Bureau has reported that,
between 2004-2006, the number of uninsured children has increased by
approximately one million children.
Although the existing CHIP has been successful, it still fails to
address the problem fully. Too many children qualify for the program
but are unable to receive insurance because of inadequate funding.
Much like the Senate bill to reauthorize this successful children's
health program, the bill we will pass today will reauthorize CHIP and
increase funding for the program by $35 billion over 5 years. The
Children's Health Insurance Program Reauthorization Act of 2007, a
compromise worked out between the House and Senate, would ensure that
there is sufficient funding to cover the children currently enrolled
and to expand the program to additional children in need.
The Congressional Budget Office estimates that 3.8 million uninsured
children would gain health coverage under this plan and according to a
study done by The Urban Institute, 80 percent of the children covered
under CHIP will come from families under 200 percent of the Federal
poverty level.
We have a moral obligation to provide Americans access to affordable
and high quality health care. No person, young or old, should be denied
access to adequate health care, and the expanded and improved
Children's Health Insurance Program is an important step toward
achieving that goal.
Mr. DOMENICI. Mr. President, I rise today in support of the
Children's Health Insurance Program Reauthorization Act of 2007, H.R.
976. Reauthorizing the State Children's Health Insurance Program,
SCHIP, before it expires is critical to ensure health care access for
millions of our Nation's children.
My home State of New Mexico has a terrible problem with uninsured
children. Recent reports have New Mexico at the bottom in the Nation
for coverage of children. In 1997, while I was chairman of the Senate
Budget Committee, I helped to create SCHIP as part of the Balanced
Budget Act. The program has been a success. Over the past decade, SCHIP
has helped reduce the number of children without insurance.
The bill we are voting on today is a compromise. In August, both the
House and the Senate passed two very different versions of an SCHIP
reauthorization. At that time, I came down to the floor and I said I
did not like what the House of Representatives was doing. I did not
support the massive increases in spending and eligibility proposed by
the House and I did not want a reauthorization that included revisions
to the Medicare Program. The conference committee listened to these
concerns, and I am pleased that the bill before us today closely
resembles the SCHIP bill passed by the Senate 68-31 in August.
My comment to children's health care remains firm today. I support
the passage of the compromise SCHIP reauthorization. It is a good bill.
It provides $35 billion in new resources to provide health coverage for
millions more children in working families. It will strengthen outreach
and enrollment efforts to make sure that all children who are eligible
for the program get the services they need. It also makes improvements
to the program by including language on mental health parity and dental
health coverage.
Mr. JOHNSON. Mr. President, I rise today to express my support for
legislation that is critically important to more than 6 million
children in the United States, including more than 14,000 South Dakota
children, who are covered by the State Children's Health Insurance
Program, or CHIP.
I voted for this program when Congress created it 10 years ago and I
have watched with great satisfaction as the number of uninsured
children in our country dropped. More children have health insurance
coverage today, which ensures that they have every chance to do their
best in school and live long, healthy, productive lives.
Congress originally authorized this program for 10 years in order to
provide an opportunity to evaluate the program and make sure that we
are doing right by our children. Well, the studies are in with
impressive results: while the number of uninsured adults has steadily
risen since CHIP was enacted, the number of uninsured low-income
children has dropped by nearly one-third.
Yet there is much more work to do. In my State alone, more than
12,000 children are eligible for health coverage through either
Medicaid or CHIP but remain uninsured. These uninsured children don't
receive their vaccinations, miss screening and other preventive
measures, and access health care at much later stages of their
illnesses than insured children. The fact that so many children,
through no fault of their own, face these struggles with health care is
something about which our Nation should be ashamed.
The President says he will veto this bill, which he calls ``an
incremental step toward the goal of government-run health care for
every American.'' Nothing could be further from the truth. If the
President's plan of providing private health insurance worked, we
wouldn't have 9 million uninsured children in the United States today,
including 18,000 South Dakota children. But the bottom line, as an
editorial in one South Dakota newspaper put it, is this:
The uninsured children of families struggling to get by do
not need lectures about the encroachment of socialized
medicine or the virtues of personal responsibility. They need
health coverage.
During the past 9 months, I have received a personal lesson in the
great value of health insurance. Our Nation's children shouldn't have
to learn this lesson the hard way. I urge my colleagues to support the
Children's Health Insurance Program Reauthorization Act, and I hope the
President will do right by our Nation's children and sign this bill
into law.
Mrs. BOXER. Mr. President, I rise today to continue my support for
the reauthorization of the Children's Health Insurance Program--an
essential effort to ensure the health of our Nation's children. Since
the inception of this program, I have agreed with the goals of this
program and strongly believe that it is necessary to meet our
responsibilities and fulfill our commitment to children.
Although I wholeheartedly support the compromise agreement on the
reauthorization of this program, it is exactly that: a compromise.
For the past 10 years, the Children's Health Insurance Program has
helped
[[Page S12234]]
provide health care for millions of children from working families that
do not qualify for Medicaid, but can't afford private insurance. These
are the children of working families whose companies do not offer
health insurance to their employees.
As the cost of health insurance rises and an increasing number of
employers are unable or unwilling to provide health insurance to their
employees and their families, the number of families who do not have
health insurance has continued to rise.
While the number of the uninsured continues to rise, the percentage
of low-income children without health insurance has dropped more than
one-third since the creation of the Children's Health Insurance
Program.
Currently the Children's Health Insurance Program provides coverage
for 6.6 million children nationwide. This reauthorization would provide
health care coverage for an additional 3.2 million children who are
uninsured today. In California, an estimated 250,000 children will be
added.
The Children's Health Insurance Program has always enjoyed the
bipartisan support of our Congress, our Governors, and our President--
and the legislation we are voting on today reflects that spirit of
cooperation.
I am glad to see that we have worked with many of our Republican
colleagues on an issue so critical to the health of children across
this Nation.
This bipartisan, bicameral agreement is largely based on the
legislation passed by the Senate in July, which would fund outreach and
enrollment efforts, allow States to use information from food stamp
programs and other initiatives for low-income families to find and
enroll eligible children, and give States the option to cover pregnant
women for prenatal care vital to healthy newborn children.
In desperation and defiance, opponents of the Children's Health
Insurance Program have made outrageous allegations maligning the
effectiveness and success of this program.
Critics have claimed that this program extends to eligibility to
wealthy families in America--this could not be further from the truth.
In my own State of California, the average family income of children
covered by this program is just 163 percent of the Federal poverty
level--less than $34,000 a year for a family of four.
There have been claims that Children's Health Insurance funding goes
to illegal immigrants--this is completely false. The reality is that
undocumented immigrants have never been eligible for Medicaid or the
Children's Health Insurance Program. Actually, there are restrictions
within this program which deny health insurance to low-income children
who are legal immigrants.
The President is spending $10 billion each month in Iraq, but has
threatened to veto a bill that will provide 10 million children with
access to health care. Under the President's proposal, he is willing to
fund the Children's Health Insurance Program with an increase of $1
billion a year--the cost of 3 days in Iraq.
If we fail to renew this program or if the President vetoes this bill
as he has threatened to do, it is the children who will pay the price.
As we near the September 30 deadline to reauthorize this program, I
strongly urge and implore that the President reconsider his position on
this bill. The need of children knows no partisan or political
barriers, and should not have to overcome the obstacles created by the
President.
There is not a man or woman in this chamber who wouldn't do
everything within their power to ensure the health of their own
children--we should do no less for the children of our Nation.
The Members of this Congress have overwhelmingly expressed a
commitment to children's health. Earlier this year, we passed a budget
resolution which set aside $50 billion for the Children's Health
Insurance Program, reaffirming our commitment to the continued success
of this program.
We can still do more and we will, but this bill is a step forward in
the right direction.
I would like to thank Senators Baucus and Rockefeller, Senators
Grassley and Hatch and the members of the Finance Committee who worked
so tirelessly to bring this legislation forward in a bipartisan way,
and keep the focus of this bill where it should be--on the children.
Mr. FEINGOLD. Mr. President, today we are voting on the
reauthorization of a program that has wide support in our country and
that has reduced the number of uninsured children nationwide by over 6
million. In fact, CHIP has helped lower the rate of noninsurance among
low-income children by one-third since its enactment in 1997. That is a
huge accomplishment, and has helped address a problem in our country
that is unacceptable--the millions of uninsured families.
In my home State of Wisconsin, CHIP, known as BadgerCare, provides
health insurance for over 67,000 families. Wisconsin has done an
incredible job of covering uninsured children as well as their parents,
and the positive effects of this program are felt at schools, in the
workforce, and at home. This bill helps support Wisconsin's efforts and
provides low-income families in my State with better access to
preventive care, primary care, and affordable care. The end result is
healthier families. BadgerCare is vital to the well-being of many
families in Wisconsin and I am very pleased that this bill supports the
program in my State, including Wisconsin's choice to cover parents of
CHIP and Medicaid children.
We know from numerous reports that when we cover parents, we bring
more uninsured children into the program as well. States like Wisconsin
have proven time and again that covering parents means covering more
kids. I worked hard with my colleagues and the Senate Finance Committee
to make sure that Wisconsin could keep families in the CHIP program,
and I am very pleased that those efforts have paid off.
This legislation is not perfect. I would like to be voting on a more
expansive package today that would offer health care access to more
children and families. I am very disappointed that this legislation
does not include language that would allow access to the program for
legal immigrants. Unfortunately, it appears that, because of Republican
opposition to this policy, legal immigrant children will continue to
have to wait five years before they become eligible for CHIP and
Medicaid. I will do my best to help change the discriminatory policy in
the future.
Despite the flaws in this legislation, the CHIP reauthorization bill
marks an important step forward in getting coverage to those who need
it. I will support this bill's final passage, and I hope the President
will reconsider his ill-advised decision to veto it. I look forward to
the day that everyone in our country has access to the basic right of
health care.
Mr. Dodd. Mr. President, I rise today in strong support of H.R. 976,
the Small Business Tax Relief Act. This is a bipartisan agreement to do
what is right for our nation's children. There are few more important
issues facing the senate than the health and well-being of our Nation's
youth. The vote to pass this legislation is a vote for children.
As the father of two young daughters, I keenly understand how
important it is to know that if one of them gets sick they have the
health insurance coverage that will provide for them. For millions of
parents, every slight sniffle or aching tooth could mean the difference
between paying the rent and paying for medical care. Today we have an
opportunity to help give those parents peace of mind about their
children's health.
It is our national shame that 9 million children wake up every day
lacking any form of health insurance. Every day, this means millions of
regular checkups are sidelined, dental exams go unscheduled, and early
diagnoses of chronic conditions such as asthma or diabetes are
postponed. For families, such delays set the stage for children to grow
up underperforming in school, developing preventable or treatable
conditions, or worse, permanent disability or even premature death.
The lack of health insurance causes more than poor health outcomes.
Access to affordable health care is essential to alleviating child
poverty. Low-income families without insurance often get stuck in an
endless cycle of medical debt, a primary cause of bankruptcy filings in
this country. Parents already struggling to make ends meet
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should not have to choose between providing their children needed
medications and putting a roof over their heads or food on their table.
I commend the chairman and ranking member of the Finance Committee
for working so hard with our colleagues in the House of Representatives
to put together a bill that will benefit the lives of millions of
children and their families. Their leadership over the years, and that
of Senators Hatch, Rockefeller, Kennedy and many others, helped create
the Children's Health Insurance Program, CHIP, and reduce the number of
uninsured children by one-third. Their persistence now to expand this
bill in the face of considerable opposition shows their commitment to
children's health. This bill is a tremendous investment in the health
and future of our children.
Specifically, the bill continues providing coverage for 6.6 million
children currently enrolled in CHIP and provides coverage for 3.1
million children who are currently uninsured today. It gives States the
resources they need to keep up with the growing numbers of uninsured
children. It provides tools and incentives to cover children who have
fallen through the cracks of current programs. And it will prevent the
President from unfairly and shortsightedly limiting States' efforts to
expand their CHIP programs to cover even more children. All together
these efforts will reduce the number of uninsured children by one third
over the next 5 years.
In my own State of Connecticut, our CHIP program, commonly known as
HUSKY B, has brought affordable health insurance to more than 130,000
children in working families since its inception in 1998. H.R. 976 is
essential to States like Connecticut so that they may continue to
operate programs like HUSKY B and build on their proven success to
insure even more children.
I am additionally very pleased that my Support for Injured
Servicemembers Act amendment was included in the final SCHIP bill. This
amendment provides up to 6 months of Family and Medical Leave Act,
FMLA, leave for family members of military personnel who suffer from a
combat-related injury or illness. FMLA currently allows three months of
unpaid leave. Fourteen years ago, FMLA declared the principle that
workers should never be forced to choose between the jobs they need and
the families they love.
If ordinary Americans deserve those rights, how much more do they
apply to those who risk their lives in the service of our country?
Soldiers who have been wounded in our service deserve everything
America can give to speed their recoveries but most of all, they
deserve the care of their closest loved ones. That is exactly what is
offered in the Support for Injured Servicemembers Act.
Senator Bob Dole and former Secretary of Health and Human Services
Donna Shalala have been instrumental in this effort through the
President's Commission on Care for America's Returning Wounded
Warriors. It's not surprising that the Commission found that family
members play a critical role in the recovery of our wounded
servicemembers. The commitment shown by the families and friends of our
troops is truly inspiring. According to the Commission's report, 33
percent of active duty servicemembers report that a family member or
close friend relocated for extended periods of time to help their
recoveries. It also points out that 21 percent of active duty
servicemembers say that their friends or family members gave up jobs to
find the time. Last week in a hearing of the Subcommittee on Workforce
Protections, we heard from one of those families and there are
thousands more to be heard. The House is moving forward with companion
legislation and I am grateful to my colleagues Congresswoman Woolsey
and Chairman Miller and their cosponsors.
I am pleased that Senator Clinton is the lead cosponsor of my
amendment. In addition, I am pleased that Senators Dole, Graham,
Kennedy, Chambliss, Reed, Mikulski, Murray, Salazar, Lieberman,
Menendez, Brown, Nelson of Nebraska, and Cardin are cosponsoring this
amendment. I thank Senator Baucus and Senator Grassley for accepting
this important amendment and appreciate the support of all of my
colleagues in this effort.
I am troubled by the comments by President Bush and members of his
administration about this bill. This legislation is vital to the health
and well being of our children. The CHIP program is a model of success
and this bill provides sustainable and predictable health care coverage
for low income children regardless of their health status. It
represents the hard work and agreement of an overwhelming majority of
Members on both sides of the aisle. It is a testament to how important
issues like children's health care can be addressed in a bipartisan
manner by a united Congress. The President's policy of block and delay
would mean Connecticut and other States would have to take away
existing health coverage for hundreds of thousands of children when
they should be covering more kids.
But despite the bipartisan agreement of this Congress, the President
threatens to veto this legislation. If he does, all Americans will know
whether the President stands for children or would rather stand in the
way of children's access to critically needed health care.
I urge my colleagues to support this critical legislation and I urge
President Bush to do what is right and sign it into law.
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