[Congressional Record Volume 147, Number 37 (Tuesday, March 20, 2001)]
[Senate]
[Pages S2587-S2588]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. FEINSTEIN (for herself, Mr. Chafee, Mr. Durbin, Mr. Reed, 
        Mrs. Murray, and Mrs. Boxer):
  S. 573. A bill to amend title XIX of the Social Security Act to allow 
children enrolled in the State children's health insurance program to 
be eligible for benefits under the pediatric vaccine distribution 
program; to the Committee on Finance.

[[Page S2588]]

  Mrs. FEINSTEIN. Mr. President, I rise today with my colleagues 
Senators Chafee, Durbin, Reed, Murray, and Boxer to introduce a bill to 
clarify that children receiving health insurance under the State 
Children's Health Insurance Program, SCHIP, in States like California 
are eligible for free vaccines under the federal Vaccines for Children, 
VFC, program.
  Providing low-income children with access to immunizations is a high 
priority of mine. I believe that we must work to ensure that our 
nation's youngsters begin life protected against the diseases for which 
there are vaccinations available.
  The Centers for Disease Control, CDC, estimates that in many areas of 
the U.S. immunization rates continue to fall below 75 percent among 
children under 2 years old. This is unacceptable.
  In 1993, the U.S. experienced the largest outbreak of whooping cough 
in over 20 years. Additionally, from 1989 to 1991, a measles outbreak 
resulted in 123 deaths and 55,000 cases. These are diseases for which 
vaccinations are available.
  While we are doing a better job of educating families about the 
importance of receiving timely immunizations, we must now focus our 
efforts on ensuring access to immunizations for those most in need.
  The federal Vaccines for Children program, created by Congress in 
1993, P.L. 105-33, is an excellent example of a program that provides 
vaccines at no cost to low-income children.
  To be eligible for the VFC program under current federal law, a child 
must be a Medicaid recipient, uninsured, or of American Indian or 
Alaskan Native heritage.
  The U.S. Department of Health and Human Services, HHS, argues that a 
child participating in SCHIP, called Healthy Families in California, is 
not eligible for the free immunizations provided by the VFC program 
because that child is ``insured.''
  I believe the interpretation of ``insured'' is not consistent with 
Congress's intent in establishing SCHIP. I believe that in defining the 
term ``insured'' at that time Congress clearly meant private health 
insurance plans.
  Children enrolled in SCHIP, or in my State the 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).
  Several California based provider groups agree. For example, in 
February 1999 the California Medical Association wrote to then-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).''
  HHS has interpreted the law so narrowly that as many as 630,000 
children in California under California's Healthy Families program have 
lost or will lose their eligibility to receive free vaccines. 
Approximately 428,641 kids have lost eligibility to date.
  The VFC program is particularly important to California in ensuring 
access to life-saving immunizations for two reasons.
  First, California ranks 40th overall among states having children 
fully immunized by the age of 19 to 35 months. In 1996, however, 
California ranked 32nd. Clearly the situation in California is getting 
worse rather than better. Allowing SCHIP children to access 
immunizations through the VFC program could increase the number of 
children receiving vaccinations in the State.
  Second, in creating SCHIP 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.
  The California Managed Risk Medical Insurance Board, which is 
administering the new program with the Department of Health Services, 
wrote to HHS in February 1999: ``It is imperative that states like 
California, who have implemented SCHIP 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.''
  A study conducted by the California Medical Association found that 
pediatric capitation rates for children ages 0-21 averages $24.24 per 
child per month. However, a 1998 Towers Perrin Study of physician costs 
for children ages 0-21 years found averages to be $47.00 per child per 
month. These numbers demonstrate the discrepancy between payment and 
costs for children enrolled in a capitation plan, which includes all 
children enrolled in California's Healthy Families program.
  Add to this discrepancy in payments the fact that children need 18 to 
22 immunizations before the age of 6. This process becomes quite 
costly!
  The discrepancy in payment and costs means that many California 
physicians cannot afford to provide patients with the necessary life-
saving immunizations, so children in my State are often going without 
vaccinations.
  This reality has caused serious problems for children in California.
  For example: 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. The Immunization Branch in California reported over 
1,000 whooping cough cases, including 5 deaths, in 1998--the largest 
number of cases and deaths since the 1960s.
  Whooping cough and chicken pox are two examples of diseases for which 
there are vaccinations available.
  We must do more to increase access to vaccinations for our nation's 
children.
  In 1998, as many 743,000 poor children in California, 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.
  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?
  Congress recognized the importance of immunizations in creating the 
VFC 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 immunizations 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, 22 percent of 
California's two-year olds are not immunized. Add to that the fact that 
we have one of the highest uninsured rates in the country.
  Over 28 percent of California's children are without health 
insurance, compared to 25 percent nationally, according to the Annie E. 
Case Foundation. Clearly, there is a need.
  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 immunizations are fundamental to a lifetime of good health. I 
urge my colleagues to join me in supporting this legislation, to help 
me keep our children healthy.
                                 ______