[Congressional Record Volume 153, Number 124 (Tuesday, July 31, 2007)]
[Senate]
[Pages S10340-S10342]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          QUALITY HEALTH CARE

  Mr. CORNYN. Mr. President, I want to turn to the topic that will 
engage us for perhaps most of the remainder of the week, and that is 
ensuring that quality health care is available to the next generation. 
This is, and should be, a top public policy priority for the Congress. 
Certainly, it is one of mine.
  I think there will be a lot of attention paid to the reauthorization 
of the State Children's Health Insurance Program that will be on the 
floor shortly. It is noteworthy that SCHIP, so called, was created by 
Congress in 1997 to fill a gap in our health insurance system. It was 
targeted at working poor families who had too much income to qualify 
for Medicaid but could not afford regular health insurance. This 
program has been enormously successful nationwide, lowering the 
uninsured rate by nearly 25 percent, and especially in my State of 
Texas, where we have about 25 percent of our total population currently 
uninsured. So this has gone a long way to make sure people got access 
to quality health care. Interacting with Medicaid, insurance coverage 
has been extended under this program to more than 1 million Texas 
children who would have otherwise not been covered. So SCHIP deserves 
reauthorization and renewal.
  Unfortunately, the Senate Finance bill that will come to the floor 
seems to take us on a path toward a major step that failed in 1994, and 
that is a federally funded takeover of national health care. The Senate 
Finance Committee is proposing a near quadrupling--that is four times--
of SCHIP funding that would increase taxes, weaken private insurance 
coverage, and create a new de facto entitlement program for middle-
class families, all courtesy of the beleaguered American taxpayer. A 
close analysis demonstrates that, if enacted, the Senate bill would 
actually have the unintended impact of degrading health care for many 
children and will not be as nearly beneficial to Texas as a more modest 
alternative, which I intend to support.
  The original SCHIP program--again, it is worth spelling out the 
acronym--State Children's Health Insurance Program--was limited to 
those families at up to 200 percent of the official poverty level or 
$40,000 for a family of four. But some States have found a way to 
expand coverage from first children, then to parents, then to childless 
adults, and then to families with much higher incomes. Some States, 
such as New Jersey, now use SCHIP funds to cover families with income 
of up to 400 percent of the poverty level--up to $82,600 a year for a 
four-person family. So that is what I mean when I say that SCHIP is now 
being transmogrified, transformed into a middle-class entitlement, if 
this finance bill were to pass.
  Minnesota, instead of using the State Children's Health Insurance 
Program to target relatively low-income children, as Congress intended, 
spends 61 percent of SCHIP funding on adults; and Wisconsin spends 75 
percent of their SCHIP funding on adults. If this were the U.S. 
military, we would call this ``mission creep.'' The Senate bill would 
encourage these distortions further. Nearly a third of the newly 
covered, some 2 million children, already have private insurance.
  So let me be clear. What this bill, if enacted, would do would take 
some people who currently have private insurance and substitute 
taxpayer-paid-for insurance under this program because, of course, why 
would anybody pay for something that the Government starts giving away 
for free? They will drop their private insurance and many of the 
parents will decide to drop theirs as well, transferring these expenses 
to the American taxpayer.
  But many SCHIP programs pay physicians at Medicaid rates; that is, 
the reimbursement for physicians--a reimbursement rate that is so low 
that many doctors simply cannot afford to take patients based on those 
Medicaid rates and, thus, they are refusing new patients. Ironically, 
the switch to Government-paid SCHIP could mean reduced health care for 
those recipients who decide to give up private insurance to get free 
insurance. But where reimbursement is at the Medicaid rate, where there 
are so few doctors who can afford to treat patients at those rates, 
children will end up with actually less care in some instances and not 
more.
  Many supporters are happy because funding for this expanded program 
will be paid by tobacco users, through a 61-cent per pack cigarette tax 
increase. But the accounting is fundamentally flawed. To make it 
balance, the Senate bill pretends spending on this accelerating program 
will go from $8.4 billion in 2012 to only $400 million in 2013.
  As our Republican leader notes, ``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. This is phony accounting. No business in America could run its 
operations this way, and the Federal Government should not try.

  Supporters of the finance bill claim a badge of fiscal responsibility 
because this bill only uses $35 billion of the $50 billion budget 
authority it was given during this year's budget reconciliation. But 
the finance bill gets that additional $15 billion in budget authority 
by setting aside billions of dollars for a so-called incentive fund. 
The SCHIP program was designed as one huge incentive already for the 
States. The creation of this program says to the States: Go cover 
children; Congress will give you more money for doing that than we will 
for covering anyone else.
  So why are we creating an incentive on top of another incentive? And 
these

[[Page S10341]]

incentive payments, of course, will be used to go beyond covering 
children, which is, of course, Congress's original stated intent.
  This goes from what I would call mission creep to another incremental 
step toward a federally controlled, Washington-dictated health care 
system, paid for by huge tax increases on the American taxpayer. 
Perhaps the answer is that this fund exists to provide expanded 
coverage for nontargeted populations; that is, populations Congress did 
not intend--adults, for example. After all, States, under the Finance 
Committee bill that is coming to the floor, will have relative freedom 
to use these funds as they see fit. Where, I ask, is the 
accountability? Where is the responsibility?
  The finance bill also puts aside at least $2 billion in a so-called 
contingency fund. First an incentive fund, then a contingency fund--
both slush funds. But this contingency fund will only be drawn down by 
$400 million total over 5 years. This represents less than 1 percent of 
overall spending. I think this blatantly shows the level at which this 
bill is overfunded. So while the bill is only claiming to spend part of 
the budgetary authority it is given, it is still creating two budgetary 
slush funds. I think it is there for another purpose. I think this is 
another attempt, as I said, to incrementally federalize health care.
  There will be some of us who will join together, with our leader and 
Senator Lott, Senator Kyl, and others, to offer a scaled-down 
alternative called Kids First, which refocuses SCHIP on its intended 
purpose. It concentrates on outreach--locating and enrolling eligible 
children. Some 75 percent of uninsured children already qualify for 
either Medicaid or SCHIP. Kids First aims to sign them up. It also 
subsidizes eligible families to keep their private coverage and doesn't 
provide an incentive for them to drop their private coverage to get 
free coverage courtesy of the American taxpayer.
  The Senate bill increases spending by $35 billion over 5 years--I 
should say so far because I know there are amendments that will be 
offered, and I think I have read Senator Kerry and others will offer 
amendments to bump that figure to $50 billion, and we have seen even 
larger figures suggested on the House side. So no telling what a 
conference committee will ultimately come back with. But Kids First, 
the alternative which will be offered by this side of the aisle, will 
cost only $10 billion more than the current SCHIP program.
  Ironically, under Kids First, the children in my State, Texas, would 
come out far ahead over the Senate Finance Committee version. SCHIP, as 
we know, is a joint Federal-State effort involving matching Federal 
funds. After cutbacks for budget reasons a few years ago, Texas is now 
ramping up its SCHIP program, enrolling additional eligible children. 
However, the Senate Finance Committee bill would confiscate about $660 
million that Texas has so far left unspent from prior years because we 
have been responsible, because we haven't used the money that was 
designated for children to cover adults, as 14 other States have. Under 
Kids First, we would keep access to all unspent funds for 2 more years 
so we can locate and recruit and sign up more children--the designated 
target for this Children's Health Insurance Program.
  But here is the bottom line: Texas would have $1.6 billion in SCHIP 
Federal matching funds available next year under Kids First and only 
$1.06 billion under the Senate bill. In other words, we would be better 
off under the alternative rather than the Senate Finance Committee 
bill, and so would the children, who would be the beneficiaries of 
those funds. Additionally, any matching funds left unspent after that 
would go back to the U.S. Treasury, and that would not be used to 
subsidize other States that game the system and distort the program 
beyond Congress's original intent.
  One alternative provides the prospect of better health care for Texas 
children, plus lower taxes, a fiscally responsible government, and more 
money and more control for my State. For this and other reasons I have 
stated, I will vote for the Kids First Act, the alternative we will 
offer, and not the Senate Finance Committee bill.
  Mr. President, I yield the floor and reserve the remainder of our 
time for the Senator from New Hampshire.
  Mr. GREGG. Mr. President, how much time remains?
  The ACTING PRESIDENT pro tempore. Sixteen minutes and twenty seconds.
  Mr. GREGG. Mr. President, I wanted to rise to carry on the discussion 
which the Senator from Texas has so eloquently begun relative to the 
proposal that is coming forward to the Senate today called SCHIP. Under 
the cloak of trying to address the issue of health care for children, 
we are seeing an explosion in cost, the purpose of which is not 
necessarily to cover children who need coverage because many of the 
children who are going to be covered here are already covered under 
private plans, but the purpose is actually to dramatically expand the 
role of government in the area of limited health care in this country, 
and it is openly acknowledged as being an effort to move down the road 
toward universal health care.
  Independent of the substantive policy of how we approach insuring and 
making sure children get health insurance in this country, there is the 
ancillary policy of fiscal discipline. This Congress, so far, under its 
Democratic leadership has abandoned the concept of fiscal discipline. 
They are spending money on all sorts of initiatives around here that go 
well beyond even the extraordinarily high numbers which were put in the 
budget under this Democratic Congress. We have returned, without 
question, to the days of tax and spend. In fact, it was interesting 
today that there was an article in the Wall Street Journal, an 
editorial that listed I think it was ten different areas where there 
have been proposals to dramatically increase the tax burden on the 
American people, to gather up funds by the Democratic Party so they can 
then be spent on other initiatives.

  This proposal, this SCHIP proposal as it comes forward to us under 
the auspices of the liberal leadership of the Senate, is a classic 
example of spending which can't be afforded and spending which uses 
gimmicks in order to mask its real costs.
  This chart reflects the fact that the spending in this proposal jumps 
$35 billion--$35 billion--over a 5-year period, taking a program that 
could be fully funded today for about a third of that but adding an 
additional two-thirds on top of that in order to take care of 
initiatives which basically fund two things: No. 1, they fund adults 
under a children's health insurance program, and No. 2, they fund 
bringing children off of private insurance and putting them on the 
public insurance system so that taxpayers generally have to pay for 
something which is now being paid for in the private sector.
  So the cost of this program jumps radically over the next 5 years, 
and then, in the ultimate act of fiscal cynicism and fraud, they claim 
the program will drop back down to being a $3.5 billion program after 
it has reached a peak of $16 billion in 2012. Are they going to abolish 
the program in 2013? Of course not. But in order to avoid their own 
rules of how you have to pay for things around here or are supposed to 
pay for things around here when you put a new program on the books, in 
an act, as I said, of fraud and cynicism, the liberal leadership of 
this Senate has decided to claim that this program, which we will be 
spending $16 billion on in 2012, we will suddenly only spend $3.5 
billion in 2013. Ironically, that number, $3.5 billion, is even less 
than what the program costs today, which is about $5 billion.
  So this whole area in here, this white area, is totally unfunded, 
unless you assume this program now being put on the books is going to 
suddenly end 5 years from now--which is, of course, absurd. We don't 
end programs in the Federal Government. We certainly don't end a 
program that is focused on trying to fund health care for children. So 
what happens is that $40 billion over the next 5 years which will be 
spent on this program, no doubt about it--in fact, a lot more than that 
if the House bill passes--is treated as if it is a virtual number, as 
if it doesn't exist, as if it is some sort of nonspending event by an 
accounting mechanism which claims that actually we are not going to 
spend that $40 billion, we are just going to spend this $3.5 billion on 
that program on an annual basis.

[[Page S10342]]

  The disingenuousness of this reaches a new level of misrepresentation 
to the American taxpayer as to what the burden is that is going to be 
put on them as a result of this proposal. Now, why do they do this? Why 
do they deny there is $40 billion of spending, which they know is going 
to occur, which my colleagues on the other side of the aisle absolutely 
know is going to occur? Why do they deny it is going to happen? Why do 
they use this gimmick where they claim we are going back to a cost of a 
program which is less than it is today after we put a cost on the books 
that is three times what it is today? Because they want to avoid 
something called pay-go--pay-go--which is their representation of how 
they discipline the Federal budget.
  Every time you listen to a colleague from the other side of the aisle 
talk about disciplining the Federal budget, you will hear those words: 
I am for pay-go; I am for pay-go. We hear it from the budget chairman 
incessantly. We hear it from other members of the other side of the 
aisle. Pay-go is the way we will discipline the Federal budget.
  Well, let's see what they have done to pay-go since they have been in 
charge of the Congress. There is no more pay-go. It should be fraud-go. 
It is actually Swiss cheese-go since this Congress has been dominated 
by the Democratic Party.
  I will bet you that everybody who ran for election from the 
Democratic side of the aisle to this Congress said they were going to 
discipline the Federal deficit using pay-go. Since they have been in 
office, since they have been running this Congress, they have either 
waived or gotten around pay-go on about 12 different occasions, 
representing billions of dollars of cost to the American taxpayer, of 
which this $40 billion item we are doing today is one of the biggest. 
With minimum wage, they went around pay-go; with the Water Resources 
Development Act, they went around pay-go; with PDUFA, they went around 
pay-go; with immigration reform, they went around pay-go; with the 
Energy bill, they went around pay-go; with the MILC bill, they went 
around pay-go; with the county payments or payments in lieu of taxes, 
at $4 billion, they went around pay-go; with the new mandatory Pell 
grants, $6 billion, they went around pay-go; and now here, with SCHIP, 
they are going around pay-go to the tune of $40 billion. Almost $90 
billion has been proposed to be spent by the other side of the aisle 
since they took control of this Congress which should have been subject 
to pay-go but where they have either waived, ignored, or gimmicked pay-
go out of existence. So where is the fiscal discipline? It doesn't 
exist. It doesn't exist.
  The only thing they intend to use pay-go for is to force taxes to go 
up on American workers. They will use it for that, there is no question 
about that. When we get to the point where some of these tax issues are 
raised by expiring, they will say pay-go applies to that and we have to 
pay for that, so taxes will go up on the American workers and on the 
American economy. But when it comes to spending money, there is no 
discipline of pay-go from the other side of the aisle.
  Anyone who stands on the other side of the aisle and claims that pay-
go is a viable vehicle for disciplining the Federal deficit, well, the 
next thing they are going to tell you is they have a bridge to sell you 
in Brooklyn or that the check is in the mail.
  The simple fact is, it is a fraud on the American taxpayer when that 
statement is made. This bill pretty much completes the thought that 
there is no more pay-go.
  Then, on top of that--they are not comfortable enough in this bill to 
spend $40 billion and claim they are not spending it, which is exactly 
what they do in the second 5 years--that is not enough for the other 
side of the aisle. In the House, they put in language repealing one of 
the most important enforcement mechanisms to discipline the cost of 
Medicare, which is, if for 2 years the payment for the cost of Medicare 
from the general fund exceeds 45 percent of the overall cost of 
Medicare--as we all know Medicare is supposed to be an insurance 
program that is paid for by the HI insurance, but it also gets support 
by the general fund--if that cost exceeds 45 percent for 2 years in a 
row, then we, as a Congress, are supposed to take another look and say 
that is not the way Medicare is supposed to be funded. It is supposed 
to be funded through the HI insurance. We go back to look at 
disciplining Medicare spending and making it more affordable.
  No. Not any longer. The House of Representatives not only spends $40 
billion they claim they are not spending and don't pay for, they also, 
in their bill, repeal the 45-percent rule, one of the few disciplines 
around here which allows this body to stand up and say we are 
profligate. Let's get this under control.
  I think the American consumer needs to know that they get what they 
pay for. In the last election they got a Congress which has a 
philosophical viewpoint which has not changed a whole lot in the last 
50 years. I was here the last time Congress was dominated by the 
Democratic Party. I was here when Tip O'Neil ran the House of 
Representatives. Wow, did we spend money back then. Let me tell you, we 
are back to that style of governance. Only this time it is being done 
with the representation that there is discipline because we are using 
pay-go. Unfortunately, however, pay-go doesn't exist when it comes to 
spending. It is ``fraud-go,'' it is ``Swiss cheese-go,'' and the 
American people get stuck with the bill.
  Our children and our children's children get stuck with the bill 
because, in order to address certain political constituencies, the 
other side of the aisle believes it needs to spend the money, and it 
does not have the courage to stand up for its own rules, the rules they 
put forward.
  I have always said pay-go was a fraud, but the other side of the 
aisle marches behind that banner in budget after budget, claiming that 
pay-go gives us fiscal discipline. Here is $90 billion of spending in 
just 6 months. They have only been in charge for 6 months--$90 billion. 
That is a lot of money in 6 months that should have been subject to 
pay-go, which has been gamed, ignored, or claimed an emergency so that 
pay-go would not apply.
  As a practical matter, let's have no more talk of pay-go in this 
body. Let's talk about what we are really doing on this SCHIP bill. We 
are going to spend $40 billion, and we do not pay for it. That is just 
in the next 5 years. If you extrapolated this, it actually works out to 
be somewhere in the $2 trillion to $3 trillion range over the life 
expectancy of the program, the 75-year life expectancy, which is the 
way we calculate things around here that deal with entitlements.
  This is not fiscally responsible, and it is clear, if we continue 
down this path, we are going to set up a train wreck for those who come 
after us and have to pay the costs of this type of profligate spending 
which has no discipline attached to it.
  I yield the floor and suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. DURBIN. Mr. President, I ask unanimous consent the order for the 
quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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