[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.

[[Page S12129]]

  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.

[[Page S12131]]

  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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