[Congressional Record Volume 140, Number 113 (Saturday, August 13, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 13, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                    INSURANCE COVERAGE FOR CHILDREN

  Mr. KENNEDY. Mr. President, the amendment that we will be considering 
today focuses on our Nation's most precious asset, our children. It 
improves what is already one of the strongest provisions of Senator 
Mitchell's health reform proposal.
  The Mitchell bill provides affordable insurance coverage for children 
in every American family beginning in 1997. People with incomes of less 
than 185 percent of poverty will be able to insure their children 
without any charge. Subsidies will be provided for people up to 300 
percent of poverty. Comparable assistance will be provided for pregnant 
women.
  For hard-working Americans, this bill guarantees that you will never 
have to choose between putting food on the table, paying a mortgage, 
and health care for your children.
  Under the bill, if you are a family with two children and your income 
is less than $27,000, you will be able to insure your children at no 
charge. If your income is $35,000, you will pay approximately $230, 
less than 1 percent of your income. If you make $37,000, you will pay 
$1,000, but still less than 3 percent of your income. Families with 
$44,000 in income, the level at which subsidies phase out, will pay the 
full price of about $1,800, or about 4 percent of the family income.
  The Mitchell bill recognizes that a health insurance card alone is 
not enough to guarantee timely health care for every child. So for 
children in the poorest school districts, the program provides Federal 
financial assistance for school-based or school-related health 
programs, under local control to make sure that children get the health 
services they need to do well in school and ultimately do well in life.
  I must say on this point, Mr. President, one of the very, very 
important provisions in the Mitchell legislation, which was also in the 
President's program, is the development of health clinics in our 
schools. We have not been able to develop those kinds of programs for a 
variety of reasons in recent years. Anyone who has had the opportunity 
to visit schools, both in the inner cities, or out in rural 
communities, knows the kind of challenge that is out there for the 
children.
  Mr. DASCHLE. Will the Senator yield on that point?
  Mr. KENNEDY. Yes.
  Mr. DASCHLE. I commend the Senator for drawing attention to the fact 
that school-based health clinics are one of the major focuses of the 
Mitchell bill.
  As the Senator so eloquently has stated, there are too many occasions 
when students have access to no other medical care than what they now 
get in their schools. In some cases they do not even have access to 
school-based clinics. So with clinics, whether they are in rural or 
urban settings, we can really put meaning to the word ``prevention''. 
We can finally catch children's medical problems prior to the time that 
they become severe and possibly untreatable. There is no other bill 
pending before the Senate that emphasizes prevention like the Mitchell 
bill.
  I am glad the Senator pointed that out. I do not know what the 
situation is in Massachusetts. But I know in South Dakota it is an 
extraordinary problem. Students today go to school with illnesses that 
are left undetected and untreated. We have a paucity of nurses. We have 
a severe shortage of nurse practitioners. We have few clinicians. We 
have little ability to treat children in rural areas. Under this bill, 
for the first time, we will be able to give students the opportunity to 
seek primary and preventive care.
  I think the Senator is absolutely right.
  Mr. KENNEDY. I thank the Senator because he brings a perspective to 
this of the importance in terms of the rural communities. In Arkansas, 
for example, they have developed these health clinics. It has taken 
some period of time. There was a good deal of resistance and reluctance 
in the initial development of those programs. I believe it took 
probably 2 or 3 years to develop half-a-dozen of those programs, all 
which involve the parents in the fashioning and the shaping of these 
health clinics as well as the teachers and the health professionals. 
Now the demand for those clinics, in rural areas as well as in the 
urban areas, is dramatic. They have been an extraordinary success. They 
are expanding on the basis of very limited resources.
  We have found in my own city of Boston, that the Cambridge Rindge and 
Latin High School is one of the few schools in an urban area in my 
State that has developed a health clinic. It has a rather interesting 
historical background, and I will not take the time of the Senate to 
point out how it got developed. But it has been an extraordinary 
success in helping children that are coming from homes where there is 
abuse, physical abuse, and substance abuse; the problems in terms of 
hunger; the detection for example in terms of many of these illnesses 
at an early stage so that the child can be cured and also be 
participating in schools.
  Many parents, hard-working parents, even when they have the children 
who are sick, still send their children to school because they do not 
have any day care to provide for them. They are endangering the other 
children. If you are able to have interventions in the health settings 
in schools, it makes an important difference.
  Mr. DASCHLE. Will the Senator yield on that point?
  Mr. KENNEDY. Sure.
  Mr. DASCHLE. How many of those clinics does the Senator have in 
Massachusetts today? Does the Senator have any idea?
  Mr. KENNEDY. I could probably count those school-based clinics on two 
hands, maybe three, but not any more.
  Mr. DASCHLE. In South Dakota the situation is exactly the same. We 
have three or four of those clinics in the entire State. That is one of 
the key issues. I am glad the Senator has drawn attention to that in 
his remarks this morning.
  Mr. KENNEDY. I want to point out to the Senator, we see our 
colleagues on the other side, that the provision passed 17 to nothing 
in our committee. It had unanimous Republican support, and Democratic 
support. We spent some time in fashioning and in shaping to make sure 
that it was really going to be reflective of local parents, local 
health care needs, age-appropriate kinds of interventions, but at the 
end of the day we were able to come together with virtually a unanimous 
proposal.
  When we are talking, as we did briefly yesterday, about how this 
legislation, the Mitchell legislation, affects children, and it has 
been, I must say, a significant improvement over the course of the 
development of legislation over that which was even recommended by the 
President; and it is a great tribute to the work that was done by the 
Finance Committee, Senator Moynihan, Senator Riegle, and others on that 
committee.
  In addition to providing affordable coverage for every American 
child, the Mitchell bill establishes a standard benefit package that 
includes comprehensive preventive benefits for children, from prenatal 
care to immunizations to regular physical examinations. Every 
physician--and most parents, too--know that good preventive care is the 
best way to make sure that children get the healthy start in life that 
they deserve. Preventive care is cost-effective, as well. Every dollar 
spent on prenatal care saves more than three times as much in reduced 
medical costs for premature babies and other low birth-weight babies. 
Every dollar spent on DPT vaccinations save $30.
  The Mitchell bill is really a health care bill of rights for every 
American child. But the Dodd amendment will make it even better. Most 
of the programs under the Mitchell bill are scheduled to begin in 1997, 
including the requirement that all insurance plans include 
comprehensive preventive benefits for children. This amendment starts 
that part of the program right away. It does not subsidize any family's 
purchase of insurance in advance of the 1997 implementation date. It 
does not add any new Government obligations. Instead, it simply says 
that every new insurance policy sold and every policy renewed, 
beginning July 1, 1995, must include comprehensive preventive benefits 
for children. Twenty-one States have already legislated this 
requirement. Many insurance policies voluntarily cover these services.
  This amendment says: Let us not wait until 1997 to bring these 
benefits to every insured child. Let us not let a single additional 
child grow up disabled or suffer unnecessary illness or death because 
we failed to provide preventive care. The cost of this additional 
benefit for policies that do not already provide it is very small--
about $2 per month per child, according to the Traveller's Insurance 
Co. But the potential value of that ounce of prevention to millions of 
American children is very great.
  I know that many of my Republican friends in this body are strongly 
committed to better health care for America's children. I urge them to 
join us in making the Mitchell bill an even better bill for children by 
adopting this amendment. I urge them to buckle down and join us in the 
business of legislating. If they think the Mitchell bill needs 
improvement, let them offer amendments. If they think they have a 
better alternative, let them offer it--so that we can debate it in the 
full view of the American people.
  When it comes to protection for America's children, the Republican 
plan simply doesn't measure up to the Mitchell bill. It doesn't achieve 
affordable coverage and it doesn't guarantee comprehensive preventive 
care without copayments or deductibles. The Mitchell plan requires 
coverage of clinical preventive services without any copayments or 
deductibles. The Republican plan requires only one benefit package to 
include any preventive services at all.
  On the crucial issue of affordability, the Dole plan helps children 
in the poorest families--and, of course, the rich can always buy 
coverage--but it provides no assistance or protection for children in 
the middle-class families that work hard, play by the rules, but still 
can't afford the coverage they need. The Dole plan makes no coverage 
available especially for children, and a family earning $22,000 a year 
would have to pay approximately $5,900 to buy family coverage--more 
than a quarter of the family's total income.
  I think we can do better than that for America's children. So I urge 
this body to adopt this amendment, and I urge my colleagues to work 
with us to make the Mitchell bill the best program possible for the 
American people--and especially for the children who are America's 
future.
  Now before the Senate we have this very interesting proposal that has 
been introduced by Senator Dodd and others that will extend the 
requirements for the inclusion of these preventive programs that were 
linked to children's needs in the schools.
  So, Mr. President, I will come back and address this issue. I see a 
number of our colleagues that want to use probably the morning hour. I 
will come back at an appropriate time in the morning and address it.
  The ACTING PRESIDENT pro tempore. Who seeks recognition?
  Mr. MOYNIHAN. Mr. President, I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The absence of a quorum is noted. 
The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. PACKWOOD. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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