[Congressional Record Volume 143, Number 44 (Tuesday, April 15, 1997)]
[House]
[Pages H1513-H1516]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   HEALTH CARE COVERAGE FOR CHILDREN

  The SPEAKER pro tempore (Mr. Lucas of Oklahoma). Under the Speaker's 
announced policy of January 7, 1997, the gentleman from New Jersey [Mr. 
Pallone] is recognized for 30 minutes as the designee of the minority 
leader.
  Mr. PALLONE. Mr. Speaker, I am pleased to say I will be joined 
tonight by the gentleman from New York [Mr. Serrano]. We are here, once 
again, to talk about the lack of health insurance for children 
throughout this Nation. The figure of 10 million children who are 
uninsured has been put forward on this House floor many times, and it 
really is a scandal and, in my opinion, completely unacceptable.
  The number of children without health insurance is growing and it is 
increasingly children in working families who are without the coverage.
  Just in my own State alone we estimate that over 200,000 children are 
without health care coverage. In one of the dailies in my district, the 
Home News, just a few weeks ago in April, they did an editorial saying 
how inadequate coverage for children was in my home State. And they 
specifically mentioned that the Families USA organization here in 
Washington estimates there are 553,000 children in New Jersey receiving 
inadequate or no health coverage. So whether it is 200- or 500,000 in 
New Jersey alone, it clearly is simply unacceptable.
  What this really means is that many children simply do not get any 
care unless they get very sick and end up in an emergency room, and 
that procedure makes no sense. It makes no sense to not have a child be 
able to go to a doctor, get very sick, and end up in an emergency room. 
It costs a lot more to treat an ailment once it has gotten to a very 
critical stage as opposed to preventing it when it first starts to 
occur, and it is also very harmful to a child's future health.
  Obviously we do not want children to be sick and be impacted in terms 
of their adult life. And I think a problem clearly exists here where 
working families should not have to be in a position of constantly 
worrying about whether their child will get hurt at the playground or 
catch the cold or a flu that is going around at the school.
  In other words, what we have is working parents who basically have to 
make choices about whether they are going to take their child to a 
doctor or not as opposed to paying the rent or doing something else.

  I just wanted to say that, and I think we have said it over and over 
again on the House floor, Democrats have for a long time been committed 
to helping families provide health care for the children. It was last 
June, it will be almost a year now, that the Democrats rolled out their 
families first agenda. And one of the priorities was to ensure adequate 
coverage for the Nation's children.
  We also started at the beginning of this session a Democratic health 
care task force, once again, with its major priority being to try to 
address the problem of children without health insurance. So Democrats 
have been there concerned about this issue. What we need to have is the 
Republicans who are in the majority join us.
  There was some progress in this regard in the last few weeks, I have 
to say. The gentleman from California [Mr. Thomas] of the Subcommittee 
on Health of the Committee on Ways and Means did have a hearing on the 
issue of kids health care. I want to applaud him for taking the 
initiative and at least recognizing the problem. But action has to 
follow.
  My concern is that, even though there was one hearing in the 
Committee on Ways and Means, that there was not any indication as a 
result of that hearing that any bill is going to come to the floor or 
any effort is going to be made to mark up a bill and take some action 
on this issue.
  Several Democrats, including myself, sent a letter to the Republican 
leadership in the last couple weeks urging them to move forward by 
marking up legislation and bringing a bill to the House floor by 
Mother's Day and Father's Day respectively, and that, we are saying, is 
mark up a bill that addresses the issue of lack of health insurance for 
children, mark it up in committee by Mother's Day, bring it to the 
floor for a vote on the House floor, on this floor by Father's Day.
  And it is our hope that we can create such a ground swell of support 
behind making children's health care a reality that House Republicans 
will be forced eventually into action.
  I wanted to say, before I introduce my colleague from New York, that 
the Democratic health care task force at this point is not necessarily 
saying that we have to have any particular solution in terms of 
legislation. Some of us are in favor of expanding Medicaid. Others have 
talked about block grants to the States along the lines of the Kennedy-
Hatch bill, which is gaining momentum now in the Senate. Some of

[[Page H1514]]

us have actually introduced the Kennedy-Hatch bill here in the House, 
myself included, but we want to see some movement on this issue.
  But whether it is tax credits, vouchers, Medicaid expansion, or block 
grants to the States, we want to see action, and we want to see a 
deadline set when we are going to address this issue of 10 million 
American children who do not have health insurance.
  Mr. Speaker, I yield to the gentleman from New York [Mr. Serrano], 
who has been on the floor with me and others many times over the last 
few months, trying to bring attention to this issue.
  Mr. SERRANO. Mr. Speaker, I want to thank the gentleman from New 
Jersey [Mr. Pallone] for having the vision to bring this issue to the 
floor and to discuss it as many times as we have and I know as many 
times as we will in the future.
  The gentleman well says it when he says that our families first 
agenda speaks to this issue. And certainly when we look at the issue, I 
think what all Americans who are watching tonight have to ask 
themselves is, Are we talking about reinventing the wheel here? Are we 
talking about creating a new Government program? What are we really 
talking about?
  It is very simple. I spend some time every day thinking about how 
lucky we are to live in this country and, at the same time, to compare 
what goes on in this country with what happens in other parts of the 
world. And we know that we are fortunate to be in a society that has 
been able to accomplish things other societies have not.
  Therefore, this issue becomes very important and very sad as we 
discuss it, because health care is not a discussion about throwing 
money away. Health care is about a basic right. Children, therefore, 
become the neediest in society if they cannot attain basic health care.
  What we are saying here is that in our country, if you were not 
listening to the beginning of this discussion and just listened to the 
middle part and we discuss 10 million children without health care, 
someone could say that we are in another Parliament or another 
legislative body somewhere in the world discussing a situation which 
fits into the conditions that they find themselves in. But we are not. 
We are in the U.S. House of Representatives in the U.S. Congress saying 
that 10 million children do not have health care available to them.
  And as the gentleman so well has pointed out, the part that makes 
this really difficult to even understand is that most of these children 
are in families where both parents or at least one parent is working. 
So we are not talking now about many of the conversations we have on 
the floor on a daily basis or on a weekly basis.
  We are talking about children that are within those families that 
supposedly are doing better in this society, but when it comes to 
providing health care for their children, they are not. The problem we 
have is that it is a burden, in my opinion, that we place on these 
American families that they should not have.
  Again, I repeat, we are not talking about American families demanding 
a new road in front of their house. We are not talking about American 
families looking for a handout. We are not talking about a gift that 
Government will give to people.
  We are talking about a basic human right, the right to decent health 
care. The country has the mechanism to deliver that health care, but in 
its lack of wisdom in this area, has allowed for 10 million children to 
fall by the wayside.
  Now, when I say over and over again that we do not have to reinvent 
the wheel, I believe that. I believe that we have in this country the 
mechanisms which allow us to cover these 10 million children. And we 
are not, as the gentleman well has stated, saying to our colleagues 
across the aisle that they must do it our way.
  What we are saying is, let us come together and let us do it. Let us 
celebrate as a nation the fact that we will cover 10 million children. 
In fact, if it was up to us, we would cover every American that is not 
covered right now.
  Now, interestingly enough, and I go back to my usual argument, there 
are countries that we criticize on a daily basis where this would not 
be a discussion. They have other problems, but this is not a 
discussion. Everyone, from the time they are born to the time they die, 
is covered by health care. And so what we are doing here tonight is 
calling on our colleagues to say, listen, there are some issues that 
are political issues. There are some issues that we have to argue back 
and forth about. There are some issues that the public expects us to 
disagree on. But covering and providing health care for 10 million 
American children who are in need of this health care, to take this 
worry away from families, to take this dilemma away from working 
families, this is something we can do. If we set our minds to do it, we 
can do it.
  Now, what really amazes me about this issue is that I do not know why 
they do not want to do it. I do not know, I cannot figure that out, 
because we are talking about something that the American public is in 
favor of.
  Interestingly enough, let us use some labels, if you go to your most 
fiscally conservative middle-class American and say, here is what we 
are going to do, we are going to expand current programs and make some 
changes to cover 10 million children who do not have health care; do 
you have a problem with that?
  I am taking a political chance here. I am saying they do not have a 
problem with that. What mother, father, who tonight knows her children 
has health care coverage, is going to be upset that another parent 
somewhere else who does not may begin to have it next month or the 
month after that?

                              {time}  2000

  This is not what Americans are about. We are about taking care of our 
neighbor and making sure that children are taken care of.
  So I will do tonight what I have done every other night that we have 
spoken on this issue, and that is to reach out to those parents who 
tonight are helping their children with their homework. Perhaps they 
are taking a little time off to watch the Met-Dodger game and 
discussing with the children the celebration of the Jackie Robinson 
legacy and what that means to this country and to the future of this 
country. Perhaps they are tucking their children in bed and kissing 
them good night, knowing that they are secure within, not rich, not 
overflowing with gifts, but secure.
  I hope that they will take some time and write to Members of Congress 
and say: Let us get this done. I do not think it is right that when I 
put my child to bed, I know that everything is OK in terms of health 
care with him, that it is provided for him, that we are covered, and 
that there are 10 million children somewhere else in this country that 
do not have this coverage.
  I would implore these American parents do that tonight, to take that 
little time and write to those of us who have not seen the light 
tonight on behalf of those children, because what happens is, if the 
parents of those children do the only writing, then people will say, 
well, of course it is the ones who need the program, need the 
assistance, who are calling us; we need to hear from other people.
  I think that this is something that we can all be very proud of. If 
we accomplish this, if we, one of these evenings, ourselves, go to bed 
knowing that there is not a child in this country who is in need of 
basic health care, I think then we can be proud of the work we are 
doing in this House.
  Mr. PALLONE. I appreciate what the gentleman said and also the fact 
that he makes the point of reaching out and having the average person 
thinking about their own situation and how they may have coverage for 
their children and have that security but so many other American 
parents do not.
  That is really the crucial issue here, that so many people lack that 
security, basically live the day and night knowing that if something 
happens to their children, they are not covered by health insurance.
  I just wanted to say that our Democratic task force last week had a 
hearing, and we will probably have more hearings, but the basic purpose 
of this hearing was to get factual material about the nature of the 
problem. In the future, we will probably have hearings on specific 
legislation.
  Families USA at that time had just put out a report, and it was 
really interesting in terms of what the gentleman just mentioned about 
how this primarily affects kids who have working parents. It is not 
very long, and I

[[Page H1515]]

wanted to make reference to some of their key findings in that regard.
  They were talking about their data that provides information about 
children without health insurance during a 2-year period, and the data 
showed the following:
  That almost half of uninsured children, 47 percent, had uninsured 
spells of 12 months or longer; that one out of seven, 15 percent, 
lacked health insurance for the full 2-year period.
  Then they went on to say that the uninsured child population, this 
population we are talking about, was comprised primarily of children 
whose parents worked. Of the children who lacked insurance for 1 or 
more months, 9 out of 10, 89 percent, lived in households where the 
head of household worked during all or part of the 24-month period.
  Then it said that uninsured children are two times more likely, 69 
percent versus 31 percent, I know these statistics get a little 
difficult, the uninsured children are two times more likely to live 
with a married rather than a single parent. Children uninsured for the 
entire 24-month period are four times more likely to live with a 
married parent. And of the children who were uninsured throughout the 
24-month period, over one out of three had a head of household who was 
employed full-time throughout that 24-month period.
  So, again, we are talking about children where both parents are 
working. Some of them are working two jobs. It is amazing, the 
statistics about the nature of this population.
  The other thing that I just wanted to say again that comes from this 
Families USA report is that we are really talking about prevention. 
What the gentleman and I want to do here is provide a mechanism for 
kids to have preventive care. That is what really this is all about.
  Most of the time, not all the time, but most of the time, if a kid 
gets really sick, they can go to an emergency room. I am not saying 
that is always true, but usually it is. But the problem is, when they 
get to that stage, it is almost too late. Oftentimes there is permanent 
damage.
  Families USA at our Democratic task force hearing used the case of a 
young girl, this was not her real name, but they used the name, Maria. 
It is a real case, and they called her Maria. It said that when Maria 
entered a new school as a third-grader, her teacher believed she was 
performing below her potential. A health examination arranged by the 
school's Healthy Start Program revealed that Maria had suffered 
multiple ear infections, probably over a period of several years.
  Maria's father ran a small nursery business and could not afford 
health insurance. Without insurance to pay for her care, Maria's ear 
infections were not treated. As a result, scar tissue built up within 
her ears. Maria became deaf in one ear and lost hearing in the other, 
and it took a year and a half to equip Maria with hearing aids after 
they had discovered this.
  This would appear this was some sort of school clinic that detected 
the problem and, as a consequence, started the rehabilitation that 
eventually led to her having a hearing aid. But this is what we are 
talking about. We are talking about lack of care, not being able to see 
a doctor, which leads to permanent damage.
  Ultimately, this child, although she now has a hearing aid, probably 
will never be able to fully hear and, with a small amount of money and 
a couple of visits to the doctor at the initial stage, before this 
started, probably would have had no problem at all.
  So we need to think about the psychological and the physical 
consequences, and think about the costs, because how much more will it 
cost for the hearing aid and apparatus down the road as she becomes an 
adult as opposed to just a simple doctor visit in the beginning?
  Mr. SERRANO. Mr. Speaker, if the gentleman would continue to yield 
briefly, as the gentleman mentioned, also this brings up another 
thought, and that is, on a daily basis we put a heavy demand on our 
school system. And we complain, we all do in this country, about the 
conditions of the schools if they are not what we want them to be in 
certain neighborhoods and the quality of the teaching if it is not what 
we want it to be in certain neighborhoods.
  But at the same time, we do not realize that there are other factors 
that impact on that situation. What the gentleman just mentioned is a 
prime example. If children are attending school who are suffering an 
ailment or a condition that may have an impact on their ability to 
learn, we then have placed a teacher and the school administration in a 
situation that they should not be placed in. They now have to cope with 
that and try to figure out what the problem is.

  So here we have a situation where we have a school-based clinic, 
which is a rarity in this society, but a school-based clinic may have 
picked up this situation of these ear infections which may leave this 
child permanently damaged for the rest of her life. Now, if that child 
had regular visits, the way most children in this country do, chances 
are that could have been picked up.
  So again, where is the investment? Is it about what it might cost 
now, which we do not think we are talking about costs here, we are 
talking about expanding existing programs, or the investment that we 
are making in the health of that child and, therefore, the education of 
that child?
  So I really think this one is an easy one. I know when we present 
something and we support it, we always try to make it sound like it can 
be done. But this is an easy one; this can be done. This is the country 
that can do it; this is the society that can do it; this is the 
Congress that can do it. All we need is the OK to say we will get 
together and do it. It is an outrage. It should not be. It is inhumane. 
It is improper. It is not a good investment for the future of our 
country, and it is not fair to these children.
  One last point. It cannot be said enough. It cannot be said enough 
that we are now talking about children who have one, possibly two 
parents working one, possibly more jobs. We have to continue to repeat 
this, not because we want to listen to ourselves talk, but because 
people in some places in this country get the wrong impression, that we 
are talking about people who may not want to help themselves or who may 
not be looking for that service.
  This is not available, and it is not available to people who can pay 
certain bills but cannot pick up a full visit at a doctor or hospital 
stay, because that is not the way it works in this country. It costs so 
much money to do that.
  So once again I thank the gentleman for bringing this subject up 
again, and we will continue to discuss it at length until we get the 
action that we think the children need.
  Mr. PALLONE. Mr. Speaker, I want to thank the gentleman.
  I really believe that we are starting to be heard. We know that, for 
example, on the Senate side there is a movement on a bipartisan basis 
to try to address this issue, and I just noticed during the Easter 
time, when we were out of session for 2 weeks, there was a lot of 
attention in the news media about it. So I believe that the more we 
talk about it, the more we will see some action on it.
  I wanted to say, if I could, before our time is up, that there was 
some really good information provided by the General Accounting Office 
that talked about why children are uninsured, the categories, whom we 
are dealing with. They basically talked about three categories:
  First, children who are eligible for Medicaid but not enrolled. 
According to the General Accounting Office, an estimated 3 million 
uninsured children are eligible but not enrolled in Medicaid. So that 
is the first category.
  We might say, why is that the case? There are a lot of socioeconomic 
reasons. As we mentioned before, most of these kids have parents who 
work, sometimes two or three jobs. It is very difficult a lot of times 
for them to even get involved with the bureaucracy where they would go 
to Medicaid and sign up and fill out a lot of papers in order to enroll 
their children.
  There is also a sense of pride, that Medicaid, probably wrongly, is 
in many cases now associated with welfare. So there is a stigma 
attached to it, and a lot of working parents, even if their children 
are eligible, simply will not enroll their children.
  The second category are parents who earn too much for Medicaid but 
too little for private coverage. Again, as the number of employers 
simply do not provide insurance, if there is no group policy and they 
have to go out and pay

[[Page H1516]]

for an individual policy, as the gentleman also knows, that is almost 
impossible for the average working family.
  The third is parents who change jobs. Nearly half of all children who 
lose health insurance do so because their parents lose or change jobs. 
So, again, if we look at this over the 2 years that Families USA is 
looking at it, we can see there are times when kids are covered and not 
covered, that there are a lot of gaps because of the fact people are 
changing jobs.
  And a lot of people in the lower income categories but who are 
working have temporary jobs and are subject to tremendous fluctuations 
in their job. They may change every 6 months or whatever because it is 
not a job necessarily that has a lot of permanence.
  So it is a real problem that we have to look at the various aspects 
of it. And I am not saying there is an easy solution. All the gentleman 
and I are saying is that we want this addressed. We want the Congress 
and the House of Representatives to take it up.
  I appreciate the gentleman's participating, again, and all the 
gentleman has done to speak out on this issue.
  Mr. Speaker, I yield back the balance of my time.

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