[Congressional Record Volume 145, Number 85 (Wednesday, June 16, 1999)]
[Senate]
[Pages S7132-S7134]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CHAFEE (for himself, Mr. McCain, Mr. Graham, Mr. Mack, Mr. 
        Moynihan, and Mr. Jeffords):
  S. 1227. A bill to amend title IV of the Personal Responsibility and 
Work Opportunity Reconciliation Act of 1996 to provide States with the 
option to allow legal immigrant pregnant women and children to be 
eligible for medical assistance under the medical program, and for 
other purposes; to the Committee on Finance.


          immigrant children's health improvement act of 1999

  Mr. CHAFEE. Mr. President, I am pleased to introduce the Immigrant 
Children's Health Improvement Act of 1999. I also want to thank 
Senators McCain, Graham, Mack, Moynihan, and Jeffords for their support 
and cosponsorship of this important legislation.

[[Page S7133]]

  In 1996, legal immigrants in this country lost critical public 
benefits because of changes made under welfare reform. While I 
supported the underlying goals of welfare reform--self sufficiency and 
individual responsibility--I continue to believe that the cuts made to 
immigrants' benefits as part of the 1996 reforms were unwarranted. 
While some of those cuts were reversed in 1997 and again in 1998, we 
still have a long way to improve the lives of the millions of 
immigrants who are legally in this country. The Immigrant Children's 
Health Improvement Act is one small but important step toward this 
goal.
  While cash benefits such as Supplemental Security Income (SSI) and 
food stamps are critical to the well-being of low-income immigrants, 
access to health care is their largest concern. Immigrants who were 
legally in the country before the enactment of the welfare reform 
legislation are still eligible for Medicaid. However, those 
immigrants--including children and pregnant women--who arrived after 
August 22, 1996, the enactment date of the welfare bill, are barred for 
five years from receiving health benefits under Medicaid or the State 
Children's Health Insurance Program (SCHIP). While these individuals 
may still get emergency medical care, they are ineligible for the basic 
medical services that may reduce the need for such emergency care. This 
makes no sense.
  The legislation we are introducing today would fix this problem by 
giving states the option to lift the five-year bar for pregnant women 
and children, allowing this narrow group of legal immigrants to receive 
health care services under either SCHIP or Medicaid. I want to 
emphasize that this legislation does not require states to cover these 
immigrant children--it merely allows the state to do so if it chooses. 
This approach is consistent with Congress' shift toward more state 
flexibility and will provide needed relief to states, such as Rhode 
Island, with high immigrant populations.
  I hope that my colleagues will join me in support of this important 
measure. I ask unanimous consent that the legislation be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1227

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Immigrant Children's Health 
     Improvement Act of 1999''.

     SEC. 2. OPTIONAL ELIGIBILITY OF CERTAIN ALIEN PREGNANT WOMEN 
                   AND CHILDREN FOR MEDICAID.

       (a) In General.--Subtitle A of title IV of the Personal 
     Responsibility and Work Opportunity Reconciliation Act of 
     1996 (8 U.S.C. 1611-1614) is amended by adding at the end the 
     following:

     ``SEC. 405. OPTIONAL ELIGIBILITY OF CERTAIN ALIENS FOR 
                   MEDICAID.

       ``(a) Optional Medicaid Eligibility for Certain Aliens.--A 
     State may elect to waive (through an amendment to its State 
     plan under title XIX of the Social Security Act) the 
     application of sections 401(a), 402(b), 403, and 421 with 
     respect to eligibility for medical assistance under the 
     program defined in section 402(b)(3)(C) (relating to the 
     medicaid program) of aliens who are lawfully residing in the 
     United States (including battered aliens described in section 
     431(c)), within any or all (or any combination) of the 
     following categories of individuals:
       ``(1) Pregnant women.--Women during pregnancy (and during 
     the 60-day period beginning on the last day of the 
     pregnancy).
       ``(2) Children.--Children (as defined under such plan), 
     including optional targeted low-income children described in 
     section 1905(u)(2)(B).''.
       (b) Applicability of Affidavits of Support.--Section 
     213A(a) of the Immigration and Nationality Act (8 U.S.C. 
     1183a(a)) is amended by adding at the end the following:
       ``(4) Inapplicability to benefits provided under a state 
     waiver.--For purposes of this section, the term `means-tested 
     public benefits' does not include benefits provided pursuant 
     to a State election and waiver described in section 405 of 
     the Personal Responsibility and Work Opportunity 
     Reconciliation Act of 1996.''.
       (c) Conforming Amendments.--
       (1) Section 401(a) of the Personal Responsibility and Work 
     Opportunity Reconciliation Act of 1996 (8 U.S.C. 1611(a)) is 
     amended by inserting ``and section 405'' after ``subsection 
     (b)''.
       (2) Section 402(b)(1) of the Personal Responsibility and 
     Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 
     1612(b)(1)) is amended by inserting ``, section 405,'' after 
     ``403''.
       (3) Section 403(a) of such Act (8 U.S.C. 1613(a)) is 
     amended by inserting ``section 405 and'' after ``provided 
     in''.
       (4) Section 421(a) of such Act (8 U.S.C. 1631(a)) is 
     amended by inserting ``except as provided in section 405,'' 
     after ``Notwithstanding any other provision of law,''.
       (5) Section 1903(v)(1) of the Social Security Act (42 
     U.S.C. 1396b(v)(1)) is amended by inserting ``and except as 
     permitted under a waiver described in section 405(a) of the 
     Personal Responsibility and Work Opportunity Reconciliation 
     Act of 1996,'' after ``paragraph (2),''.
       (d) Effective Date.--The amendments made by this section 
     take effect on October 1, 1999.

     SEC. 3. OPTIONAL ELIGIBILITY OF IMMIGRANT CHILDREN FOR SCHIP.

       (a) In General.--Section 405 of the Personal Responsibility 
     and Work Opportunity Reconciliation Act of 1996, as added by 
     section 2(a), is amended--
       (1) in the heading, by inserting ``and SCHIP'' before the 
     period; and
       (2) by adding at the end the following new subsection:
       ``(b) Optional SCHIP Eligibility for Certain Aliens.--
       ``(1) In general.--Subject to paragraph (2), a State may 
     also elect to waive the application of sections 401(a), 
     402(b), 403, and 421 with respect to eligibility of children 
     for child health assistance under the State child health plan 
     of the State under title XXI of the Social Security Act (42 
     U.S.C. 1397aa et seq.), but only with respect to children who 
     are lawfully residing in the United States (including 
     children who are battered aliens described in section 
     431(c)).
       ``(2) Requirement for election.--A waiver under this 
     subsection may only be in effect for a period in which the 
     State has in effect an election under subsection (a) with 
     respect to the category of individuals described in 
     subsection (a)(2) (relating to children).''.
       (b) Effective Date.--The amendment made by subsection (a) 
     applies to child health assistance for coverage provided for 
     periods beginning on or after October 1, 1999.

 Mr. GRAHAM. Mr. President, I rise today, along with Senators 
Chafee, Mack, McCain, and Moynihan, to introduce the Immigrant Children 
Health Improvement Act of 1999. I believe that these efforts are 
necessary in order to guarantee a healthy generation of children.
  This legislation is simple. It provides states the option to provide 
health care coverage to legal immigrant children through Medicaid and 
the State Children's Health Insurance Program (SCHIP)--in essence 
eliminating the arbitrary designation of August 22, 1996 as the cutoff 
date for benefits eligibility to children. The welfare reform 
legislation passed in 1996 prohibits states from covering these 
immigrant children during their first five years in the United States. 
This prohibition has serious consequences.
  Children without health insurance do not get important care for 
preventable diseases. Many uninsured children are hospitalized for 
acute asthma attacks that could have been prevented, or suffer from 
permanent hearing loss from untreated ear infections. Without adequate 
health care, common illnesses can turn into life-long crippling 
disease, whereas appropriate treatment and care can help children with 
diseases like diabetes live relatively normal lives. A lack of adequate 
medical care will also hinder the social and educational development of 
children, as children who are sick and left untreated are less ready to 
learn.
  In addition to allowing extended coverage of legal immigrant 
children, this initiative aims to provide Medicaid to legal immigrant 
pregnant women who are also barred from receiving services as a result 
of the 1996 welfare reform law.
  This legislation attempts to diminish the arbitrary cutoff date used 
in the 1996 welfare law to determine the eligibility of legal 
immigrants to benefits they desperately need. Our nation was built by 
people who came to our shores seeking opportunity and a better life, 
and America has greatly benefitted from the talent, resourcefulness, 
determination, and work ethic of many generations of legal immigrants. 
Time and time again, they have restored our faith in the American 
Dream. We should not discriminate between these important members of 
our community based on nothing more than an arbitrary date.
  As our nation enters what promises to be a dynamic century, the 
United States needs a prudent, fair immigration policy to ensure that 
avenues of refuge and opportunity remain open for those seeking 
freedom, justice, and a better life.
  Mr. McCAIN. Mr. President, I am proud to join my colleague Senator 
Chafee in introducing the Immigrant Children's Health Improvement Act 
of 1999. This legislation would help provide access to health care 
through the

[[Page S7134]]

Medicaid system for pregnant women and children who are legal 
immigrants.
  In 1996, Congress passed and President Clinton signed into law the 
Personal Responsibility and Work Opportunity Reconciliation Act making 
critical reforms to our nation's welfare system. This greatly needed 
piece of legislation is dramatically improving our nation's welfare 
system by requiring able-bodied welfare recipients to work and 
encouraging individuals to become self-sufficient.
  As my colleagues know, the welfare reform law limits most means-
tested benefits for legal residents who are not citizens. The specific 
provision affecting these benefits is based on the principle that those 
who immigrate to this nation pledge to be self-sufficient, and should 
comply with that agreement. However, I have been concerned that this 
provision is having a negative impact on a vulnerable segment of our 
population, children and pregnant women.
  My concern is not new. While Congress was considering this 
legislation, I raised concerns regarding several provisions which could 
have negative impact on certain vulnerable populations including 
children, pregnant women, the elderly and disabled. I believe our 
nation has a responsibility to provide assistance, when necessary, to 
our most vulnerable citizens, regardless of whether they were born here 
or in another country. I am pleased that Congress has addressed many of 
these concerns and implemented a number of changes to the 1996 welfare 
reform law. However, my concern for the pregnant women and children who 
are legal immigrants but were not protected by the changes implemented 
since 1996 still remains.
  The consequences of lack of insurance are problematic for everyone, 
but they are particularly serious for children. Uninsured and low 
income children are less likely to receive vital primary and 
preventative care services. This is quite discouraging since it is 
repeatedly demonstrated that regular health care visits facilitate the 
continuity of care which plays a critical role in the development of a 
healthy child. For example, one analysis found that children living in 
families with incomes below the poverty line were more likely to go 
without a physician visit than those with Medicaid coverage or those 
with other insurance. The result is many uninsured, low-income children 
not seeking health care services until they are seriously sick. These 
dismal consequences of lack of access to quality health care also have 
disastrous impacts on pregnant women and their unborn children.
  Studies have further demonstrated that many of these children are 
more likely to be hospitalized or receive their care in emergency 
rooms, which means higher health care costs for conditions that could 
have been treated with appropriate outpatient services or prevented 
through regular checkups. Receiving the appropriate prenatal care is 
essential for the health delivery and development for the unborn child 
which can help stave off future, more costly health care needs.
  Under our bill, states would be given the option to allow legal 
immigrant children and pregnant women to have access to medical 
services under the Medicaid program. Again, let me reiterate--this is 
completely optional for the states and is not mandatory This bill would 
provide our states with the flexibility to address the health care 
needs of some of our most vulnerable--our children and pregnant women.
  I urge our colleagues to support this important legislation.
  Mr. MOYNIHAN. Mr. President, today, I am proud to cosponsor the 
Immigrant Children's Health Improvement Act of 1999, introduced by my 
good friend and colleague Senator Chafee. We are joined by our 
colleagues Senators McCain, Jeffords, and Mack, and by Senator Graham, 
who has long been a leader on this issue.
  This bill includes three provisions which are part of the Fairness 
for Legal Immigrants Act of 1999 (S. 792), which I introduced, along 
with Senator Graham, on April 14th of this year. They would restore 
health coverage to legal immigrants--mostly children--whose eligibility 
for benefits is denied to them by the Personal Responsibility and Work 
Opportunity Reconciliation Act of 1996. It is a crucial step we should 
take. I will continue to work to move forward the broader Fairness for 
Legal Immigrants Act as well because it contains important provisions 
to prevent hunger and help the elderly and disabled.
  The Immigrant Children's Health Improvement Act would: Permit states 
to provide Medicaid coverage to all eligible legal immigrant children; 
permit states to provide Medicaid coverage to all eligible legal 
immigrant pregnant women; and permit states to provide coverage under 
the Children's Health Insurance Program (CHIP) to all eligible legal 
immigrant children.
  Note that these provisions are optional. There are no mandates in 
this bill. It would merely allow states to take common sense steps to 
aid legal immigrant children.
  The problem is that under current law, states are not allowed to 
extend such health care coverage--which is so important for the 
development of healthy children--to families who have come to the U.S. 
after August 22, 1996, until the families have been here for five 
years. Five years is a very long time in the life of a child. Such a 
bar makes little sense for them, and is nonsensical for pregnant women. 
It is common knowledge that access to health care is essential for 
early childhood development. We should, at a minimum, permit states to 
extend coverage to all poor legal immigrant children, no matter when 
they have arrived here. Let me emphasize that under the 1996 law, 
states cannot use federal funds for this--and we are restoring this 
option to them. This builds upon our recent achievements in promoting 
health care for children--legal immigrant children should not be 
neglected in these efforts.
  The provisions of that 1996 law concerning legal immigrants were 
based on the false premise that immigrants are a financial burden to 
American taxpayers. On the contrary. A recent comprehensive study by 
the National Academy of Sciences concluded that immigration actually 
benefits the U.S. economy. In fact, the study found that the average 
legal immigrant contributes $1,800 more in taxes than he or she 
receives in government benefits.
  Many Americans may not realize this, but legal immigrants pay income 
and payroll taxes. And without continued legal immigration, the long-
term financial condition of Social Security and Medicare would be 
worsened. According to the most recent Social Security trustees report, 
a decline in net immigration of 150,000 per year will reduce payroll 
tax revenues and require a 0.1% payroll tax increase to replace.
  It is in our interest to see that these immigrant families have 
healthy children. And it is not merely wise, it is just. These 
immigrants have come here under the rules we have established and they 
have abided by those rules.
  The 1996 law did grevious harm to the safety net for immigrants. Some 
states have begun their own efforts--without federal funding--to assist 
immigrants to make up the difference. Yet a new Urban Institute study 
concluded that ``[d]espite the federal benefit restorations and the 
many states that have chosen to assist immigrants, the social safety 
net for immigrants remains weaker than before welfare reform and 
noncitizens generally have less access to assistance than citizens.'' 
The Urban study also notes that ``[b]y barring many immigrants from 
federal assistance, the federal government shifted costs to states, 
many of which already bore a fiscal burden for providing assistance to 
immigrants.'' We in Washington should do our fair share.
  Mr. President, simple decency requires us to continue to provide a 
measure of a safety net to legal immigrant families. I urge the 
enactment of this legislation to ensure that we do so.
                                 ______