[Congressional Record Volume 146, Number 122 (Wednesday, October 4, 2000)]
[Senate]
[Pages S9839-S9842]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     CHILDREN'S HEALTH ACT OF 2000

  Mr. FRIST. Mr. President, I have come to the floor to discuss and 
share with my colleagues very good news, some news that is bipartisan, 
that reflects what is the very best of what the Senate is all about.
  It has to do with a bill called the Children's Health Act of 2000, a 
bill that is bipartisan, that reflects the input of probably 20 to 30 
individual Senators on issues that mean a great deal to them based on 
their experience, their legislative history, what they have done in the 
past, their personal experiences, and responding to their constituents. 
This bill passed the Senate last week and passed the House of 
Representatives last week and will be sent to the President of the 
United States sometime either later tonight or tomorrow.
  The Children's Health Act of 2000, is a comprehensive bill, a bill 
that forms the backbone of efforts to improve the health and safety of 
young people today, of America's children today. But equally important, 
it gathers the investments to improve the health, the well-being of 
children of future generations.
  It is fascinating to me because it was about a year or a year and a 
half ago that Senator Jeffords and I, after working on this particular 
piece of legislation for a couple of years, reached out directly across 
the Capitol to Chairman Bliley and Representative Bilirakis to work 
together to address a

[[Page S9840]]

whole variety of children's health issues, including day-care safety, 
maternal, child, and fetal health, pediatric public health promotion, 
pediatric research, efforts to fight drug abuse, and efforts to provide 
mental health services for our young people today.
  The good news, with all of the other debates that are going on and 
the partisanship going back and forth, is that we in the Senate, as the 
Congress, we as a government have been successful in accomplishing this 
bipartisan, bicameral effort.
  The bill that Congress now sends to the President includes two 
divisions or two parts. The first part, part A, addresses issues 
regarding children's health. The second part, part B, addresses youth 
drug abuse.
  I would like to take a few moments to outline not the entire bill, 
but a number of the provisions in this bill, because I think it 
reflects the care and the thoughtfulness with which this bill was put 
together.
  The first is day care safety. Perhaps the most critical section of 
the first part of this bill relates to day care health and safety. We 
based it on the bill which was called, the Children's Day Care Health 
and Safety Improvement Act, a bill that I introduced, again, in a 
bipartisan way, with Senator Dodd on March 9 of this year.
  Currently, there are more than 13 million children under the age of 6 
who, every day, are enrolled in day care. About a quarter of a million 
children in Tennessee go to day care. The day care safety bill 
recognizes that it is our responsibility as a society, as a Government, 
to make sure that these day care facilities are as safe as possible, 
such as the health of children in child care is protected, so that when 
a parent, or both parents, drop that child off at day care, they can 
rest assured that the child will be in a safe environment throughout 
the day.
  The danger in child care settings recently has become evident in my 
own State of Tennessee, again drawing upon how we learn and listen in 
our own States and bring those issues together and discussing them on 
the floor of the Senate and then fashion them into a bill. Tragically, 
within the span of just two years, in one city in Tennessee, four 
children died in child care settings. In addition, one in five child 
care programs in another city in Tennessee were found to have 
potentially put the health and safety of children at risk during the 
year 1999.
  But this isn't just a Tennessee concern. It affects parents and day 
care centers and children nationwide. According to a Consumer Product 
Safety Commission Study in 1997, 31,000 children, ages 4 and younger, 
were treated in hospital emergency rooms for injuries they sustained 
while in child care or at school. More than 60 children have died in 
child care settings since 1990. The statistics are startling. They are 
unacceptable. The thousands of parents dropping their children off and 
leaving them in the hands of child care providers every day deserve the 
reassurance that their children will be safe throughout the day.
  A recent study by the American Academy of Pediatrics reinforced this 
need further when it reported a disturbing trend among children with 
SIDS, Sudden Infant Death Syndrome. They looked at SIDS infants in day 
care. There were 1,916 SIDS cases from 1995 through 97 in 11 States and 
they found that about 20 percent, 391 deaths occurred in these day care 
settings. Most troubling was the fact that in over half of the cases 
the caretakers placed children on their stomach, where those same 
children at home were put to sleep on their backs by their parents. 
Parents and advocates who are dedicated to helping to eliminate the 
incidence of SIDS have urged that child care providers be required to 
have SIDS risk reduction education. When you hear these statistics and 
read these reports, you will agree. That is why I included a provision 
in this bill to carry out several activities, including the use of 
health consultants to give health and safety advice to child care 
providers on important issues, including SIDS prevention.
  Overall, our bill authorizes $200 million to States to help improve 
the health and safety of children in child care settings. The grants 
can be used for all sorts of activities, including child care provider 
training and education, inspections in criminal background checks for 
day care providers; enhancements to improve a facility's ability to 
serve children with disabilities; to look at transportation safety 
procedures; to look and study and provide information for parents on 
choosing a safe and healthy day care setting.
  This funding could also be used to help child care facilities meet 
the health and safety standards, or employ health consultants to give 
health and safety advice to child care providers. Many of us in this 
body have grandchildren or children. Our highest concerns are for the 
safety of those children and grandchildren. I understand the fears that 
so many parents have. Parents should not be afraid to leave their 
children in the care of a licensed child care facility. This bill, very 
simply, helps ensure that our child care centers will be safer.

  A second portion of the first part of this bill includes provisions 
called the Children's Public Health Act of 2000 which, again, had been 
introduced in a bipartisan way by myself, Senator Jeffords, and Senator 
Kennedy on July 13 of this past year. The purpose of this bill is to 
address a whole variety of children's health issues, including maternal 
and infant health, including pediatric health promotion, including 
pediatric research. Senator Orrin Hatch, whose name was mentioned on 
the floor a few minutes ago, has been a real leader in another area of 
traumatic brain injury. Unintentional injuries are the leading cause of 
death in the age group between 1 and 19 years. It is those 
unintentional injuries that is the number one cause of death. In fact, 
more than 1.5 million American children suffer a brain injury each 
year. Therefore, in this bill we strengthen the traumatic brain injury 
for the CDC, the National Institutes of Health, and the Health 
Resources and Services Administration.
  Birth defects are the leading cause of infant mortality and are 
responsible for about 30 percent of all pediatric admissions. This bill 
also focuses on maternal and infant health. This legislation 
establishes for the first time a National Center for Birth Defects and 
Developmental Disabilities at the CDC, to collect, analyze and 
distribute data on birth defects.
  In addition, the bill authorizes a program called Healthy Start, a 
program to reduce the rate of infant mortality and improve those 
perinatal or those outcomes around the time of birth, by providing 
grants to areas with a high incidence of infant mortality and low 
birthweight. To address the fact that over 3,000 women experience 
serious complications due to pregnancy and that two out of three will 
die from complications in their pregnancy, this bill develops a 
national monitoring and surveillance program to better understand the 
maternal complications and mortality to decrease the disparities among 
various populations at risk of death and complications from pregnancy.
  Asthma has an increasing incidence in this country and we don't know 
why. This bill combats some of the most common ailments. For instance, 
it provides comprehensive asthma services and coordinates the wide 
range of asthma prevention programs in the Federal Government, to 
address the most common childhood diseases. Asthma is a disease that 
affects over 5 million children in this country today.
  Obesity is another problem. Again, we don't fully understand it, but 
it is a problem that is increasing in magnitude. Childhood obesity has 
doubled in the past 15 years and produced almost 5 million seriously 
overweight children in adolescence. It is an epidemic. This bill 
addresses childhood obesity and supports State and community-based 
programs promoting good nutrition and increased physical activity among 
American youth.
  Lead poisoning prevention. As I look at problems across Tennessee, I 
was concerned to learn that in Memphis over 12 percent of children 
under the age of 6 may have lead poisoning. Such poisoning, we know, 
can contribute to learning disabilities, loss of intelligence, to 
hyperactivity, to behavioral problems.
  In this bill, we include physician identification and training 
programs on current lead screening policies. We track the percentage of 
children in health center programs, and conduct outreach and education 
for families at risk for lead poisoning.

[[Page S9841]]

  The Surgeon General's report of May 2000 noted that oral health is 
inseparable from overall health, and that while a majority of the 
population has experienced great improvements in oral health 
disparities affecting poor children and those who live in underserved 
areas represent 80 percent of all dental cavities in 20 percent of 
children.
  Our bill encourages pediatric oral health by supporting community-
based research and training to improve the understanding of etiology, 
pathogenesis diagnoses, or the why of the disease progression, the 
diagnosis of the disease prevention and treatment of these pediatric 
oral, dental, and cranial facial diseases. Behind all of those is 
pediatrics research.
  Our bill strengthens pediatric research. It does it in such a way by 
establishing a pediatric research initiative within the National 
Institutes of Health. It will enhance collaborative efforts. It will 
provide increased support for pediatrics biomedical research and ensure 
that opportunities for advancement in scientific investigations and 
care for children are realized.
  I should also mention childhood research protections, children who 
are involved in research, and how they are protected.
  Included in this bill are provisions to address safety initiatives in 
children's research by requiring the Secretary of Health and Human 
Services to review the current Federal regulations for the protection 
of children who are participating in investigations. It will address 
issues such as determining acceptable levels of risk and obtaining 
parental permission. They will report to Congress on how to ensure the 
highest standards of safety.
  This year the Senate Subcommittee on Public Health, which I chair, 
held two important hearings relating to gene therapy trials and human 
subject protections. We discovered a lapse of protection for 
individuals participating in clinical trial research. In the next 
Congress, we intend to make the further review in updating of human 
subject protections a major priority of this subcommittee.
  The second part of this bill, division B of the bill, contains 
provisions which address very specifically the curse of pediatric or 
youth drug abuse.
  The 1999 National Household Survey on Drug Abuse conducted by the 
Substance Abuse and Mental Health Services Administration reported that 
10.9 percent of youth ages 12 to 17 currently use illicit drugs. They 
further estimated that 11.3 percent of 12- to 17-year-old boys and 10.5 
percent of 12- to 17-year-old girls used drugs in the past month.
  Just as discouraging is the growth in youth alcohol abuse. These same 
reports reveal that 10.4 million current drinkers are younger than the 
legal drinking age of 21 and that more than 6.8 million have engaged in 
binge drinking.
  Sadly, all of these numbers detailing youth substance abuse have 
risen since 1992.
  We addressed this tragedy again head on by incorporating the Youth 
Drug and Mental Health Services Act, which in a bipartisan way was 
introduced by myself and Senator Kennedy last spring which was first 
passed in the Senate in November of 1999.
  This youth drug bill addresses the problem of youth substance abuse 
by authorizing and by reauthorizing and improving and strengthening the 
Substance Abuse and Mental Health Services Administration. This bill 
puts a renewed focus on youth and adolescence substance abuse and 
mental health services. At the same time, it gives flexibility, and it 
demands greater accountability by States for the use of Federal funds.
  Created in 1992 to assist States in reducing substance abuse and 
mental illness through these prevention and treatment programs, the 
Substance Abuse and Mental Health Services Administration provides 
funds to States for alcohol and drug abuse prevention and treatment 
programs and activities, as well as mental health services. Its block 
grants account for 40 percent and 15 percent, respectively, of all 
substance abuse and community mental health services.

  In my own State of Tennessee, the Substance Abuse and Mental Health 
Services Act provides more than 70 percent of overall funding for the 
Tennessee Department of Health, Bureau of Alcohol and Drug Abuse.
  This bill very quickly accomplishes six critical goals. It promotes 
State flexibility by easing outdated or unneeded requirements and 
governing the expenditure of Federal block grants.
  Second, it ensures State accountability by moving away from the 
present system inefficiencies to a performance-based system.
  Third, it provides substance abuse treatment services and early 
intervention substance abuse services for children and adolescence.
  Fourth, it helps local communities treat violent youth and minimizes 
outbreaks of youth violence through partnerships among schools, among 
law enforcement activities, and mental health services. It ensures 
Federal funding for substance abuse or mental health emergencies.
  And six, it supports and expands programs providing mental health and 
substance abuse treatment services to homeless individuals.
  I will close by basically stating, once again, how excited I am about 
this particular bill as we send it to the President. Over the next 
several days during morning business, I look forward to the opportunity 
of coming back and discussing this bill further with my colleagues who 
have participated so directly in this particular bill.
  I wish to respond very briefly to some comments that were made prior 
to me beginning my comments and the discussion on the floor in the hour 
preceding my comments that centered on prescription drug plans, the 
modernization of Medicare, and who has the best approach. The debate 
was very much between the Bush proposal and the Gore proposal. Let me 
very quickly summarize the objections that seniors have to the Gore 
proposal and the prescription drugs. I can do this very quickly. It 
really boils down to one sentence.
  Under the Gore proposal, seniors will have only one choice, and they 
will only have one chance to make that choice. Then there is no turning 
back. No. 1, the Gore prescription drug proposal is centered around a 
Washington-run drug HMO.
  Why does that bother seniors? Because an HMO ultimately, and often we 
see it too commonly today, sets prices, determines access, and can deny 
that access without any choice.
  No. 2, the Gore proposal has a $600 access fee. That means if you do 
not use prescription drugs today, you are going to be paying $600 more 
today for getting nothing further; $600 access. That is before you buy 
any drugs whatsoever, a $600 access fee.
  Our seniors are asking: Am I going to be one of the 13 million people 
who do not even have $600 in prescription drug requirements a year? If 
so, if I join that plan, I automatically am going to be paying more for 
what I get today.
  That is for 13 million seniors. Seniors are asking: Am I going to be 
one of those 13 million?
  Just one example: Under the Gore prescription drug proposal, if you 
have $500 a year in prescription drugs, and you joined his plan, you 
are going to have to pay $530 for $500 worth of prescription drugs 
today.
  That is why seniors are going to object. That is why the Gore plan 
really, as I see it, has absolutely no chance for passage.
  One other thing on the access fee: Let me tell our seniors very 
directly, if this bill were to pass today, if the Vice President were 
successful in getting this bill through today, as a senior your 
Medicare premiums, how much you pay every month, is going to double 
from what it is today. Your Medicare premium for what you pay today for 
Medicare is going to double. It will go from $45 to $90 within 2 years, 
if you join this plan.

  The third I said is one choice; one chance; no turning back. You have 
one chance under the Gore proposal. If you are 64\1/2\ you either get 
this prescription drug benefit or you don't.
  The problem is that a lot of heart disease doesn't develop until you 
are 65, or 67, or 70, or 75, or 80, or 85 years of age. At 64\1/2\, if 
you didn't go into these prescription drug programs, you have no chance 
to go into it in the future. You have only one chance; that is, when 
you are 64\1/2\.
  People say you only live 65, or 67, or 77 years of age. If you live 
to be 64\1/2\,

[[Page S9842]]

you are likely to live to 80 or 85 years of age. You have one choice--a 
Washington HMO; one chance when you are 64\1/2\ and no turning back.
  I make it very clear to our seniors what we are talking about when we 
talk about the prescription drug plan proposed by Vice President Gore.
  Mr. JEFFORDS. Mr. President, it gives me great pleasure to join my 
colleagues today in celebrating the passage of Children's Health Act, 
which Senators Frist, Kennedy, myself, and many others introduced 
earlier this year. The Children's Health Act passed the Senate on 
September 22, the House on September 27, and is now one step closer to 
becoming law.
  The Children's Health Act will significantly improve the well-being 
of children in this nation. This bill authorizes prevention and 
educational programs, clinical research, and direct clinical care 
services for child specific health issues.
  President Clinton needs to sign this legislation into law now. Our 
nation's medical research and treatment systems must be encouraged to 
recognize that children have unique needs. Without the initiative of 
the Children's Health Act, research into many of the diseases and 
disorders that effect children will be overlooked and neglected.
  I am also excited that the Children's Health Act includes legislation 
that the Senate passed last year to reauthorize the Substance Abuse and 
Mental Health Services Administration (SAMHSA). The Youth Drug and 
Mental Health Services Act is critically important for strengthening 
community-based mental health and substance-abuse prevention and 
treatment services.
  We introduced SAMHSA reauthorization with strong bipartisan 
cosponsorship of many members of the HELP Committee. The service and 
grant programs administered by SAMHSA have gone far too long without 
being reauthorized. We will now be able to improve access and reduce 
barriers to high quality, effective services for individuals who suffer 
from, or are at risk for, substance abuse or mental illness, as well as 
for their families and communities.
  This legislation includes the formula compromise for the Substance 
Abuse Treatment Block Grant that was originally included in the 1998 
omnibus appropriations bill. This is an issue of paramount importance 
to small and rural states, and I am pleased that this legislation 
ratifies and continues the agreement reached in 1998.
  The Children's Health Act and the Youth Drug and Mental Health 
Services Act are both the product of many months of work and 
collaboration among its many stakeholders. We have come this far 
because of the bipartisan dedication of members of HELP Committee and 
especially the leadership of Senator Frist and Senator Kennedy. I 
commend them both for their considerable efforts to help so many 
children and American families.
  I also want to thank my colleagues in the House for their strong 
cooperation and support. I am so proud of being involved in this effort 
and I think the entire House of Representatives and Senate should be 
very proud of approving the Children's Health Act.

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