[Congressional Record Volume 153, Number 123 (Monday, July 30, 2007)]
[Senate]
[Pages S10212-S10230]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SMALL BUSINESS TAX RELIEF ACT OF 2007--MOTION TO PROCEED
The ACTING PRESIDENT pro tempore. Under the previous order, the
Senate will resume consideration of the motion to proceed to the
consideration of H.R. 976, which the clerk will report.
The assistant legislative clerk read as follows:
A motion to proceed to the bill (H.R. 976) to amend the
Internal Revenue Code of 1986 to provide tax relief for small
businesses, and for other purposes.
The ACTING PRESIDENT pro tempore. The Senator from Montana.
Mr. BAUCUS. Mr. President, the psalmist sang:
Out of the mouths of children and infants, You have
ordained strength.
Today we begin debate on a bill to renew and add strength to a
program that helps children and infants, the State Children's Health
Insurance Program, known as SCHIP. CHIP works. Since the plan began 10
years ago, CHIP, or the Children's Health Insurance Program, has cut
the number of children without health insurance by more than a third,
more than a third over the last 10 years.
Health insurance matters. Children with health coverage are more
likely to get the care they need when they need it; that is, if they
have health coverage. Because of SCHIP, millions of children get
checkups. They see doctors when they are sick. They get the
prescriptive medicines they need.
Uninsured children suffer. Uninsured kids are less likely to get care
for sore throats, for earaches, and asthma. When care is delayed, small
problems can become big problems. Nearly half of uninsured children
have not had a checkup in the past year. Uninsured children are twice
as likely to miss out on doctor visits or a checkup.
I think of a single mother from my home town of Helena, MT, who
learned that her son had epilepsy. When did she find out? She found out
right after her son lost private health coverage. She checked into
other health care plans but none covered the expensive medication her
son needed. Plans called her son's epilepsy a preexisting condition.
Then a friend told her about CHIP. She applied, and she found out her
son was eligible. Thanks to CHIP, this young man got the medications he
needed, and his mother got the peace of mind she deserved.
CHIP, again known as Children's Health Insurance Program, makes sense
as an investment. A child who is healthy can go to school. A child who
is healthy in school is more likely to do well. A child who does well
in school is more likely to get a job. And people with jobs are less
likely to end up in jail or on public assistance.
Thus, CHIP helps Americans to compete. Ensuring that kids can have
health insurance is an investment in America's future.
CHIP helps. CHIP helps more than 6 million children whose parents
work
[[Page S10213]]
but cannot afford insurance on their own--6 million. These low-income
working families are not poor enough for Medicaid, and they are not
rich enough to afford private health insurance. Ninety-one percent of
children covered by CHIP live in families making less than twice the
poverty level.
It is time to strengthen CHIP. Millions of children have no health
insurance. There are more kids without health insurance than there are
kids in the first and second grades combined. Think of that: more kids
without health insurance than there are kids in America in the first
and second grades combined.
Americans overwhelmingly support getting their kids healthy, and the
Senate will begin debate on a bill that will fulfil CHIP's promise to
the 6.6 million children now covered. And our bill will cover 3.2
million more children who are now uninsured. This bill is a good
compromise. It puts enough resources on the table to make a difference
for children. It keeps CHIP focused on kids, and it is fiscally
responsible.
We keep CHIP focused on kids. Childless adults who are covered today
will transition off the program. No new waivers will be allowed for
CHIP coverage of childless adults. Coverage of low-income parents will
transition to separate block grants at a lower match rate. No new
waivers will be allowed for CHIP coverage of parents.
We build in flexibility. States will be able to designate CHIP funds
to help families afford private coverage offered by employers or other
sources.
We pay for what we do. When Congress created CHIP in 1997, we paid
for it with a cigarette tax. We continue that funding source. We
increase the Federal tax on cigarettes by 61 cents, and we make
proportional increases for other tobacco products. Increasing the
cigarette tax will also discourage smoking, particularly among teens.
And that will be good for kids, too.
CHIP is the legacy of work by Senators of goodwill from across the
spectrum. It is the legacy of work by Senators such as Chuck Grassley
and Jay Rockefeller, Orrin Hatch and Ted Kennedy. This year, Senator
Grassley and I worked with Senators Rockefeller and Hatch to craft a
consensus package that was the basis of the bill, the bill before us
today.
The Finance Committee modified it and endorsed it with a strong 17-
to-4 vote. I believe the committee has produced a bill of which the
Senate can be proud. I thank my colleagues for their hard work, for
their patience, and their commitment to getting something done.
CHIP is not new. CHIP is tried and it is true. It has worked
successfully for 10 years. And four out of five Americans would like to
see Congress add new funds to the program.
Now it is time for us to act. For the benefit of children and
infants, let's provide strength to the benefit of children. Let's
expand health care coverage, and for the benefit of children let's pass
this legislation.
Mr. President, I yield 10 minutes to one of the fathers of this
program with whom I am very proud to have worked this last year, and
did yeoman's work, did a great job for kids and also his State of West
Virginia, Senator Rockefeller.
Mr. ROCKEFELLER. Mr. President, I rise with great pride today to
speak in support of the Children's Health Insurance Program--or CHIP--
Reauthorization Act of 2007, legislation I authored with Senators
Baucus, Grassley and Hatch to provide health care to 4 million children
in need. It is fitting that we are starting debate on CHIP
reauthorization today because in less than 1 week--on Sunday, August 5,
2007--we will be celebrating the 10-year anniversary of the date that
this landmark and widely successful program was signed into law. This
all started out quite some time ago with John Chafee and myself and
some others, about 10 years ago. But there has been an intensity of
effort led by Chairman Baucus, Ranking Member Grassley, myself, and
Orrin Hatch over the last 3 months, meeting up to 2 hours a day,
virtually every day, our staff meeting around the clock to try to reach
bipartisan consensus, which we have reached, all by giving up some and
reaching accommodation.
I have to say I have a lot of pride in what we are doing today. But I
hope we will fulfill our work in the Senate in the next few days. It is
interesting that Sunday, August 5, 2007, is the actual 10-year
anniversary this program. As you know, it expires at the end of
September, in which case all children who now have health insurance
under this program--all of children, not only the new ones we are
including, but all of them--would lose their health insurance.
This legislation is incredibly personal to me, if I may say so,
because I spent 4 years chairing the National Commission on Children.
It was a long time ago. I swore I would try to honor the commission
with its very wide spectrum of American public officials and private
people, by getting our unanimous recommendations into law. And one of
them was, in fact, the Children's Health Insurance Program. So I do
that very carefully. I also do that with a certain personal emotional
experience.
When our oldest son was born, when he was 10 days old, he developed
something called pyloric stenosis, which is called projectile vomiting,
which means your stomach is not taking in food.
Because we had health insurance, and we could afford health
insurance--unlike the people of the chairman of the Finance Committee's
bill that we are discussing. Because we could afford that health
insurance, we could take him down to the hospital. He had an operation,
and he is doing fine. Otherwise he would have died. So that is partly
what is inside of me during this debate.
As I think about this, I think in 1997 we were acting out of despair
and frustration because of what was not happening for children.
Sometimes I think this body's best work comes at a point when we do
reach genuine despair and frustration, when we cannot take it any more.
We are so aware of what we are not doing that we proceed to do it.
I think that is part of what is propelling us now. The Children's
Health Insurance Program is proven, as the chairman of the committee
has said. It works very well. In 2006, more than 6 million children
were enrolled and were receiving good benefits.
Together, CHIP and Medicaid have significantly increased children's
health insurance. Even as the overall number of uninsured Americans who
are not children have gone up, the number of insured children have
remained steady and it even declined. In fact, between 1997 and 2005,
CHIP and Medicaid reduced the percentage of children below 200 percent
of poverty without health insurance by about one-third. More insured
children, less uninsured because of the good work of this bill.
West Virginia, we have 39,000 children who are affected by this
program. One can say that 39,000 is not very many, or one can say that
is 39,000 lives that have been profoundly and intimately affected by
all of this. Again, I am moved by that.
I started work as a Vista volunteer in West Virginia. I remember what
it was like when kids did not get health care. And that feeling remains
in me today as strongly as it did in 1964 when I went to West Virginia
for the first time. Anyway, the facts are not so good for everybody.
There is a wonderful 12-year-old boy named Deamonte Driver. His mom
knows that feeling all too well. Her son lost his life because the
Medicaid coverage lapsed for him, and a dental infection spread to his
brain and he died. That happens in America. It happens every single
day. We do not notice it. But that is what we are here in this Chamber
for: to minimize that as much as we possibly can.
The bill before us today is $35 billion. That provides health
insurance coverage for 4 million low-income children who would
otherwise be uninsured. Let me repeat. They would be uninsured. Most of
them are already eligible for Medicaid or CHIP but not currently
covered, and that is at a cost of $35 billion over 5 years--not per
year but over 5 years.
As Peter Orszag, who is the very talented CBO Director, said this is
the most efficient possible way per new dollar spent to get reduction
of roughly 4 million uninsured children.
Now, it was not easy to get to this point. It was very hard for me
because I wanted a $50 billion program. It was in the budget mark for
$50 billion.
[[Page S10214]]
There are a lot of things we had to give up because we had to arrive at
a place where Republicans and Democrats could agree. As we met every
afternoon for several hours in Chairman Baucus's office, we had to come
to a point where Republicans who wanted $22 billion, or the President's
program, or us, who wanted $50 billion, where we could ratchet it down
so we could agree on something. So we agreed on the $35 million. That
is where our chairman, Max Baucus, was a fearless leader. He and I have
sort of agreed--I think we have all agreed--we are going to oppose any
amendment which enlarges this program, which would tend to make us
happier, or which would diminish the program, which would tend to make
others happier. We are going to oppose amendments. That is not a
comfortable thing to do. We don't offer enough dental in this bill for
my taste. But when somebody comes and says: I want more dental because
dental is so important, because so many kids lose their teeth by the
time they are 14, 15-years-old, I will oppose that, because I want to
keep the integrity of this bill to make sure that 10 million children
who are at risk of no health insurance without CHIP get to keep their
health insurance.
Our legislation passed the committee 17 to 4. The Finance Committee
is a tough committee. Seventeen to four it passed; that is a huge vote.
So today is monumental.
The bill does basically three things. The bill eliminates the Federal
CHIP shortfall so States could keep covering the 6.6 million kids they
cover now. You remember the President reduced the budget from $15
billion to $5 billion, so that would have taken effect. The increase in
health care costs has also made things more difficult. So eliminating
the shortfalls restores CHIP coverage to 1.4 million children. Again,
1.4 million is a lot of families, a lot of lives who would have lost
CHIP and faced a lot of agony and a lot of people staying up at night
lost in despair.
Secondly, it provides new Federal resources for States to cover 2.6
million children currently eligible for Medicaid or CHIP but not
enrolled. They are out there, as eligible as anybody else, but they are
not enrolled because the money isn't there for them. We have sent $20
billion to Saudi Arabia to do what they want, to buy arms. I keep
asking: What if we were to do some of that here? What if we were to do
that on climate change? That is not the discussion of the afternoon so
I won't pursue it, but our legislation includes 1.7 million who are
Medicaid eligible, and 900,000 who are CHIP eligible. This 2-to-1 ratio
matches the ratio of uninsured Medicaid-eligible children to uninsured
CHIP-eligible children.
And, third, this bill improves the predictability and stability of
the CHIP funding formula so that States can cover more children.
At the proper time, I will support my colleagues in strongly
supporting this bill, which is a start.
The ACTING PRESIDENT pro tempore. The Senator from Montana.
Mr. BAUCUS. Mr. President, I thank my friend from West Virginia.
Before the former chairman speaks, I compliment him on his steadfast
advocacy for the members of his caucus and for the work for kids he has
demonstrated. He has a difficult job. He is standing up for his side of
the aisle. There was negotiation, innumerable meetings. I can't mention
the number of meetings we have had, there have been so many. At the
same time he has also worked for kids. I compliment him for working
hard to accomplish both objectives.
The ACTING PRESIDENT pro tempore. The Senator from Iowa.
Mr. GRASSLEY. Mr. President, I thank the chairman of the committee
for his kind words, and my kind words go to reemphasize the close
working relationship over a period of 6 years, now going into the
seventh year, he and I have had being leaders of both the Republican
and Democratic members of the Finance Committee. I thank him very much
for continuing that working relationship while he was chairman a few
years ago and now chairman again. That is why this committee produces
legislation that eventually gets to the President. I thank the Senator
very much.
The State Children's Health Insurance Program--and people watching
will hear the acronym SCHIP used often--is the product of a Republican-
led Congress 10 years ago, 1997, and it is sunsetting this year. That
is why we are here reauthorizing and bringing more kids into the
Children's Health Insurance Program. It is very much a targeted program
designed to provide affordable health coverage for low-income children
of working families. These families make too much to qualify for
Medicaid but struggle to afford private insurance if they can even get
it. It is important that we reauthorize this targeted program for
children. The Finance Committee bill proposes a reasonable approach for
reauthorizing SCHIP that is the product of months of bipartisan work in
the committee. Chairman Baucus referred to innumerable meetings. We
don't keep track of the number of meetings we have, but for every
meeting Senator Baucus and I have been involved in, usually Senator
Hatch and Senator Rockefeller were there as well. In the meantime,
including a lot of weekends of work, the staffs of the respective
Senators were involved in negotiations to get us to the floor this day.
Once again, I emphasize what I heard Senator Rockefeller say. This is
a bipartisan bill voted out of committee on a vote of 17 to 4. It is a
compromise. I think it is the best of what is possible. Clearly Members
on the left would want to do more. My colleagues on the right want to
do less and go in a different direction. Neither got what they wanted.
That is pretty much the essence of a compromise, not only on SCHIP but
the essence of compromise in the Senate probably over two centuries of
the Senate's history.
This compromise bill maintains the focus on low-income, uninsured
children and adds coverage of an additional 3.2 million low-income
children.
Although I have been pleased with the bipartisan cooperation that led
us to the substance of the bill, I can't say the same for the way in
which the bill is now being debated on the floor. Without participation
or consultation, the Democratic leadership decided to use a so-called
shell revenue bill, the House small business tax relief bill, as a
vehicle for debate. The Democratic leadership will correctly maintain
that the reason for this unusual maneuver is a strategic decision to
accelerate a couple of procedural steps. That is nothing new in the
Senate. You can't find fault with trying to shorten up the process
because the Senate process is already long enough. But since there is
no House-passed SCHIP revenue bill in the Senate now and not likely to
be one by the time the Senate debate ends this week, the Democratic
leadership wants to take a shortcut now.
While I share the goals of completing Senate action on SCHIP and
doing it this week, I would rather not be debating a general tax bill.
This shortcut means, then, that it is legitimate for Members on both
sides of the aisle to raise unrelated tax amendments. That was not the
posture we took in committee. In fact, we discouraged that, and we got
both Republicans and Democrats to agree to voting this bill out as a
health insurance bill and not as a general tax bill except for the
provisions that relate to tobacco. Of course, now we are on the floor.
The stage is set very differently.
When I found out about this maneuver from the Senate Republican
leader, Mr. McConnell, I urged the Democratic leadership, through
Senator Baucus, to reconsider. I feared this shortcut would only widen
the playing field for the first stages of the debate. Obviously, my
counsel was rejected. It is disappointing but so be it.
Despite my objections to this procedural maneuver, I do support the
Senate Finance Committee bill and will have more to say about it after
the cloture vote this afternoon. In fact, I will have a lot to say
about it. I will have a lot to say about particularly people who
believe we have gone too far. I want to make very clear that it would
be impossible to do what the President said he wanted to do under the
amount of money he wanted to put into this program, which was $5
billion over what is presently being expended. Obviously, we are way
above that at $35 billion, but we were able to do what the President
wanted to do and cover some more kids. I will go into details on that
later on.
I yield the floor.
The ACTING PRESIDENT pro tempore. The Senator from Montana.
[[Page S10215]]
Mr. BAUCUS. I yield 10 minutes to the chairman of the HELP Committee,
one of the fathers of the CHIP program, the Senator from Massachusetts.
The ACTING PRESIDENT pro tempore. The Senator from Massachusetts.
Mr. KENNEDY. Mr. President, many of the best ideas in public policy
are the simplest. The Children's Health Insurance Program is based on
one simple and powerful idea--that all children deserve a healthy start
in life, and that no parents should have to worry about whether they
can afford to take their child to the doctor when the child is sick.
CHIP can make the difference between a child starting life burdened
with disease or a child who is healthy and ready to learn and grow.
I would like to begin by thanking my colleagues Senator Baucus,
Senator Grassley, Senator Rockefeller and Senator Hatch for their
dedication to making sure that more of America's children have a start
at a healthy life. They have worked diligently to reach the bipartisan
bill that we have for us today. But I am not surprised by that.
Throughout the history of CHIP, Members on both sides of the aisle
have exercised true leadership and set politics aside to focus on the
needs of children. Senator Baucus, Senator Rockefeller, and Senator
Baucus have long been advocates for the health and well-being of
children and have been willing to work with those who shared that goal.
My old friend Senator Hatch and I worked together in 1997 to create
this program that was our shared vision for healthier future for
American children. This year, we have once again worked together to
find common ground on covering the children deserve decent, quality
health care.
As we now consider the future of CHIP it is instructive to look back
on the history of the program and the circumstances in which it was
created.
The enactment of Medicaid in 1965 brought decent health care to
families living in poverty, including children. But it became clearer
and clearer as the years and the decades passed, that more and more
children were unable to obtain health care because they lived in
families whose incomes were too high to qualify for Medicaid but too
low to afford health insurance.
Finally, in Massachusetts, in the 1990s we agreed that health care
coverage for children is a necessity and that action needed to be
taken. John McDonough, executive director of Health Care for All in
Massachusetts, deserves much of the credit for what came next. His
pioneering work while he was in the Massachusetts Legislature on
children's health care led to the passage in 1993 of the State's
Children's Medical Security Plan, which guaranteed quality health care
to children in families ineligible for Medicaid and unable to afford
health insurance.
A year later, Massachusetts expanded eligibility for Medicaid, and
financed the expansion through a tobacco tax--the same approach we used
successfully a few years later for CHIP and the same approach that is
proposed in the bill before us now.
Rhode Island and other States took similar action, and helped create
a nationwide demand for action by Congress to address the unmet needs
of vast numbers of children for good health care.
In 1997, Congress acted on that call, and the result was CHIP.
Senator Hatch and I worked together then--as we have this year--to
focus on guaranteeing health care to children who need it. Now in every
State in America and in Puerto Rico, CHIP covers the services that give
children a healthier start in life--well child care, vaccinations,
doctor visits, emergency services, and many others.
In its first year 1997, CHIP enrolled nearly a million children, and
enrollment has grown ever since. An average of 4 million are now
covered each month, and 6 million are enrolled each year. As a result,
in the past decade, the percentage of uninsured children has dropped
from almost 23 percent in 1997 to 14 percent today. That reduction is
significant, but it's obviously far from enough.
CHIP improves the overall quality of life for children fortunate
enough to have its coverage, by allowing them to get the care they need
when they need it. They are more likely to have a real doctor and a
real place to obtain care, and, their parents don't delay seeking care
when their child needs it. Children on CHIP also have significantly
more access to preventive care.
Studies also show that CHIP helps to improve children's school
performance. When children are receiving the health care they need,
they do better academically, emotionally, physically and socially. CHIP
helps create children who will be better prepared to contribute to
America. CHIP all but eliminates the distressing racial and ethnic
health disparities for the minority children who disproportionately
depend on it for their coverage.
CHIP's success is even more impressive and important when we realize
that more and more adults are losing their own insurance coverage,
because employers reduce it or drop it entirely.
That's why organizations representing children, or the health care
professionals who serve them, agree that preserving and strengthening
CHIP is essential to children's health. The American Academy of
Pediatrics, First Focus, the American Medical Association, the National
Association of Children's Hospitals and countless other organizations
dedicated to children all strongly support CHIP.
A statement by the American Academy of Pediatrics puts it this way:
``Enrollment in SCHIP is associated with improved access, continuity,
and quality of care, and a reduction in racial/ethnic disparities. As
pediatricians, we see what happens when children don't receive
necessary health care services such as immunizations and well-child
visits. Their overall health suffers and expensive emergency room
visits increase.''
Today we are here to dedicate ourselves to carrying on the job begun
by Congress ten years ago, and to make sure that the lifeline of CHIP
is strengthened and extended to many more children.
Millions of children now eligible for CHIP or Medicaid are not
enrolled in these programs. Of the nine million uninsured children,
over two-thirds--more than 6 million--are already eligible for Medicaid
or CHIP. These programs are there to help them, but these children are
not receiving that help either because their parents don't know about
the programs, or because of needless barriers to enrollment.
Think about that number--9 million children in the wealthiest and
most powerful nation on earth; 9 million children whose only family
doctor is the hospital emergency room; 9 million children at risk of
blighted lives and early death because of illnesses that could easily
be treated if they have a regular source of medical care.
Nine million uninsured children in America isn't just wrong, it is
outrageous. We need to change it as soon as possible.
We know where the Bush administration stands. The President's
proposal for CHIP doesn't provide what is needed to cover children who
are eligible but unenrolled. In fact, the President's proposal is $8
billion less than what is needed simply to keep children now enrolled
in CHIP from losing their current coverage--$8 billion short. To make
matters worse, the President has threatened to veto the Senate bill
which does the job that needs to be done if we are serious about
guaranteeing decent health care to children of working families across
America.
We can't rely on the administration to do what is needed. We in
Congress have to step up to the plate and renew our commitment to CHIP.
That is why I am supporting the CHIP bill before us. It is a genuine
bipartisan compromise. This bill provides coverage to 4 million
children who would otherwise be uninsured.
It adjusts the financing structure of CHIP so that States that are
covering their children aren't forced to scramble for additional funds
from year to year and so that Congress doesn't have to pass a new band-
aid every year to stop the persistent bleeding under the current
program. Importantly, this bill will not allow States to keep their
CHIP funds if they aren't doing something to actually cover children.
Equally important, this bill allows each State to cover children at
income levels that make sense for their state. The bill also supports
quality improvement and better outreach and enrollment efforts for the
program. It is a scandal that 6 million children today who are eligible
for the program are not enrolled in it.
[[Page S10216]]
In sum, this bill moves us forward together, Republicans and
Democrats' to guarantee the children of America the health care they
need and deserve.
Our priority should be not merely to hold on to the gains of the
past, but to see that all children have an access to decent coverage.
Families with greater means should pay a fair share of the coverage.
But every parent in America should have the opportunity to meet the
health care needs of their children.
Quality health for children isn't just an interesting option or a
nice idea. It is not just something we wish we could do. It is an
obligation. It is something we have to do, and it is something we can
do today. I look forward to working with my colleagues to make sure
this very important legislation is enacted.
I commend the chairman of the Finance Committee and Senators
Grassley, Rockefeller, and Hatch, who are putting the children of
America first and reminding all of us of the responsibility we have for
the most vulnerable Americans, the children. They have, over a
considerable period, fashioned legislation that will make an enormous
difference in not only the health of the neediest children but will
also reduce the increasing disparity in our Nation. We have tried to
make some progress in the area of education under the leadership of
Senators Baucus, Grassley, Rockefeller, and Hatch. We are going to
reduce another area of considerable disparity and that is among the
neediest children in the Nation.
We are over the long term not only going to say we are going to have
a healthier Nation because we are going to invest in children and make
sure they will get a healthy start for their future, we are going to be
a stronger nation because we are a healthier nation. Over a long period
of time, this is obviously going to have important implications in
terms of the quality of health not only of the children but of our
Nation.
This is an enormously important day in the Senate. I thank the
leadership for giving this the kind of priority in these first weeks
and months of a new Congress. Senator Reid had indicated this was a
strong priority. It is an example of where we have had strong
leadership in our Finance Committee. We have had strong leadership in
the Budget Committee. There are scarce resources because of our
involvement in Iraq, limited resources, but nonetheless, under the
leadership of Senator Conrad and with the strong support of our
colleagues, we were able to get the commitment that we on this side of
the aisle and the other side, with those courageous Republicans, are
saying this is a matter of national priority. This is of national
importance. We are moving ahead. I thank all of those Senators.
Having listened in our caucus, a number of our colleagues have been
strong supporters of our leaders on the Finance Committee. I thank my
colleague and friend John Kerry, among others. I thank all of those for
bringing us to where we are today.
This is an enormously important occasion. I welcome the opportunity
to speak to it.
I want to go back over the period when we saw the fashioning of this
legislation a number of years ago. We have found this was just about
the time the country was dealing with the issue of the tobacco
settlement. There was a question about how we could use the resources
that were going to be gained from the settlement. There was a great
debate. Many in this body thought we ought to use it all for deficit
reduction; we ought to give it back to the States and let them make the
decision. But there were a number of bipartisan Senators saying: No,
let's make sure that we develop what is an extremely important need,
and that is health care for children. There was a recognition that in
1965, with the passage of Medicaid legislation, we tried to take care--
we still don't include all the children who should be there--of the
poorest of the poor children. We said at that time, as a matter of
national policy, that we as a country were going to give focus to the
neediest in our country. It was the Medicaid program for the neediest,
but a special attention was given to children in the Medicaid
program. That was matched with dedication and commitment in the
development of a title I program to deal with education for the
neediest children in our country. Those went along together, and we are
coming back to the point where we are doing that under these
circumstances. So this legislation is important, and I welcome the
chance to say these words.
I wish to also point out, as others have pointed out, the area of
need. We know we are making a downpayment on the area of need, but we
still have a long way to go if we are serious about including all the
children who are eligible. We need to take care of the neediest
children in Medicaid.
But then we need to look at those in our economy who are working
hard, playing by the rules but who cannot afford health care for their
children. Those are the ones who are reaching $18,000 or $20,000, up to
$35,000, $38,000, $40,000 a year, depending on what part of the country
they are in. We find out that those are the individuals and those are
the families who are the most hard-pressed in any event to afford
health care. We know the cost of $8,000, $9,000 per family for health
care. We know the challenges those families are facing, and we know the
increasing number of those families who are being dropped from health
insurance.
This program was to try to build upon the Medicaid Program and then
have the CHIP program going, taking care of all children in this
country, and to take care of working families--maybe the working poor
but, more accurately, working families--to make sure their children
were going to be attended to. This, I believe, is where this
legislation is targeted. These families are working hard. They are part
of our American system. They are playing by the rules. But affording
that protection is not available to them. The CHIP program reaches out
to them. Some can say: Well, this is an expensive program. I have
listened to all my colleagues. I have listened to Senator Wyden from
the State of Oregon speak eloquently about this issue. We need to
remind ourselves this body is about trying to define priorities. What
are the Nation's priorities? What is important to us? We are here to
try to give focus and attention and direction to the areas of greatest
need.
What our bipartisan leadership today is saying is the area of
greatest need is the children. In this case, the children are members
of working families who are virtually unable to get that kind of focus
and attention and coverage unless they have access to this program.
What are greater priorities than education and health care focused on
our children? We still know there is more to be done. So I welcome this
opportunity to speak. I wished to spend a little time speaking on this
issue. I have referred to how this whole program has reduced health
disparities among children and also how it has reduced disparities on
the basis of race in our communities across the country. It was not
focused on that, but that was the unintended consequence. So this
legislation is a matter of enormous importance.
Finally, I would say, as to this program, if we are interested in
educating the children of this country, we have to make sure the
children can hear the teacher. We have to be able to make sure the
children are going to be able to see the blackboard. We have to make
sure the children have proper dental care. I commend, particularly, the
efforts they have made in dental care for children in this program. It
is not mandated, but there are resources here to encourage the
development of these dental programs. We are all aware that dental
plans are some of the first to leave. We have seen the number of
children out there with deterioration of their teeth, with all kinds of
consequences. As we all read in the Washington Post not long ago, some
children actually lost their lives.
So I thank those who have been a part of this process. I commend all
of them. This is a very worthwhile effort. I am hopeful it will be very
successful.
The ACTING PRESIDENT pro tempore. The Senator from Montana.
Mr. BAUCUS. Mr. President, I now recognize the chairman of the Senate
Budget Committee, Senator Conrad from North Dakota, for 10 minutes.
The ACTING PRESIDENT pro tempore. The Senator from North Dakota is
recognized.
Mr. CONRAD. Mr. President, I thank the chairman of the Finance
Committee not only for this recognition but for his leadership in
putting this
[[Page S10217]]
legislation together. This has not been easy to do. It has been
extraordinarily challenging. We wish to thank Senator Baucus, the
chairman of the Finance Committee, for his diligent effort and his
advocacy for this program. I also thank Senator Rockefeller of West
Virginia for the extraordinary effort he has made with respect to
extending children's health insurance in this Nation. I also recognize,
on the other side, Senator Hatch and Senator Grassley.
We are now debating legislation to reauthorize the Children's Health
Insurance Program, otherwise known as CHIP. This is one place where we
should all be in agreement. To extend health care to our children has
to be one of America's priorities. There is no greater moral obligation
than providing for the least among us, especially our children. We also
know providing health care for kids is a good investment because
improving their health early on is an investment paid for over a
lifetime. You get the return for a lifetime.
The bipartisan Children's Health Insurance Program has been extremely
successful in getting kids covered and keeping them healthy. Experts
across the country agree. Here is what one health care expert had to
say about the Children's Health Insurance Program:
It is a simple idea: We invest in children's health care,
and we get healthy children eager to learn and grow,'' said
Dr. Rob Nordgren of Child Health Services of Manchester (New
Hampshire). . . . Nordgren said children who get good health
care, which begins early in life and continues without
interruption, are less likely to need expensive
interventions as adults.
What could be a simpler or more profound idea than that? You provide
health care to children, and that is a gift that keeps on giving. It
keeps on returning on the investment through that child's lifetime.
This is a good investment.
There are 6.6 million children who now have health insurance because
of the Children's Health Insurance Program. But 9 million children
remain uninsured, and 6 million of these kids are eligible for the
Children's Health Insurance Program or Medicaid right now, but we do
not have the money to actually provide them the coverage. In this
reauthorization, Congress simply needs to invest more to reach these
kids.
But let's be clear. If we do not act, we are not only losing an
opportunity to get more kids covered--if we freeze the current program,
by 2012, there will be over 1.4 million fewer children covered simply
because of a lack of funds.
Here are some facts about this bill.
First, it provides health insurance for 4 million more uninsured
kids, children who would otherwise go without coverage. To bring it
closer to home, this bill will mean an increase in funding for North
Dakota to get more kids covered. In fact, North Dakota's allotment will
almost double, from about $7.7 million now to over $13 million next
year. This will allow the State to cover 1,450 more children over the
next two years.
Second, I think it is important to note this bill is fully paid for
over 6 and 11 years. Therefore, it fully complies with pay-go. We have
heard some other ideas here. As chairman of the Budget Committee, let
me be clear, this bill fully meets its pay-go obligations. It also
meets the other requirements of the Children's Health Insurance Program
reserve fund set out in the 2008 budget resolution that allows for the
reserve fund adjustment.
Third, it is a 5-year reauthorization. Congress will reauthorize in
2012 with new policies and with new offsets. Perhaps we will not even
need a Children's Health Care Insurance Program by then because perhaps
by then we will have reformed the way we deliver health care in this
country.
I believe the time is right to do that, and certainly in this next 5
years, it will become more critical because we know we are on a course
that is absolutely unsustainable. So my own conviction is we will be
reforming health care during this period.
Fourth, reauthorizing the children's health program could actually
spur action on broader health care reform. It is wrong that our Nation
has over 40 million uninsured. We must do something to fix this
problem. Having SCHIP in place for this next 5 years will serve as a
bridge to what we all hope will be a brighter day of fundamental health
care reform.
Now, let me conclude by saying, some have criticized this bill on
budgetary grounds. To the extent that funding levels in the outyears
are lower, it simply means we will have to pay for these costs during
the next reauthorization. But that is the way it always works.
I have been stunned to hear some of my Republican colleagues complain
that this bill sunsets at the end of 5 years. They say: Well, if the
program continues beyond that 5 years, there will be a cost in those
succeeding years. Well, of course that is true. But this bill is paid
for, for the next 5 years, unlike what they did on their enormous tax
cuts.
Look at this slide I have in the Chamber that shows what they did.
These are the tax cuts, under current law, that they put in place,
without paying for any of them, by the way. As shown on the chart, here
is what it would cost to extend those tax cuts: $421 billion in 2017--
$421 billion. That is shown on the chart. Here is what extending the
CHIP program would cost by comparison. Do you see this little, tiny
line at the bottom of the chart?
Now, our friends on the other side are complaining about that little
gap. They say nothing about this yawning chasm created by them--$4.1
trillion. They say nothing about that. But they complain about this
tiny sliver to provide health care insurance for our kids. One has to
ask: What priorities are those?
Again, this SCHIP funding is paid for. Overall, this bill sets us on
a responsible path to get every child in America covered with health
insurance. Four million fewer children will be without health insurance
as a result of this legislation. We should be proud of that.
It is not socialized medicine, as some have asserted. The Children's
Health Insurance Program and Medicaid are partnerships between States
and the Federal Government. These programs use private doctors and
private health plans to provide services. This is not socialized
medicine.
The children's health program is successful. It was created with
strong bipartisan support. Faith leaders, business groups, labor,
insurers, health providers all support this reauthorization proposal.
Partisan politics should not get in the way of providing health care
insurance for our kids. Goodness knows, if we cannot agree on anything
else on the floor of this body, we should be able to agree on providing
health care insurance for our kids.
America's children are counting on us. They deserve our very best and
they deserve our support for this legislation. We cannot let them down.
I hope all my colleagues are paying close attention to what is at
stake. If they are, they will support this legislation.
Again, I thank the chairman of the committee, Senator Baucus, for his
leadership and his untiring efforts and Senator Rockefeller for, over
and over, bringing the challenge of health care insurance for our kids
to the attention not only of the committee but of the full Senate and
of the country.
I thank the Chair and yield the floor.
Mr. BAUCUS. Mr. President, I yield 7 minutes to the Senator from
Oregon, a very valuable member of the committee and a tireless advocate
for good, solid health care.
The ACTING PRESIDENT pro tempore. The Senator from Oregon is
recognized.
Mr. WYDEN. Mr. President, I don't want to turn this into a bouquet-
tossing contest, but I do want to single out the bipartisan quartet:
Chairman Baucus, Senator Rockefeller, who is here, Senator Grassley,
and Senator Hatch. To carve out hours and hours, as the four of them
have day after day, is evidence of their commitment. I just want them
to know I am very much aware we would not be here today advocating for
America's kids without their work and their effort to find common
ground. I wish to start the day by praising the four of them.
Mr. BAUCUS. If the Senator will yield, I note the Senator from West
Virginia is a very busy man and he could be doing other things, other
meetings, and so forth, but he has decided to stay on the floor during
all debate on this bill, and I think that is a testament to how
strongly he is committed to getting this legislation passed, as well as
the Senator from Oregon. The two of you could be vying for
[[Page S10218]]
who is an even stronger advocate for health care, and you both do a
good job.
Mr. WYDEN. I thank you and all four of you for your efforts.
Mr. President, it seems to me this is the opening bell of round one
in the fight to fix health care in America. Fixing health care is the
premier domestic issue of our time.
Suffice it to say we heard in the Senate Finance Committee and we
hear on the floor of the Senate every day that the current health care
system cannot be sustained. The costs are going up too dramatically.
The rapid growth of the elderly population is, of course, relentless,
and the disadvantage our employers face every day competing in tough
global markets cannot be sustained.
My sense is the challenge for the United States is twofold. One--and
this is embodied by what Senator Rockefeller, Senator Baucus, Senator
Hatch, and Senator Grassley are doing--is to meet the immediate needs
of the most vulnerable Americans, immediately. It is obscene that
millions of youngsters, in a country as rich and strong and prosperous
as ours, go to bed at night without decent health care. The bipartisan
effort of these four Senators is moving to erase this moral blot on our
country. I am proud to be supporting the four of them in this effort.
But as we move to tackle these immediate needs of the most vulnerable
Americans, let us also set about the task of trying to transform
American health care. Senator Bennett, a member of the Republican
leadership, has joined me in this effort. We brought to the floor of
the Senate the first bipartisan health reform bill in more than 13
years. As Senator Rockefeller knows, as we are both admirers of the
late John Chafee, his was the last, and Senator Bennett and I want to
work with colleagues to pick up on this effort. Senator Bennett and I
have tried to build on the bipartisanship embodied by Senator
Rockefeller, Senator Hatch, Senator Baucus, and Senator Grassley.
What we are saying is that you need something of an ideological truce
on health care in our country. I think my party has been right in
saying you have to get everybody covered. It is the moral thing to do.
If you don't do it, the people who are uninsured shift their bills to
the insured. But I think colleagues on the other side of the aisle have
had a point as well in saying that you just can't turn everything over
to Government, that there is a role for the private sector. So Senator
Bennett and I are trying to pick up on the prospect of an ideological
truce, just as Senators Rockefeller, Baucus, Grassley and Hatch have
tried to do on the children's health program.
I can tell my colleagues, having served on the Senate Finance
Committee through the markup, and through those weeks and weeks of
discussion, that what Senator Rockefeller and the other leaders of the
Finance Committee had to do was a heavy lift. There are a lot of
colleagues on our side of the aisle who wanted to spend more. They were
interested in covering other groups of citizens. That was unacceptable
to colleagues on the other side. So Senator Rockefeller and Senator
Baucus had to swallow hard; they had to make concessions on points that
were important to them. That is what Senator Bennett and I are trying
to do in terms of transforming American health care. So I am glad
Senator Rockefeller and the group on the Finance Committee have brought
us a bipartisan piece of legislation because it lays the groundwork, in
my view, for going further.
I have a word for the administration on this point in particular: I
am very hopeful they will join the bipartisan effort here in the Senate
to find common ground. We know this bill has a long way to go. It will
be considered by this body. The other body has other ideas with respect
to how to tackle this issue.
I would say to the administration that there are a number of us on
both sides of the aisle who want to work with them on a broader piece
of health legislation. But to get to that broader piece of health
legislation, you first have to deal with the needs of the children. In
fact, in the budget resolution--and this has not been widely noticed--
it specifically stipulates that the children's health program would
come first, before there was an effort to deal with heath issues in a
broader way.
Now, I share the view of the administration with respect to the Tax
Code in health care. It is a mess. It is regressive. It
disproportionately rewards the most affluent in our society and
promotes inefficiency at the same time. If you are a high-flying CEO,
with today's Tax Code, you can go out and get a designer smile put on
your face and write off the cost of every dime of that operation on
your taxes. But if you are a hard-working woman in West Virginia or
Oregon or elsewhere and your company doesn't have a health plan, you
don't get anything out of the Tax Code.
So I am supportive of working with the administration in a bipartisan
way to fix the Tax Code as it relates to health care and to fix the
private marketplace. But you don't get there until you first deal with
the needs of our children. So I want to be conciliatory, both with
respect to the administration and with colleagues on both sides of the
aisle. We have a big opportunity with this issue.
With respect to domestic issues, one of the biggest ones--the
immigration legislation--obviously reached something of a standstill.
If we can sustain this bipartisan effort for the country's most
vulnerable--and I know of no one in the Senate--no one--who doesn't
care about the well-being of our kids--if this effort can be sustained,
there will be a broad berth for another effort to move significantly to
transform American health care.
Seven members of the Senate Finance Committee, during our discussion
of the children's health program, specifically talked about the need to
fix American health care. Senator Conrad, the distinguished chairman of
the Budget Committee, pointed out that over the next 5 years--the life
of this program--there will be plenty of opportunities to transform
American health care. Senator Bennett and I are saying we want to do it
in this session. We don't think we got elected to wait around for
another 2, 3, 4 years to fix health care; we want to do it in this
session.
We had a very promising hearing in the Senate Budget Committee where
support for our efforts was demonstrated by both the chairman of the
committee and the ranking minority member. I wish to underscore that
even the Senate budget resolution makes clear that this program for
children will be done first. As Senator Baucus and Senator Rockefeller
pointed out earlier, this is a question of reauthorizing existing
Federal law. The country has already made the judgment that the needs
of children are going to come first. But a lot of us are not going to
say the job is done by passing one extremely important bill; that there
will be more to do, there will be an opportunity to do it in a
bipartisan way.
While he is on the floor, I want to thank Senator Rockefeller,
Senator Baucus, Senator Grassley, and Senator Hatch.
The ACTING PRESIDENT pro tempore. The Senator's time has expired.
Mr. WYDEN. I ask unanimous consent for 1 additional minute.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
Mr. WYDEN. I just want to use it to thank our colleagues who are the
principal architects of the children's health program. Because of those
of us who would like to go further in this Congress, the bipartisanship
the leaders of the Senate Finance Committee have shown is going to give
us that kind of opportunity, if the administration will join this
bipartisan effort as it goes through this body and the other body.
Mr. President, I yield the floor.
Mr. BAUCUS. Mr. President, I yield 1 minute to the Senator from West
Virginia.
Mr. ROCKEFELLER. Mr. President, I thank the Chair, and I thank the
manager of the bill.
I wanted to pick up on a point Senator Conrad made briefly. I want to
get this so clear at the beginning of this whole amendment debate and
whatever debate follows: The whole concept that somehow this Children's
Health Insurance Program is a Government-run health care program--is
wrong. Throw that out. It is completely and totally wrong. It is not
even an entitlement program. It is a capped block grant program to the
[[Page S10219]]
States. It is optional. The States don't have to use it if they don't
want to. All of them do, including the District of Columbia, but it is
optional.
In virtually all cases, the CHIP programs as they are carried out by
the States are funded through private insurance, very much the way it
was done in the Medicare prescription drug benefit plan. Thirty-nine
States only use private insurance. It has nothing to do with the
Government-run health insurance program. It is health insurance under
the private sector using insurance companies, private insurance
companies.
Mr. President, I thank the Presiding Officer and yield the floor.
Mr. BAUCUS. Mr. President, I notice Senator Dole on the floor. I
don't know if she wishes to speak on this measure. I see Senator
Grassley is not on the floor, but I, on behalf of Senator Grassley,
will yield such time as the Senator would like to consume.
The ACTING PRESIDENT pro tempore. The Senator from North Carolina is
recognized.
Mrs. DOLE. Mr. President, I am perplexed by what is happening in the
Senate these days. Many of my colleagues are calling for a huge tax on
tobacco--a product purchased disproportionately more by lower income
people. This tax hike is said to provide billions of dollars to expand
SCHIP health care coverage for children whose families cannot afford
insurance coverage. While I strongly support reauthorizing SCHIP, a
massive and highly regressive tax increase on an already unstable
product is a terribly irresponsible way to fund this important program.
Furthermore, my home State of North Carolina, which has lost more
manufacturing jobs than any other State and continues to undergo a
difficult economic transition, stands to lose tremendously if the
tobacco tax skyrockets.
I am fully aware that many of my colleagues view ganging up on
tobacco and smokers as politically popular. I am not appealing to you
to change your views on smoking, but I am urging you to acknowledge the
reality that this tax increase is an irresponsible and fiscally unsound
policy.
According to the Tax Foundation, no other Federal tax hurts the poor
more than the cigarette tax. Of the 20 percent of the adult population
that smokes, around half are in families earning less than 200 percent
of the Federal poverty level. In other words, many of the families
SCHIP is meant to help will be disproportionately hit by the Senate's
proposed tax hike. In addition, tobacco sales have been declining 2 to
3 percent a year and are expected to be slashed by another 6 percent if
the Federal excise tax is increased. Yet in order for this tax-hike
trick to work, millions more Americans would have to actually take up
smoking to foot the bill.
A recent ad in Roll Call from North Carolina-based R.J. Reynolds put
it best:
Below that familiar picture of Uncle Sam pointing his
finger, was the line ``Congress Needs you to Smoke.''
That is right. More than 22 million additional Americans will need to
take up smoking to keep the SCHIP program running over the next decade.
Another example of how ill-conceived this proposal is: The Senate
very well may approve legislation this year to force the FDA to
regulate tobacco products.
That agency's staff and resources are already fully consumed by its
mission of regulating food, medical devices, and pharmaceuticals. But
if many in the Senate have their way, the FDA will soon take on
tobacco.
It is no secret that the Senate FDA bill seeks to ultimately put many
tobacco companies out of business. So it appears we are going to
eliminate tobacco companies while simultaneously relying on the tax
revenue from tobacco sales to fund children's health care.
If we are really serious about providing health care coverage to
children in lower income families, this illogical plan clearly is not
going to cut it. I oppose this tax hike plan not only because it is
fiscally unsound but also because it unfairly hurts my State of North
Carolina.
In recent years, the forces of the global marketplace have triggered
a difficult economic transformation, and our traditional industries of
furniture and textiles have shuttered the doors of their factories and
mills, resulting in the loss of 194,000 manufacturing jobs. Tobacco,
another long-time linchpin of North Carolina's prosperity, has also
faced its share of challenges from offshore competition. However, this
economic engine for North Carolina has endured, but it may collapse
altogether if the Senate moves forward with the 61-cent increase on
tobacco products.
Tobacco is woven into the fabric of my State like Texas and cattle or
Iowa and corn. In North Carolina, tobacco is part of our history and
culture. In fact, many of our State's great educational institutions
and health care facilities are rooted in tobacco funding. Today, more
than 255,000 North Carolinians rely on tobacco for their livelihood.
These are not just folks in the fields and factories but also suppliers
and retailers. The industry accounts for $22 billion in value-added
revenue, or 6 percent of North Carolina's economic activity.
Clearly, if the Senate indiscriminately picks this industry to foot
the bill for additional Government spending, North Carolina suffers
tremendously. According to Blake Brown, a widely respected agricultural
economist at North Carolina State University, North Carolina would lose
nearly $16 million in farm production and at least $540 million in
decreased manufacturing; we would lose up to $12.5 million in the State
cigarette tax revenue; and we would lose $10.3 million from our portion
of the master settlement agreement payment, which funds the bulk of our
safe economic development programs.
In addition to North Carolina losing thousands of manufacturing jobs,
supplier and retail jobs, State Agriculture Commissioner Steve Troxler
says we could lose as many as 1,800 farm jobs. Compound these jobs and
revenue losses with the looming threat of FDA regulation, and North
Carolina is looking at what Commissioner Troxler calls a double whammy.
The rug is being pulled out from under us. Am I supposed to go back
to my constituents, whose jobs are at stake, and say: Sorry, folks,
Congress doesn't think you are taxed enough, so, yes, Congress raised
taxes to the tune of $35 billion at the expense of your jobs and farms?
No single industry should be targeted and victimized by such
unreasonable Federal regulations and taxes.
Let me be clear. Reauthorizing SCHIP has my strongest support. Since
its creation in 1997, this program has lowered the number of uninsured
children by almost 25 percent. As we seek to provide greater access to
health care for all Americans, starting with children first is not only
good policy but it is the right thing to do. However, this legislation
is the wrong way to go, period.
I urge Senators to vote for the McConnell alternative. It responsibly
restores SCHIP to its original content: helping low-income children. I
am not asking my colleagues to sympathize with the tobacco industry and
smokers. I am asking you to look at the Baucus bill for what it is: a
massive tax hike that disproportionately impacts low-income people and
an ill-conceived and unsound plan that unfairly targets a single
industry and hurts the economy of several States.
Let's reauthorize SCHIP, but let's do it the right way.
Thank you, Mr. President.
The PRESIDING OFFICER (Mr. Durbin). The Senator from Montana is
recognized.
Mr. BAUCUS. Mr. President, I wish to reserve time for Senators to
speak. I ask unanimous consent that the following time be reserved for
these Senators: Casey, 5 minutes; Stabenow, 5 minutes; Whitehouse, 5
minutes; Bingaman, 5 minutes; and myself, the remaining 5 minutes. I
think that totals 25. How much time remains on this side?
The PRESIDING OFFICER. The Senator from Montana has 24 minutes
remaining.
Mr. BAUCUS. Then I will cut myself down to 4 minutes.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
Mr. BAUCUS. Mr. President, I yield 5 minutes to the Senator from
Pennsylvania, Senator Casey.
The PRESIDING OFFICER. The Senator from Pennsylvania is recognized.
[[Page S10220]]
Mr. CASEY. Mr. President, I thank Senator Baucus, my distinguished
colleague from Montana, for not only the argument he is putting forth
today on children's health insurance but in a special way his
leadership on the Finance Committee.
On the question of children's health insurance, the Senate is
confronted with a very serious matter, a matter that has long-term
implications for millions of families and our economic security. I
believe at least two questions must be asked and answered this week,
and they are as follows:
Question 1: Will the Senate make a full commitment to the children of
America and especially to their health care?
Secondly, does the Senate want America to have a high-skilled
workforce in the future to compete in an ever-changing economy and a
furiously competitive world economy?
For that reason and so many others, I thank the Senators in this
Chamber who have provided the leadership on the Finance Committee,
including Senator Rockefeller, Senator Baucus and, many years ago,
Senators Kennedy and Hatch, who came together in a bipartisan way, as
they are today, and Senator Grassley, among others.
A lot of people watching today may ask what is this program we are
talking about? We hear SCHIP, the acronym. Let's call it children's
health insurance for short because the acronyms don't make a lot of
sense sometimes. It is a 10-year program, where we have covered 6.6
million children, so they can have well-child visits, dental exams,
preventive care, all of the things we see on this chart, when we are
speaking about a well-child visit. Every child in America should have
an opportunity to communicate, through their parents, with their
physician. Every family should make sure that a child within their care
gets six visits to the doctor in the first year of life, a complete
record of physical exams, showing height, weight, and other milestones.
They should have their hearing and vision checked. They should be
checked for normal development, nutrition, sleep safety, infectious
diseases and, of course, general preventive care. It is critically
important that every child gets that, no matter what their income is or
where they live in this country.
In Pennsylvania, we have had more than a 10-year experiment; we have
had children's health insurance since 1993. I am proud that my father,
Governor Casey, and every succeeding Governor, including Republican
Governors Ridge and Schweiker, and Governor Rendell, a Democrat, who
strongly supported it and tried to expand this important program.
Today, I wish to talk for a couple of minutes about the coverage
overall across the country. In our State, it is 162,000 children. But
across the country, even though we have covered well more than 6
million children, there are still 9 million American children today who
have no health insurance at all. Of those 9 million, 6 million of them
are eligible right now for either the Children's Health Insurance
Program or Medicaid. Of those 6 million eligible but not enrolled, 78
percent are from working families. Let me say that again: Seventy-eight
percent of the children right now who are eligible for children's
health insurance or Medicaid are from working families. We should
remember that as we debate this issue. There is a lot of talk in this
Chamber that has been misleading on that question.
We know what happens when a child has health insurance. They have
access to preventive care, they perform better at school, and they are
much more likely to have healthy emotional and social development. If
we want--as I think every Member of the Senate wants--a skilled
workforce in the future, that starts with giving quality early care and
education to our children, giving them the blessing of health insurance
so they can learn more now and earn more in this new century.
There are people out there saying: How do we pay for this? You are
talking about an increase in children's health insurance. We pay for it
by making sure we are increasing a tax that should be increased for
this purpose--the tobacco tax--by 61 cents. We are going to have a long
debate, and I will wrap up in a minute. When we have this debate today
and in the next couple of days of this week, and when people come down
to the Senate floor and talk about how much it is going to cost and why
we should not do this, I ask them--especially those arguing against an
increase--to hold up this pamphlet. This is the health care every
Senator gets. They come in here and talk against this program and say
they don't want to increase it. But I think every Senator who argues
against it and says health care for Senators is a higher priority than
health care for kids should hold up the health care they get, and they
should thank the American people, and then they can go argue against
this.
We have a long debate ahead of us. We will make sure that we make
this a priority for the American people, the health care of our
children.
Mr. BAUCUS. The Senator can speak longer if he wishes. He is very
passionate. I ask unanimous consent for 5 more minutes for the Senator
from Pennsylvania.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
Mr. CASEY. My colleague from Montana gave me a lot more time and I
appreciate that.
I think it is important that we talk about this program and talk
about why some of the arguments have been framed and how they have been
framed in the last couple of days. We have had a lot of bipartisanship
here. A lot of Members of the Republican caucus in the Senate have been
brave and independent enough and have focused on the needs of children
enough to break with the President to say that we respect your view,
Mr. President, but we have to expand this program.
I appreciate that. I am grateful for their wisdom and leadership and
their integrity. They have shown an ability, and both sides have to
work together on this, to make sure that when we talk about the cost of
this program--the President thinks we should only increase it by $1
billion a year, when there is a consensus across the country, by far,
and in this Chamber and across the way in the House to increase it by
at least $7 billion a year. That is the least we should do. I think we
can go higher, but to get the job done we can compromise.
I think it is very important to remember when we are talking about
these numbers, one thing is abundantly clear: The President's proposal
is going to have one dramatic and irreversible impact for children, and
this is a fact: By 2012, if President Bush gets his way on this issue,
800,000 American children will lose their health insurance. So I want
those on the other side of the aisle who have not yet come around to
the thinking of most of the Members of the Senate to remember that. You
are just not voting for an increase that may help some children; you
are voting to cut 800,000 children off of health insurance. I know we
are going to hear from some Members of the Senate that terminology
about socialized medicine and Government-run health care and all of
that.
I ask them again to remember the health care they get as Senators
when they go on about that point. The facts are otherwise when it comes
to what we are talking about. For the Children's Health Insurance
Program and for Medicaid beneficiaries, these are individuals who are
covered through private managed-care plans, private insurance. In
Pennsylvania, we have some nine private providers for the Children's
Health Insurance Program. I defy anyone to tell us these American
companies are part of some Government-run program they do not support.
The support on this issue is overwhelming. The American Medical
Association, all of the pharmaceutical companies virtually have not
only supported it but they are advertising in favor of it, and the
private insurance companies and trade associations and so many other
major American companies.
President Bush said he did not want to federalize this program. I
don't understand it, though, because on the one hand, President Bush
says he agrees the program has worked, and on the other hand he says he
wants to cap it. I don't understand why he does that.
I think it is important for us to remember the benefits all of us
have in this Chamber at this time on our own health insurance.
[[Page S10221]]
We are going to have a lot more time later this week to talk about
other aspects of this legislation. I ask every parent out there who is
watching this debate to remember for just a moment what happens to
their child when they are sick and when they are hurt. Your first
instinct is to hug your child and to give them all the warmth and
support that you can provide them. But that is not enough. Often you
have to take them to a doctor or to a hospital. But for the parents of
children who don't have health insurance, all of the love they provide,
the warmth and embrace of a hug is not enough either, and those
families and those mothers and fathers are powerless to help their
children and show the full measure of their love.
I ask my colleagues and those watching today to consider what this
means for a child and his or her family and also what it means for
America, for our workforce, and for our economy in the future.
Mr. President, I yield the floor.
The PRESIDING OFFICER. Who yields time?
Mr. GRASSLEY. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. BAUCUS. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. BAUCUS. Mr. President, I ask that Senator Stabenow now be
recognized to speak for 5 minutes, a very valuable member of our
committee, very active member of our committee, and a fountain of
ideas.
The PRESIDING OFFICER. The Senator from Michigan is recognized for 5
minutes.
Ms. STABENOW. Mr. President, I first thank our chairman of the
committee for his passion in caring for children, always keeping us
focused as we brought together a bill that truly is a compromise in the
best sense of the word. It is as we should be doing in the Senate,
coming together with a number of perspectives and coming up with a
final product. I thank the chairman for leading us in that effort and
working with the ranking member. Together they have been a great team
on this legislation.
The chairman has constantly said to us: It is about the children. It
is about the children. Keeping us focused on what this is really about
will allow us to come together in a very strong bipartisan vote for a
very important bill.
I also thank Senator Rockefeller for his passion in caring about
children and his leadership in creating the children's health program.
He and Senator Hatch have been a critical part of getting us to this
point as well.
This is a step forward, and as with any compromise, it always
involves give and take. I come from a State that has received 1 of the
15 waivers to cover some adults in our State. That is being phased out.
That is not my first preference, but it is a compromise. It is a way to
recognize this is a children's health program, and we are all coming
together and coming to the middle to work together to get a product
that the vast majority of the Senate can support.
We are talking about a program for uninsured children, 78 percent of
whom live in working families. So we are talking about moms and dads
who are working one minimum wage job, maybe two, maybe three to make
ends meet. We have helped that family by passing an increase in the
minimum wage.
This second piece for families who are working very hard, who care
about their families and want to make sure their children have the
health care they need, is very critical to supporting working families.
That is really what the Children's Health Insurance Program is all
about.
In Michigan, according to the University of Michigan, the number of
uninsured children in our State grew by 7 percent just in 4 years,
between 2000 and 2004. At the same time, we have seen employer-based
coverage cut back and more and more families paying more and more of
the health care bill and more and more families, as well, relying on
Medicaid.
Last year in Michigan, MIChild, which is the children's health
program, one-third of the children relied on MIChild or Medicaid for
health coverage. One-third of all the children in Michigan in a State
of 9 million people were relying on the support of this program and
other public programs under Medicaid to have the health care they need.
Again, three-quarters of these children came from a home with at least
one working parent. So this is very much a program for families who are
working hard to make ends meet, families who go to bed at night and
don't want to have to say a prayer that their kids don't get sick
during the night or the next day. This allows families to have the
integrity of work and know that their children are able to receive the
care they need.
It is also very important to point out the fact that this is very
much about rural families in Michigan and around the country, not just
urban families. Certainly, we care about urban children, but we know
that in Michigan, the fact is, the majority of dollars are going to
rural communities. Thirty-two percent of all rural children receive our
children's health care program or Medicaid, 32 percent as compared to
26 percent. So this is very important for children in every part of
Michigan, as well as the country.
Because of the importance of the children's health program for so
many families, I urge my colleagues not to listen to the negative
attacks on this carefully crafted compromise as we move forward.
There are always challenges drafting a standard 5-year
reauthorization and fitting it into a budget window. In this Congress,
we have or will address several other 5-year reauthorizations: the farm
bill, FDA prescription drug user fees, the Trade Adjustment Assistance
Act, and the ``Leave No Child Behind'' education bill.
As a member of the Budget Committee, I remind my colleagues of the
problems in advancing the administration's proposal for reauthorizing
the children's health program. The Senate, in a bipartisan vote,
rejected this proposal.
The President's fiscal year 2008 budget proposed less than half of
the funding needed for states to cover existing children, let alone to
make progress in covering more uninsured low-income children.
This would be a step backwards for our children. Under the
President's budget, the number of States facing shortfalls in 2012
would increase to 46.
Enrollment of children and pregnant women over the course of a year
would fall by 1.6 million by 2012.
This is not acceptable. We have a chance before us to make a real
difference in the lives of millions of children, many of whom are in
working families.
We all made compromises on moving CHIP forward. For example, I want
to work out something that keeps my State whole, but I recognize the
need to continue to work in the bipartisan spirit that created CHIP in
the first place.
I know some of my colleagues want to debate a whole other set of
options. We should have a full debate on health care, but this is the
opportunity to cover more children.
We are eager to tackle many pressing issues, especially a plan for
small businesses. But the Children's Health Insurance Program expires
at the end of September. Right now, we must focus our energy on
reauthorizing this successful program.
Let us remember the bipartisan spirit that created this great program
for our Nation's children. CHIP is a great success story that we can
all be proud of.
I know my time is up, my short 5 minutes are up. I again urge all my
colleagues to join us in what truly is a wonderful, bipartisan effort
to cover children with health care in the United States.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, I ask unanimous consent that the time on
our side be reserved.
The PRESIDING OFFICER. Without objection, it is so ordered.
Who yields time?
The PRESIDING OFFICER. The Senator from Utah.
Mr. HATCH. Mr. President, I first wish to pay tribute to the
distinguished chairman of the Finance Committee and the distinguished
ranking
[[Page S10222]]
member and Senator Rockefeller, Senator Snowe--so many people--Senator
Kennedy, others on the committee, Senator Stabenow, Senator Wyden,
folks on our side who have really stood up on this issue, the CHIP
issue, Senator Snowe in particular, Senator Smith--I could go right on
down the line--Senator Roberts who has been a stalwart. I don't want to
leave anybody out.
This has been the result of tremendous negotiations over a long
period of time, meeting virtually every day, led by the distinguished
chairman of the committee. We have lots of issues, lots of
difficulties, lots of past experience, mistakes that were made by the
administration that have caused us a lot of problems, and yet a desire
on the part of virtually everybody to try and do what is right for our
children who basically are not being helped by our current health care
system.
As we know, the CHIP bill works remarkably well. Hardly anybody I
know has found fault with the way it has operated. The big problem is
that we spent $40 billion over the 10-year authorization of CHIP, from
1997 to today, and it expires this September. But the costs of trying
to bring on the additional kids who qualify to this program and the
extra costs that have been caused by the administration issuing
waivers, which has resulted in at least one or two States having more
adults on the program than children, has caused some difficulties. We
think we have resolved some of those problems, and we hope the vast
majority of Senators will recognize that and vote for this bill.
We know the House bill is going to be off-the-charts expensive.
Frankly, this is the bill people ought to look at, they ought to
support, and I believe we ought to support wholeheartedly because we
are trying to help the children of this country who are the least
likely to be helped because they do not vote.
The CHIP bill has helped millions of children, there is no question
about it. It was originally decided to help the children of the working
poor who were the only kids left out of the process. The poor children
were helped by Medicaid, and, of course, those in the middle class or
above were able to afford their own health insurance. But these kids
were left out of the program and, of course, left out of basic health
care. We have been able to resolve many of those difficulties through
the original CHIP program. In this program, we will do away with
waivers. We can't do away with some of the grandfathered people who are
on CHIP right now, but we will get childless adults out of the program,
and we will bring into the program pregnant women, which we did not do
before.
When we did the original CHIP bill, I was against bringing them in
because of the high cost of the bill at that time. That bill cost $40
billion over 10 years. This bill will cost $60 billion over 5. But the
reason for the original cost happened to be not only inflation, but
also the outreach programs that were included, and the fact that we
weren't covering upwards of 3 million children. Some estimate even more
under the original CHIP program.
My personal belief is, if we cover these children properly, we will
save billions of dollars in the long run. We will save more than what
it costs us to take care of these kids. But even if we didn't, we still
ought to be taking care of these children who basically are not
problems to society but can be great contributors to society if they
are healthy. If we don't take care of them while they are in their
youth, it is very likely they will not be as healthy as they otherwise
would be and, in the end, they would cost more money than if we had
faced the music and done what is right now. That is why this CHIP bill
is so important.
Again, I want to compliment and thank all of those who have
participated in bringing this bill about.
Mr. President, I understand Senator Lott wants to speak at 4:30. I
have another set of remarks I would like to make. I suggest the absence
of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. LOTT. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. LOTT. Mr. President, I believe under the agreements that have
been worked out I am going to speak at this time with regard to the
SCHIP issue.
The PRESIDING OFFICER. The Senator may proceed.
Mr. LOTT. Mr. President, let me first emphasize that we will have a
motion to proceed to the State Children's Health Insurance Program this
afternoon, and Republicans and Democrats will vote for that procedural
motion to go forward because all of us support reauthorization of the
so-called SCHIP program, which is Washington speak for State Children's
Health Insurance Program.
This is a classic example of how no good deed goes unpunished because
I remember when this program was developed legislatively on the Senate
floor. The Senator from Utah was a key player. I remember some of the
exchanges that were made at the time with Senator Hatch talking and
Senator Kennedy and Senator Phil Gramm when we created this program.
This was about, I guess, 10 years ago or so. We created it because we
did believe there was a need in America for children to have health
assistance--a health insurance program--particularly low-income
children.
There were a large number of children who were not then covered, so
it was well intentioned, and everybody wanted to go forward with a
program that would cover these children so their health needs could be
addressed and so they could live healthier lives.
I just heard Senator Hatch make the point that if we don't have this
type of health insurance available for children in critical times, a
longer term cost will greatly exceed what the cost might be for the
program at this time. So we were in it together. We created it at a
time when we had a Republican majority in the Congress and a Democratic
President in the White House. It was generally a bipartisan effort, and
we created a good program that was targeted. It was expensive, but we
believed it was important that we get this done.
Now, since that time, this program has continued to grow, and we have
seen States start adding not only higher and higher levels of income
for these children to be covered--up now to, I think, 350 percent of
poverty in some States, and another State now is actually trying to get
it up to 400 percent of poverty, which certainly is not low-income
children. That is middle-income coverage. That would cover children in
the range of a family of three making $60,000 to $70,000 a year. So
that has really started causing problems, with the higher and higher
level of income for children and adults being included. That was never
the intent.
The core mission of this program was for children to get this help,
but more and more States have included adults, and not just the
pregnant mother but the parents and even adults beyond that in some of
these States that have gotten waivers. It is going to be argued by some
Senators, Senator Grassley and probably Senator Baucus, that a lot of
this problem has been caused by this administration--probably the
previous administration but certainly this administration--by giving
waivers to the States to begin to cover a higher and higher income
level of children and adults. That is a legitimate criticism. They
shouldn't have done it, and they shouldn't have done it the way they
did. And certainly they shouldn't have done it repeatedly. I don't know
how many States have gotten waivers now--14, 16 States, something of
that nature, and more to come probably.
Some people at the Department of HHS will say: Well, we don't have
much discretion under the waiver. I don't believe that is true, and
certainly they had more discretion than they exercised. So the program
now, with these waivers, has got lots of problems, and that is why I
oppose it in its current form.
Let me first talk about the Baucus bill and give the reasons I am
opposed to it. The baseline for this children's health program is $25
billion over 5 years--$25 billion. I believe the President, and these
are general numbers, but I think the President asked for basically a $5
billion increase over those 5 years, which would have brought it up to
the $30 billion range. I was thinking in committee that was not enough;
[[Page S10223]]
that we were going to have to go higher so that we could try to cover
those children now covered in the program, realizing some who would be
eligible are not covered because, No. 1, they may not have applied, No.
2, they are covered by private insurance, and No. 3, they were covered
by Medicaid. But it was clear to me it was going to take more money in
order to cover the children we really intended to cover than the basic
of $25 billion.
Now, I thought we were going to be talking in the range of $7 billion
or $8 billion, and I still believe that is the right number to continue
to cover those children who are now covered by the program. The bill we
have before us, though, has risen by $35 billion above the so-called
baseline for a total of $60 billion over 5 years--$60 billion. A
program that was originally intended for low-income children to get
this health insurance, certainly never intended to be $25 billion, now
in this bill would be $60 billion over 5 years, and explosive in the
outyears. And this is before we go to conference with the House. The
House is talking $70 billion to $100 billion.
So even though one might say: Well, this bill has gone way too far,
this is the new baseline, if we pass it at $60 billion, it will only go
up. What will it be, $70 billion, $80 billion, $90 billion for this
program--only for this program? And by the way, a program that will
include adults and will include children probably certainly well above
200 percent of poverty.
That is why we have an alternative that will make sure we cover those
children we originally intended to cover and children now under the
program, but we did not want this sort of doubling of the size of the
program in the next 5 years. Ours would even provide for a 33-percent
increase over the next 5 years. We have a real problem. It is a massive
spending increase. It uses certain budget considerations to deal with
what happens after the fifth year.
Some people say: Well, there will be time to change that. But nobody
really believes that once you build a program, like this chart shows,
that goes up, up, and up, and then all of a sudden when it reaches a
certain level, it drops back down. It won't do that. It will continue
to go up. And therein is the second part of the problem.
How do you pay for this? The bill before us has tax increases in the
$61 billion to $70 billion range. I believe that is accurate, but a
minimum of $61 billion, with that coming from a tax on cigarettes and
other tobacco products. The fact is, when you tax something with that
much of an increase, which takes it up to a full dollar from the
current 39 cents, that is a huge increase. When you have that kind of
increase, a dollar a pack on cigarettes, what you are going to get is
less revenue. So at a time when the cost of the program is going up,
the revenue that is actually going to be coming in is going down. That
is a prescription for huge budget problems.
Of course, the argument again is, well, that is down the road; we
will have time to fix that later on. But one of my concerns about the
program as it is now is that it also will actually be taking children
now on private insurance--children who have coverage--and they will be
going off private insurance coverage and going into the so-called SCHIP
program. There are an estimated 600,000 children--and I don't know how
you estimate those numbers, which I suspect are low--but a large number
of kids, up to perhaps as many as 2.1 million, will be moved from
private health insurance programs to the Government-run health care
program.
So here we have a massive spending increase, we have a program that
will be taking children now covered off of private insurance and moving
them on to a government program, and you have a massive tax increase.
We will have an alternative that reauthorizes the program, keeps it
focused on the core mission of low-income children, which does increase
funding generously, by as much as 33 percent, and avoids the huge tax
increase. And the revenue it brings in is real, not a revenue that will
be on a declining basis. It will give, additionally, millions of
Americans access to health insurance through the small business health
plans and includes reforms in the health savings accounts.
Mr. President, I know we have a number of Senators lined up to speak,
but I just wanted to begin to point out some of the basic problems of
how we got here, what is in this bill, and the fact that we will have
an alternative that I believe is better than the one that was reported
by the Finance Committee.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The minority leader.
Mr. McCONNELL. Mr. President, are we under controlled time?
The PRESIDING OFFICER. Yes. The Senator from Iowa on the minority
side controls 40 minutes.
Mr. McCONNELL. I yield myself 10 minutes of my leader time.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. McCONNELL. Mr. President, 10 years ago a Republican-controlled
Congress created and passed the State Children's Health Insurance
Program. It targets the health care needs of poor children whose
families make too much to be eligible for Medicaid but are still in
danger of not being able to afford private health insurance.
In many ways, this program, SCHIP, is a remarkable success. The rate
of children in America living without health insurance dropped 25
percent from 1996 to 2005. Last year, 6.6 million children had health
care coverage thanks to SCHIP, including more than 50,000 in the
Commonwealth of Kentucky. Those are some truly astounding numbers.
There is a lot of good in the current SCHIP law that we should
reauthorize, but at the same time, we should also modernize and improve
it.
Our goal should be to continue to target those low-income children
who fall between the cracks and go without health insurance. And we
should seek out those children who are eligible for SCHIP, but
currently go without, and bring them into the program.
Unfortunately, I have serious concerns with the bill that the Finance
Committee sent to the floor. I do appreciate all the hard work of the
ranking member, Senator Grassley, as well as Senator Hatch, who is one
of the original authors of this program. However, the committee's bill
is a dramatic departure from current SCHIP law: It will significantly
raise taxes, increase spending, and lead to government-run health
insurance.
Funding for this proposed massive increase in spending relies not
just on a massive tax increase, but also on a budgeting gimmick. Their
plan will increase SCHIP spending every year for the next 5 years, with
projected spending of $8.4 billion in 2012.
Then suddenly in 2013, like magic, spending would drop to only $400
million--a decrease of $8 billion in one year. That's not because the
funds won't be needed--rather, it is a sleight of hand needed to fit
the program within the bill's funding limits.
But does anyone seriously think Congress will decide to cut SCHIP by
$8 billion in one year, so that millions who rely on it will lose their
health insurance? Of course not. Future Congresses will go back and
spend more, and this proposal will end up costing exponentially more
than its current price tag.
Under this scenario, the Congressional Budget Office estimates the
total cost of this bill over the period from 2008 to 2017 is actually
$112 billion--$41 billion more than the advertised price.
And most of this increase will go toward people that SCHIP was never
meant to cover.
The expansion proposal we are considering here on the floor will
allow SCHIP coverage to extend to families with incomes as high as 400
percent of the Federal poverty level--even though 89 percent of
children in families with incomes as high as 300 to 400 percent of the
Federal poverty level already have private coverage.
The bill also includes a tax increase, when the American people are
already taxed too much. So I hope we will have a free, open debate on
this bill, and every Senator will be allowed to offer ideas to improve
it.
Senators Lott, Kyl, Gregg, Bunning and I will propose an alternative
measure called the Kids First Act. It refocuses SCHIP to help the
people it was designed to help: low-income children.
While considerably less expensive to the taxpayers than the Finance
Committee's bill, it's worth noting that many States, including
Kentucky, would fare better next year under the
[[Page S10224]]
Kids First Act than under the committee bill.
Our plan is fiscally responsible and focuses Government assistance on
those who really need it. I urge all of my colleagues to seriously
consider it.
Many Senators have also worked exceedingly hard to craft
comprehensive measures addressing the uninsured in America. I applaud
their efforts, and look forward to having a full and open debate on the
Senate floor about their ideas.
I especially want to recognize Senators Burr, Coburn, Corker, DeMint
and Martinez for their work in this regard.
As we begin to consider SCHIP legislation, this Senate should focus
on reauthorizing a program that works, instead of transforming it into
a license for higher taxes, higher spending, and another giant leap
toward government-run health care.
Legislation like that will not receive a Presidential signature. But
this Senate can craft something that will. Let's work toward that and
produce a bill that focuses on the true goals of SCHIP--providing a
safety net for kids in low-income families.
I also have here an editorial from today's Wall Street Journal that
describes many of the problems with the committee's bill I just
detailed. I ask unanimous consent that it be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
[From the Wall Street Journal, July 30, 2007]
The Newest Entitlement
The State Children's Health Insurance Program sounds like
the epitome of good government: Who could be against health
care for children? The answer is anyone who worries about one
more middle-class taxpayer entitlement and a further slide to
a government takeover of health care. Yet Schip is sailing
toward a major expansion with almost no media scrutiny, and
with Republicans in Congress running for cover.
Schip was enacted in 1997 to help insure children from
working-poor families who make too much to qualify for
Medicaid. In the intervening years, the program reduced the
rate of uninsured kids by about 25 percent but has also grown
to cover the middle class and even many adults--and it gets
bigger every year. Schip expires in September without
reauthorization, and Congressional Democrats want to enlarge
its $35 billion budget by at least $60 billion over five
years.
State Governors from both parties are also leading the
charge--and for their own self-interested reasons. Schip
money is delivered as a block grant, which the states match
while designing their own insurance programs. All cost
overruns, however, are billed to the federal government,
which is on the hook for about 70 percent of Schip's
``matching rate.'' This offers incentives for state
politicians to make generous promises and shift the costs to
the feds, or to toy around with costly universal health-care
experiments. And since the states only get 57 cents on the
dollar for Medicaid, they are working hard to transfer those
recipients to Schip.
This self-interest explains a recent letter from the
National Governors Association demanding ``urgent action'' on
Schip, which got lots of favorable play in the press. Yet
these are the same Governors who have been moaning for years
about rising entitlement burdens, which is what Schip will be
soon enough. Particularly egregious was the signature on the
letter of Minnesota Governor Tim Pawlenty, a Republican who
regards himself a conservative health-care maven and should
know better.
This ``bipartisan'' cover is serving Democrats in Congress,
who want to liberalize Schip eligibility as part of their
march to national health care. The Senate Finance Committee
has voted 17-4 to increase Schip spending to at least $112
billion over 10 years. Not only does it use a budget trick to
hide a payment hole of at least $30 billion, it proposes to
offset the increase by bumping up the cigarette tax by 61
cents to $1 a pack.
House Democrats are putting the finishing touches on their
own plan, making the cigarette tax somewhat lower to win over
tobacco-state Members. Instead, the House is proposing to
steal nearly $50 billion from Medicare Advantage, the
innovative attempt to bring private competition to senior
health care.
Michigan's John Dingell explains that ``these are not
cuts'' but ``reductions in completely unjustified
overpayments''--which will come as news to insurers that
offered coverage plans based on certain funding expectations.
The ``overpayments'' he's referring to were passed expressly
as an incentive for companies to offer Medicare Advantage in
rural areas with traditionally fewer insurance options--and
are intended to be phased out over time. Democrats apparently
want to starve any private option for Medicare.
In any case, the actual costs of Schip will overwhelm these
financing gimmicks. Like all government insurance, Schip is
``covering'' more children by displacing private insurance.
According to the Congressional Budget Office, for every 100
children who are enrolled in the proposed Schip expansion,
there will be a corresponding reduction in private insurance
for between 25 and 50 children. Although there is a net
increase in coverage, it comes by eroding the private system.
This crowd-out effect is magnified moving up the income
scale. In 2005, 77 percent of children between 200 percent
and 300 percent of the poverty level already had private
insurance, which is where the Senate compromise wants to move
Schip participation. New York State is moving to 400 percent
of poverty, or some $82,000 in annual income. All of this
betrays the fact that the real political objective of Schip
is more government control--HillaryCare on the installment
plan.
We'd have thought Capitol Hill Republicans would understand
all this, especially with the White House vowing to veto any
big Schip expansion. But we hear the GOP lacks the Senate
votes for a filibuster and perhaps even to sustain a veto.
GOP Senators Mitch McConnell and Jon Kyl are backing an
alternative to account for population growth and reach the
remaining 689,000 uninsured children that Schip was intended
to help. Republicans would be wise to support this version,
or they'll take one more step to returning to their historic
minority party status as tax collectors for the welfare
state.
The PRESIDING OFFICER (Ms. Stabenow). The Senator from Utah.
Mr. HATCH. Madam President, I ask unanimous consent that my remarks
be printed in another place in the Record and the time be charged
against our amendment.
The PRESIDING OFFICER. Without objection, it is so ordered.
(The remarks of Mr. Hatch are printed in today's Record under
``Morning Business.'')
Mr. HATCH. Madam President, I ask unanimous consent that I be
permitted to yield 2 minutes to the distinguished Senator from New
Mexico; that then I be able to complete my remarks on CHIP after he is
done.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DOMENICI. First, let me thank the distinguished Senator
profusely. I thought it would not be appropriate to let the SCHIP
legislation proceed without some comments about how it got started.
Actually, in 1992, when I was chairman of the Senate Budget
Committee, I helped to create the State Children's Health Insurance
Program, also known as SCHIP, as part of the Balanced Budget Act,
believe it or not.
The program has been a success. The number of children without
insurance has declined by a very large amount. The Senate Finance
Committee has approved a reauthorization of SCHIP, and the full Senate
will take it up this week. The bill increases 5-year funding for the
program from $25 billion to $60 billion. The $35 billion expansion is
paid for in full by taxes on tobacco products.
In the current form, I will support the Finance Committee-passed
bill. I suggest that many should. In my home State's problem with
uninsured children, recent reports have New Mexico at the bottom in the
Nation in coverage of these children. About 100,000 children in my
State are without insurance, 25 percent of the adolescent population.
I have many concerns with the cost of this bill and the way it is
paid for. However, I am willing to spend the next 5 years working on
these concerns.
If the bill is substantially changed or expanded during debate this
week in the Senate, or if it is significantly changed during conference
with the House, they can count me out; I will no longer support it.
This is about the size we ought to support, to handle our money
properly and to create a program that may very well be one of those
that will help us immensely with insurance for adolescents and
children.
I yield the floor.
The PRESIDING OFFICER. The Senator from Utah.
Mr. HATCH. Madam President, I compliment the distinguished Senator
from New Mexico for his remarks. I personally appreciate them.
Mr. BAUCUS. I wish to also compliment the Senator from New Mexico.
Mr. HATCH. Madam President, this week the Senate will focus on how to
reauthorize and finance the CHIP program.
Therefore, I would like to take some time on the Senate floor today
to lay the groundwork for that process by examining the history of the
CHIP program and the successes it has had over the last decade.
The Balanced Budget Act of 1997--BBA 97--created CHIP as Title XXI of
[[Page S10225]]
the Social Security Act. Today, all 50 States, the District of Columbia
and five territories have CHIP programs. As is allowed by the law, 17
States use Medicaid expansions, 18 States use separate State programs
and 21 States use a combination approach of both their Medicaid program
and the State program.
The CHIP program is financed through both the federal and State
governments and is overseen by the States. States receive an enhanced
federal match for the CHIP program. This federal match is significantly
higher than the federal match that States receive through the Medicaid
program.
The Medicaid federal medical assistance percentage, known as F-MAP,
ranges between 50 percent and 76 percent in fiscal year 2006; the CHIP
F-MAP ranges from 65 percent to 83.2 percent.
Through BBA 97, approximately $40 billion in federal funding was
appropriated for the CHIP program. Overall, States have spent $10.1
billion dollars since it was first implemented through September 30,
2005.
Today, approximately 6.2 million children have their health insurance
coverage through the CHIP program. As one of the original authors of
the CHIP program with Senator Kennedy, Senator Rockefeller, and the
late Senator Chafee, I am very proud of the program's successes and I
want these successes to continue.
When we drafted this legislation in 1997, our goal was to cover the
several million children who had no insurance coverage. Their families
were too rich to qualify for Medicaid; however, their families did not
have enough money to purchase private health insurance. We have gone a
long way in meeting that goal, but we are clearly not there yet.
Coverage of these uninsured children is still my top priority.
I have always believed that we shouldn't even consider expanding this
program to other populations until we have covered all children who do
not have health care coverage.
Unfortunately, that has not been the case and a program that was
created for low-income children has covered childless adults, parents
of CHIP-eligible children and pregnant women. How has this happened?
Both the Clinton and Bush administrations granted waivers to States
to cover adults, something that I strongly oppose. Today, 11 States
cover parents through State waivers and six States cover childless
adults in CHIP through State CHIP waivers.
When Senator Rockefeller, Senator Kennedy, Senator Chafee and I
worked on the original legislation in 1997, our goal was to cover the
several million children who had no health insurance, but I believe
that the bill before the Senate today makes great progress in this
area.
I believe the bill the Senate is considering this week captures the
true essence of the 1997 law and builds on that foundation to insure
even more children.
That, indeed, should be our purpose.
The bill drafted by Finance Committee Chairman Baucus, Finance
Ranking Republican Member Grassley, Finance Health Subcommittee
Chairman Rockefeller and myself is the very essence of compromise.
To be fair, it does not make any of us Republicans comfortable to
face a veto threat from our President.
It does not make me comfortable to face a veto threat issued by my
colleague and good friend from Utah, Secretary Leavitt.
It does not make me comfortable to advocate for such a large amount
in new spending.
At the same time, I know none of you on the other side of the aisle
are comfortable with the fact that we did not authorize spending up to
the $50 billion limit in the budget resolution. Many of my Democrat
colleagues made sacrifices in endorsing this bill and in sacrificing
program expansions they so dearly advocated.
Senator Kennedy and I often like to joke with each other that if
neither side is totally comfortable with one of our compromises, we
must have done a good job.
And in that spirit, I say to my colleagues, we must have done a good
job.
This bill will make it all about the kids. That was our goal, and we
achieved it. Our bill will provide health coverage to 2.7 million of
the 6 million currently uninsured, low-income children who are 200
percent of the Federal poverty level and below.
I want to circle back to the cost of this bill.
I remember so well my conversations with my colleagues in 1997 about
the cost of the original CHIP bill and the precedent it could
represent.
We must recognize that we have already covered the kids who are easy
to find. Six million of them to be exact.
We can all be proud of that.
But one of the lessons we have learned along the way is that it will
cost proportionately more to cover the remaining children. They are
harder to find and thus harder to cover.
This is what CBO told us.
So you can't do the simple math and say:
It costs $40 billion to cover 6 million kids, so it should
cost $40 billion to cover the remaining 6 million kids. It
doesn't work that way.
CBO told us that we need to give States more money to cover these new
uninsured children, and that is what we have done.
We have made a number of other important decisions in this bill.
We have restored the program back to its intent to cover children,
not adults. This was a hard decision for Senators from States with
adult waivers, and I commend them for their commitment to the children.
The legislation before the committee removes childless adults from
the CHIP program by the end of FY09 and afterwards, gives the States
the option of covering these individuals through Medicaid.
It also prohibits the approval of any new State waivers for parents
to be covered through CHIP.
Only parents living in states with approved parent waivers will be
eligible for health coverage through the CHIP program.
The next tough issue was the coverage of pregnant women. While I was
not opposed to this in theory, in practice we all know that the cost of
one delivery could fund insurance for three or four children. That is
why I opposed this coverage in 1997.
I have been convinced that States should have the option of covering
pregnant women through the CHIP program. This was a difficult decision
for me and, again, a true compromise.
Third, we included money for outreach and enrollment. This is key for
enrollment, but as we found out, it is very expensive. So we made the
decision to place a limit on the amount of money dedicated to these
efforts.
Fourth, our legislation includes premium assistance through CHIP for
coverage through private plans. And if it is determined that family
coverage would be more cost efficient, the entire family would be
covered through this health plan.
This is something that was very important to me and Senator Grassley.
Utah has started such a program with the hopes of providing affordable
coverage to an entire family.
Fifth, our legislation includes a cap of 300 percent of the Federal
poverty level for eligibility in CHIP. If a State provides CHIP
coverage above that level, it will not receive the enhanced match.
States with higher eligibility levels when this legislation becomes law
would be grandfathered in.
Finally, I am pleased that this bill changes the name SCHIP back to
CHIP, the way it was before the House added the superfluous S.
Madam President, this is a good bill. It accomplishes what we have
set out to do--to take care of the children.
Yes, I wish it did not cost what it does, but I am persuaded this is
necessary spending when I think of the 6 million American children who
are leading healthier lives because of our vision and commitment.
We should not let the opportunity pass us buy to build on that solid
foundation and do even more good for the children, our future.
I will add one more point that I want my Republican colleagues to
take to heart. This is a bipartisan compromise bill. It is not like the
legislation being considered by the House of Representatives that will
cost up to an additional $50 billion to reauthorize the CHIP program
over the next 5 years.
In my opinion, the Senate version of this legislation is the better
deal for the American people, and it is my hope that my colleagues who
disagree will take one more look at this legislation.
[[Page S10226]]
I urge my colleagues to support the motion to proceed to this bill.
I hope in the final analysis, once we do proceed, our colleagues will
vote for the bill because it is the right thing to do.
How much time do we have remaining on both sides?
The PRESIDING OFFICER. The minority has 9\1/2\ minutes, and the
majority has 6\1/2\ minutes.
Mr. HATCH. I yield the floor.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Madam President, I yield 4 minutes to the Senator from
Rhode Island and ask unanimous consent that notwithstanding the quorum
calls, I be recognized for 2 minutes immediately prior to the vote.
The PRESIDING OFFICER. Without objection, it is so ordered.
The Senator from Rhode Island.
Mr. WHITEHOUSE. Madam President, I thank Chairman Baucus and Ranking
Member Grassley and the distinguished Senator from Utah, Mr. Hatch, who
have been so energetic in preserving, enhancing, and protecting this
plan. Rhode Island has a significant role, going back to the days of
John Chafee, whose name has been mentioned by Senator Hatch, and, of
course, through Senator Jack Reed, whose relentless advocacy for this
program is a legend on this floor.
My time is very short, so I will speak to a very simple point and
come back and speak more to the children's health issue later in the
debate.
It strikes me, as a new legislator, that legislating is about
choices. The distinguished Senator from Utah said this bill is
expensive, but it is the right thing to do. I would like to show two
charts to help illustrate the expense in some context.
This is a chart which illustrates the additional cost we are talking
about for children's health care in America, the subject we are
debating in these increments, the increase over the next 3 years. The
chart compares it to the cost to all of us of the Bush tax cuts going
to the 1 percent of the richest Americans. So is it expensive to spend
$2.1 billion on children's health care in 2008? It probably is. And is
it expensive to spend $5 billion on children's health care, increasing
it in 2009? Is it expensive to spend $7.9 billion? It probably is. But
this is an administration which is happy to spend $70 billion on the
richest 1 percent of America in the same year that they are fighting
about $2.1 billion to improve health care for children. They are
willing to spend $72 billion in the following year and $82 billion
after that. So in the context of comparing expense to doing the right
thing, it is a little bit expensive, but is it ever the right thing,
particularly in a world where we are judged by our choices.
Here is another demonstration of really the same principle. We are
talking about a cost spread over 5 years to help America's children
have health insurance. By comparison, the interest alone on the Federal
debt George Bush ran up with his tax cuts to the rich, just the
interest expense in the fiscal year 2007, is more than that. It is $46
billion. This administration is fighting about whether we should spend
$35.2 billion over 5 years for children's health insurance, poor
children's health insurance, versus the Gulf Stream gazillionaires' tax
breaks.
If you look to the President for leadership, you don't find it. What
you find in his budget is $5 billion across the whole period instead of
35, which, because of the increase in medical costs over that period,
it has been estimated would throw a million American children off of
health insurance.
What Chairman Baucus has done, what Ranking Member Grassley has done,
is work out a bipartisan compromise in the Senate that is the right
thing to do and not all that expensive.
I congratulate them.
I yield the floor.
The PRESIDING OFFICER. Who yields time?
Mr. GRASSLEY. I suggest the absence of a quorum.
The PRESIDING OFFICER. Without objection, the clerk will call the
roll.
The legislative clerk proceeded to call the roll.
Mr. BAUCUS. I ask unanimous consent that the order for the quorum
call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. BAUCUS. Madam President, I understand the Senator from Iowa
wishes to yield back the remainder of his time, and I understand that
under the order, I have 2 minutes remaining.
Mr. GRASSLEY. I yield back the remainder of my time.
Mr. BAUCUS. I have 2 minutes; is that correct?
The PRESIDING OFFICER. The Senator is correct.
Mr. BAUCUS. Madam President, there are a lot of points one could make
at this juncture. We will have time tomorrow and in the next several
days. The Senate is about to vote on the motion to proceed to the bill.
I understand Senators on both sides of the aisle will support it.
It is important to be on the bill. There are differing views within
this Chamber about how we get the reauthorization passed, but I don't
think there is much disagreement that we need to do something. If we
don't get to the bill, we are probably then not going to authorize the
Children's Health Insurance Program, and that is going to mean a lot of
kids are going to lose health insurance. So I urge Senators to vote to
proceed to the bill. I understand the Senate will vote to proceed, and
I think that is the right thing to do.
One point I want to make, in this very brief time, is there is some
illusion by some Senators as to some States providing CHIP to families
who are 400 percent of poverty, that somehow the Children's Health
Insurance Program is going to not only help low-income kids but help
high-income kids.
I understand that concern because it has been bandied about. But the
fact is, no State currently covers their children at 400 percent of
poverty. Only one State is thinking about it. That is New York. That
State would have to get approval--either with a waiver by HHS or have
their plan approved. I frankly doubt this current administration is
going to agree to do that.
I also point out, of all the children in the country covered by CHIP,
only 3,000 come from families above 300 percent of poverty. Only 3,000
children today come from families who are above 300 percent of poverty.
Frankly, that is an ideal calculation. That is less than one-tenth of 1
percent of the 6.6 million kids who are covered. So a very small
fraction of the children come from families who are above 300 percent
of poverty. They all live in the State of New Jersey.
I might also add, those 3,000 children in New Jersey represent about
2.4 percent of the children covered by the Children's Health Insurance
Program in that State--a very small percentage--and all these children
pay $1,400 per year for their health care, which is a contribution of
2.2 percent of their family income. Most families pay three or four
times that.
So this program--as the facts will show and the record will show--by
no stretch of the imagination is a program that is going to help high-
income kids. In fact, it is the opposite.
I urge Senators to vote to proceed to the health care bill.
Cloture Motion
The PRESIDING OFFICER. Under the previous order, pursuant to rule
XXII, the Chair lays before the Senate the pending cloture motion,
which the clerk will state.
The legislative clerk read as follows:
Cloture Motion
We, the undersigned Senators, in accordance with the
provisions of rule XXII of the Standing Rules of the Senate,
hereby move to bring to a close debate on the motion to
proceed to Calendar No. 58, H.R. 976, the Small Business Tax
Relief Act of 2007.
Harry Reid, Max Baucus, Bernard Sanders, Jeff Bingaman,
Ted Kennedy, Maria Cantwell, B.A. Mikulski, Barbara
Boxer, Daniel K. Inouye, Christopher Dodd, Patty
Murray, Benjamin L. Cardin, Barack Obama, Kent Conrad,
Dick Durbin, Ken Salazar, Blanche L. Lincoln, Jack
Reed.
The PRESIDING OFFICER. By unanimous consent, the mandatory quorum
call has been waived.
The question is, Is it the sense of the Senate that debate on the
motion to proceed to H.R. 976, an act to amend the Internal Revenue
Code of 1986 to provide tax relief for small businesses, and for other
purposes, shall be brought to a close?
The yeas and nays are mandatory under the rule.
The clerk will call the roll.
The assistant journal clerk called the roll.
[[Page S10227]]
Mr. DURBIN. I announce that the Senator from Delaware (Mr. Biden),
the Senator from New York (Mrs. Clinton), the Senator from Connecticut
(Mr. Dodd), the Senator from South Dakota (Mr. Johnson), the Senator
from Massachusetts (Mr. Kerry), the Senator from Arkansas (Mrs.
Lincoln), the Senator from Illinois (Mr. Obama), and the Senator from
Rhode Island (Mr. Reed) are necessary absent.
Mr. LOTT. The following Senators are necessarily absent: the Senator
from Kansas (Mr. Brownback), the Senator from Kentucky (Mr. Bunning),
the Senator from Idaho (Mr. Craig), the Senator from Idaho (Mr. Crapo),
the Senator from South Carolina (Mr. DeMint), the Senator from Nevada
(Mr. Ensign), the Senator from South Carolina (Mr. Graham), the Senator
from New Hampshire (Mr. Gregg), the Senator from Florida (Mr. Martinez)
the Senator from Alaska (Ms. Murkowski), the Senator from Alabama (Mr.
Sessions), and the Senator Alabama (Mr. Shelby).
Further, if present and voting, the Senator from Kentucky (Mr.
Bunning) would have voted ``yea.''
The PRESIDNG OFFICER. Are there are any other Senators in the Chamber
desiring to vote?
The yeas and nays resulted--yeas 80, nays 0, as follows:
[Rollcall Vote No. 285 Leg.]
YEAS--80
Akaka
Alexander
Allard
Barrasso
Baucus
Bayh
Bennett
Bingaman
Bond
Boxer
Brown
Burr
Byrd
Cantwell
Cardin
Carper
Casey
Chambliss
Coburn
Cochran
Coleman
Collins
Conrad
Corker
Cornyn
Dole
Domenici
Dorgan
Durbin
Enzi
Feingold
Feinstein
Grassley
Hagel
Harkin
Hatch
Hutchison
Inhofe
Inouye
Isakson
Kennedy
Klobuchar
Kohl
Kyl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lott
Lugar
McCain
McCaskill
McConnell
Menendez
Mikulski
Murray
Nelson (FL)
Nelson (NE)
Pryor
Reid
Roberts
Rockefeller
Salazar
Sanders
Schumer
Smith
Snowe
Specter
Stabenow
Stevens
Sununu
Tester
Thune
Vitter
Voinovich
Warner
Webb
Whitehouse
Wyden
NOT VOTING--20
Biden
Brownback
Bunning
Clinton
Craig
Crapo
DeMint
Dodd
Ensign
Graham
Gregg
Johnson
Kerry
Lincoln
Martinez
Murkowski
Obama
Reed
Sessions
Shelby
The PRESIDING OFFICER. On this question, the yeas are 80, the nays
are 0. Three-fifths of the Senators duly chosen and sworn having voted
in the affirmative, the motion is agreed to.
Mr. REID. Madam President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. BROWN. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER (Mr. Sanders). Without objection, it is so
ordered.
Central American Free Trade Agreement
Mr. BROWN. Mr. President, 2 years ago this week the House of
Representatives forced through the Central American Free Trade
Agreement, the dysfunctional cousin of the job-killing trade agreement,
NAFTA, the North American Free Trade Agreement. CAFTA expanded NAFTA
into five Central American countries and the Dominican Republic despite
widespread bipartisan opposition to it in the United States, in Central
America, and in the Dominican Republic.
During the CAFTA debate, the largest ever bipartisan coalition was
formed in opposition to CAFTA and in support of fair trade, a very
different direction in our trade policy. A coalition of farmers,
ranchers, cattlemen, small business men and women, labor groups, human
rights organizations, consumer and environmental and faith groups
connected the widespread opposition to NAFTA around the country, with
Democrats and Republicans, were standing up to the President.
CAFTA passed but not on its merits. In the middle of the night, the
vote was held open until enough arms were twisted to secure a win in
the House of Representatives by only two votes. CAFTA passed by the
slimmest margin of any trade agreement in the modern era. That was
because of the overwhelming opposition by those of us who support fair
trade. We forever changed the debate on trade.
Make no mistake, we want trade. As Senator Dorgan says, we want trade
and plenty of it. However, 2 years after CAFTA, supporters of the
failed NAFTA-like model still are trying to force through Congress more
of the same--more job-killing trade agreements that hurt U.S.
businesses and that exploit workers in developing nations, more
fundamentally flawed agreements designed to protect multinational
corporations, and big drug companies. They are protectionists all
right; they protect large corporations, especially the large drug
companies.
More trade agreements can send our trade deficit soaring and
hemorrhaging U.S. jobs. In 1992, the year I first ran for the House of
Representatives, our trade deficit was $38 billion. Last year, it
exceeded $800 billion. From $38 billion, that is an increase of more
than 20 times. The first President Bush said for every billion-dollar
trade agreement or deficit, it translates into 13,000 jobs. You do the
math on what an $800 billion trade deficit means.
CAFTA was passed by two votes. Since CAFTA passed 2 years ago this
last week, how has it done so far? CAFTA proponents told us if it
didn't pass, poverty would get worse in Central America; CAFTA would
promote economic growth, curb the violence in Central America, and
serve as a model for strengthening democracy. Let's look at the region
2 years later.
Violence and murders continue to silence the opposition to CAFTA
throughout Central America. State violence was responsible for the
death of several CAFTA demonstrators in Guatemala. Since 2001, more
than 2,500 women and girls have been brutally murdered in Guatemala.
Many work in factories built for export and make just a few dollars a
week. The Guatemalan Government failed to bring those responsible to
justice. And we reward that Government with a free-trade agreement.
Four Guatemalan police confessed in the murder of three Salvadoran
legislators whose crime was they opposed CAFTA. Despite the threats of
violence, still thousands of people are protesting CAFTA in Central
America.
CAFTA promoters also said the trade deal would strengthen labor
rights. U.S. Trade Representative Zoellick told us:
If CAFTA stumbles, labor rights in Central America will not
be strengthened.
The reality is, there have been disturbing developments in the
region, including the recent passage by the Honduran Government of a
law to create ``exception zones'' that will allow foreign factories to
pay less than the national minimum wage in the southern part of the
country. The national minimum wage--think how low it is. It is only a
few dimes an hour. This whole idea of a trade agreement is to lift up
standards. That is what they say, but what they do is have an exception
even from the low wages for foreign companies to come in and pay an
even lower wage.
In Guatemala, forced laborers, most of whom are well under the age of
18, are coerced to work 10- to 14-hour days, 6 or 7 days each week.
In Nicaragua, the human rights ombudsman alleges that nearly half of
the female employees working in free-trade zones had been subject to
physical or sexual abuse.
Consistent with its history of repeating the same act and expecting
different results, the administration now wants Congress to approve
deals with Peru, Panama, Colombia, and South Korea--still using the
failed NAFTA-CAFTA trade model. I think it was Albert Einstein who said
the mark of insanity is doing the same thing over and over and over and
expecting a different result. This President continues to try to push
through trade agreements.
NAFTA failed. PNTR with China is causing a hemorrhaging of industrial
jobs from Ohio, in Stubenville, Toledo, Dayton, Cleveland, Canton,
Portsmouth--from all over our State. Yet the President continues to
push these kinds of trade agreements with Peru, Panama, South Korea,
and Columbia through Congress.
This fall, Congress will debate these new free-trade agreements, and
this fall I look forward to working with my fair trade colleagues in
the House and
[[Page S10228]]
Senate in changing our Nation's trade policy. It is clear that an
overwhelming majority of the American people want a very different
trade policy. It is clear that our communities, people all over my
State of Ohio and all over this country understand that these trade
policies have cost people their jobs, they have broken too many
families, they have hurt too many communities, and they have depleted
the manufacturing base in our country.
People want a different direction in trade. We want trade; we want
more of it. We want trade under different rules. That is why we demand
fair trade.
I yield the floor. I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Ms. SNOWE. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Ms. SNOWE. Mr. President, I wish to take this opportunity to speak
today on behalf of the legislation that is pending before the Senate to
provide health insurance to an estimated 3.2 million children in
America who will undoubtedly stand to benefit from this legislation.
I wish to voice my strong support as a member of the Finance
Committee for the Baucus-Grassley reauthorization of the State
Children's Health Insurance Program. I also extend my congratulations
to Chairman Baucus and Ranking Member Grassley, as well as chairman and
ranking member of the Health Care Subcommittee, Senator Rockefeller and
Senator Hatch, for their visionary leadership and tireless perseverance
in crafting this package, which has received such broad bipartisan
support on the committee--and hopefully on the floor as well--and never
losing sight of the overarching goal of obtaining health insurance for
uninsured children.
I can well recall in the Senate more than 5 years ago when Senators
Hatch and Kennedy originally authored the legislation that paved the
way for this unprecedented program which was supported by the Federal
Government in partnership with the States in recognizing that one of
the most vulnerable populations in this country was left without health
insurance. This really did engender strong support across the board in
the Senate and in Congress, and in every State in the country it has
been remarkably successful. That is why I think that record of
experience should bode well for the passage of this legislation.
As many of my colleagues know, Senator Rockefeller and I introduced
separate SCHIP legislation earlier this year, a bill that is
cosponsored by more than 22 Members of this body. Many of the elements
of that legislation have been incorporated into the legislation that is
pending before us today.
Although there are some key components that are absent, I think
overall the core issues that are so essential to bolstering a strong
program for the future have been inserted in this legislation.
This is a strong bipartisan bill, authored in a bipartisan fashion,
and was reported out of the Finance Committee with an overwhelmingly
strong support with a 17-to-4 bipartisan vote. Time and again, we talk
about the value of setting partisan politics aside and working together
to produce solutions for the problems confronting the American people.
If there is ever a time to turn our words into action, that time is
now.
So the legislation today, while neither perfect nor ideal, represents
a strong consensus in response to a growing epidemic in our Nation
today, which is a lack of health insurance among working Americans of
limited means.
As many of my colleagues are aware, the SCHIP program is not for
children below the poverty line. They are already covered by Medicaid.
Rather, SCHIP provides fallback health coverage for children of working
men and women above the poverty line who nevertheless have been unable
to obtain even basic health care for their families, most often because
of lack of health coverage at work and the prohibitively expensive cost
of individual policies on the private market. In fact, nearly 90
percent of the uninsured children come from families where at least one
parent is working and in households earning less than $40,000 per year,
which is 200 percent of poverty, and fewer than half are offered
employer-sponsored health insurance at work. This is a 9-percent drop
since 1997. So, obviously, that is moving in a different direction,
unfortunately, and that is because of the prohibitive costs that have
been associated with health insurance plans recently.
For many working families struggling to obtain health care benefits
even accessible to them, the costs are moving further and further out
of their reach. The anguish of those who work hard to make ends meet
yet still cannot afford to pay for health coverage for their children
is truly devastating. Parents without access to affordable health
insurance for their children live in constant anxiety. They face
decisions no parent would ever want to have to confront as to whether
their child is really sick enough to go to a doctor. They worry every
day about their children doing simple activities, worrying because they
can ill afford the consequences of a broken arm or a sprained ankle.
Their only alternatives is to ratchet up their credit card balances,
often irrespective of mounting debt. That is why this SCHIP program has
been such a saving grace for so many families. It has been the one
remarkable program which has led to a substantial reduction in the
number of uninsured.
Some may say that $35 billion over 5 years, which is the estimated
cost of this program, will only cover an additional 3.2 million
children--that it will cost $2,188 per child. But I happen to believe
this is just further illustration of how health care costs continue to
spiral out of control. The staggering cost of an individual policy with
reasonable coverage is a reality families without health insurance
confront every day.
Today, the income eligibility for the Children's Health Insurance
Program in my State of Maine is 200 percent of poverty, $41,300 per
family of four. An uninsured parent who wants to buy coverage for their
child on the individual market with a $250 deductible and 20-percent
coinsurance can expect to pay $8,777 a year. This should hardly be
surprising given that a family of four seeking to purchase a health
insurance plan on the individual market will typically pay in excess of
$24,000 per year. That is $24,000 per year. So when people talk about
the fact that this is going to cost $35 billion for 3.2 million
children, that is a cost of $2,188, a price that no individual, no
family could possibly hope to obtain to provide health insurance for
their family. That is why this Children's Health Insurance Program is
so essential and critical to working families.
In 1998, a year after Congress passed this program, 14 percent of
children in Maine were uninsured. Within 5 years, the number of
uninsured in Maine dropped to 7 percent and has remained at that level.
This is, at the same time, a dramatic improvement in health coverage as
well as a definitive statement that a great deal more work remains if
we are to address the critical issues of affordability and
accessibility of health insurance, especially as they relate to health
care for our children.
That is why I am so pleased that the Baucus-Grassley bill before us
provides a significant increase in Federal investment in the Children's
Health Insurance Program beyond the reauthorization of the status quo
because States not only require sufficient Federal funding to ensure
that children currently enrolled in the SCHIP program do not lose
coverage and become uninsured, but they also need additional funding to
enroll more uninsured children.
Most critically, this legislation increases the Children's Health
Insurance Program coverage to children in households earning up to 300
percent of poverty level. That was one of the central pieces of the
legislation Senator Rockefeller and I introduced earlier this year. It
also adopts another key Rockefeller-Snowe component by ensuring
coverage for pregnant women--a long overdue upgrade in the program that
rightfully has gained broad support in this Chamber.
I believe the Finance Committees's approach to SCHIP is a balanced,
carefully considered package worthy of the Senate's support. I wish to
address
[[Page S10229]]
some of the opposition that has arisen to this bill because I think it
is important to address some of these comments and complaints.
While I acknowledge my colleagues' sincerity in searching for
solutions to our overall national uninsured program and I, in fact,
support some of the proposals they offer, I must assert that now is
neither the time nor the place for attempting to move these legislative
proposals. With the September 30 expiration date on SCHIP fast
approaching, we simply must take care of children first.
First, we heard the unfortunate veto threat issued by the White
House, and I am dismayed by this stance because it seriously misjudges
the concern Americans have about access to health care, especially for
children and especially for this program.
Year after year, poll after poll affirms that access to affordable
health care is the No. 1 domestic priority of Americans. Moreover, in a
March New York Times/CBS News poll, 84 percent of Americans surveyed
said that they supported expanding the Children's Health Insurance
Program to cover all uninsured children. That was 84 percent of the
American people, obviously across the political spectrum. By its very
nature, it includes Republicans, Independents, as well as Democrats. A
similar majority said they thought the lack of health insurance for
many children was a very serious problem for this country. So to stand
in the way of these efforts which are presented to the Children's
Health Insurance Program demonstrates a stark disregard for the wishes
of the American people.
Let there be no mistake, I think the public would hold us all
accountable if we failed to reauthorize this program but also to make
future investments in this program. I think undeniably the problem
deserves to be recognized.
Some of my colleagues will say the SCHIP reauthorization is the first
step toward Government-run health care and that we will substitute
public coverage for private insurance. This is patently untrue,
especially because most Medicaid and SCHIP beneficiaries receive
coverage through the private plans that contract with their States. For
instance, 73 percent of the children enrolled in Medicaid receive most
or all of their health care services through a managed care plan. Far
from scaling back private coverage, this bill actually shores up
employer-based coverage by giving States the option to subsidize
employer-sponsored group health care for families for whom coverage is
cost prohibitive. Moreover, the bill targets incentive payments only to
enrollment of low-income children under 200 percent of poverty, which
is, as I said earlier, $41,300 for a family of four, who are least
likely to have access to private coverage in the first place.
Some others will argue that SCHIP could reduce or eliminate coverage
for adults, especially childless adults. Although I believe that
coverage for adults can have a clear benefit for children, both in
terms of enrollment for children as well as the fact that health
problems for a working parent can lead to economic insecurity for a
family, I recognize the opinion of those who desire to place a greater
emphasis on covering children, and that is why this compromise
legislation phases out coverage of adults.
I find it interesting, if not somewhat contradictory--I know the
administration has been very vocal about the cost and scope of the
legislation before us. But this is the same administration which has
granted the State waivers to allow States to cover adults for the past
6\1/2\ years and just 2 months ago renewed waivers for adult coverage.
Clearly, the trend from the administration was to grant State waivers
recognizing the importance of insuring parents of uninsured children
because, as we have seen time and time again, if a parent is insured,
more likely the child will be insured as well and be part of the SCHIP
program.
Others may argue that the cost of this legislation is too high, given
that the baseline program is $25 billion. But I also would respond that
the $35 billion that is placed in this bill is $15 billion below the
amount we provided in the budget resolution and fully offset. This is a
direct product of the negotiations that occurred within the Finance
Committee to reach a compromise and consensus across the political
aisle, and I applaud them for the efforts they made. We know the
legislation before us will insure 3.2 million. There is probably at
least another 5 or 6 million children who may be uninsured. So we
haven't addressed the problem in its entirety.
I wish we could have gone the extra mile to do everything we could to
reach all the children who are uninsured in America, but I believe this
bill is the opportunity to push forward with the most important piece
we can at this moment in time in reaching a consensus to address at
least 3.2 million because it is $35 billion in addition to those who
are already covered, which is an additional $25 billion.
I know some would suggest this is another way of advancing
comprehensive health care reform. I think there is no question we all
desire to address the most grappling domestic problem we face, and that
is the issue of the uninsured, of which there are more than 47 million
Americans who now lack health insurance. That is certainly the most
preeminent domestic policy issue of our time. But if we cannot begin
with insuring our children, how can we possibly address the larger
population? This is a problem we must tackle, undeniably.
Unfortunately, many of the proposals that are being discussed have not
obviously been vetted yet for consideration through the committee
process, and I am concerned that ultimately it will affect this
legislation before the Senate.
For example, I have heard that possibly the Small Business Health
Insurance Plan will be attached to the pending legislation. As the
former chair and now ranking member of the Committee on Small Business,
I have long championed and been an advocate for the Small Business
Health Insurance Plan. In fact, I crafted my own legislation more than
4 years ago, so it is an issue I have advocated for a considerable
period of time and clearly one that needs to be addressed. But I would
hope we could consider that as a separate component. The fact is it
deserves to stand alone in consideration, as we tried to do last year
but, unfortunately, could not reach the 60 votes necessary to overcome
the cloture vote.
There is no question we ought to address that particular issue. At
this moment in time, since we are nearing a deadline of September 30
with respect to the reauthorization of SCHIP, I think it is important
we stay on track in the Senate and address the other issues related to
health insurance at a later point in time. I hope Members of the Senate
will set aside those amendments and give their strong support to this
legislation.
I think there is no question we have to work to achieve a consensus
on health care as a larger question, without a doubt, as we were able
to accomplish on this legislation which provides health insurance for
uninsured and insured children in America. But I hope my colleagues
will see the true benefits of this legislation and support this package
that is before us today. I hope we will not be sidetracked with
additional amendments, as I said, whether it is on the Small Business
Health Insurance Plans or providing for tax credits or health savings
accounts. I do think all those issues are critical and should be
addressed in their entirety but not as part of this legislation that
ultimately could erode the bipartisan support that has been developed
for this critical piece of legislation before us today.
I hope we will pass this bill and allow the States to increase the
SCHIP eligibility up to 300 percent, which will be the first time that
has been allowed by the Federal legislation. I think the data available
demonstrates that drawing the eligibility line at 300 percent of
poverty will help maximize the number of children we assist with this
legislation. In Maine alone, for example, approximately three-quarters
of uninsured children are from families with incomes at 300 percent of
poverty or below.
The Baucus-Grassley bill also provides States the option to provide
health coverage for pregnant women, a policy that has garnered
longstanding, well-deserved bipartisan support. The fact is, proper
prenatal care can reduce the likelihood of having a preterm baby, and
routine care for pregnant women can detect health conditions affecting
the mother as well as the baby. Sometimes these medical problems can
[[Page S10230]]
be addressed before the child is born. So I think this is an important
adjunct to this legislation.
I am also pleased the bill includes the Lincoln-Snowe amendment that
was adopted in the committee on the development of pediatric quality
measures aimed at reducing preterm births as well. Our country has one
of the highest rates of infant mortality among industrialized nations.
That is a disgrace in a land with our wealth and our means. Coverage of
pregnant women, coupled with quality measures on reducing preterm
birth, will help turn around those unacceptable statistics. Investing
in good prenatal care saves money too. According to the March of Dimes,
health care costs for babies born prematurely are nearly 15 times
greater than for full-term babies.
I hope the Senate will provide strong bipartisan support for this
legislation. I think we should recognize the success of this program
and what it has managed to accomplish over the last 5 years with strong
Federal support. I think it is an ideal partnership with the States,
which have been extremely successful and effective in the way they have
administered this program.
What is also important about this legislation is that we revised the
formula so we do not penalize States that do an excellent job of
reaching out and continuing to insure more and more children. We don't
want to reward just the status quo. So we revised the formula to take
into account the States' experiences and how they have been able to
succeed in covering low-income, uninsured children so they do not see
their allotment drop as a result of being so successful.
That is the way it has worked in the past. If, for example, States
have been very good at being able to insure many children in their
States, many more than maybe some of the other States, they would lose
part of their funding. So we have revised the formula so there isn't
this perverse disincentive to cover more children. We should recognize
success and make sure it is rewarded.
Finally, I was disappointed, and I know the Chair has been a strong
advocate for this as well, that we were not able to provide dental
coverage for children. It is something I attempted in the committee,
and it was included as part of the Rockefeller-Snowe legislation to
address this issue. The chairman of the committee, along with the
ranking member, agreed to include a $200 million Federal grant that is
specifically targeted to States to boost their coverage of dental
benefits. I am disappointed we don't have a guaranteed dental benefit
because I think it is long overdue and is something we should recognize
is a critical dimension to health insurance.
We have known of so many examples of tragedies that have occurred and
one most recently in Maryland, where a young boy died because he had an
abscessed tooth. An extraction would have cost $100. He ultimately
died. They spent more than $200,000 trying to save his life, but,
unfortunately and tragically, they did not. Think about what might have
been had he had dental coverage--simple dental coverage.
Hopefully, we will be able to achieve some kind of support for a
compromise. I know I am not satisfied with the fact that we don't have
that guaranteed benefit, but I am pleased we do have a $200 million
Federal grant as part of this program and that will be the beginning of
that process of providing dental benefits. I do think, ultimately, we
need to incorporate it as part of the underlying and fundamental
package of health insurance.
I thank the Chair and Members of the Senate for the opportunity to
address this issue. I believe that in the long run we are taking a
critical stand toward insuring more children in this country, and,
hopefully, we can do more. I think the package before us is fiscally
responsible. It provides for an offset with a 61-cent increase in the
tobacco tax. I know there are those who do not support such a tax
increase, but nevertheless, the 61-cent increase will help not only to
completely offset the additional cost of this program of $35 billion,
but it also will prevent nearly 1.9 million children from ever starting
to smoke, it will help nearly 1.2 million adult smokers quit, it will
prevent more than 900,000 smoking-caused deaths, and it will produce
$43.9 billion in long-term health care savings. So even if an increase
raises money in the short-term but levels off because, more
importantly, fewer people will smoke, that is a win-win situation.
I hope the Senate will look to the strong 17 to 4 vote coming out of
the Finance Committee, which is indicative of the broad bipartisan
support. Also, it is an example of what we can accomplish when we set
aside our political differences in order to do the right thing for
children in America. Compromise is essential, and that certainly has
been the hallmark of this effort.
We are poised to see a renewal of one of our most uniquely successful
initiatives when it comes to a health insurance program for children.
This will send a very strong signal to hard-working American families
whom the Federal Government is prepared to provide the support to help
their children and to help their families as they struggle to meet one
of the basic necessities of their life. More importantly, I hope, we
will reach the time when we will address the larger question of the
uninsured in America because it is long overdue and is a vital
necessity for millions and millions of Americans.
I yield the floor, and I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. SPECTER. Madam President, I ask unanimous consent the order for
the quorum call be rescinded.
The PRESIDING OFFICER (Ms. Klobuchar). Without objection, it is so
ordered.
____________________