[Congressional Record Volume 146, Number 68 (Tuesday, June 6, 2000)]
[House]
[Pages H3895-H3901]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH CARE FOR CHILDREN IN TEXAS
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 6, 1999, the gentlewoman from Texas (Ms. Eddie Bernice Johnson)
is recognized for 60 minutes as the designee of the minority leader.
Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, for the 60 minutes,
we plan to address the House on health care for children in Texas. I
will be joined by several Members.
My colleagues can see, Mr. Speaker, that this ad has a child that has
on boxing gloves. Our children should not have to fight to get health
care coverage that they truly deserve.
[[Page H3896]]
A child born in the year 2000 is far more likely to grow up healthy
and to reach adulthood than a child that was born in 1900. Over the
past 100 years, our Nation's scientific, technological, and financial
resources have built the most advanced health care system in the world.
But the doors of health care still remain shut to some.
Millions of children have inadequate medical care. Ensuring that
every child in our Nation receives the best possible health care, we
must have a top priority in this Nation. To a large extent, health
status is still determined by race, language, culture, geography, and
economics.
In general, children in low-income communities get sick more often
from preventable acute and infectious illnesses, such as measles,
conjunctivitis, and ear infections. Low-income children and teens are
also more likely to suffer from chronic medical conditions, such as
diabetes and asthma. These are the leading causes of school absences.
In fact, the sharpest increases in asthma rates are among the urban
youth. Very prevalent. Despite the tremendous advances in medical
technology and public health, millions of children have less of a
chance to grow up healthy and strong because of unequal access to
health care.
Texas is a perfect example. Children without health insurance or a
regular source of health care are more likely to seek care from
emergency rooms and clinics, which have long waits to see a provider,
limited follow-up, and little to no health education about preventive
strategies or ways to manage a chronic illness.
Compared with insured children, uninsured children are up to eight
times less likely to have a regular source of care, four times more
likely to delay seeking care, nearly three times less likely to have
seen a provider in the last past year, and five times more likely to
use emergency room as a regular place of care.
There is no question that insurance is key to maintaining health.
When Medicaid was initiated in 1965, infant mortality rates began to
decrease, and that continues today.
The health insurance status of children through age 18 in Texas
compared to that of the rest of the country. On this next chart,
imagine 100 children from Texas standing in front of us, 54 of these
children are insured through private employer-based policies; 24
percent are uninsured; 22 percent are covered through Medicaid. This
equals to about 1.4 million of the 6 million children in Texas without
health insurance.
On our next chart, just imagine 100 children from all over the
country standing in front of us. Sixty-four percent of these children
are insured through private employer-based programs; 21 are covered
through Medicare; 15 are uninsured.
Why is it that Texas's percentage of uninsured children is higher
than the Nation's average? The reason is due to a Texas Government that
chooses not to take advantage of the government funding that will allow
many children to be insured.
I just read a news clipping here talking about the millions of
dollars that is turned back or unused in the Federal Government simply
because we have not enrolled these children. It is unfortunate that we
have a Government so benign in Texas that will not enroll the children.
{time} 1915
As a matter of fact, Texas can expand its Medicaid coverage to the
age of 18 and cover those whose income is up to 300 percent of the
Federal poverty level. Presently, Texas only covers children up to age
18 and whose income is 100 percent of the Federal poverty level with
title XXI funds. There is something grossly inadequate about how we
take care of our children and their health care in Texas. Over half of
all States have expanded the coverage to 200 percent and beyond.
The next chart shows income eligibility levels for children 1 and
older in Medicaid and separate State programs. This chart shows that
most States have expanded health care coverage to children in title XXI
funds. This coverage is provided through Medicaid expansions and/or
separate insurance programs. Why, then, Texas? Ten States offer
Medicaid to those with incomes up to 150 percent of the Federal poverty
level. Texas falls within that category. Texas falls at the bottom. Our
children fall at the bottom.
There are several colleagues that I have here, Mr. Speaker, who will
also make comments on whether or not our children are being treated
fairly if they have to simply fight for the health care they deserve.
I yield to the gentleman from Texas.
Mr. HINOJOSA. Mr. Speaker, I thank the gentlewoman from Texas (Ms.
Eddie Bernice Johnson) for the work that she is doing, and I agree with
her opening remarks that our children should not have to fight to get
the health care coverage that they deserve.
Mr. Speaker, I am happy to announce that for the first time, a
Children's Health Insurance Program, or CHIP, is available in South
Texas. CHIP is low-cost health insurance provided under a State-
subsidized insurance program. Any Texas uninsured children, newborns
through age 18, are eligible. All costs are flexible and based on
family income. For example, a family of four qualifies if the household
income is $34,000 or less. If they make more than that, they can
qualify for greatly reduced insurance through another program, Texas
Healthy Kids.
The CHIP operates like a health maintenance organization, or HMO. It
is run by the TexCare Partnership which partners with all 254 Texas
counties to sponsor services through one of three different plans. One
is CHIP, two is Medicaid, and three is the Texas Healthy Kids. CHIP
provides services such as hospital care, surgery, x-rays, therapies,
prescription drugs, mental health and substance abuse treatment,
emergency services, eye tests and glasses, dental care and regular
health care checkups and vaccinations.
For Texas, CHIP is funded from the proceeds of our tobacco settlement
with the tobacco companies a couple of years ago. It is critically
important in our State because Texas has the highest rate of uninsured
in the country. Unfortunately, Texas has the Nation's second highest
number of uninsured children. The worst problem we have is that not
enough parents are using this great program.
South Texas, in particular, has carried the burden of uninsured
children for many years. About 1.4 million of Texas' 5.8 million
children lack health insurance, but 470,000 of them are now eligible
for coverage under CHIP. Almost one-fourth, or 109,000, of the newly-
eligible kids live on the Texas-Mexico border. When children do not
have the health insurance, they have to rely on costly medical
treatment at the last minute. This threatens the child's future well-
being. But now we have a true opportunity to change that. CHIP will
give a lot of children the opportunity to lead healthy lives without
the fear of getting sick.
Let me share a quote from a lady from my district who recently went
through the enrollment process. She said: ``My husband and I are
hardworking middle-income people who were disqualified from Medicaid
because I became employed. We have two incomes, and we can't afford
insurance. Now we are told by the TexCare Partnership we will have
insurance for our children with low premiums and low copayments that we
can afford. My children have health care when they need it.''
CHIP was first implemented in 1998 to address a national crisis,
almost 12 million children that were without insurance. In Texas, we
are now able to offer insurance to approximately half a million
children that otherwise would have none. While we can make this offer,
it is up to each parent or guardian to enroll or at least inquire about
getting their children in this program.
Believe it or not, the hardest part of the CHIP program is getting
parents to enroll their children. Most parents need to take advantage
of this genuinely great program. I want to stress that even if a parent
has never qualified for health insurance for their children before, now
they can. CHIP solves the cost problem for many Texas families. In
CHIP, many families will only pay an annual fee of $15 to cover all
their children in this plan. Some higher-income families will pay
monthly premiums of $15 or maybe $18 which covers all children in the
family. Most families will also have copayments for doctor/dental
visits, prescription drugs, and emergency care. And families must
reenroll their children once a year.
[[Page H3897]]
Mr. Speaker, children can only get this insurance if their parents
apply. I hope all parents listening will take the initiative and make
certain their children are enrolled. The application process is simple
and straightforward. Any Texan can call my office in McAllen or in
Beeville to get the number for the CHIP hotline. If parents want local
assistance or information in my congressional district, they can call
my office for that number or visit any public library in Hidalgo County
or in Bee County to pick up a bilingual brochure and application.
Ms. EDDIE BERNICE JOHNSON of Texas. Could the gentleman tell me why
we are just beginning to talk about this information since this has
been available for a while?
Mr. HINOJOSA. It has been a fight to get the Texas leadership in the
legislature to move the decision-makers to get this enrollment process
going. I know that in my office we have been fighting on this for at
least 18 months. I can assure the gentlewoman that I am delighted to
see it finally get started, because it will stop the suffering of many
of the working families that I represent in the 15th District.
Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I yield to the
gentleman from Texas (Mr. Lampson).
Mr. LAMPSON. I thank the gentlewoman from Texas for yielding. Mr.
Speaker, I rise to address this issue of children's health insurance. I
want to commend the gentlewoman from Texas (Ms. Eddie Bernice Johnson)
for the work that she is doing in this regard, the gentleman from Texas
(Mr. Hinojosa), and the other Members that we are going to be hearing
from. As a government worker, I am guaranteed that my children will
have access to quality health care. This knowledge brings me some peace
of mind. As it stands, many parents in my home State of Texas do not
have this same peace of mind. In fact, many children who are eligible
for State or Federal programs are needlessly foregoing quality health
care or receiving care in expensive emergency situations only.
As a Member of Congress and as a father, I believe that every family
deserves to share the peace of mind that I have today. That is why I am
working to reform the current children's health care insurance system.
Medicaid and the new State Children's Health Insurance Program, S-CHIP,
are the two key publicly funded health insurance programs that offer
coverage for low-income adolescents in Texas today. Medicaid provides
health insurance coverage for more than 40 million individuals, mostly
women, children and adolescents, at an annual cost of about $154
billion in combined Federal and State funds.
In addition to these funds, S-CHIP made available approximately $48
billion in Federal funds over 10 years to help States expand health
insurance coverage to low-income children and youth. S-CHIP works to
subsidize families with income levels not covered by the Medicaid
program. Funded with Federal block grant dollars and State matching
dollars, S-CHIP is a health insurance program for children in families
who make too much money to be eligible for Medicaid but who cannot
afford other private insurance options.
Mr. Speaker, Texas gained a major victory during the 1999 legislative
session when it passed S-CHIP. This State program will help affordable
health insurance for families earning up to 200 percent of the Federal
poverty level. The Federal Government currently allows coverage to
children as high as 300 percent. Together, these programs provide many
uninsured children in Texas with quality health care.
While the combination of S-CHIP and Medicaid offers powerful
opportunities to reduce the percentage of uninsured children in the
United States, we can do more. Despite the recently passed S-CHIP
program, my home State still has the second highest rate of uninsured
children in the country. At the present time, there is a pressing and
undisputable need for eligibility reforms and aggressive outreach to
low-income families in Texas. Statistics show that Texas is ineffective
in retaining low-income kids on Medicaid. Part of this failure can be
attributed to the red tape that unnecessarily burdens the neediest
families in Texas. The bureaucratic hurdles that must be overcome to
receive Medicaid eligibility in Texas include a face-to-face interview,
an assets test, no continuous eligibility, and no presumptive
eligibility.
Fortunately, Texas has been given the opportunity to adopt less
restrictive methods for counting income and assets for family Medicaid.
Without these changes, enrollment will continue to be difficult and
complex for applicant families that are referred to Medicaid, many of
whom will have a child eligible for CHIP and another one eligible for
Medicaid.
Texas can make the system more navigable by implementing a few simple
changes. These changes include eliminating the assets test for
children's Medicaid, ending the requirement for face-to-face
application, adopting uniform statewide documentation and
verification options for Medicaid and Texas CHIP, and, finally,
adopting 12-month continuous eligibility for children's Medicaid.
At a time of unprecedented prosperity, it is untenable for children
to not have access to basic health care. Even more absurd is the fact
that many of these sick children are eligible for State and Federal
health insurance programs. The time to act is now. We cannot sit idly
by and watch our children suffer needlessly. The solution is in our
hands.
Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, this has been
available now for at least 2 years. We have already talked about the
fact that when people have a language problem or they live a long ways
from where they might be able to get health care relief, it is usually
the lowest income which means usually the least well educated.
Has Texas taken on any leadership or responsibility to try to be sure
that we can spread the word to the persons who are eligible?
Mr. LAMPSON. We certainly should be. We need to spread that word,
because what it is doing it is encouraging people to go into the most
expensive areas to seek the care that they need. That may be a hospital
emergency room. A hospital in my hometown and other hospitals within my
district are grossly strapped right now because of the closing of so
many, just as an example, rural health care facilities that have lost
their ability to continue to offer services across this country.
As this group of people, the children about which we are speaking
right now, also find their way into these same facilities, we are
driving the cost of health care up to the point where it is causing
others not to have access. Where we can do something about it and help
fix this problem and make it easier for those to gain the access that
they so richly deserve and that we want them to have so that their
health does not have an adverse effect on the rest of us in society,
then certainly we ought to be taking the opportunity to do it.
{time} 1930
Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, according to the New
York Times, on Sunday, May 21 of this year, Texas had not spent any of
the dollars allocated to take care of these children that are poor.
Mr. LAMPSON. Mr. Speaker, if the gentlewoman will yield, that is
obviously very, very, very wrong. We have the opportunity to help
children, we have the opportunity to help people, and if we cannot
reach out and let them know, and make certain that they know about the
programs that can provide a better quality of life, then we make
serious mistakes. That is why I commend the gentlewoman for the work
that she is doing in trying to accomplish just that task.
We can make a difference in people's lives if the word can reach
them, if we can do the things that help make their task a little bit
easier in getting the quality of care that they need and deserve. I
thank the gentlewoman for doing that, and I thank her for sharing the
time this evening.
Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I yield to the
gentlewoman from Texas (Ms. Jackson-Lee).
Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the gentlewoman for
this emphasis on a very important issue. To even begin to think of the
great need of children with respect to health care and not respond to
their need seems to be a travesty and a tragedy.
[[Page H3898]]
I could not help but listen to the dialogue that the gentlewoman had
with our colleague, the gentleman from Texas (Mr. Lampson). It seems
certainly that there has been a problem with the leadership from the
executive of the State of Texas and particularly the Texas Department
of Health. Although there may be other issues that they have excelled
on, this is one that has seen a great vacuum in leadership.
I remember following the work of the State legislature, and many of
the legislators from the urban centers had to work very hard to ensure
that the funding for the CHIPs program included children beyond the age
of 12. The initial effort by the Texas Department of Health and the
governor's office was to only provide these CHIP monies for children up
to 12, and many of them with the encouragement of many of us in
Congress and the questioning of many of us in Congress, asked the
question: Do you mean a child does not get sick after age 13?
It seems to me an outrage. I want to applaud those legislators who
took the leadership and demanded that they address the question of the
needs of good health care, like Sylvester Turner and Rodney Ellis and
Garnett Coleman and I am sure that I am leaving out many others around
the State, who were actively involved in pressing the point that we
needed to have this kind of funding for children beyond the age of
children.
Mr. Speaker, it has already been said that Texas is at the bottom of
retaining low-income kids on Medicaid since welfare reform in 1996. It
also has been noted that Texas has the highest rate of uninsured in the
country, and Texas has the second highest rate of uninsured children in
the Nation. But what also needs to be noted is that right now in the
State of Texas, some 500,000 children qualify for CHIP, and that means,
that symbol that the gentlewoman has, the picture of that baby that
says, do our children have to really fight, or should our children have
to really fight to get good health care. With 500,000 children already
qualifying for CHIP, it seems that we are behind the times in moving
forward to ensure that this program works. It is well known that Texas
has been slow compared to other States in implementing CHIP.
This is not to say that we do not have some very committed health
professionals in our own local communities who have been begging for
the CHIP program to be implemented. Children enrolled in Texas CHIP can
get a comprehensive benefits package which include eye exams and
glasses, prescription drugs and limited dental checkups and therapy,
all of the items that provide for a healthy child.
Just last week in my district, Senator Paul Wellstone and myself held
hearings on mental health. I know we do not have mental health parity,
but to hear the parents of children come forward and cry out for needed
services in mental health for diagnostic services, for counseling
services, knowing full well that we need to keep working toward parity,
that is also health care that parents need.
So we can see that the CHIPS program is long overdue in our
community. To avoid a logistical nightmare for both the State and
parents, Texas should act as quickly as possible to implement changes
in children's Medicare eligibility. To reinforce what has been said, we
need to eliminate the access test for children's Medicaid. Texas now
makes parents of Medicaid-eligible children document not just income,
but also the value of savings, IRAs, automobiles, and valuables. There
is a lot better way to do it, and we can utilize the Federal law that
is used by the Federal Government in 40 States, plus the District of
Columbia.
It is important to drop the requirement for face-to-face
applications, recertification interviews, because we realize that
parents are very busy. We should allow mail-in applications. This is
not required by Federal law. Thirty-eight States, plus the District of
Columbia, allow mail-ins. So it is important that as we deal with the
elimination of assets which are not required by the Federal Government,
nor required by 40 States, we can then make more easier, if you will,
the ability for these parents to apply and become eligible for CHIP.
The main point that I think we are trying to impress upon our State
and the focus of this Special Order that I think is so very important
is our children are voiceless. Their parents are fighting for them, but
they are the ones who every time a ballot is cast, a child cannot vote,
yet they are in need of the good health care that this CHIPS program
would allow.
Mr. Speaker, I would hope that the State of Texas would see the value
of responding to the needs of our children and quickly eliminate the
complicated process that keeps this CHIPS program from being
implemented. I think it is important that we get leadership from the
State, and I think it is most important that the Texas Department of
Health establish a focus that says in a certain period of time, we will
ensure that the CHIPS program is working throughout the entire State,
and that that needs to be done now.
Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, reclaiming my time,
statistics tell us that more and more children are being absent from
school because of asthma, and yet, it has been determined that we have
one of the worst environments in the Nation, so bad that Oklahoma is
complaining that we are polluting parts of Oklahoma. If we have this
available and not making any effort to cover the children while we are
also providing an environment that is conducive to making them even
more unhealthy, what does this tell us? Is there any compassion in
Texas?
Ms. JACKSON-LEE of Texas. Mr. Speaker, if the gentlewoman will yield,
it seems like we are lacking a great deal of compassion, and the
gentlewoman has hit the nail on the head. Healthy children make healthy
adults. Children are apt to get all manner of childhood diseases and
ailments. Asthma is one of the most devastating childhood diseases that
lead into adult asthma. We do have a problem in our respective
communities with air quality. We are fighting that problem well now. In
fact, as the gentlewoman well knows, she was one of the supporters, and
I continue to support, the Mickey Leland Toxic Center that is located
in the Texas Medical Center that deals with air quality standards and
does the research on respiratory diseases. We find that many children
have them.
I believe that there is no compassion in this State if we cannot get
the CHIPS program implemented to provide for the children of this State
when the program has been passed by this Congress under the Balanced
Budget Act since 1997. This is now the year 2000. Why does not the
State of Texas, 43rd, if you will, in the care of mental health and
some very low number, I know, in the care of health period having the
highest number of uninsured cannot provide the CHIPS program for their
children. I think that we need to show a great deal more compassion on
behalf of Texas children and the Nation's children and ensure that
these children do have insurance to make them healthy children and then
healthy adults.
Mr. Speaker, I am happy to rise in support of our nation's increased
investment in childcare in the form of insurance coverage. A serious
oversight has occurred when studies and statistics show a large portion
of children that are not covered by medical insurance.
Nationally, over 11 million of our nation's children--one in seven of
those children living in the United States are uninsured. Two-thirds of
these children live in families with income below 200 percent of the
poverty level ($33,400 for a family of four in 1999).
Many escape through the cracks simply because they do not fit the
description policy makers have in regards to poverty. Low-income
uninsured children typically live in two-parent, working households and
have little contact with the welfare system.
In the same instance, families who are below standard income have the
misfortune of being undereducated regarding the health benefits they
and their children have access to through their entitled aide. Forty-
one percent of parents of these eligible uninsured children postponed
seeking medical care for their offspring because they could not afford
it.
A much-needed solution for adolescents who need insurance comes in
the form of Medicaid and the new State Children's Health Insurance
Program (CHIP). These two key organizations are publicly funded health
insurance programs that offer coverage for low-income adolescents.
These programs enacted by Congress more than thirty years apart, both
augment and complement each other. While each has distinctly different
characteristics, together they offer a powerful opportunity to reduce
the percentage of uninsured adolescents in the
[[Page H3899]]
United States and to increase adolescents' access to health care.
I must ask that as my colleagues deliberate this week on the real and
necessary benefits of the defense appropriations to our nation's
security, that they also consider the benefit to domestic security,
which is created by their support of health care for all of our
nation's youth.
Medicaid provides health insurance coverage for more than 40 million
individuals--most are women, children, and adolescents--at an annual
cost of about $154 billion in combined federal and state funds.
Eligibility for Medicaid is determined by each state according to its
specific guidelines. However, the federal government specifies the
mandatory eligibility categories and the optional eligibility
categories.
Medicaid is significantly affected by several of the mandatory and
optional eligibility categories.
The State Children's Health Insurance Program made available
approximately $48 billion in federal funds over ten years to help
states expand health insurance coverage to low-income children and
youth.
Federal law permits states to use CHIP funds to expand coverage in
three ways: through Medicaid expansions; state-designed, non-Medicaid
programs; or a combination of these two approaches.
SCHIP, is funded with federal block grant dollars and state matching
dollars, as a health insurance program for children in families who
make too much money for Medicaid, but who cannot afford other private
insurance options.
SCHIP has extended coverage to an additional 2 million children who
do not qualify for Medicaid. Yet millions of children are believed to
be eligible for these programs, but remain uninsured.
Uninsured youth will benefit from Medicaid and CHIP only if the
states in which they live chose to extend eligibility and if states
then work to enroll them. This requires more than working with funding
for these programs. It entails communicating to the community that
needs the service that something is available.
SCHIP benefits depend heavily on program design and state discretion.
States currently cover children whose family incomes range generally
from below the Federal poverty level (FPL) to as high as 300 percent of
poverty.
Even when adolescents are enrolled in insurance programs that provide
comprehensive benefits, a number of other factors influenced whether
adolescents actually receive the services they need. These include
affordability, confidentiality, and availability of providers with
expertise and experience in caring for adolescents.
In Texas the rate of uninsured is higher than any other state in the
country. In particular Texas has the second highest rate of uninsured
children in the nation. In an attempt to combat this high rating the
state of Texas has combined the options available to states in order to
expand health insurance coverage. This combination includes expansion
of Medicaid and state-designed, non-Medicaid programs.
Texas covers children whose family incomes range from below the FPL
to 200 percent of poverty. The Federal government allows coverage to
children as high as 300 percent.
Texas--Statistics
Texas has the highest rate of uninsured in the country.
Texas has the second highest rate of uninsured children in the
nation.
There are 1.4 million uninsured children in Texas--600,000 are
eligible for, but not in Medicaid; nearly 500,000 qualify for CHIP.
Texas attempt to combats the number of uninsured children by
combining the options available to states in order to expand health
insurance coverage. Texas' combination includes the expansion of
Medicaid and state-designed, non-Medicaid programs.
At present time, there is a need for eligibility reforms and
aggressive outreach for low-income health programs in Texas.
Texas is at the bottom of retaining low-income kids on Medicaid since
welfare reform in 1996.
193,400 Texas children fell off the Medicaid rolls during the past
three years, a 14.2 percent decline.
Medicaid data collected finds an increase in the number of people
enrolled in Medicaid in June 1999 compared to June 1998, but the
magnitude of this success rate is dampened due to the decline of
Medicaid in nine states--one of them was Texas.
The status quo in Texas is that children (up to age 19) in families
with incomes at or under 100 percent of the federal poverty income
level (FPL, $14,140 for a family of 3) can qualify for Medicaid.
Drop the requirement for face-to-face application/re-certification
interviews for children's Medicaid. (Allow mail-in applications.) This
is not required by federal law, and 38 states plus the District of
Columbia allow mail-in application for children. Three states also
allow community-based enrollment outside the welfare office.
Adopt and publicize for children's Medicaid the same simple, flexible
documentation and verification options used for Texas CHIP. To make a
joint mail-in application feasible, children's Medicaid and CHIP must
accept the same documents for income and other required verifications.
Children's Medicaid documentation should be identical statewide, to
make a true joint CHIP-Medicaid mail-in application possible. Federal
law allows states to reduce income documentation for children's
Medicaid in any way, or even to eliminate it in favor of using third-
party verification. Seven states require no income documentation for
children's Medicaid.
To avoid a logistical nightmare for both the state and parents, Texas
should as quickly as possible implement changes in children's Medicaid
eligibility. Without these critical changes, enrollment will be
difficult and complex for the many applicant families that are referred
to Medicaid--many of whom will have one child eligible for CHIP, and
another eligible for Medicaid. States already implementing CHIP report
that large proportions of applicants end up in Medicaid. The changes
needed are as follows:
Eliminate the assets test for children's Medicaid. Texas now makes
parents of Medicaid-eligible children document not just income, but
also the value of savings, IRAs, automobiles, and valuables, etc. The
test is not required by federal law, and 40 states plus the District of
Columbia have already dropped in for children.
Recent federal law changes allow states to cover parents in families
with children up to any income limit the state chooses.
Texas has been given the choice to adopt less restrictive methods for
counting income and assets for family Medicaid; for example, states can
increase earned income disregards, and alter or eliminate asset tests.
Texas has been slow compared to other states in implementing CHIP.
Children enrolled in Texas CHIP will get a comprehensive benefits
package--includes eye exams and glasses, prescription drugs, and
limited dental check-ups, and therapy.
CHIP does not serve as an alternative to Medicaid for those families,
who based on their income, are eligible for Medicaid.
Adopt 12-month continuous eligibility for children's Medicaid.
Children enrolled in Texas CHIP stay enrolled for 12 months, regardless
of any changes in income during that period. In Texas Medicaid, parents
must report any income change within 10 days, and Medicaid is cut off
the next month if the new family income is too high for Medicaid.
Twelve-month eligibility for Children's Medicaid is a state option
Congress created when it passed CHIP. This was done in an effort to
allow for identical policies in Medicaid and CHIP, and promote
continuity of health care. Fifteen states have adopted continuous
eligibility for Children's Medicaid, and Ohio will begin the policy
July 2000.
Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I thank the
gentlewoman very much.
I yield to the gentleman from Texas (Mr. Bentsen).
Mr. BENTSEN. Mr. Speaker, I thank the gentlewoman for yielding.
Let me first start out by commending the gentlewoman for having this
Special Order to talk about the CHIPs program and the need for greater
access to health care for children in this country. As the gentlewoman
knows, back in 1997, we were part of an effort to start the CHIPs
program, this was a Federal effort. I was pleased to be a member of the
House Committee on the Budget when the 1997 Balanced Budget Act, the
reconciliation bill, was crafted and ultimately passed and signed by
the President. I think there is a certain amount of credit that is due
the President as well for his steadfast support for this program.
It is correct that unfortunately, our State, and as a proud Texan I
have to say it is unfortunate that our State was a little late in
getting a CHIPs program up and running. The legislature, which meets
biennially, did not get a chance to take this up or did not choose to
take this up until 1999.
I think it is a little ironic when some of us were saying that the
legislature should move on this, that the governor perhaps should call
a special session to address this very popular bipartisan program, that
with fear that Texas might ultimately lose some funds, we now see that
the other body has decided to borrow from some of the funds that
Congress set aside back in 1997 from the tobacco tax for this. We do
know that Congresses have a way sometimes of borrowing and failing to
repay those funds. So I am a little nervous that Texas might lose out
as a result of that.
Mr. Speaker, I watched with great interest when our legislature had
the debate over whether to cover at 150 percent or 200 percent of the
poverty level.
[[Page H3900]]
I think the legislature, under the leadership of Speaker Pete Laney,
did the right thing in going to 200 percent, and that will begin to
address what is really a health care crisis in Texas and a health care
crisis across the country with uninsured children.
When we were doing the 1997 act, we estimated that there were 10
million children across the country without insurance; about 3 million
of those are Medicaid-eligible children and the rest are children of
working families who make too much money to be in the Medicaid program
but do not get health insurance through the workforce or choose not to
take it but cannot afford to buy it on their own.
Now, with respect to that, as my colleague from Houston just talked
about, in terms of the Medicaid program, there is no question that we
could do a much better job of enrolling children in Medicaid. I have
offered, and I think the gentlewoman is a cosponsor, a bill, H.R. 1298,
that would give schools the ability to grant presumptive eligibility
for children who might be eligible, who are eligible for Medicaid, in
the same way that the 1997 act gave that to Federal health care
workers.
Our colleague, the gentlewoman from Colorado (Ms. DeGette) has a bill
that would extend that same ability to grant presumptive eligibility to
what are called SCHIP workers, State Children'S Health Insurance
workers as well, so that we would have the ability of not only
enrolling children in the CHIPs program, but also enrolling those
children who are Medicaid eligible in the Medicaid program.
One of the unfortunate facts of our home State of Texas is that we
lead the Nation in the number of Medicaid-eligible children who are not
enrolled in the program, about 800,000 kids in Texas who should be in
the Medicaid program.
Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, reclaiming my time,
there has been a whole legislative session that has come and gone since
these dollars have been available, and as of May 21 of this year, we
had not used any of the dollars allocated for Texas. Can the gentleman
think of any reason why we have denied these children the right to
health care when there is nothing standing in the way between them and
health care enrollment?
Mr. BENTSEN. Mr. Speaker, if the gentlewoman would yield, we hear
from some that we should not be passing new laws, we ought to be
enforcing the laws that we have, but sometimes we find from some of the
people who say that they are not enforcing the laws that are on their
books, and this is one that ought to be enforced.
That gets to the point that I was making on Medicaid, why this is
important. I represent the largest medical center in the world, has the
largest children's hospital, Texas Children's Hospital, in my district.
They have an emergency room that was built I think for something along
the lines of 20,000 emergency room visits a year. They get about
60,000. Why do they get so many? They get so many because they have a
lot of children who do not have health insurance who are getting
ambulatory care, who are getting primary care in the emergency room.
What is wrong about that? Well, one, it overwhelms the system, but
the other problem is the cost structure. As the gentlewoman well knows
from her professional career before Congress, the cost structure is
much higher in the emergency room. A lot of these kids who could have
gotten more preventive care if they had been receiving regular primary
care, and from the Federal standpoint, and this is something that those
of us in the Congress, as stewards of the Federal taxpayer and the
budget, should be concerned about is the way that is funded are two
ways.
One, it is funded by the hospitals picking up the cost any way they
can, and the other is the Federal Government picks up 100 percent of
the tab through the disproportionate share program.
{time} 1945
This becomes a big problem, because the States share the Medicaid
program with the Federal government, as the gentlewoman knows, and at
least they could be picking up 40 percent of the tab for these 800,000
kids in Texas who ought to be in the program, rather than having the
Federal government pick up the entire tab.
As the gentlewoman knows, we reduced the Medicaid DSH program in the
1997 Act. We were able to hold the line in Texas because of the good
work she did and others in the delegation. But it only makes sense that
we ought to enroll these kids in the Medicaid program, we ought to get
full enrollment in the CHIP program. In the long run, it will be
cheaper than having to continue to fund huge dollars through the DSH
program.
Beyond the bottom line aspect, it is the right thing to do, because
we want to have healthy kids in Texas, we want to have healthy kids
across this country. It is the compassionate conservative thing to do,
but it is not enough to care. It is to care enough to do it.
The gentlewoman is on the right track with her special order. We have
much more work to do in this area. We need the leadership to get this
done, to get these kids enrolled, to make the changes in the Medicaid
law so that we can get more kids in there, and we will have a healthier
and a stronger society by it. I commend the gentlewoman for having this
special order.
Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, the gentleman from
Texas (Mr. Green) could not be here, but he left a statement. I notice
in the statement, in his congressional district, which is also in the
Houston area, at least 70 percent of the children in the Aldine School
District rely on the school nurse for primary health care services, or
as their initial health care provider. That does not have to be, and it
should not have to be.
We have too many children who are not getting any kind of attention
in Texas. We cannot allow this to continue. It is ironic that we talk
about how great we are, this big, wonderful State, with the greatest
prosperity in the history of the State. We have all of these children
starting out, without the availability of health care, a full life
perhaps with chronic illnesses because they do not have access to the
care that they deserve, and they can have it. They would have it if we
had a Texas government that had enough compassion to enroll them in the
program.
Nobody wishes to be poor, no one wishes to be uneducated, no one
wishes to be a long ways from various health care outlets. But when
that happens, the entire State ought to have access to that care. They
need to be informed and they need to be enrolled. This is simply not
the time to turn our heads and pretend this is not going on. It is not
the time to simply say to poor kids, get back, be quiet, you might make
us look bad.
We have got to give attention to these poor kids who are kids of
working parents, low-income parents, who do not have access to health
care that taxpayers are willing to pay for. The money is available.
Texas has access to the money and refuses to use it. Is that
compassion, I ask the Members? Is this America? This is not what we
stand here and fight for, and what we fund each day.
We tried to be very sure that when welfare reform came, that our poor
kids would not fall through the cracks. We did our part at this level.
It is time for the State of Texas to look up and acknowledge that
though we have much wealth, we have the largest number of poor kids
being neglected. In a State where you can hardly breathe the air, we
have kids who are getting their lungs injured every day simply because
they do not have access to care that has been paid for. We simply
refuse to use it.
Mr. Speaker, I call upon all of my colleagues to join me in making a
plea to the State of Texas, my home State. I was born in the State and
I know the State. I served there in the House and in the Senate. This
callousness must not continue, and certainly we must not allow it to
spread in this Nation.
Mr. Speaker, I include for the Record the statement of the gentleman
from Texas (Mr. Green).
The statement referred to is as follows:
Mr. GREEN of Texas. Mr. Speaker, it is hard to believe that, here in
the world's richest country, one in seven American children does not
have health insurance.
Yet, in the midst of our Nation's longest and strongest economic
expansion, the health of over 11 million of our children is being
jeopardized.
In the Houston region, over a quarter million children are uninsured.
[[Page H3901]]
In my Congressional district, at least 70% of children in the Aldine
Independent School District rely on the school nurse for primary
healthcare services or as their initial healthcare provider.
Our children deserve better.
Congress created Medicaid, and later the new Children's Health
Insurance Program (CHIP), to offer coverage for low-income children.
These two programs are an investment in good health--an investment
that pays dividends in the long term because prevention saves taxpayers
money.
They have reduced the percentage of uninsured children and parents in
the United States. And, they have increased access to quality health
care services.
Medicaid provides health insurance coverage for more than 40 million
individuals--mostly women, children, and adolescents--at an annual cost
of about $154 billion in combined federal and state funds.
Eligibility for Medicaid is determined by each state according to its
specific guidelines.
States have wide discrepancy in determining what optional benefits
will be given, who will be eligible for those benefits and the
procedure used to grant the benefits.
While Medicaid has benefited the poorest of the poor, it has not been
able to address a second group of uninsured--the working poor.
In 1997, Congress passed the Children's Health Insurance Program or
CHIP, which made available approximately $48 billion in federal funds
over ten years to help states expand health insurance coverage to low-
income children and youth.
Federal law permits states to use CHIP funds to expand coverage in
three ways: through Medicaid expansions; state-designed, non-Medicaid
programs; or a combination of these two approaches.
CHIP, funded with federal block grant dollars and state matching
dollars, is a health insurance program for children in families who
make too much money for Medicaid, but who cannot afford other private
insurance options.
CHIP has extended coverage to an additional 2 million children who do
not qualify for Medicaid. Yet millions of children are believed to be
eligible for these programs, but remain uninsured.
Uninsured children will benefit from Medicaid and CHIP only if the
states in which they live chose to extend eligibility and if states
then work to enroll them.
States currently cover children whose family incomes range generally
from below the Federal poverty level (FPL) to as high as 300% of
poverty.
While some states moved very quickly to insure low-income children,
Texas did not. In the first year in which funds were available, the
State of Texas expanded Medicaid coverage for children at or below 100
percent of the federal poverty line.
This resulted in 58,286 children ages 15-18 having insurance. More
than 102,000 remained uninsured, even though they were eligible for
coverage under the old federal Medicaid rules. This was a very slow
start.
However, thanks to the efforts of the Texas Legislature during the
76th Legislative Session, our state is making progress.
Because of the efforts of Senator John Whitmore and Representative
Kevin Bailey, Texas created a separate children's health insurance
program for children at or below 200 percent of the federal poverty
line.
This will provide health insurance for 500,124 Texas children through
age 18. In my region, this means 90,802 children will have health
insurance.
While this is a good development, we still have a long way to go.
Other states are further along in providing health coverage for
children. In the first year of the program, Texas expanded coverage for
58,286 children. By comparison, Alabama enrolled 38,980 children;
California enrolled 222,351 children; Florida enrolled 154,594
children; Georgia enrolled 47,581 children; Massachusetts enrolled
67,852 children; Missouri enrolled 49,529 children; New Jersey enrolled
75,652 children; New York 521,301 children; North Carolina enrolled
57,300 children; Ohio enrolled 83,688 children; and South Carolina
enrolled 45,737 children.
Of the states that chose to create a separate children's health
program, many are extending coverage to more children than is Texas,
including California at 250 percent; Connecticut at 300 percent; New
Jersey at 350 percent; Vermont at 300 percent; and Washington at 250
percent.
Texas can do more. And we should do more. We have the highest rate of
uninsured persons in the country.
And, Texas has the second highest rate of uninsured children in the
nation. Over 41% of parents of eligible uninsured children postponed
seeking medical care for their child because they could not afford it.
There are 1.4 million uninsured children in Texas--600,000 are
eligible for, but not in Medicaid; nearly 500,000 qualify for CHIP.
Texas covers children whose family incomes range from below the
federal poverty level to 200% of the federal poverty level. Yet the
Federal government allows coverage to children as high as 300%.
Texas, like the rest of the nation, could do more to conduct an
aggressive outreach to ensure that eligible children receive the
services they need.
New outreach is clearly needed--now, more than ever. Like many
states, after federal welfare reform was enacted in 1996, we saw a huge
drop in the number of persons applying for and participating in
Medicaid. 193,400 Texas children fell off the Medicaid rolls during the
past three years, a 14.2% decline.
Because these two programs are no longer linked, many lower-income
persons do not realize that they are eligible for health insurance.
Unfortunately, Texas is the worst state in the Nation in terms of
retaining low-income kids on Medicaid.
And, a recent New York Times article shows that Texas has used none
of the federal funds it is entitled to for outreach. We can do better.
Why are so many persons not receiving the Medicaid and CHIP services
they're entitled to?
Red tape burdens the neediest families in Texas.
Medicaid program eligibility requirements in Texas include:
A Face-to-face interview
An Asset test
No continuous eligibility--families must periodically re-enroll
No presumptive eligibility--even if families have proven that they
are eligible for another program with the same income guidelines, they
must go seven states (Texas included) expanded coverage to only 100
percent of the as quickly as possible implement changes in Children's
Medicaid eligibility.
Texas can take steps now to reduce it's state government bureaucracy.
For example, the state could:
Eliminate the assets test for children's Medicaid. Texas now makes
parents of Medicaid-eligible children document not just income, but
also the value of savings, IRAs, automobiles, and valuables.
The test is not required by federal law, and 40 states plus the
District to Columbia have already dropped it for children.
Texas could also drop the requirement for face-to-face application/
recertification interviews for children's Medicaid and allow mail-in
applications.
Thirty-eight states plus the District of Columbia allow mail-in
application for children. Three states also allow community-based
enrollment outside the welfare office.
Texas could adopt for children's Medicaid the same simple, flexible
documentation and verification options used for Texas CHIP. To make a
joint mail-in application feasible, children's Medicaid and CHIP must
accept the same documents for income and other required verifications.
Federal law allows states to reduce income documentation for
children's Medicaid in any way, or even to eliminate it in favor of
using third-party verification. Seven states require no income
documentation for children's Medicaid.
The state could adopt 12-month continuous eligibility for children's
Medicaid. Children enrolled in Texas CHIP stay enrolled for 12 months,
regardless of any changes in income during that period.
In Texas Medicaid, parents must report any income change within 10
days, and Medicaid is cut off the next month if the new family income
is too high for Medicaid.
Texas could also adopt twelve-month eligibility for Children's
Medicaid--this continuous eligibility is a state option Congress
created when it passed CHIP. Fifteen states have adopted continuous
eligibility for Children's Medicaid, and Ohio will begin the policy in
July 2000.
Hopefully, my colleagues in the state legislature will consider some
of these ideas as they continue their push to expand health care to the
uninsured.
Thanks to their efforts, Texas has done many good things in the past
year to reduce the number of uninsured children. We can certainly do
more. I am hopeful that successful state partnerships like Medicaid and
CHIP will be used by the state to their full potential.
____________________