[Congressional Record Volume 143, Number 32 (Thursday, March 13, 1997)]
[Senate]
[Pages S2223-S2225]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              HEALTHY CHILDREN'S PILOT PROGRAM ACT OF 1997

  Mr. SPECTER. Mr. President, today I am introducing legislation 
directed at providing health coverage to children who lack health 
insurance in America.
  This issue has been recognized as one of the leading--if not the 
leading--problems on incremental health coverage in America today. I am 
glad that President Clinton's health care plan proposed in 1993 was not 
adopted. That was a matter that was fought out on the Senate floor in 
some great detail in 1994. I participated in that debate. When I read 
President Clinton's health plan, I was amazed by the number of 
agencies, boards, and commissions, and asked an assistant to make a 
list of all of them. My assistant made a chart instead of a list. I had 
that chart on this floor and many other places, and I shall spare you 
the chart today. Bob Woodward of the Washington Post said that chart 
was the key factor in defeating the Clinton health care plan because it 
showed on one page in red more than 100 new agencies, boards, and 
commissions, and in green about 50 existing bureaus giving new jobs. 
Then we proceeded, I think wisely, with the Kassebaum-Kennedy bill on 
incremental health coverage. Now I think we need to go ahead and 
provide for coverage for children in America.
  Very briefly, let me summarize my proposal before going into 
specifics. It is said that there are 10 million children who lack 
health insurance. My analysis shows that there is a critical group, 
perhaps the most critical group, of some 4 million children which my 
bill addresses in an incremental way; 3 million other children are 
eligible for Medicaid coverage but not enrolled, and 3 million other 
children are in families which would not be eligible for health 
insurance under my plan because their family income levels are too 
high. My legislation will provide a pilot program which would provide 
vouchers to States for families which earn up to 235 percent of the 
poverty level to purchase health insurance in the marketplace.
  Later today I am going to have a news conference with the Brandt 
family from Pennsylvania, because they are illustrative of this issue. 
I would now like to discuss the key elements of my proposal and why I 
have asked the Brandts to travel to Washington today.
  Mr. President, it is no less true for being a commonplace that 
nothing could be more important to our Nation than our children. I am 
introducing today legislation aimed at beginning to fill an enormous 
and unacceptable gap in our country's support for the health and well-
being of our children.
  Mr. President, as President Clinton discussed during the State of the 
Union Address last month, there are today approximately 10 million 
American children who have no health insurance coverage from any 
source--private or public--and who therefore lack access to the kinds 
of preventive and primary care services which can be the difference 
between staying healthy and getting sick or between minor illness and 
serious, disabling or even mortal illness.
  Now, let me say at the outset that this is not a Republican or 
Democrat issue. Our two parties do have different approaches to the 
roles and the cost of our Federal Government but there is not one party 
that cares about kids and one party indifferent to our childrens' 
health. Let us work constructively on this and actually address the 
problem rather than just trying to wrack up political points.
  As with most statistics conjured up for social policy debates, the 
President's figure of 10 million uninsured children needs further 
discussion to get to the heart of the matter. Of these 10 million 
uninsured, approximately 3 million children live in families with 
incomes which make them eligible for Medicaid. I support outreach 
efforts by the States to enroll these children in Medicaid but, because 
coverage is accessible to these families if they avail themselves of 
it, this problem is not the gaping hole in our health care system of 
which I spoke a moment ago.
  Likewise, of the 10 million uninsured children, another approximately 
3 million live in families with incomes greater than the median 
household income. There are even uninsured children in more than a few 
high income families.
  Those numbers are deeply disturbing, but I see them as a clarion call 
for greater parental responsibility, rather than for legislative or 
governmental action. I know it is easy for those of us with substantial 
incomes and employer-paid health benefits--such as we here in the 
Senate--to preach to families without these protections, but I cannot 
imagine any higher priority for a family with any more than just enough 
income to keep food on the table and a roof over their heads than

[[Page S2224]]

to provide health insurance for their kids. And I see it as clearly 
inappropriate--despite some proposals on the other side of the aisle to 
do so--to spend tax dollars to subsidize health insurance for higher 
income families. The cutoff level I propose in this bill, approximately 
$38,000 for a family of four is already a bit higher than median 
household income in the United States--$34,076--$34,524 in my own State 
of Pennsylvania. In other words, taken together, Medicaid and the new 
initiative I am proposing would allow eligibility by income for more 
than half of the households in our country. To go beyond that is to do 
what too many Government programs already do--tax those who have less 
for the benefit of those who have more, Robin Hood in reverse.
  This leaves approximately 4 million children, ineligible for Medicaid 
but living in families without the resources to obtain coverage on 
their own. This is an American tragedy--the tragedy of the working 
poor. Mom, Dad, or both going to work every day, often more than 5 days 
per week, but being paid low wages, without health benefits. These are 
honest taxpaying citizens, but their kids' futures are in jeopardy. 
They are falling through a crack in our health care system which must 
be sealed off.
  Some States, including my own State of Pennsylvania, are attempting 
to address this problem. In Pennsylvania, a public/private partnership, 
combining a publicly funded program called BlueCHIP, the Children's 
Health Insurance Program, on which Governor Ridge will spend $39 
million this year, and a private initiative called the Caring Program 
for Children are reaching 60,000 out of the estimated 300,000 uninsured 
Pennsylvania children who are not eligible for Medicaid.
  But, as this statistic indicates, even generous State and private 
resources are wholly inadequate to meet the need. And this need, this 
hole in our health care system, is not a statistic. It is real.
  I would like to speak to you today about some Pennsylvanians whose 
stories demonstrate both the real need for action on the matter of 
uninsured children and the effectiveness of a program, such as the one 
I am proposing today, in helping real people face life's storms. These 
good people have been helped by Pennsylvania's existing efforts to 
provide health coverage to children and their story is the best 
argument which can be made for a national effort to solve this problem.
  Here with me today is the Brandt family, from Tarentum, PA, in 
Allegheny County: mother, Scarlett; father, Richard; daughter, Lindsay, 
age 11; and son Chad, age 7.
  First, I would like to thank the Brandts very deeply for their 
willingness to be here today, not only because it involves a precious 
day off from work for both Scarlett and Richard, a day out of school 
for both Lindsay and Chad and a long car ride to Washington and back, 
but even more so because it involves a family decision to put pride 
aside and to be willing to face the press as symbols for a policy 
debate. This is not an easy position for people to put themselves in--
and even less so their children--but the Brandts believe in the need to 
tell America about this too long ignored problem of uninsured children 
and about the way life brightens with just a little help to fill this 
basic need. I am very grateful to them for putting their desire to help 
others ahead of their own privacy.
  Scarlett and Richard both have full time jobs; Scarlett is a 
hairdresser and Richard is a truck driver. But neither of 
their employers offer health benefits and this hard working, taxpaying 
family simply doesn't earn enough money to go out and purchase private 
health insurance on their own. Before the Pennsylvania programs began 
helping the Brandts in 1993, Lindsay had lived the first 7 years of her 
life without any health insurance coverage and her little brother Chad 
had gone without coverage from birth until he was 3 years old.

  Here, then, are counter examples for the think tank commentators who 
argue against Federal action on children's health insurance by pointing 
to examples of children who are only uninsured for transitional periods 
of months as their parents change jobs. Here, in Lindsay and Chad, are 
examples of the heart of this problem--the long-term uninsured children 
of the working poor.
  How did Scarlett and Richard make due without health insurance for 
their kids? They scrounged what services they could from community 
health clinics and they used emergency rooms in ways that, when 
multiplied by all those who act similarly, damage and drain our entire 
health care system. They also restricted the activities of their 
children--and recent studies indicate this is a common coping strategy 
for parents in their shoes--cracking down on sports and even bike 
riding to try to avoid injuries. When Chad became ill as a toddler, 
with recurring ear infections, the family had to rotate payments to 
their creditors--some months skipping a utility bill, some months 
cutting back on groceries--just to be able to afford the prescription 
medicines for their little boy.
  Even with all of these ways of dealing with their situation, the 
Brandts lived every day under a cloud of fear about their children's 
health and their family's future and Lindsay and Chad lived with unmet 
health care needs--for physician care, for vision care, and for dental 
care.
  In 1993 the Brandt family got help from the programs operated by 
Western Pennsylvania's Caring Foundation for Children. It turned out 
that this assistance proved even more necessary than they knew at the 
time.
  In April 1996, Lindsay Brandt was diagnosed with hemiplegic 
migraines. This condition causes stroke-like symptoms. When an incident 
occurs, Lindsay suffers paralysis on the side of her body opposite from 
the headache, her speech slurs, her vision is blurred, and she becomes 
confused. Although she has needed five ambulance trips to the hospital 
since developing this condition, Lindsay is now on medication to 
prevent further episodes.
  Obviously, all of this care has been expensive. Obviously, the sort 
of problem the Brandts feared in their uninsured years came to pass. It 
might well have destroyed this family had it happened before they got 
health insurance coverage for their kids. Thank God, it did not.
  The legislation I am introducing today is a measured response to this 
major problem. We must react with both compassion and consideration.
  Here is my proposal:
  A 5-year pilot program funded with discretionary dollars--rather than 
a permanent entitlement--to provide block grants to the States in 
support of health insurance for uninsured children who are not eligible 
for Medicaid or for employer-based private health insurance and whose 
families have incomes up to 235 percent of the poverty level, $37,718 
for a family of four.
  States which are already providing health insurance coverage to 
children eligible under this bill, such as under their own Medicaid 
plans, would be required to maintain their efforts but would, in 
effect, receive credit from the Federal Government in the form of 
dollars equal to the costs of the coverage they are providing to 
children in families up to the bill's cutoff level of 235 percent of 
poverty.
  My bill would offer full vouchers, with the level determined by the 
Secretary of HHS based on costs for an insurance policy covering 
preventive, primary, and acute care services for a child, for families 
earning up to approximately $29,700 per year for a family of four and 
partial subsidies from that income level until phased out at 
approximately $38,000 for a family of four.
  By limiting eligibility to children who do not have access to 
employer-based private health insurance, we avoid creating a 
disincentive to private coverage. We should all applaud the employers 
who are covering their employees, including lower wage employees, with 
family health insurance. Indeed, there are approximately 10 million 
American children in families earning between the poverty line and 235 
percent of poverty who do receive private health insurance coverage, 
compared to the 4 million who do not. This is another example of the 
overall effectiveness of our market-based health care system even as it 
is also the most striking example of a particular case of market 
failure.
  By making this a 5-year pilot program, we admit the complexity of the 
health care system and the task of health care reform. This approach,

[[Page S2225]]

with block grants and vouchers, may well prove to be the best way to 
cover kids who need health insurance, but we all know about the 
unintended consequences of social policy initiatives and we all know 
how hard it is to reform an entitlement, even if it has truly perverse 
effects, and so I am proposing a 5-year demonstration of this approach 
in the appropriately humble spirit of ``trial and correction'' which I 
have many times before said on this floor should inform our entire 
project of health reform.
  By making this program subject to appropriations, we ensure that we 
undertake this important effort in a fiscally responsible manner.
  Specifically, to provide sufficient funds to properly test this 
approach to children's health coverage in a way that does not bust the 
budget, my bill establishes the ``Healthy Kids Trust Fund,'' on budget, 
funded through the sale of available broadcast and nonbroadcast 
spectrum assets. I am not wedded to this offset but offer it to make 
clear my intention to see this program paid for with hard dollars, not 
confederate money.

  Furthermore, my proposal provides that:
  The first year of the program, fiscal year 1998, would be devoted to 
HHS and State planning, with the new insurance coverage commencing on 
or about October 1, 1998.
  Coverage would be phased in, beginning with children 0-5 years old in 
fiscal year 1999 and expanding in subsequent years to cover children 6-
9, 10-12, and 13-17.
  In the 104th Congress, I was pleased to cosponsor the Health 
Insurance Portability and Accountability Act of 1996, better known as 
the Kassebaum-Kennedy bill (S. 1028). There is no question that 
Kassebaum-Kennedy made significant steps forward in addressing 
troubling issues in health care. The bill's incremental approach to 
health care reform is what allowed it to generate consensus support in 
the Senate; we knew that it did not address every single problem in the 
health care delivery system, but it would make life better for millions 
of American men, women, and children.
  In retrospect, I urge my colleagues to note a most important fact--
the Kassebaum-Kennedy bill was enacted only after some Democrats 
abandoned their hopes for passing a nationalized, big government health 
care scheme, and some Republicans abandoned their position that access 
to health care is really not a major problem in the United States 
demanding Federal action.
  Although we succeeded in enacting incremental insurance market 
reforms, there is still much we need to do to improve our health care 
system. Additional reforms must be enacted if we are serious about our 
commitment to meet the needs of the American people. I am hopeful that 
my colleagues understand how important it is to our constituents that 
we continue to reform the health care system. Just look at the Brandt 
children and multiply their need by millions. Looking back at our 
success with the Kassebaum-Kennedy bill, I am equally hopeful that my 
colleagues have come to realize that if we are to continue to be 
successful in meeting our constituents' needs, the solutions to our 
Nation's health care problems must come from the political center, not 
from the extremes.
  Mr. President, I hope the legislation I am introducing today can be 
the basis for taking this next, crucial step in our process of 
bipartisan, incremental health reform. My proposal seeks to achieve 
incremental expansion of health care through a conservative means--a 
fully funded program with carefully crafted eligibility rules for a 
limited period of time, a program based on State administration and 
personal choice and responsibility. Let us take this step. Let us make 
this test. Let us see to it that the anguish and Russian roulette 
endured by all those situated similarly to the Brandt family are 
stopped and millions more of our Nation's greatest assets are given a 
basic ingredient for decent and productive lives.
  Mr. President, how much time do I have remaining on the additional 
time which I sought independent of Senator Domenici's time?
  The PRESIDING OFFICER. The Senator has 7 minutes and 10 seconds 
remaining. The Senator from New Mexico has 39 minutes remaining in 
regard to the previous order.
  Mr. SPECTER. I thank the Chair.

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