[Congressional Record Volume 153, Number 145 (Thursday, September 27, 2007)]
[Senate]
[Pages S12235-S12247]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   FURTHER CHANGES TO S. CON. RES. 21

  Mr. CONRAD. Mr. President, section 301 of S. Con. Res. 21, the 2008 
budget resolution, permits the chairman of the Senate Budget Committee 
to revise the allocations, aggregates, and other appropriate levels for 
legislation that reauthorizes the State Children's Health Insurance 
Program, SCHIP. Section 301 authorizes the revisions provided that 
certain conditions are met, including that the legislation not result 
in more than $50 billion in outlays for SCHIP over the period of fiscal 
years 2007 through 2012 and that the legislation not worsen the deficit 
over the period of the total of fiscal years 2007 through 2012 or the 
period of the total of fiscal years 2007 through 2017.
  I find that H.R. 976, the Children's Health Insurance Program 
Reauthorization Act of 2007, satisfies the conditions of the deficit-
neutral reserve fund for SCHIP legislation. Therefore, pursuant to 
section 301, I am adjusting the aggregates in the 2008 budget 
resolution, as well as the allocation provided to the Senate Finance 
Committee.
  I ask unanimous consent that the following revisions to S. Con. Res. 
21 be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

  CONCURRENT RESOLUTION ON THE BUDGET FOR FISCAL YEAR 2008-S. CON. RES.
  21; FURTHER REVISIONS TO THE CONFERENCE AGREEMENT PURSUANT TO SECTION
         301 DEFICIT-NEUTRAL RESERVE FUND FOR SCHIP LEGISLATION
------------------------------------------------------------------------
                   In billions of dollars
------------------------------------------------------------------------
Section 101................................................
(1)(A) Federal Revenues:
    FY 2007................................................    1,900.340
    FY 2008................................................    2,022.051
    FY 2009................................................    2,121.498
    FY 2010................................................    2,176.937
    FY 2011................................................    2,357.666
    FY 2012................................................    2,495.044
(1)(B) Change in Federal Revenues:
    FY 2007................................................       -4.366
    FY 2008................................................      -28.745
    FY 2009................................................       14.572
    FY 2010................................................       13.216
    FY 2011................................................      -36.884
    FY 2012................................................     -102.052
(2) New Budget Authority:
    FY 2007................................................    2,371.470
    FY 2008................................................    2,504.975
    FY 2009................................................    2,523.486
    FY 2010................................................    2,579.022
    FY 2011................................................    2,697.385
    FY 2012................................................    2,734.795
(3) Budget Outlays:
    FY 2007................................................    2,294.862
    FY 2008................................................    2,469.884
    FY 2009................................................    2,570.685
    FY 2010................................................    2,607.628
    FY 2011................................................    2,703.144
    FY 2012................................................    2,716.346
------------------------------------------------------------------------


 CONCURRENT RESOLUTION ON THE BUDGET FOR FISCAL YEAR 2008--S. CON. RES.
  21; FURTHER REVISIONS TO THE CONFERENCE AGREEMENT PURSUANT TO SECTION
         301 DEFICIT NEUTRAL RESERVE FUND FOR SCHIP LEGISLATION
------------------------------------------------------------------------
                   In millions of dollars
------------------------------------------------------------------------
Current Allocation to Senate Finance Committee:
    FY 2007 Budget Authority...............................    1,011,527
    FY 2007 Outlays........................................    1,017,808
    FY 2008 Budget Authority...............................    1,078,905
    FY 2008 Outlays........................................    1,079,914
    FY 2008-2012 Budget Authority..........................    6,017,379
    FY 2008-2012 Outlays...................................    6,021,710
Adjustments:
    FY 2007 Budget Authority...............................            0
    FY 2007 Outlays........................................            0
    FY 2008 Budget Authority...............................        9,098
    FY 2008 Outlays........................................        2,412
    FY 2008-2012 Budget Authority..........................       47,678
    FY 2008-2012 Outlays...................................       34,907
Revised Allocation to Senate Finance Committee:
    FY 2007 Budget Authority...............................    1,011,527
    FY 2007 Outlays........................................    1,017,808
    FY 2008 Budget Authority...............................    1,088,003

[[Page S12236]]

 
    FY 2008 Outlays........................................    1,082,326
    FY 2008-2012 Budget Authority..........................    6,065,057
    FY 2008-2012 Outlays...................................    6,056,617
------------------------------------------------------------------------

  I yield the floor.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. KENNEDY. Mr. President, I thank my colleague from North Carolina 
for extending the courtesy of my being able to proceed. We have been 
moving back and forth. I understand there is 20 minutes left for the 
Democrats, and the Senator from Pennsylvania has taken 5; am I correct? 
How much time remains?
  The PRESIDING OFFICER. Fifteen and a half minutes remains.
  Mr. KENNEDY. I yield myself 7 minutes, and I ask the Chair to remind 
me when there is 1 minute left.
  Mr. President, I think this debate over the course of the day has 
been enormously constructive. I think the American people have been 
watching it, and they have a much clearer idea about the alternatives 
that are before us. They should know by this time that when all is said 
and done, this program, the SCHIP program, was fashioned to try to look 
after the working poor, recognizing that Medicaid dealt with the very 
poor but that the working poor were finding increasing pressure and 
were, in increasing numbers, unable to get any kind of health 
insurance. That was basically the targeted area.
  As we reviewed earlier in the course of the discussion, this was 
basically a State-run program. Using the private sector, it has 
guidelines as to what the health care coverage should be in various 
areas, but the States make those judgments and decisions--quite a bit 
different from Medicaid. So the origin of it, having listened to some 
of this debate, it is important to note this is very different from 
other kinds of Federal programs but not greatly dissimilar from what 
the President has indicated that he supported in the prescription drug 
program. It was initially using the cigarette tax money that was a part 
of the settlement earlier, where we were using it, and therefore the 
relationship with the increase in the cigarette tax at the present 
time.
  Now, Mr. President, I only have a few minutes here, and we have gone 
through these charts about how this is covering 6 million and we expect 
that to go to 10 million. We have also reviewed the fact that when we 
look at the comparison with adults and children, we can see under this 
program that uncovered children have gone down dramatically and the 
adults have gone up. So this has been an extraordinary success. CBO has 
indicated this is the best way. If we are interested in covering 
children, CBO has indicated this is the way.
  The point I wish to make in the time I have remaining is that when 
all is said and done, when we vote--and we are going to vote in just a 
little while--the American families ought to realize a very important 
fact; that is, every single Member of the Senate, with the exception of 
one, has comprehensive health care and our children are all covered. 
Understand that, America? All of our children are covered. All of our 
children are covered. The next thing to know, Mr. And Mrs. America, 
your taxpayer money is paying for 72 percent of our health care 
coverage cost. Do we understand that now?
  For those who are saying: Well, I am not going to support this 
because it costs too much; I am not going to support this because it 
may be 300 percent of poverty, we get paid $160,000. We are well above 
the 200, the 300, the 400 percent of poverty level. Yet we are going to 
have Members on the floor of the Senate this afternoon who are going to 
turn thumbs down to American families who are watching this debate and 
knowing that our premiums, our health insurance is being paid for by 
the American taxpayers. I wonder how people do that. I wonder how they 
do it. You would think, if they are so offended about Federal 
Government spending or a Federal Government program, they wouldn't use 
it themselves. But, no, they do. They will take it. But when it comes 
to looking out for working families, there are going to be many in this 
Chamber who will say: No, we are not going to look out for working 
families. You can go ahead and pay for mine--I get my children 
covered--but we don't think the Federal Government ought to be 
tampering with this issue. We don't think the Federal Government ought 
to be looking into whether it is going to have a program to provide 
coverage for the sons and daughters of working families who cannot 
afford a $10,000 health insurance program that would cover themselves 
and their families although the taxpayers are paying for ours.
  Mr. President, this is extraordinary hypocrisy we are about to see 
here on the floor of the Senate. How can people in good faith do this 
and still accept the Federal Government help? How can they be 
complaining all afternoon about a Federal Government program and then 
have a better Federal program paying for their own--paying for their 
own. It is just hypocrisy of the greatest sort, and I think that is 
something that is important.
  The most important point has been mentioned eloquently by many of my 
colleagues; that is, the importance of covering those children. The 
most important point is that too many parents will cry themselves to 
sleep tonight wondering whether their child is $200 sick because they 
may have to go to the emergency room. That is the heart of this.
  Before we all get worked up, Mr. President, it is important to note 
what the financial bottom line on this is too. What has been pointed 
out over the course of the past days, again, is the question of 
priorities. We see in this chart here what we are talking about--
priorities. That is what this vote is. Do we want to say we can cover, 
for 1 day in Iraq at a cost of $300 million, 246,000 children; for 1 
week in Iraq at $2.5 billion, 1.7 million children; or for 41 days at a 
cost of $12.2 billion, 10 million kids?
  The PRESIDING OFFICER. The Senator has 1 minute remaining.
  Mr. KENNEDY. Mr. President, this is a choice. There are those who 
want to continue the ongoing flow of resources to Iraq when we have 
asked our military to do everything they could, and they have done it 
with great valor, and yet still the Iraqi politicians cannot get it 
together. They are holding American service men and women hostage--
hostage. The blood of American servicemen is flowing in Baghdad, and 
this is wrong.
  This is an issue of priorities. I believe we ought to invest in the 
children, and I think we have benefited enough here in the Senate from 
our own largess from the Federal taxpayers in terms of supporting 
ourselves that we should be ashamed if we cannot see the responsibility 
we have to look after children of working families in this country.
  I thank the Chair, and I yield the floor.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. BURR. Mr. President, it is my understanding I have 10 minutes.
  The PRESIDING OFFICER. The Senator is correct.
  Mr. BURR. I would ask the Chair to notify me when I have 2 minutes 
remaining.
  Mr. President, I heard my good friend from Massachusetts talk about 
the Federal system. Let me take a minute to talk about the Federal 
system.
  I have been here for 13 years. The coverage I have is less and the 
cost is more than when I was in the private sector working for a 
company with 50 employees, but I accept that.
  Last year, I learned something new, though. When my oldest son became 
22, I got a notice that under the Federal plan he automatically falls 
off our insurance. Well, it happens for every Federal employee, but 
what was my experience? That is what I wish to share with you.
  I called to find out what the Federal Government had negotiated so 
that my child could have health insurance. They said the exact same 
coverage would now be $5,400 for that individual--a 22-year-old college 
student, healthy as a bull. I decided I would go to North Carolina and 
I would negotiate to see if I couldn't find similar coverage. Not only 
could I find similar coverage, but I found the same coverage, and I 
found it with the same company. I now pay $1,500 a year for the same 
coverage with the same company my son was covered by under the Federal 
health care plan. Now, here is

[[Page S12237]]

the glaring difference. From a standpoint of my insurance, the Federal 
Government still pays the same amount and I still pay the same amount. 
When you take a healthy person off insurance, the premium doesn't go 
down.
  So for the 6 million kids who are targeted in SCHIP expansion--and 
everybody agrees 3 million are uninsured and 3 million are currently 
insured--I don't want anybody to walk away and believe we are reducing 
the premium cost of the families who are currently privately insuring 
these kids. As a matter of fact, the CBO statistics prove exactly what 
happened with my son, in the fact that we will now transition to a 
private sector program for him. For those 3 million SCHIP kids, we 
could access health care coverage for an average of $1,130 a year. But 
in this legislation, it says we will be paying $3,950 a year for the 
same level of coverage for those kids. We will pay it for those who 
weren't insured and we will pay it for those who were insured. Their 
family insurance won't go down, and we will pay three times as much for 
the coverage than if we went to the private sector and we negotiated 
that coverage.
  To some up here, that makes unbelievable sense. To those of us who 
come out of business, to those of us who understand what the people in 
our States whom we represent struggle with day in and day out, it makes 
absolutely no sense.
  Forget the fact that adults will still be covered under this 
Children's Health Insurance Program; that private coverage will be 
replaced with government-run coverage; that within this bill, this 
children's health care bill, are hidden earmarks--earmarks that create 
a health care center in Memphis and earmarks that deal with the pension 
system in Michigan. My God, is this about kids and health care or is it 
about what we can hide in a bill and disguise and cover as a benefit to 
children? It overturns an administration rule targeting SCHIP for low-
income children. The bill would overturn an HHS directive that requires 
States to focus first on covering low-income kids, thereby eliminating 
any State accountability to cover the neediest kids first.
  Well, most of us have done oversight work. If we could trust the 
States or people we give money to, we wouldn't need oversight 
committees. But they meet every day, all day long, because we can't 
trust any single entity to follow the rules. We are basically taking 
the rules and throwing them away. Will we cover adults? Sure, States 
will make decisions to cover adults. States will make decisions that 
will go far outside of low-income children.
  Now, the speaker prior to Senator Kennedy said this was not a debate 
about health care reform. He is right. It is one of the few things I 
have heard on the floor today that is accurate. But it should be. This 
should be about health care reform.
  It is the belief of some that we should feel good about overpaying 
for a program that will cover 3 million uninsured in this country and 
reassign 3 million who are insured to now be under the dole of the 
Federal Government and the American taxpayer when, in fact, we have 47 
million uninsured in this country. That is exactly what we should be 
debating on the Senate floor today--how do we reform health care to 
where we cover the 47 million who are uninsured in this country.
  Well, when we debated SCHIP before it was conferenced, we talked 
about this incredible new plan that had been introduced by a number of 
us--the Every American Insured Health Act--a plan that covered 47 
million uninsured. It did it in a budget-neutral way. It eliminated the 
cost shift that exists in our system today. We estimate saving $200 
billion a year. That is for a plan that I suggest is very much targeted 
for 47 million uninsured, and the CBO will verify that it is budget 
neutral. For those who might not be one of those 47 million 
individuals, who might say I don't have skin in this game: If we are 
able, through the elimination of cost shifting because we are now 
providing primary care for people who today do not have insurance, who 
will not be in the emergency room accessing care at the most expensive, 
most inefficient place--who actually have preventive care, who have 
wellness access, who have a medical home, who have a doctor for the 
first time, and we are able to squeeze out $200 billion of waste that 
we can pump back into health care--an amazing thing happens. It brings 
everybody's premiums down.

  For a person in the country who might be sitting there saying, I have 
insurance, I am covered, I am OK; it doesn't make any difference to me 
whether they have this debate about insurance reform--it should matter 
to you because it is unsustainable to continue the inflation rate of 
health care at the rate it is going. If you want to see that end, if 
you want to see your premium come down, we have to reform health care, 
and I tell you it starts with insuring 47 million Americans, not 3 
million kids. We should provide the resources so those 47 million can 
access their care in their State with the most competitive products 
they can find for the scope of coverage.
  This plan is out there. We introduced it. We didn't ask for a vote. 
We should have. But we have another opportunity and that opportunity 
is, let's reauthorize the current SCHIP plan, let's put the dollars in 
that are needed to make sure nobody falls off the system, but let's 
choose not to expand it to include, at three times the cost, 3 million 
kids and take 3 million kids off their parents' insurance and put them 
over on the Government insurance for the taxpayers to pay for.
  Rather than do that, why not engage in an honest, real debate on the 
floor and let's come up with a reform package that covers the 47 
million. Let's come out with a bill on the Senate floor that doesn't 
leave anybody behind. If we are going to cover 3 million uninsured 
kids, what about the other millions we are not covering? The reason we 
do not go higher is because the higher you go, the larger the 
percentage of kids you are pulling off of their parents' insurance.
  What we have learned from my experience, and I think nobody would 
disagree with me: It saved me no money. The Federal Government's share 
of my health care today is more than it was when my first child was on 
my insurance plan. And in December, I have the great fortune that I am 
going to go through this again. I am going to have my second child who 
will become 22, and this arcane Federal guideline, statute, whatever it 
is at OPM, will kick in and they will say we will no longer cover your 
healthy 22-year-old son.
  I will go to North Carolina and I will access insurance, probably at 
$1,500 like his brother has. I will now have $3,000 a year in 
additional coverage, only to find out that the Federal Government, for 
my plan for me and my wife, is paying more money than we were before.
  There is a reason. It is because when you take healthy people out of 
the pool, the actuaries look at us old folks and say: You know, they 
are a greater risk to us.
  The reverse is true, too. If over time we allow adults to infiltrate, 
which we already have, the children's insurance program, amazing things 
are going to happen. The premium is going to go up because we are 
putting older folks, who are less healthy, in the pool.
  This makes a lot of sense to me because it works the same one way as 
it does the other. I think the sad thing today is I have to stand up 
and say I am not going to support an expansion of SCHIP, but I will 
support reauthorization of SCHIP with dollars that say nobody falls 
off.
  I will also commit today to be the most engaged Member of the Senate 
if we will come down here and have a health care reform debate. Bring 
the proposals to the floor. But don't come if you are not willing to 
prove you are going to insure 47 million uninsured in the country. 
Don't come unless you are willing to get all the cost shift out of the 
health care system. Don't come unless you are willing to take $200 
billion and have that impact positively on everybody's premium in this 
country. Don't come to the floor unless you are willing to extend 
wellness and preventive care through the policies we are able to 
create. Don't come unless you are willing to reform insurance products 
so they are truly market based. Don't come if you don't want insurance 
products to be portable, when employees can take them from job to job 
just like the retirement benefits we have and that we fought so hard 
for.
  Today I am disappointed because we have an opportunity in this 
program.

[[Page S12238]]

We can't extend this program, though, if in fact passing a bad bill is 
the result.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. GRASSLEY. Mr. President, I say to the Senator from North Carolina 
who just completed, I am willing to work with him on all the goals he 
wants to do. Earlier in the writing of this legislation, back during 
the months of March, April, and May, we tried to get the White House to 
get some other Democrats involved and helping Senator Wyden, who wanted 
to go in that direction, and the White House couldn't deliver.
  When it comes down to doing something all at once, or doing it in two 
separate pieces, sometimes you have to do it in two separate pieces. 
This is one of those issues. We have to do the Children's Health 
Insurance Program first and then I am going to join people like Senator 
Burr. Only I am going to be working in a bipartisan way with Senator 
Wyden, to see what we can do to take care of all of the uninsured in 
America.
  We can do that. The President wants to do it. There are Democratic 
leaders who want to do it. Senator Clinton has come out with a program 
doing it through private health insurance. But we cannot do it on this 
bill. The people who have been talking for 6 months about doing it on 
this bill had an opportunity, when it was up in the Senate, to offer an 
alternative. For all their talk, for months, nothing was offered along 
the lines of what they wanted to do.
  Don't come back complaining after we get a compromise between the 
House of Representatives and the Senate, and still complain, when you 
had a debate on this 2 months ago and you didn't have a plan to offer. 
You can't get anything passed in this Senate if you don't have it down 
on paper and offer it to us for consideration. But now, after this job 
is done, let's all get together and do it right. And we will do it 
right.
  I want to spend my time talking about some of the misinformation that 
was spread about this bill when it was first considered in the Senate 2 
months ago and is still being considered today, just as if the debate 
and all the explanations we gave two Mondays ago didn't make a bit of 
difference. So let's go through it again. Let's get very basic and 
let's say where the misinformation is wrong.
  I am not here to embarrass any of my colleagues so I am not going to 
use any names. But yesterday a Member of my party took to the floor 
talking about this bill pending before the Senate. I wish to address 
some of those issues that were raised by my friend and colleague.
  This colleague repeatedly referred to the Children's Health Insurance 
Program as leading to a national system of health care.

       The goal here is to radically expand the size of a public 
     insurance program to families that are really doing quite 
     well, families making up to $80,000 that may not have 
     children, or the children may already be insured by the 
     private sector because you want to move more people onto the 
     public insurance system because you want to have a 
     nationalized system.

  I have one simple question to ask all the critics of this bill who, 
when confronted with the actual policies in this compromise, respond by 
shrieking: 80,000 income, $80,000 income; and that question is: If this 
bill became law tomorrow, how many families earning $80,000 a year 
would be eligible for this Children's Health Insurance Program? And the 
answer is: None. None.
  As they say in baseball: You can look it up.
  I have one simple question to critics who, when asked to respond to 
what is actually in the black and white of this bill, react by 
screaming, as we heard in that quote I just gave: National health care, 
socialized medicine. And that question I ask those folks is this: Under 
what contorted reasoning is a capped block grant inclusive of policies 
that prohibit new waivers for parents, phase childless adults 
completely off of this children's program, and limit matching funding 
for higher income kids, nationalized health care? That is what this 
bill does. It takes care of problems that have developed over the last 
10 years. There have been legitimate criticisms of it. It fixes those 
problems and doesn't do any of the things that people say are going to 
happen, such as families of $80,000 being able to put their kids on 
this program.
  You can call all of this rhetoric something. You can call it anything 
you want. But in Iowa you can't call a cow a chicken and have it be 
true.
  I have some charts here I want people to see. This colleague of mine 
also referred yesterday to what is ``budget gimmickry'' about this 
legislation. I have this response to that colleague of mine. He said 
this yesterday, ``There is the problem.''
  He was pointing to this chart that he had up at that time. Let me 
start the quote over again.

       For example, there is the problem that there is a scam 
     going on, a scam in this bill as to how it is paid for. You 
     can see this chart I have in the Chamber. This reflects the 
     increased costs of the bill as it goes forward. But, in order 
     to make their own budget rules, which they claim so 
     aggressively to be following, such as pay-go--

  meaning pay as you go--

       they have to take the program, in the year 2013, from a $16 
     billion annual spending level down to essentially zero. In 
     other words, they are zeroing out this program in the year 
     2013 . . . that is called a scam.

  I end the quote of my colleague.
  I am a proud member of the Budget Committee. I think I know how the 
budget process works. I believe in fiscal discipline and spending 
restraints. I agree that even under a Republican-controlled Congress, 
spending got out of control. Part of the reason why Republicans lost 
control of the Congress last election is because we didn't show concern 
enough to control spending.
  I believe part of the reason the President is threatening a veto of 
this bill is he is trying to play catchup for failing to veto 6 years 
of spending bills when Republicans controlled the Congress. I agree 
that fiscal discipline ought to be applied to spending bills and we 
should pay some attention to the level of spending and how spending is 
financed.
  From that standpoint, let me focus on the criticism that has been 
made about how this Children's Health Insurance bill is financed. We 
need to step back, and in stepping back we need to look at the whole 
picture. The Children's Health Insurance Program is a pretty small part 
of that picture. The thing about the Children's Health Insurance 
Program is that it is not like Medicaid or Medicare. It is not a 
permanent program. This program expired after 10 years. We are working 
on it now to reauthorize it. It will expire after 5 years. You never 
hear of Medicare or Medicaid expiring, sunsetting, so it has to be 
reenacted. It has been going on for 43 years.
  SCHIP, then, is not an entitlement and I have heard my colleagues 
recently refer to it as an entitlement.
  Now, there were some who wanted to turn this Children's Health 
Insurance Program into an entitlement program. So it has been 
discussed, I admit. I am not one of those. And nobody in the Senate 
that I know of spoke that way. But the House bill would have lifted the 
cap on the national allotment for the Children's Health Insurance 
Program and extended the program forever.
  The word ``entitlement'' may be applicable. I fought hard to maintain 
the block grant concept, the sunset concept--as has been the case since 
the program was started 10 years ago--- and to ensure that the program 
did expire so that in the future, Congress would be forced to 
reevaluate it and maybe improve or cut back, whatever the situation is 
5 years from now, just as we have been doing this year with the sunset 
program.
  So despite the best efforts of House Democrats, because in the House 
it is more partisan than the way we do business in the Senate, this is 
a bipartisan bill. Regardless of the best efforts of House Democrats 
under the compromise bill when the program expires, it truly ends. The 
day after the authorization ends, poof, no more Children's Health 
Insurance Program unless Congress reenacts it.
  The Children's Health Insurance Program before us is an expiring 
program. So let me say that again. It is an expiring program. It is not 
an entitlement. Why do colleagues keep trying to fuzzy the debate by 
using words that are not applicable?
  Well, I know most of us in this Chamber would no sooner let the 
Department of Defense expire then we would

[[Page S12239]]

let the Children's Health Insurance Program expire. That is a simple 
fact. But that does not make it an entitlement any more than the 
Department of Defense programs are entitlements. Because it is an 
expiring program, it is subject then to a very particular budget rule 
that makes this chart not exactly intellectually honest.
  The budget rule says the Congressional Budget Office must score 
future spending for programs based upon last year's program current 
authorization. So the baseline for the Children's Health Insurance 
Program right now, and for next year and next year, is $5 billion. For 
the next 5 years, the baseline each of those years is $5 billion, and 
also for the next 10 years. If you want to go beyond 5 years, and we do 
not do it in this bill, but sometimes the Congressional Budget Office 
does it, the baseline is still $5 billion. It is actually $5 billion a 
year forever as far as the Congressional Budget Office is concerned.
  Does anyone in this Chamber think the budget rule governing the 
Children's Health Insurance Program is realistic? Well, it is obviously 
not. But that is the way the Congressional Budget Office does business 
around here. So let's not kid ourselves.
  According to the Congressional Budget Office, over 1 million children 
would lose coverage if we simply reauthorized the Children's Health 
Insurance Program at the assumed baseline of $5 billion a year. Now, I 
have never heard anybody around here saying they want to throw a 
million kids off of this program. So what do you do? You provide for 
where you are.
  Well, you can throw them off if you want to, but I have not heard any 
of my colleagues, even the ones complaining about this bill, I have 
never heard them complain that we ought to throw 1 million kids off the 
program.
  Who would go home and tell their constituents that they voted to do 
that? But over 1 million kids would lose coverage. That is not 
politically viable.
  During the consideration of this Senate Finance Committee bill, there 
was a children's health insurance alternative that included an increase 
in the Children's Health Insurance Program by spending $9\1/2\ billion 
over 5 years.
  Now, understand, the White House ought to hear that. Even Republicans 
in the Senate are telling the President: Your $5 billion will not do 
what you want it to do. Those are even the Members who oppose the 
Finance bill, acknowledging that $5 billion was not enough. Everyone 
knows the current baseline is not realistic, that it created a hole in 
the budget that had to be filled.
  So what do we do? If you do not want to throw kids off, you fill that 
hole. It is that simple. We had to comply, though, with the budget 
rule. That is the way you have to do business around here. You get a 
point of order against your bill, and you have to have 60 votes to 
override it. So we did.
  Do those budget rules make sense? Well, that is a question for the 
Budget Committee, not for our Finance Committee. The Budget Committee 
sets those rules, and they are not for the Finance Committee to change.
  There is another budget rule the Finance Committee was required to 
follow. That rule is called pay-go, pay-as-you-go, which means that you 
raise revenue or cut spending someplace else to pay for the new things 
you are doing. It means the bill needs to cover its 6-year cost, and 
that makes sense. After all, this bill proposes new spending, and we 
should pay for it. And this bill does it. This bill complies with those 
budget rules. It complies with the pay-as-you-go requirement.
  Now, the children's health reauthorization that we are debating is 
only a 5-year authorization. And, as I think everyone knows, the bill 
is paid for by an increase in the tobacco tax, just like the original 
CHIP bill was paid for when it was created by a Republican-controlled 
Congress 10 years ago.
  Now, just like in 1997 when the Republicans did it, we had a problem 
with how the tobacco tax worked. The revenue from the cigarette tax is 
not growing as fast as health care costs grow. So that means the 
revenue raiser is not growing as fast as the costs of the program. So 
the Finance Committee did what it was required to do to comply with 
pay-go budget rules. The Finance Committee bill reduces children's 
health insurance funding to just below the funding that is in the 
current baseline.
  That means the Finance Committee, in 5 years, will have the same 
problem we faced in putting this bill together today. They will have to 
come up with the funds to keep the program running, if that is what 
they decide to do 5 years from now.
  We are covering even more low-income kids in this bill. That is a 
good thing. Assuming that Congress does not tackle the increasing 
problematic issue of health care costs across the board, as Senator 
Burr was begging us to do, the Finance Committee, in 5 years, will have 
a bigger hole to fill. They will have more kids to keep covering, and 
health care costs will be even higher than they are today. That is for 
the Finance Committee to face down the road 5 years.
  That is just like the job the Finance Committee had today if we were 
going to continue the Children's Health Insurance Program beyond the 
10-year sunset. So what I am saying is, this is really nothing new. 
Now, my friend and colleague whom I have been quoting all the time, a 
person for whom I have great admiration, has once again distorted the 
so-called cliff that he referred to on this chart. That is where the 
line goes down after the year 2012.
  He has, once again, produced a chart that shows a dramatic decline in 
funding of the program. Here is the chart used to raise the issue about 
financing the compromised bill, which is largely the Senate Finance 
Committee bill. It shows only the funding in our bill.
  The approach that this chart takes reminds me of the story of the 
seven blind men trying to describe an elephant. Each described 
different parts of the elephant: one the tusk, another one the tail, 
another one the ear, another one the leg, and none could describe the 
whole elephant. They could not see the whole picture. So we have to 
look at the whole picture.
  As we all know, this program was created to supplement Medicaid. So I 
am going to show you the whole picture. You have to involve Medicaid. 
The goal of the program was to encourage States to provide coverage to 
uninsured children with incomes just above the Medicaid eligibility: 
Medicaid for the lowest income people, SCHIP to help lower income 
people who maybe could not afford private health insurance or their 
workplace did not have it.
  So to put my colleague's concerns into perspective, we need to look 
at the whole picture. We need, and we should, look at SCHIP spending as 
it relates to Medicaid spending. I would like to draw your attention to 
this chart so everyone can fully appreciate the consequences of our 
SCHIP program that is a fiscal disaster to some of my friends, as you 
listen to the debate, the consequences of the SCHIP program in the 
context of the Medicaid Program which it supplements. So I want you to 
take a closer look.
  Let's start with this tiny green line down to the bottom. That is the 
Children's Health Insurance Program under current law, the straight 
line across the bottom. I know we have to squint to see it. But that 
green line represents the Children's Health Insurance Program baseline 
under current law.
  As I have already discussed, it is $5 billion each year for the next 
10 years, and maybe forever, depending on what Congress does in the 
future.
  Now, let's look more closely and honestly at the actual problem we 
are facing. This massive orange area above that green line I just 
referred to is Medicaid for several years into the future, 10 years 
into the future. It is a lot bigger, isn't it, than the Children's 
Health Insurance Program?
  Then, on top of that, we are looking to add what is in this bill, new 
spending for the Children's Health Insurance Program. The new spending 
is represented by that narrow blue line across the top there labeled 
``funding in the compromise agreement.''
  Again, you almost have to squint to see that blue line. And as you 
can clearly see then, costs are growing at a rapid pace overall. The 
overwhelming driver of the cost is not the relatively small increase of 
the blue line. And then the decline, you see a decline in that blue 
line on top in CHIP spending. That is just kind of a blip on the radar 
compared to the massive increase we see in Medicaid spending.
  We have a big problem. It is not going to go away. But it is not the

[[Page S12240]]

Children's Health Insurance Program. It is the entitlement program that 
SCHIP is not a part of because I made a point--10 times in the last 2 
days--that this is not an entitlement, even though my colleagues still 
talk about entitlement. Where are they coming from? What planet? I 
don't know.
  But entitlement spending is, in fact, ballooning out of control in 
future years if we do not act. We are going to struggle to keep these 
programs afloat. When you look at the whole picture, this whole 
picture, it puts things about the SCHIP program and the criticism of 
the SCHIP program in perspective. But the criticism is not justified.
  Now, remember all of the fire and brimstone about the awful cliff on 
the chart that we had before, the awful cliff of this compromise bill? 
The way that it continues to be described, you would think the world is 
about to end. And now looking at the big picture, where exactly is that 
cliff, you might ask? Again, you will have to squint to see that cliff. 
That cliff starts downward after the year 2012. So you saw on the 
previous chart, you see that big dropoff. That is what I raise about 
the intellectual accuracy of that chart. OK?
  If we go back to the other chart and look at the real program, that 
is how it goes down a little bit after 2012. It is not that dramatic 
compared to what we are doing on Medicaid. You can see how this debate 
has tried to distort what we are accomplishing.
  So this little blue line is what this debate is all about. This 
little blue line is the funding in the compromise agreement. This 
little blue line is what all the fuss is about. It seems like a whole 
lot of hollering is going on over a dip that is hard to even see.
  Let me tell you what the compromise agreement and this little blue 
line is not. This is not, as some people want us to believe, a 
government takeover of health care. This little blue line is not 
socialized medicine or nationalized medicine or anything like that. 
This little blue line is not bringing the Canadian health care system 
to America. That little blue line is not the end of the world that we 
know. To suggest that this little blue line and this tiny dip we see 
after the year 2012 is the dismantling of the U.S. health care system 
borders on hysteria.
  While I concede that allotments under our bill in the years beyond 
the 5-year reauthorization in this legislation do behave as described 
in my friend's chart, the one with the big dropoff, I don't think it 
warrants the heated rhetoric we are hearing today and yesterday. SCHIP 
is not a real fiscal problem. The problem is that issue nobody wants to 
talk about. What are we going to do about entitlements? Nobody has 
political guts enough to agree with it, but they want to put this 
Children's Health Insurance Program on the same par as those Medicaid 
issues.
  My friend I have been quoting all day and I worked together a year 
ago, now maybe 2 years ago, on the Deficit Reduction Act, to try to 
rein in this egregious Medicaid spending. I am proud of the work we 
did. He praised me so much 2 years ago for the heavy lifting I did for 
the entire Senate on saving some money--I should say Senate Republicans 
for saving some money--but how times have changed. We also found out 
how hard it is, at the time of the Deficit Reduction Act, to dial back 
entitlement spending. Even in a Republican-controlled Congress and even 
with the special procedural protections of reconciliation, we only 
succeeded in shaving $26 billion off that orange part of the chart. The 
problem of entitlement spending is still out there, and SCHIP is like a 
pimple on an elephant compared to the elephant that Social Security, 
Medicare, and Medicaid are.
  I am very hopeful that once we are done with the CHIP debate, we can 
roll up our sleeves and get down to the business of tackling health 
care reform on a much larger scale, as Senator Byrd referred to, and I 
have referred to Senator Wyden from Oregon working on it over a long 
period of time. I know Senator Wyden wants to take this on, and I am 
going to join him in that bipartisan effort.
  As I have said many times, I had hoped we could have used this debate 
on SCHIP to focus on these larger issues of health care reform and 
helping the uninsured. I tried to engage my colleagues on the other 
side. I was repeatedly thwarted in that effort and told that SCHIP had 
to get done first. Well, hopefully we can get SCHIP done and then turn 
to the bigger issues so the next time the Congress has to tackle the 
Children's Health Insurance Program, this big orange block would not be 
so huge.
  Before closing, another criticism we had of this bill in the last 
debate 2 or 3 months ago was this. I will quote Senator Lott. I don't 
think he will mind my using his name. He was quoted on July 31: The 
House is going to pass a bill at what, maybe $80, $90, $100 billion, 
paid for by taking money away from Medicare beneficiaries. We go on 
conference, what will happen? What always happens. You split the 
difference. We are at 60. They are at 90. How about $75 billion. How is 
that going to be paid for? Is it going to be paid for by cutting 
benefits for the elderly or raising taxes of all kinds?
  Well, it is paid for the same way we paid for it on July 31, 2007, 
with the tobacco tax, not by Medicare money.
  He went on to say: I fear what is going to happen in conference. I 
don't know. Maybe the Senator from Montana and Senator Grassley can sit 
there and say: Oh, no, no, no, we are not going above what we passed in 
the Senate. But I think the reverse is going to be true. This is the 
base. The $60 billion is the beginning.
  Where did we come out? Exactly where Senator Baucus and I told the 
Senate we were going to come out. We came out with the $35 billion that 
passed this body. So all those people who are worried about the 
position of the Senate being lost in conference by Senator Baucus and I 
representing the Senate--and let's say Senator Rockefeller and Senator 
Hatch as well--would you please tell me you were wrong?
  I yield the floor.
  The PRESIDING OFFICER (Mr. Nelson of Florida). Who yields time?
  The Senator from Maryland.
  Mr. CARDIN. Mr. President, I yield myself 2 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CARDIN. Mr. President, today is truly an important day for 
America's children. On Tuesday, the House passed the Children's Health 
Insurance Bill, and very soon, the Senate will vote. We will provide 
$35 billion over the next 5 years to expand health insurance coverage 
for the children of America's working families.
  We know that there is a crisis in health care in this country. More 
than 46 million Americans don't have any health insurance coverage; 9 
million of them are children, and most of them are in working families. 
That is a disgrace.
  Now there are many proposals out there to increase the number of 
Americans with health insurance coverage. As Congress begins to 
consider these proposals, there is something we can do today to 
decrease the number of uninsured children by nearly 4 million.
  Earlier this year, in February, I introduced to the Senate Finance 
Committee a Baltimore family that has benefited from CHIP. Craig and 
Kim Lee Bedford are working parents who own a small business and simply 
cannot afford health insurance for their 5 children through the 
commercial market. Through the Maryland MCHP program, the Bedford 
Family's 5 children receive affordable, quality health care.
  We have the evidence that enrollment in the CHIP program improves the 
health of the children who are enrolled, their families, and the 
communities in which they live.
  When previously uninsured children are enrolled in CHIP, they are far 
more likely to receive regular primary medical and dental care, and 
they are less likely to use the emergency room for visits that could be 
handled in a doctor's office.
  They are more likely to get necessary immunizations and other 
preventive care, and to get the prescription drugs they need.
  But there are still millions of children who have not enrolled in the 
programs offered by their States.
  Our States are making progress--simplifying their enrollment 
procedures, expanding outreach efforts, and using joint applications 
for Medicaid and CHIP so that families can enroll together.
  But this reauthorization bill, with $35 billion in added funding, is 
needed to help them make real progress.

[[Page S12241]]

  I want to talk for a moment about Maryland's program.
  It has one of the highest income eligibility thresholds in the 
Nation, and this is important because of the high cost of living in our 
State.
  It is at 300 percent not because our Governor wants to move people 
from private insurance to public insurance plans. It is at 300 percent 
because working families at this income level do not have access to 
affordable health insurance policies. Those families need CHIP.
  Children under the age of 19 may be eligible for MCHIP if their 
family income is at or below 200 percent of the Federal poverty level, 
or up to $34,000 for a family of three.
  We also have an MCHIP Premium program, which extends coverage to 
children at moderate income levels--between 200 and 300 percent of 
poverty, or up to $51,500 for a family of 3.
  The premiums, which are paid per family, regardless of the number of 
eligible children, are between $44 and $55 a month.
  Our program has been a true success. Enrollment has grown from about 
38,000 enrollees in 1999 to more than 101,000 today.
  In my State of Maryland, the need has always exceeded the available 
funds. The Federal match through the CHIP formula established in 1997 
is not enough to meet all of the costs of the MCHIP program.
  Some States do not use their entire allotment, while other States, 
like Maryland, have expenditures that exceed their allotments. Congress 
has addressed this problem by redistributing the excess to the 
shortfall States.
  The 109th Congress passed provisions to address the Fiscal Year 2007 
funding shortfalls.
  That bill didn't include any new money, but it allowed the 
redistribution of $271 million already in the program, and that was 
important for thousands of Maryland families.
  Without that legislation, Maryland would have been forced to either 
freeze enrollment or reduce eligibility for CHIP.
  Now, we must move forward for future years. That is what we are doing 
on the floor of the Senate today.
  This conference report increases the allotment for Maryland for next 
year from its current projected level of $72.4 million for fiscal year 
2008 to $178.8 million.
  It also allows us to continue to cover children in families with 
incomes up to 300 percent of poverty. Maryland would also have access 
to a contingency fund if a shortfall arises and additional funds based 
on enrollment gains. With this new money, Maryland can cover as many as 
42,800 children who are now uninsured over the next 5 years.
  There is another vitally important part of this conference report 
that I want to talk about. Title 5 ensures that dental care is a 
guaranteed benefit under CHIP.
  According to the American Academy of Pediatric Dentistry, dental 
decay is the most common chronic childhood disease among children in 
the United States.
  It affects one in five children aged 2 to 4; half of those aged 6-8, 
and nearly three-fifths of 15-year-olds. Tooth decay is five times more 
common than asthma among school age children. Children living in 
poverty suffer twice as much tooth decay as middle and upper income 
children. Thirty-nine percent of black children have untreated tooth 
decay in their permanent teeth; 11 percent of the Nation's rural 
population have never visited a dentist; an estimated 25 million people 
live in areas that lack adequate dental care services.
  I want to say a few words about a young man named Deamonte Driver. He 
was only 12 years old when he died last February from an untreated 
tooth abscess. It started with an infected tooth. Deamonte began to 
complain about a headache on January 11. By the time he was evaluated 
at Children's Hospital's emergency room, the infection had spread to 
his brain, and after several surgeries and a lengthy hospital stay, he 
passed away.
  For want of a tooth extraction that would have cost about $80, he was 
subjected to extensive brain surgery that eventually cost more than a 
quarter of a million dollars. That is more than 3,000 times as much as 
the cost of the extraction. After Deamonte's death, the public took 
note of the link between dental care and overall health that medical 
researchers have known for years.
  His death showed us that, as C. Everett Koop once said, ``there is no 
health without oral health.''
  Deamonte's brother, DaShawn, is still in need of extensive dental 
care, and, like him, there are millions of other American children who 
rely on public health care systems for their dental needs.
  No child should ever go without dental care. I have said before that 
I hoped Deamonte Driver's death would serve as a wake-up call for the 
110th Congress. I believe that it has.
  Earlier this year, I brought Deamonte's picture down to the floor. I 
have it with me again today.
  It is here because we must never forget that behind all the data 
about enrollment and behind every CBO estimate, there are real children 
in need of care.
  When I spoke about Deamonte right after his death, I urged my 
colleagues to ensure that the CHIP reauthorization bill we send to the 
President includes guaranteed dental coverage.
  This bill would make guaranteed dental coverage under CHIP the law of 
the land, and I want to take this time to personally thank the members 
of the conference committee for ensuring that a dental guarantee is in 
this bill.
  One other tragic piece of Deamonte's story is that, once his dental 
problems came to light, his social worker had to call 20 dental offices 
before finding one who would accept him as a patient.
  The conference report includes a provision that will make it much 
easier for parents and social workers to locate participating 
providers.
  It requires the Secretary of Health and Human Services to include on 
its Web site www.insurekidsnow.gov and the HHS toll free number, 1-877-
KIDS-NOW, information about the dental coverage provided by each 
State's CHIP and Medicaid programs, as well as an up-to-date list of 
providers who are accepting CHIP and Medicaid patients.
  Parents will be able--with one phone call or a few mouse clicks--to 
find out what their child is covered for and where they can receive 
care. There is more work to do, as I have learned from working with my 
dedicated colleagues here on this issue, particularly Senators Bingaman 
and Snowe.
  We still have to improve reimbursement for dental providers, and get 
grants to the states to allow them to offer dental wraparound coverage 
for those who may have health coverage, but no dental insurance. But 
these provisions are a very good start.
  I am deeply disappointed by the President's statements about CHIP. 
When he says that this is Government-run insurance, he is mistaken.
  This program is administered by our States, with help from the 
Federal Government, to ensure that working families who cannot afford 
private health insurance, can enroll their children in private health 
insurance plans.
  I would hope that after today's vote in the Senate, he will 
reconsider his position on this bipartisan, responsible, and paid-for 
bill.
  CHIP covers urban and rural children, who live in every state, 
whether Democratic or Republican.
  Congress has come together after months of work to reauthorize a 
program that's been a proven success and has served the needs of 
America's working families. I urge the President to join us in this 
truly bipartisan effort and sign this bill into law.
  I thank the leadership for bringing forward this bill. We have talked 
about the fact that we have 46 million people without health insurance, 
9 million children without health insurance. We can do something about 
it today. This bill will cover 4 million uninsured children. We can do 
something about the uninsured. During the course of the hearings in the 
Senate Finance Committee, I brought Craig and Kim Lee Bedford, 
constituents from Maryland, to testify before the committee. These are 
working parents with five children. They simply could not afford health 
insurance. But the CHIP program has allowed us in our State to cover 
these children. Mrs. Bedford said: I no longer have to decide whether 
my child is sick enough to go to a doctor. That is the practical effect 
of this legislation. It is going to help families in our State.

[[Page S12242]]

  I heard the arguments about over 200 percent of poverty. In our 
State, we cover up to 300 percent of poverty. That is $51,500 a year. 
You have to pay a premium. The premium is between $44 to $55 a month 
for the entire family. But in Maryland, you can't afford health 
insurance if you make that type of income for a family. This bill will 
allow us to cover those children. For my own State of Maryland, bottom 
line means we are going to be able to cover 42,800 more children. In 
Maryland, we had the tragic circumstances of Deamonte Driver, a 12-
year-old who died as a result of untreated tooth decay. That should 
never happen in America. This bill will help us to cover American 
families and our children.
  I urge my colleagues to support the bill and yield the floor.
  The PRESIDING OFFICER. The Senator from South Carolina.
  Mr. DeMINT. Mr. President, I am encouraged that the Senate is taking 
up the whole issue of health care in America. We know this is one of 
the most important issues to the American people. We know a number of 
Americans don't have access to health care, and it is very important 
that we debate this as a Senate, not just children but the American 
goal of how do we get every American insured. How do we make sure every 
American has access to good health care throughout their life and their 
children do as well? We can agree on that goal. It is not just about 
children, it is about health care in America and figuring out as a 
Congress how do we make sure every American has access to good health 
care.
  The question today and the question we need to continue to debate is: 
Do we want the Government to provide that health care or do we want to 
figure out how to make sure that individuals have access to a health 
insurance policy that they can own and keep? Because we know the best 
and most efficient delivery of health care is going to come through 
individually owned policies that people don't lose when they change 
jobs, they don't lose when they retire. I hope our focus will turn from 
Government health care to helping individuals have a policy that they 
own and can keep. We should all question, do we want the Government 
that ran the Katrina cleanup or runs the Post Office or spends $1,000 
for a hammer at the Pentagon and wastes billions, literally hundreds of 
billions of dollars in waste, fraud and abuse every year, do we want 
that Government to take care of our children, to take care of our 
seniors, and to run the health care system today?
  We are talking about health insurance for children. A number of 
people are saying individuals cannot afford to buy it. Before we 
consider that, we need to realize this Congress has made it very hard, 
if not virtually impossible, for individual Americans to have a health 
insurance policy they can own and keep. We need to be reminded that 
this Congress has created a Tax Code that gives tax breaks to 
businesses who provide health insurance but not to individuals who want 
to buy it. That means the cost of individual insurance is higher and 
many times unaffordable. We have proposed in Congress--unfortunately, 
my Democratic colleagues have fought back--to allow small businesses to 
come together and pool their resources so they can buy health insurance 
and make it available to their employees when they cannot afford it as 
individual companies. But this Senate killed that idea. It would have 
made it more affordable for individuals. Yet we complain about the 
uninsured.
  We know a number of States have added so many mandates onto their 
insurance policies, it is too expensive for citizens to buy it. Yet 
this Congress will not allow Americans to buy health insurance anywhere 
they want in the country. We have allowed individual States to create 
monopolies, where someone in South Carolina can't buy a policy from New 
Mexico unless it is certified in South Carolina. We know we could 
create a national market and make individual policies much less 
expensive, but this Congress would not do it.
  The fact is, this Congress has made individual health insurance 
unaffordable and unaccessible to Americans and now, today, we are going 
to ride in on our white horse and save the day with Government health 
insurance.
  Children should have health insurance. This whole plan of children's 
health insurance started for poor children whose families make too much 
for Medicaid but were still under 200 percent of poverty. Today we are 
proposing not just to reauthorize and continue this program for poor 
children but to raise it so children and families with incomes up to 
$82,000 are going to get free Government health care. When this plan is 
fully implemented, about 75 percent of the children who live in America 
today will be on Government health insurance, which means we as a 
Congress have made a decision that we want America to have Government 
health plans and not to have individual plans they can own and keep. 
Because if 75 percent of the children are on Government plans and our 
seniors are on Government plans and many of our military are on 
Government plans, there is no more room for private market health 
insurance policies to work. In effect, what we are doing is deciding 
today that we want national health care in America when we vote for 
this.
  I have heard this bill talked about as a compromise and that we can 
split the difference. But colleagues, you can't split the difference 
between freedom and socialism. You can't split the difference between 
Government health care and individuals owning their own health plans. 
We are talking about something that doesn't exist. What we have split 
the difference between is spending $80 or $90 billion more than we need 
for poor children, and we have brought that down a little bit. We have 
funded it with some bogus funding, and we think we are doing something 
to help America.
  This bill is not for children. This bill is selling out the future 
for every child in America because we are turning this country into a 
socialistic style of government, taking away people's freedom. We are 
here, once again, pretending we are doing something we are not. We are 
not taking care of children. We are selling their freedom away under 
the pretense of children. We have learned in this body that all we have 
to do is do it for the children and come down and say it applies to 
children, and we dare anyone to vote against it. I am going to vote 
against it because this is not for our children, and it is not for our 
country.
  We are selling out our future. If we would focus ourselves on helping 
individuals access private policies, we could get every American 
insured. If we made our Tax Code fair for everyone, if we allowed 
States to partner with us, we could have every American with a health 
insurance policy without the Government running this. We should not 
even pretend we expect this Government to run the health care system in 
an efficient way.
  Colleagues, I appreciate the debate on health care. We need to have 
it. We need to have an American goal that every citizen is going to 
have access to good health care and health insurance. This is not the 
way to do it. This is a decision to become more like socialized Europe, 
to sell out our freedoms, and to give Government control of our health 
care.
  I encourage all of my colleagues to rethink this decision to vote for 
this bill, and to vote against it.
  I yield back.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. Mr. President, I thank the Chair. I believe I have up 
to 10 minutes, and I yield myself that time.
  The PRESIDING OFFICER. The Senator is recognized for 10 minutes.
  Mr. DOMENICI. Mr. President, I have heard my distinguished friend 
from South Carolina, and have great respect for his thought process, 
for the way he presents things. Frankly, I do not mind listening to 
him, so I was here early, and I got to hear what he had to say.
  But we have been working on this issue of SCHIP for more than a few 
months, in fact, for more than a few years. So some come in at the end 
and have a whole new theory about it, and others, like myself, who 
happened to be the Budget chairman back a few years ago, when this 
program was born--and I remember making room for it in a budget 
resolution so it could be a reserve fund, and we could end up with this 
amount of money. It kind of lived through 2 or 3 years of getting 
knocked around and not doing its job, and doing part of it, and as 
things progressed I ended up supporting a proposal that involved SCHIP.

[[Page S12243]]

  This Children's Health Insurance Program Act of 2007 is now before 
us. I indicated my support for it when Senator Chuck Grassley and his 
cohort, the chairman of the Finance Committee from Montana, were 
putting together a compromise bill using this money that had been 
allocated for health care some 3 or 4 years ago. So I supported it as 
Senator Grassley and others put together a program.
  New Mexico has a terrible problem with uninsured children. Nearly 25 
percent of the children have no insurance--worst in the country. SCHIP 
will help this problem, no doubt about it.
  The bill we are voting on today--whether my good friend who spoke 
just before me agrees with the terminology--is a compromise. Many on 
the other side of the aisle wanted $50 billion to $70 billion more in 
spending. On my side of the aisle, they wanted much less. Some wanted 
as low as $5 billion. This bill gave us $35 billion--right down the 
middle. Whether that means anything, it does to me. It means some 
people worked very hard to try to get a bill we could support, that 
would begin to get us somewhere with reference to changing the 
direction of health care for children who might see light someday. The 
bill gave us $35 billion, I repeat.
  In August, I came to the floor and made a statement. I said I did not 
like what the House of Representatives was doing. I said I did not 
support massive increases in spending and eligibility proposed by the 
House. I made it very clear I did not want a reauthorization that 
included revisions to the Medicare Program.
  Now, I am just one Senator, but it turns out that five or six or 
seven Republican Senators somehow or other all thought the same way. 
They were thinking just as I was, that we were not going to let 
ourselves get used so that this SCHIP was opening a crack in the door, 
and we did not know what we were talking about, and we would open the 
door, and we would spend three times what we had in mind.
  Well, that was not going to happen. Senator Grassley came around and 
asked, and I said: $35 billion. That is it. If you put any more in, I 
am out.
  I remember him coming to me and saying: Is that it?
  Twice I said: That is it. Don't bother me anymore. I am your friend, 
but anybody can understand $35 billion is $35 billion. It is not $38 
billion. It is not $50 billion. If you want to do any more, go look for 
somebody else to make your majority.
  He said: No, I don't want to do that. I want you. Is that all you 
will do?
  I said: Yes, that is all I will do.
  So everything I did is not part of the record, but I am reflecting 
for the Senate and for those on my side of the aisle who do not 
understand why I am doing what I am doing and want the President to 
veto this bill. I do not want him to veto it. I think it is a mistake, 
and I am saying it right now, and I will say it again.
  But I did say I did not want massive increases in spending and 
eligibility proposed by the House. I did say I did not want a 
reauthorization that included revisions to the Medicare Program. 
Clearly, I made that point. I made it not only to Senator Grassley, but 
I made it to the chairman of the committee, Senator Max Baucus of 
Montana.
  We got to where Senator Baucus would speak to me every 2 or 3 days 
and report to me what was going on. I was not on the conference. But 
the reason he did that was he understood if he went to conference and 
changed that $35 billion, which had become a very important number, he 
would start losing me.
  So I was just as effective as being at the conference, but so were 
about seven or eight others who were still on board and who still think 
$35 billion is enough because the cheapest insurance around is 
insurance to cover children. We all know that. Now, that is not 
degrading. It is a fact. You can buy more insurance for children per 
dollar than for any other class of people. That is logical. Children do 
not get sick as much as old people. They do not get sick as much as 
middle-aged people. So they are healthy. The insurance is cheap.

  Now, the conference committee listened--the one that Senator Grassley 
and Senator Baucus were part of--they compromised the bill before us, 
and they did it in a fair way. What was fair? Thirty-five billion 
dollars--no more, no less--the amount we had agreed to that we said we 
would help them with. If they wanted to dream about big dreams for this 
small program--that I remember vividly we started in the Budget 
Committee, and it languished around. We started it some 4 years ago, or 
5. I have not been back as chairman of that committee for quite a 
while, so it was not done yesterday.
  The conference committee, as I said, listened, and they did exactly 
what Senator Grassley and Senator Baucus had told us would happen. They 
provided $35 billion in new resources to provide health coverage for 
millions more children in working families.
  Here we get into an argument: Who is working in families and who is 
not? Well, I understand we could have that argument and extend it 
beyond 8 o'clock. We could be here until morning. But we are not going 
to do that. It is established.
  It strengthens outreach and enrollment efforts to make sure all 
children who are eligible for the program get the services they need. 
That has always been a problem with children. The Presiding Officer 
knows that. We cover children, and then in 2 years they come back and 
say: Yes, we covered them, but they did not get covered.
  What do you mean?
  Well, we did not find them.
  Well, how do we find them?
  Well, the best way is to wait until they go to the emergency room, 
and then you find them in the emergency room and you sign them up.
  I thought: My, is that the best way we can do it? It turns out it is 
very difficult, especially among our poor people, to get them to round 
up their children and come and get them lined up. The best way is if 
they happen to go to a hospital. You get them then. You don't want them 
to go to a hospital, but I am telling you what it turns out to be. 
Maybe it has changed since I last worked on this. Years do go by. But I 
think what I said is still right.
  It also makes improvements to the program such as mental health 
parity, which I know a little bit about. I am glad this legislation 
ensures plans that offer mental health services provide benefits that 
are equivalent to other physician and health services. This is one of 
the most difficult areas of unfairness for American coverage we have 
had, and we are making big strides toward resolving it. This bill makes 
its little contribution to resolving that problem.
  The administration has issued a statement indicating the President 
will veto this legislation. Mr. President, that is a mistake. Maybe you 
will win; maybe you won't. I guess in the Senate you won't win, Mr. 
President. Maybe you will win in the House. I don't know. But this will 
not go away. It is solved. It ought to be done. We ought to go on and 
look somewhere else if we are going to try to find money to save. Those 
who think this is a great veto item, I think what I have just explained 
is, it is not a very good one. We ought to go ahead and take care of 
some of the children and get on to some other issues.
  A majority of my colleagues have said they support this bill. Sixty-
nine Members voted for cloture this morning--cloture meaning to cut off 
debate and get on with the vote.
  My commitment to children's health care remains firm today. It 
remains as firm as when I agreed to the first use of SCHIP money in a 
new and different, innovative way so its asset value could multiply 
significantly. I support the passage of the compromise SCHIP 
reauthorization.
  All in all, it is a pretty good bill. I hope it outlasts our debate 
and is voted on tonight. Then I hope it is not vetoed by the President.
  I yield the floor and thank the Presiding Officer for recognizing me.
  The PRESIDING OFFICER. The Senator from South Dakota is recognized 
for 10 minutes.
  Mr. THUNE. Mr. President, I have listened intently to much of the 
debate today on this SCHIP reauthorization. Let me preface my remarks 
by saying, first and foremost, I do support children. I like children, 
contrary to the implication that has come out of this debate that 
people who are not in favor of this particular piece of legislation are 
not in favor of the children. I am very much supportive and in favor of 
helping children. Furthermore, I also

[[Page S12244]]

support extending the SCHIP program. I would even support increasing 
funding for the SCHIP program in a way that would cover those children 
who are eligible but are not currently being covered.
  That is a substantial number of children across the country, which is 
why I think it is essential if we are going to reauthorize this 
program, if we are going to extend this program, we do it in a way that 
takes into consideration there are a lot of children in America today 
who are eligible for the SCHIP program who are not being covered. So, 
frankly, I support not only extending the program but also increasing 
funding for the program.
  We had a number of amendments that would have done that during the 
debate in the Senate that would have increased it substantially and, 
frankly, would have also, according to the CBO, covered more children 
than this piece of legislation we are going to vote on today.
  But I have to say for a lot of us who do support extending the 
existing program and increasing funding to cover children who are 
eligible but not currently covered, this is a bridge too far because 
what this essentially does is, it not only expands the scale of the 
program, it expands the scope of the program. That is where a lot of us 
take issue with this legislation.
  If you look at what the SCHIP program costs today, it is about $5 
billion a year. It has cost us $40 billion over the course of the last 
10 years. This legislation today would increase the 5-year cost to $60 
billion, the 10-year cost to $121 billion. So where we are paying $5 
billion a year today for the SCHIP program, this increases that to $12 
billion a year, $60 billion over 5 years, or a $35 billion increase 
over the existing program, and $121 billion over 10 years.

  Now, that again is an expansion, not just of scale but also of scope, 
because this covers adults, it increases the income levels that are 
eligible under the program that the States can incorporate up to 300 
percent of the poverty level, and even allows and grandfathers in those 
States which have asked for waivers to go to 300 percent or 400 percent 
of the poverty level. So it does substantially increase or expand the 
scope of the program.
  I think the other thing which is important and which is a concern for 
me in this whole debate is the fact that when you get to the year 2012, 
it is no longer paid for. Nobody here is disputing that fact. This is 
funded for the first 5 years or so of this program, but when you get to 
the last 5 years of the program, there is a cliff, and there isn't 
funding there to fund the program. In fact, the funding which is 
provided in the form of a cigarette tax increase actually assumes there 
are going to be 22 million new smokers over the course of the next 10 
years. That would create a substantial number of problems for the 
health care system in this country and is certainly not something we 
want to encourage. But the reality is that when you get to 2012, you 
hit a cliff, and this is not paid for. It is going to have to be paid 
for in some form or fashion, which we all assume is going to be some 
substantial tax increase because it is going to be about $60 billion 
underfunded during the last 5 years of the program.
  The other thing I will say which is, again, of great concern to me is 
this doesn't solve the underlying problem we have in this country. We 
have a health care problem in this country that needs to be addressed, 
that Congress needs to address head-on.
  There are a lot of wonderful proposals and ideas that have been 
discussed, some of which have been proposed in the form of legislation, 
some of which have been voted on, and some of which have been defeated 
in the Senate.
  A small business health plan, something many of us have supported for 
a long time, going back to my days in the House of Representatives, 
actually has been defeated on numerous occasions in the Senate. It is a 
proposal that would allow small businesses to form together, to 
leverage that group size they have and be able to lower the cost of 
health insurance coverage.
  We heard my colleague from South Carolina talk earlier today about a 
national market for health care.
  We have had suggestions, bipartisan suggestions about allowing a tax 
deduction that each individual could use in order to buy health 
insurance.
  There is the proposal for a tax credit that has been offered by a 
couple of my colleagues on this side.
  There are a lot of good ideas out there we ought to be adopting, or 
at least debating, and driving toward health care reform which empowers 
consumers in this country, which puts more people in charge of their 
own health care, and which allows them to have access to coverage where 
they own their own health care coverage and can make better and more 
informed decisions and get the cost of health care in this country 
under control. I don't believe this does that because what this 
legislation does is it increases government-run, Washington-controlled 
health care. This is an expansion of the government component of health 
care. It does nothing in the long run to address what is a very serious 
crisis in this country; that is, the need to bring reforms to our 
health care system.
  The other thing I will say which I, frankly, take issue with as well 
with regard to this legislation is the fact that low-cost, efficient 
States such as South Dakota--and we have a 200-percent Federal poverty 
level in our SCHIP program in South Dakota--end up subsidizing higher 
costs in inefficient States. We have taxpayers in South Dakota who are 
covered, as I said, up to 200 percent of the Federal poverty level, or 
about $41,000 per family, who are going to end up subsidizing States 
that choose to exercise the option to go to a higher level. Frankly, 
there is no incentive for States not to go to the higher level, to go 
to the 300 percent, and those that already have requested waivers to go 
to 350 or 400, you are already talking about, in the case of 400 
percent of the Federal poverty level, over $80,000 a year.
  Now, what is ironic about that is the Federal Government is going to 
be telling people in this country that not only are you poor--in other 
words, you are eligible for this particular low-income health insurance 
program--but you are also rich, so rich that you are going to be 
subject to the alternative minimum tax.
  I offered an amendment to the debate we had weeks ago that would have 
prevented those who are subject to the alternative minimum tax because 
under the Internal Revenue Code in this country they are considered 
rich--rich enough to pay the alternative minimum tax--that would have 
said that people who are subject to the alternative minimum tax cannot 
at the same time be eligible for a program that is designed to help 
low-income families and low-income children. That was defeated in the 
Senate by a vote of 42 to 57.
  So there are a lot of issues with regard to this legislation that 
give me grave concerns, reasons that I can't support it. As I said 
before, an expansion of a government-run health care program in this 
country--it is not paid for after the year 2012--leads us toward 
nationalized, Washington-controlled health care and moves us away from 
what ultimately ought to be our goal; that is, providing access for 
more Americans to coverage through our market-based system in this 
country.
  It requires that low-cost, efficient States such as my State of South 
Dakota are going to be subsidizing high-cost, inefficient States--
States such as in the New Jersey, New York area--that are already 
talking about going to 350 percent or 400 percent of the poverty level, 
which, as I said earlier, in the case of New York, that would get you 
up to where you would have those in the income level of over $80,000 a 
year qualifying and being eligible for a program that is designed to 
help low-income children and low-income families and, ironically, 
subjects them to the alternative minimum tax. The alternative minimum 
tax was a tax put into place in the first place to tax people who are 
making too much money and not paying enough taxes. That, to me, seems 
to be a very conflicted message we are sending with this bill.
  We need a strong, market-based health care system in this country. We 
need to start that debate. This debate delays that debate because we 
are going to be adopting legislation that increases--adds to the 
government-run component of health care in this country and moves us 
away from the debate we ought to be having, which is, how

[[Page S12245]]

can we improve access for more Americans to affordable health care 
coverage, where they can own their own coverage, where they don't have 
to rely on a government system that is inefficient, that is Washington-
based, and that is controlled by bureaucrats here in Washington, DC?

  We want to put people and patients more in control of health care. 
This particular bill does not do that. I will be voting no, and I urge 
my colleagues as well to vote no. I hope we can get to the big debate, 
the debate we ought to be having; that is, how do we reform the health 
care system in this country?
  With that, Mr. President, I yield back the remainder of my time.
  The PRESIDING OFFICER. The Senator from Maine is recognized.
  Ms. COLLINS. Mr. President, I rise in support of the legislation that 
will extend and increase funding for the State Children's Health 
Insurance Program.
  One of the very first bills I cosponsored as a new Member of the 
Senate back in 1997 was the legislation that first established the 
SCHIP program. I remember Senator Hatch coming to talk to me about this 
bill and enlisting my support for it. I am very happy I was one of the 
original cosponsors of the SCHIP bill.
  This program provides much needed health care coverage for children 
of low-income parents who simply cannot afford the cost of health 
insurance and do not get health insurance through the workplace; yet 
they make a little bit too much money to qualify for the State's 
Medicaid Program.
  Since 1997, the SCHIP program has contributed to more than a one-
third decline in the number of uninsured low-income children. That is a 
tremendous success. It is hard for me to understand why anyone would 
vote against an extension, a modest expansion, of what has been such a 
highly successful and effective program. Today, an estimated 6.6 
million children, including more than 14,500 in the State of Maine, 
receive health care coverage through this program.
  Still, as this legislation recognizes, there is more we can do to 
further decrease the number of uninsured low-income children. While the 
State of Maine ranks among the top four States in reducing the number 
of uninsured children, we still have more than 20,000 children who 
don't have coverage. Nationally, about 9 million children remain 
uninsured.
  Unfortunately, the authorization for the SCHIP program, which has 
done so much to help low-income children in working families obtain the 
health care they need, is about to expire. That is why I encourage and 
I urge all of my colleagues to join me in supporting this legislation.
  I commend the Senate conferees on this bill. They did a very good job 
of coming up with a very reasonable proposal--a proposal that costs 
less than the House version and yet will make a real difference to low-
income uninsured children. I would point out that this is a bipartisan 
bill. On the cloture vote earlier today, it had overwhelming support, 
as 69 Senators voted to proceed with the vote on this bill.
  The legislation that is before us will increase funding for the SCHIP 
program by $35 billion over the next 5 years--a level which is 
sufficient to maintain the coverage for the 6.6 million children 
currently enrolled, as well as to expand the coverage so that we can 
reach more children who are currently uninsured. In the State of Maine, 
the bill before us will allow us to cover an additional 11,000 low-
income children who are currently eligible for SCHIP but not enrolled.
  The bill also improves the program in a number of important ways. 
Like Senator Domenici, I am very pleased that the bill includes a 
requirement for States to offer mental health services through their 
SCHIP program. Treating behavioral and emotional problems and mental 
illness while children are young--early intervention--can make such a 
difference. I know from hearings I have held in the Homeland Security 
and Governmental Affairs Committee that the current systems for 
providing mental health care to children are woefully inadequate. The 
result is oftentimes parents are faced with a horrible choice of giving 
up custody of their children in order to secure the treatment they need 
for serious mental illnesses. That is a choice no parent should ever 
have to make.
  We also need to improve oral health care, dental health care for 
children, and this bill will do just that. Despite the demonstrated 
need, children's dental coverage offered by States isn't always what it 
should be. Low-income and rural children suffer disproportionately from 
oral health problems. In fact, 80 percent of all tooth decay is found 
in just 25 percent of children--80 percent of the problems in 25 
percent of the kids. That is simply because they don't have access to 
oral hygiene, they don't have access to dentists and dental hygienists 
who could help ensure their health. I am very pleased, therefore, that 
the bill before us will strengthen the dental coverage offered through 
SCHIP to ensure that more low-income children have access to the dental 
services they need to prevent disease and promote good oral health.
  Finally, the bill will eliminate the State shortfall problems that 
have plagued the SCHIP program as well as provide additional incentives 
to encourage States to increase outreach and enrollment, particularly 
of the lowest income children.
  The bill before us today is the prescription for good health for 
millions of our Nation's low-income children in working families. That 
is why I am so disappointed that the President has threatened a veto of 
this legislation. I just do not understand his decision, and I think it 
could be a terrible mistake. This important program can simply not be 
allowed to expire. I urge all of our colleagues to join me in 
supporting it.
  Let me make one final point. I have heard a lot of our colleagues on 
my side of the aisle argue that we need a far more extensive debate on 
health care policy in this country, and they are right. But we should 
not hold the SCHIP program hostage to that broader debate. We do need a 
broader debate. We need a broader debate on how to lessen the number of 
uninsured Americans, which now exceeds 45 million Americans. We need a 
broader debate on how to help our small businesses better afford the 
cost of health insurance for their employees.
  We need a broader debate on how we can effectively use the Tax Code 
to help subsidize the cost of insurance for those who don't receive 
insurance through the workplace.
  I hope Senate leaders will charge the relevant committees to 
undertake a couple of months of hearings to bring together the best 
minds possible and then dedicate a month of debate on the Senate floor 
to a wide variety of solutions to both promote broader access to health 
care, to help our uninsured better afford health coverage, and to 
improve the quality of health care in this country.
  That is an important and overdue debate. In fact, the Senator from 
Louisiana, Senator Landrieu, and I have, for several Congresses, 
introduced a broad health care bill with these goals in mind.
  Let us not jeopardize the existence of a successful, effective 
program for low-income children because we want to have that broader 
debate. Let's send this bill to the President. Let's urge him to sign 
it into law, and then let's turn our attention to this long, overdue, 
much needed debate.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Whitehouse). The Senator from Arizona is 
recognized.
  Mr. KYL. Mr. President, I want to begin my remarks by noting that, 
along with my colleagues, I support reauthorization of SCHIP. 
Unfortunately, the bill before the Senate today is not just an SCHIP 
reauthorization; it is an SCHIP expansion, based on the following 
misguided principles:
  First, it would turn a program for low-income children into a program 
for adults as well.
  Second, it expands SCHIP to cover children from higher income 
families.
  Third, it covers people already insured, not just the uninsured.
  Fourth, it circumvents budget rules to hide a $41 billion cost not 
paid for under the bill.
  I will address the first issue. When we authorized this program in 
1997, the Republican-led Congress intended SCHIP to provide health 
coverage to low-income, uninsured children. Ten years later, the 
program created for children covers adults.
  In fiscal year 2006, 14 States enrolled over 700,000 adults in SCHIP. 
In fact,

[[Page S12246]]

this year, 13 percent of SCHIP funds will go to adults other than 
pregnant women. For example, Wisconsin covers almost twice as many 
adults as children under the SCHIP program, spending 76 percent of its 
SCHIP funds on adults. Illinois spends 62 percent on adults. Rhode 
Island spends 54 percent on adults. New Jersey spends half of its money 
on adults.
  So what happens under the bill before us? It allows the States, with 
these existing waivers, to continue enrolling new parents--adults, 
obviously--at a higher reimbursement rate than Medicaid.
  There is no ``a'' in SCHIP. If Congress created SCHIP for low-income 
children, we in Congress should ensure that is where the funds go; 
otherwise, we are being dishonest with the American people and we 
should rename the program.
  Second, when the program was created, in 1997, we targeted low-income 
children whose families earn too much to qualify for Medicaid but not 
enough to obtain private health insurance. We never intended for all 
children, regardless of the income of their families, to become 
dependent on a Government health insurance program. That is not what is 
happening today.
  Eleven States have income thresholds at or above 300 percent of the 
Federal poverty level. Rather than refocusing SCHIP on low-income 
children, nothing in the bill prohibits States from increasing 
eligibility levels above 300 percent of the Federal poverty level.
  In fact, the bill grandfathers in the two States with the Nation's 
highest levels and at a higher reimbursement rate than the rest of the 
country. Why should Arizonans, my constituents, pay their taxpayer 
dollars, which are intended for low-income children, to be sent to New 
York and New Jersey to cover families earning up to $82,600 a year?
  I have heard some say over and over again this will only happen if 
the administration allows it. That is not true.
  First, I direct my colleagues' attention to page 82, lines 3 through 
11 of the bill. It states there is an exception for any State with an 
approved State plan amendment or waiver--that is New Jersey--or a State 
that has enacted a State law--that is New York. There is an exception. 
So it is not that the President can stop this. The bill provides the 
exception.
  To clarify the policy even further, page 82 includes new language 
that was not in the Senate-passed bill. This new language reinforces 
that States should have the flexibility to set their own income 
eligibility levels, no matter how high, making it nearly impossible for 
any administration to reject such State requests.
  Third, very importantly, the bill guts an August 17 letter issued by 
the administration designed to make sure that States enroll low-income 
families first and foremost. They said you have to make sure 95 percent 
of your low-income, eligible kids are enrolled in the SCHIP program 
before you can expand it to cover the higher income families. Well, 
that has been taken out of the bill and the bill guts the provision.
  From my analysis, nothing in this bill gives the administration the 
clear authority to prevent taxpayer dollars from being sent to higher 
income families. Even the Concord Coalition, a nonpartisan advocacy 
group, warns that the bill ``fails to target new entitlement spending 
at those most in need.''
  Third, as a result of expanding SCHIP to children from higher income 
families and some adults, the bill ``crowds out'' private health 
insurance and substitutes that coverage with government-run, taxpayer-
subsidized insurance.
  The Congressional Budget Office estimates that 2 million people will 
drop their private coverage under this bill. For every two individuals 
added to SCHIP, or Medicaid Program, one drops private coverage. This 
is why we say it is a step toward government-run health care--you take 
people with good private health insurance and take them off of the 
private health insurance roll and substitute in the government health 
insurance program.

  For the newly eligible populations--the people not yet enrolled in 
the program--CBO shows a one-for-one replacement, meaning that for each 
600,000 newly insured individuals, 600,000 individuals go off of 
private coverage. Is that what we are all about, what we should be 
doing here? Should Congress not focus on ways to provide health care 
coverage to the uninsured, rather than to those who already have 
insurance? Of course, the answer is yes.
  Finally, the SCHIP bill is not paid for. Under our rules, we are 
required to state the cost of a program such as this over 10 years and 
pay for it over that time period. Under the bill, SCHIP spending goes 
up every year for 5 years and, all of a sudden, magically, 
artificially, the spending drops off precipitously, as if there is no 
more need for it. It basically disappears. Obviously, the reason for 
that is to circumvent the budget rules and avoid paying for the bill. 
The assumption, obviously, is artificial and wrong and everybody knows 
it. The program is, in fact, going to continue out over the full 10 
years; it doesn't stop after 5. So you need to make up the last 5 
years.
  How much does that cost? According to the CBO, $41 billion will be 
needed to sustain the program for the last 5 years of the 10-year 
program. In other words, the bill has in it a $41 billion hole. If you 
fill in that hole over the course of the 10 years, the cost of the bill 
exceeds $110 billion. That is why some of us appreciate the President's 
determination to veto the bill as too much spending on a program that 
has been expanded way beyond its original purpose and is substituting 
private health insurance coverage for a new government program.
  A future Congress will have no other choice than to disenroll 
millions of children, which will not happen, or more likely, raise 
taxes to fill that $110 billion cost. Of course, it will be our 
children who will bear this bill's deficit.
  I will conclude where I started. Like everybody else in the Chamber, 
I support the reauthorization of SCHIP. I don't support its expansion 
in the way it has been done under this bill. Republicans have offered a 
fiscally responsible alternative that reauthorizes SCHIP for 5 years, 
preserving health care coverage for millions of low-income children. It 
adds 1.3 million new children to SCHIP. It is offset without new taxes 
or budget gimmicks. It minimizes the reduction in private health 
coverage by targeting it to low-income children.
  We should pass an SCHIP extension and we should work toward a 
reauthorization, such as the Republican alternative, that is fiscally 
responsible and upholds SCHIP's original intent. Doing so is a step 
toward renewing our commitment to America's children.
  Mr. GRASSLEY. Mr. President, since the Senate passed the bill the 
first time, the subject of ``crowd-out'' has become a lot more 
important in this debate.
  Crowd-out is the substitution of public coverage for private 
coverage. Crowd-out occurs in CHIP because the CHIP benefit is very 
attractive and there is no penalty for refusing private coverage if you 
are eligible for public coverage.
  On August 17, CMS put out a letter giving States new instructions on 
how to address crowd-out.
  I appreciate the administration's willingness to engage on the issue. 
I think they have some very good ideas. But I also think there are some 
flaws in their policy.
  States are supposed to cover 95 percent of the low-income kids. But 
it has been a month since they issued the letter and CMS still cannot 
explain what data States should be using.
  Personally, I think CMS should have answers before they issue 
policies. And if they still can't a month later, I believe, as the 
saying goes, they obviously aren't ready for prime time.
  So the compromise bill 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 in addressing crowd-out.
  Following these two reports, the Secretary, in consultation with 
States, will develop crowd-out 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 FPL and 
on crowd-out.

[[Page S12247]]

  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 crowd-out for this population, incorporating the best 
practices recommended by the Secretary.
  After October 1, 2010, Federal matching payments are not permitted to 
States that cover children whose family incomes exceed 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.
  Simply put, cover your low-income kids or you get no money to cover 
higher income kids.
  Now I know some people are obsessed with the State of New York and 
their and their efforts to cover kids up to 400 percent of poverty.
  It seems to come up in the talking points of every person who speaks 
out against our bill. This bill does not allow any State to go to 400 
percent of poverty.
  In fact, 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, to continue 
to do so if they don't do a better job of covering low-income kids.
  If you are concerned about the State of New York, don't waste your 
time looking at this bill. You will not find answers to New York's fate 
here.
  The answer is where it has always been--in the office of HHS 
Secretary Mike Leavitt. Only he has the authority to allow any State to 
cover children up to 400 percent of poverty. This bill does nothing to 
change that authority. It is up to the Secretary.
  I heartily encourage those of you who haven't to read the bill. It is 
all there in black and white.

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