[Congressional Record Volume 153, Number 144 (Wednesday, September 26, 2007)]
[Senate]
[Pages S12128-S12131]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SCHIP
Mr. GRASSLEY. Mr. President, soon the Senate will be debating the
Children's Health Insurance Program. I might refer to that from time to
time as CHIP, C-H-I-P, Children's Health Insurance Program.
This program is sunsetting in a week. The program was started 10
years ago, a product of a Republican-led Congress. It is a targeted
program. It is a program designed to provide affordable health coverage
for low-income children of working families. Those are families,
working families, who make too much to qualify for Medicaid but
struggle to afford private insurance and may not even have it.
Last July, because this program has to be reauthorized right now, the
Senate Finance Committee reported bipartisan legislation to enhance and
improve CHIP by a strong vote of 17 to 4.
In August, the Senate passed the Finance bill with the same
bipartisan support by a vote of 68 to 31. On Tuesday, 265 Members of
the House of Representatives voted for the bill that now will be before
the Senate. That bill is a product of informal conferencing between the
House and Senate. Clearly, we have a bill with strong bipartisan
support. I want to emphasize that because this is the way the Senate
Finance Committee has operated over a long period of time, both with
Republicans in control and Democrats in control. Senator Baucus worked
very closely with me when we were in the majority. Senator Baucus has
continued that working relationship now that Democrats control the
Congress and he is chairman of the committee. I welcome and appreciate
that bipartisan leadership. It is obviously represented in this product
that will soon be before the Senate.
This legislation maintains the fundamental provisions of the Senate.
I want to emphasize that it maintains the fundamental provisions of the
Senate bill not to denigrate the work of the House of Representatives
but as a reflection of the fact that we had to work out something that
would not be filibustered in the Senate. In the House of
Representatives they don't have such provisions for filibuster. The
House had some deference to the Senate. I appreciate that. But I also
appreciate the fact that a lot of my colleagues--and these are
Republican colleagues to whom I refer, not Democratic colleagues--said
so often during the months of consideration of this bill before we
finally passed it the first time that this $35 billion didn't mean much
that we passed in the Senate because the House of Representatives
passed a $50 billion CHIP bill and it would come back much bigger. I
tried to say to my colleagues at that particular time that there would
have to be a realization that if we were going to avoid a filibuster in
the Senate, we would have to have something closer to the Senate
provisions than the House. So I emphasize that this is pretty much the
legislation the Senate originally passed, albeit right now it is a
compromise between the House and Senate. There was a cap on new
spending of $35 billion. There are no Medicare provisions in this bill
as there were in the Senate bill. Spending is paid for by an increase
in the cigarette tax. I commend the majority in the House and Senate
for cooperating with Senate Republicans and for working with us on our
priorities during the negotiations that led to this agreement. This
compromise agreement is consistent with the principles we put forth in
the Senate bill.
Mr. REID. Mr. President, would my friend yield?
Mr. GRASSLEY. Of course I will.
Mr. REID. I was in my office with the TV on listening to my friend
from Iowa. I was compelled to come to the Chamber. I have been in
Washington for a long time as a Member of Congress. I served in other
offices before I came. All my adult life I have been involved in
government one way or the other. They were all part-time jobs until I
came back. The reason I came to the floor is that in my experience over
all these many years I have rarely seen anyone with the leadership that
this ranking member, former chairman of the Finance Committee, offered
with this very difficult children's health issue. I say that without
qualification. I have said it in closed meetings, and I have said it in
public meetings, and I say it before the American people this
afternoon. I wish we could have done more with this. I wish we could
have done more. But, as I said, and as the distinguished senior Senator
from Iowa heard me say in my office, in my years in government, I have
spent more time on this issue than anything else I have ever worked on.
We could not be at the point we are now but for the Senator from Iowa.
It has been very difficult. The House had to give up a tremendous
amount of what they wanted. The Senator from Iowa and I both served in
the House. They are two different institutions. It is difficult for the
House, from my having served there, to understand and appreciate the
difficulties we have here.
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I don't know how I can say more than what I have said. I am impressed
with the way Senator Grassley has handled this bill. We had difficult
issues that came with the House because they had so much, and we were
only going to offer them a lot less than what they wanted. But the
Senator from Iowa was firm. He was gracious. He was a gentleman through
it all.
As I have told a number of people, with Chuck Grassley, no one ever
has to wonder how he stands. It is not ``I will go talk to my staff,''
or ``I will get back to you.'' He told us in those meetings what he
could do and what he couldn't. I was compelled to come to the floor
because we had a real gesture of statesmanship by the Senator from Iowa
with this SCHIP legislation.
Mr. GRASSLEY. Mr. President, before the distinguished Senate majority
leader leaves, I thank him for those very kind remarks. I also want to
recognize him. Without his being an honest broker as an intermediary
between the House and the Senate, particularly among Democrats, I don't
think we would be here either. I appreciate that very much. As a person
who has worked hard on this for 4 months, it wouldn't have happened
without the Senate majority leader as well. I thank him very much.
Getting back to the bill, I want to explain that this is
fundamentally the Senate bill. We had a cap on new spending at $35
billion. That is where the Senate was. The Senate didn't have any
Medicare provisions in their bill. The House did. We didn't have any in
our bill, the House had Medicare provisions in theirs. Those are
dropped out. There is a lot of Medicare provisions that we must act on,
but Senator Baucus and I want to do that as separate pieces of
legislation. We will do that, and we have committed to the House to do
that.
Spending is paid for by an increase in the cigarette tax. That is
similar in both the House and Senate. I do want to commend the majority
in the House and Senate for cooperating with Senate Republicans and for
working with our priorities during the negotiations that led to this
agreement. This compromise agreement is consistent with principles that
we put forth in the Senate bill. I made clear during the debate on the
bipartisan Senate bill before we originally passed it that the Senate
went as far as I was willing to go in terms of spending and politics.
It makes sense that we stayed true to the Senate bill. The Senate,
after all, had a veto-proof majority. So it made sense to stay as close
as possible to that successful formula, if the President would go
through with his statement of veto and actually veto it.
The legislation before this body maintains all of the key policy
provisions of the Senate-passed bill. This bipartisan bill refocuses
the program on low-income children. It phases adults off the program.
It prohibits a new waiver for parent coverage. It reduces the Federal
match rate for States that cover parents. It includes new improvements
to reduce the substitution of public coverage for private coverage.
This compromise bill maintains the focus on low-income uninsured
children and adds coverage for more than 3 million low-income children.
The compromise bill discourages States from covering higher income
kids by reducing the Federal matching rate for States that wish to
expand eligibility over 300 percent of Federal poverty limits. It
rewards States that cover more low-income kids by providing targeted
incentives to States that increase enrollment for coverage of low-
income kids. So there is a very clear message to the States, all 50
States: Cover your poorest kids, meaning your kids from low-income
families, first. Don't spend money on childless adults, as we heard so
often during the debate. The word CHIP has no A in it. It is for
children, not adults. Don't spend money on parents unless you can prove
you are covering low-income kids. Don't spend money on higher income
kids unless you can prove that your State is covering your lower income
kids first. It is all there in black and white. Everybody can read it.
I get a sense, talking to some of my colleagues, that they haven't
read what we are going to be voting on. Anyone who suggests this bill
is an expansion to higher income kids or other populations, as has been
done under some waivers given by the Bush administration, is simply not
reading the bill.
Since the Senate passed a bill the first time, the subject of
crowdout has become a lot more important in the debate. I want to
define the word ``crowdout.'' That is the substitution of public
coverage for people who were previously in private insurance,
individual or corporate, health care policies. Crowdout occurs in CHIP
because the CHIP benefit is attractive and there is no penalty for
refusing private coverage if you are eligible for public coverage.
On August 17, the Center for Medicare and Medicaid Services put out a
letter giving States new instructions on how to address the crowdout,
trying to stop going from private coverage to the CHIP program. I
appreciate the administration's willingness to engage this issue. They
have some very good ideas. But I also think there are some flaws in
that policy stated on August 17 by the Secretary of HHS. States are
supposed to cover 95 percent of the lowest income kids under that
policy statement. But it has been a month since they have issued the
policy statement, and CMS still cannot explain what data States should
be using to make that determination about 95 percent. Personally, I
believe CMS should have answers before they issue policies. If they
still can't explain how it works a month later, I believe, as the
saying goes, they obviously aren't ready for prime time. So the
compromise bill that is before the Senate and passed the House last
night replaces the CMS letter with a more thoughtful, reasonable
approach.
The Government Accountability Office and the Institute of Medicine
would produce analyses on the most accurate and reliable way to measure
the rate of public and private insurance coverage and on best practices
by States that they would take to address crowdout problems because we
don't want to create a public program that moves people from one
private coverage to the other. That has happened to some extent over
the last few years. We don't want to go further. This deals with that
problem. We want to talk about people who don't have any health
coverage rather than moving people from private to public.
Following the two reports that are referred to by the Institute of
Medicine, as well as the Government Accountability Office, the
Secretary, in consultation with the States, under this bill will
develop crowdout best practices recommendations for the States to
consider and develop a uniform set of data points for States to track
and report on coverage of children below 200 percent of Federal poverty
guidelines and on crowdout.
Next, States that extend CHIP coverage to children above 300 percent
FPL must submit to the Secretary a State plan amendment describing how
they will address crowdout for this population, encouraging the best
practices recommended by the Secretary to limit moving people from
private coverage to public. After October 1, 2010, Federal matching
payments will not be permitted to States that cover children whose
families' income exceeds 300 percent of poverty, if the State does not
meet a target for the percentage of children at or below 200 percent of
poverty enrolled in CHIP because we want the emphasis upon low-income
children being covered. And at the lower income level, less have to
have insurance in the private sector as opposed to higher income people
maybe having to have that. So, simply put, cover lower income kids
first or the State does not get money to cover higher income kids.
Now, I know some people are obsessed with the State of New York in
their efforts to cover kids up to 400 percent of poverty. It seems to
come up in the talking points of every person who is against the
legislation now before the Senate. This bill does not change the CHIP
eligibility rules in any way--not one bit. This bill does not expand
the CHIP program to cover middle-income families or higher income kids.
It does not do it. The bill actually goes in the other direction. The
real fact is the bill makes it very difficult for any State to go above
300 percent of poverty. It will make it very difficult for New Jersey,
the only State currently covering kids above 300 percent of poverty, to
continue to do so if they do not do a better job of covering low-income
kids.
[[Page S12130]]
If you are concerned about the State of New York, well, do not waste
your time looking at this bill. You will not find answers to New York's
fate here in this legislation. The answer is where it has always been--
in the office of the Secretary of HHS, Mike Leavitt. Only he has the
authority to allow any State to cover children up to 400 percent of
poverty. The authority to approve what States do with the CHIP program
rests with him and no one else. This bill does nothing to change that
authority. That is a fact. I heartily encourage those of you who have
not read the bill and are talking along this line to read the bill. You
will find out that what I have just said is a fact. It is all there in
black and white.
I also want to say a few words about the President's position on this
bill and speak directly to the President, as I spoke to him on the
phone at 10 minutes to 9 last Thursday about why he should not veto
this bill.
Mr. President, it is unfortunate that you are not--or at least there
are words out that you are not--going to support this bill, that you
might veto it. I would hope, Mr. President, that you would reconsider.
I would hope that you would sign this bill. President Bush, you
yourself made a commitment to covering more children. I could quote
several times you have said this. But I will go back to something I
heard you say personally. It was during the Republican National
Convention in New York City. Mr. President, you were very firm on this
point. Here is what you said. I want to quote what you said:
America's children must also have a healthy start in life.
In a new term, we will lead an aggressive effort to enroll
millions of poor children who are eligible but not signed up
for the government's health insurance programs. We will not
allow a lack of attention or information to stand between
these children and the health care they need.
So, Mr. President, that is what you said back at the Republican
Convention. You were reelected. You have a lot of mandates you are
trying to carry out. This Republican Senator is trying to help you
carry out that mandate you were elected on based on that speech you
made.
I think that you, Mr. President, were pretty clear in your
convictions then. I would like to repeat your words because I think
they are very important. President Bush, you said that you would ``lead
an aggressive effort to enroll millions of poor children . . . [in] the
government's health insurance programs.'' That is the end of your
quote. I am happy to make sure we fulfill that commitment you made,
President Bush, but I believe your current budget, where you suggested
$5 billion more, does not do the job. I happen to agree with your
policy. I think this bill carries out your policy. But I do not think,
President Bush, this bill can do that. You obviously cannot do that for
the $5 billion more you have in your bill.
The Congressional Budget Office reports that your budget proposal,
President Bush, for SCHIP for fiscal year 2008 would result in a loss
of coverage--not an increase of coverage that you say you want--a loss
of coverage of 1.4 million children and pregnant women. Increasing the
numbers of uninsured children is clearly not the goal you expressed or
what we want to accomplish in our legislation. So we carry out the
policies of covering the kids you want to cover with the amount of
money that will do it. That is what we have done in this legislation
before us.
Now, this bill does not warrant the overheated rhetoric we heard in
the House last night.
I want to say to the President--before I get on to the point about
what was said in the House last night--also, the President has another
policy he wanted to work into this SCHIP reauthorization. He wanted to
use the private sector and use the tax deductibility of individual
policies to cover some--and even a great amount--of uninsured people.
He thought the SCHIP bill would be a vehicle to do that. I agree with
the President's policy on doing that.
There was a period of time--during February, March, and April--that
we were negotiating with the White House when I said I thought very
much what Senator Wyden of Oregon was trying to do--and the Senator is
on the floor--was worthy of doing. I asked the White House would they
try to find some help for me and Senator Wyden, that maybe we could do
this. They did not find any support for that. They still say they want
to do that, but sometime along April or May, we had to make a decision
here. Were we going to do what the President wanted to do on SCHIP? So
we could not do what the White House wanted to do through the private
sector as part of SCHIP, so in order to negotiate a bipartisan
agreement, we had to forget that aspect. But I promised the White House
all the time that I was going to be working for those goals of covering
the uninsured through tax deductibility of individual policies, as
Senator Wyden has suggested, and get universal coverage, even, if we
can. I am still committed to that.
I spoke to the President of the United States about that last
Thursday when I was on the phone with him. I said: Let's get this SCHIP
behind us. And I am going to join Senator Wyden in his effort to do it
so we can get bipartisanship started on that issue, as well as what we
have on SCHIP.
So I am asking President Bush: Won't you please consider signing this
bill, and then let Senator Wyden and me work with you on trying to take
care of the 47 million people who do not have health insurance--do it
through the private sector, do it through the tax deductibility of
policies like that.
We even had Senator Clinton, in her statement in Iowa, in her
campaign for the Presidency, speak along the same efforts of using tax
deductibility of private insurance to take care of medical problems
generally but mostly the problems of the uninsured.
So I think we can move in ways of accomplishing what the President
wants to accomplish, but it just could not be done on the SCHIP. So you
have to do what you have to do around here. If it takes two steps to
get the job done, you do it. So I want everybody to know I am not
abandoning any efforts to take care of the uninsured. I am going to
work with Senator Wyden on that.
Now, if I could go to the debate, the overheated rhetoric we had last
night in the House. This is a bill which improves coverage for kids who
are poor. This bill does not make it easier for illegal immigrants to
get benefits. I do not know how that comes up, but that red herring has
been going on over the last 24 hours, and somehow people believe
anything they are told. Here is a case of reading the bill again. The
bill clearly states that funds cannot go to illegal immigrants.
The desperate efforts I heard on the House side to suggest this bill
makes it easier for illegal immigrants to get benefits simply strains
credibility. The bill does not extend eligibility for illegal immigrant
children or pregnant women. I heard that.
The bill does not make CHIP an entitlement. Now, we all know what the
definition of ``entitlement'' is. That was thrown out in the debate in
the Senate 2 months ago when we had this bill up. An entitlement is
something that, if you qualify for it, you get it, and the money comes
from the Federal Treasury, and there is no limit on the amount of
money. That is an entitlement. This is a specific amount of money which
is going to be spent on this program. Not one dollar more can be spent.
This is not an entitlement. Even as recently as a meeting I was in
within the last 4 hours, among a mass of my colleagues, that argument
was used. I do not know how intellectually dishonest you can be. You
are a Member of the U.S. Senate. You know what the language of
Government is. Maybe the people at the grassroots do not think of
entitlements the way we do. They do not think of programs, appropriated
accounts the way we do. But everybody who has been around this Senate a
few months knows what those things are. And to call this program an
entitlement is intellectually dishonest.
This bill is not a Government takeover of health care, either. And
you heard that. This bill is not socialized medicine. Screaming
``socialized medicine'' during a health care debate is like shouting
``fire'' in a crowded theater. It is intended to cause hysteria that
diverts people from reading the bill, looking at the facts.
To those of you, my colleagues, who make such outlandish accusations,
I say: Go shout ``fire'' somewhere else. Serious people are trying to
get real work done. Now is the time to get this work done.
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I appreciate very much the leadership Chairman Baucus has provided. I
thank him and Senator Rockefeller for what they did to reach a
bipartisan agreement because they gave as much as Senator Hatch and I
gave as we were negotiating--the four of us--for this bipartisan
agreement.
I also extend a sincere thanks to Senator Hatch, who is on the floor
with me, for being a part of this effort. Senator Hatch was the main
Republican sponsor of this bill 10 years ago, creating the State
Children's Health Insurance Program. His commitment to the ideals and
fundamentals of the program is steadfast, and the program is better for
it.
When we began the debate on CHIP, I wrote down some principles I want
to refer to--principles I gave my staff that I believed in that I
thought were accomplishable goals in this reauthorization. I probably
wrote these down--well, anyway, I will refer to them. But I wrote these
principles down in my own handwriting and handed them to my staff and
said this is how I think we ought to proceed with the negotiations on
the CHIP bill. I am not going to go through and read it line by line,
but this is what I wrote down sometime back in February, and I am going
to refer to some of these without holding this paper up again.
Here are some highlights of these principles I wrote down entitled
``Principles on SCHIP and How They Compare to The Bill.''
It cannot be a middle-class entitlement, I said. This bill is not an
entitlement. It must be paid for. This bill is paid for.
Another principle I wrote down is that it must be focused on families
below 200 percent of Federal poverty level. This bill is focused on
those low-income families.
Another principle: Kids should be covered before adults. This bill
clearly makes that a requirement.
Another thing I said is the program should be capped--not an open-
ended entitlement to States. The program continues to be capped in this
bill.
I am here to say that my principles remain intact in this compromise
document; therefore, I support the compromise bill and I urge my
colleagues to do the same.
I yield the floor.
The PRESIDING OFFICER (Ms. Cantwell). The Senator from Vermont is
recognized.
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