[Congressional Record Volume 150, Number 67 (Thursday, May 13, 2004)]
[Senate]
[Pages S5477-S5479]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. GRAHAM of Florida:
  S. 2420. A bill to amend title XXI of the Social Security Act to make 
all uninsured children eligible for the State children's health 
insurance program, to encourage States to increase the number of 
children enrolled in the Medicaid and State children's health insurance 
programs by simplifying the enrollment and renewal procedures for those 
programs, and for other purposes; to the Committee on Finance.
  Mr. GRAHAM of Florida. Mr. President, I rise to introduce the State 
Children's Health Insurance Program, SCHIP, Expansion Act of 2004. This 
Congress passed the Children's Health Insurance Program in the late 
1990s. It has been a great success. There are 5 million American 
children today who have quality medical insurance because of this 
program; without this program there would be another 5 million 
Americans uninsured.
  The expansion of this legislation in 2004 would allow States to 
expand health coverage under the SCHIP program to all uninsured 
children, regardless of their family income. It would also provide 
critical funding for this important program.
  This week is Cover the Uninsured Week. This is a collaborative effort 
of the Robert Wood Johnson Foundation and many other organizations 
highlighting the vast number of uninsured in this country and the need 
to find a solution.
  Yesterday, I introduced legislation with Senators Daschle and Kennedy 
which will call for the Nation to cover all Americans by the year 2006. 
The goal of universal coverage is one that I believe every Member of 
this Senate

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shares. Based on the experience of the last decade, it is my judgment 
that the road to achieving that goal of full coverage begins with a 
first step. We have not taken a significant first step on the road to 
closing the gap now in over 5 years. In that 5-year period, we have 
seen a dramatic increase in the number of uninsured Americans, 
including uninsured children.
  We could take that first step by providing health coverage for all 
children. That step will be a large one.
  Today, there are an estimated 9 million American children under the 
age of 19 who are uninsured for their health care. Over 640,000 of 
those children live in my home State of Florida. There are other large 
groups of uninsured Americans, however, and one might ask, why pick out 
children from this large group of uninsured Americans? The goal is to 
cover all Americans. The reality is the effort to accomplish that 
objective in one giant step has proven to be without success. Uninsured 
children, in my judgment, represent the group that we should start 
with, for the following reasons.

  We know this about uninsured children: They are four times more 
likely to delay seeking care than insured children, and they are five 
times more likely than insured children to use an emergency room for 
regular medical care. Lack of timely treatment can turn a simple health 
problem into a serious childhood illness. Covering children is cost 
effective, and more important, it improves the lives of children. It 
can, in fact, save the lives of children. Let me give two common 
examples.
  Ear infections are a very common affliction of young children and 
easily treated with an inexpensive antibiotic. However, if that ear 
infection is not diagnosed and not treated, the infection can mature 
into deafness and learning disabilities. What happens when an 
unvaccinated child is struck with bacterial meningitis? Failure to 
diagnose and treat this contagious disease with an antibiotic can lead 
to brain damage, even to death.
  Our Nation's publicly funded health programs play a critical role in 
providing access to care in order to prevent such occurrences. As I 
said in the beginning, SCHIP has made an enormous difference in the 
health and lives of over 5 million American children, many of whom are 
from working families.
  We know 8 out of 10 of the currently uninsured Americans come from a 
family in which one or both parents are working.
  Despite the success of SCHIP, States have taken to such tactics as 
capping enrollment and placing limits on eligibility and benefits. I am 
sorry to have to report some of the things that have happened in my 
State, not because they are peculiar, but because they are increasingly 
representative of what is happening in States across America.
  Until recently, Florida had amassed a waiting list of children who 
were eligible for the SCHIP program but who were not being served, 
primarily because of limitations on State funds to match the Federal 
funds. We had a waiting list of nearly 100,000 Florida children. 
Although most of these children have since been temporarily enrolled, 
the Florida SCHIP program has eliminated all outreach activities; that 
is, those activities that had informed families about the availability 
of these programs have been eliminated. Florida has also restricted 
eligibility for children in families whose employers offer any kind of 
dependent coverage, regardless of its cost.
  If there is one thing we know, it is that one of the factors that is 
fueling the increase in the numbers of uninsured Americans is that even 
when employers provide at least the appearance of health insurance 
coverage but that coverage is so expensive that it amounts to more than 
5, sometimes almost 10 percent of that family's income, and as 
available as it may appear, in real economic terms it is not available. 
Yet in my State, I am sad to report that a child who has fallen into 
that circumstance will not any longer be considered eligible for the 
SCHIP program.
  Florida has eliminated its SCHIP waiting list. No one in the future 
will ever say that Florida has nearly 100,000 children who are eligible 
for but not receiving SCHIP coverage because there will not be any list 
of children who are waiting for their opportunity to be covered. This 
is a means by which knowledge of the number of uninsured children who 
are denied access to the program will be denied to the people of 
Florida, as will, therefore, their ability to influence public policy 
to increase the health care coverage of the children of Florida.

  What would the legislation I introduce today do to address these 
problems? First, it would allow States to expand health coverage to 
uninsured children, regardless of the income, so that no child goes 
without necessary care.
  Second, it would provide Federal financial support to assure the 
long-term stability of the SCHIP program. To meet congressional budget 
limits, Federal funding for SCHIP declined by over $1 billion a year, 
beginning in the fiscal year 2002, and running through the current 
fiscal year of 2004. That reduction, which is referred to as the CHIP 
dip, has brought the Federal funds available for children's health 
insurance from $4 billion annually down to $3 billion.
  The consequence of this is that many States which had a fully 
operational SCHIP program--that is, they were using the full amount of 
the pre-2002 Federal funds--are now facing another component of their 
fiscal crisis.
  The SCHIP Expansion Act would restore Federal funding allotments to 
their pre-2002 level, assurance that States could continue to cover 
more uninsured children.
  The legislation would also invest additional resources in SCHIP, 
allowing States that are currently using all of their Federal funds to 
expand their programs, providing relief to many States that anticipate 
a shortage of funding in the near future.
  The Center on Budget and Policy Priorities estimates that by 2007, on 
the current course, 39 States will have spent their entire funding 
allotments. Additional funds are necessary to allow these States to 
continue to reach new currently uncovered, uninsured children. Many of 
our uninsured children are, in fact, already eligible for coverage 
under SCHIP, but where you have limitations in Federal or State funds, 
they are not enrolled. Effective outreach and streamlined enrollment 
are keys to improving coverage.
  SCHIP expansion will help States cover more children by increasing 
funds for outreach in States. That will simplify the enrollment 
process.
  Finally, this legislation will prohibit States that have not 
exhausted all available Federal funds from capping enrollment in their 
SCHIP program. Where enrollment is capped, children are put on a 
waiting list--if the State has not done what Florida has done, which is 
to eliminate the waiting list, and they will go without coverage. 
Without coverage, their parents must choose between paying for rent and 
paying for medicine for their sick children.
  Have we not reached a sad state of affairs in this Nation when many 
of our elder citizens have to make a choice between paying for 
prescription drugs or eating a nutritious meal three times a day, and 
that many of our parents of young children who are sick and without 
medical insurance must make a choice between paying the rent or paying 
for the medicine for their child?
  My bill assures no family faces such a choice as a result of an 
arbitrary enrollment tax. States which choose to participate in SCHIP 
must be willing to participate fully and cover as many children as they 
can with the funds they have available. There is no reason in a nation 
of unsurpassed wealth and of unsurpassed medical talent that any child 
should be without health insurance coverage.
  Investment in proven effective public programs is imperative.
  Although our overall goal is universal coverage, assuring that all 
children have access to quality health care is a crucial first step. In 
my opinion, steps 2 and 3 should be to cover the working poor and the 
early retirees. These steps won't achieve the goal of full coverage 
even in conjunction with the full coverage of children, but they will 
significantly close the gap of those Americans today who are without 
health coverage.
  The SCHIP expansion program represents a serious and long overdue 
commitment to expanding coverage for the most vulnerable in our 
society, our young boys and girls. This measure has

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the support of the Children's Defense Fund, Catholic Charities USA, the 
Association of Maternal and Child Health Programs, and Families USA.
  I ask unanimous consent that a letter of support be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                       Association of Maternal and


                                        Child Health Programs,

                                     Washington, DC, May 13, 2004.
     Hon. Bob Graham,
     U.S. Senate,
     Washington, DC.
       Dear Senator Graham: The Association of Maternal and Child 
     Health Programs (AMCHP) supports your efforts to ensure that 
     children have access to health care coverage through the 
     State Children's Health Insurance Program (SCHIP). All 
     children deserve quality health care.
       The SCHIP Expansion Act of 2004 highlights the vital 
     importance of the SCHIP program in assuring the health of our 
     nation's children. The bill provides states with financial 
     incentives to continue to expand the number of children 
     covered by SCHIP. At the same time, the bill prevents states 
     from rolling back coverage by capping enrollment.
       AMCHP is a national, nonprofit organization that represents 
     state public health leaders administering family health 
     programs. These family health programs serve over 27 million, 
     children and youth, including almost 18 million children. Our 
     members serve insured, underinsured, and uninsured women, 
     children and their families.
       Thank you again for your leadership on this important issue 
     and we look forward to working with you to address the needs 
     of the 8 million uninsured children in this country.
           Sincerely,
                                                 Deborah Dietrich,
                         Director, Center for Policy and Advocacy.

  Mr. GRAHAM of Florida. I call upon this Congress to act and to act 
this year to pass this important legislation, and to remove from the 
rolls of the uninsured for health coverage Americans, at least those 
most fragile and vulnerable, those we love the most, our children.
                                 ______