[Congressional Record Volume 146, Number 100 (Thursday, July 27, 2000)]
[Senate]
[Pages S7891-S7892]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. FEINSTEIN (for herself, Mr. Byrd, and Mrs. Boxer):
  S. 2976. A bill to amend title XXI of the Social Security Act to 
allow States to provide health benefits coverage for parents of 
children eligible for child health assistance under the State 
children's health insurance program; to the Committee on Finance.


              family health insurance program act of 2000

  Mrs. FEINSTEIN. Mr. President, today, Senators Byrd, Boxer and I are 
introducing legislation to allow States, at their option, to enroll 
parents in the State-Children's Health Insurance Program, known as S-
CHIP. This bill could provide insurance to 2.7 million parents 
nationwide and 356,000 parents in California by using unspent 
allocations States will otherwise lose on September 30, 2000. Congress 
has appropriated a total of $12.9 billion for S-CHIP for fiscal years 
1998, 1999, and 2000, or about $4.3 billion for each fiscal year. 
California received $854.6 million in 1998, $850.6 million in 1999, and 
$765.5 million in 2000. Right now California stands to lose $588 
million just in fiscal year 1998 funds because California has faced 
many hurdles in enrolling children. That is in part why we are 
introducing this bill, to enhance enrollment of more children and to 
help states use available S-CHIP funds.
  S-CHIP is a low-cost health insurance program for low-income children 
up to age 19 that Congress created in the Balanced Budget Act of 1997. 
After three years, S-CHIP covers approximately two million children 
across the country, out of the three to four million children estimated 
to be eligible. Congress created it as a way to provide affordable 
health insurance for uninsured children in families that cannot afford 
to buy private insurance.
  States can choose from three options when designing their S-CHIP 
program: (1) expansion of their current Medicaid program; (2) creation 
of a separate State insurance program; or (3) a combination of both 
approaches. In California, S-CHIP, known as Health Families, is set up 
as a public-private program rather than a Medicaid expansion. Healthy 
Families allows California families to use federal and State S-CHIP 
funds to purchase private managed care insurance for their children. 
Under the federal law, States generally cover children in families with 
incomes up to 200 percent of poverty, although States can go higher if 
their Medicaid eligibility was higher than that when S-CHIP was enacted 
in 1997. In California, eligibility was raised to 250 percent in 
November 1999, increasing the number of eligible children by 129,000.
  Basic benefits in the California S-CHIP program include inpatient and 
outpatient hospital services, surgical and medical services, lab and x-
ray services, and well-baby and well-child care, including 
immunizations. Additional services which States are encouraged to 
provide, and which California has elected to include, are prescription 
drugs and mental health, visions, hearing, dental, and preventive care 
services such as prenatal care and routine physical examinations. In 
California, enrollees pay a $5.00 co-payment per visit which generally 
applies to inpatient services, selected outpatient services, and 
various other health care services.
  The United States faces a serious health care crisis that continues 
to grow as more and more people are becoming uninsured. Despite the 
robust health of the economy, the U.S. has seen an increase in the 
uninsured by nearly five million since 1994. Currently, 44 million 
people (or 18 percent) of the non-elderly population are uninsured. In 
California, 23.5 percent, or 7.3 million, are uninsured. One study 
cited in the May 2000 California Journal found that as many as 2,333 
Californians lose health insurance every day. A May 29, 2000 San Jose 
Mercury article cited California's emergency room doctors who 
``estimate that anywhere from 20 percent to 40 percent of their walk-in 
patients have no health coverage.'' This a problem that needs to be 
addressed now.

  The bill we are introducing would allow States to expand S-CHIP 
coverage to parents whose children are eligible for the program. In my 
State, that would be families up to 250 percent of the federal poverty 
level. For the year 2000, the federal poverty level for a family of 
four is $17,050. In California, with the upper eligibility limit of 250 
percent of poverty, families of four making up to $42,625 are eligible. 
This bill could reach approximately 2.7 million parents nationwide and 
more than 356,000 parents in California. The bill we are introducing 
retains the current funding formula, State allotments, benefits, 
eligibility rules, and cost-sharing requirements.
  An S-CHIP expansion should be accomplished without substituting S-
CHIP coverage for private insurance or other public health insurance 
that parents might already have. The current S-CHIP law requires that 
State plans include adequate provisions preventing substitution and my 
bill retains that. For example, many States require that an enrollee be 
uninsured before he or she is eligible for the program.
  This bill is important for several reasons. Many State officials say 
that by covering parents of uninsured children we can actually cover 
more children. More than 75 percent of uninsured children live with 
parents who are uninsured. If an entire family is enrolled in a plan 
and seeing the same group of doctors--in other words, if the care is 
convenient for the whole family--all the members of the family are more 
likely to be insured and to stay healthy. This is a key reason for this 
legislation, bringing in more children by targeting the whole family.
  Private health insurance in the commercial market can be very 
expensive. The average annual cost of family coverage in private health 
plans for 1999 was $5,742, according to the Kaiser Family Foundation. 
California has some of the lowest-priced health insurance, yet the 
State ranks fifth in uninsured for 1998-1996. In California, high 
housing costs, high gas prices, expensive commutes, and a high cost-of-
living make it difficult for many California families to buy health 
insurance. According to the California Institute, the median price of 
single family home rose 17 percent, to $231,710, from February 1999 to 
February 2000. The California Housing Affordability Index, which 
measures the percentage of Californians that are able to purchase mid-
priced homes, declined 11 percent from 1999 to 2000. With prices like 
these, many families are unable to afford health insurance even though 
they work full-time.
  Many low-income people work for employers who do not offer health 
insurance. In fact, forty percent of California small businesses (those 
employing between three and 50 employers) do not offer health 
insurance, according to a Kaiser Family Foundation study in June.
  We need to give hard-working, lower income American families 
affordable, comprehensive health insurance, and this bill does that.
  The President has proposed to cover parents under the S-CHIP program. 
The California Medical Association and Alliance of Catholic Health Care 
support our bill.
  Current law requires States to spend federal S-CHIP dollars within 
three years of the appropriation. Many States, including California, 
could lose millions of dollars of unspent federal

[[Page S7892]]

Fiscal Year 1998 funds on September 30, 2000. I am working to get an 
extension of that deadline. In the meantime, we could begin to cover 
parents while getting that extension and working to increase funds for 
the program. According to estimates from the Health Care Financing 
Administration, the following 39 States could lose the following 
amounts, totaling $1.9 billion. Arizona, California, Georgia, Illinois, 
Louisiana, Michigan, New Mexico, and Texas stand to lose the most 
money. These eight States alone would lose $1.4 billion.

        States                                                 Millions
Arizona...........................................................$77.2
Arkansas...........................................................45.4
California........................................................588.8
Colorado...........................................................12.9
Connecticut.........................................................9.4
Delaware..............................................................6
District of Columbia................................................2.4
Florida............................................................41.5
Georgia............................................................78.1
Hawaii..............................................................8.9
Idaho...............................................................4.1
Illinois...........................................................84.2
Iowa................................................................1.4
Kansas..............................................................1.5
Louisiana..........................................................73.3
Maryland...........................................................26.7
Michigan...........................................................51.4
Minnesota..........................................................28.3
Montana.............................................................1.8
Nevada.............................................................18.6
New Hampshire.......................................................7.5
New Jersey............................................................2
New Mexico.........................................................57.9
North Dakota........................................................2.9
Ohio...............................................................19.8
Oklahoma...........................................................37.6
Oregon.............................................................18.3
Pennsylvania.......................................................0.64
Rhode Island........................................................4.6
South Dakota........................................................4.4
Tennessee..........................................................26.4
Texas.............................................................443.6
Utah................................................................1.7
Vermont.............................................................1.6
Virginia...........................................................38.4
Washington.........................................................45.1
West Virginia......................................................11.3
Wisconsin............................................................23
Wyoming.............................................................6.9

  Our bill would offer another option for States like mine to use these 
unspent funds.
  I urge my colleagues to join us in supporting and passing this bill. 
By giving States the option to cover parents--whole families--we can 
reduce the number of uninsured with existing funds and encourage the 
enrollment of more children and we can help keep people healthy by 
better using this valuable, but currently under-utilized program.
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