[Congressional Record Volume 148, Number 131 (Tuesday, October 8, 2002)]
[Senate]
[Pages S10057-S10063]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
UNANIMOUS CONSENT REQUEST--S. 724
Mr. BINGAMAN. Mr. President, today, once again, I will rise for the
purpose of asking unanimous consent to take up and pass S. 724. I will
withhold doing that until Senator Nickles is able to come to the floor.
I understand he wishes to address the issue.
[[Page S10058]]
This is a subject I raised last week here in the Senate. S. 724 is
the Mothers and Newborns Health Insurance Act of 2001. It was reported
by the Senate Finance Committee unanimously in July. It is legislation
which was introduced by Senators Bond and Breaux and would simply give
States the option of covering pregnant women in the State Children's
Health Insurance Program, or the CHIP program, for the full range of
pre- and postpartum care.
This legislation did pass out of the Senate Finance Committee by
unanimous vote. It includes language we incorporated in an earlier
bill, S. 1016, which was the Start Healthy, Stay Healthy Act of 2001
introduced by me and supported by Senators Lugar, McCain, Corzine,
Lincoln, Chafee, Miller, and Landrieu, and it provides children with
continuous health care coverage throughout the first and most fragile
year of life.
According to the Centers for Disease Control, the United States ranks
21st in the world in infant mortality and 26th in the world in maternal
mortality. For a nation as wealthy as ours, these statistics are simply
unacceptable.
Unfortunately, the regulation the administration issued last week to
allow unborn children to be covered by the State Children's Health
Insurance Program, or CHIP, leaves pregnant women out of that equation.
That is contrary to the clinical guidelines of the American College of
Obstetricians and Gynecologists. It is contrary to the guidelines of
the American Academy of Pediatrics. Both organizations indicate that
the woman and the unborn child need to be treated together.
If you are covering only the fetus, as this regulation that came out
last week purports to do, this eliminates important aspects of coverage
for women during all the stages of birth, pregnancy, delivery, and
postpartum care. The various health services that pregnant women could
be denied, without passage of this legislation, were elaborated on the
Senate floor earlier. We need to do better by our Nation's mothers than
we have done so far. This legislation will do that.
Let me also make it clear, though, that this bill is about children's
health. Senator Bond's bill appropriately is called the Mothers and
Newborns Health Insurance Act. It is given that title for a very good
reason. We all know the importance of an infant's first year of life.
Senator Bond's legislation, as amended in our committee, the Finance
Committee, provides 12 months of continuous coverage for children after
they are born.
Again, the United States ranks 21st in the world in infant mortality.
We need to do a better job by our Nation's newborn infants just as we
need to do a better job by our Nation's mothers. The rule that was
passed last week does provide an option for 12 months continuous
enrollment to States, but it makes the time for that 12 months
retroactive to the period that the child was in the womb. Therefore, if
9 months of pregnancy were covered, the child would lose coverage in
the third month after birth. Potentially lost would be a number of
well-baby visits, immunizations, and access to pediatric caregivers.
This legislation, S. 724, which was introduced by Senator Bond, has a
large number of bipartisan cosponsors. Senator Daschle is a cosponsor.
Senator Lott is a cosponsor. Many others of my colleagues are
cosponsors.
Last Wednesday, we tried to pass S. 724 and objections were raised.
Senator Nickles asked a number of questions, and Senator Lincoln and I
prepared some detailed responses. We made several points in those
responses. Let me just summarize those.
First, with regard to the cost of this legislation, the bill is
almost entirely offset over the first 5 years it would be in existence,
and it actually saves money over the 10-year period.
With regard to whether the administration supports the bill,
Secretary Thompson has repeatedly expressed support for passage of
legislation, including specifically mentioning support for S. 724 and
companion legislation in the House. He has done that on two occasions.
With regard to whether the regulation eliminates the need for
legislation, the regulation itself notes that it leaves many gaps in
coverage that the rule creates, including denials of care for pregnant
women through pregnancy, through delivery, and through postpartum care.
With regard to the burden this bill could place on States, the
legislation would simply allow States the option to expand coverage to
pregnant women through the CHIP program, or not to expand that
coverage, as they choose. States that do not wish to expand coverage
would not be compelled to do so. The National Governors Association
believes all States should have that option. Therefore, the NGA has
specific policy in support of expanding options to cover pregnant women
through this CHIP program.
I ask unanimous consent to have printed in the Record the more
detailed response Senator Lincoln and I sent to Senator Nickles with
respect to the objections and questions he raised on the floor last
Wednesday.
There being no objection, the material was ordered to be printed in
the Record, as follows:
U.S. Senate,
Washington, DC, October 4, 2002.
Hon. Don Nickles,
Assistant Minority Leader,
Capitol, Washington, DC.
Dear Senator Nickles: On Wednesday, October 2, 2002, we
tried to pass by unanimous consent bipartisan legislation by
Senators Bond and Breaux, the ``Mothers and Newborns Health
Insurance Act'' (S. 724), which passed the Senate Finance
Committee in July by unanimous consent. The legislation has a
number of bipartisan cosponsors, including Senators Daschle
and Lott.
We were unable to proceed with passage of this important
legislation to cover pregnant women due to the objection you
raised, which, you stated, were based on questions you wanted
answered prior to passage. Through this letter and
attachment, we have addressed all the issues that you raised.
Therefore, we will once again ask for unanimous consent to
proceed to passage next week, and we hope we can count on
your support.
Thank you for your immediate consideration. The health of
many of our nation's mothers and children await this
important action by the Senate.
Sincerely,
Jeff Bingaman.
Blanche L. Lincoln.
Attachment.
Questions and Answers About S. 724
Question. How much does the bill cost and what is the
offset?
The CBO estimate of the pregnant women bill was $611
million over five years and $1.08 billion over 10 years prior
to the issuance of the rule. The legislation also uses SSI
pre-effectuation reviews as the offset, with a savings of
$279 million over 5 years and $1.34 billion over 10 years.
Over ten years, there is a net savings to the passage of this
legislation.
However, according to the Administration, the cost of their
rule is $330 million between fiscal years 2003 and 2007. With
that taken into account, the cost of passage of pregnant
women coverage would drop to $281 million over five years. As
a result, the overall net cost of the bill would be almost
nothing over five years and would save money over the 10-year
period.
Question. . . . It's just my understanding that Secretary
Thompson has promulgated a reg[ulation] which I believe he
thinks satisfies a lot of the unmet health care needs of
children, including unborn children, and . . . so he supports
the reg[ulation] that he's promulgated and is now effective
and does not support the legislation which goes far beyond
the reg[ulation] that he's just promulgated . . . Maybe he
did make a statement that was supportive in March but he may
well feel like that was accomplished in the reg[ulation].
Department of Health and Human Services (HHS) Secretary
Tommy Thompson has stated repeatedly his support for the
passage of legislation to allow states the option to cover
the full range of health services to pregnant women through
the State Children's Health Insurance Program (SCHIP), and
specifically mentioned S. 724 on at least one occasion.
In a statement issued on January 31, 2002, Secretary
Thompson praised Senators Bond, Breaux and Collins for
``bipartisan leadership in supporting S. 724, a bill that
would allow states to provide prenatal coverage for low-
income women through the SCHIP program. We support this
legislative effort in this Congress.''
In testimony before the Senate Finance Committee on
February 14, 2002, Secretary Thompson expressed support for
legislation expanding coverage to pregnant women rather than
states having to seek waivers.
In testimony before the House Labor-HHS Appropriations
Subcommittee on March 6, 2002, Secretary Thompson said, ``And
so, if you can pass the bill [the House companion bill to S.
724 introduced by Representatives Hyde and Lowey], we don't
need the rule.'' He added, ``Let's pass the legislation.''
In a letter to Senator Bingaman dated April 12, 2002,
Secretary Thompson wrote:
``Prenatal care for women and their babies is a crucial
part of medical care. These services can be a vital, life-
long determinant of health, and we should do everything
we can
[[Page S10059]]
to make this care available for all pregnant women. It is
one of the most important investments we can make for the
long-term good health of our nation.
``As I testified recently at a hearing held by the Health
Subcommittee of the House Energy and Commerce Committee, I
also support legislation to expand SCHIP to cover pregnant
women. However, because legislation has not moved and because
of the importance of prenatal care, I felt it was important
to take this action [of issuing regulations].''
Repeatedly, Secretary Thompson has expressed support for
legislation over the past year. As to whether he now thinks
the rule eliminates the need for legislation, it is important
to note that HHS issued a waiver on September 27, 2002, to
Colorado requested by Republican Governor Bill Owens to cover
pregnant women through SCHIP. The Colorado waiver was issued
on the same day the Secretary issued a press release on the
rule to allow coverage to ``unborn children'' through SCHIP.
As Secretary Thompson is quoted, ``Approved this waiver means
that thousands of uninsured women and their babies will be
able to get health care coverage.'' This is the third wavier
granted by Secretary Thompson to cover not just ``unborn
children'' but pregnant women, as previous waivers were given
to Rhode Island and New Jersey. Clearly, the Republic
Governor of Colorado did not think the rule fully covered
their desire to provide coverage to pregnant women.
HHS acknowledges in the regulation that the rule covering
``unborn children'' does not fully cover pregnant women and
is in lieu of legislation being passed by Congress to provide
care to pregnant women. The regulation also acknowledges that
despite the rule that ``there are still gaps'' and that
waivers are not a fully acceptable way to address them. As
the rule reads:
``This regulation bridges a gap in eligibility between the
Medicaid and the SCHIP programs that has now existed for five
years. Members of the Congress have also recognized this gap
and have introduced various pieces of legislation over the
years to address this gap. The opportunity to expand vital
health insurance coverage during a critical time is at hand.
``We welcome all of these suggestions for expanding health
insurance coverage and indeed States and the Secretary have
already used the flexibility in current regulations. However,
there are still gaps. We also welcome support for the actions
of the Secretary in granting waivers to States . . . But the
Secretary's ability to intervene through one mechanism (a
wavier) should not be the sole option for States and may in
fact be an inferior option. Waivers are discretionary on the
part of the Secretary and time limited while State plan
amendments are permanent, and are subject to allotment
neutrality.''
The rule explains what gaps still exist. For example, the
rule highlights what cannot be covered for women via care to
``unborn children.'' If you only are covering the fetus, this
eliminates important aspects of coverage for pregnant women
during all the stages of a birth--pregnancy, delivery, and
postpartum care. Among other things, pregnant women would not
be covered during their pregnancy for cancer, medical
emergencies, accidents, broken bones, or mental illness. Even
life-saving surgery for a mother would appear to be denied
coverage.
Further, during delivery, coverage for epidurals is a state
option and is justified only if the health of the child is
affected. On the other hand, anesthesia is covered for
Caesarean sections. The rule would wrongly push women and
providers toward performing C-sections to ensure coverage.
And finally, during the postpartum period, women would be
denied all health coverage from the moment the child is born.
Important care and treatment, including but not limited to
the treatment of hemorrhage, infection, episiotomy repair, C-
section repair, family planning counseling, treatment of
complications after delivery (including, once again, life-
saving surgery), and postpartum depression would not be
covered.
Question. I'm also going to check with the states, because
I also believe this is an expansion of Medicaid, which I know
my state is struggling to pay. As a matter of fact, actually
reducing payments in some cases in Medicaid because they just
don't have the budget. And, our state health director . . .
has told us don't increase any new expansions on Medicaid
because we can't afford it . . . Pregnant women [are eligible
for Medicaid] with incomes less than 185% of poverty . . .
and I believe this legislation would take that up to 300%.
So, it would make many more people eligible for Medicaid
which would also increase the costs to the states, which some
states can't afford it.
The legislation provides for an expansion of coverage for
pregnant women, at a state option, through the State
Children's Health Insurance Program (SCHIP).
As the Committee report (Senate Report 107-233) reads:
``The Committee bill allows states to cover additional
pregnant women under SCHIP. The SCHIP expansion group
includes pregnant women with family income above the state's
Medicaid financial eligibility standard for pregnant women in
effect on January 1, 2002, up to the income eligibility for
SCHIP children in effect as of January 1, 2002 . . .
``Current federal law enables low-income pregnant women to
receive coverage under SCHIP through age 18, but it does not
provide such coverage to women ages 19 and above. While
states have the ability to add SCHIP coverage for pregnant
women over age 18 through Section 1115 waivers, states find
this process to be both time-consuming and administratively
burdensome. The Committee bill allows states to cover
pregnant women through the simpler state plan amendment
process. The committee bill also eliminates the disparity in
coverage levels between pregnant women and infants that has
been created through SCHIP, enabling both mothers and their
newborn children to immediately receive health coverage under
the program.''
According to the Congressional Research Service (CRS), 38
states and the District of Columbia provide coverage up to
200% of poverty or less. States cannot exceed those levels of
coverage through SCHIP beyond the levels of poverty covered
for children.
Also, if a state cannot afford an expansion of coverage to
additional pregnant women, they do not have to. It is a state
option. However, it allows those states that choose to expand
coverage to pregnant women to do so without having to seek a
waiver, just as the regulation has done for ``unborn
children.''
As a result, there is strong support for this legislation
from the National Governors' Association. Their policy
position (H.R.-15. ``The State Children's Health Insurance
Program (S-CHIP) Policy'') expresses strong support for
passage of such legislation. As it reads:
``The Governors have a long tradition of expanding coverage
options for pregnant women through the Medicaid program.
However, pregnant women in working families are not eligible
for SCHIP coverage. The Governors call on Congress to create
a state option that would allow states to provide health
coverage to income-eligible pregnant women under SCHIP. This
small shift in federal policy would allow states to provide
critical prenatal care and would increase the likelihood that
children born to SCHIP mothers would have a healthy start.''
States are partners with the federal government in Medicaid
and SCHIP. They are asking for additional state flexibility
in coverage options here that should be granted by the
passage of S. 724. The ``Mothers and Newborns Health
Insurance Act of 2002.''
Mr. BINGAMAN. Mr. President, again, at the appropriate time, once
Senator Nickles has arrived in the Chamber, I will rise once again to
seek unanimous consent that we be allowed to bring up and pass S. 724,
as passed out of the Finance Committee.
Mr. President, I am informed Senator Nickles will not be able to come
to the floor in the near future. Therefore, I will go ahead and make
the unanimous consent request at this time.
I ask unanimous consent that the Senate proceed to the immediate
consideration of Calendar No. 541, S. 724; that the committee
substitute be agreed to, the bill be read a third time and passed, the
title amendment be agreed to, the motions to reconsider be laid on the
table, with no intervening action or debate, and that any statements
related to the bill be printed in the Record.
The ACTING PRESIDENT pro tempore. Is there objection?
Mr. THOMAS. Mr. President, on behalf of several of our Members who
want to talk, I object.
The ACTING PRESIDENT pro tempore. Objection is heard.
Mr. BINGAMAN. Mr. President, I see my colleague from New Jersey is
here to speak. He has been a strong supporter of this legislation from
the time it was first introduced. I will yield the floor at this time
so he may speak.
The ACTING PRESIDENT pro tempore. The Senator from New Jersey.
Mr. CORZINE. Mr. President, I, too, rise in support of the efforts
about which Senator Bingaman was speaking. Senator Bond, Senator
Lincoln, and the Presiding Officer have also been supportive of working
to expand the access to prenatal care for pregnant women. I thank all
those involved for efforts to pass this legislation.
I have to say I am disappointed we are not able to get this unanimous
consent, given the overwhelming support in the Finance Committee. There
was unanimous passage there of all the elements Senator Bingaman just
spoke about with regard to funding. I will speak to it a bit myself.
But this is something that, given our record as a nation, being 21st
in the world with regard to deaths of children at birth, just is hard
to understand--why we are not taking the steps to address this fact and
give those States the flexibility to deal with it.
As I said, I am pleased the Finance Committee unanimously passed the
legislation, S. 724, which includes, as the Senator from New Mexico
mentioned, the major provisions of legislation we introduced about 18
months
[[Page S10060]]
ago called Start Healthy, Stay Healthy. Many of us have been supportive
of that legislation.
The bipartisan bill, as it now stands, seeks to expand pregnancy-
related care to low-income women who fall above Medicaid eligibility
levels. Under this bill, pregnant women would be eligible for the full
spectrum of prenatal and postpartum care, as recommended by the
American Academy of Pediatrics and the American College of
Obstetricians and Gynecologists.
Unfortunately, what many of us believe is noncontroversial
legislation is being held up for reasons of which I am not completely
certain. There were a number of questions raised last week by the
Senator from Oklahoma which have been answered in detail in a letter
about which the Senator from New Mexico spoke. But the main objection
is that it somehow contradicts a rule published by the Bush
administration to expand health insurance to unborn children but not to
pregnant women.
Actually, many of us believe this legislation complements the
administration's rule and will result in pregnant women receiving more
comprehensive pre- and postnatal care, which will clearly result in
healthier births and give newborns a better start in life.
Furthermore, S. 724, as amended, guarantees health coverage to
children born to eligible women until age 1 regardless of income
eligibility. The administration's rule would only guarantee that health
care for 3 months of their lives. So we think it does an outstanding
job of broadening the coverage to make sure that kids really do start
healthy and that they will stay healthy as they go forward in their
lives.
The administration has stated that the goal of its new rule is to
increase a woman's access to prenatal care. I think all of us applaud
that. I certainly do. Why, then, is the woman explicitly left out of
that rule? For example, under the administration's rule, it is
uncertain whether pregnant women will be offered treatment for ailments
that may not be directly related to pregnancy.
For instance, under the administration's rule, a pregnant woman would
not be eligible to receive care for cancer, diabetes, medical
emergencies, accidents, broken bones, or mental illness. It is also
unclear whether or not a woman would be provided certain types of care
during delivery. In order to have an epidural covered, for instance, a
doctor would have to certify that it was in the best interest of the
fetus.
Finally, the rule provides for absolutely no postpregnancy care.
Treatment of postpartum complications, including hemorrhaging,
infection, and postpartum depression, would be inaccessible to the
mother.
These things are hard to put in the context of what is the desire of,
I think, most of us to see that there is a good continuum, a good start
for our children. I think there are some conflicts that are put in
place by the regulations that would be very hard to enforce and could
be endangering to both the child and certainly to the mother's health.
I think they do not meet the commonsense test.
It contradicts also ACOG's standard of care, which views pregnancy-
related care as including prenatal, labor and delivery, and postpartum
care. Second, surely we can agree that neglecting the mother's health
is not the best way to give a newborn a healthy start in life.
If the administration and Members of Congress are serious about
providing meaningful health care to pregnant women and their children,
I believe we should support passage of the bipartisan initiative, S.
724. This legislation gives the States the option to enroll low-income
pregnant women into their CHIP programs, a proposal that HHS Secretary
Thompson has endorsed verbally and in writing many times, which is
indicated in the letter Senator Bingaman has forwarded to
Senator Nickles.
This legislation will provide for all of the care related to the
fetus outlined under the administration's rule, but it will also
provide full access to prenatal and postpartum health care, other
essential health care for pregnant women, and 1 year of continuous
coverage for newborns.
Let me be clear, States will still have the option of expanding care
to fetuses under the administration's rule. But by passing this
legislation, we would also give the States the option of expanding care
to pregnant women along the lines of what I talked about earlier.
My own State of New Jersey has already received a waiver from HHS,
and a number of other States have; a number are applying. It is
actually a very complicated and onerous process to get these waiver
procedures in place. I think we ought to make it legislatively
appropriate, statutorily appropriate, for all States, so they have the
choice of moving in this direction if they so choose.
Every week in our country 8,500 children are born to mothers who lack
access to prenatal care. This is one of those areas where insurance
coverage can actually be provided and make a big difference, so we do
not end up paying more for health care for children who are brought
into the world in poor health conditions, who then end up costing
society even more because they have had poor prenatal care. Every day
we wait to pass this legislation, more children will be born with
serious health problems because their mothers cannot afford health
care.
I hope we can address this issue. There is strong bipartisan support.
I think it is time to move. I very strongly support the efforts of all
my colleagues who are pushing for S. 724 and hope we can put the
politics aside and vote today to pass this important legislation.
Mr. President, I suggest the absence of a quorum.
The ACTING PRESIDENT pro tempore. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mrs. LINCOLN. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
Mrs. LINCOLN. Mr. President, I rise today to speak again on the
importance of passing S. 724, the Mothers and Newborns Health Insurance
Act, as soon as possible. It is beyond me why in the world we cannot
move forward on such a practical piece of legislation. This bill will
make a real difference in the health of thousands of low-income women
and their babies across our great Nation, not to mention the money it
is going to save this Nation, because we all know that for every $1 we
invest in prenatal care, we save anywhere from $5 to $6 down the road.
It is not only compassionate and good policy, it is also good
economics.
Last Wednesday, Senator Bingaman asked for unanimous consent to pass
this bipartisan bill, but Senator Nickles from Oklahoma objected. Since
then, Senator Bingaman and I have sent Senator Nickles a letter
answering the questions he had about this particular legislation.
It is so important Members understand how critically important this
piece of legislation is, and that these questions can be answered. With
those questions answered, it is my hope that we can pass S. 724 today.
This bill, which we unanimously approved in the Finance Committee,
gives States the option. They can simply take the option, if they
choose, of covering pregnant women under the State's Children's Health
Insurance program. Most importantly, the bill allows coverage for
prenatal care, delivery, and postpartum care. These are all complete
parts of delivering healthy children. It is not just one opportunity to
care for a fetus that is being carried by a woman; it is, more
importantly, the opportunity to bring that child into the world
healthy. We all know to do that, we must look at the health of the
mother in a prenatal situation. We have to look at the delivery, and we
also have to look at the postpartum care, which is essential for women
to care for and maintain healthy children.
I am so pleased we are joined on the floor by some of our colleagues
who work so hard to improve the health of women and children: Senator
Corzine, Senators Landrieu and Clinton are leaders in this area. I am
glad they have all been here or will be here to speak. I understand
Senator Mikulski, Senator Feinstein, and Senator Lugar have submitted
statements for their support of S. 724.
Some of us talk a lot about the importance of process in the Senate.
Sometimes it does not translate to our colleagues or friends and
constituents out there in the greater part of our Nation. Some of us
complain when bills
[[Page S10061]]
do not go through the regular process of committee markups and on to
the Senate floor. When we are talking about such an important issue,
people do understand, when the Senate does not act on something that is
this critical to the well-being of their life, particularly to the
health of their children.
This bill went through the classic Senate process, as is described in
Government textbooks. As Senators Bingaman, Bond, and I discussed last
week, S. 724 unanimously passed the Finance Committee and is now on the
legislative calendar under general orders. Even better, it has strong
bipartisan support. Both the majority leader and minority leader have
cosponsored it. That is because the idea of ensuring a healthy start in
life is a sound policy, it is good fiscal policy, and it is not a
partisan issue. I have no earthly idea why we are trying to make it
one. If we really care about life, the Senate needs to pass this
commonsense bill.
I want to make an important point about the necessity of S. 724 in
light of the administration's regulation that provides CHIP coverage to
unborn fetuses. This regulation fails to cover the full range of
medical services needed by a woman during and after pregnancy. Simply
put, it flies in the face of the Guidelines for Prenatal Care Fourth
Edition, established by the American College of Obstetricians and
Gynecologists and the American Academy of Pediatrics, guidelines that
are used by doctors all across our country.
Under the regulation, doctors will not be reimbursed for providing
care they are ethically obligated to provide. In the modern practice of
obstetrics, postpartum care is absolutely a critical part of the
overall care and the treatment the women receive prenatally and during
labor and delivery. Postpartum care is essential for any of us who have
gone through pregnancies and who have been so blessed to have had good
prenatal care, who have seen what it can do in the delivery room, by
providing the ability to go through a healthy delivery, and then, when
you come out of that delivery, to be blessed and fortunate enough to go
home within 2 days with your children because you have had good care.
It is so common sense.
It is so positive for everybody concerned: The taxpayers who may be
paying the tax bill or the medical bills, for the individual who wants
to get off to the right start, the mother who wants to get off to the
right start, the child who needs to get off to a healthy start.
We have learned so much about early development in children and what
it means later on in life in their ability to succeed and learn, how
critical it is they not be in that neonatal unit, but that they can be
born healthy, and they can all go home together to start that life off
correctly.
We have an opportunity to make a difference in each and every newborn
life. There is no excuse that we should not move quickly. With rising
medical malpractice rates, particularly for obstetricians and
gynecologists, these doctors may simply decide to stop serving CHIP
patients. This regulation may become another disincentive for doctors
to participate in programs serving our low-income population.
Failing to pass S. 724 leaves doctors choosing between following
clinical guidelines which we know, through research, is the most proper
care women need; they have to choose between following these clinical
guidelines they know and trust or getting paid. These decisions will be
especially hard for doctors who serve high-risk women, given the fact
postpartum care is even more critical for women who have preexisting
medical conditions such as diabetes or hypertension--any of these.
Under the President's order, these women wouldn't get care. They
could only care for the unborn fetus they are carrying. It makes no
sense whatsoever that the pregnant woman could not even get the care
she needed, and the doctor, if giving it ethically, cannot even be
reimbursed.
This bill does not overturn the administration's regulation. It
simply complements it. It makes the regulation better. It clarifies
that doctors will get reimbursed for the clinical care they provide,
and it will ensure pregnant women get the full scope of medical care
they need.
S. 724 is supported by 25 national organizations, including the
American Academy of Pediatrics, the American College of Obstetricians
and Gynecologists, and the March of Dimes. Each of these organizations
has expressed serious concern with the administration's regulation, and
believes this bill is better.
I ask unanimous consent that a complete list of the organizations be
printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Organizations supporting S. 24:
American Association of University Affiliated Programs;
American Academy of Pediatrics;
American College of Nurse Midwives;
American College of Obstetricians & Gynecologists;
American College of Osteopathic Pediatricians;
American Hospital Association;
American Medical Association;
American Osteopathic Association;
American Public Health Association;
Association of Women's Health, Obstetric and Neonatal
Nurses;
Association of Maternal and Child Health Programs;
Catholic Health Association;
Council of Women's & Infants' Specialty Hospitals;
Easter Seals;
Family Voices;
Greater New York Hospital Association;
March of Dimes;
National Association of Children's Hospitals;
National Association of Public Hospitals & Health Systems;
National Women's Health Network;
National Association of County & City Health Officials;
Society for Maternal-Fetal Medicine;
Spina Bifida Association of America;
The Alan Guttmacher Institute;
United Cerebral Palsy Associations.
Ms. LINCOLN. Mr. President, I thank my colleagues who have joined me.
In the last few days of the session, let us prove to the American
people we in the Senate do understand what goes on in their everyday
lives, we do care, and we can act in ways that will actually make a
difference in their lives; that we won't sit here and talk about
process.
This bill has been through every piece of process there is. Let us
come together in a partisan way and move forward at least this piece of
legislation that will make a difference in not only a child's life, a
woman's life, an entire family's life, a community's life, but in this
Nation's success.
I yield the floor.
The ACTING PRESIDENT pro tempore. The Senator from Louisiana.
Ms. LANDRIEU. Mr. President, I understand several of my colleagues
have come to the floor to speak in favor of this piece of legislation
Senator Lincoln is championing so well and appropriately. I rise to
take a moment to add my words of support for this very important
measure.
I understand the Senator from Missouri will be following me, if
possible.
Last year in Louisiana, there were about 67,000 children born. If you
think about a medium-sized town, that is like a medium-sized town born
every year.
The ACTING PRESIDENT pro tempore. The time of the majority has
expired.
Ms. LANDRIEU. Mr. President, I ask unanimous consent for 2 minutes.
Mr. REID. Mr. President, that is fine, as long as the minority gets
an extra 2 minutes.
Mr. BOND. Reserving the right to object, I did not hear that.
Mr. REID. I said as long as the minority gets an extra 2 minutes.
Mr. BOND. I appreciate that.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
Ms. LANDRIEU. Mr. President, 67,000 babies were born in Louisiana
last year. It would be most certainly in the interest not only of those
particular children and those particular families but the community
that reaches out, in the broader sense, to the people of our Nation to
make sure those new babies, and their moms who are delivering them, are
coming into the world in the healthiest way possible. Not only does
that help us across the board in health issues, it helps us because
then we are better able to educate those children because they have
been born in a healthy manner, we are more able to reach out and
prevent all sorts of illnesses and diseases and mental health problems,
and save the taxpayers of this country billions of dollars.
[[Page S10062]]
So the Senator from Arkansas is so right. The rule proposed in the
House falls short. Let us pass this bill that encompasses the health of
children and their mothers and give them the prenatal care they need to
get these children born healthy for their own benefit and for the
benefit of the taxpayers in our Nation.
I thank the Senator from Missouri for his strong leadership on this
issue as well.
I yield the floor.
The PRESIDING OFFICER (Ms. Landrieu). The Senator from Missouri is
recognized.
Mr. BOND. Mr. President, I thank my colleagues for giving me the
opportunity to rise today in support of the unanimous consent request
to consider and pass S. 724, the Mothers and Newborns Health Insurance
Act of 2001. I believe the bill is essential to the health care of
children and pregnant women in America. Thus, I am proud to be an
original sponsor of the legislation with Senator Breaux and Senator
Collins.
The goal of the legislation is quite simple: To make sure more
pregnant women and more children are covered by health insurance so
they have access to the health care services they need to be healthy.
This legislation would simply give the States the option and
flexibility to cover low-income pregnant women in the State Children's
Health Insurance program, which we call SCHIP, for the full range of
necessary prenatal, delivery, and postpartum care.
Let me reiterate, this is a choice for the States, should they choose
to exercise it. No State, under this bill, is required, or forced, to
expand coverage to additional pregnant women. This bill merely provides
States the option.
This bill will complement the administration's final rule that allows
States to expand SCHIP coverage to an ``unborn child'' by covering
additional vital health care services for the pregnant mother that the
rule, unfortunately, does not cover.
The rule attempts to treat the unborn child without treating the
mother. This approach is in direct conflict with the clinical
guidelines set forth by the American College of Obstetricians and
Gynecologists and the American Academy of Pediatrics, which state a
pregnant woman and the ``unborn child'' must be treated together. It
certainly makes common sense to a layperson, but there is a
professional opinion that the two cannot be treated separately.
It is simply counterintuitive to deny coverage for disease
management, medical emergencies, accidents, broken bones, mental
illness, or surgeries for the mother during pregnancy. Failure to treat
the mother in such circumstances will have a direct and profound effect
on the health and development of her unborn child.
In addition, under the rule, during delivery, coverage for epidurals
is a State option and is justified only if the health of the child is
affected. On the other hand, anaesthesia is covered for Caesarean
sections. The rule would wrongly push women and providers toward
performing more C-sections to ensure coverage for epidurals--a choice
which is more expensive and, in most cases, a much harder road to
recovery for the mother.
Finally, after delivery, women would be denied all health coverage
from the moment the child is born. Important care and treatment,
including the treatment of hemorrhage, infection, episiotomy repair, C-
section repair, and the treatment of complications after delivery would
not be covered.
This bill will work hand in hand with the administration's rule by
giving States the flexibility and option to treat the mother and child
together and provide the full range of necessary prenatal, delivery,
and postpartum care--care which is essential to the health and well-
being of both the mother and the baby.
No health care program that ignores this fact can fully address the
issue of children's health care. This bill will eliminate the illogical
disconnect between pregnant women and babies.
This bill has strong bipartisan support in both the Senate and the
House, as well as the endorsement of the National Governors Association
and 25 other national organizations, including the March of Dimes,
American Academy of Pediatrics, American Public Health Association,
National Association of Children's Hospitals, American College of
Obstetricians and Gynecologists, and the Catholic Health Association.
In addition, Secretary Thompson, in the past, has voiced his strong
support for this legislation.
In fact, in a January 31, 2002, press release on the administration's
rule, Secretary Thompson congratulated Senators for ``bipartisan
leadership in supporting S. 724, a bill that would allow States to
provide prenatal coverage for low-income women through the SCHIP
program.'' He went on to say, ``We support this legislative effort in
Congress.''
All women need prenatal care. Young or old, first baby or fifth, all
mothers-to-be benefit from regular care during pregnancy.
Studies have shown that an uninsured pregnant woman is much less
likely to get critical prenatal care that reduces the risk of health
problems for both the woman and the child. Babies whose mothers receive
no prenatal care or late prenatal care are at-risk for many health
problems, including birth defects, premature births, and low birth-
weight.
We know prenatal care improves birth outcomes and can save money.
According to the National Center for Health Statistics, infants born to
mothers who receive no prenatal care or late prenatal care are nearly
twice as likely to be low birth weight.
Moreover, low birth weight and pre-term births are one of the most
expensive reasons for a hospital stay in the United States with
hospital charges averaging $50,000--an especially serious financial
issue for families without health insurance.
A report by the IOM entitled Health is a Family Matter notes,
``Infants of uninsured women are more likely to die than are those of
insured women. In one region of West Virginia, the fetal death rate
dropped from 35.4 to 7.0 per 1,000 live births after introduction of a
prenatal care program for the uninsured.''
In addition to ensuring better health outcomes, research and state
experience suggests that covering pregnant women is a highly successful
outreach mechanism for enrolling children.
I thank Senator Bingaman for his leadership in the Finance Committee
on this issue. With his help, this bill passed the Finance Committee in
the beginning of August by unanimous consent.
Madam President, studies have shown time and time again that babies
born to mothers receiving late or no prenatal care are more likely to
face complications--which results in hospitalization, expensive medical
treatments and ultimately increased costs to public programs. We must
close the gap in coverage between pregnant mothers and their children
to improve the health of both and to address more fully the issue of
children's healthcare.
This is crucial legislation, and urge my colleagues to join me in
support of it so that we can pass this bill.
I yield the floor.
Mrs. FEINSTEIN. Mr. President, I rise today to voice my support for
immediate passage of the Mothers and Newborns Health Insurance Act of
2001, as reported by the Senate Finance Committee in July.
This important legislation would simply give States the option to
provide health insurance coverage to pregnant women under the State
Children's Health Insurance Program. Such coverage would include the
full range of care, both during pregnancy and postpartum.
This means that a pregnant women would have access to epidurals
during the birthing process and any health-related services necessary
postpartum. It also means that a pregnant women who has other health
conditions, such as diabetes or high blood pressure, would be able to
receive treatment for such disorders. Even life saving surgery for a
pregnant woman appears to be not covered under the propose rule.
Keeping the mother healthy is not only in her best interest, but
clearly in the best interest of the child. Providing a mother with
access to health care services could help ensure that her child will
have the opportunity to be raised by a healthy mother who will
hopefully live a long life.
Additionally, providing the mother with access to health care
services during pregnancy could also help eliminate complications
during childbirth
[[Page S10063]]
and postpartum. This could potentially cut down on health care costs.
Passage of this legislation is particularly important since last week
the administration issued a final proposed rule that would give States
the option to provide health insurance through SCHIP to a fetus. No
mention is made of providing the same coverage to the woman carrying
the fetus. Woman are completely left out of the equation. It simply
makes no sense to issue a regulation that provides for health insurance
for a fetus but not the woman preparing to give birth. In my mind, it
makes more sense to simply expand access to prenatal and postpartum
care.
In a country as prosperous as the United States, it is disturbing
that we still rank 26th in the world in maternal mortality. This could
all be avoided if we only did a better job of ensuring that all
pregnant women, regardless of their income or status, had access to the
full-range of health care services throughout the continuum of their
pregnancy.
Currently under SCHIP, only women under the age of 19 are covered for
pregnancy-related services. However, what happens to a woman who turns
20 halfway through her pregnancy? A 20-year old woman would not be able
to access the same services under current law but would certainly need
access to prenatal and postpartum care to ensure a safe pregnancy and
maximize the chances of giving birth to a healthy child. This
legislation would eliminate this discrepancy.
States can currently apply for a waiver to provide coverage to
pregnant women. Many States have applied for such a waiver. The waiver
process is often burdensome and timely. Why not just give all States
the option to provide such coverage?
HHS Secretary Thompson himself said on March 6, 2002, before the
House Labor-HHS Appropriations Subcommittee: ``And so, if you can pass
the bill, we don't need the rule. Let's pass the legislation.''
I echo Secretary Thompson's sentiment. In the remaining days of
Congress, let's pass this commonsense legislation. It is a good
investment. It will help protect our Nation's pregnant women by
providing them with access to vital health care services, and will help
ensure that our Nation's children are born to healthy mothers who have
been given the foundation necessary to lead a long and healthy life.
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