[Congressional Record Volume 143, Number 12 (Tuesday, February 4, 1997)]
[Extensions of Remarks]
[Pages E137-E138]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   MAKE A COMMITMENT TO CHILDREN NOW

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                       Tuesday, February 4, 1997

  Mr. STARK. Mr. Speaker, I am introducing today a bill to help low-
income working families buy health insurance for their uninsured 
children. Families who buy an individual children's health insurance 
policy will be given a 95 percent refundable tax credit against the 
cost of the policy.
  Health insurance equals access to health care. Access to health care 
equals better health and a better quality of life. It is that simple.
  Health insurance can mean the difference between life and death--and 
between a good quality life and a stunted life. A recent GAO report 
provides a concise summary of why the lack of insurance is so 
important.
  Studies have shown that uninsured children are less likely than 
insured children to get needed health and preventive care. The lack of 
such care can adversely affect children's health status throughout 
their lives. Without health insurance, many families face difficulties 
getting preventive and basic care for their children. Children without 
health insurance or with gaps in coverage are less likely to have 
routine doctor visits or have a regular source of medical care. . . . 
They are also less likely to get care for injuries, see a physician if 
chronically ill, or get dental care. They are less likely to be 
appropriately immunized to prevent childhood illness--which is 
considered by health experts to be one of the most basic elements of 
preventive care.
  Numerous studies have underscored the importance of access to health 
insurance. Despite the widespread recognition of the problem, there are 
10 million children in the United States without health insurance. Said 
differently, 14.2 percent of all children are uninsured, according to 
the latest analysis of the Bureau of Census' March 1995 current 
population survey by the General Accounting Office (GAO).
  Many analysts predict that this figure will continue to grow, mainly 
because private health insurance continues to decrease. Private 
coverage--employer-based and individually-purchased insurance--for 
children declined steadily between 1987 and 1993, from 73.6 percent 
down to 67.4 percent of all children. Currently 40 percent of children 
are not covered under their parents' employment based health insurance. 
According to experts at the Center for Health Policy Research at George 
Washington University, one child loses private coverage approximately 
every minute.
  Health insurance for children in America is getting worse--not 
better. With the recent attack on welfare, and therefore Medicaid, it 
may get disastrously worse--fast. We desperately need to reverse the 
trend of rising uninsured rates for children. The General Accounting 
Office recently issued a report to Senator Christopher Dodd, dated June 
17, 1996, entitled ``Health Insurance for Children: Private Insurance 
Coverage Continues to Deteriorate,'' The report states
  The number of children without health insurance coverage was greater 
in 1994 than at any time in the last 8 years. In 1994, the percentage 
of children under 18 years old without any health insurance coverage 
reached its highest level since 1987--14.2 percent or 10 million 
children who were uninsured. In addition, the percentage of children 
with private coverage has decreased every year since 1987, and in 1994 
reached its lowest level in the past 8 years--65.6 percent * * *.
  Several States have built on existing programs to expand health 
insurance coverage for uninsured children. At the State level, the 
current strategy to cover the uninsured is to fill in the gaps in 
insurance coverage. In July of 1996, Massachusetts adopted coverage 
expansions for children in Medicaid in the State's Children's Medical 
Security Plan; in New York and Florida as well funds were appropriated 
to extend children's health insurance programs to additional children. 
Although a few States have moved forward to expand health insurance 
coverage for children, it is not enough. We need to do more.
  The bill I am introducing today is not a mandate; it does not require 
any individual to buy health insurance. It does, however, provide 
incentives for the sale and purchase of individual children's health 
insurance policies, and it does help families, especially very low 
income families, buy a policy of their choice.
  The bill would create a refundable tax credit of 95 percent of the 
cost of the premium to buy health insurance for a child. The credit is 
available to families based on a computation of adjusted gross income 
plus an additional $5,000 amount for each child covered.
  This bill is a small, incremental step forward. It is by no means 
everything I would like. If I could waive a magic wand, I would make 
sure that everyone in America had high quality health insurance 
tomorrow morning. That isn't going to happen--but this small step, 
starting with children, could help millions of children grow up to be 
healthier, more productive citizens. Like my amendment which started 
the COBRA Health Continuation program which has been used by 40 million 
Americans, this bill could make a world of difference to millions of 
Americans in the years ahead.
  We spend long hours debating whether there should be prayer in 
school, but no time discussing how much parents pray that their 
children don't get sick because the parents can't pay the bills. We 
spend days debating obscenity on the Internet, but little time debating 
how obscene it is for a society as rich as ours to have so many 
children and parents unable to seek adequate medical care. It's time to 
debate a critical issue--the health of our children.

  To repeat, the bill is not a mandate, but a chance for the 99.99 
percent of parents who care to have affordable health insurance for 
their children. It uses the private market exclusively. It is a first 
step. I welcome cosponsors for the bill, and comments and suggestions 
from the public on ways to improve the bill.
  The following is a summary of the bill:

            Children's Health Insurance Act of 1997 Summary


                         i. offering of policy

       Group health plans must make available qualifying coverage 
     for eligible children whose parent(s) has group health 
     coverage under the plan. Group health plans must offer 
     coverage at least annually. Each insurer that offers health 
     insurance coverage must have available for purchase health 
     insurance for eligible recipients under the age of 21. A 
     health insurance policy must be reasonably priced (it is 
     reasonably priced if the premium or other charge for the 
     coverage does not exceed 150 percent of the average price for 
     similar coverage offered in the same state).


                          ii. benefit package

       The benefit package must include benefits provided under 
     Medicare (parts A and B) plus well child care benefits 
     including newborn

[[Page E138]]

     and well baby care, routine office visits, immunizations, 
     routine lab tests, preventive dental care, and EPSDT 
     services. A prescription drug benefit for catastrophic costs 
     is also included. There is no cost sharing for preventive 
     services.


                       iii. qualifying dependent

       A qualifying young dependent is defined as an individual 
     who is under 21 years of age, and is claimed as a dependent 
     for tax purposes. It does not include an individual who has 
     applied for and who has been determined eligible for 
     Medicaid.


                             IV. Tax Credit

       Each taxpayer who purchases a health insurance policy for 
     their dependent receives a tax credit in an amount up to 95 
     percent of the cost of the premium to buy health insurance 
     for a qualifying dependent. The credit is available to 
     taxpayers based on a computation of adjusted gross income 
     plus an additional $5,000 amount for each child covered. 
     There is full tax credit provided at the adjusted gross 
     income of up to $15,000 plus $5,000 per child covered by the 
     health insurance policy. The ``$15,000'' figure represents 
     approximately 200 percent of poverty for an individual under 
     the age of 65. For example, a family with adjusted gross 
     income of $25,000 and two qualifying children would receive a 
     refundable tax credit of 95 percent of total premium paid for 
     coverage of the two children. As a family's income rises and 
     the need for a subsidy is less critical, the credit phases 
     out. The credit is available only to subsidize traditional 
     health insurance coverage for children. The bill provides for 
     an advanced payment structure for 60 percent of the tax 
     credit similar to the earned income tax credit advanced 
     payment system. A return relating to premiums received for 
     health insurance coverage for children would be required.


                             V. Excise Tax

       The bill provides for an excise tax on any group health 
     plan (25 percent of each premium received by the group health 
     plan for the plan year in which the failure occurs) or 
     insurer that offers individual health insurance policies (25 
     percent of the total amount of the premiums paid to the 
     insurer for such coverage for the plan year in which the 
     failure occurs) who fails to offer an individual children's 
     health insurance policy for sale. The tax would not apply 
     where the failure to offer a children's health insurance 
     policy was due to reasonable cause and not willful neglect. 
     The tax would also not occur if the failure to offer the plan 
     was corrected within a 30 day period.


                          VI. Other Provisions

       Medicaid cost-sharing assistance for qualifying children 
     with family income below 150 percent of the poverty line 
     would be financed 100 percent by the Federal Government. 
     There is coordination with other tax provisions subsidizing 
     health costs to disallow the credit in instances where the 
     taxpayer also claims a medical expense for the same premium 
     cost or claims a deduction for health insurance costs of 
     self-employed individuals. Grants to states for health 
     insurance outreach and information programs would be 
     established.

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