[Congressional Record Volume 143, Number 54 (Wednesday, April 30, 1997)]
[Senate]
[Pages S3849-S3851]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CHAFEE (for himself, Mr. Rockefeller, Mr. Jeffords, Mr. 
        Breaux, Ms. Collins, Ms. Snowe, Mr. Bingaman, Mr. Hatch, Mr. 
        Kennedy, Mr. Kerrey, Mr. Dodd, Mr. Kerry, Mr. D'Amato, Mr. 
        Bryan, Mr. Baucus, Mr. Robb, Mr. Hutchinson, Mr. Inouye, Mr. 
        Specter, Mr. Daschle, Ms. Moseley-Braun, and Mr. Moynihan):
  S. 674. A bill to amend title XIX of the Social Security Act to 
encourage States to expand health coverage of low income children and 
pregnant women and to provide funds to promote outreach efforts to 
enroll eligible children under health insurance programs; to the 
Committee on Finance.
     children's health insurance provides security (chips) act
  Mr. CHAFEE. Mr. President, I am very pleased today to introduce 
legislation to provide health insurance for millions of children who 
are not currently covered. Before I talk about the bill, let me take a 
moment to thank all of the members of the bipartisan coalition who have 
worked so hard to put this legislation together. Senator Rockefeller, 
the lead Democratic cosponsor and my colleague on the Finance 
Committee, deserves very special mention in this regard. Senator 
Rockefeller has worked for many, many years on these issues and I am 
personally grateful for all his leadership and hard work in this 
endeavor. He is a true hero when it comes to America's children.
  There are currently 10 million children in this country who do not 
have health insurance. Many of these children live in families where 
one or both parents are working but do not have employee coverage and 
earn too much to qualify for Medicaid. Others, though eligible, simply 
fall through the cracks, while still others lose eligibility because of 
age-based restrictions. This is a tragic problem and our proposal tries 
to provide real solutions.
  The Chafee-Rockefeller proposal offers the States additional Federal 
matching funds if they choose to provide Medicaid coverage to all 
children up to 150 percent of the Federal poverty level. It is a 
completely voluntary program--we hope that all States will participate, 
but we leave that decision to the Governors. States, like Rhode Island, 
that are already providing coverage at these levels will immediately 
begin to get additional Federal matching funds once they have provided 
the 1-year continuous coverage. Our bill also provides grant funds for 
States to use for outreach to the 3 million children who are eligible 
for Medicaid but not enrolled.
  I believe that the Medicaid Program is the best avenue to reach these 
uninsured children. Expansions in the Medicaid Program over the years 
have done wonders in increasing coverage for children and pregnant 
women. We also have to keep an eye on cost, and Medicaid is an 
inexpensive way to cover children--while half of Medicaid beneficiaries 
are children, children only account for 15 percent of overall Medicaid 
spending. And Medicaid is a program that already exists, so we don't 
have to create a new program or a new bureaucracy. In short, Medicaid 
works and works well.
  By encouraging States to provide Medicaid coverage to all children 
under 18 up to 150 percent of poverty, our proposal also tries to fix 
one of the program's problems: under the current Medicaid program a 
child's eligibility depends not only on family income, but also on age.
  Let me illustrate this for you: a 6-year-old girl lives in a family 
of four whose annual income is $21,000. That little girl gets Medicaid 
because Federal law requires that all children 6 and under be covered 
up to 133 percent of the Federal poverty level. On her seventh 
birthday, that little girl doesn't get much of a birthday present--she 
loses her Medicaid coverage because Federal law only requires that 
children between the ages of 7 and 13 be covered up to 100 percent of 
poverty, and her family's income level is slightly above that level. 
Her 4-year-old brother, however, keeps his Medicaid coverage, at least 
for the next 2 years. How bizarre that there are two children in the 
same family and one gets coverage because he's under 6 and the other 
doesn't because she's older than 6. Our proposal would give States the 
option to continue Medicaid coverage for both children until they are 
18.
  So, I am very pleased to introduce this legislation today along with 
this distinguished bipartisan group of Senators. I look forward to 
working together toward the goal of getting critical health care 
coverage to these children.
  Mr. ROCKEFELLER. Mr. President, I am extremely pleased and proud to 
be introducing legislation today with my colleague from Rhode Island, 
Senator Chafee. As my colleagues in the Senate already know, Senator 
Chafee has long been a leader in the area of health care, especially 
when it comes to the health care of children. I am also extremely 
pleased to be introducing this bill with the help of Senator Breaux and 
the newest member of the Finance Committee, Senator Jeffords. We are 
excited to be joined by so many of our colleagues on the Finance 
Committee, Senators Moynihan, D'Amato, Baucus, Hatch, Bryan, Kerrey, 
and Moseley-Braun, and with so many of our other colleagues who have 
joined us as original cosponsors, including Senators Collins, Bingaman, 
Snowe, Kennedy, Kerry, Dodd, Robb, Hutchinson, Inouye, Daschle, and 
Specter.
  Mr. President, our legislation already enjoys broad bipartisan 
support because it meets a serious need and it meets that need in a 
very cost-effective manner. Our legislation builds on an existing 
program and employs an approach that the Finance Committee

[[Page S3850]]

has used repeatedly over the past decade to expand health coverage to 
children and pregnant women. Our legislation is, therefore, not new, 
original, or terribly innovative. But, we know it works.
  For me personally, this legislation fulfills another part of my 
promise to work tirelessly to turn the recommendations of the National 
Commission on Children, which I was honored to chair, into reality. 
That blue ribbon panel of children's leaders from many fields, 
representing a wide spectrum of views, successfully developed a 
unanimous report to recommend an action plan to give America's children 
a real shot at becoming productive, healthy citizens. During our 
deliberations, we recognized that ensuring basic health care for 
children should be one of the country's highest priorities. The bill we 
are introducing today challenges Congress to make the commitment to 
this basic objective that is so vital for the entire country's future.
  Our legislation is complementary to many of the other children health 
bills that have been already proposed this year. That is one reason why 
I am also a cosponsor of other health bills that have been introduced 
by Senators Hatch and Kennedy and Senator Daschle. These bills are not 
competing bills. They all seek to expand the number of children with 
health insurance and they could all easily fit together to meet a 
large, and I am sad to report, a growing need in this country.
  A total of 10 million children in the United States do not have 
health insurance and as a result, the vast majority of them do not get 
necessary health care. Numerous studies have shown that uninsured 
children do not receive basic preventive care and immunizations. They 
are less likely to see a doctor for both acute and chronic illnesses 
and are more likely to delay seeking necessary care. Uninsured sick 
newborns receive fewer services in the hospital than those with health 
coverage. Children without insurance are less likely to have a regular 
source of medical care. This means that these children miss out on 
getting properly screened for problems that could be easily treated 
early or that need to be monitored on a routine basis. According to the 
American Academy of Pediatrics, having a regular source of medical care 
could reduce per-child health care costs by 22 percent.

  Those are the facts. But let us not forget the emotional turmoil a 
parent goes through trying to figure out when, or if, to get an earache 
treated or a rash checked out. Imagine how hard it must be for a mother 
and father to decide to wait just one more day in hopes that a 
troubling symptom will disappear only to have those symptoms worsen in 
the middle of the night. Some families don't even allow their children 
to play sports for fear of an injury. Having millions of families and 
children in these types of situations is just plain wrong, and we must 
try to help.
  Mr. President, the vast majority of uninsured children live in 
families where a parent works. Unfortunately, many of these families 
are unable to afford coverage offered by their employer when it is 
offered. In too many instances working parents don't even have that 
option. The trends for job-based insurance are very disturbing. Between 
1987 and 1995 the percentage of children with job-based insurance 
declined from 67 to 59 percent. But this downward trend is not new. 
Between 1977 and 1987 job-based insurance declined by 5 percent. Every 
minute that goes by another child loses his or her private health 
insurance.
  Mr. President, our bill is very simple. We encourage States to expand 
coverage for children by offering them an enhanced Federal match. Under 
our bill, the States would be eligible to receive a 30-percent increase 
in their current Federal matching rate if they choose to expand 
coverage for pregnant women, infants, and children up to 150 percent of 
poverty. We cap the Federal match at 90 percent so that all States 
would be required to contribute some additional funding. Under our 
bill, Rhode Island would be eligible to receive an enhanced Federal 
match rate of 70 percent up from 54 percent. West Virginia would be 
eligible to receive a 90 percent Federal match, up from 72 percent.
  Our legislation targets those families earning less than one-and-one-
half times the poverty level or about $24,000 a year for a family of 
four. Only a quarter of families at or below this income level have 
job-based insurance. By comparison, 81 percent of families earning 
wages above 150 percent of poverty have job-based insurance. The 
concern of replacing private insurance with public coverage--the so 
called crowding out effect--is minimized when so little job-based 
coverage even exists for families at these income levels.

  Under current law, Medicaid eligibility varies based on a child's age 
and a family's income level. Our legislation aims to establish uniform 
level of eligibility. I recently heard from a West Virginia mother 
desperate for health insurance for her 1-year-old. She and her husband 
work and earn about $22,000 a year. When their daughter turned 1, she 
lost her Medicaid coverage. She qualified for Medicaid when she was an 
infant but because Medicaid's income standard for eligibility is 
different for a 1-year-old she no longer qualified after her first 
birthday. The mother's employer offered health insurance, but at a cost 
of $289 a month or $3,500 a year. They could not afford to buy it. This 
mother was absolutely desperate for assistance because she knew her 
daughter needed immunizations and other well child care services.
  Mr. President, our legislation seeks to end instances of children 
losing their Medicaid coverage just because they have a birthday. Our 
legislation seeks to end instances of children in the same family 
having to meet different income standards.
  We do this not by mandating States to expand their Medicaid Program. 
We believe that by providing additional Federal money States will be 
able to move beyond their current eligibility levels. Our legislation 
would also allow those States that have already exceeded 150 percent of 
poverty to receive an enhanced Federal match. This match would be for 
those children they are already covering between 100 percent and 150 
percent of poverty. We did not think it was fair to penalize those 
States who have already tried to improve coverage for children.
  A key way to expand the number of children enrolled in Medicaid is to 
guarantee eligibility for 12 months. Some 3 million children are 
currently eligible but not enrolled in the Medicaid Program. Some of 
these children qualify for a few months of Medicaid coverage. But 
because of slight changes in their parents' income, they lose coverage 
over the course of the year. Our bill would require States to guarantee 
12 months of eligibility for all children on Medicaid as a condition of 
receiving an enhanced Federal match.
  Expansions of Medicaid in the late 1980's resulted in a decreased 
number of low birthweight babies, improved access to health care, a 
decline in infant mortality rates, and millions more children in 
working families with health insurance. We can build on these successes 
with this legislation. I look forward to working with my colleagues in 
the Senate and in the House in advancing this bill. I am excited at our 
opportunity to meet a very real and vital need of millions of America's 
children.
  Mr. JEFFORDS. Mr. President, the children of America need our help. 
Nearly 10 million children have no health insurance. Many of these 
children live in families with working parents who simply do not make 
enough money to afford health insurance.
  In order to help address this national problem, I am pleased to 
cosponsor, with many of my good friends and colleagues, the Children's 
Health Insurance Provides Security [CHIPS] Act. The CHIPS Act will 
provide Federal financial incentives to encourage States to provide 
uniform Medicaid coverage up to 150 percent of poverty for children of 
all ages.
  The Medicaid Program provides health care for poor children and 
pregnant women. My home State of Vermont, through its Dr. Dynasaur 
program, uses Medicaid and is now ranked second best in the Nation in 
providing health insurance coverage for children under 18 years of age.
  We felt it was important to improve our existing Medicaid system, a 
system which is already in place and currently provides health coverage 
to 16 million low-income children. Three million additional children 
are eligible to receive Medicaid benefits, but they are just not 
enrolled. We should fix that problem.

[[Page S3851]]

 We also feel that it is important to provide incentives to expand 
Medicaid coverage nationally to the children of families who are at 150 
percent of the Federal poverty level--the working poor. This 
legislation builds upon the good work done in Vermont, and many other 
States, in ensuring that our children have access to health care.
  Our bill encourages States to expand current Medicaid eligibility for 
children and pregnant women to 150 percent of the Federal poverty level 
by increasing the amount of money that the Federal Government 
contributes to the Medicaid Program. States that elect to participate 
in the program will need to guarantee that all children are covered to 
at least 100 percent of the Federal poverty level and that all children 
are provided with 12 months of continuous medical coverage.

  The bill also provides grant money for outreach programs. States may 
design their own outreach programs based on their special needs and 
specific populations. We will help by simplifying the application 
process for Medicaid and other Federal programs for which these 
children qualify. One third of all uninsured children are eligible but 
not enrolled in Medicaid. Our bill, by emphasizing outreach and 
administrative simplification, will help get many of these children 
enrolled in the Medicaid Program.
  We must commit our efforts to giving children the best possible start 
in life. As a recent report entitled ``the Social Well-Being of 
Vermonters'' indicates, the foundations we lay for our young children 
will affect their later success in all areas of life. A healthy start 
begins with a healthy pregnancy and early, comprehensive prenatal care. 
Our legislation will give many children the health insurance coverage 
they need and, by doing so, help ensure a solid foundation for our 
country's future.

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