[Congressional Record Volume 149, Number 17 (Thursday, January 30, 2003)]
[Senate]
[Pages S1827-S1828]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. CANTWELL (for herself and Mrs. Murray):
  S. 264. A bill to amend title XXI of the Social Security Act to 
extend the availability of allotments to States for fiscal years 1998 
through 2000, and for other purposes; to the Committee on Finance.
  Ms. CANTWELL. Mr. President, I rise today to introduce the Children's 
Health Protection and Eligibility Act. I am delighted to be joined on 
this bill by my good friend, Senator Patty Murray. Senator Murray has 
been a champion for children's health issues throughout her career in 
the Senate. This important legislation addresses the allocation of 
budgeted but unspent SCHIP funds that are currently out of reach of 
States and, under current law, are scheduled to be returned to the 
Federal treasury. This legislation also helps those States with the 
highest unemployment rates use more of their SCHIP dollars to provide 
health insurance coverage for low-income children.
  Washington State is in the middle of an economic crisis resulting 
from a downturn in both our aviation and high-tech sectors. With the 
jobless rate at seven percent, we have one of the highest unemployment 
rates in the country. 214,300 Washingtonians are unable to find work. 
And just over the last month, our State has lost 2,946 jobs, and over 
50 percent of those are in the high-paying manufacturing sector.
  In 2000, before the recession began, there were 780,000 uninsured 
people in Washington State, including 155,000 children. That number has 
surely grown as the economy has worsened and our population has risen. 
In fact, in October, the Census Bureau reported that the number of 
uninsured increased for the first time in two years. Sadly, there are 
41.2 million people nationwide without health insurance, 8.5 million of 
whom are children.
  The increasing number of uninsured isn't the only problem facing the 
health care system. Last September, the Kaiser Family Foundation 
reported the largest increase in health insurance premium costs since 
1990, while the Center for Studying Health System Change found that 
health care spending has returned to double-digit growth for the first 
time since that year.
  The lack of health insurance has very real consequences. We know that 
the uninsured are four times as likely as the insured to delay or 
forego needed care, and uninsured children are six times as likely as 
insured children to go without needed medical care. Health insurance 
matters for kids, and coverage today defrays costs tomorrow.
  Five years ago, Congress created a new $40 billion State grant 
program to provide health insurance to low-income, uninsured children 
who live in families that earn too much to qualify for Medicaid but not 
enough to afford private insurance. In most States, the State 
Children's Health Insurance Program, SCHIP has been extremely 
successful. Nearly one million children gained coverage each year 
through

[[Page S1828]]

SCHIP and, by December 2001, 3.5 million children were enrolled in the 
program.
  Unfortunately, however, not all States have been able to participate 
in this success, and perversely, the States that have been left out are 
those that had taken bold initiatives by expanding their Medicaid 
programs to cover low-income children at higher levels of poverty. 
Sadly, the recession and high unemployment means that the health 
insurance coverage we do have for children, pregnant women, and low-
income individuals is in jeopardy due to State budget crises.
  Washington State has been a leader in providing health insurance to 
our constituents. We have long provided optional coverage to Medicaid 
populations and began covering children up to 200 percent of poverty in 
1994, three years before Congress passed SCHIP.
  When SCHIP was enacted in 1997, most States were prohibited from 
using the new funding for already covered populations. This flaw made 
it difficult for Washington to access the money and essentially 
penalized the few States that had led the nation on expanding coverage 
for kids. This means that my State only receives the enhanced SCHIP 
matching dollars for covering kids between 200 and 250 percent of 
the Federal poverty level. Washington has been able to use less than 
four percent of the funding the Federal Government gave us for SCHIP.

  Today, Washington has the highest unemployment in the country, an 
enormous budget deficit, and may need to cut as many as 150,000 kids 
from the Medicaid roles. Because it is penalized by SCHIP rules and 
cannot use funds like other states, Washington State is sending $95 
million back to the federal treasury or to other States. This defies 
common sense, and I do not believe that innovative States should be 
penalized for having expanded coverage to children before the enactment 
of SCHIP.
  This is why we are introducing the Children's Health Protection and 
Eligibility Act. This bill will give States the ability to use SCHIP 
funds more efficiently to prevent the loss of health care coverage for 
children. This bill targets expiring funds to States that otherwise may 
have to cut health care coverage for kids. States that have made a 
commitment to insuring children could use expiring SCHIP funds and a 
portion of current SCHIP funds on a short-term basis to maintain access 
to health care coverage for all low-income children in the State. The 
bill also ensures that all States that have demonstrated a commitment 
to providing health care coverage to children can access SCHIP funds in 
the same manner to support children's health care coverage.
  First, as my colleagues know, 1998 and 1999 state allotments 
``expired'' at the end of fiscal year 2002 and are scheduled to be 
returned to the Federal treasury. Our bill allows States to keep their 
remaining 1998 and 1999 funds, and use these funds for the purposes of 
this legislation.
  Second, unused SCHIP dollars from the fiscal year 2000 allotment are 
due to be redistributed at the end of fiscal year 2002 among those 
States that have spent all of their SCHIP funds. Our bill would allow 
the retention and redistribution of these funds as was done two years 
ago through the Medicare, Medicaid, and SCHIP Benefits Improvement and 
Protection Act P.L. 106-554. However, under our bill, States that had 
an unemployment rate higher than six percent for two consecutive months 
in 2002 would be eligible to keep all of their unspent 2000 SCHIP 
allotment.
  Third, at State option, for certain Medicaid expenditures, qualifying 
States would receive the difference between their Medicaid Federal 
matching assistance percentage, or FMAP, and their enhanced SCHIP 
matching rate. This temporary measure would be paid out of a State's 
current SCHIP allotment to ensure children's health care coverage does 
not erode as States face enormous budget deficits. States would be able 
to use any remaining funds from fiscal years 1998, 1999, and 2000 SCHIP 
allotments, plus ten percent of fiscal 2001, 2002, and 2003 allotments.
  Finally, our bill allows States that have expanded coverage to the 
highest eligibility levels allowed under SCHIP, and meet certain 
requirements, to receive the enhanced SCHIP match rate for any kids 
that had previously been covered above the mandatory level.
  Children are the leaders of tomorrow; they are the very future of our 
great Nation. We owe them nothing less than the sum of our energies, 
our talents, and our efforts in providing them a foundation on which to 
build happy, healthy and productive lives. During this tough economic 
time, it is more important than ever to maintain existing health care 
coverage for children in order to hold down health care costs and to 
keep children healthy. I urge my colleagues to join us in support of 
this bill.
  Mrs. MURRAY. Mr. President, I rise today to join with Senator 
Cantwell in introducing the Children's Health Protection and 
Eligibility Act. This important legislation will ensure that low income 
children in Washington State are not denied access to health insurance 
coverage. The legislation provides a fair and equitable distribution of 
unobligated State balances in the CHIP program. It ensures that States 
like Washington that have led the Nation in caring for their children 
are not denied access to vital CHIP dollars. It rewards Washington 
state for putting children first.
  Washington State is facing the greatest fiscal crisis since World War 
II. Between June 2001 and November 2002, Washington State lost more 
than 74,000 non-farm jobs. This economic recession has hit families in 
Washington state hard.
  In 2002, before the recession began, there were 155,000 uninsured 
children in Washington State. Current estimates place this number even 
higher. With additional layoffs and more families losing COBRA 
coverage, the number of uninsured children will only continue to grow. 
Washington State must have access to its CHIP dollars to prevent more 
children from losing their health care safety net.
  Because Washington State was so far ahead of the rest of the Nation 
in 1997, when CHIP was enacted, our state has been unable to use its 
full allocation. A majority of children who would be eligible for 
participation in CHIP were already covered in 1997 under the Medicaid 
program. As a result, Washington State has been unable to count these 
children as ``CHIP'' The federal share of CHIP is currently 67 percent 
as opposed to Medicaid, which provides only a 50 percent match for 
Washington state. If the State was able to provide coverage for some of 
these low income children under CHIP, it would reduce pressure on our 
state's Medicaid program. Without this relief, Washington State will 
face additional Medicaid reductions. Many of the children that 
currently have coverage will lose this coverage and join the ranks of 
the uninsured.
  Allowing the number of children without insurance to grow is both 
inhumane for our children and irresponsible for our society. Uninsured 
children are six times as likely as insured children to go without 
needed medication. Uninsured children are more likely to be treated in 
the emergency room than insured children. These children are showing up 
more and more in the emergency room to get basic primary care. The cost 
of providing this care only increases as their families are forced to 
delay care. We all pay when children go without health insurance 
coverage.
  This is not just a question of saving money. Providing comprehensive, 
prevention-based health insurance to children is a sound investment. 
Delaying this care only adds to the overall cost of health care, 
education and our criminal justice system. This legislation that we are 
introducing puts our kids at the front of the line.
  I urge my colleagues to join with us in support of this legislation. 
Let's send the right message to our States: If you do the right thing, 
you will no longer be denied your fair allocation. Instead, you will be 
rewarded for putting children first.
                                 ______