[Congressional Record Volume 143, Number 27 (Wednesday, March 5, 1997)]
[House]
[Pages H747-H748]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CHILDREN'S ONLY HEALTH CARE
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 7, 1997, the gentleman from New Jersey [Mr. Pallone] is
recognized for 60 minutes as the designee of the minority leader.
Mr. PALLONE. Mr. Speaker, I am here today to once again talk about
the need for Congress to pass a children's only health care bill and
the Republicans' continued refusal to let this Democratic plan move
forward.
Again we are here in the middle of another week, in the third month
of the 105th Congress, and the Republicans basically have nothing to
do. Ten million American children have no health insurance, yet day
after day after day the Republican leadership schedules no real
business for the House of Representatives to consider.
Yesterday was a perfect example of just how little the Republicans
have to do. Even though Democrats have legislative plans to provide
health care to the Nation's 10 million uninsured children ready for
consideration, the Republican leadership decided it was more important
to debate a symbolic measure about the Ten Commandments.
Let me repeat that, Mr. Speaker, because it is really kind of
unbelievable when one thinks about it. Instead of allowing legislative
plans to ensure that all American children have health insurance to be
considered, the House Republican leadership felt it was more important
to consider a symbolic measure on how Congress feels about the display
of the Ten Commandments in Government offices and courthouses.
The point is that children's health care, pure and simple, is
something that needs to be addressed. The problem of uninsured children
continues to grow as Congress watches from the sidelines. Indeed, last
week I was joined by colleagues, some from New York, to discuss a
report released by the New York City public advocate, Mark Green, that
found a disturbing rise in the number of uninsured children in New York
City.
As congressional Republicans continue to prevent the Federal
Government from taking action to confront this problem, what is
happening, essentially, is that various States around the country are
trying to make some progress on the issue. An excellent example of such
action was just published in an article about the action the State of
Massachusetts has taken to implement a children's only health plan.
This was in the New York Times on Friday.
I am pleased today to talk a little bit about that, because I think
that the Massachusetts children's medical security plan, which is the
name that is given to this proposal, is basically a good plan, designed
to insure children whose parents earn too much money to qualify for
Medicaid coverage but still cannot afford to purchase health care for
their kids.
We have been through this before. If the family is eligible for
Medicaid, then they have health insurance coverage. But we have a lot
of people, working people, people that are on the job, in many cases
both parents working at separate jobs, who do not get health insurance
through their employer. They are not eligible for Medicaid because
their income is not low enough, and so they simply go without health
insurance for their children because they cannot afford to pay a
premium that they would have to obtain privately or through some other
means.
So basically what Massachusetts did was to try to come up with a plan
to deal with those individuals who were above the income level for the
Medicaid threshold but still do not get health insurance on the job for
their children or who cannot afford to pay for health insurance
privately.
The article in the New York Times details some individuals. For
example, Mark Leary, of Lawrence, MA, was able to take his 3-year-old
daughter to doctors to receive treatment for an ear infection even
though the supermarket he works for does not offer health insurance.
It also talks about another individual, Paula Lincoln of Rockland,
MA, who was able to still bring her children in to the doctor for
checkups after she lost her teaching job.
It mentions another self-employed person, Elaine Choquette of
Blackstone, MA, who uses the program to pay to bring her two sons to
the doctors as well. Miss Choquette was quoted as saying, ``I pay my
taxes, and I never thought of it being anything compared to welfare.''
This is not a welfare program. This is a program in the State of
Massachusetts for working people. The program in Massachusetts is very
much like many of the proposals that Democrats here in Congress have
developed. Most of the programs awaiting consideration are like the
Massachusetts program. They are designed to help hard working parents
who make too much money to qualify for Medicaid yet still cannot afford
health insurance for their kids.
The really big difference between the Massachusetts program and the
various Federal programs awaiting consideration is that theirs has been
enacted. In other words, the Massachusetts Legislature actually
considers and passes legislation in response to societal challenges,
and the Republican-controlled 105th Congress clearly does not.
The New York Times article on the Massachusetts plan reports that
Representative Bill Thomas, the California Republican who heads the
Subcommittee on Health of the Committee on Ways and Means, said in
early February that he would soon hold hearings to get a sense of the
scope of the problem of kids not having health insurance. But it is now
March, and although we have debated the merits of hanging the Ten
Commandments on the wall of Government buildings, I have yet to see a
hearing on the issue held or a legislative plan examined.
{time} 1500
Again, every day the Republicans waste is another day that parents
have to endure the reality of being unable to take their children to
the doctor. This is no small price to pay.
I have to say that the Massachusetts State Health notes that while
uninsured children had always had access to emergency treatment, the
State's health plan now allows parents to bring their children in for
routine medical visits, check on immunizations, and tests for lead
poisoning.
One of the points that we have been trying to make during this debate
on kids' health insurance is that it may very well be that in some
cases, perhaps even in most cases when an uninsured child gets really
sick, that they end up going to the emergency room and they get some
type of care. But that is not the way the health system should operate.
They need preventative care. They need vaccinations. They need to go to
the doctor for routine checkups. We do not want a situation where the
only time children get any kind of medical treatment is if they really
get ill and they have to go to the emergency room.
It is my hope that the Republicans will recognize that while we seek
to enable children to receive treatment, the matter itself is not
routine. This is an urgent matter. Any kind of obstructionism on the
issue of kids' health insurance I believe is really callous, and the
Democrats, of course, continue to articulate and move forward with
various plans that both the President and other of my Democratic
colleagues have put forward.
I just wanted to talk a little about some of the things that
Massachusetts
[[Page H748]]
does to give an idea of how this would actually work.
Again in Massachusetts, very similar to what happened here at the
Federal level, there was an effort a few years ago to try to come up
with a universal health care system where the State would basically
provide health care or health insurance, I should say, for everyone.
But in the same way that we were not able to accomplish that on a
Federal level, the effort instead began to focus sort of in a piecemeal
fashion on what elements of the uninsured could be insured effectively
and at a reasonably affordable price.
One of the points that we keep making, those of us who would like to
see kids' health insurance enacted, is that it is very affordable. It
does not cost a lot of money to provide health insurance for kids. And
we are talking about 10 million children right now that do not have
health insurance. If you look at it in the spectrum of things, it is
relatively cheap to provide insurance for them.
Basically, Massachusetts recognized this. They figured that if they
could not move for health insurance for everyone, at least they could
move for health insurance for children. Just to give some idea of how
they did it, they expanded both their Medicaid program and the
Children's Medical Security Plan, which was a State plan they had in
effect beginning in 1993. Medicaid paid for a significant part with
Federal dollars but now covers everyone up to 133 percent of the
poverty level or all families of four with incomes up to $20,748 a
year.
So what they did is they expanded Medicaid so that it covered a
little higher income level, 133 percent of the poverty level, for
families of four with incomes up to $20,748 a year. But then they have
this supplemental plan, the Children's Medical Security Plan, which
provides a somewhat less generous package, if you will, than Medicaid,
more limited mental health and prescription drugs; but for families
with incomes of less than $31,200 a year, 200 percent of poverty, the
coverage is free, and they have a copayment of $1 per doctor's visit.
So now we are getting up to people, families at the 200 percent of
poverty level. For families with incomes of $31,200 to $62,400, the
charge is $10.50 per child per month, and the copayment is $3. And
above that level, the charges are $52.50 a month and $5 a visit.
So essentially what they are doing here is, on a sliding scale,
making it possible for people at these higher income levels, they are
not terribly high income levels, but at higher income levels would
still be able to opt into this program. It is a way to guarantee that
every child who does not have health insurance now would be able to
take advantage of this program.
Ultimately, no child would be ineligible for this type of program
unless the parents, on their own, voluntarily decided that they did not
want to participate in it. Everyone would be eligible on a sliding
scale up to any income level.
The program is administered for the State by the John Hancock Mutual
Life Insurance Company at a charge of $10.50 a month for each child,
and it allows parents to take their children to any doctor in the
State. So again you have complete choice in terms of where you go to
the doctor or the hospital.
Again the reason why this is so successful is essentially because of
what it means for preventative care. In the article in the New York
Times there is a Dr. Robert Sorrenti, a pediatrician who is a vice
president of John Hancock, and he said that the sort of routine
treatment, regular doctor visits, vaccinations, the preventative type
care, was often avoided by parents who were short of money, but 90
percent of the registered children in this program are now seeing a
doctor on a regular basis for preventative purposes.
In Massachusetts, approximately 150,000 uninsured children, about
60,000, will be covered through the expanded Medicaid program that
Massachusetts now offers, and they expect that the expanded Children's
Medical Security Plan program would reach 40,000 to 60,000 more
children. It has enrolled about 7,000 more children since the expansion
took effect in November.
So if you are taking that full range of 150,000 uninsured children,
between the 60,000 covered by Medicaid and possibly another 60,000 that
would be covered under this supplemental insurance program, you can see
how you are getting very close, really, to almost 100 percent of the
uninsured children that would be covered by the plan.
Of course, the real key is what we are going to do on the Federal
level. Obviously, it is very good for States like New York and
Massachusetts and others to experiment and to come up with different
ways of trying to provide health insurance for children, but the
problem will not be addressed on a universal basis on the Federal level
unless this Congress takes up the issue.
I myself and many of my colleagues are determined that we will
continue to raise the issue, we will continue to point out the problem
of the uninsured and how many children there are out there until the
Republican leadership and our colleagues on the other side decide to
finally bring this up, give it a hearing, bring the legislation to the
floor, and move toward making sure that every child in this Nation has
the opportunity to have health insurance. In the long run if we do not
do this, the negative impact not only on our children but on our Nation
as a whole, I think, could be catastrophic because the numbers of the
uninsured continue to increase on a regular basis.
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