[Congressional Record Volume 145, Number 39 (Thursday, March 11, 1999)]
[Senate]
[Pages S2579-S2581]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BOND:
  S. 592. A bill to improve the health of children; to the Committee on 
Finance.


                         Healthy Kids 2000 Act

  Mr. BOND. Mr. President, one year ago today, the Birth Defects 
Prevention Act passed the House of Representatives, clearing its way 
for the President's signature.
  With this new funding, the Centers for Disease Control has 
implemented a national strategy, in conjunction with the States and 
local organizations such as the March of Dimes, to prevent the 
devastating incidence of birth defects.
  Building upon that success, today I rise to introduce the Healthy 
Kids 2000 Act--comprehensive approach which addresses the broad 
spectrum of health issues affecting our nation's children.
  And I want to thank the March of Dimes and the National Association 
of Children's Hospitals for supporting me in this effort to improve the 
health of our nation's children and pregnant women as we move into the 
new millennium.

[[Page S2580]]

  I also want to thank my colleague from Ohio, Mike DeWine, for his 
work on children's health issues, and for allowing me to adopt some of 
his ideas for inclusion in this bill. Senator DeWine has been a 
dedicated leader on children's health, and has been essential to the 
development of the sections of this bill that focus on poison control 
centers and pediatric research within the National Institutes of 
Health.
  I am struck, every time I go into the neonatal wards across my home 
state of Missouri, at the tiny one and two pound babies, hooked up to 
monitors and tubes and looking so helpless. Many of them will survive; 
a few may not. My first thought is always one of thanks that I have 
been blessed with a very healthy son.
  The good news is that we are making progress in preventing diseases 
and in making sick and injured children well. Healing never thought 
possible a few years ago for those who are burn victims, or born with 
birth defects, or trauma victims, or even cancer patients, now occurs 
on a daily basis around our country.
  The question about how to finance health care and how to improve 
access to and the quality of health care, however, are the hottest 
challenges we face as a nation.
  There are some things we can all agree on: that the care and well-
being of our children should come first, particularly those who are 
ill. Prenatal care is also paramount, because a great deal of child 
health is determined in the womb.
  Thus as a nation, we must stand up and speak for those who cannot 
speak for themselves.
  That is why I am introducing the ``Healthy Kids 2000 Act.'' The idea 
behind it is simple: we want pregnant women to be healthy, and we want 
children to be healthy. So we are going to remove some of the barriers 
they encounter in receiving good, appropriate health care.
  This bill will give States the flexibility to enroll eligible 
pregnant women in the State Children's Health Insurance Program (CHIP) 
and to coordinate essential outreach efforts to enroll qualified 
children. This program has already been funded by Congress to assist 10 
million children whose families lack health insurance. These children 
are eligible to receive basic health care services like immunizations 
and antibiotics for ear infections, but pregnant women are not now 
eligible. Since so much of a child's health is determined in the womb, 
it is imperative that low-income pregnant women receive quality 
prenatal care.
  Similarly, we need to ensure that the National Institutes of Health 
research machine is focusing on diseases and conditions which afflict 
our nation's children, such as birth defects, SIDS, cystic fibrosis, 
juvenile diabetes, and arthritis, just to name a few. A simple 
statistic will highlight this need: 80% of prescription medications 
marketed in the U.S. today are not approved by the FDA for use by 
children under 12 because studies have not been conducted to document 
their safety or whether or not they work for children. That is a 
terrible disservice to the young people of our country who may need the 
relief of a particular prescription drug.
  This bill will also consolidate programs and provide more funds for 
local initiatives to prevent birth defects and maternal mortality.
  150,000 infants are born each year with a serious birth defect, and 
birth defects are still the leading cause of infant death. During the 
1990s we have witnessed an increase in maternal death during pregnancy 
and childbirth. There is no question that we need better approaches to 
ensure that women have healthier, safe pregnancies, and healthier 
babies. And my bill will help fund these vital prevention strategies.
  This bill will also ensure direct access to obstetric care, and 
direct access to pediatric care. Children have health needs that are 
very different than those of the adult population. Diseases and 
medications behave differently than in adults, and when children are 
treated, it should be by those who understand those differences.
  Finally, this initiative will assist children's hospitals in 
educating the next generation of pediatricians. Even with strapped 
budgets, teaching children's hospitals offer the more egalitarian 
health care in this country. These hospitals turn no one away. And it 
is essential that we support this noble mission by equipping children's 
hospitals with the tools to continue their educational and research 
efforts.
  So much of the most important work in our society goes unnoticed, and 
unrewarded. Saving the lives of our children, improving the health of 
our children, even caring for our children on a daily basis is not 
glamorous work, or sometimes even all that much fun. Doctors, nurses, 
mothers, fathers, child-care workers and teachers are performing the 
most difficult, and the most important, work of our society: raising up 
the next generation to be happy, healthy, and productive citizens.
  We must assist them in their efforts, and we can take a positive step 
by debating and enacting Healthy Kids 2000.
  Mr. President, I ask unanimous consent that letters of support be 
printed in the Record.
  There being no objection, the letters were ordered to be printed in 
the Record, as follows:

                                           National Association of


                                         Children's Hospitals,

                                    Alexandria, VA, March 9, 1999.
     Hon. Christopher ``Kit'' Bond,
     U.S. Senate, Russell Senate Office Building, Washington, DC.
       Dear Senator Bond: The National Association of Children's 
     Hospitals (N.A.C.H.), which represents more than 100 
     children's hospitals across the country, strongly supports 
     your efforts to address the full spectrum of children's 
     health care needs through your new ``Healthy Kids 200 Act,'' 
     legislation that knits together several important individual 
     initiatives to improve the health and well-being of our 
     nation's children.
       This legislation takes a comprehensive approach to 
     addressing barriers and obstacles, both health system and 
     governmental, that families and pediatric providers encounter 
     in improving the health care of children. Its focus on 
     strengthening health coverage, graduate medical education, 
     research, and public health protections for children clearly 
     reflects the children's hospitals' own four-fold missions of 
     clinical care, education, research, and public health 
     advocacy for child health. Together, they are essential to 
     the ability of communities to meet the unique health care 
     needs of their children.


                       children's health coverage

       This legislation recognizes that the prescription for good, 
     comprehensive health care for children is not only health 
     insurance coverage but also quality and access to care. The 
     ``Healthy Kids 200 Act'' would provide important health care 
     protections for children as well as enable providers, 
     professionals, systems, and workers to assure improved 
     quality of health care for children.
       By providing families access to providers that specialize 
     in pediatrics for the care delivered to their children, the 
     legislation takes the important step of ensuring that 
     children receive health care in the most appropriate setting 
     and condition possible.
       The legislation recognizes that, as the President's 
     Advisory Commission on Consumer Protection and Quality in the 
     Health Care Industry writes, ``[c]hildren have health and 
     development needs that are markedly different from adults and 
     require age-appropriate care. Developmental changes, 
     dependency on others, and different patterns of illness, 
     disability and injury require that attention be paid to the 
     unique needs of children in the health system.''
       In addition, the legislation improves upon the State 
     Children's Health Insurance Program (SCHIP) by allowing 
     states the option to use SCHIP to provide health insurance 
     coverage for pregnant women. The linkages between prenatal 
     care and healthy children have long been understood in 
     American social policy, including Medicaid, the Maternal and 
     Child Health Block Grant and WIC. As the GAO found in its 
     report Health Insurance; Coverage Leads to Increased Health 
     Care Access for Children, Medicaid coverage of maternal and 
     child health improves health care access but also decreases 
     infant and child mortality.
       For these reasons, N.A.C.H. supports giving states the 
     option of covering low income, uninsured pregnant women 
     through SCHIP, as well as the bill's provision to establish 
     automatic enrollment of their infants upon birth through that 
     critical first year of life.


                          Pediatric Education

       N.A.C.H. applauds you for including in the ``Healthy Kids 
     2000 Act'' the commitment to commensurate federal graduate 
     medical education support for independent children's 
     hospitals proposed by the ``Children's Hospitals Education 
     and Research Act,'' which you have twice co-sponsored with 
     Senator Bob Kerrey (D-MO). Through the establishment of a 
     capped time-limited fund, the legislation would go a long way 
     toward providing a more equitable competitive playing field 
     for independent children's hospitals.
       Like all teaching hospitals, children's hospitals receive 
     less and less support for their graduate medical education 
     (GME) programs from most insurers. Unlike other teaching 
     hospitals, independent children's hospitals receive virtually 
     no support for GME from the one remaining, stable source of 
     GME support--the Medicare program--because

[[Page S2581]]

     they serve children, not the elderly. Yet, these hospitals 
     play a critical role in training the next generation of 
     health care providers for children. Although they represent 
     less than one percent of all hospitals, they train nearly 30 
     percent of all pediatricians and nearly half of all pediatric 
     subspecialists.


                           pediatric research

       As centers of research devoted to improving the prevention, 
     diagnosis, treatment, and evaluation of children's illnesses 
     and conditions, children's hospitals very much appreciate 
     your efforts to bring new visibility the need for increased 
     NIH investment in pediatric biomedical research overall and 
     in pediatric research training in particular. While there are 
     a variety of ways to structure this increased investment in 
     NIH, we know that you share our conviction that in the end, 
     the result must be a real increase in total support for 
     pediatric research. Its purpose should be to stimulate 
     significant additional pediatric research investment and 
     growth in the number of researchers focusing on children's 
     health, not to cause a shift in funding that comes at the 
     expense of any current NIH research efforts for children.


                   pediatric public health promotion

       With so many children's hospitals serving as their states' 
     or regions' poison control centers, N.A.C.H. especially 
     appreciates the provisions of your legislation to stabilize 
     and improve our nation's poison control system. Over half of 
     the two million poisonings reported in 1996 were by parents 
     of children under age 6. Almost 2 out of 3 poison calls are 
     on behalf of children under age 18. Legislation that serves 
     to improve and stabilize this critical system will 
     undoubtedly improve the lives and health of children as well.
       N.A.C.H. also supports the bill's provisions to improve 
     prenatal care and birth defects research through the Centers 
     for Disease Control and Prevention, which are important to 
     reduce morbidity and mortality from birth, improving health, 
     and preventing life-long health care costs for children and 
     adults.
       In conclusion, Senator Bond, we commend you for the breadth 
     and depth that this bill undertakes to improve the health of 
     our nation's children. This legislation certainly sets the 
     standard for what the 106th Congress should consider and pass 
     with respect to child health.
       If you have any questions or need additional information, 
     call Peters Willson or Bruce Lesley at 703-684-1355.
           Sincerely,
     Lawrence A. McAndrews.
                                  ____

                                                   March of Dimes,


                                     Birth Defects Foundation,

                                    Washington, DC, March 8, 1999.
     Hon. Christopher Bond,
     U.S. Senate, Russell Senate Office Building, Washington, DC.
       Dear Senator Bond: On behalf of more than 3 million 
     volunteers and 1500 staff members of the March of Dimes, I 
     want to commend you for introducing the ``Healthy Kids 2000 
     Act.'' We are particularly pleased that you have included in 
     this legislation three specific initiatives important to the 
     Foundation and to the health of mothers, infants and 
     children.
       The first section of the bill, ``Health Care Accessibility 
     and Accountability for Mothers and Newborns,'' includes a 
     much needed initiative to improve access to health care for 
     pregnant women. Numerous studies have shown that prenatal 
     care improves the likelihood that a child will be born 
     healthy. Your proposal that states be given the flexibility 
     to cover prenatal care for income-eligible pregnant women 
     through the new State Children's Health Insurance Program (S-
     CHIP) is an important step to take. If enacted, this 
     provision would help provide women the prenatal and maternity 
     care they need to have healthy, full term babies. The March 
     of Dimes strongly supports access to prenatal care. Because 
     of the Foundation's concern that more than 350,000 women do 
     not have access to these needed services, the Foundation has 
     identified the expansion of S-CHIP to cover pregnant women as 
     one of its highest federal legislative priorities for 1999.
       The Foundation is also pleased to support the ``Pediatric 
     Public Health Promotion'' provision that would establish a 
     National Center for Birth Defects Research and Prevention at 
     the Centers for Disease Control and Prevention. This change 
     in law would elevate the visibility of the birth defects 
     activities of the CDC, authorized by the Birth Defects 
     Prevention Act (P.L. 105-168), which you guided to enactment 
     in 1998. As you know, for many years the March of Dimes has 
     been a strong supporter of federal birth defects research and 
     prevention activities. We applaud you for proposing to 
     integrate the activities of various programs to further 
     promote the prevention of birth defects.
       In addition, the March of Dimes commends you on including 
     the ``Pediatric Research Initiative'' in the ``Healthy Kids 
     2000 Act.'' If enacted, this initiative would establish the 
     authorization needed to obtain additional funding for 
     pediatric biomedical research within the National Institutes 
     of Health. The Foundation believes that a partnership between 
     the public and private sectors is the more effective way to 
     raise the level of investment in clinical research pertaining 
     to children. The March of Dimes urges Congress to strengthen 
     the national commitment to all children.
       We thank you for your leadership and are eager to work with 
     you on this and other legislative initiatives important to 
     the health of the nation's mothers, infants and children.
           Sincerely,
                                            Dr. Jennifer L. Howse,
                                                        President.
                                 ______