[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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