[Congressional Record Volume 145, Number 56 (Thursday, April 22, 1999)]
[Extensions of Remarks]
[Pages E758-E759]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


   INTRODUCTION OF ``THE CHIP DATA AND EVALUATION IMPROVEMENT ACT OF 
                                 1999''

                                 ______
                                 

                            HON. BART STUPAK

                              of michigan

                    in the house of representatives

                        Thursday, April 22, 1999

  Mr. STUPAK. Mr. Speaker, today I am introducing the CHIP Data and 
Evaluation Improvement Act of 1999. This legislation was introduced by 
Senator Moynihan and Senator Chafee in the Senate earlier this year. I 
want to thank them for their hard work and their leadership on this 
legislation. I look forward to working with them, as well as Members of 
this body to ensure swift passage of this legislation.
  This legislation would ensure comparable data and an adequate 
evaluation of children's health coverage under the new Children's 
Health Insurance Program (CHIP) and Medicaid.
  In 1997, CHIP was established to provide health coverage for low-
income uninsured children. The Balanced Budget Act of 1997 provided $48 
billion over 10 years, mostly in the form of a block grant, for States 
to develop children's health insurance programs.
  With new Federal CHIP funding, more States are beginning to develop 
their own programs. To date, 48 States have CHIP plans that have been 
approved by the Health Care Financing Administration, with most just 
beginning to implement their programs. In my home State of Michigan, 
reports have been mixed about the effectiveness of the program. All 
Members want to ensure that the program we instituted is carried out in 
an appropriate manner. We await reports on the effectiveness of their 
efforts to cover the Nation's uninsured children and I believe this 
bill will go along way in developing information on its effectiveness.
  Implementing their programs is the first challenge the States must 
confront. For the Federal Government, the first challenge clearly will 
be to track the experience of children and of the CHIP programs. We 
will need data to answer some basic questions: Is the number of 
uninsured children being reduced over time, and how effective are the 
State CHIP programs at serving them? What are the best practices and 
initiatives for finding and enrolling the Nation's uninsured children?
  The CHIP Data and Evaluation Improvement Act of 1999 calls for a 
detailed Federal CHIP evaluation by the Secretary of Health and Human 
Services. Current law requires a CHIP report from the Secretary to 
Congress; however, no funds were authorized. This bill would provide 
the necessary funds to conduct an evaluation. The evaluation would 
focus, in part, on outreach and enrollment and on coordinating the 
existing Medicaid program and the new CHIP program. In this era of 
devolution of social programs, the Federal Government has an 
increasingly critical responsibility to ensure adequate and comparable 
national data. This bill would ensure that standardized CHIP data is 
provided. At the very least, the Federal Government should provide, on 
a national level, estimates of the number of children below the poverty 
level who are covered by CHIP and by Medicaid.
  The CHIP Data and Evaluation Improvement Act would provide funding so 
that existing national surveys would provide reliable

[[Page E759]]

and comparable State-by-State data. The most fundamental question we, 
as policy makers, will be asking is whether the number of uninsured 
children is going down. With an increasing percent of uninsured, a 
stable rate might be considered a success! This bill would provide 
additional funding to the Census Bureau for its Current Population 
Survey--a national data source of the uninsured--to improve upon the 
reliability of its State-by-State estimates of uninsured children.
  In addition, the proposal would provide funding for another national 
survey to provide reliable State-by-State data on health care access 
and utilization for low-income children. Although this survey may also 
provide data on the number of uninsured, the CPS would be the primary 
source for such figures.
  Also, to develop more efficient and centralized statistics, this bill 
would coordinate a Federal clearinghouse for all data bases and reports 
on children's health. Centralized and complete information is the key 
to sound policy and programs.
  We need this information, not only to determine whether the States 
are properly instituting their CHIP programs, but to ensure that we 
continue our commitment to ensure that no children in this country are 
left without health care coverage.
  I have included a summary of the bill prepared by Senator Moynihan's 
staff to be included in the Record.

    Summary of the CHIP Data and Evaluation Improvement Act of 1999


                                Purpose

       In 1997, 10.7 million children were uninsured. The new 
     State Children's Health Insurance Program (CHIP) and existing 
     state Medicaid programs are intended to provide coverage for 
     low-income children. The crucial question is whether the 
     number of uninsured children has been reduced. Improved 
     state-specific data is needed to provide that information. In 
     addition, the Federal government should evaluate the 
     effectiveness of these programs in finding and enrolling 
     children in health insurance.


                                Proposal

       State-by-state Uninsured Counts and Children's Health Care 
     Access and Utilization. (1) Provide funds ($10 million 
     annually) to the Census Bureau to make appropriate 
     adjustments to the Current Population Survey (CPS) so that 
     the CPS can provide reliable state-by-state data on uninsured 
     children. (2) Provide funds ($9 million annually) to the 
     National Center for Health Statistics to conduct the 
     Children's Health portion of the State and Local Area 
     Integrated Telephone Survey (SLAITS) in order to produce 
     reliable state-by-state data on the health care access and 
     utilization for low-income children covered by various 
     insurance programs such as Medicaid and CHIP.
       Federal Evaluation. With funding ($10 million), the 
     Secretary of Health and Human Services would submit to 
     Congress a Federal evaluation report that would include 10 
     states representing varying geographic, rural/urban, with 
     various program designs. The evaluation would include more 
     specific and comparable evaluation elements than are already 
     included under Title XXI, such as including surveys of the 
     target population (enrollees and other eligibles). The study 
     would evaluate outreach and enrollment practices (for both 
     CHIP and Medicaid), identify barriers to enrollment, assess 
     states' Medicaid and CHIP program coordination, assess the 
     effect of cost sharing on enrollment and coverage retention, 
     and identify the reasons for disenrollment/retention.
       Standardized Reporting. States would submit standardized 
     data to the Secretary, including enrollee counts 
     disaggregated by income (below 100%), race/ethnicity, and 
     age. If income could not be submitted in a standard form, the 
     state would submit a detailed description of eligibility 
     methodologies that outline relevant income disregards. States 
     would also submit percentages of individuals screened that 
     are enrolled in CHIP and in Medicaid, and the percent 
     screened eligible for Medicaid but not enrolled.
       Administrative Spending Reports for Title XXI. States would 
     submit standardized spending reports for the following 
     administrative costs: data systems, outreach efforts and 
     program operation (eligibility/enrollment, etc.).
       Coordinate CHIP Data with Title V Data Requirements. 
     Existing reporting requirements for the Maternal and Child 
     Health Block Grant provide data based on children's health 
     insurance, including Medicaid. This bill would include the 
     CHIP program in its reporting. IG Audit and GAO Report. The 
     Inspector General for the Department of Health and Human 
     Services would audit CHIP enrollee data to identify children 
     who are actually eligible for Medicaid. The General 
     Accounting Office will report the results to Congress. 
     Coordination of all Children Data and Reports. The Assistant 
     Secretary of Planning and Evaluation in the Department of 
     Health and Human Services would consolidate all federal data 
     base information and reports on children's health in a 
     clearinghouse.

     

                          ____________________