[Congressional Record Volume 144, Number 51 (Thursday, April 30, 1998)]
[Senate]
[Pages S3930-S3931]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. FEINSTEIN:
  S. 2013. A bill to amend title XIX of the Social Security Act to 
permit children covered under private health insurance under a State 
children's health insurance plan to continue to be eligible for 
benefits under the vaccine for children program; to the Committee on 
Finance.


            children's health insurance program legislation

  Mrs. FEINSTEIN. Mr. President, today I am introducing a bill to 
clarify that children receiving health insurance under the new 
Children's Health Insurance Program (CHIP) are eligible for free 
vaccines under the 1993 federal Vaccines for Children (VFC) program.
  I want to especially commend the leadership of Congresswoman Jane 
Harman who is introducing an identical bill in the House today.
  We are introducing these bills because the U.S. Department of Health 
and Human Services has apparently interpreted the law so narrowly that 
as many as 580,000 children in California will lose their current 
eligibility to receive free vaccines, under California's new Healthy 
Families program.
  The federal Vaccines for Children program, created by Congress in 
1993 (P.L. 105-33), provides vaccines at no cost to poor children. In 
1997, as many 775,000 poor children in my state, who were uninsured or 
on Medicaid, received these vaccines. California received $60 million 
from the federal government to provide them.
  Mr. President, what can be so basic to public health than 
immunization against disease? Do we really want our children to get 
polio, measles, mumps, chicken pox, rubella, and whooping cough--
diseases for which we have effective vaccines, diseases which we have 
practically eradicated by widespread immunization? Every parent knows 
that vaccines are fundamental to children's good health.
  Congress recognized the importance of immunizations in creating the 
program, with many Congressional leaders at the time arguing that 
childhood immunization is one of the most cost-effective steps we can 
take to keep our children healthy. It makes no sense to me to withhold 
them from children who (1) have been getting them when they were 
uninsured and (2) have no other way to get them once they become 
insured.
  According to an Annie E. Casey Foundation report, 28 percent of 
California's two-year old children are not immunized. Add to that the 
fact that we have one of the highest uninsured rates in the country. 
Our uninsured rate for non-elderly adults is 22 percent, the third 
highest in the U.S., while the national uninsured rate is 17 percent. 
As for children, 1.7 million or 18 percent of our children are without 
health insurance, compared to 13 percent nationally, according to 
UCLA's Center for Health Policy Research. Clearly, there is a need.
  In creating the new children's health insurance program in 
California, the state chose to set up a program under which the state 
contracts with private insurers, rather than providing eligible 
children care through Medicaid (Medi-Cal in California). Unfortunately, 
HHS appears to be interpreting this method of providing these children 
health insurance as making them ``insured,'' as

[[Page S3931]]

defined in the vaccines law, and thus ineligible for the federal 
vaccines. I disagree.
  It is my view that in creating the federal vaccines program, Congress 
made eligible for these vaccines children who are receiving Medicaid, 
children who are uninsured, and native American children. I believe 
that in defining the term ``insured'' Congress clearly meant private 
health insurance plans. Children enrolled in California's new Healthy 
Families program are participating in a federal-state, subsidized 
insurance plan. Healthy Families is a state-operated program. Families 
apply to the state for participation. They are not insured by a 
private, commercial plan, as traditionally defined or as defined in the 
Vaccine for Children's law (42 U.S.C. sec. 1396s(b)(2)(B). On February 
23, the California Medical Association wrote to HHS Secretary Donna 
Shalala, ``As they are participants in a federal and state-subsidized 
health program, these individuals are not ``insured'' for the purposes 
of 42 U.S.C. sec. 1396s(b)(B).''
  The California Managed Risk Medical Insurance Board, which is 
administering the new program with the Department of Health Services, 
wrote to HHS on February 5, ``It is imperative that states like 
California, who have implemented the Children's Health Insurance 
Program (CHIP) using private health insurance, be given the same 
support and eligibility for the Vaccines for Children (VFC) program at 
no cost as states which have chosen to expand their Medicaid program.'' 
The San Francisco Chronicle editorialized on March 10, 1998, ``More 
than half a million California children should not be deprived of 
vaccinations or health insurance because of a technicality. . . ,'' 
calling the denial of vaccines ``a game of semantics.''
  Children's health should not be a ``game of semantics.'' Proper 
childhood immunizations are fundamental to a lifetime of good health. I 
urge my colleagues to join me in enacting this bill into law, to help 
me keep our children healthy.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2013

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. PERMIT CHILDREN COVERED UNDER PRIVATE HEALTH 
                   INSURANCE UNDER A STATE CHILD HEALTH PLAN TO 
                   CONTINUE TO BE ELIGIBLE FOR BENEFITS UNDER THE 
                   VACCINE FOR CHILDREN PROGRAM.

       (a) In General.--Section 1928(b)(2)(A)(ii) of the Social 
     Security Act (42 U.S.C. 1396s(b)(2)(A)(ii)) is amended by 
     inserting ``, except that for purposes of this paragraph a 
     child who is only insured under title XXI shall be considered 
     as being not insured'' after ``not insured''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall take effect as if included in the enactment of the 
     Balanced Budget Act of 1997.
                                 ______