[Congressional Record Volume 143, Number 63 (Wednesday, May 14, 1997)]
[House]
[Pages H2657-H2662]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH INSURANCE FOR THE NATION'S CHILDREN
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 yield to the gentleman from Massachusetts
[Mr. Olver].
an issue relative to h.r. 1469
Mr. OLVER. Mr. Speaker, I am very grateful to the gentleman from New
Jersey for allowing me to finish the statement that I was doing earlier
under his time.
As I was saying, under the section 601 of the bill, H.R. 1469, the
emergency appropriation bill which we will deal with tomorrow, there is
a change in the law proposed and promoted by my predecessor Silvio O.
Conte which would allow the American currency to be made by a joint
partnership that had up to 50 percent foreign ownership, rather than
the original law, as it was, that would allow only 10 percent
ownership.
{time} 1700
The reason for that is that it would allow joint ventures with
foreign national currency paper suppliers. The provision in section 601
has been specifically designed to give the currency production for our
American currency over to the most likely foreign player, Thomas De La
Rue, the British currency maker. De La Rue is more than a billion
dollar a year business that has a monopoly on the supply of currency
paper to the British Government. By policy of the British Government,
no American company nor even another British company is allowed to bid
and compete on the British currency paper contracts.
A capitalization subsidy to such a new supplier is particularly
unfair because it is a foreign manufacturer who has a monopoly in their
own market. It is actually unfair for any new supplier where there is
already a willing supplier, and it is certainly outside our present
procurement law. It is especially unfair when it is being given to a
very large company, a goliath of paper companies.
These are American taxpayer dollars we are talking about for these
capitalization subsidy payments, and it is hardly the way to use our
taxpayer dollars when we are trying to balance the budget.
In a final irony, we tomorrow will vote on a so-called Buy American
amendment which is offered by the gentleman from Ohio [Mr. Traficant].
All of us will vote for that amendment, and then in very short order we
will be asked to use American taxpayer dollars to subsidize turning
over the manufacture of the American currency to the monopoly in their
own market British currency maker.
American taxpayers deserve better than to be asked to pay for massive
capitalization subsidies for foreign companies to make our currency,
and I hope that tomorrow we will not adopt section 601 of H.R. 1469
when the matter comes up before us.
Mr. PALLONE. Mr. Speaker, at this point what I would like to do is to
move into the issue of kids' or children's health care. Before I do
that, I just wanted to say that Democrats in general have been
concerned for almost 2 years now, and have put forth as part of their
families first agenda an effort and a program to try to cover the 10
million children in these United States that do not have health
insurance coverage at this point.
We have been very upset, I would say, over the fact that the
Republican leadership really has not made an effort to address the
concern of children's health care. In fact, over the last 2 weeks what
we have seen sort of on the opposite end is an effort to cut money for
the Women, Infants and Children's Program, the WIC Program, which
hopefully will be addressed tomorrow when the supplemental
appropriation bill comes up but still has not been adequately addressed
by the Republican leadership.
Just by way of background, last month the Republicans on the
Committee on Appropriations, largely along party lines, voted to limit
the funding for the WIC Program. For those who do not know, the program
provides milk, formula, and other nutritional benefits for our Nation's
children. It is short about $76 million for this fiscal year. Most of
the request, actually, for this funding to make up for the cut, most of
the request came from the Governors of our 50 States, many of whom, the
majority of whom actually are Republican.
Today when the supplemental appropriations bill came up on the floor
to be debated for the first time and the rule was being considered, we
saw the Republican leadership essentially playing a shell game with the
fate of approximately 180,000 children who need the WIC Program and are
not going to be funded if we do not get this additional money. What the
Republican leadership did, basically, was to tie additional funding to
WIC to this controversial rule and effectively gag all debate on any
further amendments to meet these Governors' requests for additional WIC
funding.
I cannot emphasize enough how important this WIC Program is. There
are certain States like Nebraska and Arizona who have already begun to
cut off nutritional assistance to many children because they are not
getting this money that is needed. Believe me, more States are going to
be following suit very soon if we do not have some action on the WIC
Program.
I think it is important because, again, WIC is a priority. The
Republican leadership has not made it a priority any more than they
have made the issue of children's health care a priority. Many of us in
our Democratic task force on children's health care have been
complaining now for several months about the fact that the Republicans
have not addressed this issue.
Last summer, Democrats began beating sort of a drum on the need to
provide assistance to working families with uninsured children. This is
primarily a concern of working families, because if they are of very
low income, then they are eligible for Medicaid for their children. But
if they are not, if they are above the Medicaid threshold, and in that
case most of the people are
[[Page H2658]]
working, then they are not eligible for Medicaid and they are not able
many times to cover health insurance for their children.
About a month ago, the Democrats finally called on the Republican
leadership to move forward with a health care proposal by Mother's Day.
Mr. Speaker, Mother's Day passed and the Republicans still have not
produced anything. So our Democratic task force basically developed a
plan of our own.
I would like to go into some of the details of this plan but I am
just going to briefly, if I could, mention some of the important
points. Then I would like to yield to the gentlewoman from Oregon [Ms.
Furse] because she has developed a very important part of this overall
package.
Let me just say that the Democratic proposal consists of, first, an
outreach program to cover the 3 million kids eligible for Medicaid who
are not currently enrolled. Of the 10 million children that are not
covered by health insurance right now in the Nation, approximately 3
million are actually eligible for Medicaid but for one reason or
another are not enrolled, so we have an outreach program to cover them.
Second, we are expanding Medicaid to make sure kids are covered year
round when they are enrolled. What happens now is oftentimes, every 3
months or so, there will be a review of the child to see whether or not
they are eligible for Medicaid. That has created a lot of disruption
and caused a lot of kids to not be covered by health insurance. What we
are saying is that if they are eligible for Medicaid, that the child
stays in the program for at least 1 year.
Then we have a Medikids grant to help cover more children in working
families beyond the Medicaid Program. We are estimating that this could
help working families up to $48,000 a year in income for a family of
four.
Then we have the insurance reforms to provide access to children-only
health insurance policies. The gentlewoman from Oregon will explain
that in more detail. Basically what that involves is, for those who
cannot afford private health insurance, to make sure that they have
access to it for their children.
Lastly I wanted to mention that what the Democrats are putting
forward as part of our health care proposal for kids guarantees that
the funds in the balanced budget agreement go directly to covering as
many kids as possible. I want to commend the President. The proposed
budget agreement which we will probably consider next week on the House
floor does provide for a certain amount of money, I think it is
estimated to be about $17 billion over the next 5 years, to provide
expanded coverage for children's health care. But we as Democrats want
to make sure that this money goes directly to cover as many of these 10
million children as possible.
With that, I yield to the gentlewoman from Oregon.
Ms. FURSE. I thank the gentleman for yielding.
It is an enormous shock, is it not, to realize that 10 million
American children have no health insurance? To me it just feels like
that is a big national security issue. We are very, very keen to create
weapons systems. But, my goodness, what about those children who if
they do not get health insurance early will really suffer from a lot of
diseases and conditions that could have been easily met? Where I want
to congratulate the gentleman on having pulled together the task force
and to work with the gentleman is terrific, because we are trying to
reach those 10 million children.
What my bill does, and it comes, as always, out of constituents who
have called and told me what is going on in their lives. What my bill
does is it makes sure, it requires insurance companies who handle
medical insurance to offer a package that is affordable and is a kids-
only policy. What is affordable? We could all talk about what is
affordable, but what is not affordable is a family plan that is $400,
$500 a month for a family who maybe have lost a job, who cannot use
their COBRA benefits because they cannot afford it. But what is
affordable is a policy that we have in Oregon which is $34 a month.
That will cover a child from birth to 18 years in Oregon. That is the
way it goes. It is $34 a month. That allows for the family like the
family who called me and said,
Congresswoman, we cannot allow our children to have a
normal childhood. We don't let them climb trees because we're
afraid if they fell out of a tree and got hurt, we wouldn't
be able to afford to take them to a doctor. I raise my kids
out in the country.
I cannot imagine what it must be like to be a parent and say to your
kid that they cannot do normal kid things because we do not have health
insurance for them.
Part of our Democratic package, and I think the gentleman is
absolutely right, the Democrats decided this was a crisis, this was an
issue that we had to deal with and that was, take care of those 10
million children. Part of those 10 million could be covered under this
health insurance policy that we would require insurance companies to
create. It would mean that those children whose parents, and 62 percent
of the children without health insurance are children whose parents are
working people. They go to work every day. They are not sitting on
their couches watching television. They are going to work, but their
employer does not provide them with health insurance or they just
cannot afford it but they are not eligible for Medicaid. They would be
able to buy this $34 or $35, whatever we could make available.
My bill, the part we have included in the Democratic package, will
also provide that you cannot say, Well, this child has a preexisting
condition, we're not going to cover them. We are building on the
Kennedy-Kassebaum bill which we passed, bipartisan bill, last year,
saying it is not fair to say to people, Because you have a preexisting
condition, you can't get insurance. Those are the people who need
insurance. Think of the children with diabetes who need to have good
medical attention, and they would be covered, because these families
could afford that affordable care but they are not eligible for
Medicaid.
I am pleased that we are going to be able to offer something from the
Democratic Caucus that will provide for those 10 million children.
Again I think what we are dealing with is a national security issue. If
we do not have healthy children, we do not have healthy adults, we do
not have people who can be the best and the brightest that they could
be. That is a real loss to this country, it seems to me, and that is
why we must step forward, we must say this is a priority, we are going
to fund these things. Of course my bill does not require any government
funding. It just makes available to those families who really want to
look after their kids, they want to do the best for their kids. I am
very pleased it is in the package and I am very pleased that we have
stepped forward and said we as Democrats are going to take care of
kids.
Mr. PALLONE. I wanted to say that what the gentlewoman is saying
about this being perceived as a national security issue I think is very
legitimate because the bottom line is that the number of uninsured
children is growing. I keep pointing out to my colleagues, my
constituents as well that a few years ago when the President took up
the issue of health care and was trying to put together a universal
health care plan at the Federal level, he was doing it because he
realized that the number of uninsured in general in the country was
growing. We had figures then by the year 2000 there were going to be, I
do not know how many, I think then it was 30, now it is 40 million
uninsured and it would be even higher by 2000. That problem has not
gone away. The number of children that are uninsured continues to grow.
We had information from the Children's Defense Fund which has been one
of the organizations that has been taking a lead on this issue, and
they said that back in June 1996, which is when the Democrats first
started to put together this families first agenda that they just gave
an exponential chart about how the number just continued to grow. Since
1989, the number of children without private health insurance has grown
by an average of 1.2 million every year, or 3,300 a day. If this trend
continues, there will be 12.6 million children without private coverage
by 2000.
What the gentlewoman is saying about this being a national security
problem I think is totally legitimate. Of course it is true for a lot
of adults as
[[Page H2659]]
well, but particularly for children it makes no sense not to cover them
because it is their future, it is the future of the country, plus it is
very cheap. As the gentlewoman pointed out when she was giving some
figures about Oregon and what it takes if you have a children-only
policy, it is unbelievable how inexpensive it can be, particularly if
you are just covering kids.
Ms. FURSE. As a parent, and I know the gentleman is a parent of small
children, I am a grandmother, what we know is that we do not sleep well
at night if we know that our children do not have that security. It is
security, it is the knowledge that if they should become ill or if we
just want to keep them healthy, we have that opportunity to go to.
{time} 1715
Mr. Speaker, we have the very best medical system in the world, but
if our children cannot access that medical system, it does not matter
how good it is. We have got to make sure that it is available to
everyone, not just the rich, not just the very poor, but those working
families who care so much about their kids and want to do the right
thing for them, and they cannot pay the rent and the food and this
very, very expensive insurance.
So, if we can provide them something that will take some part of
those 10 million, then with our Medigap, Medikids Program that we are
going to put forward, and with this outreach that you described so that
everybody who is eligible will be able to access Medicaid, I think we
could do the responsible thing.
Mr. PALLONE. I agree, and I want to thank you for pointing out in
particular how right now the private insurance field does not
necessarily allow the people or does not make it affordable enough for
people to buy insurance policies just for their children.
Basically, if you look at what our task force has proposed, we are
sort of looking at this 10 million children and we are trying to sort
of attack it from different points of view because we realize it is a
complex problem. It is not something that you can address in just one
stroke, so to speak. And as I mentioned before, you do have about 3
million who actually are eligible for Medicaid, and I know that when we
tried to get a little information about why those 3 million are not on
Medicaid, we got different reactions. We found out, first of all, that
the people, many cases the parents of those 3 million, are both working
because of the bureaucracy, perhaps of not knowing how to, either not
having the information or not having the time or not thinking it is
worthwhile, they are just not knowledgeable enough or do not have
enough time to enroll their kids. Plus, people are very proud.
Mr. Speaker, Medicaid, unfortunately I think, is viewed by many
people as sort of a welfare program handout, and so in many ways it has
a negative connotation that people think that they should not apply for
it if they are working, that somehow it is a handout. And I think that
is wrong, but you know it takes a certain amount of education to make
people understand that it should not be viewed that way. So then you
have that component.
Then you have the expansion of Medicaid; in other words, right now
there are many States that take Medicaid up to a certain percentage of
poverty but do not take it beyond that in order to attract Federal
funds. So what we like to do is expand the Medicaid Program to higher
levels to take in more people at higher levels of poverty or percentage
of poverty.
And then with the Medikids Program, we are giving the States the
matching grants to capture people up to 48,000 in income. Now some
people would say to themselves, well, gee that is high, 48,000, but
surprisingly I think the estimate was that there are something like
1\1/2\ million children out of that 10 million that are not covered
that are with parents who make above that 48,000, above the 300 percent
of poverty. So the only way that we are going to attract those people
is essentially what you have put forward, which is to make some changes
in the private insurance program so that we can attract some people who
just have not been able to afford it for whatever reason.
And I know that in New Jersey, 48,000 may sound like a lot of money,
but it is not if you have two children or more and, you know, if maybe
only one parent is working and the other one is staying home with the
kids. It is not unusual for people to find out that they cannot afford
health insurance.
Ms. FURSE. Or if you have two people working at minimum wage. You
know, my goodness. We struggled so hard last year to get a minimum wage
increase, you know, against so much opposition to that; but just think
if you are working on minimum wage, yes, you might feel like, or well,
I should not ask for something from the Government because I am
working. But you know it is the best investment we make in this country
is any time we invest in our kids. What a return we get on it.
And I know that there are single moms and single dads out there who
are trying to keep rent and food and day care and all those things and
just do not feel and do not know that they could turn to Medicaid. So
we need to bring them in, and then those others who are making just a
little bit more, but it would not be a lot more, to still want to have
their own insurance policy, a kids only insurance policy.
Mr. PALLONE. I just, if I could, I just wanted to talk a little bit
about the matching grant program because I know that that is one that
has received a lot of press attention both in the Senate as well as in
the House in terms of what we are doing. As I said, we are trying with
our proposal to expand Medicaid and bring it to higher levels of
poverty or percentages of poverty, but the matching grant program is a
little different, and we call it Medikids because what it does is it
targets those families basically who make between approximately 16,000
and 48,000. Those are the ones who make too much to be eligible for
Medicaid right now but still we feel need some help from the Federal
Government with matching money from the States.
But there is a lot of flexibility in this program, just to mention
that how this additional money can be used. States can form public or
private partnerships, they can use the money to build upon existing
State programs. You mentioned Oregon. I know New Jersey has an existing
State Program. New York; there are a number of States. Or they can just
create a new initiative, if they want to, and it is totally voluntary
to the States. If they do not want to do it, they do not have to, but
hopefully they will.
Now in order for States to qualify for this Medikids matching grant,
they have to provide Medicaid coverage for pregnant women up to 185
percent of the poverty level and children through age 18 and families
up to 100 percent of the poverty level, or 16,000 a family of four.
Gets a little bureaucratic here, but basically there are about 30
States right now that meet this first requirement.
But just for my own State of New Jersey, for example, we only cover
kids up to 13 now; OK? So we would have an incentive, if you will, to
take advantage of this matching grant program, but we would have to
raise the threshold up to 18 at 100 percent of poverty.
So it is basically creating an incentive, if you will, for the States
to expand the Medicaid Program, and then they get this additional money
beyond that to take to include people that would not be eligible for
Medicaid under any circumstances.
I think that that is sort of a good way to go about it, because again
what we are trying to do is to capture some Federal moneys, get some
State moneys, and then at the same time implement the changes in the
private insurance market, or COBRA, that you have suggested, and if you
think about it, between the outreach, between expanding Medicaid,
between the matching grant program and the private insurance changes, I
think we can go pretty far. I mean certainly all of the 10 million
children who are not now covered by insurance could be covered under
one of those various factors that we are putting forward, and at the
same time it can be fit into the budget proposal, which is coming up
next week and presumably over the next month or so. So our goal is to
have this included as part of that process.
Mr. Speaker, I just want to thank the gentlewoman from Oregon again
for all her help in this.
Ms. FURSE. Mr. Speaker, I thank the gentleman for caring about the
kids of
[[Page H2660]]
America. We really must keep them front and foremost in our minds.
Mr. PALLONE. Thank you.
Mr. Speaker, I just wanted to take a little more time, if I could, to
talk about some of the reasons why we need a plan like the Democratic
proposal with regard to children's health insurance.
As I mentioned before, Democrats have been talking about this as part
of our family first agenda at least since June 1996, and the reason
again is because the number of kids or children who do not have health
insurance continues to grow. But I wanted to stress, if I could for a
few minutes, how this is essentially a problem for working parents and
that our task force and our Democratic proposal was essentially trying
to craft a program that would primarily address the concerns of working
parents.
Right now, 9 out of 10 children without health insurance have parents
who work, and nearly two and three have parents who work full time
during the entire year, and these parents either do not get health
insurance benefits through their employer, they get the benefits for
themselves but not for their kids, or they get such a small
contribution towards their kids' insurance that they cannot afford to
make up the difference.
As I said before, Medicaid helps the poorest children, and families
who are well off can afford private coverage, but there are millions of
working parents who are trapped in the middle, unable to afford health
insurance for their kids. A family health insurance policy can cost
$6,000 or more, which frankly is out of reach for many working
families. We talked about possibly families up to $48,000 a year for a
family of four. Six thousand dollars is a lot of money for a family
that is making up to $48,000 a year.
Now even for families who do get health insurance for their kids
through their employer, insurance has gotten very expensive. In 1980,
54 percent of employees at medium and large companies had employers who
paid the full cost of family coverage. By 1993 more than 79 percent of
these employees were required to pay for their insurance. And the
average employee now pays over $1,600 a year for family coverage, and
employees of small businesses are paying an average $1,900 a year.
Mr. Speaker, some people say well, you know, so what? You know this
is a capitalist society; the Federal Government cannot do everything
for everyone. But there are severe consequences of children not having
health insurance. This is highlighted by cities that show that
uninsured children tend to receive significantly fewer health care
services than insured children.
If I could just provide some facts regarding the consequences of
children not having health insurance:
First of all, reduced care when sick. Uninsured children are less
likely to have their health problems treated and less likely to receive
medical care from a physician when necessary. For example, uninsured
children obtain care half as often for acute earache, recurring ear
infections and asthma as do children with public or private coverage.
Reduced care for injuries. Children with no insurance are less likely
than those with insurance to receive care for injuries.
Reduced medical visits. Uninsured children are 2.3 times less likely
to have obtained a medical care visit in the past 12 months than are
insured children.
Reduced well child visits. During the course of a year, fewer than
half, or 44.8 percent, of uninsured preschool children have any well
child visits, and fewer than one-third receive their age-appropriate
recommended scheduled visits.
And finally, no regular source of care. Uninsured children are seven
times as likely as insured children to be without a source of routine
health care, and when they obtain health services, they are far more
likely than insured children to utilize high-cost hospital emergency
rooms as their usual source of care.
So what are we talking about here? We are essentially saying that
these children do not get preventive care, and when they do not get
preventive care, they get sicker, and in the long run the costs of
providing for their medical care goes up, and much of that cost ends up
coming back to the Government or ends up being passed on to people who
are paying for their health insurance through uncompensated care costs.
The main thing we are trying to emphasize here is that it makes no
sense whether it is as Ms. Furse said from her national security point
of view or from a cost point of view or from a preventive point of view
nothing--it does not make sense to not try to insure these 10 million
children, and we believe that with our health care task force and our
Democratic proposal we have a plan that can provide for insurance for
most, if not all, these 10 million children within the confines of the
balanced budget proposal that the House will be considering over the
next few weeks or over the next month.
And at this time I yield to the gentlewoman from Texas [Ms. Jackson-
Lee] who again has been on the forefront of this issue and has come to
the floor many times to argue for the need to cover the 10 million
uninsured children.
Ms. JACKSON-LEE of Texas. I thank the gentleman from New Jersey [Mr.
Pallone], and certainly I want to thank him for his leadership. I would
like to thank him for his victory because that is what he is working
toward, and that is why I am joining you, because I would really much
prefer us being able to say in the next couple of weeks, before the
summer session or recess, district recess break, that what we have done
is that collectively and in a bipartisan manner we have stood up for 10
million uninsured children.
I think that is why we are all here. I think that is why your
committee and the committee that I have joined you on, the task force,
has intently worked on creating something that makes sense. It is
important to come to the floor of the House and do the people's
business and make sense, and I do not think that we can stand much
longer for 10 million uninsured children.
I went home this past weekend and interacted with several of my
constituents and physicians, and they brought it to my attention again.
Texas has 1 million uninsured children, and if I might just share with
you another crisis with respect to this matter, and that is that in my
community today we have just heard that Medicaid dollars that come from
the Federal Government and then to the State government have been
denied my Harris County hospital district.
What does that mean? There are applications under the block grant
process for HMO's. The Harris County hospital district applied for
such, and they were denied it. There is another instance where children
in our community may go underserved, if you will.
And so I think it is very important that the legislation dealing with
uninsured children also impacts on raising the level of those who can
be served, and when I say that it means that this impacts poor working
parents. We have already got a crisis in many of our communities about
how Medicaid is utilized, and your proposal and the proposal we have
joined in on says that we want to increase or find all the Medicaid-
eligible children so that they can be on Medicaid.
I have a crisis where my Harris County district, hospital district,
may suffer and not get the Medicaid dollars that they need because
someone selected another group to run that system other than the very
entity that serves poor children.
{time} 1730
But if I might say that we need to focus on uninsured children of
working parents, along with the crisis of those who are the poorest of
the poor, and I think it is important to make these notations.
Most children without health care coverage are in that position
because their parents work for companies who have cut health coverage
for children or who offer no health coverage at all. We need to be
aware of that so people will not say, why do they not get a job. Each
year since 1989, 900,000 fewer children have received private health
insurance. In other words, every 35 seconds one less child is privately
insured. In America as a world power, I do not think that that is
something that we want to be known for.
Without private insurance, millions of working parents who have
labored on behalf of this country and their
[[Page H2661]]
families cannot afford health insurance for their children. So while
Medicaid, and as I said, we have a crisis there, covers the poorest of
children, and we are working to make sure that eligible children get
covered as well, millions of children of working parents do not have
any coverage at all.
Insurance coverage is critical to the health of our children, because
children without health insurance, as the gentleman said, often do not
receive the necessary treatment services or even the most basic
service. A charitable group went into one of my schools in my district
and found out that 60 children had not ever been tested or had their
eyes tested and any number of them needed glasses. The reason? These
are poor working families who have no choice. Medical expenses are
sufficiently high and those financially burdened parents will simply
opt to not take their children to the doctor, forgo needed pediatric
preventive care because of the vastness of their burdens.
For example, studies have shown that the majority of uninsured
children with asthma, and we talked about this in committee, never see
a doctor. Many of these asthmatic children are later hospitalized with
problems that could have been averted with earlier intervention.
Those of us in communities that see and share pollution know those
stories full well. We know when at the Texas Children's Hospital there
is a drive-by. Is it a drive-by shooting? No, it is a drive-by of the
emergency room because they cannot take any more children in the
emergency room because the parents who come there are poor, without any
coverage whatsoever, and they are working parents and they use the
emergency room as their doctor. Now is the time when our Texas
Children's Hospital, one which prides itself in caring for children,
says, ``No more.''
One-third of uninsured children with recurrent ear infections do not
see the doctor and some later develop permanent hearing loss. Many
children with undiagnosed vision problems cannot even read a
blackboard, and they sit in school and become diagnosed as slow
learners when actually they have a physical problem.
Finally, studies show that children without insurance do not receive
adequate immunization, have higher rates of visits for illness care,
and have more frequent emergency room visits.
I would like to engage the gentleman in a little dialog, because I
know we often talk about how young we are, and I will continue to
emphasize our youth. I do think, however, that the gentleman may have,
like me, come through a period when all we could hear was ``Get your
polio vaccination, get your polio vaccination.'' Every parent was
making sure they ran somewhere, and of course when medical costs were
reasonable, to make sure their child, that was the one thing that was
instilled in them that they would do for their child, was to make sure
they had their polio vaccination. What a difference it made in our
lives.
Now today there are children entering school who do not have a proper
immunization record because they have not been able to access medical
care and preventive medical care. I just want to engage the gentleman
in a colloquy as to whether or not he has seen circumstances where
hard-working parents cannot get the basic minimum, which is certainly
the immunization record and package that we most think our children
should have, those early immunization shots that prevent terrible
diseases such as polio, such as the time when the Nation was
instructing all parents, ``Get your polio vaccine.'' Do does the
gentleman know today that there are some parents that have not been
able to get their polio vaccine for their children?
I yield to the gentleman.
Mr. PALLONE. Mr. Speaker, I know the gentlewoman from Texas [Ms.
Jackson-Lee] is right, and I know for a fact that there are people in
that category. I think it is a twofold problem, and I think it relates
to the issue of health insurance for kids in general.
On the one hand there is the fact that there are a lot of people
increasingly who do not even realize that they need to do this, and
then of course, once they do, not having the access, because as we
know, vaccination is not as widespread as it once was, particularly in
urban areas or certain rural areas where people just either are not
aware or they do not have access any more.
I wanted to just mention, if I could, the gentlewoman talked about
enrolling, and we mentioned before there are 3 million children of the
10 million who are eligible for Medicaid and who are not enrolled. We
spent some time with the task force, as the gentlewoman knows, trying
to figure out how to deal with this, because outreach is not really
something that oftentimes is effectively done on the Federal level.
What we have in our bill is grants to States to help local
communities to develop outreach programs with maximum flexibility to
employ community resources. There again, I know it is a little
different from what the gentlewoman was saying, but I think it is the
same thing, that we need to motivate these community groups, regardless
of the nature of the group, that will do the kind of outreach and get
them the grant so that they can go out and find kids that are eligible
for Medicaid or, as the gentlewoman says, kids that have not been
vaccinated, kids that have not been able to either access preventive
health care or whose parents are not knowledgeable of it. That is a big
problem today. A lot of people are not aware of it, and obviously the
gentlewoman is aware of it. I yield back.
Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the gentleman.
I think the package that we have worked on is truly a bipartisan
package. When I say that I mean I cannot imagine why this legislation
would not be attractive to our colleagues on both sides of the aisle.
The reason is because we have an aspect that gives to the States
incentives for outreach to help get the word out and to help bring down
the lack of information for those who are not getting their children
immunized.
In addition, it enhances outreach to eligible children not yet
enrolled in Medicaid. So what it says is, there are eligible children,
the funds are there, let us not waste the dollars by creating more
dollars, let us make sure we get all the eligible children enrolled.
That is a positive stopgap measure.
Then we have that it provides the grants, as the gentleman said, to
States and territories to assist families with children with incomes up
to 30 percent of poverty to purchase health insurance. That is a
creative idea.
This, I think, brings people from both sides of the aisle around to
this issue. It requires insurers to offer group-rated policies for
children only. I think we remember in the last Congress where we
debated and said, if we want to do business with the U.S. Government,
we should put an incentive on those insurers who insure the U.S.
Government to create child-related policies, and that is the direction
in which we are going, and give families who qualify to continue health
insurance coverage under COBRA, but cannot afford the premium for the
entire family, the option to purchase the child-only policy.
I do not see where we can leave this session and not give an answer
to those 10 million uninsured children. Particularly, I do not see how
we cannot create child-directed health insurance policies so that we do
not have to hear the stories about parents telling their children, ``Do
not climb that tree, do not ride that bicycle. No, you cannot go
swimming with your Boy Scout troop. Why? Because I am fearful of what
may happen to you, and I have no health insurance to protect you.''
So I would just encourage our colleagues, really, let me get a little
bit more stronger on this. We need this on the floor of the House now.
We need this legislation passed now. There are too many children who
are being harmed, who are not being protected. In a country as wealthy
and as prosperous and as successful as this country, there are too many
of our children who do not have adequate health insurance.
I yield to the gentleman.
Mr. Speaker, I rise today to voice my concern for the 10 million
children in our Nation who are without health care insurance. I believe
that strengthening and expanding health care coverage for all of
America's children must be our first priority. We have heard many of
the statistics surrounding this health insurance crisis before. Some of
these figures are so striking, however, that I would like to bring them
to your attention.
Nine out of ten children who are without health coverage have parents
who work.
[[Page H2662]]
Nearly two in three of these children have parents who are employed
full time during the entire year. Two-thirds of these children live in
families with income above the poverty line and more than three in five
live in two-parent families.
Most children without health care coverage are in that position
because their parents work for companies who have cut health coverage
for children or who offer no health coverage at all. Each year since
1989, 900,000 fewer children have received private health insurance
coverage. In other words, every 35 seconds one less child is privately
insured.
Without private insurance, millions of working parents who labor to
support their families cannot afford to provide health coverage for
their children. The cost of health insurance when not purchased through
an employer is often prohibitive. So while Medicaid helps our poorest
children, and more-affluent families can afford private coverage,
millions of working parents in the middle cannot provide coverage for
their children.
Insurance coverage is critical to the health of our children.
Children without health insurance coverage often do not receive
necessary treatment services or even the most basic care. Medical
expenses are sufficiently high that financially burdened parents will
often delay or forgo needed pediatric preventative or medical care.
Some examples--studies have shown that the majority of uninsured
children with asthma never see a doctor. Many of these asthmatic
children are later hospitalized with problems that could have been
averted with earlier intervention. One-third of uninsured children with
recurrent ear infections do not see the doctor and some later develop
permanent hearing loss. Many children with undiagnosed vision problems
cannot even read a blackboard. Finally, studies show that children
without insurance do not receive adequate immunization, have higher
rates of visits for illness care, and have more frequent emergency room
visits.
It is obvious that to deny children health care coverage, denies them
the opportunity to lead healthy lives and to reach their fullest
potential. We, in the Democratic Party, have worked hard to draft
legislation that will address the plight of many of these uninsured
children. This legislation will: first, enhance outreach to eligible
children not yet enrolled in Medicaid; second, encourage and provide
additional funds to States and territories to expand the Medicaid floor
for health insurance for low-income children; third, provide for grants
to States and territories to assist families with children with incomes
up to 300 percent of poverty to purchase health insurance; fourth,
require insurers to offer group-rated policies for children only; and
fifth, give families who qualify to continue health insurance coverage
under COBRA but cannot afford the premium for the entire family, the
option to purchase a child only policy.
I encourage my colleagues to support this legislation. We, in this
Congress, should commit ourselves to providing every child the chance
to reach his or her fullest potential. We should provide health
insurance coverage for every American child and promise to leave no
child behind.
Mr. PALLONE. Mr. Speaker, I want to thank the gentlewoman for
pointing these things out, because if we think about it, there is
really no reason why this should be a partisan issue at all. I think
that hopefully we are moving in the direction of trying to get our
Republican colleagues and leadership on the Republican side to join
with us.
I think that the fact that they agreed with the President to at least
include a pot of money for children's health care in the proposed
balanced budget agreement which will come to the floor in some fashion
over the next few weeks, shows that we have been making some progress,
and I guess, if I could just emphasize that again, that this Democratic
proposal can all be achieved within the context of the balanced budget
agreement.
I believe, and I think it is only fair to say, that it was because of
the consistent and strong pressure from the Clinton administration and
congressional Democrats that funding for the Children's Health Care
Initiative was included in the bipartisan budget agreement that was
announced on Friday, May 2. Including funding for this initiative was a
victory for the congressional Democrats who have been saying for the
last year that this program needs to be included as one of our
priorities, one of our budget priorities.
I should say that the budget agreement leaves the details of the
children's health insurance initiative undefined. The agreement simply
states that it assumes $16 billion in funding over the next 5 years to
extend health insurance to up to 5 million uninsured children. Under
the agreement, the expanded coverage may be achieved by extending
Medicaid and providing cap grants to the States.
So basically the agreement lends itself to the Democratic proposal
that our task force has put together, in that the pot of money is there
and it has the Medicaid expansion as well as the matching grant program
to the States. But we believe very strongly, the way we put this
package together, that we can capture a lot more than 5 million
uninsured children; that we can, through a combination of going after
those who are not currently enrolled but eligible for Medicaid, as well
as the expansion of Medicaid, as well as the matching grants, as well
as changes to the private insurance, in the private insurance area,
that we can capture almost all, if not all, of the 10 million children
that are not insured.
Let me just say, Mr. Speaker, in closing, that I believe very
strongly the Democrats will continue to move forward on this issue
because we understand the nature of the problem. We understand that 9
out of 10 children without health insurance are in working families. We
understand that children without health insurance are less likely to
receive the care that they need when they are injured or they are sick,
and I have to say that as a parent myself, I would hate to have to
worry about my child getting hurt at the playground because I do not
have the health insurance coverage for him or for her. Families should
not have to worry about whether or not they can afford to take their
child to the doctor if their child becomes sick.
Mr. Speaker, I do not think that the Republican leadership sees this
issue in these terms. If they did, I believe that they would be more
aggressive in trying to develop a solution for America's uninsured
children. Democrats want to help the average American family, and we
believe that our plan will do just that. We are going to continue to
speak out on the House floor and by whatever means we have, in our
districts, until such time as a plan is put forward, is marked up in
committee and comes to the floor of the House that will address the
problem of these 10 million uninsured children.
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