[Congressional Record Volume 147, Number 112 (Friday, August 3, 2001)]
[Senate]
[Pages S8966-S8967]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Mr. Lugar, Mr. Torricelli, and Mr. 
        Corzine):
  S. 1390. A bill to amend title XXI of the Social Security Act to 
require the Secretary of Health and Human Services to make grants to 
promote innovative outreach and enrollment efforts under the State 
children's health insurance program, and for other purposes; to the 
Committee on Finance.
  Mr. BINGAMAN. Mr. President, the bipartisan legislation I am 
introducing today with Senators Lugar, Torricelli, and Corzine entitled 
the ``Children's Health Coverage Improvement Act of 2001'' would 
improve outreach and enrollment efforts targeted at children to 
dramatically reduce the number of uninsured children in this country. 
This legislation is a companion bill to S. 1016, the ``Start Healthy, 
Stay Healthy Act of 2001,'' which would expand and improve coverage to 
children and pregnant women through Medicaid and the State Children's 
Health Insurance Program, CHIP.
  The legislation provides $100 million in grants annually from the 
unspent allocations in CHIP to community-based public or non-profit 
organizations, including community health centers, children's 
hospitals, disproportionate share hospitals, local and county 
government, and public health departments, for the purposes of 
conducting innovative outreach and enrollment efforts.
  The bill further clarifies that the outstationed workers requirement 
in Medicaid, which requires that eligibility workers be available in 
the public in our nation's community health centers and safety net 
hospitals, shall also enroll children in CHIP if they are eligible for 
coverage under that program as well.
  As you are aware, the State Children's Health Insurance Program, 
which was passed as part of the Balanced Budget Act of 1997, was the 
largest expansion of health coverage since the enactment of Medicare 
and Medicaid in 1965. The program, designed to cover low-income 
children under age 18, provides on average $4 billion a year to the 
states to either expand Medicaid, establish a separate state program 
apart from Medicaid, or a combination of the two approaches.
  Unfortunately, according to an Urban Institute report entitled How 
Familiar Are Low-Income Parents with Medicaid and SCHIP?, it is 
estimated that up to 80 percent of the 11 million uninsured children in 
the country are eligible for but unenrolled in Medicaid or SCHIP. Thus, 
ineligibility for coverage is no longer a barrier for the vast majority 
of uninsured children. Instead, as the report notes, ``A major 
challenge today is how to reach and enroll the millions of children who 
are eligible but who remain uninsured.''

[[Page S8967]]

  The biggest problems are knowledge gaps, confusion about program 
rules, and problems created by bureaucratic barriers to coverage. 
According to the study, ``Only 38 percent of low-income uninsured 
children have parents who have heard of Medicaid or SCHIP programs and 
who also understand the basic eligibility rules,'' Moreover, less than 
half of parents, 47 percent, of low income uninsured children were even 
aware of the separate SCHIP program.

  As the authors conclude, ``For SCHIP expansions to reduce uninsurance 
among children, it is critical that families know about the coverage 
available through separate non-Medicaid SCHIP programs . . . .''
  In addition, senior health researcher Peter J. Cunningham at the 
Center for Studying Health System Change recently published an article 
in Health Affairs entitled ``Targeting Communities With High Rates of 
Uninsured Children'' that highlights that the ``key to getting children 
insured'' is improved ``enrollment outreach.''
  As the article notes, ``Policymakers have understood from the 
beginning that the key to the success of SCHIP is in getting eligible 
children to enroll . . . The results of this study suggest that 
outreach activities and other efforts to stimulate enrollment need to 
be especially focused in high-uninsurance areas, both because they 
include a large concentration of the nation's uninsured children and 
because take-up rates of public and private coverage have historically 
been lower in these areas.''
  Cunningham particularly notes that children in high-uninsured 
communities are disproportionately Hispanic. As he points out, 
``Hispanics typically have lower take-up rates for health insurance 
programs for which they are eligible. This could be attributable to 
immigration concerns, language barriers, lack of awareness of public 
programs, or not understanding the roll that insurance coverage plays 
in the United States in securing access to high-quality health care.''
  As a result, the legislation also contains a provision giving 
priority to community-based organizations in communities with high 
rates of eligible but unenrolled children and in areas with high rates 
of families for whom English is not their primary language. It is 
certainly my desire for programs such as ``promotoras'' or community 
health advisors to receive these grants, as they have been incredibly 
effective in New Mexico in improving health insurance coverage to 
children.
  An estimated 11 million children under age 19 were without health 
insurance in 1999, including 129,000 in New Mexico, representing 15 
percent of all children in the United States and 22 percent of children 
in New Mexico, the fourth highest rate of uninsured children in the 
country. An estimated 103,000 of those children are in families with 
incomes below 200 percent of poverty, so the majority of those children 
are already eligible for but unenrolled in Medicaid.
  Why is this important? According to the American College of 
Physicians-American Society of Internal Medicine, uninsured children, 
compared to the insured, are: up to 6 times more likely to have gone 
without needed medical, dental or other health care; 2 times more 
likely to have gone without a physician visit during the previous year; 
up to 4 times more likely to have delayed seeking medical care; up to 
10 times less likely to have a regular source of medical care; 1.7 
times less likely to receive medical treatment for asthma; and, up to 
30 percent less likely to receive medical attention for any injury.
  In fact, one study has ``estimated that the 15 percent rise in the 
number of children eligible for Medicaid between 1984 and 1992 
decreased child mortality by 5 percent.'' This expansion of coverage 
for children occurred, I would add, during the Reagan and Bush 
Administrations, so this is clearly a bipartisan issue that deserves 
further bipartisan action.
  Mr. President, I urge this legislation's immediate passage. We can 
and must do better for our children.
  I ask unanimous consent for the text of the bill to be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1390

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Children's Health Coverage 
     Improvement Act of 2001''.

     SEC. 2. GRANTS TO PROMOTE INNOVATIVE OUTREACH AND ENROLLMENT 
                   EFFORTS UNDER SCHIP.

       (a) In General.--Section 2104(f) of the Social Security Act 
     (42 U.S.C. 1397dd(f)) is amended--
       (1) by striking ``The Secretary'' and inserting the 
     following:
       ``(1) In general.--Subject to paragraph (2), the 
     Secretary''; and
       (2) by adding at the end the following:
       ``(2) Grants to promote innovative outreach and enrollment 
     efforts.--
       ``(A) In general.--Prior to any redistribution under 
     paragraph (1) of unexpended allotments made to States under 
     subsection (b) or (c) for fiscal year 2000 and any fiscal 
     year thereafter, the Secretary shall--
       ``(i) reserve from such unexpended allotments the lesser of 
     $100,000,000 or the total amount of such unexpended 
     allotments for grants under this paragraph for the fiscal 
     year in which the redistribution occurs; and
       ``(ii) subject to subparagraph (B), use such reserved funds 
     to make grants to local and community-based public or 
     nonprofit organizations (including organizations involved in 
     pediatric advocacy, local and county governments, public 
     health departments, Federally-qualified health centers, 
     children's hospitals, and hospitals defined as 
     disproportionate share hospitals under the State plan under 
     title XIX) to conduct innovative outreach and enrollment 
     efforts that are consistent with section 2102(c) and to 
     promote parents' understanding of the importance of health 
     insurance coverage for children.
       ``(B) Priority for grants in certain areas.--In making 
     grants under subparagraph (A)(ii), the Secretary shall give 
     priority to grant applicants that propose to target the 
     outreach and enrollment efforts funded under the grant to 
     geographic areas--
       ``(i) with high rates of eligible but unenrolled children, 
     including such children who reside in rural areas; or
       ``(ii) with high rates of families for whom English is not 
     their primary language.
       ``(C) Applications.--An organization that desires to 
     receive a grant under this paragraph shall submit an 
     application to the Secretary in such form and manner, and 
     containing such information, as the Secretary may decide.''.
       (b) Extending Use of Outstationed Workers To Accept Title 
     XXI Applications.--Section 1902(a)(55) of such Act (42 U.S.C. 
     1396a(a)(55)) is amended by inserting ``, and applications 
     for child health assistance under title XXI'' after 
     ``(a)(10)(A)(ii)(IX)''.
                                 ______