[Congressional Record Volume 145, Number 128 (Tuesday, September 28, 1999)]
[Senate]
[Pages S11574-S11575]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. FEINSTEIN (for herself and Mrs. Boxer):
  S. 1656. A bill to amend title XXI of the Social Security Act to 
permit children covered under a State child health plan (SCHIP) to 
continue to be eligible for benefits under the vaccine for children 
program; to the Committee on Finance.


              KEEPING CHILDREN HEALTHY WITH IMMUNIZATIONS

 Mrs. FEINSTEIN. Mr. President, today I am introducing a bill 
to clarify that children receiving health insurance under the 
Children's Health Insurance Program (CHIP) in states like California 
are eligible for free vaccines under the 1993 Federal Vaccines for 
Children (VFC) program.
  I want to especially commend the leadership of Congresswoman Nancy 
Pelosi who is introducing a companion bill in the House today.
  I am introducing this bill because the U.S. Department of Health and 
Human Services has interpreted the law so narrowly that as many as 
528,000 children in California have lost or will lose their eligibility 
to receive free vaccines, under California's Healthy Families program. 
Approximately 169,000 kids have lost eligibility to date.
  California ranks 37th overall among States having children fully 
immunized by the age of 18 to 24 months. From 1993 to 1997, Orange 
County, California, had 85 hospitalizations and four deaths related to 
chicken pox. Across the State in 1996 there were 15 deaths and 1,172 
hospitalizations related to chicken pox. More recently, the 
Immunization Branch in California reports that in 1998 over 1,000 
whooping cough cases, including 5 deaths, were reported--the largest 
number of cases and deaths since the 1960's. Whooping cough and chicken 
pox are diseases for which there are vaccinations. We must do more to 
increase access to vaccinations for our nation's children.
  The Federal Vaccines for Children program, created by Congress in 
1993 (P.L. 105-33), provides vaccines at no cost to poor children. In 
1998, as many 743,000 poor children in my state, who were uninsured or 
on Medicaid, received these vaccines. This number is down by 
approximately 32,000 children in comparison to the 1997 immunization 
figures for California's poor children. California received $80.3 
million in 1999 from the Federal Government to provide vaccines.
  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 24 percent, the third 
highest in the U.S., while the national uninsured rate is 17 percent. 
As for children, 1.85 million or 19 percent of our children are without 
health insurance, compared to 15 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 has interpreted this form of ``health insurance'' as making them 
``insured,'' as 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'' at that time 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

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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.

                          ____________________