[Congressional Record Volume 147, Number 37 (Tuesday, March 20, 2001)]
[Senate]
[Pages S2588-S2589]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. FEINSTEIN:
  S. 574. A bill to amend titles XIX and 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.
  Mrs. FEINSTEIN. Mr. President. Today, I am 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 uninsured parents 
nationwide and 356,000 parents in California at a time when the 
uninsured rate in

[[Page S2589]]

the country and in California continues to rise.
  Congress has appropriated a total of $17.2 billion for SCHIP for 
Fiscal Years 1998, 1999, and 2000, or about $4.3 billion for each 
Fiscal Year.
  SCHIP 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, SCHIP covers approximately two million children 
across the country, out of the three to four million children estimated 
to be eligible.
  Congress created SCHIP as a way to provide affordable health 
insurance to uninsured children in families that cannot afford to buy 
private insurance. States can choose from three options when designing 
their SCHIP program: 1. expansion of their current Medicaid program; 2. 
creation of a separate State insurance program; or 3. a combination of 
both approaches.
  California's SCHIP is known as the Healthy Families program and is 
set up as a public-private program rather than a Medicaid expansion. 
Healthy Families allows California families to use federal and State 
SCHIP 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 SCHIP 
was enacted in 1997 or through waivers by the Department of Health and 
Human Services. In California, eligibility was raised to 250 percent of 
poverty in November 1999, which increased the number of eligible 
children by 129,000.
  Basic benefits in the California SCHIP 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, vision, 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 go without insurance. The U.S. has seen 
an increase in the uninsured by nearly five million since 1994.
  Currently, 42 million people, or 17 percent, of the non- elderly 
population in the country are uninsured. In California, 22 percent, or 
6.8 million, of the nonelderly are uninsured.
  A 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.''
  Among the 1.85 million uninsured children in California, nearly two-
thirds or 1.3 million are eligible for Medicaid or SCHIP, 
called Healthy Families in the state, according to the University of 
California at Los Angeles.

  Last year, we passed legislation enabling California to keep 
approximately $350 million of the $600 million unspent SCHIP funds. My 
state and others were at risk of losing funds because the law required 
states to use all their funds in three years and time was running out 
on the 1998 funds. Since my state and others still have these funds, as 
well as funds allotted in fiscal years 1999, 2000 and 2001, enrolling 
parents and more children could be a good way to increase enrollment.
  The bill we are introducing today would gives States the option to 
expand SCHIP coverage to parents whose children are eligible for the 
program at whatever income eligibility level the state sets. In my 
State, that would mean a family of four earning up to $42,625 would be 
eligible for coverage.
  This bill would retain current funding formulas, State allotments, 
benefits, eligibility rules, and cost-sharing requirements. The only 
change is to allow States the option to enroll parents.
  An SCHIP expansion should be accomplished without substituting SCHIP 
coverage for private insurance or other public health insurance that 
parents might already have. The current SCHIP 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 does 
not change that requirement.
  This bill is important for several reasons. More than 75 percent of 
uninsured children live with parents who are uninsured. Many experts 
say that by covering parents of uninsured children we can actually 
cover more children.
  If an entire family is enrolled in a plan and seeing the same 
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 is around $6,000. California has some of the lowest-priced health 
insurance, yet the State ranks fourth in uninsured.
  In California, high housing costs, high gas and electricity prices, 
expensive commutes, and a high cost-of-living make it difficult for 
many California families to buy health insurance. Over eight in ten of 
uninsured Californians are working, but they do not earn enough to buy 
private insurance. SCHIP is a practical and attractive alternative.
  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 employees, do not offer health 
insurance, according to a Kaiser Family Foundation study in June 2000. 
Californians in 1999 were 6.6 percentage points less likely to receive 
health insurance through employers than the average American, 62.8 
percent versus 69.4 percent, according to UCLA experts.
  We need to give hard-working, lower income American families 
affordable, comprehensive health insurance, and this bill does that.
  The California Medical Association and Alliance of Catholic Health 
Care agree with us and support this legislation.
  I urge my colleagues to join me in supporting and passing this bill. 
By giving States the option to cover parents--whole families--we can 
reduce the number of uninsured, encourage the enrollment of more 
children, and help keep people healthy by maximizing this valuable, but 
currently under-utilized program.
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