[Congressional Record Volume 145, Number 128 (Tuesday, September 28, 1999)]
[Senate]
[Pages S11566-S11567]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. LINCOLN (for herself, Ms. Landrieu, Mr. Smith of Oregon, 
        Mr. Bayh, and Mrs. Feinstein):
  S. 1646. A bill to amend title XIX and XXI of the Social Security Act 
to improve the coverage of needy children under the State Children's 
Health Insurance Program (SCHIP) and the Medicaid Program; to the 
Committee on Finance.


          improved maternal and children's health coverage act

 Mrs. LINCOLN. Mr. President, today I rise to introduce the 
Improved Maternal and Children's Health Coverage Act. I am joined by my 
colleagues Senator Landrieu, Senator Gordon Smith, Senator Evan Bayh 
and Senator Dianne Feinstein.
  A similar bill was introduced in the House of Representatives by 
Congresswoman DeGette and Congresswoman Morella.
  This legislation is intended to help increase the coverage of 
uninsured children under the Children's Health Insurance Program, 
better known as CHIP.
  Right now there are 10.7 million uninsured children in the United 
States. The goal of CHIP is to insure 5 million children nationally.
  However, we have only enrolled 1.3 million of the targeted 5 million 
children so far. We can do better. We must do better.
  Let's get rid of barriers to coverage! There are several simple, 
administrative changes that we can make in this legislation that will 
help break down the barriers to enrollment.
  First, we can reduce the need for excessive documentation. States 
would be required to develop and use a uniform, simplified application 
form to determine eligibility for both Medicaid and CHIP. This means 
families only have to fill out one form.
  Second, families would only have to deal with one state agency to 
establish eligibility for either program. It is unfair to make parents 
go from agency to agency to enroll for state health insurance coverage.
  Third, we can do a better job making a greater variety of application 
sites available to families. Rather than only being able to apply at a 
state agency, states could opt to expand application site options. 
Let's take the application process to the places that parents and their 
children go on a regular basis--examples include schools and child care 
centers.
  This bill also expands health insurance coverage options to pregnant 
women who do not qualify for Medicaid because their incomes are 
slightly above Medicaid guidelines. Thousands of pregnant women earn 
just a bit too much to qualify for Medicaid, but they do not have 
health insurance because either their employer or their husband's 
employer doesn't offer it.
  We all know the importance of prenatal care to the health of unborn 
children. If a mother receives proper prenatal care, her child has a 
much greater chance of being born healthy. That is why the National 
Academy of Pediatrics, the National Association of Children's Hospitals 
and the March of Dimes--just to name a few organizations--support this 
legislation.
  In an era of making every federal dollar stretch as far as possible, 
this provision makes sense. For every $1 we spend on prenatal care, we 
save $3 later on that would be spent on complicated deliveries and 
serious birth defects. Sometimes you have to spend money to save money.
  Several years ago, the Arkansas governor and the state legislature 
implemented the AR Kids First health insurance program for children who 
did not qualify for Medicaid. AR Kids First precedes CHIP.
  The statistics for enrollment in the CHIP program in Arkansas are a 
bit ahead of the national curve. So for, AR Kids First has enrolled 
half of all eligible children. Over 45,000 now have coverage as a 
result of the state's proactive efforts and commitment to children's 
health.
  It has been so successful in enrolling eligible children for health 
insurance that the Department of Health and Human Services recently 
granted approval to allow AR Kids First to operate as the state's CHIP 
program.
  I applaud their efforts and hope that other states can learn from the 
outreach success of AR Kids First.
  Finally, this bill eliminates the sunset clause for a pot of money 
that Congress allocated for states to help them link families leaving 
welfare with the Medicaid and CHIP programs. As part of the 1996 
welfare reform law, Congress gave $500 million to states to see that 
families with children in the welfare system continue to receive health 
care coverage.
  Prior to 1996, poor families with children automatically received 
health benefits through Medicaid when they signed up for AFDC. Since 
Congress passed welfare reform legislation, Medicaid and TANF are no 
longer legally connected. States must revamp their eligibility systems 
to see that families with children do not fall through the cracks.
  There has been confusion between governors and the Department of 
Health and Human Services about the time period that this money could 
be spent.
  States run the risk of losing this money just 2 days from now. On 
September 30th, 16 states are in jeopardy of losing this funding and 18 
more states will lose funding by December 31, 1999.
  So, as you see, this piece of the Maternal and Children's Health 
Coverage Act is critical--and timely.
  I hope that the Congress and the President will act swiftly to 
eliminate the sunset clause and give states more time to spend this 
valuable pot of money.
  Mr. President, Congress is currently engaged in a debate over the 
Patients' Bill of Rights. I hope that we don't lose sight of an equally 
important goal of seeing that all children in America have health care 
insurance.
  I believe this bill takes a positive step forward in helping states 
move closer to the goal of providing health insurance to 5 million 
uninsured children. We can do this. We must do this.
 Ms. LANDRIEU. Mr. President, today I join my colleagues, 
Senator Lincoln from Arkansas, Senator Bayh from Indiana, Senator Smith 
from Oregon, and Senator Feinstein from California to introduce the 
``Improved Maternal and Children's Health Coverage Act of 1999,'' that 
would improve the health coverage of needy children under the State 
Children's Health Insurance Program (CHIP) and Medicaid. CHIP was 
implemented during the Balanced Budget Act of 1997 to ensure children 
living in working families that do not qualify for Medicaid, but still 
cannot afford health insurance, receive the care they need.
  As part of the 1996 welfare reform law, Congress allocated $500 
million to states to provide children and families access to Medicaid. 
This fund will expire for 16 states on September 30, 1999, and for 18 
more States, including Louisiana, on December 31, 1999. Our proposal 
would extend the life of this fund to allow states to continue to use 
these dollars as they carry out outreach efforts for both Medicare and 
CHIP providing our children with health care.
  Eleven million of the nation's children remain uninsured despite the 
passage of the State Children's Health Insurance Program. Mr. 
President, we

[[Page S11567]]

need to strengthen this essential program. In Louisiana alone, there 
are 268,000 children who still do not have health insurance. About half 
of these children are eligible for Medicaid or CHIP, but are not 
enrolled because of the lack of outreach. I know that in my colleague's 
state of Arkansas, they have insured just over half of the children who 
are eligible. The ``Improved Maternal and Children's Health Coverage 
Act'' will provide better outreach services to those families who may 
not know of their eligibility. It provides for a simplified and 
coordinated enrollment process that would determine eligibility for 
both Medicaid and CHIP.
  Additionally, the measure gives the states the option to cover 
pregnant women. Studies have shown that prenatal care improves the 
health of new born children and reduces the risk of birth defects. It 
is so very important that our children have health coverage from the 
first day of life.
  Parents are just beginning to be aware that this special program 
exists and that their children are eligible. It is our responsibility 
as leaders to make sure that our children are given the best possible 
opportunities for success. This means we must provide quality access to 
children's health services. We must not let these children fall through 
the cracks.
                                 ______