[Congressional Record Volume 155, Number 18 (Thursday, January 29, 2009)]
[Senate]
[Pages S1007-S1050]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    CHILDREN'S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT OF 2009

  The ACTING PRESIDENT pro tempore. Under the previous order, the 
Senate shall resume consideration of H.R. 2, which the clerk will 
report.
  The assistant legislative clerk read as follows:

       A bill (H.R. 2) to amend title XXI of the Social Security 
     Act to extend and improve the Children's Health Insurance 
     Program, and for other purposes.

  Pending:

       Coburn amendment No. 49 (to H.R. 2, as amended), to prevent 
     fraud and restore fiscal accountability to the Medicaid and 
     SCHIP programs.
       Coburn amendment No. 50 (to H.R. 2, as amended), to restore 
     fiscal discipline by making the Medicaid and SCHIP programs 
     more accountable and efficient.

  The ACTING PRESIDENT pro tempore. The senior Senator from Nebraska is 
recognized.


                           The Guest Chaplain

  Mr. NELSON of Nebraska. Mr. President, I am very pleased that Rabbi 
Daniel Fellman could join us today as guest Chaplain to deliver the 
opening prayer for the Senate.
  Rabbi Fellman, a native of Omaha and a respected religious leader, 
currently is assistant rabbi at Anshe Emeth Memorial Temple in New 
Brunswick, NJ. He is a much admired teacher who has served on the 
faculty

[[Page S1008]]

at the Yavneh Day School in Cincinnati and numerous religious schools. 
He served as student rabbi in congregations in Natchez, MS; Petoskey, 
MI; Joplin, MO; and LaSalle, IL. He also served in summer rabbinic 
positions in Nebraska and at the University of Cincinnati Hillel. In 
Cincinnati, he helped foster interfaith understanding as a member of 
the steering committee of the Catholic-Jewish Educators Dialogue of the 
American Jewish Committee.
  Rabbi Fellman received his undergraduate degree in political science 
from Colorado College. He earned a master of arts in Hebrew letters 
from Hebrew Union College-Jewish Institute of Religion in Cincinnati, 
and he was ordained in June 2005.
  On a more personal note, however, Rabbi Fellman is an Eagle Scout, 
and, like me, Boy Scouts taught him the importance of dedication and 
service to the community.
  While he is still young now, I have counted him as a friend for a 
long time. During my first campaign for Governor in 1990, I was 
grateful when a teenage Daniel Fellman often showed up with his father, 
University of Nebraska at Omaha political science professor Dick 
Fellman--who is with us today, and his mother--to volunteer.
  One night Daniel Fellman, a relatively green driver then, got into an 
automobile accident. There were no serious injuries sustained, but news 
reached one of my closest aides and my campaign manager the next 
morning before Daniel arrived in the office. That was my great friend, 
the late, great Sonny Foster.
  The next morning, when Daniel did arrive at our campaign office, 
Sonny greeted him: Hello, Crash. Ever since, to me and a few others, he 
has been ``Crash Fellman,'' but now he is Rabbi Fellman. We understand 
it is a nickname, always given and received by a smile.
  I thank Rabbi Fellman and his parents and his family for being here 
today and for his words of prayer this morning. May they guide us to do 
what is right for America and for the world.


                   Recognition of the Minority Leader

  The ACTING PRESIDENT pro tempore. The Republican leader is 
recognized.


                     Economic Stimulus Legislation

  Mr. McCONNELL. Mr. President, Republicans have had an opportunity 
this week to highlight a number of our better ideas to ensuring low-
income children receive quality health care. We will continue to offer 
our plans to improve this program. I think there is certainly a 
possibility of finishing the SCHIP bill today, which will let us turn 
to the economy next week.
  We all know the economy is clearly the top issue on the minds of all 
Americans. I think we all agree we need to act to strengthen our 
economy and to create jobs. Unfortunately, the bill produced by the 
Democratic Congress falls short on a number of important fronts. First, 
it does not fix the main problem, which is housing. We need to address 
that issue, and my colleagues will have better ideas to stimulate home 
ownership. Next, we need to let taxpayers keep more of what they earn. 
Finally, we should not be spending taxpayer dollars we do not have on 
programs we do not need.
  We have seen a lot of reports recently on what is in the bill--
everything from buying cars for Federal employees, to beautifying ATV 
trails, to spiffing up the headquarters building at the Department of 
Commerce. In a time of trillion-dollar deficits, we cannot afford 
Washington business as usual. We should insist on the highest 
standards. Are these projects really necessary? Will they stimulate the 
economy? Will they create jobs? Should we ask the American people to 
foot the bill? Republicans believe that letting individuals and 
businesses keep more of what they earn will have a quicker stimulative 
effect than having the Government spend it on projects, particularly 
ones that are likely to be delayed for 3 to 4 years.
  We look forward to offering amendments to improve this critical 
legislation and move it back to the package President Obama originally 
proposed--40-percent tax relief, no wasteful spending, and a bipartisan 
approach.
  Republicans have better ideas to dramatically improve this bill that 
will go at the problem, create jobs, and stimulate the economy. We have 
better ideas to address the housing crisis, which is where this problem 
originated. But in order to pass these and other commonsense 
amendments, we will need support from our friends on the other side of 
the aisle. Fixing our economy requires innovative ideas, commonsense 
solutions, and bipartisan cooperation. It is clear from last night's 
vote in the House that the only thing that is bipartisan about this 
bill is the opposition to it. It simply does not meet the standard of 
bipartisan cooperation set by President Obama and welcomed by 
Republicans in Congress.
  Republicans stand ready to work with our friends across the aisle to 
create truly bipartisan legislation which will actually stimulate the 
economy and create jobs, and we are ready to start next week.
  Mr. President, I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. BAUCUS. Mr. President, we had a good day on the Children's Health 
Insurance Program bill yesterday. We considered 10 amendments; we 
conducted 6 rollcall votes. All in all, I think it was a very 
productive day because we are very close to finishing and passing the 
Children's Health Insurance Program--reauthorizing it--so it can be 
sent to the House. My expectation is the House will then take the 
Senate bill and send it to the President so we can get it signed very 
quickly.
  This morning, at about 10 a.m., we expect Senator Hatch to come to 
the floor to offer his amendment regarding the definition of an unborn 
child. I know Senator Boxer, and perhaps some other Senators, wish to 
be here to address that issue and speak on that as well.
  Last night, Senator Coburn offered two amendments and spoke about 
another, and we hope to work with him to process those amendments.
  For the information of Senators, we are working to set up a series of 
votes on amendments, perhaps later this morning. A specific time has 
not been set. My guess is it will be quite late this morning. Frankly, 
we are working to finish this bill this afternoon. This bill is moving 
along very quickly, and I urge Senators to bring any remaining 
amendments they may have to the floor so we can wrap it up.
  This is a wonderful program. There aren't very many people who 
disagree with the Children's Health Insurance Program as enacted by 
Congress back in 1997. It was wonderful work on the part of Senator 
Rockefeller, Senator Hatch, Senator Kennedy, and the late Senator John 
Chafee. They worked very hard.
  It is very interesting, there were very serious discussions on the 
one hand, with many Senators who thought this should be another 
entitlement program for children; on the other hand, some Senators 
thought, no, this should not be an entitlement program, it should be a 
block grant program. That was the compromise; that States get a big 
chunk of money, to be matched by State payments to provide health 
insurance for the working poor--for kids of families who are just above 
the income levels set for Medicaid. It has worked very well. It is very 
important, and I am very happy, frankly, and proud of the attempt that 
was begun back in 1997 by the Senators I mentioned.
  We had hoped to get this approved a couple years ago, late in 2007, 
but unfortunately those two efforts were vetoed by President Bush. But 
here we are today. This is 2009--a new era, a new opportunity--and I 
think most Senators are quite proud of the efforts we are making to 
help more kids get better health insurance.
  I hope Senator Hatch gets to the floor soon so he can offer his 
amendment and then we can proceed.
  I yield the floor, and I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. HATCH. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.

[[Page S1009]]

  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.


                            Amendment No. 80

  Mr. HATCH. Mr. President, I ask unanimous consent to set aside the 
pending amendment and call up the Hatch amendment No. 80.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered. The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from Utah [Mr. Hatch], for himself, Mr. Vitter, 
     Mr. Brownback, Mr. Thune, and Mr. Bennett, proposes an 
     amendment numbered 80.

  Mr. HATCH. Mr. President, I ask unanimous consent that further 
reading of the amendment be dispensed with.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  The amendment is as follows:

  (Purpose: To codify regulations specifying that an unborn child is 
                 eligible for child health assistance)

       On page 76, after line 23, add the following:

     SEC. 116. TREATMENT OF UNBORN CHILDREN.

       (a) Codification of Current Regulations.--Section 
     2110(c)(1) (42 U.S.C. 1397jj(c)(1)) is amended by striking 
     the period at the end and inserting the following: ``, and 
     includes, at the option of a State, an unborn child. For 
     purposes of the previous sentence, the term `unborn child' 
     means a member of the species Homo sapiens, at any stage of 
     development, who is carried in the womb.''.
       (b) Clarifications Regarding Coverage of Mothers.--Section 
     2103 (42 U.S.C. 1397cc) is amended by adding at the end the 
     following new subsection:
       ``(g) Clarifications Regarding Authority to Provide 
     Postpartum Services and Maternal Health Care.--Any State that 
     provides child health assistance to an unborn child under the 
     option described in section 2110(c)(1) may--
       ``(1) continue to provide such assistance to the mother, as 
     well as postpartum services, through the end of the month in 
     which the 60-day period (beginning on the last day of 
     pregnancy) ends; and
       ``(2) in the interest of the child to be born, have 
     flexibility in defining and providing services to benefit 
     either the mother or unborn child consistent with the health 
     of both.''.

  Mr. HATCH. Mr. President, America's Founders built their case for 
independence on the foundation of self-evident truths; not party 
platforms or partisan positions, not opinion polls or intellectual fads 
but self-evident truths. Our Creator, they said, endows us with 
inalienable rights, including the right to life. Government, they said, 
exists to secure those rights. They believed that when America was 
born, and I still believe that today. I offer this amendment in that 
same spirit. The conviction about the essential dignity of our fellow 
human beings motivates the Civil Rights movement here at home and the 
human rights movement abroad. No matter what our income, race, sex, 
religion, location or age, we all have our humanity in common.
  I came to the Senate with the conviction and tried to act on that 
conviction ever since by working to protect children's lives and 
promote children's health. These go hand in hand. That is why I worked 
so hard with Senator Kennedy and others to originally pass the 
children's health program and bill. It was kind of a miracle that we 
were able to get it done over 10 years ago when we did it. It was done 
in the Finance Committee and became the glue that held both the 
Republicans and Democrats together on the first balanced budget in over 
40 years.
  As I said, I came to the Senate with very strong convictions. Again, 
I have tried to act on those convictions ever since by working to 
protect children's lives and to promote children's health because I 
believe they go hand in hand. Elaine and I have 6 children, 23 
grandchildren, and 3 great-grandchildren, and we speak for children, 
grandchildren, great-grandchildren, and beyond, all over America.
  I cannot understand those who insist that we establish hundreds of 
programs to help millions of people by spending billions of dollars but 
who do not believe the lives of those very same people should be 
protected.
  The Children's Health Insurance Program is about promoting children's 
health. My amendment does exactly that. A child in the womb is just as 
alive, just as human as that very same child will be after he or she is 
born. The CHIP program exists to help States promote children's health. 
The children who need help might be in a house or an apartment, in a 
city or out in the country, in a large family or single-parent home, in 
a crib or in the womb. That just seems to me, well, self-evident.
  Since October 2002, a regulation issued by the Department of Health 
and Human Services has defined a child as anyone from conception to 18 
years of age. It may sound a little odd to call someone who can drive, 
vote, or serve in the military a child, but it is the most natural 
thing in the world to say that when those very same individuals were in 
the womb, they were children.
  Under this HHS regulation, States have had the option of providing 
CHIP coverage to children before as well as after birth. My amendment 
would codify that regulation to continue helping States protect the 
health of children.
  I would point out to my colleagues that so far, 14 States have 
approved plans to provide CHIP coverage to children before birth. Those 
States include Arkansas, California, Oregon, Rhode Island, Tennessee, 
Texas, Washington, and Wisconsin.
  I also wish to clarify that my amendment would also provide health 
coverage to pregnant women. Some have claimed that under this HHS 
regulation, pregnant women would only get CHIP coverage for conditions 
specifically related to their pregnancy. I want to assure my colleagues 
that my amendment will ensure that States have the option of providing 
services to benefit either the mother or the child or both.
  My amendment also clarifies that States may provide mothers with 
postpartum services for 60 days after they give birth. Mothers have 
health needs before and after they give birth and their children have 
health needs before and after they are born. My amendment ensures that 
the CHIP program continues to meet those very important needs.
  I urge my colleagues not to put the health of children at greater 
risk by sidetracking my amendment with a bogus debate over abortion. 
This is about children and their health, not abortion.
  America itself is built on the foundation of inalienable rights which 
we receive from God. Government exists to secure those rights. Those 
rights do include the right to life, and they specifically include the 
right to life. My life, your life, the life of each of my Senate 
colleagues did not begin when we were born. Each of us was just as 
alive, just as human the day before our birth as the day after--or as 
we are today. Our efforts to promote children's health, including 
through the CHIP program, flow from that self-evident truth.
  My amendment will continue allowing States to promote the health of 
children and their mothers before as well as after those children are 
born. I urge all my colleagues to support it.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from California is 
recognized.
  Mrs. BOXER. Mr. President, with great respect for my friend from 
Utah, I rise to oppose his amendment, not only as a Senator but as a 
mom and a grandmother. What the Senator is seeking to do essentially is 
separate the woman from the child she is carrying, separate her from 
her pregnancy. I think I can speak with authority here. I know my 
friend is a grandpa and a dad and has a magnificently beautiful family, 
but I gave birth to two kids. I can assure my friend that when you 
cover the pregnant woman, you are covering that child from the time 
that child is a fetus to the time that child is born.
  I would just say that it appears to me as if this amendment is a 
diversionary amendment from this very important bill to expand and 
improve the health of our children, including the health of our moms 
who are pregnant, a diversion to a debate about when does life begin--
let's fight about abortion. You know what, we will have many 
opportunities to have that argument. When we have that argument over 
Roe v. Wade, I think pro-choice will prevail. But this is not the place 
to have that argument. This is a place where my friend from Utah and I 
should walk down this aisle being very happy that under this law that 
is before us, this bill that is before us, States absolutely can choose 
to cover a pregnant woman. This is a big step forward, and this is very 
important.
  Again, I think the idea behind this amendment is to divert us from 
this

[[Page S1010]]

very important bill. In my State, it will expand coverage to more than 
half a million kids and many pregnant women.
  The debate over when life begins and all of that is a very 
philosophical debate. My religion may teach something other than my 
friend's. I totally respect every view on that subject. I also respect 
the women of this country and the view they bring through their moral 
code and their religion and whatever else they bring to the table as 
human beings. On the day we debate that, I will be out here debating 
it, but I am not going to get into this debate with my friend today 
over when life begins. Today is a day where we are going to work on 
making sure that our children are covered with health insurance and 
that our pregnant women are covered with health insurance. The good 
news I bring to the Senate today is that under this bill, pregnant 
women will be covered by this. This is very important.
  Again, to try to separate the woman from the child she is carrying, 
from the fetus in her womb, is nonsensical. Maybe my friend sees it 
another way. But when you take care of a pregnant woman, you are taking 
care of her fetus, you are taking care of her pregnancy, you are 
working hard to make sure that baby is healthy.
  I just became a grandma 3 weeks ago, and my daughter had excellent 
health care. I want to assure my friends on the other side of the aisle 
that as she was being treated, so was the child she was carrying, my 
beautiful grandson.
  Let's not take a beautiful bill and start fighting over an issue that 
has been a philosophical argument forever--what is the point at which 
life begins? My religion teaches me one thing. My friend's religion may 
teach him another. Who is right? Who is wrong? All we, as humankind, 
can do is to give our best effort to figure that out. But in this bill, 
what we are trying to do is bring health insurance to pregnant women, 
bring health insurance to our kids. To divert it with this subject is a 
disservice to the bill that is before us.
  I know my friend is passionate on this point. I totally respect him 
for that. But I hope we will defeat this amendment because it is a 
diversion. It is a fight about Roe v. Wade. It is a fight about whether 
a woman has a right to choose, and it does not belong on this bill.
  Mr. President, I yield the floor.
  The ACTING PRESIDENT pro tempore. The senior Senator from Utah is 
recognized.
  Mr. HATCH. Mr. President, as always, I care for the Senator from 
California. We are good friends. You know, I hasten to point out that 
her own State of California has approved unborn child State plans. 
Look, this amendment by definition has nothing to do with abortion 
since women who seek help covering their unborn children's health are 
not women seeking abortion. They are separate, and the Senator should 
not try to mix them. This is not an issue about abortion. This is an 
issue about a living, unborn child and her or his mother.
  I might add that 14 States have approved unborn child State plans, 
including the States of Arkansas, California, Illinois, Louisiana, 
Massachusetts, Minnesota, Michigan, Oklahoma, Oregon, Rhode Island, 
Tennessee, Texas, Washington, and Wisconsin have all approved unborn 
child State plans.
  I agree with the Senator, the bill has worked beautifully, the CHIP 
bill, for the last 10 years. I know. I wrote every word in it and did 
so with Senators Kennedy, Rockefeller, Chafee, and others, as a matter 
of fact. But I don't think anybody doubts that I carried the ball in 
getting that bill through the Finance Committee and the whole Congress.
  I see a one-sided attempt here to change the bill in ways that will 
make it less effective and not cover as many children as it should. 
Some argue the legislation already gives States the option to cover 
pregnant women, so this amendment is not necessary. But the distinct 
difference between this amendment and what is in the underlying bill is 
that this amendment allows States to cover children before birth. 
Children have health needs as much before as after they are born, so 
legislation to promote children's health ought to cover them. Let me 
emphasize that this is a State option, not a State requirement.
  Some argue this amendment is an attempt to inject, as I think the 
distinguished Senator from California has argued, the abortion issue 
into a bipartisan effort to protect children's health through the 
authorizing of the CHIP program. The truth is exactly the opposite. As 
I said when introducing my amendment, this has nothing to do with 
abortion. It has everything to do with promoting children's health, and 
any reasonable person ought to be concerned about the unborn as much as 
they are the born and, of course, the mother involved. This amendment 
takes care of all three.
  I feel very strongly about this. I do not think anybody should try to 
make this an abortion issue--not myself, not the distinguished Senator 
from California, or anybody else, for that matter. I don't see how 
anybody can vote against an amendment that protects the life of the 
unborn child after having read the Constitution about its great desire 
to protect life, liberty, and the pursuit of happiness. That is what 
this amendment is all about.
  I feel strongly about it. I hope our colleagues will support it, 
because it would be a great thing to help this bill along. I would feel 
much better if this was amended. I have to admit, I do not feel good 
about the approach that has been taken by my colleagues on the other 
side of the aisle.
  The fact is that Senator Grassley and I carried the ball for the last 
2 years, working with Senators Reid, Baucus, Rockefeller, Durbin, and 
others; working with the House, Speaker of the House Pelosi, Rahm 
Emanuel and others who were there, including Steny Hoyer.
  We worked closely together to do CHIPRA I. We got an overwhelming 
vote in the Senate. On CHIPRA II, we got an overwhelming vote in the 
Senate, enough to override the President's veto in the Senate. I do not 
think that would have happened but for the bipartisan effort we put 
together. We had a solid, strong vote in the House, but not enough to 
override the President's veto.
  Now, I have heard people run down President Bush for his vetoes on 
CHIP. I think President Bush followed the advice of some very young 
advisers in the White House who basically gave him bad advice. Had he 
allowed CHIPRA I or CHIPRA II to go through, we would not be having 
this awful debate today; we would all be together. The whole Congress 
would have been together, and this whole effort would have been truly 
bipartisan. We could have set a bipartisan tone right off the bat, 
instead of this partisan tone that has been set by bringing up the bill 
without even talking to the two lead Republicans who in 2007 worked so 
carefully, honestly, and diligently to try and bring about a bipartisan 
resolution for a new CHIP bill.
  And, by the way, we took a lot of flack in the process from some in 
the administration and some on our side for supporting the legislation 
in 2007. We took it. We took it gladly. And our colleagues on the other 
side saw us take it. They saw us stand firm. They saw Senator Grassley 
and myself stand on the floor, along with a whole host of others, in a 
bipartisan way, putting together what would have made CHIP even better 
for the next certainly 5 years.
  This bill only funds the CHIP program for 4\1/2\ years, because if 
they had gone the extra half year, it would have priced the bill out of 
the marketplace. But I have to say, we are going to have to come up 
with that money anyway, and end up going that extra half year. So 
everybody better understand all that is being done today by my friends 
on the left, ignoring people, like me and Senator Grassley, who have 
worked so closely with them--and they have a right to do that. I can 
live with that, as I vote against their partisan bill.
  All I can say is they have a right to do it. But it is the wrong 
thing to do. It is the wrong way to start off this Congress after the 
President himself has shown such a propensity to want to work together. 
I have to say, I was there when the President came and spoke to our 
caucus last Tuesday. He was impressive. He was friendly. He was making 
every effort to be bipartisan. But he apparently had not fully examined 
the stimulus bill that has been passed only in a partisan way by

[[Page S1011]]

the House. I would call people's attention to the Wall Street Journal 
yesterday and their editorial on all the bad things that are in the 
bill; or Investors Business Daily and their editorial, and how that it 
is not a stimulus bill at all, but a great big potpourri of long-wanted 
liberal programs that are not going to stimulate the economy the way 
they should.
  I am not saying there is not any stimulus in the bill, but there is 
not much compared to the cost of the bill. When you add interest to the 
bill, it is well over $1 trillion. Of course, you know, they keep 
interest off because that would make it over $1 trillion. But interest 
is going to have to be paid regardless.
  Now, this particular bill on the floor right now is one where I have 
a tremendous interest, namely, children and children's health. I am 
going to continue to take great interest in it.
  I want to caution my colleagues on the left that they are making a 
tremendous mistake here. I think we could have had 95 votes for CHIPRA 
II or CHIPRA I. That would send a tremendous message that has not been 
sent around here in a long time.
  Now, the CHIP program, so everybody understands, already covers 
children before birth at the States' option. I read off the States that 
have made that an option, including the distinguished Senator from 
California's State.
  This is not a new policy. It is already working. This amendment 
simply continues that policy by codifying the HHS regulation. Women who 
want their babies need this assistance. Women in California and other 
States want this. Please do not deny this type of basic humane 
assistance or help for women and their children with a fake argument 
about abortion. Let's have an abortion debate on another day. Everybody 
knows I am pro life. I feel very strongly about that. I will stand up 
for the pro-life position. But it has nothing to do with what we are 
debating here today. Let's help children and their mothers now.
  Let's codify what a whole raft of States have said we ought to do, 
including the very important State of California, one-seventh of the 
whole economy, one-seventh, I should say, in size in the world economy 
today, and a State I have a lot of regard for.
  Fourteen states have gone along with this regulation. And, frankly, I 
do not see one good argument against protecting unborn children and 
their mothers who want those children covered through the wonderful 
child health insurance program. This is a very important set of issues.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from California is 
recognized.
  Mrs. BOXER. Mr. President, my friend from Utah says he wants an 
honest debate, and then he says, and I am quoting him--not word for 
word--he says, pregnant women are not covered in this bill. That is a 
dishonest debate.
  States have the option to cover pregnant women, just as under the 
Bush regulation they have the option to cover the unborn child. Okay? 
So let's straighten it out.
  My colleague has mentioned my State several times. My State was so 
anxious to cover pregnant women that they did cover them under the 
unborn child regulation which was put into place by George Bush, 
because he injected the whole abortion debate into the CHIP program.
  What we do is we get away from that. In this bill we talk about 
covering pregnant women. So for anyone to stand up here and suggest 
that the only way to cover pregnant women is by codifying George Bush's 
regulation that, by the way, this Chamber voted down twice--let's be 
clear.
  My colleague says that this is a left-right issue. This is not a 
left-right issue at all. When my colleagues voted on this a couple of 
times before, it was bipartisan to reject the Allard amendment, which 
was to codify the very law that my friend is suggesting we do today. I 
will predict we will defeat this by a much bigger margin, because of 
the elections that were just held.
  I say again, with all respect, anyone who in their heart wants to 
cover pregnant women, which means covering the child they are carrying, 
should be very proud of this bill. Because that is what we do. So to 
stand up here and say we have to codify George Bush's wording on this, 
which was ``unborn child,'' saying if we do not pass this amendment, 
pregnant women and their babies are not covered, this is a straw man or 
a straw person. Pregnant women are covered. The fetus is covered from 
the minute that woman goes to the doctor until the minute she gives 
birth, and through all of those times in between. It is the ability of 
the States to do it. But we refuse in this bill, and I hope we will 
continue this, to put forward such a divisive issue and an argument 
that does not belong on this bill.
  If my friend was right, if he stood up here and said, right now 
pregnant women are not covered, I would go over there and say, well, 
let's work out some wording to make sure they are covered. But we do 
not have to do that. They are covered.
  What my friend wants is to codify what George Bush put into play, a 
political decision to inject abortion politics into a children's health 
bill. I think it is a sad day for the children of this country to be 
drawn into a debate. And, again, mentioning my State several times, 
when my State had no choice. If they wanted to cover pregnant women, 
they had to cover them under this. Guess what. Now they will not have 
to do it, because this bill corrects the problem.
  So I have to say, when my friend says it is a left-right debate, it 
has nothing do with left-right, and he knows it. In my State, some of 
the strongest pro-choice constituents are Republicans, and some of the 
strongest pro-life constituents are Democrats. This is not a left-right 
issue. It is an issue we all address in our own way using our own 
logic, our religion, our moral values, and we come to a conclusion.
  Do not inject it into this bill. I hope we reject this, because this 
is now the second abortion-related amendment my Republican friends have 
offered in as many days. If that is what they think this election was 
about, I think they are missing something. People want our kids to have 
health care. They want our families to have health care. They want to 
solve the economic problems.
  Today we learned there are even more jobless claims. Millions of 
people are unemployed. And we are having our second abortion-related 
vote. I think if this party, this Grand Old Party does that, I see 
several colleagues who may say, well, it is your right, it is your 
privilege, I will debate you. I think we will prevail today.
  But if every single bill we bring forward turns into an abortion-
related debate, I do not know where my colleagues are coming from. 
Because let me reiterate, every pregnant woman has the right to have 
this health care option should their State choose it.
  We do not need to change the language and codify a very divisive 
amendment which was a regulation under George Bush. It should be a new 
day around here. We should not have to have this division. But I have 
already heard they may offer more abortion-related amendments on this 
children's bill.
  Who knows what is to come? But you know what, I think my leader, 
Harry Reid, is right. Let them come at us with these amendments. Let 
the American people see the priorities, when everyone knows every 
pregnant woman is eligible for coverage. To now indicate they are not 
unless my friend's amendment passes is simply, if I could say, an out 
and out falsehood. It is not true. It is not true.

  I have the bill. I will read the section, if my friend needs me to.
  I ask unanimous consent to print in the Record the last two votes we 
had on this very same subject where those trying to inject the abortion 
issue failed.
  There being no objection, the material was ordered to be printed in 
the Record, as follows;

        U.S. Senate Roll Call Votes 110th Congress--2nd Session

       As compiled through Senate LIS by the Senate Bill Clerk 
     under the direction of the Secretary of the Senate.


                              Vote Summary

       Question: On the Amendment (Boxer Amdt. No. 4379).
       Vote Number: 80; Vote Date: March 14, 2008, 12:11 AM.
       Required For Majority: 1/2; Vote Result: Amendment Agreed 
     to.
       Amendment Number: S. Amdt. 4379 to S. Con. Res. 70 (No 
     short title on file).
       Statement of Purpose: To facilitate coverage of pregnant 
     women in SCHIP.

[[Page S1012]]

       Vote Counts: YEAs--70; NAYs--27; Not Voting--3.


     Vote Summary By Senator Name, By Vote Position, By Home State

       Alphabetical by Senator Name
     Akaka (D-HI), Yea
     Alexander (R-TN), Yea
     Allard (R-CO), Nay
     Barrasso (R-WY), Nay
     Baucus (D-MT), Yea
     Bayh (D-IN), Yea
     Bennett (R-UT), Nay
     Biden (D-DE), Yea
     Bingaman (D-NM), Yea
     Bond (R-MO), Yea
     Boxer (D-CA), Yea
     Brown (D-OH), Yea
     Brownback (R-KS), Nay
     Bunning (R-KY), Nay
     Burr (R-NC), Nay
     Byrd (D-WV), Not Voting
     Cantwell (D-WA), Yea
     Cardin (D-MD), Yea
     Carper (D-DE), Yea
     Casey (D-PA), Yea
     Chambliss (R-GA), Yea
     Clinton (D-NY), Yea
     Coburn (R-OK), Nay
     Cochran (R-MS), Nay
     Coleman (R-MN), Yea
     Collins (R-ME), Yea
     Conrad (D-ND), Yea
     Corker (R-TN), Yea
     Cornyn (R-TX), Yea
     Craig (R-ID), Nay
     Crapo (R-ID), Nay
     DeMint (R-SC), Nay
     Dodd (D-CT), Yea
     Dole (R-NC), Yea
     Domenici (R-NM), Not Voting
     Dorgan (D-ND), Yea
     Durbin (D-IL), Yea
     Ensign (R-NV), Nay
     Enzi (R-WY), Nay
     Feingold (D-WI), Yea
     Feinstein (D-CA), Yea
     Graham (R-SC), Yea
     Grassley (R-IA), Yea
     Gregg (R-NH), Nay
     Hagel (R-NE), Nay
     Harkin (D-IA), Yea
     Hatch (R-UT), Nay
     Hutchison (R-TX), Yea
     Inhofe (R-OK), Nay
     Inouye (D-HI), Yea
     Isakson (R-GA), Yea
     Johnson (D-SD), Yea
     Kennedy (D-MA), Yea
     Kerry (D-MA), Yea
     Klobuchar (D-MN), Yea
     Kohl (D-WI), Yea
     Kyl (R-AZ), Nay
     Landrieu (D-LA), Yea
     Lautenberg (D-NJ), Yea
     Leahy (D-VT), Yea
     Levin (D-MI), Yea
     Lieberman (ID-CT), Yea
     Lincoln (D-AR), Yea
     Lugar (R-IN), Yea
     Martinez (R-FL), Nay
     McCain (R-AZ), Yea
     McCaskill (D-MO), Yea
     McConnell (R-KY), Yea
     Menendez (D-NJ), Yea
     Mikulski (D-MD), Not Voting
     Murkowski (R-AK), Yea
     Murray (D-WA), Yea
     Nelson (D-FL), Yea
     Nelson (D-NE), Yea
     Obama (D-IL), Yea
     Pryor (D-AR), Yea
     Reed (D-RI), Yea
     Reid (D-NV), Yea
     Roberts (R-KS), Nay
     Rockefeller (D-WV), Yea
     Salazar (D-CO), Yea
     Sanders (I-VT), Yea
     Schumer (D-NY), Yea
     Sessions (R-AL), Nay
     Shelby (R-AL), Nay
     Smith (R-OR), Yea
     Snowe (R-ME), Yea
     Specter (R-PA), Yea
     Stabenow (D-MI), Yea
     Stevens (R-AK), Yea
     Sununu (R-NH), Nay
     Tester (D-MT), Yea
     Thune (R-SD), Nay
     Vitter (R-LA), Nay
     Voinovich (R-OH), Nay
     Warner (R-VA), Yea
     Webb (D-VA), Yea
     Whitehouse (D-RI), Yea
     Wicker (R-MS), Nay
     Wyden (D-OR), Yea
       Grouped By Vote Position

                                YEAs--70

     Akaka (D-HI)
     Alexander (R-TN)
     Baucus (D-MT)
     Bayh (D-IN)
     Biden (D-DE)
     Bingaman (D-NM)
     Bond (R-MO)
     Boxer (D-CA)
     Brown (D-OH)
     Cantwell (D-WA)
     Cardin (D-MD)
     Carper (D-DE)
     Casey (D-PA)
     Chambliss (R-GA)
     Clinton (D-NY)
     Coleman (R-MN)
     Collins (R-ME)
     Conrad (D-ND)
     Corker (R-TN)
     Cornyn (R-TX)
     Dodd (D-CT)
     Dole (R-NC)
     Dorgan (D-ND)
     Durbin (D-IL)
     Feingold (D-WI)
     Feinstein (D-CA)
     Graham (R-SC)
     Grassley (R-IA)
     Harkin (D-IA)
     Hutchison (R-TX)
     Inouye (D-HI)
     Isakson (R-GA)
     Johnson (D-SD)
     Kennedy (D-MA)
     Kerry (D-MA)
     Klobuchar (D-MN)
     Kohl (D-WI)
     Landrieu (D-LA)
     Lautenberg (D-NJ)
     Leahy (D-VT)
     Levin (D-MI)
     Lieberman (ID-CT)
     Lincoln (D-AR)
     Lugar (R-IN)
     McCain (R-AZ)
     McCaskill (D-MO)
     McConnell (R-KY)
     Menendez (D-NJ)
     Murkowski (R-AK)
     Murray (D-WA)
     Nelson (D-FL)
     Nelson (D-NE)
     Obama (D-IL)
     Pryor (D-AR)
     Reed (D-RI)
     Reid (D-NV)
     Rockefeller (D-WV)
     Salazar (D-CO)
     Sanders (I-VT)
     Schumer (D-NY)
     Smith (R-OR)
     Snowe (R-ME)
     Specter (R-PA)
     Stabenow (D-MI)
     Stevens (R-AK)
     Tester (D-MT)
     Warner (R-VA)
     Webb (D-VA)
     Whitehouse (D-RI)
     Wyden (D-OR)

                                NAYs--27

     Allard (R-CO)
     Barrasso (R-WY)
     Bennett (R-UT)
     Brownback (R-KS)
     Bunning (R-KY)
     Burr (R-NC)
     Coburn (R-OK)
     Cochran (R-MS)
     Craig (R-ID)
     Crapo (R-ID)
     DeMint (R-SC)
     Ensign (R-NV)
     Enzi (R-WY)
     Gregg (R-NH)
     Hagel (R-NE)
     Hatch (R-UT)
     Inhofe (R-OK)
     Kyl (R-AZ)
     Martinez (R-FL)
     Roberts (R-KS)
     Sessions (R-AL)
     Shelby (R-AL)
     Sununu (R-NH)
     Thune (R-SD)
     Vitter (R-LA)
     Voinovich (R-OH)
     Wicker (R-MS)

                             Not Voting--3

     Byrd (D-WV)
     Domenici (R-NM)
     Mikulski (D-MD)
  
                                  ____

                                  

        U.S. Senate Roll Call Votes 110th Congress--2nd Session

       As compiled through Senate LIS by the Senate Bill Clerk 
     under the direction of the Secretary of the Senate.


                              Vote Summary

       Question: On the Amendment (Allard Amdt. No. 4233).
       Vote Number: 81; Vote Date: March 14, 2008, 12:29 AM.
       Required For Majority: 1/2; Vote Result: Amendment 
     Rejected.
       Amendment Number: S. Amdt. 4233 to S. Con. Res. 70 (No 
     short title on file).
       Statement of Purpose: To require that legislation to 
     reauthorize SCHIP include provisions codifying the unborn 
     child regulation.
       Vote Counts: YEAs--46; NAYs--52; Not Voting--2.


     Vote Summary By Senator Name, By Vote Position, By Home State

       Alphabetical by Senator Name
     Akaka (D-HI), Nay
     Alexander (R-TN), Yea
     Allard (R-CO), Yea
     Barrasso (R-WY), Yea
     Baucus (D-MT), Nay
     Bayh (D-IN), Nay
     Bennett (R-UT), Yea
     Biden (D-DE), Nay
     Bingaman (D-NM), Nay
     Bond (R-MO), Yea
     Boxer (D-CA), Nay
     Brown (D-OH), Nay
     Brownback (R-KS), Yea
     Bunning (R-KY), Yea
     Burr (R-NC), Yea
     Byrd (D-WV), Not Voting
     Cantwell (D-WA), Nay
     Cardin (D-MD), Nay
     Carper (D-DE), Nay
     Casey (D-PA), Yea
     Chambliss (R-GA), Yea
     Clinton (D-NY), Nay
     Coburn (R-OK), Yea
     Cochran (R-MS), Yea
     Coleman (R-MN), Yea
     Collins (R-ME), Nay
     Conrad (D-ND), Nay
     Corker (R-TN), Yea
     Cornyn (R-TX), Yea
     Craig (R-ID), Yea
     Crapo (R-ID), Yea
     DeMint (R-SC), Yea
     Dodd (D-CT), Nay
     Dole (R-NC), Yea
     Domenici (R-NM), Not Voting
     Dorgan (D-ND), Nay
     Durbin (D-IL), Nay
     Ensign (R-NV), Yea
     Enzi (R-WY), Yea
     Feingold (D-WI), Nay
     Feinstein (D-CA), Nay
     Graham (R-SC), Yea
     Grassley (R-IA), Yea
     Gregg (R-NH), Yea
     Hagel (R-NE), Yea
     Harkin (D-IA), Nay
     Hatch (R-UT), Yea
     Hutchison (R-TX), Yea
     Inhofe (R-OK), Yea
     Inouye (D-HI), Nay
     Isakson (R-GA), Yea
     Johnson (D-SD), Nay
     Kennedy (D-MA), Nay
     Kerry (D-MA), Nay
     Klobuchar (D-MN), Nay
     Kohl (D-WI), Nay
     Kyl (R-AZ), Yea
     Landrieu (D-LA), Nay
     Lautenberg (D-NJ), Nay
     Leahy (D-VT), Nay
     Levin (D-MI), Nay
     Lieberman (ID-CT), Nay
     Lincoln (D-AR), Nay
     Lugar (R-IN), Yea
     Martinez (R-FL), Yea
     McCain (R-AZ), Yea
     McCaskill (D-MO), Nay
     McConnell (R-KY), Yea
     Menendez (D-NJ), Nay
     Mikulski (D-MD), Nay
     Murkowski (R-AK), Nay
     Murray (D-WA), Nay
     Nelson (D-FL), Nay
     Nelson (D-NE), Yea
     Obama (D-IL), Nay
     Pryor (D-AR), Nay
     Reed (D-RI), Nay
     Reid (D-NV), Nay
     Roberts (R-KS), Yea
     Rockefeller (D-WV), Nay
     Salazar (D-CO), Nay
     Sanders (I-VT), Nay
     Schumer (D-NY), Nay
     Sessions (R-AL), Yea
     Shelby (R-AL), Yea
     Smith (R-OR), Yea
     Snowe (R-ME), Nay
     Specter (R-PA), Nay
     Stabenow (D-MI), Nay
     Stevens (R-AK), Yea
     Sununu (R-NH), Yea
     Tester (D-MT), Nay
     Thune (R-SD), Yea
     Vitter (R-LA), Yea
     Voinovich (R-OH), Yea
     Warner (R-VA), Yea
     Webb (D-VA), Nay
     Whitehouse (D-RI), Nay
     Wicker (R-MS), Yea
     Wyden (D-OR), Nay
       Grouped By Vote Position

                                YEAs--46

     Alexander (R-TN)
     Allard (R-CO)
     Barrasso (R-WY)
     Bennett (R-UT)
     Bond (R-MO)
     Brownback (R-KS)
     Bunning (R-KY)
     Burr (R-NC)
     Casey (D-PA)
     Chambliss (R-GA)
     Coburn (R-OK)
     Cochran (R-MS)
     Coleman (R-MN)
     Corker (R-TN)
     Cornyn (R-TX)
     Craig (R-ID)
     Crapo (R-ID)
     DeMint (R-SC)
     Dole (R-NC)
     Ensign (R-NV)
     Enzi (R-WY)
     Graham (R-SC)
     Grassley (R-IA)
     Gregg (R-NH)
     Hagel (R-NE)
     Hatch (R-UT)
     Hutchison (R-TX)
     Inhofe (R-OK)
     Isakson (R-GA)
     Kyl (R-AZ)
     Lugar (R-IN)
     Martinez (R-FL)
     McCain (R-AZ)
     McConnell (R-KY)
     Nelson (D-NE)
     Roberts (R-KS)
     Sessions (R-AL)
     Shelby (R-AL)
     Smith (R-OR)
     Stevens (R-AK)
     Sununu (R-NH)
     Thune (R-SD)
     Vitter (R-LA)
     Voinovich (R-OH)
     Warner (R-VA)
     Wicker (R-MS)

                                NAYs--52

     Akaka (D-HI)
     Baucus (D-MT)
     Bayh (D-IN)
     Biden (D-DE)
     Bingaman (D-NM)
     Boxer (D-CA)
     Brown (D-OH)
     Cantwell (D-WA)
     Cardin (D-MD)
     Carper (D-DE)
     Clinton (D-NY)
     Collins (R-ME)
     Conrad (D-ND)
     Dodd (D-CT)
     Dorgan (D-ND)
     Durbin (D-IL)
     Feingold (D-WI)
     Feinstein (D-CA)
     Harkin (D-IA)
     Inouye (D-HI)
     Johnson (D-SD)
     Kennedy (D-MA)
     Kerry (D-MA)
     Klobuchar (D-MN)
     Kohl (D-WI)
     Landrieu (D-LA)
     Lautenberg (D-NJ)
     Leahy (D-VT)
     Levin (D-MI)
     Lieberman (ID-CT)
     Lincoln (D-AR)
     McCaskill (D-MO)
     Menendez (D-NJ)
     Mikulski (D-MD)
     Murkowski (R-AK)
     Murray (D-WA)
     Nelson (D-FL)
     Obama (D-IL)
     Pryor (D-AR)
     Reed (D-RI)
     Reid (D-NV)
     Rockefeller (D-WV)
     Salazar (D-CO)
     Sanders (I-VT)
     Schumer (D-NY)
     Snowe (R-ME)
     Specter (R-PA)
     Stabenow (D-MI)
     Tester (D-MT)
     Webb (D-VA)
     Whitehouse (D-RI)
     Wyden (D-OR)

                             Not Voting--2

     Byrd (D-WV)
     Domenici (R-NM)
  Mrs. BOXER. Again, I want my colleagues to understand, we are 
debating a children's health care bill. Happily, I can say every 
pregnant woman in this country is eligible for health care. It is a 
wonderful thing. We avoid the divisive language of my friend's 
amendment which is codifying something George Bush put into place. It 
was not supported in the Senate. It was not supported twice. I respect 
his right to offer it as many times as he wants and let the American 
people see what we are debating. My State wanted so much to cover 
pregnant women, they said: We will go along with this language. But now 
they will not have to. They don't have to get engaged in an abortion 
debate, when you are serving children. I view this, frankly, as a 
needless debate. If the issue is covering pregnant women and their 
children, we have taken care of it. If this amendment is about 
injecting abortion and when life begins, it definitely succeeds.
  I hope the Senate will speak loudly and clearly, regardless of how 
one feels about when life begins because that is not a partisan issue. 
Everybody comes

[[Page S1013]]

to their own conclusion. This is an attempt to inject the abortion 
debate into a children's health care bill. It is diversionary. It is 
unnecessary. We should be so proud this bill covers every pregnant 
woman. It is one of those moments we could walk down the aisle together 
saying isn't it wonderful because pregnant women will get health care. 
That will lead to healthier children. We all know that.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Udall of New Mexico). The Senator from 
Utah.
  Mr. HATCH. Mr. President, this is not an injection of abortion into 
the debate. This is a children's health bill. I was the original author 
of the one that worked so well for over 10 years. A raft of States have 
determined that they should take care of the unborn through their CHIP 
programs. It is not an issue of abortion. In the world view of those 
who support abortion, the fact is, they don't want to give recognition 
to the unborn child. That is their right, if they want to feel that 
way. I think it is ridiculous. It is unspiritual. It is ignoring life 
itself. But to make that part of this debate is the wrong thing to do. 
We are trying to protect children.
  The distinguished Senator from California said: All women are going 
to be protected by this bill. That is not true. It is a state option so 
they are covered only if a State decides to cover low-income, pregnant 
women. We want to make sure that if the state has the option to not 
just cover the woman but the unborn child as well. Anybody with brains 
ought to want to do that and ought to avoid the whole issue of 
abortion, which I am trying to do by protecting the mother and the 
unborn child and codifying the 2002 regulation.
  Section 111 of the bill says there is a State option to cover low-
income pregnant women under CHIP through a State plan amendment. Some 
States have chosen to do that. But why not recognize the rights of the 
unborn child? To try and make this into an abortion debate because they 
just don't believe the unborn child lives is another thing. The point 
of my amendment is to ensure States continue to have the option in the 
future to cover unborn children, plain and simple, without any 
ambiguity. We codify the 2002 regulation into law. Frankly, it is about 
time we do things like that in a children's health bill. But to make 
this abortion argument is--I hate to say it--completely wrong.
  I am concerned not only with mothers, but I am also concerned about 
those unborn children who deserve the best health we can give them. My 
amendment gives the States the right to do that by codifying this 
important regulation. I know some supporters of abortion rights are 
afraid this will legitimize the fact that the unborn child is alive and 
is a human being. That is another argument. I agree that argument is 
right; that unborn child is alive, it is a living human being inside 
the mother's womb. The point of when the spirit enters the body is a 
legitimate question, I suppose, to some. But why would we be afraid to 
protect the rights of that unborn child? Why would we be afraid to do 
that? Why are folks so afraid if we legitimize the understanding that 
this unborn child actually is a living being, that somehow or other it 
is going to destroy their political world? It isn't going to do that.
  This is a children's health bill. I take a tremendous interest in it. 
I not only want to protect the pregnant woman, I want to protect that 
unborn child. I don't know of any pregnant woman who wants her child 
who would not want this type of protection. To make this into a bogus 
argument is the wrong thing to do.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from California is recognized.
  Mrs. BOXER. Mr. President, the reason I want to respond to this, my 
friend is so eloquent, and he is such a great debater, but I have to 
bring us back to reality. If you are standing here today because you 
care about kids and you want to make sure pregnant women get all the 
health care they need so if there is trouble in the pregnancy, if there 
is a problem--there are so many miraculous things that can be done, and 
I have seen some of those in my own family, the things they can do to 
make sure a child is healthy. If the purpose of my friend, out of his 
love for his children and all children, which I know he has--if my 
purpose in supporting this bill is to make sure children are healthy, 
if that is our purpose, we could be very proud of this bill.
  This bill says--and I will reiterate this as long as I have to--every 
single poor pregnant woman in America today is eligible for health care 
during her pregnancy, from the first day to the last day. Then, of 
course, a poor child would continue to get that health care. So anyone 
else who says that isn't true simply hasn't read the bill.
  I ask unanimous consent to print in the Record, so my friend can't 
say something that is without rebuttal, page 50 of the bill, section 
2112, which talks about low-income pregnant women to be covered through 
a State plan amendment.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

      Subtitle B--Focus on Low-Income Children and Pregnant Women

     SEC. 111. STATE OPTION TO COVER LOW-INCOME PREGNANT WOMEN 
                   UNDER CHIP THROUGH A STATE PLAN AMENDMENT.

       (a) In General.--Title XXI (42 U.S.C. 1397aa et seq.), as 
     amended by section 112(a), is amended by adding at the end 
     the following new section:

     `SEC. 2112. OPTIONAL COVERAGE OF TARGETED LOW-INCOME PREGNANT 
                   WOMEN THROUGH A STATE PLAN AMENDMENT.

       `(a) In General.--Subject to the succeeding provisions of 
     this section, a State may elect through an amendment to its 
     State child health plan under section 2102 to provide 
     pregnancy-related assistance under such plan for targeted 
     low-income pregnant women.
       `(b) Conditions.--A State may only elect the option under 
     subsection (a) if the following conditions are satisfied:
       `(1) Minimum income eligibility levels for pregnant women 
     and children.--The State has established an income 
     eligibility level--
       `(A) for pregnant women under subsection 
     (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) of 
     section 1902 that is at least 185 percent (or such higher 
     percent as the State has in effect with regard to pregnant 
     women under this title) of the poverty line applicable to a 
     family of the size involved, but in no case lower than the 
     percent in effect under any such subsection as of July 1, 
     2008; and
       `(B) for children under 19 years of age under this title 
     (or title XIX) that is at least 200 percent of the poverty 
     line applicable to a family of the size involved.
       `(2) No chip income eligibility level for pregnant women 
     lower than the state's medicaid level.--The State does not 
     apply an effective income level for pregnant women under the 
     State plan amendment that is lower than the effective income 
     level (expressed as a percent of the poverty line and 
     considering applicable income disregards) specified under 
     subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or 
     (l)(1)(A) of section 1902, on the date of enactment of this 
     paragraph to be eligible for medical assistance as a pregnant 
     woman.
       `(3) No coverage for higher income pregnant women without 
     covering lower income pregnant women.--The State does not 
     provide coverage for pregnant women with higher family income 
     without covering pregnant women with a lower family income.
       `(4) Application of requirements for coverage of targeted 
     low-income children.--The State provides pregnancy-related 
     assistance for targeted low-income pregnant women in the same 
     manner, and subject to the same requirements, as the State 
     provides child health assistance for targeted low-income 
     children under the State child health plan, and in 
     addition to providing child health assistance for such 
     women.
       `(5) No preexisting condition exclusion or waiting 
     period.--The State does not apply any exclusion of benefits 
     for pregnancy-related assistance based on any preexisting 
     condition or any waiting period (including any waiting period 
     imposed to carry out section 2102(b)(3)(C)) for receipt of 
     such assistance.
       `(6) Application of cost-sharing protection.--The State 
     provides pregnancy-related assistance to a targeted low-
     income woman consistent with the cost-sharing protections 
     under section 2103(e) and applies the limitation on total 
     annual aggregate cost sharing imposed under paragraph (3)(B) 
     of such section to the family of such a woman.
       `(7) No waiting list for children.--The State does not 
     impose, with respect to the enrollment under the State child 
     health plan of targeted low-income children during the 
     quarter, any enrollment cap or other numerical limitation on 
     enrollment, any waiting list, any procedures designed to 
     delay the consideration of applications for enrollment, or 
     similar limitation with respect to enrollment.
       `(c) Option to provide presumptive eligibility.--A State 
     that elects the option under subsection (a) and satisfies the 
     conditions described in subsection (b) may elect to apply 
     section 1920 (relating to presumptive eligibility for 
     pregnant women) to the State child health plan in the same 
     manner as such section applies to the State plan under title 
     XIX.

[[Page S1014]]

       `(d) Definitions.--For purposes of this section:
       `(1) Pregnancy-related assistance.--The term `pregnancy-
     related assistance' has the meaning given the term `child 
     health assistance' in section 2110(a) with respect to an 
     individual during the period described in paragraph (2)(A).
       `(2) Targeted low-income pregnant woman.--The term 
     `targeted low-income pregnant woman' means an individual--
       `(A) during pregnancy and through the end of the month in 
     which the 60-day period (beginning on the last day of her 
     pregnancy) ends;
       `(B) whose family income exceeds 185 percent (or, if 
     higher, the percent applied under subsection (b)(1)(A)) of 
     the poverty line applicable to a family of the size involved, 
     but does not exceed the income eligibility level established 
     under the State child health plan under this title for a 
     targeted low-income child; and
       `(C) who satisfies the requirements of paragraphs (1)(A), 
     (1)(C), (2), and (3) of section 2110(b) in the same manner as 
     a child applying for child health assistance would have to 
     satisfy such requirements.
       `(e) Automatic enrollment for children born to women 
     receiving pregnancy-related assistance.--If a child is born 
     to a targeted low-income pregnant woman who was receiving 
     pregnancy-related assistance under this section on the date 
     of the child's birth, the child shall be deemed to have 
     applied for child health assistance under the State child 
     health plan and to have been found eligible for such 
     assistance under such plan or to have applied for medical 
     assistance under title XIX and to have been found eligible 
     for such assistance under such title, as appropriate, on the 
     date of such birth and to remain eligible for such assistance 
     until the child attains 1 year of age. During the period in 
     which a child is deemed under the preceding sentence to be 
     eligible for child health or medical assistance, the child 
     health or medical assistance eligibility identification 
     number of the mother shall also serve as the identification 
     number of the child, and all claims shall be submitted and 
     paid under such number (unless the State issues a separate 
     identification number for the child before such period 
     expires).
       `(f) States Providing Assistance Through Other Options.--
       `(1) Continuation of other options for providing 
     assistance.--The option to provide assistance in accordance 
     with the preceding subsections of this section shall not 
     limit any other option for a State to provide--
       `(A) child health assistance through the application of 
     sections 457.10, 457.350(b)(2), 457.622(c)(5), and 
     457.626(a)(3) of title 42, Code of Federal Regulations (as in 
     effect after the final rule adopted by the Secretary and set 
     forth at 67 Fed. Reg. 61956-61974 (October 2, 2002)), or
       `(B) pregnancy-related services through the application of 
     any waiver authority (as in effect on June 1, 2008).
       `(2) Clarification of authority to provide postpartum 
     services- Any State that provides child health assistance 
     under any authority described in paragraph (1) may continue 
     to provide such assistance, as well as postpartum services, 
     through the end of the month in which the 60-day period 
     (beginning on the last day of the pregnancy) ends, in the 
     same manner as such assistance and postpartum services would 
     be provided if provided under the State plan under title XIX, 
     but only if the mother would otherwise satisfy the 
     eligibility requirements that apply under the State child 
     health plan (other than with respect to age) during such 
     period.
       `(3) No inference.--Nothing in this subsection shall be 
     construed--
       `(A) to infer congressional intent regarding the legality 
     or illegality of the content of the sections specified in 
     paragraph (1)(A); or
       `(B) to modify the authority to provide pregnancy-related 
     services under a waiver specified in paragraph (1)(B).'.
       (b) Additional Conforming Amendments.--
       (1) No cost sharing for pregnancy-related benefits.--
     Section 2103(e)(2) (42 U.S.C. 1397cc(e)(2)) is amended--
       (A) in the heading, by inserting `or pregnancy-related 
     assistance' after `preventive services'; and
       (B) by inserting before the period at the end the 
     following: `or for pregnancy-related assistance'.
       (2) No waiting period.--Section 2102(b)(1)(B) (42 U.S.C. 
     1397bb(b)(1)(B)) is amended--
       (A) in clause (i), by striking `, and' at the end and 
     inserting a semicolon;
       (B) in clause (ii), by striking the period at the end and 
     inserting `; and'; and
       (C) by adding at the end the following new clause:
       `(iii) may not apply a waiting period (including a waiting 
     period to carry out paragraph (3)(C)) in the case of a 
     targeted low-income pregnant woman provided pregnancy-related 
     assistance under section 2112.'.

  Mrs. BOXER. Let no one stand and say that unless we support the 
amendment of the Senator from Utah, a pregnant woman and the child she 
is carrying will not get coverage. That is false. What my friend wants 
is to codify George Bush's regulation that he correctly pointed out my 
State adopted. Why did my State adopt it? They were forced to adopt it 
if they wanted to cover pregnant women. They had to use that language 
of the unborn child. This is all about the abortion debate. It has to 
be. Under this bill I support, every pregnant woman is covered or is 
eligible for coverage. Under the amendment my friend is offering today, 
every pregnant woman would be eligible. So it is just about the 
language. That is the fact.
  Let me repeat that. Under the bill, every pregnant poor woman is 
eligible for coverage. Under the amendment of my friend, every poor 
pregnant woman is eligible for coverage. What he insists on is that you 
have to separate the woman from the child she is carrying in order to 
make a political point about when life begins. This is not the 
appropriate time to have that debate. Believe me, I look forward to the 
debate. We have had it on the Senate floor. Tom Harkin had an amendment 
a couple of times to say that Roe v. Wade ought to be codified. It 
should not be overturned. We had votes on that. By the way, we did win 
that vote. But that is not what this is about. This is about making 
sure every pregnant woman gets coverage. Instead of being happy about 
it, my friend is agitated about the language and wants to write it in 
his way so we can then get into a debate about when life begins.
  How you would ever separate a pregnant woman from the child she is 
carrying goes against nature. I have had two kids. I know. It is all 
about health care to the pregnant woman. When the child is born, it is 
about health care to the woman and, yes, the baby. My friend can stand 
here all he wants and say I am the one who is injecting abortion into 
this debate. I am not the one offering a divisive amendment. I am not 
the one raising the subject matter of when a fetus is a separate life 
from the mother. That is for another time. We have work to do. We have 
people struggling in this country. My friend attacked the stimulus 
bill.
  By the way, that debate is coming as well. But the one area I know we 
should be able to work together on is making sure our kids are healthy. 
We should walk down the aisle together being very pleased we have taken 
care of that in this bill. Believe me, the more people lose their jobs 
and they can't get another one, the more this program is going to be 
necessary.
  I hope we can have a vote on this in the near future. I guess I would 
like to ask my friend if he wants to continue this debate. I can stay 
all day. But I didn't know what his plan was.
  Mr. HATCH. I don't want to continue it all day. I do believe there 
are some people who want to speak on this side. I will just make one or 
two comments.
  Mrs. BOXER. I yield the floor at this time and retain my right to 
respond.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. HATCH. Mr. President, let's not pit mothers against their 
children. This is not an either/or situation. Let's protect both 
mothers and their unborn children. In fact, the purpose of this bill is 
to provide health care coverage to low income, uninsured children. The 
Senator and I simply disagree. This amendment concerns unborn children 
and covering them. She seems to think it is about abortion. I don't. 
Her own State is covering unborn children through the regulation of the 
prior administration. Thirteen other States are as well.
  Mr. President, I think I have made the case. Let me say that I ask 
unanimous consent that Senator Robert Casey be also listed as a prime 
cosponsor on this amendment, along with the distinguished Senator from 
Nebraska, Mr. Nelson.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. HATCH. I feel very blessed to have these two very strong 
Democrats willing to support a recognition that these unborn kids are 
human beings, they are human life, and that a child health insurance 
program bill ought to cover them.
  With that, Mr. President, I know Senator Bunning is here and I will 
yield the floor.
  Mrs. BOXER. Mr. President, if I might have a moment before Senator 
Bunning speaks.
  The PRESIDING OFFICER. The Senator from California is recognized.
  Mrs. BOXER. Thank you, Mr. President. Because some of the things that 
are said around here--and, by the way, we will have a whole list of 
Republicans helping us to defeat this, so I am

[[Page S1015]]

not going to name people. But let me say this: To stand up and say we 
are pitting a woman against her child when we support this bill that 
makes eligible for coverage every pregnant woman is simply a hurtful 
and untrue remark, especially to say it to someone who adores her 
children and her grandkids, and I take great offense. It is the 
opposite.
  This amendment separates a woman from her child because instead of 
saying you are going to cover a pregnant women, you are saying you are 
covering the unborn child. And what about the woman? She is not even 
mentioned. I take offense at that line of attack.
  We say when you cover a pregnant woman, you cover her child, you 
cover that fetus from the moment that woman goes to get health care. 
What my friend does is separate the woman from her child by saying we 
are going to give the child health care while the child is in the womb 
and do not even mention the woman--do not even mention the woman. So 
who is separating the woman from her child?
  Again, it is very clear that this is about the abortion debate. And 
as many times as my friend says it--and he raises my State again, so 
let me say again, yes, many States did provide health care under this 
definition of unborn child. They had no choice because President Bush 
put a regulation in place, and if my State wanted to help pregnant 
women, they had no choice but to help them under that particular 
regulation.
  Well, what we are doing today is saying to States: You do not have to 
get into the abortion debate. If a woman is poor and she is eligible 
for Medicaid, and she is pregnant, she gets the health care as well as 
the baby she is carrying.
  So do not say that those of us who vote against this amendment are 
separating women and children. It is the total opposite. For whatever 
reason, under that old regulation, the child was mentioned and not the 
woman. That defies science. That defies reality. You treat the woman 
and the child she is carrying.
  So, again, I take offense at this. I do not want to be jumping up 
every time, but I will if there is something said here that is not 
true. I have total respect for the other side on the abortion debate--
complete respect for them. And that is what this is about, and they 
know it. Because if they only cared about the pregnant woman and her 
child, they are taken care of in this bill.
  Mr. President, I thank you very much, and I yield the floor.
  The PRESIDING OFFICER. The Senator from Kentucky is recognized.
  Mr. BUNNING. Mr. President, I am not entering into this debate.
  Mr. President, I ask unanimous consent that Senator Hatch's amendment 
be set aside so that I may offer another amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered. The 
amendment is set aside.


                            Amendment No. 74

  Mr. BUNNING. Mr. President, I call up my amendment No. 74.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Kentucky [Mr. Bunning] proposes an 
     amendment numbered 74.

  Mr. BUNNING. Mr. President, I ask unanimous consent that reading of 
the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

  (Purpose: To eliminate any exceptions to the prohibition on States 
 receiving an enhanced Federal matching rate for providing coverage to 
 children whose family income exceeds 300 percent of the poverty line 
     and to use the savings for the outreach and enrollment grant)

       Beginning on page 75, strike line 18 and all that follows 
     through page 76, line 2, and insert the following:
       ``(B) Increased funding for outreach and enrollment 
     grants.--
       ``(i) Appropriation.--In addition to amounts appropriated 
     under subsection (g) of section 2113 for the period of fiscal 
     years 2009 through 2013, there is appropriated, out of any 
     money in the Treasury not otherwise appropriated, the amount 
     described in clause (ii), for the purpose of the Secretary 
     awarding grants under that section.
       ``(ii) Amount described.--The amount described in this 
     clause is the amount equal to the amount of additional 
     Federal funds that the Director of the Congressional Budget 
     Office certifies would have been expended for the period 
     beginning April 1, 2009, and ending September 30, 2013, if 
     subparagraph (A) did not apply to any State that, on the date 
     of enactment of the Children's Health Insurance Program 
     Reauthorization Act of 2009, has an approved State plan 
     amendment or waiver to provide, or has enacted a State law to 
     submit a State plan amendment to provide, expenditures 
     described in such subparagraph under the State child health 
     plan.''.

  Mr. BUNNING. Mr. President, I also ask unanimous consent that Senator 
Collins from Maine and Senator Hatch from Utah be added as cosponsors 
to this amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BUNNING. I appreciate their support.
  When SCHIP was created, I supported the bill and felt it filled a 
need in our health care system. The bill focused on providing health 
insurance to low-income children whose parents made too much money to 
qualify for Medicaid but did not have private health insurance.
  Many States have done a good job of keeping the focus of their SCHIP 
programs on low-income children, including Kentucky that only covers 
children below 200 percent of poverty. However, other States have 
expanded their SCHIP programs to cover children in families most of us 
would not consider low income. Some States are even covering adults, 
including parents and childless adults. These expansions erode the 
original intent of the program.
  The Baucus SCHIP bill we are considering today further expands the 
SCHIP program, including allowing States to cover children in families 
up to 300 percent of the poverty level. That is $66,000 of income a 
year for a family of four.
  Personally, I think 300 percent is too high for SCHIP, and the focus 
of this reauthorization bill should be reaching those kids who are 
currently eligible for the program but are not enrolled.
  The Baucus bill also allows States choosing to cover children above 
300 percent of poverty to still get Federal money for their efforts but 
only at their lower Medicaid matching rate, not the higher SCHIP 
matching rate.
  Two States--2 out of 50--however, get a special exemption under this 
bill and will get their higher SCHIP matching rate for covering 
children above 300 percent of poverty, specifically New York and New 
Jersey.
  New York wants to cover families up to 400 percent of poverty or that 
is $88,000 a year for a family of four. New Jersey currently covers 
families up to 350 percent of poverty or $77,000 a year for a family of 
four.
  These are certainly not low-income families, and I feel strongly the 
States should not get additional Federal money for covering families 
making up to $88,000 a year.
  My amendment is fairly simple. It simply removes this exemption for 
New York and New Jersey so they have to play by the same rules all the 
other 48 States play by. If they go above 300 percent of poverty, they 
get their Medicaid matching rate but not the higher SCHIP rate.
  As I have said, I think 300 percent is too high, and if I were 
writing the bill, I certainly would not allow States to get any Federal 
money if they were covering families over 300 percent of poverty. 
However, that is not the bill before us. So my amendment tries to 
equalize the playing field between the 50 States and be a little more 
fiscally responsible with taxpayers' dollars.
  Under my amendment, New York and New Jersey can still choose to cover 
children above 300 percent, they just will not get the higher SCHIP 
matching rate. If the people in New York and New Jersey want to cover 
families making up to $88,000 a year, they should be the ones paying 
for the coverage, not requiring my citizens in Kentucky and other 
citizens in all the other 48 States across America to foot the bill.
  Finally, my amendment takes the savings from reimbursing New York and 
New Jersey at the Medicaid matching rate and directs that money to more 
outreach and enrollment dollars so we can get everybody who is eligible 
for SCHIP enrolled. We are having difficulty doing that. Kentucky only 
has 85 percent. I do not know how much some of the other States have. 
But we ought to be able to get to 100 percent of coverage. The other 
money that is saved by that would allow them to seek out those eligible 
children under SCHIP.

[[Page S1016]]

  The SCHIP reauthorization should be about making sure low-income 
children who are eligible for SCHIP are covered, not about covering 
children in families making up to $88,000 a year.
  So with my amendment, you have two options: more money for outreach 
and enrollment and requiring all States to play by the same rules or 
requiring the people of your State to pay more taxes so that New York 
and New Jersey can cover families who make $77,000 or $88,000 a year.
  To me, the choice is simple, and I hope the other Members of the 
Senate can support my amendment.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Utah is recognized.
  Mr. HATCH. Mr. President, I am a cosponsor of the distinguished 
Senator's amendment. I am proud of him and very pleased to support his 
amendment on New York and New Jersey, and I rise in support of that 
Bunning amendment. He is right. Why on Earth should States be rewarded 
by getting a higher CHIP match rate for covering kids over 300 percent 
of the Federal poverty level? That is around $64,000 for a family of 
four.
  Now, when we wrote the CHIP bill in 1997, with Senators Kennedy, 
Rockefeller, and Chafee, CHIP was created to cover children of the 
working poor, the only ones left out of the whole financial system--not 
children from families of four whose income is $77,000 like New 
Jersey's CHIP program or $88,000 like the CHIP waiver the state of New 
York has filed. And that does not even count some of the income 
disregards that may raise the income level to over $100,000. It is 
ridiculous.
  My colleague is right. Senator Bunning is right. These two States 
should not receive the higher CHIP matching rate. I strongly support my 
colleague's amendment, and I congratulate him for bringing it to the 
floor. I hope our colleagues will work to support that amendment 
because it makes a lot of sense.
  Mr. President, I ask unanimous consent that Senator Sessions be added 
as a cosponsor to the Hatch amendment No. 80.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. HATCH. I yield the floor.
  The PRESIDING OFFICER. The Senator from South Dakota is recognized.
  Mr. JOHNSON. Mr. President, I ask unanimous consent that the pending 
amendment be set aside.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. JOHNSON. Mr. President, I rise to express my support for the CHIP 
Reauthorization Act, and to urge my colleagues to improve CHIP and 
cover an additional 4.1 million kids.
  I voted to create this program in 1997, and I have watched with great 
satisfaction as the number of uninsured children in our country has 
dropped. Thanks to CHIP, my State can provide health insurance to about 
11,000 kids every month. As a result, these kids have every chance to 
do their best in school and live long, healthy, productive lives.
  This is a great achievement, but we have more work to do. South 
Dakota still has about 18,000 uninsured kids. Half of these kids meet 
the income requirements for Medicaid and CHIP but remain uninsured. 
With health insurance premiums doubling in the past 8 years and 
unemployment on the rise, more families cannot keep up. Fortunately, 
this bill helps these families when they need it the most and allows 
States to cover more kids and provides bonus payments for focusing on 
low-income kids. I am especially pleased that the bill allows children 
whose private insurance does not include dental coverage to enroll in 
the CHIP dental program.

  I understand some of my colleagues object to allowing States to end 
the 5-year waiting period for covered legal immigrant children and 
pregnant women in Medicaid and CHIP. This debate is not about whether 
to provide coverage but, rather, to end the 5-year wait these future 
citizens must endure. A sick child does not have 5 years to wait, and 
it is not in the spirit of our Founding Fathers to force legal 
immigrants to wait 5 years for services they desperately need. I urge 
my colleagues to remember that other than Native Americans, we are a 
nation of immigrants.
  On a personal note, I am pleased to join in the debate on CHIP this 
year, as I missed much of the 2007 debate while recovering from my AVM. 
That experience taught me the infinite value of good health insurance 
and great health care, a lesson from which I hope we can all learn.
  This bill, which is fully paid for over the reauthorization period, 
is exactly what low-income families need during this time of economic 
uncertainty. I urge my colleagues to join me in supporting the CHIP 
Reauthorization Act.
  I yield the floor, and I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                            Amendment No. 47

 (Purpose: To ensure that children do not lose their private insurance 
    and that uninsured children can get access to private insurance)

  Mr. BAUCUS. Mr. President, last night, Senator Coburn sought to bring 
up his amendment No. 47. At that time, we asked him to withhold so we 
might look at the amendment because we neglected to get the Coburn 
amendment No. 47 until that moment. He spoke on the amendment. We have 
looked at the amendment. So on behalf of Senator Coburn, I ask 
unanimous consent that the pending amendments be temporarily laid aside 
and that Senator Coburn's amendment No. 47 be called up.
  The PRESIDING OFFICER. Without objection, it is so ordered. The clerk 
will report.
  The assistant legislative clerk read as follows:

       The Senator from Montana [Mr. Baucus], for Mr. Coburn, for 
     himself and Mr. Thune, proposes an amendment numbered 47.

  Mr. BAUCUS. Mr. President, I ask unanimous consent that the reading 
of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The amendment is printed in the Record of Tuesday, January 27, 2009 
under ``Text of Amendments.'')
  Mr. BAUCUS. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. LEVIN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. LEVIN. Mr. President, I ask unanimous consent that Senator Dorgan 
be recognized for 5 minutes and then Senator Grassley, who I expect 
will be here at that time, be recognized for up to 10 minutes, and then 
I will be recognized for up to 10 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from North Dakota.
  Mr. DORGAN. Mr. President, we are debating the subject of children's 
health care at a time when our economy is in desperate trouble. Most 
all of us understand that 20,000 people today and 20,000 people 
tomorrow will have lost their jobs. Think of that. We are experiencing 
20,000 people a day losing their jobs in this country right now during 
this economic difficulty. It was one thing at a time when the folks at 
the bottom of the economic ladder had a job and then had to worry about 
the issues understanding second job, second shift, second mortgage. But 
now it is not even that. Now they do not have a job at all.
  Last month, over half a million people lost their jobs. As that 
happens, the question is about the necessities of life. How do you 
provide for the necessities of life? How about your children's health 
care?
  I don't know what is second or third in everybody's life. I don't 
know what might be in second, third or fourth place in people's lives. 
But I know what ought to be in first place, and is for most people, and 
that is their children, their well-being, the health of their children.
  This legislation deals with that subject, trying to provide health 
care to children who do not have health care, expanding the number of 
children under the Children's Health Insurance Program. Nearly seven 
million children are now enrolled. This expands it.

[[Page S1017]]

Four million additional children who do not have health care would 
receive health care under this expansion. It makes a lot of sense.
  In my State, we have 3,500 children receiving benefits under the 
Children's Health Insurance Program. There are another 14,000 who are 
uninsured in North Dakota. So surely this ought to represent one of the 
significant priorities for the children of our country and for the 
children of our individual States.
  I have come to the floor talking a lot about health care for American 
Indians. I have put up a couple charts on the floor talking about Avis 
Little Wind. She lost her life. I have talked about Ta'Shon Rain Little 
Light. She was 6 years old. She lost her life.
  The fact is, these are children for whom we would expect health care 
would be available, and it was not. Multiply that by a million or 10 
million children who determine whether their health care needs are met 
when they are sick by whether their parents have money in their 
pockets. That ought not be a criteria by which we treat sick children 
in this country ever--not ever.
  One hundred years from now, we will all be gone and historians will 
look back and evaluate us--who we were, what we did, what our values 
were if you take a look at what we decided to spend money on, what kind 
of a budget did we have. Historians 100 years from now can take a look 
back and evaluate, at least in part, what our value system was. What 
did we think was important? What was valuable to us? What was most 
important to us?
  The question that is begged by this legislation is, Are our children 
important to us? Do we care about our children's health? Don't tell me 
children are important if you are not willing to do almost anything 
necessary to provide for your children's health.
  We must do this. This is not difficult. A lot of issues come to the 
floor of the Senate that are difficult and complicated and complex. You 
have to try to evaluate all the nuances to try to figure how do we put 
this together. This is not any of that. This is not difficult in terms 
of the mechanics, how it works. We know it works. It is not difficult 
in terms of the value system. Can you name two other things we do on 
the floor of the Senate that are more important than preserving the 
health of our children or treating a sick child who has no other 
options to get treatment or go to a doctor or go to a health clinic? 
Name something more important than that for your children or for the 
children you love.
  This is not difficult, and we should not make it difficult. What we 
ought to decide is that this is a priority for this country. It is a 
long-delayed priority. We passed it twice, and President George W. Bush 
vetoed it twice. But its delay ought not concern us at this moment. 
What ought concern us now is that we move and move quickly to address 
this problem and say to America's children: You rank at the top of our 
priorities, yes, in our personal lives and also in our public lives. 
You rank at the top, and we are going to provide health care to 
America's children who are uninsured.
  That ought to represent the best of our country and the best of what 
we can do in both political parties that serve in the Congress.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa is recognized for up to 
10 minutes.
  Mr. GRASSLEY. Mr. President, for the benefit of my Members, I do not 
think I will use 10 minutes, but it is always dangerous for me to say 
that.
  (The remarks of Mr. Grassley and Mr. Levin pertaining to the 
introduction of S. 344 are printed in today's Record under ``Statements 
on Introduced Bills and Joint Resolutions.'')
  Mr. LEVIN. Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Mississippi is recognized.
  Mr. WICKER. Mr. President, the SCHIP legislation the Senate is 
considering this week purports to provide more health insurance for our 
Nation's poorest children. But in truth, the bill shortchanges the 
neediest of children in States such as Mississippi. Instead of paying 
taxpayer dollars for our poorest children, those who need health 
insurance the most, the bill we are considering today gives taxpayer-
funded health insurance to middle-class families in wealthy States. The 
SCHIP bill we will be voting on today does nothing to ensure that all 
American children under 200 percent of the poverty level have health 
insurance. In fact, the bill diverts this important program, which I 
have supported for years, away from its intended purpose. SCHIP was 
designed to cover low-income children between 100 percent and 200 
percent of the poverty level. That comes to $22,000 to $44,000 per year 
for a family of four. These families require assistance under SCHIP 
because they earn too much to qualify for Medicaid, but they are not 
able to afford private health coverage for their children. This was the 
intent of SCHIP.

  What we ought to be doing in this bill is prioritizing low-income 
American children and making sure as many uninsured poor kids as 
possible are covered under the increased funding we are going to 
provide. Instead, this bill allows States to expand their programs 
without demonstrating they have covered the poorest children first. In 
my State of Mississippi, for example, SCHIP covers 65,000 children, but 
there are another 30,000 children below 200 percent of the poverty 
level who are without health insurance. This bill would not cover those 
children, even with the expanded funding.
  Other States that are similarly situated include Iowa, Nebraska, 
North Dakota, North Carolina, and Arkansas. I urge the Senators from 
those States to join me in an effort to correct this inequity. I urge 
all Senators to make this bill better so we make sure we include 
poorest of the poor children first.
  In the past decade since SCHIP was created, the number of uninsured 
poor children has decreased from 28 percent to 15 percent. But we 
cannot, in the face of that success story, neglect the remaining 15 
percent. Many of them are in the States I have mentioned.
  Fifteen percent of America's poorest children still do not have 
health care, and we are debating a bill that would expand SCHIP beyond 
its intended purpose, to cover higher income families and other adults.
  SCHIP allotments in fiscal year 2009 will be $5 billion. Under this 
bill we would almost double that amount to $9 billion per year. But 
only an additional $79 million is needed to cover these poor uncovered 
children in States such as Mississippi. If we are going to almost 
double the size of the program, we ought to make sure poorest of the 
poor are covered.
  If this bill were really about health care for poor children, we 
would guarantee each State sufficient funds to cover every child in a 
family below 200 percent of the poverty level. It is that simple. And 
we would do that before moving on to cover more affluent families in 
the more affluent States.
  Senator Cochran and I have submitted an amendment that would do that. 
Our amendment would prohibit States from receiving funds to cover 
individuals above 200 percent of the poverty level until we can 
guarantee that 90 percent--not 100 percent but 90 percent--of the 
poorest children nationwide are covered.
  The result of our amendment would be that the more affluent States 
would simply have to wait if they want to cover middle-class children, 
if they want to cover families making as much as $88,000 a year or 
more. They would have to wait until the poorest of the poor children in 
Mississippi and Arkansas and North Carolina and North Dakota and 
Nebraska and Iowa are covered.
  I have been watching the votes this week. It appears the leadership 
has locked in a majority to resist amendments of this nature. I thought 
the bill was about making it easier to cover children under 200 percent 
of the poverty level--between 100 percent and 200 percent. If 
amendments such as that of Senator Cochran and myself are not agreed 
to, we have to wonder is the real intent of this legislation to replace 
our private health care system with a government-run system at the 
expense of people who need help the most?
  One of my colleagues yesterday said we are ruining SCHIP. I have to 
concur with that, if this legislation is not amended. I urge my 
colleagues to join me in bringing the focus of SCHIP back where it 
belongs, on helping poor children.
  Mr. President, I yield the floor. I suggest the absence of a quorum.

[[Page S1018]]

  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. PRYOR. Mr. President, I ask unanimous consent the order for the 
quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. PRYOR. Mr. President, I rise in full support of renewing and 
improving the Children's Health Insurance Program. In Arkansas we know 
this program as ARKids First, Part B. In my part of the country, the 
program ensures that low-income children get the doctor visits and 
medicines they need when they are sick and the checkups they need when 
they are healthy. This program has been highly effective, and I believe 
the bill before us will build upon that success.
  Let me tell one story. In 2007, this program covered more than 64,000 
Arkansas children and more than 4.4 million children nationally. There 
is a young boy named Connar in a little town called Poyen, AR. Poyen is 
in Grant County. The population of the whole town is 272 people. It is 
on a State highway--229--in part of our State that is challenged in 
getting health care to its citizens. At 5 years old, he had very 
serious hearing problems. He underwent multiple surgeries to restore 
his hearing. Without the Children's Health Insurance Program, his 
grandmother would have never been able to afford the appointments and 
medical care. The good news is, today, after these surgeries and after 
his treatment, he has overcome his hearing loss and his related 
developmental delays.
  What that means is he will now be able to enter kindergarten with 
other kids his age. We prepared him for a lifetime of success through 
this program. That means he will not have to have special education, he 
will not have to have other programs available to him for him to 
function in society. We made the downpayment on his future with the 
Children's Health Insurance Program.
  But he is lucky because that same year, 2007, there were 9.4 million 
children who went without access to doctors, lifesaving prescription 
drugs, immunizations, preventive screenings, and the basic medical care 
they need. That is 1 out of every 9 children in this country who 
slipped through the cracks between Medicaid and private insurance.
  Since then, since 2007, pink slips have multiplied and, more than 
ever, parents are making the tough decision to provide their family 
with a roof over their heads and forgo health care coverage. When these 
kids don't get medicine and proper medical care, we see them in 
emergency rooms in a lot of pain and at a greater cost to the taxpayer.
  As you know, there have been studies--one I am familiar with in the 
State of Arizona, but there have been many other studies--that compare 
what this program costs to the cost of not having the program. It is 
actually cheaper to the taxpayer, much cheaper to society in the big 
picture to have this program get these kids the medical care they need 
when they need it.
  This body will have an important vote to cast this week that will 
determine who will see a doctor and who will not. Will children such as 
Connar receive the critical care they need or will we abandon them, 
abandon him like we have 9 million others?
  I ask my colleagues on both sides of the aisle not to turn this moral 
issue into an ideological debate. Children deserve a healthy start in 
life regardless of the parents' wealth. Senators Baucus and Rockefeller 
have produced a compassionate and cost-effective bill that provides 
this opportunity for millions of children. That is what I want for the 
children in my State of Arkansas and for the children of our Nation.
  I yield the floor and I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. BAUCUS. Mr. President, I ask unanimous consent the order for the 
quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BAUCUS. Mr. President, a few moments ago the Senator from 
Mississippi, Senator Wicker, offered an amendment. Basically, it is 
directed at the so-called August 17, 2007, directive that President 
Bush promulgated. That directive issued strict guidelines to States 
regarding Children's Health Insurance Program enrollment, focusing on 
potential crowdout, and mandated that States adopt more restrictive so-
called crowdout policies. Among the policies in that August 17 
directive was a requirement that the States prove that at least 95 
percent of the children below 200 percent of the poverty level have 
some coverage before they can enroll higher income children. The 
amendment offered by the Senator from Mississippi would, in the same 
vein, prohibit States from receiving the Federal match for individuals 
under the program above 200 percent of the Federal level unless they 
enrolled 90 percent of all children under 200 percent.
  That is an impossibly high standard, one that cannot be met. 
Certainly, the 95 percent in the August 17 directive could not be met. 
That is why that directive was never put into effect.
  It is too tight. It would not work. Yesterday, this body voted 
against an amendment which would set the requirement at 80 percent, and 
the amendment before us sets the requirement not at 80 percent but a 
much higher rate; that is, 90 percent. These are impossible standards 
for States to meet. It is virtually impossible for a State to meet 90 
percent. Even mandatory provisions--let's take auto insurance. The 
takeup rate in States is not 90 percent. Even where it is 90 percent, I 
think the average is like in the eighties somewhere. This is not 
mandatory. The CHIP program is not mandatory. It is an optional program 
for States. It is optional whether a person wants to participate in 
CHIP or participate in the private market. It is totally optional. So 
it is impossible for a State to achieve a 90-percent rate. That is a 
standard which is much too high.
  Also, another reason it is so difficult for States to reach a 90-
percent rate is because of the economic downturn we are facing. With 
the downturn we are facing, people are leaving employment, regrettably, 
they are being laid off, which means they are losing health insurance. 
The more people who are laid off, the more people lose health 
insurance, the more difficult it is for a State to show that it is 
meeting a 90-percent requirement.
  That is just a mechanical effect of this amendment. The practical and 
personal effect is that this is going to hurt kids because the 
amendment has the effect of denying Federal dollars to States when they 
cannot meet an impossibly high so-called takeup rate. Therefore, I urge 
my colleagues to not vote for this amendment. It is not a good idea.
  It does try to attempt to address something called crowdout, which 
has been debated here on the floor for a long time. Frankly, this 
crowdout debate is missing the mark here. We are not keeping our eye on 
the ball. The ball really is, how do we get more kids covered under the 
Children's Health Insurance Program?
  For all of the reasons Senators have indicated, my gosh, we want our 
kids to be healthy. Healthy kids go to school. Healthy kids in school 
perform better in school. If they perform better in school, they are 
going to do better when they graduate. We want healthy kids. The more 
we have healthy kids, the more likely it is we are going to have 
healthy families and more productive families and be able to address 
some of the adverse consequences the recession now presents to us.
  I yield the floor.
  The PRESIDING OFFICER (Mrs. Hagan.) The Senator from Wyoming is 
recognized.
  Mr. ENZI. Madam President, I rise today to talk about the State 
Children's Health Insurance Program, or what folks around here call 
SCHIP. This program was created by a Republican Congress in 1997 to 
help low-income kids get health insurance. The program expired in 2007, 
and Congress has worked to pass temporary extensions through March of 
this year. I am glad the Senate is now working on a longer term bill to 
extend this vital program.
  I am a cosponsor and a strong supporter of the ``Kids First Act,'' S. 
326, which extends the current SCHIP program. This bill provides health 
coverage to low-income kids and will give

[[Page S1019]]

States the resources they need to continue to operate their SCHIP 
programs.
  To help more low-income children get health coverage, the bill 
provides $400 million over the next 4.5 years for States and other 
qualified entities to improve outreach and enrollment for low-income 
children. These funds will target the low-income children SCHIP was 
meant to help. The bill also enhances private options that provide more 
affordable and efficient care by encouraging premium assistance so that 
parents can have enough money for private health insurance for their 
children.
  The Kids First Act also focuses on kids, not adults. Some States 
currently spend SCHIP money on adults when this money was meant for 
children. The bill takes the money spent on adults and uses it to 
insure children. The Kids First Act requires that all States phase out 
nonpregnant adults, including parents, and not allow the addition of 
any new nonpregnant adults to the program.
  American children are the top priority and primary focus of the bill 
I support. The bill maintains existing law, which ensures that scarce 
resources go to covering American citizens first.
  The bill does all these things, and it does them in a fiscally 
responsible way, without raising taxes. An economic recession is no 
time to raise taxes or expand Government programs and inefficient 
bureaucracies.
  I have seen the potential for what SCHIP can do to help low-income 
kids in my home State of Wyoming. Wyoming first implemented its SCHIP 
program, Kid Care CHIP, in 1999. In 2003, Wyoming formed a public-
private partnership with Blue Cross Blue Shield of Wyoming and Delta 
Dental of Wyoming to provide the health, vision, and dental benefits to 
nearly 6,000 kids in Wyoming. These partnerships have made Kid Care 
CHIP a very successful program in Wyoming.
  All children enrolled in the program receive a wide range of benefits 
including regular check-ups, immunizations, well-baby and well-child 
visits, emergency care, prescription drugs, hospital visits, mental 
health and substance abuse services, vision benefits, and dental care. 
Families share in the cost of their children's health care by paying 
copayments for a portion of the care provided. These copays are capped 
at $200 a year per family.
  Wyoming is also engaged in an outreach campaign targeted at finding 
and enrolling the additional 5,000 kids that are eligible for Kid Care 
CHIP but are not enrolled.
  I am proud of the great job Wyoming is doing implementing its 
program. I also want to note that Wyoming will get the same amount of 
money under the Kids First Act that I support as compared to Senator 
Baucus' bill, H.R. 2.

  Unfortunately, all these descriptions apply to the Kids First Act, 
which is not the bill before us today. The bill before us today is a 
very partisan bill that fails to focus on low-income, American kids 
first.
  Senator Baucus' bill, H.R. 2, would encourage middle-class families 
to drop their existing health insurance plans and instead get on the 
taxpayer dime. That is just not right; we need to put low-income 
children first.
  Under H.R. 2, 2.4 million children will lose their private health 
insurance coverage and be forced to enroll in Government-run programs, 
where they may not have access to the physician and other health 
provider services that they need. The bill will also make it easier for 
both legal and illegal aliens to get covered under SCHIP.
  Another important big difference is that the taxpayers will get to 
keep fewer of their hard-earned dollars if this SCHIP bill is enacted. 
At a time when the country faces a severe recession, raising taxes is 
not a good solution for any problem.
  I am disappointed Senator Baucus and the Democratic leadership in the 
House and the Senate and the White House turned SCHIP into a partisan 
exercise. Along with the American people, I too was looking forward to 
change. I was encouraged by President Obama's call for change and was 
ready to work with him to make sure we could focus on the 80 percent we 
could agree on.
  I was also encouraged by my discussions with Senator Daschle when he 
came before my committee as a nominee to become the Secretary of Health 
and Human Services. He committed to working with me and the other 
Republicans on my committee so together, we could work on a bill to 
reform our health care system. He promised bipartisanship and said he 
would convince my Democratic colleagues on the committee to work 
together to develop bipartisan solutions to our Nation's health care 
problems.
  Unfortunately, with this SCHIP bill, the Senate is taking a step away 
from the process Senator Daschle described. The ranking member of the 
Finance Committee, Senator Grassley, as well as Senators Hatch and 
Roberts, among other members worked hard for a number of years on a 
bipartisan bill, but that bill is not the bill before us today.
  Rather than following the example set by Senators Grassley, Hatch and 
Roberts, the sponsors of this bill chose to focus on the partisan 
issues that highlight the 20 percent upon which it is impossible to 
agree. I hope this is not the first taste of how the next 2 years will 
be here in the Senate.
  I will close my remarks, but I just want to remind folks that we can 
do better. In general, if we work together on bipartisan bills, we can 
produce a better product. I think the bill before us today should focus 
on covering low-income, American kids first, and I hope that as we 
continue working on health care reform, we can work together rather 
than against each other so we can put the best policies possible before 
the American people.
  We can do better, we must do better. Following Wyoming's lead of 
using the private market, we would insure every American kid whose 
family is uninsured and below 300 percent of poverty. I think that is a 
good answer for the family. We can do it without spending more. We can 
do it so kids are not thrown out mid-year because their parent or 
parents make a little more. They would be insured all year. So we would 
increase their eligibility from 200 percent of poverty to 300 percent, 
$40,000 a year to $60,000 a year, for a family of four and cover every 
uninsured American kid. But we will see that amendment voted down so 
statistics will look better. The current bill is a good statistics 
bill, it increases the number covered dramatically to include adults 
earning up to $120,000 a year in some instances and it is easier to 
find more people to sign up, at the taxpayer's expense. No, let's 
concentrate and force States to find the poor that are lost and 
neglected.
  Madam President, I yield the floor, and I suggest the absence of a 
quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. MENENDEZ. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                            Amendment No. 74

  Mr. MENENDEZ. Madam President, I come to the floor to speak again on 
behalf of children of New Jersey and others in the country and the 
working families in my home State who seem to be under attack by some 
of our colleagues here on the floor. I did not know there are different 
values to the importance of the health care of a child regardless of 
the happenstance of where they live, but it seems some think so.
  On behalf of these children and families, I rise strongly to object 
to Senator Bunning's amendment. In New Jersey, we cover over 130,000 
children and, yes, we cover children to a higher percentage of the 
Federal poverty level. But there is a reason for that, and I will go 
through that right now. But there are only 3,300 New Jersey children 
who are covered under that higher Federal poverty level from the 
130,000 who are covered below the poverty level Senator Bunning and 
others would want to maintain. So we are talking about 3,300 children 
but 3,300 children whose health and development and well-being depend 
upon the ability of States such as New Jersey to do this.
  The families who are covered at this level are paying toward this. 
They are not getting a free ride. They are paying $128 each month in 
premiums and between $5 and $35 in copays each and every month. So this 
is not a free ride. These families in New Jersey are working, and they 
are working at some of

[[Page S1020]]

the toughest jobs we have. But they work at jobs in which they do not 
have health care coverage, and they are working at jobs that do not 
give them enough in the context of what it costs to live in New Jersey 
to afford health care insurance. So somehow those people have to be 
penalized when you listen to the other side.
  Now, let me talk to those who want to talk about fairness. New Jersey 
followed the law. The former administration approved New Jersey's 
waiver to continue insuring kids at up to 350 percent of the Federal 
poverty level because they understood the reality that a family living 
in New Jersey--to make essential elements of their costs for housing, 
food, transportation, childcare, and, yes, insurance--just was far 
behind others in the Nation who, in fact, could achieve those goals for 
a lot less money. So the Bush administration gave a waiver. They gave a 
waiver. They understood it.
  New Jersey needs to cover children up to 350 percent because New 
Jersey families face higher living costs and they get less return on 
their Federal dollar. Let me talk about that. I hear my colleagues 
bemoaning the fact that my State allegedly wants some sort of special 
treatment, that because we want to provide health benefits to children, 
we are somehow taking advantage of the Federal Government. That is 
simply ridiculous.
  Let me put it in perspective. For every $1 a New Jersey taxpayer pays 
in Federal dollars toward the Federal Government, our State only gets 
back 65 cents. My colleague from Kentucky, who was on the floor and 
whose amendment we are debating now and who rails about New Jersey--his 
State gets $1.51 for every $1 Kentuckians send to the Federal Treasury. 
So they get more back than, in fact, they pay.
  Let's talk about fairness. The reality: One size does not fit all. As 
shown on this chart, for a family in New Jersey, living in Middlesex 
County, whose monthly income is about, roughly, $4,600, for their 
housing, it is going to cost them $1,331; for food, it is about 
$645.70; for childcare, it is $844.80; for their transportation, it is 
$393.80; for their taxes, it is $479; and for their health insurance, 
it is almost $1,800. So what do they end up with? They end up with a 
negative amount in terms of their budget. These are people who are 
working--working--trying to sustain their families. But they end up in 
the negative if they try to provide health insurance for their 
families. So the answer is, they cannot provide health insurance for 
their families unless they get some help. Yes, one size does not fit 
all.
  So let's look at that same family. For that family in New Jersey to 
get the same ability in terms of their purchasing power as a family in 
Louisville, KY, that needs about $55,808--for that same family, whose 
happenstance is that they live in New Jersey versus Louisville, KY, for 
the same exact things, they need $77,000, roughly, in purchasing power.
  Now, why do I have to hear an argument that says those families, in 
fact, whether they be in Kentucky or Arizona or Oklahoma or Georgia or 
Tennessee or Utah or in all these other States, who, in fact, deserve 
to have their children covered--they deserve to have their children 
covered, and I am fighting for their children to be covered as well--
but why do I have to listen to that, in fact, their children are more 
valuable than my children in New Jersey who need this amount of money 
to be able to meet the same goals and dreams and aspirations and health 
care that they have? So they can get benefits under the bill, but my 
children in New Jersey should be denied? That is the core of the 
argument here. One size does not fit all. I would love for a family in 
New Jersey at $55,000 to be able to make ends meet. That is simply not 
the fact. So we need to ensure all children are covered within this 
class.
  I am simply baffled and I find it embarrassing that some in 
Washington--those who have some of the best health care coverage in the 
world--would propose to jeopardize coverage to some of America's 
neediest families.
  In this economy, in this recession, we cannot allow our children to 
be the silent victims. It is morally wrong to jeopardize the health 
care of these children. What have they done? What have they done to 
deserve this? It is even more outrageous during a time when jobs and 
homes are being taken away from their parents.
  Where is the moral compass in this Chamber? I hear my colleagues 
speaking eloquently about how our children are our most precious asset, 
and they certainly are. But they are also our most vulnerable asset. Is 
a child in New Jersey worth less than a child in other parts of the 
country simply because of the happenstance of where they live and the 
costs that are necessary in order for them to meet the same quality of 
life?
  So I hope my colleagues, as other amendments have been rejected, will 
once again reject this amendment. This is about being for the value of 
life. You cannot fulfill your God-given potential if you do not have 
good health. You cannot say you are profamily when, in fact, you would 
take away the insurance necessary for that family to be able to realize 
their God-given potential. This is about all children, regardless of 
where they happen to reside, the happenstance of what station in life 
they were born into, that if they fall into this criteria that, in 
fact, they should be covered.
  That is why this amendment should be defeated. I hope, after having 
considered amendment after amendment after amendment on the same 
fundamental issue, we can finally move to final passage of this bill.
  Madam President, I yield the floor and suggest the absence of a 
quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. REID. Madam President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. REID. Madam President, as we were completing our last vote last 
night, I explained to the Members of the Senate what our schedule would 
be the next few days. Following my statement, Senator Leahy and I 
engaged in a discussion on the Senate floor about the timing for a vote 
for Attorney General-designee Eric Holder.

  Chairman Leahy expressed an opinion that he and I share: that with 
the many difficult challenges facing the Obama administration, and 
particularly the Justice Department, it is imperative for the Senate to 
confirm Attorney General-designee Holder as soon as possible.
  Unfortunately, while it was my strong preference to conduct the vote 
this week--as I explained to Senator Leahy on more than one occasion I 
was hoping we would do that when we completed work on CHIP, the 
Children's Health Insurance Program--I had to inform him that I had a 
conversation just a few minutes before I made my remarks on the floor 
with Senator McConnell, and Senator McConnell said he didn't want to 
move forward until Monday. In the conversation with Senator McConnell I 
was pleasant, as most of our conversations have been, and I believed I 
needed to explain to the Senate what the proposal was and what we were 
planning on doing. The one thing I didn't do is explain to Senator 
Leahy first--and I should have done that--that we weren't going to be 
able to complete it after the Children's Health Insurance Program--on 
the same day at least; we would have to wait and do it later because in 
the Senate the power of the minority is significant.
  I have privately discussed this with Chairman Leahy, that it was an 
oversight on my part. He wasn't informed of the arrangement I had 
reached with Senator McConnell before I announced it on the Senate 
floor. So I apologize to my friend from Vermont, the chairman of the 
Judiciary Committee. He has been a good friend, he and Marcel, for so 
many years, and I am very sorry about the misunderstanding.
  Chairman Leahy and I, along with virtually every Senator, agree that 
we must confirm this exceptionally qualified and talented nominee--and 
that includes Republicans who feel the same way--as quickly as possible 
so we can begin the critical work of rebuilding the Justice Department 
to fight terrorism, crime, and protect the constitutional rights of all 
Americans. There is no one who has been more of an advocate for having 
a strong, powerful, fair Justice Department than Senator Leahy. So I am 
sorry about that confusion, and if I embarrassed him in any way, again, 
I tell him I am sorry.

[[Page S1021]]

  I note the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  The PRESIDING OFFICER. The Senator from Florida is recognized.
  Mr. NELSON of Florida. Madam President, I ask unanimous consent that 
the order for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. NELSON of Florida. Madam President, it is such a delight to see 
the Presiding Officer in the chair, the distinguished new Senator from 
the great State of North Carolina whom, every time I look at her 
wonderful smile, I think: That smile was born and bred in Florida. We 
are so happy to have the Presiding Officer here as a part of the Senate 
representing the great State of North Carolina.
  Madam President, I, of course, am going to vote for S. 275, the 
Children's Health Insurance Program. This reauthorization is a long 
time coming. We went through the trauma of having it vetoed by the 
President last year. We attempted to override that veto and got a close 
vote but didn't get enough. So here we are. We will have the votes this 
time.
  My particular additional interest in this is because in my life 
before the Senate, I had the privilege of being the elected State 
treasurer in Florida, which is also--was then--under Florida law at the 
time, the State insurance commissioner. In that capacity, I chaired 
what is known as the Florida Healthy Kids Program. It was a very 
innovative way in which we would reach out through the school system to 
make health insurance more affordable for children under the theory 
that if a child is sick, a child is clearly not going to learn. We know 
by all of the sociological studies that if a child does not get the 
proper medical observation and treatment during those formative years, 
it can manifest itself in so many more complicated ways later on in 
life which, just from a societal point of view, becomes a much greater 
expense on society; whereas, if children can get the proper health 
care, it is not only a good, humanitarian commonsense, Judeo-Christian 
kind of practice, but in an overall cost to society it is much more 
efficient and economical.
  We saw in this innovative program in the 1990s in Florida, the 
Healthy Kids Program, where we could make insurance available to 
children through the school system according to their parents' ability 
to pay. We piggybacked it on top of the School Lunch Program because 
already there, you had a determination of a family's financial means 
and capability. What we saw was that it spread like wildfire throughout 
the Florida school system in each of the counties, and it became not 
only very popular, it became very effective.
  Here we have a program where we are applying that concept for the 
whole country. It started back a couple of decades ago. We are 
reauthorizing it, and we are enhancing it. It makes good common sense. 
It clearly makes good health sense. It makes good economic sense. And 
in America, where we want to give the best of every opportunity for our 
children, it fulfills that dream and that desire as well. For these 
reasons, it is hard for me to believe anyone would vote against the 
reauthorization of this program.
  I commend our leadership, that they have brought up this bill 
basically as the first bill for us to pass.
  Madam President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mrs. LINCOLN. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Udall of Colorado). Without objection, it 
is so ordered.
  The Senator from Arkansas is recognized.
  Mrs. LINCOLN. Mr. President, I rise today to speak in support of 
legislation that is long overdue, the reauthorization of the Children's 
Health Insurance Program, known as CHIP.
  For those of us who have children who are young, in school, bringing 
home all kinds of unbelievable colds, sniffles, and all the other 
sickness, we realize our children today need health care. How wonderful 
it is, as a nation, that we have gathered to put together a 
comprehensive package that will help increase the number of children 
who can be covered.
  As a mother myself, as a daughter, as a wife, as the wife of a 
physician, better understanding the opportunity we have as a nation to 
do this makes me extremely proud because I see other mothers at school 
who cannot afford to provide health insurance for their children.
  A close friend of my boys was injured on the playground the other day 
and was taken by emergency vehicle to the hospital. He was OK. But the 
mother came up to me later and said: You know, I am working as hard as 
I can, but I can't afford health insurance. What am I going to do? I 
can't pay for this.
  We have the opportunity in this job in the Senate to make an impact 
on the lives of working families across this great country.
  This is a bipartisan program that for the last 12 years has allowed 
us to make health care coverage more accessible for millions of 
children, coverage that is critical to the lifelong health of a child 
and to a family's peace of mind.
  In conjunction with Medicaid, CHIP has been tremendously successful 
in reducing the number of uninsured children in my State and across 
this country. We have done much work on this bill over the course of 
the last couple of years to improve upon it, to talk about what we can 
do to make it a better bill. And here we now come to the floor of the 
Senate with an opportunity to pass something that will be monumental in 
the lives of working families.
  Since the program's inception, the number of children without health 
care coverage has dropped by one-third. I am proud that Arkansas has 
become a national leader in reducing its number of uninsured children 
from 21 percent in 1997 to 9 percent today. Now more than 70,000 of 
Arkansas's children currently receive coverage through CHIP which we 
know in Arkansas as Our Kids First, a great program that helps working 
families all across our State. Unfortunately, passage of SCHIP had been 
held hostage for the past 2 years due to President Bush's two vetoes 
which we tried to override and were unsuccessful.
  At this critical time in our Nation's history, when working families 
are struggling, they are faced with economic crisis all over this 
country, I believe we have a moral obligation to extend this program 
and provide health care coverage to millions of children who are now 
uninsured.
  Can you think of anything more important to the households of these 
working families than to ease their minds, to create peace of mind by 
saying to them: You are now eligible for a program that can help you 
provide health insurance for your children.
  It is interesting, when we talk about things that make us happy or 
things that make us feel fulfilled, as we grow older, we realize it is 
less and less about us and it is more and more about our children. It 
is no different from my family to any other family across this great 
land, to parents across this country who want desperately to be able to 
provide for their children. Here is our opportunity to help them.
  As parents, we are no different. Whether you are unemployed or 
whether you are a Senator, what gives you that fulfillment is to be 
able to see your children fulfilled, to see them healthy with access to 
the kind of health care that will help them reach their potential 
because we know that unhealthy children are less likely to learn, they 
are less likely to become healthy adults. They are certainly going to 
be more costly to the system if they depend on emergency services, not 
to mention the chronic diseases that can occur because they are 
neglected from getting the health care that they need early on.
  There are so many good things in this bill and so many good things 
this bill does. Peace of mind comes to mind, first, because I think of 
those parents who are unable to provide that health insurance.
  The bipartisan SCHIP bill provided by the Senate Finance Committee is 
essentially the same bill that passed overwhelmingly in the last 
Congress. As I mentioned before, we have discussed this bill, and we 
have tried to work out compromises. Is it 100 percent of what everybody 
in this body wants?

[[Page S1022]]

No, it is not. But no bill ever is. Are we going to miss an opportunity 
to help working families across this country because it is not 100 
percent of what every one of us wants? I hope as Senators, as parents, 
we are not so blind that we would let that happen. It builds 
tremendously upon the success of the program by giving States more of 
the tools they need while preserving their flexibility to strengthen 
their programs and, ultimately, cover more children.

  I would remind you, Mr. President, and I would remind all my 
colleagues, that we all have worked to keep flexibility in this bill. 
We also must keep in mind that many of the provisions in this bill are 
options to the States. Not a mandate that the State must cover but an 
option that gives States the flexibility to be what they are and to 
address the specific needs they may have in addressing both the chronic 
conditions of their children and, more importantly, covering the 
population of children who need coverage most in their States.
  CHIP reauthorization will allow States to preserve coverage for the 
children currently enrolled while reaching an additional 4.1 million 
low-income children. I don't know of a greater way, quite frankly, that 
we could show other countries who we are and what our value system is 
than to reach out and cover 4.1 million more low-income children; to 
express to the world where we put our values, where we want to make an 
investment--an investment in future leaders, a future workforce, the 
future leaders not just of our country but in the global community as 
well.
  This proposal would also provide much-needed funding to States for 
outreach and enrollment efforts to enroll many of those who are 
currently uninsured. This is critically important to me in my State of 
Arkansas, where two out of three uninsured children are eligible for 
ARKids First or Medicaid but are not enrolled. We need the resources to 
reach out and ensure that these children and their families understand 
what these great programs are and what they would mean to their 
children.
  It also takes additional steps to ensure infants and toddlers get a 
healthy start by providing care for expectant mothers. At the age I was 
when I delivered my twins, people thought I was Methuselah, but nobody 
ever missed the opportunity to tell me how very important it was to 
care for myself if I loved my children, and I did. I did everything I 
possibly could to ensure that I could bring those children into this 
world as healthy and happy as possible. It was a blessing to me. There 
are other mothers out there--expectant mothers--who want desperately to 
ensure that they can do everything possible to bring their children 
into this world healthy and happy, and the key is prenatal care.
  I have long been a supporter of improving access to health care 
coverage for expectant mothers. I understand how important it is, both 
as a mother myself but, more importantly, looking at what it means to 
us as a country to ensure that we bring as many children into this 
world as healthy and happy as we possibly can--not only because it is 
vital to the health of both the mother and the infant but also because 
it often reduces future health care costs, which we know can be high in 
premature births. In fact, it was reported in 2005 that the 
socioeconomic costs associated with preterm birth in the United States 
were at least $26.2 billion. Every year, more than 500,000 infants are 
born prematurely, and that is nearly one out of every eight babies.
  I can remember delivering my children in the Medicaid section of the 
University Hospital where my husband worked, and I remember going 
upstairs to the NIC unit, and I took my dad with me. My dad was a dirt 
farmer. He is no longer with us, but he is here in spirit with me 
today, as he always is. But he was a dirt farmer in east Arkansas, and 
I took him with me to the NIC unit. I had never seen my daddy cry 
before then. But he looked at those premature babies, and he said: What 
is their life going to be like?
  The more we can provide the kind of health care that expectant 
mothers need, we will not have to ask that question. We can ensure that 
babies will be born healthy and happy.
  As I mentioned before, it is of particular concern for me because 
also, in recent reports, more than 14 percent of our births in Arkansas 
are premature, ranking it among the States with the highest incidence 
of preterm births. By taking these needed steps to improve access to 
care for expectant mothers, I am confident we can make strides to 
improve health outcomes for them and for their children.
  The Finance Committee proposal also includes incentives to ensure 
that States reach out to the lowest income kids first and phase out the 
adult waivers that have been existent under the previous 
administration.
  In addition, the bill provides the Federal authority and resources to 
invest in the development and testing of quality measures for 
children's health care. This provision will help ensure that States and 
other payers, providers, and consumers have the clinical quality 
measures they need to assess and improve the quality and performance of 
children's health care services. Making determinations on children's 
health care based on studies that have been done on adults doesn't make 
sense. It is critical that we focus on those quality measures based on 
our research and study of children and applying it in the appropriate 
way.
  Additionally, it allows some States to use income eligibility 
information from other Federal programs, such as school lunch programs, 
to speed the enrollment of eligible children into the CHIP program or 
into Medicaid. We have the income information about these families for 
the school lunch program, which is critically important to the well-
being of our children, so why wouldn't we want to ensure that those 
same families, meeting those same eligibility requirements, could move 
quickly into the CHIP program to get the other health care needs of 
their children met? This would certainly simplify the administrative 
process for States, and it would reduce paperwork burdens that are put 
upon hard-working, low-income families.
  This bill would also provide greater access to much-needed dental 
care for lower income children and would ensure that children enrolled 
in CHIP would have access to mental health care that is on par with the 
level of medical and surgical care that they are currently provided.
  The dental portion, the wraparound, is twofold. I can remember when I 
first visited one of the very first Head Start Programs in my 
community, and I saw these children lined up with little Styrofoam cups 
they had decorated. They had a donated toothbrush and a free sample of 
toothpaste. They were so proud each day to be able to walk to the 
community sink there in the Head Start facility and brush their teeth.
  Dental care is essential. It is absolutely essential. All you have to 
do is look at children of low-income families whose teeth are rotten, 
who aren't getting dental care, who aren't getting supervision or not 
being taught the life skills they need. When those teeth are rotten, 
they hurt, they make those children sick, they are unable to eat, they 
get no nutrition, and then we wonder why they cannot focus in the 
classroom or why they cannot learn. This dental wraparound program is 
excellent for ensuring not only that children will get the dental care 
they need, but the wraparound portion of it ensures that we will not 
see crowding out; that families who have private insurance which 
doesn't cover dental can then get their dental coverage in a wraparound 
package and maintain the other private insurance they have. Those are 
critical needs and critical sensitivities we have looked at in this 
bill to ensure that we are doing the most we possibly can for the 
children of our country.
  As you can see, this bipartisan bill is a step in the right direction 
to provide care and coverage for our most precious resource--our most 
precious asset in this great country--and that is our Nation's 
children. We have to look no further than the children of this country 
to understand that all of what we do today means nothing if we have not 
given them the ability to carry on the great lessons of this great 
country we are blessed to be a part of. And if they do not reach their 
potential, whether it is because they haven't gotten dental care, they 
haven't gotten immunizations, they haven't gotten the proper kind of 
health care they need to be able to learn and flourish and reach their 
potential, we will have done an injustice to our country.

[[Page S1023]]

  As we move forward, I wish to encourage my colleagues to support this 
important piece of legislation in the same bipartisan spirit that was 
demonstrated when it was created 12 years ago. We are not here to 
create a work of art. We are here to create a work in progress. After 
12 years, we have come to understand the importance of what has changed 
in our communities, what has changed in our economy, what has changed 
among our working families, and to meet the needs that exist in today's 
world. After 2 years of waiting, we cannot fail our Nation's children 
yet again.
  I hope every one of us in this body will think of a child who was 
born 2 years ago, unable to access CHIP coverage--a family with a child 
born 2 years ago. If we fail to do it now, and they have to wait 2 more 
years, they have missed 4 years of critical development in their life 
without health care. We will never, ever be able to reverse that.
  This is the time. Now is the time. We have talked and talked, we have 
reached out to one another to come up with the best possible solutions 
we could, but now is the time to pass this bill. In a time when more 
and more Americans are struggling to find affordable health care, it is 
up to us to put politics aside, not only for the future of our Nation 
but for the well-being of millions of our children across this great 
Nation. It is not just our future. Most importantly, it is their 
future. They are depending on us, and it is time we fulfill our 
commitment to them.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Arizona is recognized.
  Mr. KYL. Mr. President, I wish to speak in favor of the Bunning 
amendment, which I hope we will be able to vote on a little while later 
this afternoon.
  It is a very simple amendment that sets the maximum amount for 
eligibility under the SCHIP program at 300 percent of poverty. In other 
words, we set the poverty level in this country three times that amount 
that would be the qualifying level for a family to qualify their kids 
under the SCHIP program. That is a lot more than what was originally 
intended when the SCHIP program was put in effect, but it is a level 
that represents the maximum for all but two States in the country.
  Most States are somewhere around 200 percent of poverty. My State of 
Arizona is exactly at 200 percent of poverty. The State of the chairman 
of the committee, who is from Montana, is now at 175 percent, although 
I understand there is legislation that will take that up to 250 
percent. So with the States bunched around primarily the 200 percent of 
poverty level, some now at the 300 percent, that represents a good 
compromise on where the limit should be set, and we need to set the 
limit for a variety of reasons I will go into in a moment.
  Let me tell you what the implications of the amendment would be. 
There are only two States that would have to cut back under the 
program. In fact, they would not have to actually cut back in the 
coverage of children, they would simply follow the same rules as 
everyone else, and their reimbursement would be at the Medicaid rate 
rather than the higher SCHIP rate for these higher income kids. So they 
could still cover them; they just don't get quite as much reimbursement 
from the Federal Government in order to do it.
  Now, there would be some savings as a result of these two States not 
having Federal funding at the SCHIP level, and that additional savings, 
under the Bunning amendment, could be put into outreach and enrollment 
grants to help find eligible, uninsured, low-income children. The 
reason for that is, the whole point of the program is low-income 
children. Yet there are millions of low-income children who are not 
enrolled in the program. We have to find them, we have to get them 
enrolled. That will cost some money. So the savings that are achieved 
in this amendment would go toward that end.

  The third and basic point here is that the Bunning amendment ensures 
we keep our promise to preserve the SCHIP coverage for low-income 
children and ensure parity amongst the States. If we have a limit of 
300 percent, not all of the States would want to go to 300 percent but 
they would know they could do that. If they wished to keep it below 300 
percent, they would be paying less. They would be receiving less from 
the Federal Government, but it would be uniform for everyone.
  As I said, I think Senator Bunning is wise to set it at this level, 
even though that means the average family of four has $66,000 in 
income. That is hardly low income or poverty level. But $66,000 of 
income would cover families who clearly could use the help. It is 
obviously very generous. It is clearly way above poverty, so I do not 
think Senator Bunning goes very far in limiting this to 300 percent of 
poverty. These numbers translate to 200 percent of poverty is $44,000 
income per year. Of the two States that are above the 300 percent, one 
is New Jersey at 350 percent. That translates into $77,175 a year. The 
other is New York at $88,200 per year.
  We can all have some disagreements in this body, but nobody can argue 
that $88,000-plus in income is a poor family, is a poverty or low-
income family. That is not what this program was designed to cover.
  Add to that, you can add in $40,000 for expenses for transportation 
and clothing and housing and so on, and you can actually get above 
$120,000 in income and qualify for this low-income program for kids. 
That is not right.
  One thing I know that folks in Arizona, folks in New Mexico, folks in 
Montana all say when they look to Washington is: We know we need to pay 
income taxes, we know we need to spend money on things, but stop 
wasteful Washington spending. I think sometimes they may view our 
spending as more wasteful than it is, but the reality is there is a lot 
of wasteful spending here. This is a lot of spending beyond what was 
the original intent of the legislation.
  When I talk in Arizona about low-income kids, people nod their heads 
and say, yes, we need to help low-income families with kids. If I said 
to them so that means $120,000 a year--most of the families in Arizona 
don't make $120,000 a year, let alone calling that low income. It is 
not. If only for truth in advertising purposes, we should support the 
Bunning amendment and, again, he sets the level at 300 percent of 
poverty or $66,000. In one sense you would have a tough time defending 
that as a low-income program. But that is where he set it. At least 
nobody can contend that he is trying to be too cheap here. Mr. 
President, $66,000 a year for a family of four to qualify for a low-
income poverty program I think is quite generous.
  I think I indicated I would answer a couple of questions here about 
why we need to do this. One argument for the folks in New Jersey is we 
have a higher cost of living in those States. Of course it is not twice 
as high. It does not cost twice as much to buy a car in New York or New 
Jersey or Arizona, so that argument only goes so far--and it is about 
``this'' far.
  Second, what these States have done is cover more kids at higher 
income levels because it is easier. Think about it. You expand the 
program to cover a lot of high-income kids. You can find those kids. It 
is the very low income we are having the trouble finding. Those are the 
ones who need to get registered in this program, but they are hard to 
find. They are in our Indian reservations, in our inner cities, and 
maybe some out in farm country in Montana or wherever. That is who we 
should be focused on here.
  It is easy to say let's raise this up to families making $88,000 a 
year. Sure, you can find those kids. But the fact you are then 
enrolling more kids in the SCHIP program doesn't mean you are getting 
the ones who need the care the most.
  There is another problem with that. The Congressional Budget Office 
notes that with these higher income family kids, there is a one-to-one 
ratio from adding a child onto SCHIP and losing health insurance 
coverage in the private sector. For every one child who is added on, a 
child loses health insurance coverage from an employer. The ratio 
generally is between 25 and 50 percent, but at the higher income level 
it reaches a one-to-one ratio. This is the crowdout effect we were 
talking about before. It doesn't do us any good to add somebody to the 
Government-run program if the only effect of that is to cause them to 
lose their insurance policy from their family's employer. You

[[Page S1024]]

have not helped anybody in that case. All you have done is transferred 
the expense from the employer to the taxpayer.
  In the case of these high-cost States such as New York and New 
Jersey, the people of New Mexico or Arizona or Montana, for example, 
are paying twice as much for those kids as they are for the kids in 
their own State.
  We are sending money from Arizona to New York. Arizona has it at 200 
percent of poverty, or a $44,000 income level. New York has twice that, 
$88,000. The net effect of that is Arizonans are simply sending money 
to New York to take care of the New York kids. That is not fair. That 
was not what this program was originally designed to do. What Senator 
Bunning has done is say let's cap it, not at some low level but the 
relatively high level of 300 percent of poverty, $66,000 a year. If 
they want to cover kids higher than that, they can, but they are 
reimbursed at the somewhat lower Medicaid rate than the SCHIP rate, and 
he takes the savings from that and helps us fund the kids who need the 
coverage, the low-income kids.
  I cannot for the life of me see why any of us, except perhaps the 
four Senators from New Jersey and New York, would not support this 
amendment. The only two States that would suffer at all under this 
amendment are those two States because they have chosen to go far above 
what the other States provide in terms of coverage. They can still 
cover the kids, as I said, they just don't get quite as much money from 
taxpayers in other States to do that.
  Why wouldn't those of us from the other States support the Bunning 
amendment? It is going to be very hard for some people to go home to 
their constituents when those folks say, Why didn't you support the 
Bunning amendment? Why should I have to pay money for somebody making 
$88,000 in New York State to cover these higher income kids when that 
probably means that their employer takes the obligation he has and 
moves it over to the taxpayers? This is not very logical.
  The Bunning amendment is a modest attempt to get the program back to 
its original intent, slightly less expensive, to generate some funds to 
get the low-income kids in, and have more equity among the States.
  I cannot think of an amendment that would more reasonably try to deal 
with all these problems, and I do urge my colleagues, for a moment 
here, let's put partisanship aside. The President has urged us to do 
that. We don't have to have just partisan votes on all of these 
amendments--all the Democrats vote no, all the Republicans vote aye. 
That doesn't get us anywhere. I hope my colleagues on the other side of 
the aisle will put on their independent thinking hats. If they need to 
say something to the leadership or whatever--look, this is a reasonable 
amendment, I am going to support it--then do that. We do not have to be 
in lockstep here. It may be that there is a Republican amendment that 
deserves to be supported. This is one.
  I urge my colleagues, let's approach this independently. This is a 
good amendment. Let's support it. I hope my colleagues will consider 
doing that when we vote on the Bunning amendment a bit later on this 
afternoon.
  The PRESIDING OFFICER. The Senator from Montana is recognized.
  Mr. BAUCUS. Mr. President, basically the Bunning amendment is the 
fourth amendment that would put a cap on eligibility. Yesterday the 
Senate rejected the Cornyn amendment that would cap it at 200 percent 
of poverty, a Roberts amendment with a cap of $65,000, and a Murkowski 
amendment with a cap of 300 percent of poverty. All these amendments, 
including the Bunning amendment, have the same flaw; that is, they 
would raise the possibility of kicking kids off the Children's Health 
Insurance Plan; that is, they are diminishing amendments. They do not 
add, they subtract. The kids currently on the Children's Health 
Insurance Plan are taken off. That is not something I think we want to 
do.
  The specific amendment in question here will have that effect. It 
will basically say that because the States that have been mentioned 
here essentially get a match rate according to the Children's Health 
Insurance Plan, that because of the amendment--the amendment says they 
will get less, they will get the Medicaid match rate, which is less 
than the Children's Health Insurance Plan; therefore, those kids cannot 
participate.
  Theoretically there could be some participation because the match 
rate in Medicaid, which I think is around 15 percent lower--in the case 
of let's say New York or New Jersey--than the Children's Health 
Insurance Plan match. But still the effect is the same. If this 
amendment were to go into effect, children currently in, say, New 
Jersey who receive the Children's Health Insurance Plan match rate will 
probably get kicked off. A lot will be kicked off the Children's Health 
Insurance Plan because the match rate is lower, down to the Medicaid 
rate.
  That is not right. The fact is all of these amendments, including the 
Bunning amendment, are restrictive. It is constrictive. It is a 
reducing amendment. It pressures to take children off the Children's 
Health Insurance Plan rather than add children.
  People talk about 200 percent of poverty, 300 percent of poverty, et 
cetera. I think New Jersey is at 350 percent of poverty. One 
interesting point there is they are at that rate, A, because they asked 
for it and, B, because President Bush's administration gave a waiver 
and said, yes, go ahead and do it. President Bush, his administration, 
and the Republican Secretary of HHS, said, yes, New York, go ahead and 
do that. That is fine. You should do that.
  One can guess why they may have granted that waiver. The reason is 
because when you talk poverty levels, such as 200 percent of poverty, 
that is a national figure. It is not a different number for each State, 
it is what is the national number. New Jersey, I think, has the highest 
per capita income of any State in the Nation. Clearly, the Federal 
poverty level which applies to New Jersey probably does not match what 
the realities are in that State. The realities are if you take a family 
a little bit above the national median income, a family in that State, 
in New Jersey, is probably facing the same economic pressures and 
difficulties--paying for health insurance, providing for the kids and 
the kids' medical bills--as would the average family in a State where 
the median income is the same as the national median income. That is 
probably why New Jersey asked for that waiver and probably why the 
Republican Secretary of Health and Human Services granted that waiver. 
But that is where we are. That is history. It makes sense.
  The fact is, this amendment says, no, we are going to undo that, even 
though New Jersey is used to it, even though New Jersey applied for the 
waiver and lawfully was granted the waiver, we say: No, no, not that 
anymore. We are going to reduce the match rate you and New Jersey get 
and it is again going to have the pressure of hurting kids in that 
State and taking kids off the Children's Health Insurance Plan. That is 
not the right thing to do.
  I therefore respectfully urge Senators to not support this 
restrictive amendment which does not add kids to the Children's Health 
Insurance Plan. Rather, it takes kids off the Children's Health 
Insurance Plan.
  The PRESIDING OFFICER. The Senator from Iowa is recognized.
  Mr. GRASSLEY. Mr. President, I rise for the purpose of supporting the 
Bunning amendment. What I say will have some rebuttal to what the 
distinguished chairman of the committee has said just.
  Medicaid and the Children's Health Insurance Plan were created to 
cover low-income children. An income of more than $63,000 for a family 
of four is not low income. I know the Senators from the State of New 
York and New Jersey will argue that $63,000 is low income in their 
States. I know they will talk about the cost of living in those States.
  As an example, the median home price in Des Moines is greater than 
that in Binghampton, Buffalo, or Rochester in the State of New York.
  The underlying bill says all States can cover above 300 percent of 
the Federal poverty level. I think that should be limited, as it was in 
the second bill that was a bipartisan bill passing the Senate in 2007. 
But if we are going to allow States to cover above 300 percent, all 
States should be treated equally, and an exception for two States--and 
I might emphasize only two States--is not fair, and it is not

[[Page S1025]]

right. This amendment strikes that exception so all States are treated 
equally.
  I urge support for the Bunning amendment that we will vote on in a 
little over an hour. I hope Senators coming to the Senate floor will 
take that into consideration. Treating all States favorably is 
essential.


                            Amendment No. 83

  (Purpose: To provide H.R. 3963 (CHIPRA II) as a complete substitute)

  The amendment I am going to introduce is the exact contents of the 
bill we call the 2007 bipartisan bill No. 2 because that is the No. 2 
bill vetoed by President Bush. This amendment I am offering today, I am 
doing so with Senator Hatch because he was there with me through all of 
that discussion in 2007 that brought us to a bipartisan bill.
  The amendment is the bill that, 2 years ago, Speaker Pelosi called 
``a definite improvement on the first bill,'' meaning the first bill 
the President vetoed. This amendment I am going to soon lay before the 
Senate is a bill I believe is the best bipartisan compromise we could 
put together to cover as many low-income children as possible. This 
amendment is that 2007 bill that told States they could not cover 
children above 300 percent of poverty level in the Children's Health 
Insurance Program. Why do we concentrate so much on that level and not 
above that level?
  In 2007, we thought letting States cover children above the national 
median income diverted attention from the mission of Medicaid and the 
Children's Health Insurance Program, which was obvious then and still 
obvious today; that is, that we ought to be putting the emphasis on 
low-income children.
  The underlying bill allows States to cover children up to any income 
level and, as I said, includes a special grandfathering exclusion for 
New York to cover children and families with incomes up to $83,000 per 
year. The second bipartisan children's health insurance bill--that is 
the amendment before us or that I will put before us now--returns the 
focus where it has been since 1997 in the CHIP bill. The emphasis is 
upon getting low-income children into a plan so they have the health 
care they need.
  This amendment is the bill that includes a policy to address the 
problem of crowdout that was the subject of an amendment yesterday. It 
is a policy that is not in the underlying bill, which brings me to the 
question: What exactly went wrong with the crowdout policies that so 
many of us voted for in 2007?
  Certainly, it is not because the Democrats have put forward a policy 
that addressed crowdout in a better or more efficient manner. 
Certainly, it is not because the Democrats have new analyses that 
crowdout is no longer occurring, especially in the expansion of public 
programs. When Children's Health Insurance Program dollars go to higher 
income children who already have private coverage, that money could 
have gone to low-income children. Make no doubt about it, 4 million new 
people being covered does not take care of the problem of covering low-
income children. There are still going to be millions out there who 
will not be covered whom we ought to have a focus on.
  The second bipartisan children's health insurance bill of 2007 that 
is now the amendment I am going to lay before the Senate returns the 
focus to low-income children. Finally, this amendment-to-be is the bill 
that we voted on in 2007 which did not have the divisive legal 
immigrant issue in it. The underlying bill today has $1.3 billion of 
coverage for legal immigrants, more than 100,000 of whom already have 
private or public coverage, dollars that could have gone to cover more 
low-income children.
  The second bipartisan children's health insurance bill--that is the 
amendment I am going to lay before the Senate--now returns the focus to 
low-income children. Now, today in the Senate, there are 43 Democrats 
and 12 Republicans, of which I am one, who were Members of the Senate 
in 2007 and voted for this bill that my amendment is going to 
represent.
  Those 43 and 12 Republicans who are still here--that is 55 of us--if 
we would stand together, we could still do great things. We could show 
that bipartisan amendments still mean something in the Senate. When the 
vote count ended, we would probably have more than 70 votes for this 
amendment. Instead, I know if I call for a vote on this amendment, 43 
ayes that were cast in 2007 would become ``no'' votes.
  After watching the difficulty those 12 Republicans, including this 
Republican, faced by voting aye and sticking together because we 
thought we were doing good policy, watching 43 ayes turn to noes on the 
very same policy is a bitter pill to swallow.
  Mr. President, I ask unanimous consent to set aside the pending 
amendment and to call up amendment No. 83.
  The PRESIDING OFFICER. Without objection, the pending amendments are 
set aside.
  The clerk will report.
  The bill clerk read as follows:

       The Senator from Iowa [Mr. Grassley] proposes an amendment 
     numbered 83.

  Mr. GRASSLEY. Mr. President, I ask unanimous consent that the reading 
of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The amendment is printed in today's Record under ``Text of 
Amendments.'')
  Mr. GRASSLEY. Mr. President, I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Utah is 
recognized.
  Mr. HATCH. Mr. President, I support this amendment of the 
distinguished Senator from Iowa. Essentially, what we are doing is 
striking the Baucus bill being considered on the floor and replacing it 
with the CHIPRA II bill that passed overwhelmingly in this body in 
2007, enough votes to override a Presidential veto. Not one Democrat 
voted against this bill. Not one.
  But what my good friend, Senator Grassley, and I are offering is a 
bill that represents a solid bipartisan agreement that we worked out 
with Senators Rockefeller and Baucus. I do not blame Senator Baucus for 
the mess we are in right now, or this partisan approach to CHIP, 
because he represents his side. But I do believe there has been a real 
lack of effort by some on the Democratic side to work with us after all 
of the time that we spent trying to make sure we had something that 
would work in the last Congress.
  What we have is a true bipartisan agreement where we were there from 
start to finish. Senator Grassley and I, Senators Baucus and 
Rockefeller, and those in the House--we spent hours together, months 
together, working out the details of this bill. We spent morning, noon, 
and night for 6 months to get the bill to that point. It was built on a 
foundation of tough agreements and tough decisions. We were part of the 
process from the very beginning and stayed with the process until the 
very end. That resulted in a true bipartisan agreement.
  The bill passed overwhelmingly in both the House and the Senate by a 
veto-proof margin in the Senate. Senator Grassley and I worked our guts 
out, put our hearts and souls into both CHIPRA I and CHIPRA II. We were 
proud of our work with Senators Rockefeller and Baucus because that 
work not only reauthorized the CHIP program for 5 additional years, it 
covered more low-income uninsured children. It retained the original 
goal of the original CHIP program, which, by anybody's measure, has 
worked very well over the prior 10 years.

  The bill before us today does not represent that agreement. We talked 
to our colleagues at the beginning and then we were not included in the 
discussions that evolved into the CHIP bill recently considered by the 
Finance Committee and now on the Senate floor. We were not even 
invited. It seems to me once we were not needed anymore we were more or 
less thrown by the wayside because our votes were no longer needed.
  This is not the way to start off the 111th Congress, especially after 
the last campaign where our President said he wants to work in a 
bipartisan way, he wants us to get together, he wants us to be able to 
work with each other, he wants us to accomplish a great deal for this 
country.
  I think I am known for bipartisan work around here, and I certainly 
have taken a lot of flack for some of the President's Cabinet people I 
supported, and supported right off the bat, because they were qualified 
people. I believe the President should have his

[[Page S1026]]

choice as long as they are qualified and not otherwise disqualified.
  Well, I am going to support this amendment of Senator Grassley's, 
which represents the true bipartisan agreement of 2007. Now, let me 
mention a few of the highlights in CHIPRA II.
  The amendment states there will be no Federal CHIP dollars for 
coverage of children over 300 percent of poverty; that is around, 
$63,000 for a family of four. Now, to be honest with you, when we did 
the original CHIP bill, we wanted it to be 200 percent of poverty 
because those kids were the only ones left out of the health care 
system, the children of the working poor. We did it so we would have 
enough money to try and cover all of the kids who really qualified for 
CHIP. Even with that, we found we were not able to get to all of them. 
So you can imagine, with the current economic difficulties, we are 
going to have even more pressure to get to more and more kids. If we 
start allowing states to cover over 300 percent of poverty, which at 
least one State does and another is in the process of doing, it is not 
going to be long until this program becomes a Federal Government 
boondoggle where everybody will expect money from the Federal 
Government for health coverage.
  This amendment eliminates the earmark to allow New York to cover 
children up to 400 percent of poverty, $84,800. By the time they use 
income disregards, some estimate that families could be making over 
$100,000 a year and still qualify for the CHIP program.
  Now what does that do? That takes money from the 6 million kids who 
are low income and uninsured. It is crazy. Yet that is what this bill 
allows. Senator Grassley and I had to agree to go to 300 percent, which 
is over $63,000 for a family of four in 2007. But to now go to 400 
percent of poverty, admittedly New York City is an expensive place, but 
New York's rural areas are not that different from other States, except 
they are taxed to death in the State of New York. But that should not 
be the problem of everybody in the country.
  This amendment includes the bipartisan crowdout policy that addresses 
the issue of families giving up private coverage in order to enroll in 
a public program. Our amendment would require a number of studies on 
crowdout, would improve data collection on the coverage of low-income 
children, would require all States to adopt these ``best practices'' to 
reduce crowdout, and would provide the Secretary with the authority to 
hold States accountable for covering low-income children.
  With regard to crowdout, we did our best to stop it so people would 
not drop their health insurance that they can afford so their kids 
would qualify for the CHIP program. That is one of the problems with 
covering higher income families, because, naturally, if parents find 
they are going to be better off opting for CHIP coverage as opposed to 
private health coverage, they are going to crowd-out lower-income 
children from CHIP coverage. That is what this bill really does.
  It is a shame because it means less money and less health coverage 
for those who are truly needy, those for whom this bill was meant.
  If we covered the children of the working poor, the only ones who 
were formerly left out of the health care system, we could probably do 
a much better job if we kept it to 200 percent of poverty. But Senator 
Grassley and I agreed to go to 300 percent of poverty in the interest 
of a bipartisan agreement even though each of us felt that probably was 
a mistake.
  This amendment does not include the controversial legal immigrant 
provision allowing States to claim a Federal match for coverage of 
legal immigrant children and pregnant women.
  Look, I started the Republican senatorial Hispanic task force. I 
brought Hispanic leaders from the country to Washington at least twice 
a year to help us understand how we could better assist Hispanic 
people. We brought together Democrats, Independents, and Republicans. I 
have a long reputation of trying to help Hispanic people.
  Under our immigration laws, sponsoring families who brought others to 
this country legally entered an agreement to take care of those 
individuals for 5 years. It has worked. The current bill on the floor, 
the partisan bill, wipes that all out. In the process, how many 
children who are U.S. citizens are going to be left out because we have 
expanded this program in ways that will not take care of them?
  Mr. DURBIN. Will the Senator yield for a question?
  Mr. HATCH. Sure.
  Mr. DURBIN. I know he has an amendment pending relative to taking 
care of providing prenatal care to make certain that children are born 
healthy in the United States. I would like to ask the Senator if he is 
arguing now that we should not provide maternal care for pregnant women 
who are legal immigrants to the United States with the full knowledge 
that the lack of that care may mean the child will be born sick and the 
child will be a citizen of the United States?
  Mr. HATCH. Heavens no.
  Mr. DURBIN. Is the Senator arguing we should not provide obstetrical 
care to pregnant legal immigrant women?
  Mr. HATCH. Certainly not. And as the Senator knows, many States today 
provide that care to legal immigrants through CHIP or otherwise. And 
let me emphasize that all expenses are supposed to be provided by the 
sponsoring families for 5 years. If that was the wrong time or it 
should have been shortened, I would have worked with the distinguished 
Senator to do that. But that was the deal. That was the rule. That was 
what we worked on. That is what we thought would work. That is what we 
thought was fair.
  What I don't want to do is have our own children who are U.S. 
citizens be without care while we cover those who were supposed to be 
covered by their sponsor families who brought them to the United 
States.
  Mr. DURBIN. If the Senator will yield, if a person is here legally 
though not a citizen, is a legal immigrant mother, is it not true that 
her child born here will be a legal citizen?
  Mr. HATCH. Yes, it is true. And they would be covered by CHIP.
  Mr. DURBIN. Then if we deny care----
  Mr. HATCH. What about those who were brought in who are not legal 
citizens? I am not against helping them.
  Mr. DURBIN. I don't think there should be a provision for 
undocumented illegals.
  Mr. HATCH. If I may take my time back, I am not against any children 
receiving help. A lot of these children get help through our system of 
health care. But I am talking about a CHIP bill that cannot take care 
of our current children who are U.S. citizens and now we have included 
a provision that would allow legal immigrants to be covered before the 
5 year waiting period.
  I might add, many States today provide coverage to legal immigrant 
children. Many States do that. I commend them for doing it. But I am 
worried about having a bill that can get broad bipartisan support that 
literally first covers our children who are U.S. citizens. This bill 
does not do that. Let's be honest about it, it doesn't. Today, there 
are as many as 6 million or more low income, uninsured children who are 
U.S. citizens who do not have health coverage some of whom could 
potentially not be covered by CHIP because legal immigrant children 
will now be covered through CHIP. It is my hope that their family 
sponsors will take care of them. And if not, these legal immigrant 
children and pregnant women are still going to be taken care of by the 
States. I don't know of any pregnant woman who goes to an emergency 
room and who isn't going to be taken care of.
  I think this is a principle that is very important. We should be 
doing what we can do. But what is more important is that we agreed to 
not include the legal immigrant provision in CHIPRA II. It 
overwhelmingly passed, and every Democrat voted for it. Now we come up 
with a partisan approach that basically undermines that agreement. I am 
very concerned about it. Frankly, I think Senator Grassley is right in 
bringing up this amendment.
  But don't let anybody fool you. There isn't a child I don't want to 
help. In fact, the way this bill arose, two families from Provo, UT, 
came to me. Both husbands worked; both wives worked. Both husbands and 
wives worked. Neither family, at that time in 1994, earned more than 
$20,000 combined income a year. Yet they were working poor who wanted 
to work and not be on the dole, but they couldn't afford insurance for 
their children, who were

[[Page S1027]]

the only kids, the working-poor kids, the only kids left out of the 
process. So we came up with CHIP to try to resolve that issue. Even 
with that, we were not able to do everything we wanted to do, but it 
worked amazingly well. I don't know anybody who denies that fact. I 
don't know anybody who would dispute me on this statement. I would like 
to see them try.
  The fact is, the bill worked well. Over the last 2 years, in a 
bipartisan way, we worked to try to solve some of the problems that 
arose, even with a good working CHIP bill. We worked in good faith. All 
of a sudden, we find a bill brought up here without any input from us 
that is a partisan bill, that makes it even more difficult to cover all 
these kids.
  Everybody knows I believe in health care, and I believe we ought to 
cover everybody. I would like to do it, but I don't want to do it by 
bankrupting the country or making those who do work have to take care 
of those who don't. I am a very strong believer in helping those who 
cannot help themselves but would if they could, but I am not very 
excited about helping those who can help themselves but won't. 
Unfortunately, we have a few of those types of people in this country.
  What galls me is that I know the President wants to work in a 
bipartisan way. But the House just acts like, so what, we are just 
going to do what we want to do. I can understand that type of thinking 
because they were irritated with some members in the House, even though 
we ended up with a very strong vote in the House. It just wasn't enough 
to override the veto. They were irritated with some of those who didn't 
agree with CHIPRA I or CHIPRA II. But in the Senate, we had, as I 
recall, 69 votes--more than we needed to override a veto. The reason we 
did is because it was bipartisan.
  I don't know how many people are going to vote for CHIPRA II at this 
time, but I just remind my colleagues that every Democrat voted for it 
when it came up. Frankly, even if we didn't get it passed because the 
House sustained the veto, it was a tremendous victory.
  I am not going to spend the rest of my life griping about it. But the 
fact is, it is a shame that with a President who wants to be 
bipartisan, the first thing out of the box, the first real bill out of 
the box happens to be a bill that they know Senator Grassley and I 
worked hard on, that we carried a lot of water on, that we took a lot 
of flak for in 2007. Then we find out they are going to do something 
that is just plain partisan, that isn't going to work as well, and it 
is going to cost the American people a lot more.
  I hope everybody in this body will support Senator Grassley's and my 
amendment on the CHIPRA II bill. If they don't, personally, I can live 
with it, but I won't be happy. I think what is going on is not fair, 
and it is a direct slap in the face to those of us who worked so hard 
with our friends on the other side. And they are friends. I mean, they 
are all friends. I care for them. But this is a particularly important 
bill to me. Right now, it looks as if it is turning into just a 
partisan exercise.
  I yield the floor.


            Unanimous-Consent Agreement--Executive Calendar

  The ACTING PRESIDENT pro tempore. The majority leader is recognized.
  Mr. REID. If I could interrupt this very interesting debate, as in 
executive session, I ask unanimous consent that on Monday, February 2, 
at 3:15 p.m., the Senate proceed to executive session to consider the 
nomination of Eric Holder to be Attorney General of the United States; 
that there be 3 hours of debate with respect to the nomination, with 
the time equally divided and controlled between Senators Leahy and 
Specter, chairman and ranking member of the Judiciary Committee, or 
their designees; that at 6:15 p.m., the Senate vote on confirmation of 
the nomination; that upon confirmation, if there be confirmation, the 
motion to reconsider be laid upon the table; that there be no further 
motions in order, the President be immediately notified of the Senate's 
action, and the Senate resume legislative session.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  The Senator from Montana.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that at 3:10 p.m. 
today, the Senate proceed to a series of votes in relation to the 
following pending amendments in the order listed: Coburn No. 47, 
Bunning No. 74, and Hatch No. 80; further, that no amendments be in 
order to these amendments prior to the votes; that there be 2 minutes 
of debate equally divided between the votes; and that all votes after 
the first vote be limited to 10 minutes.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  The assistant majority leader.
  Mr. DURBIN. Mr. President, I would like to speak to the pending 
matter before us.
  Mr. HATCH. Will the Senator yield?
  Mr. DURBIN. I am happy to yield to the Senator from Utah.
  Mr. HATCH. I don't think I answered the question as well as I would 
like to. The question was, Do we want any children of pregnant women, 
legal immigrant children, not to be helped? Twenty-one States already 
pay for that. I think most of the others do through emergency rooms. 
They don't go without health care. But what is happening here is that 
we are taking what 21 States are actually doing and we are basically 
just alleviating them from having to do that, that which they are 
capable of doing and wanted to do, and just taking it over by the 
Federal Government when, in fact, these problems were solved in a way 
that was reasonable, with not only families taking care of people they 
brought into this country for 5 years under their obligation but also 
because the States would take care of them with State money. I wanted 
to make that clear. I do appreciate working with my colleagues on the 
other side, but I am a little disappointed that it has turned out this 
way.
  Mr. DURBIN. Mr. President, let me preface my remarks by saying a word 
of tribute to the Senator from Utah. I hope he doesn't leave the floor 
because this may be historic, but I thank him personally for his 
support of this SCHIP bill through the years. I know it has not always 
been easy. Sometimes he has been a lone voice. And though we may 
disagree about one aspect or another, I greatly admire the fact that he 
has stood up and supported this. I hope at the end of the day he will 
continue to because bipartisan support for this program is very 
important. I salute him.
  Mr. HATCH. If the Senator will yield, I thank him for his gracious 
comments. He knows our friendship means a great deal, and also with the 
distinguished chairman of the committee. I think he is a very fine man 
who has done a very good job on this committee. But I am going to have 
a difficult time supporting this bill without some bipartisan approach 
that would work a lot better than this is going to work. But I thank 
the Senator again.
  Mr. DURBIN. Mr. President, I thank the Senator from Utah.
  I want to try to bring this down to the bottom line. This really is a 
debate about children's health coverage. This is not a debate about 
immigration. I hope my colleagues will be willing to have that debate 
about immigration, and soon, because it is long overdue in this 
country.
  Much of this debate is focused on the idea that this provision in the 
bill would call on undocumented immigrants to abuse the system and that 
our financially strapped system would be run down by an influx of these 
undocumented immigrants jumping onboard.
  Let me make it clear: Undocumented immigrants have never been 
eligible for the major benefit programs in America, and this law does 
not change that. We are talking about legal immigrants, people who are 
in the United States legally, people who are working and paying taxes, 
people who are more than likely to become tomorrow's citizens.
  It is a different group. These are not those hiding in the shadows 
because they are here illegally. These are people who have legal 
documentation as to their presence in the United States. They can go to 
work. They pay taxes. What we are talking about is making certain the 
children of these legal immigrants have a chance to be healthy. It is 
likely many of those children are already U.S. citizens, and many will 
become U.S. citizens. Their being

[[Page S1028]]

unhealthy does not make sense for that family, and it certainly does 
not make sense for our Nation.
  Legal immigrants were able to get some assistance, but the 1996 
Federal welfare law restricted those benefits by enacting a 5-year 
waiting period. This was during the Gingrich era. The policy was 
instated over 10 years ago, and almost immediately we started changing 
it, realizing it really did not work as well as planned. Congress and 
many States recognized we had gone too far and we were causing serious 
harm to seniors and persons with disabilities and vulnerable families 
throughout the country.
  Over time, and with the support of Presidents from both political 
parties--President Clinton and President George W. Bush--Congress 
restored eligibility to many but not all lawfully residing immigrants 
who needed Social Security assistance or food stamps. We have not yet 
restored health care services to these individuals and families. We 
have attempted to do so in the past.
  During the debate on Medicare Part D prescription drugs for seniors, 
the Senate version of the Medicare bill included this same language. We 
all know how successful the effort was. It passed this Chamber with a 
strong bipartisan vote of 76 to 21. When there was an attempt to change 
it, water it down, it was rejected by the Senate by a vote of 65 to 
33--a strong bipartisan vote.
  In addition to longstanding support from Republicans, Democrats, and 
Independents, the removal of legal immigrant barriers to health care is 
also backed by diverse stakeholders. The National Governors Association 
and the National Conference of State Legislatures are on record 
supporting the approach of this bill.
  In addition, the bipartisan U.S. Commission on Immigration Reform 
called for lifting restrictions on legal immigrants' eligibility for 
public benefits shortly after the 1996 restrictions went into place. 
The arguments for such a policy are overwhelming.
  According to a 2003 factsheet from Families USA, extending health 
insurance to this population actually saves the health care system of 
America a lot of money. Covering uninsured children and pregnant women 
through Medicaid can reduce unnecessary hospitalizations by 22 percent. 
Preventing unnecessary hospital visits results in substantial savings 
in uncompensated care. Women without access to prenatal care are four 
times more likely to deliver low birth weight babies and seven times 
more likely to deliver prematurely with complications.
  Avoiding these pregnancy complications is not only the humane thing 
to do, it is the economic thing to do. It produces great savings to the 
system. Like all of us, when immigrant kids are insured--legal 
immigrant kids are insured--their families make better decisions when 
it comes to the use of health care. They are twice as likely to have 
seen a primary care doctor in the last year as those who are uninsured. 
They are three times more likely to have preventive well-child visits. 
They are more likely to get a flu shot.
  In contrast, uninsured immigrant children are four times as likely to 
have used an emergency room more than once as immigrant children who 
are covered. ER care is expensive, sometimes unnecessary. We can avoid 
it by doing the smart thing in providing health insurance for the 
children of these legal immigrants.
  So I say this: There is a lot of debate in this Chamber, and has been 
over the last several days, about families, family values, life, 
respecting life. Those are all valuable concepts and principles. But 
isn't that the bottom line in this debate? If you really do respect 
families and family values, if you really do respect life and children, 
why would you deny basic health insurance to these children? They are 
the children of legal residents of the United States, people paying 
their taxes, who want the best for their kids, like we all do.
  That is why this is so important. We have come at this in the last 
couple days--and I salute the chairman of the Finance Committee for his 
patience. We have come at this from 10 different directions. It is 
still the bottom line. The bottom line is, if you value these kids, if 
you want them to be healthy, if you want to give them a fighting chance 
for a good life so they can be happy, healthy, and good citizens of the 
United States, don't deny them this health care.
  No child should have to wait 5 years for health care. Five years is a 
lifetime to a child with a medical problem. Many of these conditions 
have long consequences if we do not treat them early. So let's make 
sure we do the right thing. As someone said in some of the debate the 
other day, children are contagious. You cannot say, well, we are going 
to put in a classroom those citizen kids with those legal resident 
kids, and the legal resident kids do not get to go to the doctor. They 
have to wait until they are really sick or the parent, in desperation, 
has to take them to an emergency room, and it does not affect the whole 
classroom. It does.
  We are literally in this together. Our children and grandchildren are 
in this together. Our country can do better. I hope we defeat these 
amendments and stick with this basic bill.
  Mr. President, I yield the floor.
  The ACTING PRESIDENT pro tempore. The senior Senator from Montana is 
recognized.
  Mr. BAUCUS. Mr. President, I very much thank the Senator from 
Illinois for his statement in several respects. One is that he 
complimented the Senator from Utah. That was the proper thing to do 
because the Senator from Utah has done a lot and led the way for 
children's health care. I thank the Senator for making that point very 
clear. It is true, Senator Hatch has been one of the real leaders in 
helping to protect kids. He worked a few years ago on the original 
Children's Health Insurance Program, and he, Senator Rockefeller, and 
the late Senator John Chafee were several of the prime movers to get 
children's health insurance passed in 1997.
  I would like to say a word or two about the pending amendment offered 
by my good friend from Iowa, Senator Grassley. He mentioned--and, 
frankly, some of the speakers have mentioned--a lot about partisanship 
and seeking bipartisanship, and so forth. We all want to work together. 
That is clear. Frankly, to be honest, I do not like the word 
``partisanship.'' I do not like the word ``bipartisanship'' because 
that connotes there are two sides trying to force something together. 
I, rather, think we should--without sounding corny about it--just try 
to do what is right.
  The amendment offered by my friend from Iowa, Senator Grassley, will 
have the effect of taking about three-quarters of the million children 
off the Children's Health Insurance Program or, to state it more 
accurately, if you take the current bill before us, we will 
add approximately 4 million children to the approximately 6 million 
children who are currently covered. We are told 10 million kids would 
be covered under the Children's Health Insurance Program.

  Remember, the Children's Health Insurance Program is for low-income 
kids of the working poor. These are families who are not as poor as 
those who qualify for Medicaid. It is just the next level up, the 
working poor. They have had a real tough time making ends meet. The 
Children's Health Insurance Program is aimed at that group, at the 
working poor.
  Under the legislation before us, not only will the 6 million who 
currently have children's health insurance coverage receive that care, 
but 4 million more will be covered under the bill for a total of 10 
million.
  Cutting to the chase, the bottom line, the effect of the amendment 
offered by Senator Grassley will be to deny coverage to three-quarters 
of a million people who otherwise would be covered under the bill or, 
to state it in very gross terms, if the total under the bill is 10 
million covered, that means under the Grassley amendment it would be 
9.25 million covered; that is, about 750,000 kids could not be 
eligible. These are kids who currently in these times need help. These 
are kids with families where, most likely, the parent is having a hard 
time finding work or is maybe laid off, really struggling.
  We know real wages have not gone up in this country at all in the 
last decade. Times are tough for a lot of people. They may have lost 
their house or are losing their house or they may find their rent has 
gone up even more. There are a lot of reasons people are facing tough 
economic times. These are the people we want to help.

[[Page S1029]]

  Now, if these kids in working poor families do not get health 
insurance, we all know the consequences. One is deferred health care. 
They are not going to go to a doctor for checkups. They will not get 
their checkups. One is deferred medication. They do not get their 
medication. They will get sick more likely.
  When they get sick, what happens? Well, if they get real sick, they 
probably have to go to the emergency room. What happens there? They get 
emergency care, deferred care. It is expensive care. It is postponed 
care.
  Then what happens? Well, they get the care in the emergency room, but 
then what is the followup? They will not be seeing a doctor. They will 
not be seeing a pediatrician. They will not be seeing an internist, 
somebody who is a primary care doc, a family doc, who could follow up 
to make sure the child is doing well.
  What else happens? Well, the costs in the emergency room are passed 
on to somebody else. Who are they passed on to? We all know they are 
passed on to the hospitals, they are passed on to the doctors, who then 
have to charge their private paying patients more. For those, frankly, 
who are so concerned about private health insurance--and we all are 
very much--the net effect of denying children coverage under the 
Children's Health Insurance Program is not only deferred care, it also 
means increased premiums for the private health insurance market. That 
makes it sort of a vicious circle: the higher the premiums go, the 
harder it is for people, for families to get private health insurance. 
It is a big problem.
  You might ask, who are the 750,000 people the Grassley amendment 
would deny participation in the Children's Health Insurance Program? 
Really, his amendment basically strikes the bill on the floor and 
replaces it with what is called CHIP II. There is a big loss of 
coverage for perfectly legal immigrants. These are people in our 
country, frankly, who, for all intents and purposes, are Americans. 
They stood in line in some country legally to get to the point where 
they would enter our country. They are going through the process 
legally. They pay property taxes when they are in America, if they own 
real property. They, hopefully, pay some income taxes. That means they 
would have a decent job. They certainly pay sales taxes in this 
country. These are working people in our country.
  They have served in our armed services. I am sure there are some over 
in Iraq, some in Afghanistan right now. These are perfectly legal folks 
in our country. The only difference is, they have to wait a little 
longer to get full citizenship. But they are in line doing all that 
they need to do under our law to get full citizenship.
  They go to public schools in America. Legal immigrants go to school. 
Those are public programs. So it seems to me, if you have public 
programs, such as schools and the other public programs like that, then 
certainly children's health insurance should be fully available to them 
as well.
  But, again, just as a basic reminder, the effect of the Grassley 
amendment is to deny health insurance to about three-quarters of a 
million people compared with the underlying bill. I do not think we 
want to deny coverage to the kids of the working poor who do need 
health insurance, especially during these very difficult economic 
times. So, therefore, I urge Senators not to support that amendment.
  The ACTING PRESIDENT pro tempore. The senior Senator from New Jersey 
is recognized.
  Mr. LAUTENBERG. Mr. President, I will take a minute to salute the 
leadership of the Senator from Montana on the Finance Committee. He has 
done a masterful job trying to keep things together as we get ourselves 
back to a more stable economy. I congratulate him for the work done and 
ask him to continue to exert the effort and leadership he has thus far.
  Mr. President, I come to the floor to protect the well-being of more 
than 3,000 children in New Jersey.


                            Amendment No. 74

  A particular focus as we seek to stimulate an economic revival is to 
preserve and protect the Children's Health Insurance Program which has 
helped millions of kids get to a doctor for regular checkups to keep 
them well and get them the medicines or treatment they need.
  However, instead of continuing that safety net or strengthening it, 
the Senator from Kentucky is targeting 3,000 children in my State, 
putting their coverage at risk. It is an assault on equity in our 
diverse country. Incomes vary and certainly costs of living differ and 
Federal assistance to States reflects their subsistence needs.
  This amendment will deprive children of essential health care. These 
children are from working families who are producing income--modest as 
it may be--not enough to take care of all their needs but, 
nevertheless, essential in their family circumstance.
  I wish to note that while our economy is going deeper and deeper into 
a recession, there is an attack on children's well-being by a Senator 
whose State in 2005 was the ninth largest recipient of Federal 
assistance. His State--Kentucky--receives 90 cents more for every 
dollar they pay to the Federal Government than New Jersey does. With 
the way my Republican colleagues are talking, one might think too many 
children in New Jersey are receiving health insurance.
  While this assault is taking place, it is important to plead our case 
in the Senate. Right now, the number of children in New Jersey without 
health coverage is far above the national average. In fact, more than a 
quarter of a million kids in my State do not have health insurance, and 
now the Bunning amendment would put more children in my State at risk 
of losing their health insurance.
  One of the other serious problems with this amendment is it intimates 
that costs among States are identical in each case. The Federal poverty 
level cannot be applied, for instance, equally in New Jersey and 
Kentucky. In New Jersey, we have the twin problems of very high costs 
of living and very high health insurance costs. The cost of living in 
the State of New Jersey is 30 percent higher than the national average. 
In fact, only two other States have a higher cost of living than New 
Jersey. Nearly all the families who rely on this program to get medical 
care for their children still have to pay copays, monthly premiums, and 
other out-of-pocket expenses.
  This amendment is a bomb intended to disrupt the process the entire 
country desperately wants to see accomplished--and that is protecting 
children's health.
  Given New Jersey's contribution when it comes to filling other 
States' needs, I find it particularly offensive. We know other States 
have different needs than we do, and we join in supporting these needs. 
If there is a natural disaster in a particular State, for example, the 
other 49 chip in. That is what our Republic demands.
  Time and time again, New Jersey's taxpayers are asked to shoulder the 
burden to help other areas of the country that are in need, and for 
every dollar New Jersey gives to the Federal Government, we only 
receive 61 cents back. As a matter of fact, we are last in the list of 
States. Compare that with Kentucky. For every dollar Kentucky pays to 
the Treasury, it gets back $1.51.
  Whether it is the Universal Service Fund for phone service, Essential 
Air Service in aviation or other programs, New Jersey gives far more 
than it gets back.
  The Bunning amendment is contrary to everything we are trying to 
accomplish on the floor this week. More than 3,000 children in New 
Jersey are depending upon us now to protect their health. Whether it is 
illness, disease, violence, toxic pollution, terrorism or other 
threats, it is our job to protect our children, particularly when they 
are holding out their hands in need. Children in New Jersey are 
depending on the Members of this institution to oppose the Bunning 
amendment.
  Two years ago, on a bipartisan vote, the Senate rejected a similar 
amendment that was offered by the Senator from Kentucky. It is an 
assault he continues with. I ask my colleagues to reject this amendment 
once again. Do it with a flourish, and do it with emphasis, because we 
have to stop States picking on other States in our moments of great 
need.
  Mr. President, I yield the floor and note the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.

[[Page S1030]]

  Mr. BAUCUS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.


                            Amendment No. 47

  Mr. BAUCUS. Mr. President, I wish to address one of the amendments 
that will be coming up. There is a series of votes at 3:10 this 
afternoon. That is about 25 minutes from now. The first vote scheduled 
will be on the Coburn amendment No. 47. That is the amendment that 
deals with premium assistance.
  Essentially, this amendment requires States to substitute premium 
assistance for the traditional Children's Health Insurance Program and 
Medicaid for children above the income eligibility determined by a 
State as of January 1, 2009. Basically what that says is this: If a 
State decides it wants to cover more children--let's not forget, when 
this program was enacted in 1997, the decision was that this would be a 
block grant program to give States the option, first, as to whether 
they want to participate in the program and also the option to design 
programs the way they think makes most sense in their States.
  In 1997, the debate was should this be an entitlement program, such 
as Medicaid, where children of the working poor are entitled to get 
health insurance, as people are entitled to get health care under 
Medicaid. This Congress made the decision, no, it should not be an 
entitlement program, it should be a block grant program.
  What does that mean? It means Congress, roughly every 5 years, 
reauthorizes the Children's Health Insurance Program. It provides money 
for the programs and money is allocated to the States under a formula. 
Obviously, larger population States would get more dollars than lower 
population States. But there is a match; that is, the Federal 
Government will pay a certain percentage for the program and the States 
pay another percentage. Under the formula, the Federal Government pays 
a little more than do the States.
  Nevertheless, that is what Congress decided in 1997, and this 
legislation before us basically continues that same approach. It is a 
State option. States can decide for themselves what children they want 
to include. They can determine what level of poverty applies.
  The Coburn amendment says: OK, let's say some States currently set 
their eligibility rates for low-income children, let's say, at 175 
percent of poverty. That is not unlikely. There are a lot of States 
that are in that neighborhood. In fact, my State of Montana, until this 
last year, had 175 percent of poverty. They passed a referendum raising 
that to 250 percent of poverty.
  This legislation says if a State wants to increase its eligibility 
rate, any increase that is in effect after January 1 of this year means 
that the State cannot put those children into the Children's Health 
Insurance Program but, rather, must take the money and apply it to 
premium assistance.
  What does that mean? That means that money has to go to families to 
buy private health insurance coverage for their children. They cannot 
go into the program. But that money they get has to buy private health 
insurance. The fancy term is ``premium assistance.''
  The amendment goes further. It says, in addition to that, when you 
have to buy private health insurance, with premium assistance, you have 
to wait 6 months. You cannot get it right away. You have to wait 6 
months. So there is going to be a period, 6 months, where kids will 
have no health insurance. Not only are they not covered under the 
Children's Health Insurance Program, but they cannot get health 
insurance.
  What if somebody gets sick during that 6-month period? They cannot 
get insurance in the public program. They cannot get private health 
insurance. They have to wait. Tell me what sense that makes. I cannot 
understand how that makes any sense at all. The first requirement makes 
no sense to me. It is wrong, in my view. The second adds insult to 
injury.
  For those reasons, I strongly encourage Members not to support the 
Coburn amendment. It has a very restrictive effect. It makes it very 
difficult for kids in working poor families to get health insurance. 
Let's not forget we are in difficult times. These are recession times. 
People do not have jobs. Health insurance is very expensive, extremely 
expensive in the private market. There is discrimination in the 
individual market. Insurance companies can discriminate against you. If 
you have a preexisting condition, they can say: no health insurance. If 
you have a history of medical care, they can say: Sorry, you have been 
sick too much; we are not going to cover you, and for other reasons.
  Let's say a child falls into this category; that is, the State raises 
eligibility and this child is currently in a family that is 175 percent 
of poverty, now at 250 percent of poverty. They are still the working 
poor. That is a very poor family. Let's say that person applies for 
health insurance because they lost their job. Let's say the insurance 
company applies normal preexisting rules in the market. Not only can 
that person not get health insurance in that 6-month period, they may 
not get it at all.
  I strongly urge Members not to support this amendment. The practical 
effect of this amendment is to significantly discourage health 
insurance for poor kids, kids belonging to working poor families. I 
urge the amendment be defeated.
  Mr. President, I yield the floor and suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.


                            Amendment No. 83

  Mr. BAUCUS. Mr. President, there are a lot of amendments around here 
flying fast and furious. Frankly, we have read them in the past several 
minutes. I have one amendment in my hand. We received that a few 
minutes ago. It is hard to go through it quickly. I am not complaining. 
That is sometimes the way the Senate operates.
  As a consequence, I think I overstated, after my staff read the full 
amendment, the number of kids that the Grassley amendment would cover 
compared with the underlying bill.
  As I mentioned earlier, current law covers about 6 million children. 
The bill before us would add approximately 4 million more--roughly 10 
million. I stated the amendment offered by Senator Grassley from Iowa 
would have the effect of reducing coverage by about three-quarters of a 
million people. I said about 750,000 fewer kids would be covered if the 
Grassley amendment were adopted to this bill.
  It looks as if I have overstated that figure. We checked with CBO. On 
the other hand, we don't know what the right figure is. CBO does not 
know. While I probably overstated the figure, it is probably less than 
or fewer than 750,000 kids, but we don't know how much less.
  Looking at the bill rationally, analytically, clearly the Grassley 
substitute will cover fewer kids. Why? Because the Grassley substitute 
does not allow coverage for legal immigrants who have not waited 5 
years. That clearly means there are a lot of kids in that category. 
Obviously, there are going to be fewer kids covered.
  Second, the Grassley amendment uses the formulation in the second 
vetoed bill in 2007, and that second vetoed bill is more restrictive 
than the first vetoed bill. If we look at those two different 
categories, first, legal immigrants, and, second, with the definition 
of coverage under the second bill, compare the two with the underlying 
bill and a good number of kids will not be covered.
  We do not know exactly how many, but it will be quite a few. We 
pretty much think it will not be 750,000 fewer, but it is going to be 
quite a bit fewer.
  I apologize to my good friend from Iowa for making that mistake. It 
was an honest mistake. Things happen fast around here, and that was our 
first impression looking at the amendment. After we called CBO and 
studied it further to find the exact number, we realized I was 
incorrect in the statement I gave. But again, we don't know what the 
exact number is.
  I yield the floor and suggest the absence of a quorum.

[[Page S1031]]

  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. BUNNING. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Casey). Without objection, it is so 
ordered.


                     Amendment No. 74, as Modified

  Mr. BUNNING. Mr. President, I ask unanimous consent to modify my 
amendment, No. 74.
  The PRESIDING OFFICER. Is there objection?
  The Chair hears none, and the amendment is so modified.
  The amendment, as modified, is as follows:

       Beginning on page 75, strike line 18 and all that follows 
     through page 76, line 2.

  Mr. BUNNING. Mr. President, when I have a chance during the 2 minutes 
of debate, I will explain what the modification is.
  I yield the floor.


                        Vote on Amendment No. 47

  The PRESIDING OFFICER. Under the previous order, there is 2 minutes, 
equally divided, prior to the vote on the Coburn amendment No. 47.
  Mr. BAUCUS. Mr. President, I do not see Senator Coburn. I ask 
unanimous consent that all time be yielded back on that amendment, and 
I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second? There appears to 
be a sufficient second. All time is yielded back.
  The clerk will call the roll.
  The bill clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Massachusetts (Mr. 
Kennedy) is necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 36, nays 62, as follows:

                      [Rollcall Vote No. 24 Leg.]

                                YEAS--36

     Alexander
     Barrasso
     Bennett
     Bond
     Brownback
     Bunning
     Burr
     Chambliss
     Coburn
     Cochran
     Corker
     Cornyn
     Crapo
     DeMint
     Ensign
     Enzi
     Graham
     Grassley
     Gregg
     Hatch
     Hutchison
     Inhofe
     Isakson
     Johanns
     Kyl
     Martinez
     McCain
     McConnell
     Risch
     Roberts
     Sessions
     Shelby
     Thune
     Vitter
     Voinovich
     Wicker

                                NAYS--62

     Akaka
     Baucus
     Bayh
     Begich
     Bennet
     Bingaman
     Boxer
     Brown
     Burris
     Byrd
     Cantwell
     Cardin
     Carper
     Casey
     Collins
     Conrad
     Dodd
     Dorgan
     Durbin
     Feingold
     Feinstein
     Gillibrand
     Hagan
     Harkin
     Inouye
     Johnson
     Kaufman
     Kerry
     Klobuchar
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     Lugar
     McCaskill
     Menendez
     Merkley
     Mikulski
     Murkowski
     Murray
     Nelson (FL)
     Nelson (NE)
     Pryor
     Reed
     Reid
     Rockefeller
     Sanders
     Schumer
     Shaheen
     Snowe
     Specter
     Stabenow
     Tester
     Udall (CO)
     Udall (NM)
     Warner
     Webb
     Whitehouse
     Wyden

                             NOT VOTING--1

       
     Kennedy
       
  The amendment (No. 47) was rejected.
  Mr. DURBIN. Mr. President, I move to reconsider the vote.
  Mr. NELSON of Nebraska. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  The PRESIDING OFFICER. The Senator from Montana is recognized.


                            Amendment No. 74

  Mr. BAUCUS. Mr. President, the next amendment is the Bunning 
amendment. I think under the agreement Senator Bunning is recognized to 
speak for 1 minute.
  The PRESIDING OFFICER. There is now 2 minutes of debate equally 
divided on the Bunning amendment, as modified.
  Mr. BUNNING. Mr. President, I have had to modify my amendment 
slightly because CBO says directing more money to outreach and 
enrollment creates a score. So I have taken the outreach section out.
  However, the amendment is still very simple. It removes the exception 
for New York and New Jersey to cover families above 300 percent of 
poverty and get the highest SCHIP matching rate. Instead, they would 
get the lower Medicaid matching rate covering these families like every 
other State in the Union. So you have a choice today: Require the 
people of your State to pay more taxes so New York and New Jersey can 
cover families who make $77,000 or $88,000 or treat every State the 
same.
  The PRESIDING OFFICER. The Senator from Montana is recognized.
  Mr. BAUCUS. The Bunning amendment is the fourth amendment this week 
that would put a cap on the eligibility of the Children's Health 
Insurance Program, a cap to prevent kids from entering the program. 
Yesterday, we rejected a Cornyn amendment with a cap of 200 percent of 
poverty, a Roberts amendment with a $65,000 cap, and a Murkowski 
amendment with a conditional cap of 300 percent of poverty. Now the 
Bunning amendment would set a hard cap at 300 percent of poverty. We 
should vote this down for the same reasons we voted the others down; 
that is, because it deprives kids of getting health insurance.
  Mr. BUNNING. Mr. President, I ask for the yeas and nays.
  Mr. BAUCUS. Mr. President, I move to table the Bunning amendment and 
ask for the yeas and nays on the motion to table.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to the motion.
  The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Massachusetts (Mr. 
Kennedy) is necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 54, nays 44, as follows:

                      [Rollcall Vote No. 25 Leg.]

                                YEAS--54

     Akaka
     Baucus
     Bayh
     Begich
     Bennet
     Bingaman
     Boxer
     Brown
     Burris
     Byrd
     Cantwell
     Cardin
     Casey
     Conrad
     Dodd
     Dorgan
     Durbin
     Feingold
     Feinstein
     Gillibrand
     Hagan
     Harkin
     Inouye
     Johnson
     Kaufman
     Kerry
     Klobuchar
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     McCaskill
     Menendez
     Merkley
     Mikulski
     Murray
     Nelson (FL)
     Pryor
     Reed
     Reid
     Rockefeller
     Sanders
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall (CO)
     Udall (NM)
     Warner
     Webb
     Whitehouse
     Wyden

                                NAYS--44

     Alexander
     Barrasso
     Bennett
     Bond
     Brownback
     Bunning
     Burr
     Carper
     Chambliss
     Coburn
     Cochran
     Collins
     Corker
     Cornyn
     Crapo
     DeMint
     Ensign
     Enzi
     Graham
     Grassley
     Gregg
     Hatch
     Hutchison
     Inhofe
     Isakson
     Johanns
     Kohl
     Kyl
     Lugar
     Martinez
     McCain
     McConnell
     Murkowski
     Nelson (NE)
     Risch
     Roberts
     Sessions
     Shelby
     Snowe
     Specter
     Thune
     Vitter
     Voinovich
     Wicker

                             NOT VOTING--1

       
     Kennedy
       
  The motion was agreed to.
  Mr. CARDIN. Mr. President, I move to reconsider the vote.
  Mr. BAUCUS. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.


                            Amendment No. 80

  The PRESIDING OFFICER. There is now 2 minutes equally divided on the 
Hatch amendment No. 80.
  The Senator from Utah.
  Mr. HATCH. Mr. President, this amendment would codify the 2002 HHS 
regulation which gives States the option of providing CHIP coverage to 
children before as well as after birth. Fourteen States have already 
approved plans to provide CHIP coverage to children before birth: 
Arkansas, California, Illinois, Louisiana, Maine, Minnesota, Oklahoma, 
Oregon, Rhode Island, Tennessee, Texas, Washington, and Wisconsin.
  This amendment also allows States to provide health services to the 
mother for 60 days after the birth of her child. In addition, the 
amendment also would provide health coverage to pregnant women for 
issues not relating to the pregnancy. This amendment will continue 
allowing States to promote the health of children and their mothers 
before and after birth by codifying the 2002 HHS regulation.

[[Page S1032]]

  I am happy to have a number of cosponsors on this amendment, 
including the distinguished Presiding Officer. I urge my colleagues to 
support this amendment.
  The PRESIDING OFFICER. The Senator from California.
  Mrs. BOXER. Mr. President, the Hatch amendment would codify the 
divisive Bush regulation that only covers the unborn child but not the 
mother. In other words, they separate the two. What we do in the 
underlying bill is we cover both. We cover the pregnant woman and the 
child she is carrying. There is no reason to have this amendment. Look 
at page 50 of the bill. It clearly states that prenatal care will be 
delivered to that pregnant woman. This is about adding abortion to this 
debate. It doesn't belong in this debate. It is not necessary. We have 
already voted this down twice. I trust we will vote it down now.
  I ask for the yeas and nays on the amendment.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The question is on agreeing to amendment No. 80.
  The clerk will call the roll.
  The legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Massachusetts (Mr. 
Kennedy) is necessarily absent.
  The PRESIDING OFFICER (Ms. Klobuchar). Are there any other Senators 
in the Chamber desiring to vote?
  The result was announced--yeas 39, nays 59, as follows:

                      [Rollcall Vote No. 26 Leg.]

                                YEAS--39

     Alexander
     Barrasso
     Bennett
     Bond
     Brownback
     Bunning
     Burr
     Casey
     Chambliss
     Coburn
     Cochran
     Corker
     Cornyn
     Crapo
     DeMint
     Ensign
     Enzi
     Graham
     Grassley
     Gregg
     Hatch
     Hutchison
     Inhofe
     Isakson
     Johanns
     Kyl
     Lugar
     Martinez
     McCain
     McConnell
     Nelson (NE)
     Risch
     Roberts
     Sessions
     Shelby
     Thune
     Vitter
     Voinovich
     Wicker

                                NAYS--59

     Akaka
     Baucus
     Bayh
     Begich
     Bennet
     Bingaman
     Boxer
     Brown
     Burris
     Byrd
     Cantwell
     Cardin
     Carper
     Collins
     Conrad
     Dodd
     Dorgan
     Durbin
     Feingold
     Feinstein
     Gillibrand
     Hagan
     Harkin
     Inouye
     Johnson
     Kaufman
     Kerry
     Klobuchar
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     McCaskill
     Menendez
     Merkley
     Mikulski
     Murkowski
     Murray
     Nelson (FL)
     Pryor
     Reed
     Reid
     Rockefeller
     Sanders
     Schumer
     Shaheen
     Snowe
     Specter
     Stabenow
     Tester
     Udall (CO)
     Udall (NM)
     Warner
     Webb
     Whitehouse
     Wyden

                             NOT VOTING--1

       
     Kennedy
       
  The amendment (No. 80) was rejected.
  Mrs. BOXER. Madam President, I move to reconsider the vote.
  Mr. BAUCUS. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mr. SPECTER. Madam President, I voted against the Hatch amendment for 
the following reasons.
  This amendment sought to codify in law a legal concept of unborn 
children, therefore establishing the fetus as protected separately from 
the mother. The need to provide health care coverage for expectant 
mothers is clear and the State Children's Health Insurance Program 
reauthorization being considered allows States to provide coverage to 
pregnant mothers.
  While I support the policy of providing health coverage to pregnant 
mothers in the pending legislation, this amendment is an effort to 
advance a political cause rather than provide a medical necessity.
  This amendment has no practical effect in terms of health care 
coverage for pregnant women.
  The PRESIDING OFFICER. The Senator from Montana is recognized.
  Mr. BAUCUS. Madam President, I am aware of only a couple more 
amendments that require rollcall votes before we go to final passage. I 
expect we may have a DeMint amendment on tax deductions. I expect that 
amendment may require a rollcall vote. Second, shortly we will hear 
from Senator Coburn on his substitute amendment No. 86, and I expect 
this amendment may also require a rollcall vote. In addition, I hope we 
can address two amendments by the ranking Republican member, Senator 
Grassley, and I have some hope that we will be able to address those 
amendments with voice votes. I am hoping the remaining amendments may 
only require voice votes. So Senators should be aware that we are 
getting close to finishing this bill. I am hoping we might be able to 
vote again in an hour or 90 minutes, but we are closing in.
  The PRESIDING OFFICER. The Senator from South Carolina is recognized.


                            Amendment No. 85

  Mr. DeMINT. Madam President, I ask unanimous consent to set aside the 
pending amendment and call up DeMint amendment No. 85.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The clerk will report.
  The legislative clerk read as follows:

       The Senator from South Carolina [Mr. DeMint] proposes an 
     amendment numbered 85.

  Mr. DeMINT. Madam President, I ask unanimous consent that the reading 
of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

(Purpose: To provide an above-the-line Federal income tax deduction for 
 health care costs of certain children in an amount comparable to the 
average federal share of the benefit provided to any non-citizen child 
           for medical assistance or child health assistance)

       At the appropriate place, insert the following:

     SEC. --. INCOME TAX DEDUCTION FOR HEALTH CARE COSTS OF 
                   CERTAIN CHILDREN.

       (a) In General.--Part VII of subchapter A of chapter 1 of 
     subtitle A of the Internal Revenue Code of 1986 is amended--
       (1) by redesignating section 224 as section 225, and
       (2) by inserting after section 223 the following new 
     section:

     ``SEC. 224. DEDUCTION FOR HEALTH CARE COSTS OF CERTAIN 
                   CHILDREN.

       ``(a) Deduction Allowed.--In the case of an individual who 
     is an eligible taxpayer, there shall be allowed as a 
     deduction for the taxable year an amount equal to so much of 
     the qualified child health care costs of the taxpayer for the 
     taxable year as does not exceed the amount that is--
       ``(1) $1,500, multiplied by
       ``(2) the number of qualifying children of the taxpayer.
       ``(b) Definitions.--For purposes of this section--
       ``(1) Eligible taxpayer.--The term `eligible taxpayer' 
     means a taxpayer whose taxable income for the taxable year 
     does not exceed the exemption amount applicable to such 
     taxpayer under section 55(d) for such taxable year.
       ``(2) Qualified child health care costs.--The term 
     `qualified child health care costs' means the aggregate 
     amount paid by the taxpayer for medical care (as defined in 
     section 213(d)) for all qualifying children of the taxpayer.
       ``(3) Qualifying child.--The term `qualifying child' has 
     the meaning given such term by section 24(c).
       ``(c) Identification Requirement.--No deduction shall be 
     allowed under this section to a taxpayer with respect to any 
     qualifying child unless the taxpayer includes the name and 
     taxpayer identification number of such qualifying child on 
     the return of tax for the taxable year.
       ``(d) Denial of Double Benefit.--The amount of the 
     deduction otherwise allowed under this section with respect 
     to any qualifying child for any taxable year shall be reduced 
     by the amount of any deduction allowed under section 213 with 
     respect to such child for such taxable year.
       ``(e) Coordination With SCHIP and Other Health Benefits.--
     No deduction shall be allowed under this section to a 
     taxpayer with respect to any qualifying child if such child 
     is eligible for any benefit under any health assistance 
     program funded in whole or in part with Federal funds.''.
       (b) Above-the-Line Deduction.--Subsection (a) of section 62 
     of the Internal Revenue Code of 1986 is amended by adding at 
     the end the following new paragraph:
       ``(22) Deduction for health care costs of certain 
     children.--The deduction allowed by section 224.''.
       (c) Clerical Amendments.--The table of sections for part 
     VII of subchapter A of chapter 1 of subtitle A of the 
     Internal Revenue Code of 1986 is amended--
       (1) by striking the item relating to section 224, and
       (2) by adding at the end the following new items:

``Sec. 224. Deduction for health care costs of certain children.
``Sec. 225. Cross reference.''.

       (d) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2008.

  Mr. DeMINT. Madam President, in deference to my colleague from 
Oklahoma, I won't speak on the amendment at this point, but I will 
briefly state its purpose.

[[Page S1033]]

  The purpose of this amendment is to help American taxpayers pay for 
their children's health care to the same degree we are forcing them to 
help pay for the health care of noncitizen children in this underlying 
bill. Specifically, it would provide all eligible American families 
with an above-the-line Federal income tax deduction for each child 
comparable to the average Federal share of the benefit provided to any 
noncitizen child under the SCHIP legislation.
  I will speak more about the bill following Senator Coburn's 
introduction of his amendment, but for now I yield the floor.
  The PRESIDING OFFICER. The Senator from Oklahoma is recognized.


                            Amendment No. 86

  (Purpose: To ensure that American children have high-quality health 
               coverage that fits their individual needs)

  Mr. COBURN. Madam President, I ask unanimous consent to set aside the 
pending amendment and call up amendment No. 86.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The clerk will report.
  The legislative clerk read as follows:

       The Senator from Oklahoma [Mr. Coburn], for himself, Mr. 
     Burr, and Mr. Gregg, proposes an amendment numbered 86.

  Mr. COBURN. I ask unanimous consent that the reading of the amendment 
be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The amendment is printed in today's Record under ``Text of 
Amendments.'')
  Mr. COBURN. Madam President, the bill we are considering is designed 
to help low-income kids have coverage and have care. What do we know 
about the kids who are in those programs and the care they have? Here 
is one of the things we know: They don't have access to 60 percent of 
the doctors in this country because the reimbursement rates are so low 
they won't be seen. That is the first thing. No. 2 is they don't have 
access to the best drugs because a lot of Medicaid programs and SCHIP 
won't pay for the best drugs for those children.
  I got to thinking about this bill and what it does and what it is 
intended to do. What is in agreement in the Senate is that we want all 
of the kids covered. We want every child in this country to be able to 
have access to quality care with no limitation of their choice of who 
their doctor is going to be--the one the child and the parent feel the 
most comfortable with--because we know if that is the case, they are 
going to be most compliant. So we want them to have the greatest care, 
and we want every one of them to be able to have access to care.
  This bill brings up Government payments under SCHIP to 300 percent of 
the poverty level--60,000 bucks, essentially. Anybody making, 
essentially, over that wouldn't be benefited by this bill but everybody 
under it. It adds $70 billion worth of taxes to the American people to 
be able to do that. As it does it, it takes 2 million kids who are 
presently covered by insurance off insurance and gets 2 million out of 
the 8.9 million or 9.8 million kids who aren't covered today with 
anything. So we are going to spend $70 billion to get 4 million kids, a 
little less than 4 million kids covered, of which we are going to 
absorb the costs that are already being paid by businesses for those 
kids right now.
  By the way, I ask unanimous consent to add Senators McConnell, Enzi, 
Cornyn, DeMint, Johanns, Kyl, Alexander, Graham, Burr, Chambliss, 
Thune, and Barrasso as cosponsors of the amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. COBURN. So maybe it is instructive for us to look at what we are 
doing right now and say: What could we do with that money? Right now, 
we have 31 million kids in America who don't have private coverage. In 
other words, we have 31 million out of the 78 million kids who don't 
get to choose where they want to go, don't get to have the best drugs, 
don't get the referral to the best centers, don't get the referral to 
the best doctors because they are on a Government-run program. So 8.9 
million kids aren't even covered by any program right now, and not all 
of those 8.9 million kids are in families who are at 300 percent of the 
poverty level or less. This is based on 2005 numbers, and we know it is 
greater now, but these numbers for the number of children are accurate 
right now. We are spending $67 billion to do that.
  What does that mean? That means we are spending $2,160 each to cover 
22 million kids. Well, if you divided the 31 million kids who are out 
there into this number, you would get $2,160 available for every child 
at 300 percent of the poverty level who is not covered right now by 
their parents, and that includes Medicaid and SCHIP. So you have $2,160 
to work with.
  Now, the average price in the individual market in this country is 
less than $1,200 a year. Some will say: Well, that coverage is not as 
good. Well, let's make it $1,700, which is $300 more than what our kids 
cost. Let's make it $1,700, or let's make it $1,800, or let's make it 
$2,160. What could we buy for $2,160 for every kid at 300 percent of 
the poverty level or less who is not on the program? What we could buy 
for all of them is a top-grade policy outside of Government-run 
programs that would give insurance to 100 percent of the children who 
don't have insurance and give them 100 percent access to every quality 
doctor in this country on a competitive basis and give them access to 
the drugs the Members of Congress' kids have access to and the same 
doctors to whom the Members of Congress have access.
  The important point is, we have a government-run program and the 
administrative costs and the inefficiencies of it cost more than 
private insurance, than if we would just go out and buy every one of 
these guys an FEHPB--Federal Employees Health Benefits Plan--a top-
drawer plan. Why would we run it through the Government? Why would we 
take away choice? Why would we take away access by running it through a 
government-run program and one that is highly inefficient?
  There is another thing we should know. The rate of fraud in private 
insurance products is about 3 percent. The rate of fraud in Medicaid is 
10.4 percent, and in SCHIP it is 14 percent. So because the Government 
is running the program and we can't run it well and we don't run it 
well, we are losing about 11 percent or 11 cents out of every dollar 
that we are trying to get to kids because we can't run efficient or 
effective programs.
  So wouldn't it be smarter, rather than to have all of this 
gobbledygook government, to make sure that every kid in this country 
whose parents don't make $60,000, who isn't covered with insurance 
today, has access to a top-drawer health insurance policy that gives 
them 100 percent access, gives them 100 percent quality, and gives them 
100 percent access to the drugs and the physicians they want? Who is 
going to argue with that?
  As a matter of fact, several of my colleagues are cosponsors of the 
Healthy Americans Act, and that is exactly what it does. It is going to 
be very interesting to see if they are cosponsors of this bill but yet 
don't vote for this for kids. And that is a bipartisan bill. So if it 
is good enough for all of America and if it is good enough for the 
Members of Congress and their kids and if it is good enough for Federal 
employees, why can't we give that to the children of this country who 
don't have health insurance? Why can't we do that? We can't do it 
because it doesn't fit into the partisan rancor of Washington.
  This is a commonsense proposal that doesn't cost a penny more than 
what we spent in 2005. And we cover all of the kids, not just 4 million 
more; we cover 8.9 million more with the same amount of money. All the 
children have access.
  It is not a child's fault if their parents can't afford or don't have 
a job that gives them access to 100 percent of physicians or access to 
the best medicines or access to equal care. It is not the child's 
fault. So if we are going to spend this much of the American taxpayers' 
money, why don't we get value for it? Why don't we decide we want value 
for this money?
  So if you take all the kids out there--31 million--on what we spent 
in 2005, you can spend $2,160 on every one of them--every one of them--
and get them a top-drawer health insurance policy. Top drawer. Top of 
the line. That is almost double what the charge is for an individual 
policy now. So we could spend almost twice as much to get that same 
coverage. Why would we

[[Page S1034]]

not do that? What is going to keep us from helping all the kids?
  I will tell my colleagues the other aspect of it. We are also not 
going to raise taxes $71 billion if we do this plan. Let me say that 
again. President Obama said your taxes won't be raised. This bill 
raises $71 billion--granted, from tobacco products, which I don't have 
any objection to--but let's save the $71 billion on tobacco products 
for something else when we can efficiently buy our kids health care and 
buy them a health insurance policy.
  Another key point: As somebody who has cared for Medicaid kids and 
Medicaid moms, when you have the ``Medicaid'' stamp on your forehead, 
it is not equivalent care. When we give all these children access to a 
private insurance policy of their own, it is no longer a Medicaid 
program, it is their insurance policy. Providers will never know how 
they got that policy. They will never know if it was an employment-
based policy, an individually bought policy, or a policy that comes 
through SCHIP and Medicaid.
  What we do is we take the demeaning qualities and characteristics of 
having to be dependent through a government program, and we throw that 
out. So the bias goes out, the discrimination goes out, and the self-
esteem goes up.
  What will happen if this passes? The first thing that will happen is 
we will save $70 billion. The second thing that will happen is not 4 
million kids--actually, it is a net 2 million kids will get coverage--
8.9 million kids will get coverage, and we will do it with the same 
amount of money we spent in 2005. Every child will be covered. There 
will be a real choice of who is going to be your provider. Right now 
you get hustled into whoever will take care of you in these programs. 
Some are great and some are not. Confidence will be restored. There 
will be increased quality of outcome and increased access to 
specialists who now today cannot afford to see a Medicaid or SCHIP 
patient because their overhead is so great.
  Finally, $70 billion--I know we are talking about $1 trillion in the 
stimulus package--doesn't seem like much, but $70 billion is a lot of 
money. If you look at it, it is about $2,000 per man, woman, and child 
over the next 5 years that we will save in this country.
  If the goal of SCHIP and all the speeches we have heard all week long 
is to care for kids, to make sure kids have access, to make sure they 
have care, if that is the goal, then anybody who is not going to vote 
for this amendment is not secure in saying they want to cover all the 
kids. This one will.
  This substitute allows the Secretary to develop autoenrollment. There 
is $100 million in this amendment so we can have outreach, trying to 
get kids coverage. This takes away the negative consequences of 
applying for Medicaid or applying for SCHIP when your parents cannot 
afford to get you coverage.
  The other thing it does is there is a compensation in terms of making 
sure we help people who have insurance keep their insurance by 
compensating to keep them on their employer's insurance, which costs a 
whole lot less. It costs maybe $200 or $300 a year. But the most 
important thing it does is it provides liberty and freedom and equal 
access for every child in this country.
  They are going to say this will not work. But notice there is not 
going to be a point of order filed against this amendment because this 
amendment does not cost any money. It saves money. It does not cost a 
penny. It will not cost us and will cover so many more children.
  My question to my colleagues, as we wrap up the SCHIP bill, is: Do 
you want to do it right? Do you want to do it better? Do you want to 
cover all the kids. Or do you want to play the games of Washington and 
political gamesmanship and partisanship and say: Yes, I care about the 
kids, but I couldn't do the right thing, the easy thing, the 
commonsense thing, the things that are associated with order, priority, 
and common sense that says: Gosh, we can buy and get better coverage 
for less money; why wouldn't we do that?
  We are going to hear all the reasons. We may not hear any because 
most of the amendments I offered nobody will debate them. They know 
they have the votes to defeat them so they will not debate. They will 
not come out and say why this would not be a good idea.
  The American taxpayers ought to think: Here is a great opportunity 
for us to save a ton of money and do something very good socially: 
cover innocent children with quality health care that they do not have 
access to today, with no increase in cost--with no increase in cost. 
Yet we are going to see a vote where they are going to say no. Then we 
are going to know if you care about kids and whether you care about 
access for kids.
  I will end my debate at this time and yield to my colleague from 
North Carolina, Senator Burr.
  I ask unanimous consent to add Senator Vitter as a cosponsor.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from North Carolina is recognized.
  Mr. BURR. Madam President, we are at a point where the rubber meets 
the road. We are challenged daily in this institution and across the 
country by the American people to find solutions to real problems. In 
1997, we found a problem. It was called uninsured children. In the 
House Energy and Commerce Committee, I was one of those who crafted the 
original SCHIP program. It was the right way to go at that time.
  Health care has changed a lot since 1997. We have continued to 
reauthorize SCHIP. We have talked about expansions. As a matter of 
fact, we debated, over the last couple days, why an expansion of 
eligibility actually hurts low-income children, the ones below 300 
percent of poverty. Why does a State want to increase the eligibility 
income of beneficiaries under SCHIP? It is because there are some kids 
who are hard to get to. They are hard to find to give them health care. 
Rather than leave anything on the table, states would like for us to 
make it easier by expanding the pool of eligibility so we can take 
higher income kids and put them in the program.
  In 2008, there were 7.4 million kids enrolled in SCHIP. It is a 4-
percent increase from 2007, but it is a little bit misleading because 
within that 7.4 million, the monthly average was 5.5 million kids 
enrolled in SCHIP. What that implies is there are 1.9 million kids who 
sort of rotate in and rotate out of SCHIP because they possibly migrate 
from one State to another. So they are not permanent enrollees.
  Throughout these days, we have heard Members say our objective is 
that we want to cover as many kids as possible. Now we have Members 
standing and saying, as many kids as possible is not what the goal 
should be of the Senate. The goal should be every child under 300 
percent should be covered.
  Dr. Coburn did a very good job of spelling out for us that we have 
quite a large pool of individuals. We have 49 million kids under 300 
percent of the poverty level. Of the 78 million kids in America, 22.1 
million are currently under Federal programs--Medicaid and SCHIP; 8.9 
million kids are uninsured.
  We have a proposal in front of this body. That Baucus proposal is to 
raise taxes of $70 billion-plus and to cover 5.7 million of the 8.9 
million uninsured. Actually, that is not the case because of the 5.7 
million, 2 million are currently covered by their parents' insurance. 
We are actually going to increase the rolls by 3.7 million children for 
$70 billion-plus. We still leave quite a few kids out there without 
insurance, without coverage. Even though their families have too much 
money for Medicaid, and they are not enrolled in SCHIP.
  This is the time to reform this program. This is the time to say 
let's design a program that catches 100 percent of the kids at 300 
percent of poverty and below. This is the time to totally rethink how 
we deliver this care.
  As a matter of fact, the proposal that Dr. Coburn has made not only 
can be funded without the $70 billion tax increase and cover 100 
percent of the kids, but it actually saves the American taxpayers $144 
billion over 5 years. There is the part you did not hear from Dr. 
Coburn. We actually save $144 billion over 5 years.
  You see, the current Baucus proposal on the table is going to 
increase enrollment of uninsured children under 300 percent of poverty, 
and it is going to cost $74 billion. If you add that to the number of 
uninsured who remain in the pot, which is 2.9 million, under the way 
they have approached this bill, it

[[Page S1035]]

would cost roughly $70 billion more to cover that pool of 2.9 million. 
So, in fact, for my colleagues, if you want to know what we have done 
in this amendment, as Dr. Coburn said, we have come up with a health 
care proposal that covers 100 percent of the uninsured children under 
300 percent of the poverty level, and in doing it, we have saved the 
American taxpayers $144 billion over the next 5 years if--if--the goal 
is to cover 100 percent of the uninsured children under 300 percent of 
poverty. We only save $144 billion if that is the intent to cover all.

  If the intent is to cover all, why in the world would you spend $144 
billion more dollars if you can do it with today's dollars?
  Congress--the Senate and the House--has been deficient since the 
beginning of this program because we do not cover all the kids. Yet I 
remember that was the objective the day we wrote the bill. Let's get on 
a path to cover all.
  We are also deficient in the fact that the way SCHIP is structured, 
we rely on the 60 percent of all health care providers who actually see 
this population. Forty percent of the health care professionals in this 
country restrict access to Medicaid beneficiaries or SCHIP 
beneficiaries. We have now limited the pool of professionals to 40 
percent.
  With the changes in this amendment, we now open the pool to 100 
percent. We increase the choice of a child with Medicaid and SCHIP, and 
we have now put them in a product where 100 percent of the health care 
professionals, in fact, will invite them in and be their medical home 
or their primary doctor, their pediatrician. Without this amendment, we 
will continue to serve less than 100 percent of the 300 percent of 
poverty and below, and we also limit the number of health care 
professionals who are going to see these children, that generation whom 
we feel incredibly committed to make sure are successful, not just in 
life but in health.
  This does not need to go on, but I do wish to make this point to my 
colleagues. This is not another amendment. I know we have had votes on 
amendments for the last 2 days, and we routinely come down here and it 
is pretty much a party-line vote, although I learned earlier in this 
debate that when one Republican votes for it out of committee, it is 
now bipartisan. I am not sure that is the definition President Obama 
had of ``bipartisanship'' when he gave a wonderful inauguration speech 
on these Capitol stairs. Given that one Republican did vote for the 
bill, it is now bipartisan.
  This amendment is about the next generation. It is about the most at-
risk children in this country. It is about a real option and a real 
choice, where that population has full coverage, sees any doctor, 
enters any medical delivery point in the system, and saves $144 billion 
over what we would have to spend under the current method. It does not 
eliminate SCHIP. As a matter of fact, we reauthorize SCHIP for 2 
additional years while the Secretary is able to put together the 
architecture for this product to be in the marketplace.
  This is a real opportunity for this body to change the direction and, 
more importantly, to fulfill the promise that is made over and over on 
this Senate floor, that what we are doing is to make sure every child 
in America has health care coverage. If we adopt this amendment, if we 
vote yes for Tom Coburn's amendment, we will have completed that 
promise we made to America's children.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa is recognized.
  Mr. GRASSLEY. Madam President, I rise for three or four purposes that 
I will do in succession.
  No. 1, I would like to define bipartisanship for the Senator from 
North Carolina. No. 2, I want to give a statement in support of the 
Coburn amendment. No. 3, I would like to bring to final debate my 
amendment 83, if the majority manager would like to vote on it at that 
time--and that would be a voice vote--and then I would have my last 
amendment to introduce, which is amendment No. 71 that I would speak 
about.
  First of all, I think I know something about establishing 
bipartisanship in the Senate. I was part of a bipartisan proposal 2 
years ago that maybe Senator Burr didn't like, but it was very 
bipartisan. It is kind of an institutional thing, bipartisanship, as 
far as I practice it in the Senate and as Senator Baucus has practiced 
it, up until this particular amendment. What you do to get to be 
bipartisan, you sit across the table from each other, Republican and 
Democrat--and maybe more than one Republican, maybe more than one 
Democrat--with expert staff, and you build up a piece of legislation 
that is eventually put before the committee as a Baucus-Grassley bill 
or as a Grassley-Baucus bill, depending on who is in the majority. Then 
what you do is you make up your mind that you are going to be arm in 
arm defending that through the committee process, through the Senate, 
through conference, and all the way to the President. And you try to 
maintain 65 to 70 votes within the Senate. That is the way I define 
bipartisanship.
  It is a little bit like if you and your wife were going to buy a new 
car for that old jeep that you drive around. If you said it is going to 
be a family affair, you would be sitting down with your wife and 
asking: What kind of a car do you want? What color do you want? What 
accessories do you want? You wouldn't go up to your wife, I hope, and 
say: Honey, we are going to buy a new car. This is what we are going to 
buy and it is a mutual decision. You wouldn't do that. You would work 
with your wife to decide what kind of car you want.
  So if you want bipartisanship in the Congress of the United States--
and I am sure that is what our President was talking about during his 
campaign--you have to work together to get it. But it is not like this 
issue was handled--or maybe I can speak more accurately about the 
stimulus issue that will be up next week--where 48 hours or 24 hours 
before it comes up, Republicans are given a document and are notified 
that this is what we are going to do.
  So I say to the Senator from North Carolina, that is my definition on 
what bipartisanship is. I don't know whether you agree with it, but at 
least that is what I have tried to practice, and I think Senator Baucus 
has basically tried to practice that as well.
  Mr. BURR. If the Senator will yield, that is the definition I 
understand exactly. But that is not the process we completed on SCHIP 
or the stimulus package. My hope is the President will win at the end 
of the day.
  Mr. GRASSLEY. Madam President, one of the reasons I said I came to 
the floor was to speak about the Coburn amendment and to say why I am 
going to vote for it. This amendment, which has been the product of 
Senator Coburn's and Senator Burr's speeches a few minutes ago, 
presents a fundamental choice about how we will go forward with health 
care reform in this country. Now, I wish to emphasize ``how we will go 
forward with health care reform,'' which is maybe the next health care 
issue that is going to be before our Senate.
  The underlying bill covers 4 million kids. It leaves 2 million kids 
without coverage. Why? Well, as CBO has told us so often, if you ask 
State government to go out and cover kids, as we do in Medicaid and the 
Children's Health Insurance Program, States need more and more Federal 
dollars to do so. So let's face it, that is exactly how this bill 
works. We throw billions of dollars at the States, and the States go 
out and find kids and pay for their health care. The more money we 
throw at the States, the more kids they cover. The less money we throw 
at States, the fewer kids they cover.
  The Coburn amendment takes a totally different approach. This 
amendment generally follows the successful way that the Medicare Part D 
benefit works. By the way, let me say parenthetically about Medicare 
Part D, which has been law now for 4 or 5 years, it is about the only 
Federal program I know about that has come in under budget. I am not 
talking about just for 1 year, I am talking about the projections CBO 
made for it at that time for the 10 years into the future. I don't have 
an exact figure in mind now, but maybe 6 months ago I used a figure 
that was in the billions of dollars that it was under what we 
anticipated spending.
  So we are talking about a Coburn amendment that follows the pattern 
of Part D Medicare, which works, and it

[[Page S1036]]

is financially a protection for the taxpayers' dollars. If the Federal 
and State governments work together to create a healthier market, the 
private sector will be more efficient in covering kids. That is the 
Part D model. That is the model we have before us in the Coburn 
amendment. It is the private sector, on the one hand, in that 
philosophy, versus the public sector on the other hand.
  I wish my colleagues had more time to fully develop this with the 
Congressional Budget Office because the contrast this amendment paints 
is one we are going to be facing in the health care reform. So I wish 
to emphasize that the next health care debate we have is going to be 
health care reform and we ought to have that debate and we ought to 
bring about the reform that is necessary.
  So let's think of that as laying the groundwork for a lot of debate 
that we are going to have in the upcoming issue of health care reform. 
Basic questions: Do we want a government-run solution? Is growing our 
Government bureaucracy in the area of health care the pathway to 
covering all Americans? Or do we want governments to help the market 
work better; or possibilities of Government and private partnerships? 
Do we want to harness the ingenuity that is out there in the private 
sector in covering all Americans?
  Now, I don't answer those questions, but those are questions 
everybody in this body, and I hope grassroots America, will look at in 
the coming months. With this vote, I am giving you a partial answer to 
my approach to these questions.
  I would like to go on to, hopefully, what will lead us to a vote on 
amendment No. 83, I believe is the number of the amendment, but before 
I do that, I would like to speak about an issue that came up when I was 
off the floor earlier this afternoon. The chairman of the Senate 
Finance Committee, my friend, Senator Baucus, characterized the 
Grassley-Hatch amendment I offered earlier as not covering 750,000 
individuals as compared to the underlying bill. This is about my 
amendment 83.
  Now, I understand Senator Baucus later came to the floor to 
acknowledge that his characterization of the Grassley-Hatch amendment 
was incorrect and he apologized, and I thank him for that. However, the 
chairman is still inaccurate, from my point of view, in some 
characterizations of the Grassley-Hatch amendment, and that is what I 
wish to go into.
  The chairman stated my amendment would cover fewer individuals 
because it does not include the legal immigrant provision. I would like 
to draw all my colleagues' attention, but particularly Senator Baucus' 
attention, to footnote ``f'' on the enrollment table of the 
Congressional Budget Office production on the underlying bill. Footnote 
``f'' states:

       The Medicaid and SCHIP figures and the Medicaid SCHIP total 
     may include some legal immigrant children and pregnant women 
     who receive health insurance provided through State-funded 
     programs.

  In other words, the so-called new enrollments of legal immigrants are 
actually individuals who are currently insured with State or local 
funds. In terms of additional enrollment figures, the chairman notes 
correctly that we don't have a CBO table. He is correct that we don't 
know the actual enrollment numbers resulting from the Grassley-Hatch 
amendment.
  I would reiterate what I said earlier. The amendment we are going to 
be voting on is the same bill that 55 Members of this body--and they 
are presently Members of this body--voted on and successfully passed by 
a wide margin in 2007. So I have to ask the question, before we vote on 
my amendment: If it was good enough then, why isn't it good enough now?

  If the majority doesn't want to vote on this now, I will go on to 
offer my other amendment. Do I ask for the question, Madam President, 
on amendment No. 83?
  The PRESIDING OFFICER. The amendment is not the pending amendment.
  The Senator from Montana.
  Mr. BAUCUS. Madam President, there is no reason we can't make it the 
pending amendment. But I would like to say, first, very briefly, that I 
deeply appreciate the remarks by my good friend. I know all of us are 
trying to get the right numbers, the accurate numbers. It is a search 
for the truth, and CBO has not given us the right number, so it is hard 
to know exactly what the effect will be.
  It seemed to me, somewhat logically, that the inclusion of legal 
immigrants would mean probably more people covered, even though some 
may be covered some other ways. We don't know the number, but that is 
sort of the effect. Therefore, I say to my colleagues, I think it is 
better to include more people, more kids, in the Children's Health 
Insurance Program and not fewer.
  With respect to the vote on the last bill, where 55 Members of the 
Senate supported it, and the Senator's question: If not then, why not 
now, the answer is because now the underlying bill is a little better. 
It covers more kids. It is better to cover a few more kids than not to 
cover a few more kids. So that is why it is not right now where it 
might have been right then.
  Madam President, I ask unanimous consent that we proceed to the 
Grassley amendment. Notwithstanding the other amendments, I ask that we 
proceed to the Grassley amendment at this point.


                        Vote on Amendment No. 83

  The PRESIDING OFFICER. Without objection, it is so ordered. The 
amendment is now pending.
  Is there further debate on the amendment? If not, the question is on 
agreeing to the amendment.
  The amendment (No. 83) was rejected.


                            Amendment No. 71

  Mr. GRASSLEY. Madam President, I would, first of all, like to give my 
rationale for an amendment I am going to present to the Senate before I 
actually present it. It will be amendment No. 71, though.
  Congress has known for some time that the Children's Health Insurance 
Program faces expiration March 31 of this year. We all knew Congress 
would have to act quickly once the new session got underway. The 
majority had three different options they could have taken in moving 
forward. First, they could have simply picked up one of the two vetoed 
bills and quickly passed it. It would have received bipartisan support. 
I would have preferred the second bill over the first, but I could have 
probably found a way to support the first bill. Either of those bills 
would have moved quickly and would have had significant bipartisan 
support.
  The second option the majority could have taken was to do a short-
term extension of the Children's Health Insurance Program while we 
worked on broader health care reform. That is what this amendment does. 
It is a six-quarter extension of SCHIP through the end of the next 
fiscal year.
  Now, I do understand there is a point of order against this 
amendment. This amendment actually should have been done on the 
stimulus bill, where everything and the kitchen sink appears to be 
going, but that is a debate for next week. It would have been a drop in 
the bucket on that bill.
  If the underlying bill is enacted, it will provide coverage to many 
people who were previously uninsured--approximately 4 million 
children--by the year 2013. While I don't want to denigrate the 
accomplishments of this bill, everyone in this Chamber knows we need to 
roll up our sleeves and get to work on covering the other 42 million 
uninsured Americans who will not benefit from this bill--millions of 
whom are children this bill does not provide coverage for.
  I wish to focus on that task. I want us to work in a bipartisan 
manner to get coverage for all Americans, and everything in that 
process so far has been bipartisan, but it is something we are going to 
have to deal with on SCHIP again. So I am willing and ready to do the 
hard work it is going to take. We could have set aside SCHIP while we 
focused on that most important task of full-fledged health care reform. 
Instead, the majority has chosen a third option: to bring up a bill 
that walks away from the bipartisanship of 2007 and threatens 
relationships moving forward with broad health care reform. I want to 
emphasize ``threatens'' because so far everything has been bipartisan 
in meetings and discussions and everything.

  I have made no secret of my disappointment in the changes made in the 
underlying bill. It is very important that people watching the debate 
understand how totally unnecessary a

[[Page S1037]]

partisan fight is. The majority had bipartisan bills they could have 
brought up for consideration. I had an amendment earlier that would 
have replaced the underlying bill with the second of those earlier 
bills. The majority could have done a simple extension of SCHIP while 
we worked together on covering 46 million uninsured, not just the 4 
million covered by this legislation. That is what this amendment does. 
It is the last chance for cooler heads to prevail.
  It was reported recently that the Speaker of the House said, ``We won 
the election. We write the bills.'' Seeing the majority take that 
approach on the Children's Health Insurance Program, an issue that 
always had broad bipartisan support, does not give me comfort moving 
forward on health care reform.
  I ask unanimous consent to set aside the pending amendment and call 
up my amendment, No. 71. I do not know how much debate there will be on 
it, but I have nothing more to say on that amendment.
  The PRESIDING OFFICER (Mr. Whitehouse). Without objection, it is so 
ordered. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Iowa [Mr. Grassley] proposes an amendment 
     numbered 71.

  Mr. GRASSLEY. Mr. President, I ask unanimous consent that the reading 
of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

(Purpose: To extend the State Children's Health Insurance Program for 6 
   quarters in order to enact bipartisan, comprehensive health care 
                                reform)

       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``SCHIP Funding Extension Act 
     of 2009''.

     SEC. 2. FUNDING THROUGH FISCAL YEAR 2010.

       (a) Through Fiscal Year 2010.--
       (1) In general.--Section 2104 of the Social Security Act 
     (42 U.S.C. 1397dd(a)), as amended by section 201(a)(1) of the 
     Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public 
     Law 110-173) is amended--
       (A) in subsection (a)(11), by striking ``and 2009'' and 
     inserting ``through 2010''; and
       (B) in subsection (c)(4)(B), by striking ``2009'' and 
     inserting ``2010''.
       (2) Availability of extended funding.--Funds made available 
     from any allotment made from funds appropriated under 
     subsection (a)(11) or (c)(4)(B) of section 2104 of the Social 
     Security Act (42 U.S.C. 1397dd) for fiscal year 2009 or 2010 
     shall not be available for child health assistance for items 
     and services furnished after September 30, 2010.
       (b) Additional Allotments To Maintain SCHIP Programs 
     Through Fiscal Year 2010.--Section 2104 of the Social 
     Security Act (42 U.S.C. 1397dd) is amended by striking 
     subsection (l) and inserting the following new subsections:
       ``(l) Additional Allotments To Maintain SCHIP Programs for 
     Fiscal Year 2009.--
       ``(1) Appropriation; allotment authority.--For the purpose 
     of providing additional allotments described in subparagraphs 
     (A) and (B) of paragraph (3), there is appropriated, out of 
     any money in the Treasury not otherwise appropriated, such 
     sums as may be necessary, not to exceed $3,000,000,000 for 
     fiscal year 2009.
       ``(2) Shortfall states described.--For purposes of 
     paragraph (3), a shortfall State described in this paragraph 
     is a State with a State child health plan approved under this 
     title for which the Secretary estimates, on the basis of the 
     most recent data available to the Secretary, that the Federal 
     share amount of the projected expenditures under such plan 
     for such State for fiscal year 2009 will exceed the sum of--
       ``(A) the amount of the State's allotments for each of 
     fiscal years 2007 and 2008 that will not be expended by the 
     end of fiscal year 2008;
       ``(B) the amount, if any, that is to be redistributed to 
     the State during fiscal year 2009 in accordance with 
     subsection (f); and
       ``(C) the amount of the State's allotment for fiscal year 
     2009.
       ``(3) Allotments.--In addition to the allotments provided 
     under subsections (b) and (c), subject to paragraph (4), of 
     the amount available for the additional allotments under 
     paragraph (1) for fiscal year 2009, the Secretary shall 
     allot--
       ``(A) to each shortfall State described in paragraph (2) 
     not described in subparagraph (B), such amount as the 
     Secretary determines will eliminate the estimated shortfall 
     described in such paragraph for the State; and
       ``(B) to each commonwealth or territory described in 
     subsection (c)(3), an amount equal to the percentage 
     specified in subsection (c)(2) for the commonwealth or 
     territory multiplied by 1.05 percent of the sum of the 
     amounts determined for each shortfall State under 
     subparagraph (A).
       ``(4) Proration rule.--If the amounts available for 
     additional allotments under paragraph (1) are less than the 
     total of the amounts determined under subparagraphs (A) and 
     (B) of paragraph (3), the amounts computed under such 
     subparagraphs shall be reduced proportionally.
       ``(5) Retrospective adjustment.--The Secretary may adjust 
     the estimates and determinations made to carry out this 
     subsection as necessary on the basis of the amounts reported 
     by States not later than November 30, 2008, on CMS Form 64 or 
     CMS Form 21, as the case may be, and as approved by the 
     Secretary.
       ``(6) One-year availability; no redistribution of 
     unexpended additional allotments.--Notwithstanding 
     subsections (e) and (f), amounts allotted to a State pursuant 
     to this subsection for fiscal year 2009, subject to paragraph 
     (5), shall only remain available for expenditure by the State 
     through September 30, 2009. Any amounts of such allotments 
     that remain unexpended as of such date shall not be subject 
     to redistribution under subsection (f).
       ``(m) Additional Allotments To Maintain SCHIP Programs for 
     Fiscal Year 2010.--
       ``(1) Appropriation; allotment authority.--For the purpose 
     of providing additional allotments described in subparagraphs 
     (A) and (B) of paragraph (3), there is appropriated, out of 
     any money in the Treasury not otherwise appropriated, such 
     sums as may be necessary, not to exceed $4,000,000,000 for 
     fiscal year 2010.
       ``(2) Shortfall states described.--For purposes of 
     paragraph (3), a shortfall State described in this paragraph 
     is a State with a State child health plan approved under this 
     title for which the Secretary estimates, on the basis of the 
     most recent data available to the Secretary, that the Federal 
     share amount of the projected expenditures under such plan 
     for such State for fiscal year 2010 will exceed the sum of--
       ``(A) the amount of the State's allotments for each of 
     fiscal years 2008 and 2009 that will not be expended by the 
     end of fiscal year 2009;
       ``(B) the amount, if any, that is to be redistributed to 
     the State during fiscal year 2010 in accordance with 
     subsection (f); and
       ``(C) the amount of the State's allotment for fiscal year 
     2010.
       ``(3) Allotments.--In addition to the allotments provided 
     under subsections (b) and (c), subject to paragraph (4), of 
     the amount available for the additional allotments under 
     paragraph (1) for fiscal year 2010, the Secretary shall 
     allot--
       ``(A) to each shortfall State described in paragraph (2) 
     not described in subparagraph (B) such amount as the 
     Secretary determines will eliminate the estimated shortfall 
     described in such paragraph for the State; and
       ``(B) to each commonwealth or territory described in 
     subsection (c)(3), an amount equal to the percentage 
     specified in subsection (c)(2) for the commonwealth or 
     territory multiplied by 1.05 percent of the sum of the 
     amounts determined for each shortfall State under 
     subparagraph (A).
       ``(4) Proration rule.--If the amounts available for 
     additional allotments under paragraph (1) are less than the 
     total of the amounts determined under subparagraphs (A) and 
     (B) of paragraph (3), the amounts computed under such 
     subparagraphs shall be reduced proportionally.
       ``(5) Retrospective adjustment.--The Secretary may adjust 
     the estimates and determinations made to carry out this 
     subsection as necessary on the basis of the amounts reported 
     by States not later than November 30, 2010, on CMS Form 64 or 
     CMS Form 21, as the case may be, and as approved by the 
     Secretary.
       ``(6) Availability; no redistribution of unexpended 
     additional allotments.--Notwithstanding subsections (e) and 
     (f), amounts allotted to a State pursuant to this subsection 
     for fiscal year 2010, subject to paragraph (5), shall only 
     remain available for expenditure by the State through 
     September 30, 2010. Any amounts of such allotments that 
     remain unexpended as of such date shall not be subject to 
     redistribution under subsection (f).''.
       (c) Extension of Treatment of Qualifying States.--
       (1) In general.--Section 2105(g)(1)(A) of the Social 
     Security Act (42 U.S.C. 1397ee(g)(1)(A)) is amended by 
     striking ``or 2009'' and inserting ``2009, or 2010''.
       (2) Applicability.--The amendment made by paragraph (1) 
     shall be in effect through September 30, 2010.
       (3) Repeal of limitation on availability of fiscal year 
     2009 allotments.--Paragraph (2) of section 201(b) of the 
     Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public 
     Law 110-173) is repealed.

  The PRESIDING OFFICER. The Senator from Montana is recognized.
  Mr. BAUCUS. Mr. President, very simply, I do not agree with this 
amendment. Why? Because here we are. It is about 5 o'clock. We are on 
the verge of passing a 4\1/2\ year reauthorization of the Children's 
Health Insurance Program. We are on the 2-yard line. We are about ready 
to put this ball across the goal to score a touchdown, to get this 
passed. This amendment sets us back several yards, quite a few yards. 
We are on the 2-yard line for a 4\1/2\ year reauthorization. If this is 
agreed to, we are back to the 50-yard line.
  I think it is better to get this bill past the goal line and pass 
this 4\1/2\ year

[[Page S1038]]

legislation. I urge we do not adopt this amendment that sets us back.
  The PRESIDING OFFICER. The Senator from Iowa is recognized.
  Mr. GRASSLEY. Mr. President, I wish to emphasize that I do not 
disagree with what he said, he said it accurately, but here is the 
point I am trying to make. In just a few months, we are going to be 
working on health care reform and we are going to be working, within 
those few months, on how the Children's Health Insurance Program fits 
in with it. We are going to be going through this exercise once again, 
so we wasted a lot of time here for nothing.
  I yield the floor.
  Mr. BAUCUS. Mr. President, I hope not for nothing. This is pretty 
productive.
  The PRESIDING OFFICER. Is there further debate? If not, the question 
is on agreeing to the amendment.
  The amendment (No. 71) was rejected.
  Ms. KLOBUCHAR. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. DeMINT. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                            Amendment No. 85

  Mr. DeMINT. Mr. President, I would like to make some comments about 
DeMint amendment No. 85. This is an amendment that I believe is very 
important to American families, taxpayers. Here in Washington, there 
seems to always be enough money to help those who cannot take care of 
themselves. Most of the time, that is a good thing because we certainly 
want to have those safety nets for those families, particularly 
families who need health care for their children. The difficulty is 
that those families who are working and are struggling and are being 
independent often have to pay the price for that.
  I have personal family experience that drives this whole issue home. 
As we consider the expansion of the children's health bill to expand it 
to folks with higher incomes, I realize that affects my own family.
  My oldest son is married with a child, expecting another. He is back 
in graduate school, doing some part-time work, struggling to make ends 
meet and pay for his own health insurance. As they expect their second 
child, with that high-deductible policy, they are paying for most of 
their health care themselves.
  As he heard about the debate on this issue as well as some of the 
other bailout issues, he mentioned to me--he said: Dad, it is hard in 
my situation to make enough money to pay for our own health care. I 
want to be independent, but I realize the tax dollars I do pay are 
paying for the benefits of others who are often making more than I am.
  He has friends in school who are on welfare and food stamps and 
Medicaid, taking everything they can from the Government. But most 
Americans, most middle-class Americans and even those who fall below 
middle class, are struggling today to make ends meet on their own and 
not be dependent on the Government. The amendment I have introduced 
tries to achieve some level of fairness to those American taxpayers who 
are working and trying to make ends meet.
  My son could qualify for SCHIP, this children's health program. 
Certainly while he is in school he is below 200 percent of poverty. But 
right now he pays for his own health care. We even charge him taxes on 
the amount he has to spend for his own health care. Then his regular 
taxes have to go to help all his friends who are living off the 
Government dole.
  If we are going to help families with children, we ought to be fair 
about it. This bill we are considering expands the children's health 
plan. The current law in America certainly covers American citizens, 
but the Federal money is not allowed to be used for noncitizens. That 
is basically part of our immigration deal. When folks come here and 
they are sponsored, the agreement is that for 5 years they take care of 
themselves and they are not a burden on the American taxpayer.
  But the bill we are debating today changes that law. It gives 
benefits, health care, to noncitizens at the expense of middle-class 
working Americans. I do not want to take that away. That is not what 
this bill is about, my amendment. I am not changing anything this bill 
already offers.
  But what this amendment does is it gives every American family with 
children, qualifying children under the children's health plan we are 
debating, an above-the-line deduction of up to $1,500. And what it is, 
it gives American citizens the same benefit we are giving non-
Americans, noncitizens, in this underlying bill.
  We do not ask the Government to pay for their health care. We say, as 
a matter of fairness, we are not going to make them pay income taxes on 
what they have to spend on health care for their children. That is what 
this is about, a deduction for the cost of health care for children.
  We phase this out as income goes up. If a family qualifies for the 
AMT, they cannot get this deduction. So this is about middle-class 
Americans, people who are actually out there today trying to make it on 
their own without Government help, paying for their own health care. We 
are not going to charge them taxes on the cost of their health care 
with this amendment.
  Specifically, the DeMint amendment, a taxpayer fairness amendment, 
would allow American families, citizens and legal immigrant families, 
the ability to receive a tax deduction of up to $1,500 for each child 
to cover health care-related costs.
  This deduction, per child, is comparable to the average Federal share 
of the benefit provided to any child under this SCHIP bill, the 
underlying child health care bill. But no family who is already 
claiming SCHIP or Medicaid or any Federal health plan would be able to 
use this deduction.
  This deduction is for Americans with that spirit of independence who, 
regardless of how little they are making, want to pay their own way. 
And let's not penalize them for it. Let's not tax what they have to pay 
for health care and then give it free to someone else. Let's not make 
them pay taxes to help pay for someone else's health care and still 
leave them out in the cold.
  This is a matter of basic fairness. I encourage my colleagues, 
Republican and Democrat, if the whole point of this legislation is to 
help struggling families with children make sure they have health care 
for their children, let's be fair to American citizens and at least 
give them an equal benefit that we are giving to noncitizens. Let's not 
make middle-class working Americans pay for health care for noncitizens 
while we are basically taxing the struggling American worker who is 
trying to pay for it on their own.
  I think a vote on this amendment will be coming up relatively 
shortly. Again, I encourage all of my colleagues to vote for the DeMint 
taxpayer fairness amendment.
  I reserve the remainder of my time, and I suggest the absence of a 
quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. DORGAN. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DORGAN. I ask unanimous consent to speak in morning business for 
10 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                              Buy American

  Mr. DORGAN. Mr. President, this morning the Washington Post has a 
front-page story that says ``Buy American Rider Sparks Trade Debate, 
Proviso Limits Steel and Iron from Abroad.'' This is a story about a 
provision that is in both the House stimulus bill and the Senate 
stimulus bill that encourages, to the extent we are stimulating 
investment in infrastructure projects--building roads and bridges and 
dams and schools and repairing libraries and so on in order to try to 
put people back to work--that the acquisitions to come from American 
sources, where possible. If you are going to buy steel, buy iron, skid 
steer loaders, any number of different kinds of equipment, it ought to 
be coming from American factories so that we put people back on factory 
floors and back to work.
  The Washington Post has editorialized in opposition to this. The 
story

[[Page S1039]]

itself almost sounds a bit like an opinion piece. It talks about 
``opponents say it amounts to a declaration of war against free trade'' 
and ``will spark retaliation'' and so on.
  I wanted to make a comment about this, because I think it is an 
important issue and one we ought to discuss. If today is like most 
other days recently, 20,000 people will have lost their jobs; 20,000 
people will come home tonight and have to tell someone in the family 
that they lost their job. And 20,000 people every day are losing their 
jobs, 500,000 to 600,000 people a month. We don't know exactly what the 
menu is to try to put this economy back on track, but we know that 
doing nothing is not a solution. So the Congress is putting together a 
stimulus proposal, an economic recovery proposal to try to do things 
that would put people back on payrolls.
  The quickest way to restore confidence is to put people back to work 
so they are earning a salary, have a job, and can provide for their 
families. And in the context of creating legislation that would put 
people back to work, building roads and bridges and building water 
projects and repairing schools and so on, the question is, we should 
spend American taxpayer money on U.S.-made products in order to make 
these repairs and build these projects. It's just common sense.
  The Washington Post story had a number of things attached to it that 
were not accurate. I want to talk about it for a moment. This provision 
in the Senate bill says that public works projects that are funded by 
this stimulus bill should use American steel, iron, and manufactured 
goods. That is not radical. We ought not be embarrassed to suggest that 
we try to use, where we can, products that are built in this country so 
that we put people back to work on the manufacturing floors and the 
plant floors building these products. That is the purpose of this 
legislation.
  The Washington Post suggests that the proposal has few exceptions. 
That is not true. The proposal has a broad public interest exemption, 
one that allows the administration to waive the ``Buy America'' program 
if it deems it to be in the public interest to waive it. There are 
exceptions where the products are not available. There are exceptions 
where using domestic material would increase the cost of the project by 
over 25 percent. There are plenty of exemptions and exceptions here--
public interest, 25 percent, not available. But in circumstances where 
a domestic product is available, where it is available at a price that 
is within the bounds of reason, and where we want to try to find a way 
to acquire products that are made in this country in order to put 
people back to work, that is a perfectly reasonable and important thing 
to do.
  The Washington Post also suggested and had other people suggest as 
well that asking that we would purchase iron and steel and manufactured 
products in this stimulus bill made in America would somehow violate 
our trade agreements. That is simply untrue again. The Federal grant 
programs that are in this stimulus bill to the States for 
infrastructure investments, construction, repair and so on are not 
covered by our international trade agreements. So it is not true that 
what we are doing here would somehow violate trade agreements.
  I had a reporter say to me: Some economists have said this harkens 
back to 1920s protectionism. I said: Give me a break. I am so tired of 
that nonsense. It cannot possibly be a sober economist. This country 
has a $700 billion a year trade deficit. We buy $2 billion more each 
day than we sell to foreign countries. We consume 3 percent more than 
we produce. We have a giant trade deficit. How could anyone in their 
right mind suggest this country is protectionist? It is absurd. How can 
anybody decide that when we put together a stimulus package to try to 
put people back to work, that we ought not buy things, to the extent we 
can, that are manufactured and produced in this country? It makes no 
sense to me.
  The Washington Post also indicated that the foreign Governments could 
retaliate if we did this. Again, we have a $700 billion trade deficit, 
so it's hard to see how our trade imbalance could be less favorable.
  But at any rate, let me say that Mr. Sarkozy in France said last 
month, with respect to their stimulus package, they want to make sure 
they are purchasing things that are made in France. It is a perfectly 
logical thing.
  No, this is not creating a trade war. This is an emergency situation 
in which each of our countries is trying to put people back to work. 
That is a perfectly logical thing to do.
  The Washington Post story also pointed out that the previous stimulus 
package, of which a fair amount was provided in tax cuts, went to 
stimulate manufacturing in China. A fair amount of it went to Wal-Mart. 
Eighty percent of the products in the Wal-Mart store shelves are made 
in China. So we are not going to stimulate economic jobs by purchasing 
Chinese goods. I am not suggesting somebody ought to stop their car at 
the moment and not walk into Wal-Mart. That is not my point at all. My 
point is, if we want to put people back on payrolls to try to put this 
country back on track and give people some confidence at a time when 
20,000 people are losing their jobs every single day, the way to do 
that, with the hundreds of billions of dollars that are in this bill, 
is to say, at least try to buy things that are made in America. That is 
not unfair. It is not selfish. It is the right thing to do.
  It is only in areas of the rarified air of our Nation's capital and 
some other areas where we have ground our heads to such a point that we 
don't understand what is logical. I understand it is a global economy. 
I fully understand that. There are circumstances where you perhaps 
cannot buy a product that is made here because there aren't any made 
here. There are circumstances where the domestic product's price is 
truly exorbitant. We don't want to do that. I understand all of that. 
All of that is provided for in this Buy American provision. Yet you see 
folks out in the hallways here having an apoplectic seizure over what 
some economist is saying about something that is so fundamentally sound 
in terms of what we ought to be doing to try to strengthen the economy 
of this country, to reach out to American citizens and say: We 
understand a job is important for you. We understand you have lost your 
job. We understand it wasn't your fault, and we will see if we can help 
you get a job back on the plant floor, back on the factory floor 
someplace, producing products made in this country. It is a fair thing 
to do and a critically important thing to do, if the result of this 
stimulus program is going to do as advertised, and that is put 
Americans back to work.
  We have been through a long and tortured trail in recent months 
trying to determine what has happened and what needs to happen to try 
to fix what is wrong. What unites all of us is, none of us has been 
here before. We have never seen the convergence of the collapse of our 
financial system, the largest names in American finance sitting there 
with toxic assets in their financial bellies trying to figure out how 
they overcome the dreadful mistakes of the last 10 years with asset 
bubbles and a carnival of greed. At the same time that we see this 
collapse at the top of the financial system, we read about the subprime 
loan scandal and the nearly unbelievable circumstances of bad business 
that created it.

  In addition to that, we read about companies that have taken massive 
quantities of money from the American taxpayers in the form of TARP 
funds, in the form of the Federal Reserve Board. By the way, it is 
about $7.5 trillion that has now been committed in the name of the 
American taxpayer in ways that I don't think is written in the 
Constitution. But we have watched all this happen and we still see what 
is going on on Wall Street. We hear about airplanes on order. We hear 
about bonuses. We have watched that for the last 10 years and wondered, 
how on Earth can this kind of house of cards continue to exist? The 
answer is, it couldn't and it doesn't, except there is a lot for this 
Congress to do with respect to oversight, investigation, and to require 
accountability.
  One piece of business, an attempt to try to deal with the wreckage of 
this economy from this past decade of excess, one piece of business is 
to try to see if we can stimulate the economy to put people back to 
work. It is interesting how at the top everybody is interested in 
bringing a pillow and some aspirin to say: Are you comfortable? Can we 
help you? That is what happens

[[Page S1040]]

if you are a big bank. But how about at the bottom, the people who lost 
their job and their house. Anybody around to say: We want to help you?
  In a stimulus program, if we put together construction projects, 
projects to create an asset for this country's future, and if we say: 
We would like you to see if you can buy the products with which you 
will produce those assets here in America so we can put people back on 
the payroll and get them working once again, that is not radical; that 
is the right thing to do. If there is a big, old dust storm and a whole 
lot of angst about asking people if they can buy in this country during 
this stimulus, that is too bad. That is exactly what we should do.
  It is my intent, with respect to this legislation--I believe the 
intent of many others--that we continue to keep this provision in the 
stimulus bill as it moves through the Congress.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that the pending 
amendments be temporarily laid aside so that the Senator from New 
Mexico, Mr. Bingaman, can call up an amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from New Mexico is recognized.


                            Amendment No. 63

  Mr. BINGAMAN. Mr. President, I call up amendment No. 63.
  The PRESIDING OFFICER. The clerk will report.
  The bill clerk read as follows:

       The Senator from New Mexico [Mr. Bingaman] proposes an 
     amendment Numbered 63.

  Mr. BINGAMAN. Mr. President, I ask unanimous consent that the reading 
of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

(Purpose: To clarify that new paperwork and enrollment barriers are not 
 created in the Express Lane Enrollment option and that income may be 
 determined by Express Lane agencies based on State income tax records 
                              or returns)

       On page 99, beginning on line 8 strike ``through'' and all 
     that follows through ``application,'' on line 10, and insert 
     ``in writing, by telephone, orally, through electronic 
     signature, or through any other means specified by the 
     Secretary and''.
       On page 108, between lines 3 and 4, insert the following:
       ``(H) State option to rely on state income tax data or 
     return.--At the option of the State, a finding from an 
     Express Lane agency may include gross income or adjusted 
     gross income shown by State income tax records or returns.''.


                     Amendment No. 63, as Modified

  Mr. BINGAMAN. Mr. President, I send a modification of the amendment 
to the desk.
  The PRESIDING OFFICER. The amendment will be so modified.
  The amendment, as modified, is as follows:

       On page 99, beginning on line 9 after ``mation'' insert 
     ``in writing, by telephone, orally, through electronic 
     signature, or through any other means specified by the 
     Secretary or by''.

       On page 108, between lines 3 and 4, insert the following:
       ``(H) State option to rely on state income tax data or 
     return.--At the option of the State, a finding from an 
     Express Lane agency may include gross income or adjusted 
     gross income shown by State income tax records or returns.''.

  Mr. BINGAMAN. Mr. President, I wish to briefly describe the import of 
this amendment, as modified.
  Express Lane enrollment seeks to address the problem that up to 6 
million children in this country are eligible but are not enrolled in 
either Medicaid or CHIP and that the vast majority of these children 
are enrolled in other Federal programs at the same time.
  Eligibility for other Federal programs--here I am speaking about food 
stamps or the National School Lunch Program or the WIC Program--
enrollment in those programs is at lower levels of income eligibility 
than Medicaid and CHIP, so those children identified by those other 
Federal programs as low income are virtually, by definition, eligible 
for Medicaid or for CHIP.
  I have worked with Senator Baucus and my colleagues in the Finance 
Committee to write a provision in the bill which will provide a State 
option to utilize Express Lane eligibility to enroll children into the 
CHIP program.
  This amendment provides a very simple technical clarification that 
parents may consent to their children's enrollment in CHIP or Medicaid 
through various means established by the Secretary, including orally, 
through electronic signatures, and otherwise. Without this 
clarification, a child could be determined eligible through Express 
Lane, but a parent might have to go to a State Medicaid agency to sign 
a form instead of providing an electronic signature or authorizing 
coverage over the phone. This is the exact kind of needless 
bureaucratic hurdle Express Lane is intended to prevent.
  So I urge my colleagues to support this amendment, as modified.
  Mr. President, I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                            Amendment No. 85

  Mr. BAUCUS. Mr. President, I wish to address two pending amendments. 
The first one I will address is the DeMint amendment which provides for 
a deduction for health care costs for certain children.
  Essentially, the DeMint amendment allows for a deduction for health 
care costs of children who are not in a Federal program, either 
Medicaid or the Children's Health Insurance Program, up to $1,500. That 
is up to the average federally funded program, which I understand is up 
to $1,500.
  On the face of it, that might sound like something people might want 
to do, to give an extra tax deduction for children's health care 
expenses. The trouble is, we are here today trying to make sure that 
the Children's Health Insurance Program works and works better. A lot 
of effort has gone into this legislation, and there have been a lot of 
amendments from various Senators trying to improve on the bill.
  First, this is not a tax bill. The Tax Code does allow employees who 
receive health care benefits from their employer to not count that as 
taxable income. That is true. It is a big provision in the Tax Code 
today. I think it amounts to roughly $250 billion, $260 billion a year. 
The employer is able to take the deduction of employer health care 
expenses, whatever the expenses might be, and there is no limit today 
in current law. All health care that is provided by the employer is not 
taxable income to the employee. In fact, when we deal with health care 
reform, we will have to look at that. We do not want to move away from 
employer-provided coverage. That is something the American public is 
used to. They understand it. Companies are used to it. They understand 
it.
  Some have suggested abolishing that tax and basically saying 
individuals have to find their own insurance, irrespective of 
employment. I do not think that is a good idea, and I think that is the 
judgment of the Congress.
  Senator DeMint wishes to add a tax provision basically providing the 
children who are not covered by either the Children's Health Insurance 
Program or Medicaid, as I understand the amendment, with a deduction 
for health care expenses up to $1,500 every year. I do not think this 
is the time and place to be coming up with single rifleshot, arbitrary 
tax amendments on a nontax bill. These provisions have to be considered 
together. These tax provisions have to be considered together, 
certainly in the context of health care reform. We take up various ways 
to give incentives to people to get health insurance, especially in the 
private market, in the individual market right now because right now it 
is very difficult for some people in the individual market to get 
health insurance. We will probably provide health credits to assist 
people in the private market.
  We also could look to the employer exclusion and see if that can be 
modified. All this should be addressed in the context of comprehensive 
health care reform. We need comprehensive health

[[Page S1041]]

care reform in this country. We already know how much we pay for health 
care in this country. We pay twice as much per capita than the next 
expensive country. We have 46 million Americans not covered by health 
insurance. It is an abomination. We are the only industrialized country 
in the world that does not provide a mechanism to provide health 
insurance for its people. That makes no sense. The United States is 
slipping, frankly, in a lot of areas. Look at our financial banking 
system. It is crumbling. In Davos, Switzerland, we have been roundly 
criticized as a country for letting this happen to us. Of course, the 
credit markets seized up. It is very complex. The fact is, it has 
happened and we Americans have let it happen.
  We also have to reform our health care system and reform it in a way 
so Americans can get health care more easily than they can now, make 
sure they are all covered, improve the costs, and improve our delivery 
system. Our delivery system is in the dark ages. We in America 
compensate doctors and hospitals on the basis of volume, not on the 
basis of quality.
  Many of us have ideas. We have to put all this together into 
comprehensive health reform. I wrote a white paper months ago. I don't 
mean to pat myself on the back, but most people feel that is the best 
beginning to get comprehensive health care reform. Others have a lot of 
ideas to add to it, subtract from it. But it is probably a pretty good 
foundation of where we have to reform our health care system. That is 
where we should take up provisions such as the DeMint amendment. That 
is where we should decide whether it makes sense to change the Tax Code 
to get better health care, outside of the children's health care 
program.
  This is not an amendment addressed to the Children's Health Insurance 
Program. This is an amendment that has to do generally with children, 
irrespective of income of families. This amendment has nothing to do 
with income of families. It says basically if you are not covered, you 
get a $1,500 contribution. I guess in some sense the proponents of the 
amendment could argue this is for upper income people, for moderate 
income people, for families whose children are not enrolled in the 
Children's Health Insurance Program. That may be. But that issue must 
be addressed in the context of comprehensive health care reform. That 
is the best place. I do not think it makes sense to adopt this kind of 
amendment. Then somebody else will have an amendment for a tax break 
here, a tax break there, and who knows what. This should be taken up in 
comprehensive health care reform or a comprehensive tax bill.
  We are going to take up tax legislation later this year. There will 
be lots of opportunities to address health care in our Tax Code. But 
this is not the time and place. I urge Senators to resist the siren's 
song, resist temptation because this is not the road we should go down, 
not at this time. There is a time and place for everything. There is a 
time and place for health care tax amendments. This is not the time and 
place.
  Frankly, I think the more we as a Congress are strategic, we plan a 
little more, we don't just react to the idea of the instant but think 
things through a little bit more, we will be a lot better off and we 
will be serving our people better than we are at this moment.
  I strongly urge Members to resist this amendment so we can get on to 
health care reform and tax reform at a later date. I urge Senators not 
to vote for the DeMint amendment because it, frankly, does not belong 
on this bill.


                            Amendment No. 86

  On another matter, I wish to speak to the Coburn amendment No. 86. 
Essentially, this amendment would get rid of the Children's Health 
Insurance Program, abolish it. That is right, abolish it. This is the 
same program that had such strong support in America. Republicans have 
supported it and Democrats have supported it over the decade. It 
currently serves almost 7 million people, and with the legislation 
before us, we will boost that to 10 million people. The same CHIP 
program, the underlying bill, as I said, 10 million people, it works. 
It worked for 12 years. It is effective. People like it. Why? Because 
it works. It is a shared partnership between Uncle Sam and the States. 
It makes no sense to throw this away because it has worked so well.
  To be fair, the Senator from Oklahoma wants to not only abolish the 
program but replace it with a private system. As I understand it--I 
don't want to put words in his mouth--a private account system. It 
sounds a lot like Social Security privatization, which is roundly 
criticized. It is a good thing we didn't adopt that with the shape the 
stock market is in. People putting savings in a private Social Security 
account would find they would have lost a lot.
  In the meantime, Social Security is strong, it is there, the benefits 
are there. It is kind of like a defined benefit plan, a defined 
contribution plan. Seniors can count on it. Social Security is there. 
It is financed by the payroll tax. The trust fund is in very good 
shape. The Social Security trust fund is not in jeopardy for, gosh, 30 
years from now essentially. Seniors know that Social Security is there.
  In the same vein, families, working poor families, families who do 
not have the same income as others, should rest assure the Children's 
Health Insurance Program is there. They need that constancy, that 
predictability. Therefore, I urge Senators not to support the Coburn 
amendment which essentially abolishes the CHIP program and replaces it 
with a private system which is precarious at best, certainly given 
these times.
  The PRESIDING OFFICER. The Senator from Oklahoma.
  Mr. COBURN. Mr. President, first, this does not get rid of the 
system, and it certainly does not privatize it. What it does is it 
guarantees every child in this country, all 3l million--which is 
something this bill does not do--all 3l million who don't have an 
insurance policy today will be insured with a plan equal to what we 
have for our children.
  What it doesn't get rid of is access. They only have access to 40 
percent of the physicians now. It gives them access to 100 percent of 
all the physicians. We are defending a system that, first, is only 
going to enroll 4 million new kids, is still going to leave 5 million 
not covered and 2 million of the 4 million they enroll are from those 
who already have private insurance, and we are going to say we will 
stick with a system to take care of the ones we have now and we are not 
going to give real access, and with the not real access comes no choice 
of a physician because we limited the number of physicians who can 
participate because of the economics of it.
  I will tell you what it does get rid of. It gets rid of $70 billion 
of taxpayers' money that we are not going to use to cover every one of 
these kids. Based on the 2005 numbers, we can buy a premium health 
insurance policy for all 31 million kids--the 8.9 million who do not 
have any coverage now and the 22 million who are covered in either 
SCHIP or Medicaid today. We save all the administrative expense. We 
autoenroll them so we don't have to worry about picking up only 4 
million with an additional $70 billion in taxes.
  To say this is privatization is a total mischaracterization of it. 
What it does is it guarantees that all children will not have a 
Medicaid stamp or SCHIP stamp on their forehead that says: Yes, we are 
giving you coverage but you can't see all the physicians, you can't get 
referrals to the best because you have a government-run program.
  Not only do we increase access and quality, we save tremendous 
amounts of money, and it will still be a government-run program because 
it will be administered by the Secretary in a way that guarantees these 
kids are autoenrolled. They will have premium health insurance coverage 
and we still save money, even after that. We are spending $2,160 per 
kid now based on 2005 numbers, and we will cover every one of these 
kids and not spend more money than that.
  To characterize this as getting rid of coverage is wrong. What it 
does is greatly create and increase access for children in this country 
to have the same access that our children have. It saves money and 
markedly improves quality for those children. Every American child 
ought to have access, and what we do is take the money we are spending 
now and spend it more wisely, and create a system where they all have 
coverage.
  I yield the floor.
  The PRESIDING OFFICER. Who seeks recognition?

[[Page S1042]]

  Mr. BAUCUS. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. GRASSLEY. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. GRASSLEY. Mr. President, in closing today--and I know we have a 
few votes, but we are about done--I wish to talk about bipartisanship. 
I believe I have a history of getting bipartisan compromises done. Over 
the last several years, I have worked to deliver important bipartisan 
legislation on taxes, trade, and health care. We work together, we make 
commitments, and we sometimes have to say no to Members of our own 
party who would put their specific interests ahead of bipartisanship. 
It is tough at times, but when we work together to produce legislation, 
we are better off for doing so.
  Lately, I have seen a disturbing change in the way bipartisanship 
appears to be working around the Senate. Last year, on Medicare, we 
were working together for months--I am talking about for months--on a 
bipartisan bill to extend a lot of things in Medicare. It was jointly 
drafted. There were many provisions in the bill I strongly supported. 
But when we came to an impasse on some of the tough political issues, 
the majority solved the tough issues the way they wanted them and moved 
forward. That is not the way I think bipartisanship should work.
  Then we have this bill before us today. It is largely the work of 
Senators Baucus, Hatch, Rockefeller, and myself. It should be a 
bipartisan piece of legislation, but it is not. In this case, the 
majority decided to make some very political changes in the bill and 
presented it to us as a ``take it or leave it'' proposition. Today, I 
choose to leave it.
  Some Senators have tried to argue that this bill is 90 percent the 
bill we voted in 2007. I wonder that those Senators don't realize how 
insulting it is to me to hear that. It is an open admission that the 
majority unilaterally changed 10 percent of the bill and has presented 
it to me as a take it or leave it; it can still be bipartisan, Chuck 
Grassley, if you will just do what we tell you to do.
  The stimulus bill coming next week is no better. We were presented 
with a bill and asked if we wanted to sign on to it and call it 
bipartisan. That approach shouldn't come as a surprise to anybody or 
much of a surprise at all. As the Speaker said: We won the election, we 
write the bills. I must admit I appreciate why House Republicans 
decided yesterday they would not sign off on Speaker Pelosi's version 
of bipartisanship.
  We need to get back to real bipartisanship around here.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana is recognized.


                     Amendments Nos. 94, 95, and 96

  Mr. BAUCUS. Mr. President, I have a series of amendments in the 
nature of technical corrections that I have worked out with the ranking 
Republican Member, so Senator Grassley and I send these to the desk. I 
understand they have been cleared all the way around. So I send this 
package of amendments to the desk, and I ask unanimous consent that 
they be considered en bloc; that the amendments be agreed to and that 
the motions to reconsider be laid upon the table.
  The PRESIDING OFFICER. Is there objection?
  Hearing no objection, it is so ordered.
  The amendments were agreed to, as follows:


                            amendment no. 94

 (Purpose: To make a technical correction to the option to cover legal 
                 immigrant children and pregnant women)

       Beginning on page 135, strike line 21 and all that follows 
     through page 136, line 2, and insert the following:
       ``(C) As part of the State's ongoing eligibility 
     redetermination requirements and procedures for an individual 
     provided medical assistance as a result of an election by the 
     State under subparagraph (A), a State shall verify that the 
     individual continues to lawfully reside in the United States 
     using the documentation presented to the State by the 
     individual on initial enrollment. If the State cannot 
     successfully verify that the individual is lawfully residing 
     in the United States in this manner, it shall require that 
     the individual provide the State with further documentation 
     or other evidence to verify that the individual is lawfully 
     residing in the United States.''.


                            amendment no. 95

(Purpose: To make technical corrections to the State option to provide 
                   dental-only supplemental coverage)

       Beginning on page 216, strike line 8 and all that follows 
     through page 219, line 21, and insert the following:
       ``(5) Option for states with a separate chip program to 
     provide dental-only supplemental coverage.--
       ``(A) In general.--Subject to subparagraphs (B) and (C), in 
     the case of any child who is enrolled in a group health plan 
     or health insurance coverage offered through an employer who 
     would, but for the application of paragraph (1)(C), satisfy 
     the requirements for being a targeted low-income child under 
     a State child health plan that is implemented under this 
     title, a State may waive the application of such paragraph to 
     the child in order to provide--
       ``(i) dental coverage consistent with the requirements of 
     subsection (c)(5) of section 2103; or
       ``(ii) cost-sharing protection for dental coverage 
     consistent with such requirements and the requirements of 
     subsection (e)(3)(B) of such section.
       ``(B) Limitation.--A State may limit the application of a 
     waiver of paragraph (1)(C) to children whose family income 
     does not exceed a level specified by the State, so long as 
     the level so specified does not exceed the maximum income 
     level otherwise established for other children under the 
     State child health plan.
       ``(C) Conditions.--A State may not offer dental-only 
     supplemental coverage under this paragraph unless the State 
     satisfies the following conditions:
       ``(i) Income eligibility.--The State child health plan 
     under this title--

       ``(I) has the highest income eligibility standard permitted 
     under this title (or a waiver) as of January 1, 2009;
       ``(II) does not limit the acceptance of applications for 
     children or impose any numerical limitation, waiting list, or 
     similar limitation on the eligibility of such children for 
     child health assistance under such State plan; and
       ``(III) provides benefits to all children in the State who 
     apply for and meet eligibility standards.

       ``(ii) No more favorable treatment.--The State child health 
     plan may not provide more favorable dental coverage or cost-
     sharing protection for dental coverage to children provided 
     dental-only supplemental coverage under this paragraph than 
     the dental coverage and cost-sharing protection for dental 
     coverage provided to targeted low-income children who are 
     eligible for the full range of child health assistance 
     provided under the State child health plan.''.
       (2) State option to waive waiting period.--Section 
     2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)), as amended by 
     section 111(b)(2), is amended--
       (A) in clause (ii), by striking ``and'' at the end;
       (B) in clause (iii), by striking the period and inserting 
     ``; and''; and
       (C) by adding at the end the following new clause:
       ``(iv) at State option, may not apply a waiting period in 
     the case of a child provided dental-only supplemental 
     coverage under section 2110(b)(5).''.


                            amendment no. 96

(Purpose: To clarify that no eligible entity that receives an outreach 
      and enrollment grant is required to provide matching funds)

       Beginning on page 80, strike line 22 and all that follows 
     through page 81, line 7, and insert the following:
       ``(e) Maintenance of Effort for States Awarded Grants; No 
     Match Required for Any Eligible Entity Awarded a Grant.--
       ``(1) State maintenance of effort.--In the case of a State 
     that is awarded a grant under this section, the State share 
     of funds expended for outreach and enrollment activities 
     under the State child health plan shall not be less than the 
     State share of such funds expended in the fiscal year 
     preceding the first fiscal year for which the grant is 
     awarded.
       ``(2) No matching requirement.--No eligible entity awarded 
     a grant under subsection (a) shall be required to provide any 
     matching funds as a condition for receiving the grant.

  Mr. BAUCUS. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that at 7:30 p.m. 
the Senate proceed to votes in relation to the following amendments in 
the order listed: DeMint No. 85; Coburn No. 86, with 4 minutes equally 
divided to debate prior to this vote; Coburn No. 50; Coburn No. 49; 
Bingaman No. 63, as modified; Hutchison amendment--which doesn't have a 
number, nevertheless the Hutchison amendment.
  Further, that no amendments be in order to the amendments prior to 
the

[[Page S1043]]

votes; upon disposition of the amendments listed, that no other 
amendments be in order to the bill; the bill be read a third time; that 
there be up to 4 minutes of debate equally divided between the chairman 
and the ranking member, or their designee, prior to a vote on passage 
of H.R. 2, the Children's Health Insurance Program Reauthorization 
bill, as amended; that upon passage, the Senate insist on its 
amendment; request a conference with the House on the disagreeing votes 
of the two Houses and that the chair be authorized to appoint conferees 
on the part of the Senate, with concurrence of the managers and the two 
leaders; that there be 2 minutes of debate equally divided between the 
votes; and that all votes after the first vote in the sequence be 
limited to 10 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The PRESIDING OFFICER. The Senator from South Carolina is recognized.


                            Amendment No. 85

  Mr. DeMINT. Mr. President, I would like to make a few comments about 
my amendment, No. 85. Senator Baucus commented about it after I brought 
it up. There are a few matters I would like to clear up.
  The Senator mentioned this is not a tax bill, his children's health 
bill. Yet it is a tax bill. There is a large tax increase on cigarettes 
to pay for this bill, so it is very much dealing with taxes.
  He also said this is not the place to deal with families with 
children who have insurance through their employers or may be paying 
for their own insurance. This is a time to deal with Americans with 
children who cannot pay for health care. The underlying bill itself 
increases the criteria all the way up to twice the poverty level or 
more. It is dealing with many families with substantial incomes. It is 
giving benefits to some families who are not paying for their own 
insurance at the expense of those who are struggling to pay for their 
own health insurance.
  My amendment is very appropriate to the underlying bill. It is about 
children's health care, and it is about being fair to American 
citizens. The bill we are considering today gives generous benefits to 
children who are not citizens of the United States. They are here and 
my amendment does not change those benefits. But we should be fair and 
give equal benefits to American families, workers, taxpayers, who are 
paying for their own insurance.
  My colleague, Senator Baucus, mentioned many of these families are 
getting insurance through their employers. But just about all of them, 
if not all of them, have to pay a part of that expense themselves, 
which is very difficult. They cannot deduct that money.
  We need to make sure this bill is fair. My amendment makes the bill 
fair to every family with children. It gives them an above-the-line 
deduction for up to $1,500 of their expenses, and that is up to the 
amount we give to noncitizens in this children's health bill.
  This is fair to Americans, and it is time we start being fair to 
Americans. We cannot take money continuously from the middle class to 
do our good deeds all over the country and then leave middle-class 
Americans emptyhanded. If they are going to work and struggle to pay 
for their own health insurance, the very least we can do is not tax the 
money they spend to pay for their own health care. Why do we penalize 
people who are trying to live themselves without government money? Most 
Americans are doing everything they can to get by without government 
support. Let's stop penalizing them. Let's stop asking them to pay for 
all of our good deeds and good intentions.
  This is a simple amendment that gives a deduction for people who are 
paying for their own health insurance, a deduction that is equal to 
what we are giving to noncitizens in this underlying bill.
  Again, I encourage my colleagues to think twice, think about 
Americans, our own middle-class workers. Give them a fair shot. Vote 
for this amendment.
  Mr. President, I yield the floor.
  Mr. GRASSLEY. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. ROCKEFELLER. Mr. President, I ask unanimous consent that the 
order for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                            Amendment No. 97

  Mr. ROCKEFELLER. Mr. President, notwithstanding the previous order, I 
ask unanimous consent that the technical amendment which is at the desk 
be considered and agreed to and the motion to reconsider be laid on the 
table.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment (No. 97) was agreed to, as follows:

       On page 283, line 21, insert ``, 2009'' after April 1.

  Mr. ROCKEFELLER. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. TESTER. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                        Vote on Amendment No. 85

  Under the previous order, the question is on agreeing to amendment 
No. 85 offered by the Senator from South Carolina.
  Mr. TESTER. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The clerk will call the roll.
  The bill clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Massachusetts (Mr. 
Kennedy) is necessarily absent.
  The PRESIDING OFFICER (Mr. Udall of New Mexico). Are there any other 
Senators in the Chamber desiring to vote?
  The result was announced--yeas 40, nays 58, as follows:

                      [Rollcall Vote No. 27 Leg.]

                                YEAS--40

     Alexander
     Barrasso
     Bayh
     Bennett
     Bond
     Brownback
     Bunning
     Burr
     Cantwell
     Chambliss
     Coburn
     Cochran
     Corker
     Cornyn
     Crapo
     DeMint
     Ensign
     Enzi
     Graham
     Grassley
     Gregg
     Hatch
     Hutchison
     Inhofe
     Isakson
     Johanns
     Kyl
     Lugar
     McCaskill
     McConnell
     Murkowski
     Nelson (NE)
     Risch
     Roberts
     Sessions
     Shelby
     Thune
     Vitter
     Webb
     Wicker

                                NAYS--58

     Akaka
     Baucus
     Begich
     Bennet
     Bingaman
     Boxer
     Brown
     Burris
     Byrd
     Cardin
     Carper
     Casey
     Collins
     Conrad
     Dodd
     Dorgan
     Durbin
     Feingold
     Feinstein
     Gillibrand
     Hagan
     Harkin
     Inouye
     Johnson
     Kaufman
     Kerry
     Klobuchar
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     Martinez
     McCain
     Menendez
     Merkley
     Mikulski
     Murray
     Nelson (FL)
     Pryor
     Reed
     Reid
     Rockefeller
     Sanders
     Schumer
     Shaheen
     Snowe
     Specter
     Stabenow
     Tester
     Udall (CO)
     Udall (NM)
     Voinovich
     Warner
     Whitehouse
     Wyden

                             NOT VOTING--1

       
     Kennedy
       
  The amendment (No. 85) was rejected.
  Mrs. BOXER. Mr. President, I move to reconsider the vote, and I move 
to lay that motion on the table.
  The motion to lay on the table was agreed to.


                            Amendment No. 86

  The PRESIDING OFFICER. Under the previous order, there will be 4 
minutes of debate equally divided prior to a vote in relation to 
amendment No. 86 offered by the Senator from Oklahoma.
  The Senator from Oklahoma is recognized.
  Mr. COBURN. Mr. President, this amendment really is the amendment 
that is going to take care of our children. It is going to take the 
Medicaid stamp and SCHIP stamp off their foreheads. It is going to 
create access to the finest doctors, not just 40 percent of the doctors 
as we see in Medicaid and SCHIP. It is going to give the same care to 
all the children--those at the 300 percent poverty level and under--
that we give to our own kids. It does all that not spending the $70 
billion in increased taxes that is in this bill and auto-enrolling 
children so that we don't just pick up 4 million kids, we pick up all 
8.9 million kids who are not insured.
  To my colleagues who sponsored the Wyden bill, the Healthy Americans

[[Page S1044]]

bill, that is exactly what is in that bill, except we are going to do 
it for children without increasing costs but increasing the quality, 
increasing the care, and increasing the outcomes. We are going to truly 
make children on the same level we are in terms of their access. They 
are going to get to choose their doctor rather than have their doctor 
chosen for them. They are going to get a referral to the best rather 
than to one who will just take them. They are going to get the same 
thing we get, and they deserve it, and we are not going to spend a 
penny more than we are spending today.
  We don't do away with SCHIP, we don't privatize SCHIP; what we do is 
say we really care about kids and we are going to give them the same 
thing we have. At the same time, we are going to save the American 
taxpayers $70 billion.
  I yield my time.
  Mr. BAUCUS. Mr. President, this amendment phases out the Children's 
Health Insurance Program as we know it. It strikes the underlying bill 
and phases out the Children's Health Insurance Program over the next 2 
years and replaces it with a competitive bidding procedure, somewhat 
similar to Medicare Part D, where private plans that want to cover kids 
will submit bids, submit their plans to Uncle Sam for approval. So 
essentially it totally eliminates the Children's Health Insurance 
Program over a 2-year period and replaces it with a competitive-bidding 
process not too dissimilar from Medicare Part D where private plans 
offer health insurance to participants. I think it is much too much of 
a radical departure, and I urge its defeat.
  Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a second.
  All time is yielded back.
  The question is on agreeing to amendment No. 86.
  The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. DURBIN. I announce that the Senator from Massachusetts (Mr. 
Kennedy) is necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 36, nays 62, as follows:

                      [Rollcall Vote No. 28 Leg.]

                                YEAS--36

     Alexander
     Barrasso
     Bennett
     Bond
     Brownback
     Bunning
     Burr
     Chambliss
     Coburn
     Cochran
     Corker
     Cornyn
     Crapo
     DeMint
     Ensign
     Enzi
     Graham
     Grassley
     Gregg
     Hatch
     Hutchison
     Inhofe
     Isakson
     Johanns
     Kyl
     Lugar
     Martinez
     McCain
     McConnell
     Risch
     Roberts
     Sessions
     Shelby
     Thune
     Vitter
     Wicker

                                NAYS--62

     Akaka
     Baucus
     Bayh
     Begich
     Bennet
     Bingaman
     Boxer
     Brown
     Burris
     Byrd
     Cantwell
     Cardin
     Carper
     Casey
     Collins
     Conrad
     Dodd
     Dorgan
     Durbin
     Feingold
     Feinstein
     Gillibrand
     Hagan
     Harkin
     Inouye
     Johnson
     Kaufman
     Kerry
     Klobuchar
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     McCaskill
     Menendez
     Merkley
     Mikulski
     Murkowski
     Murray
     Nelson (FL)
     Nelson (NE)
     Pryor
     Reed
     Reid
     Rockefeller
     Sanders
     Schumer
     Shaheen
     Snowe
     Specter
     Stabenow
     Tester
     Udall (CO)
     Udall (NM)
     Voinovich
     Warner
     Webb
     Whitehouse
     Wyden

                             NOT VOTING--1

       
     Kennedy
       
  The amendment (No. 86) was rejected.
  Ms. STABENOW. Mr. President, I move to reconsider the vote.
  Mr. NELSON of Nebraska. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  The PRESIDING OFFICER. The Senator from Montana.


                            Amendment No. 50

  Mr. BAUCUS. Mr. President, I say to my good friend from Oklahoma, we 
are prepared to accept the next Coburn amendment. I wonder if the 
Senator is prepared to yield back the balance of his time so we can 
accept it. He does. That is great.
  The PRESIDING OFFICER. All time is yielded back. The question is on 
agreeing to amendment No. 50.
  The amendment (No. 50) was agreed to.


                            Amendment No. 49

  Mr. BAUCUS. We are on the next amendment.
  The PRESIDING OFFICER. There is 2 minutes equally divided on the next 
amendment.
  Mr. COBURN. Will the Chair state what the amendment is?
  The PRESIDING OFFICER. Amendment No. 49.
  Mr. COBURN. Mr. President, what this amendment does is it says you 
have 14 percent improper payment rate in SCHIP, we have 10.6 percent 
improper payment in Medicaid. The average improper payment rate across 
the rest of the Federal Government on every agency--this amendment says 
that before New York can go to 400 percent, they have to bring their 
improper payment rates in line with the rest of the Federal Government. 
The improper payment rate in New York--New York alone--accounts for 50 
percent of the fraud in Medicaid. Fifty percent of that is in New York 
State alone.
  So what this amendment would do is it would delay the improper 
payment reporting requirements and limit earmark program expansion 
until the Medicaid and SCHIP improper payment rates match the Federal 
average of improper payment rates. It is meant to help us get back on 
track. We just started getting improper payment rates on Medicaid, and 
they are out of control. We should not be delaying the onset of that, 
and we should put teeth into it so that where it is bad, we don't 
expand it and make it worse.
  With that, I reserve the remainder of my time.
  The PRESIDING OFFICER. The Senator's time has expired.
  The Senator from Montana.
  Mr. BAUCUS. Mr. President, this is yet another way to throw kids out 
of or off the Children's Health Insurance Program. It is a cap. It is a 
cap, the effect of which is to deny children coverage. It is similar to 
several other amendments brought up in the past, where there is 
sometimes a dollar cap, sometimes a percentage cap, and there are 
various other ways. This is another one of those caps, and I think it 
is not right to take kids off the Children's Health Insurance Program 
rolls. So I urge its defeat.
  Mr. COBURN. Mr. President, I ask for the yeas and nays.
  Mr. BAUCUS. Mr. President, I think we could voice vote this.
  Mr. COBURN. I agree. I withdraw my request.
  The PRESIDING OFFICER. All time is yielded back. The question is on 
agreeing to amendment No. 49.
  The amendment (No. 49) was rejected.
  Mrs. BOXER. Mr. President, I move to reconsider the vote, and I move 
to lay that motion on the table.
  The motion to lay on the table was agreed to.
  The PRESIDING OFFICER. The Senator from Montana.


                            Amendment No. 63

  Mr. BAUCUS. Mr. President, I think the next amendment is the Bingaman 
amendment No. 63.
  The PRESIDING OFFICER. The Senator is correct.
  The Senator from New Mexico is recognized.
  Mr. BINGAMAN. Mr. President, there are about 6 million children in 
the country who are eligible for Medicaid or CHIP who are not enrolled. 
In many of these cases, these are children who are also eligible for 
and enrolled in other Federal programs that have similar or even more 
severe requirements for eligibility. To fix this problem, we put a 
provision in the bill--Senator Baucus and those in the Finance 
Committee--included a provision for so-called express lane eligibility 
as a way to sign up children for the CHIP program.
  My amendment simply clarifies that the consent of the parent--not the 
determination of eligibility but the consent of the parent--for the 
enrollment of the child in the CHIP program or Medicaid can be 
accomplished through something other than a formal signed document at 
the Medicaid office. We give the Secretary the discretion to set that 
up. We believe this is a great change and will help us to register the 
children who ought to be registered for the CHIP program.

[[Page S1045]]

  I urge my colleagues to support the amendment.
  The PRESIDING OFFICER. The Senator's time has expired.
  The Senator from Iowa.
  Mr. GRASSLEY. Mr. President, this is where you get the wool pulled 
over your eyes. Here we are, in the last moments of a very partisan 
debate, and we have one last vote to abandon further compromises we 
made in 2007. This one weakens fraud protection.
  In that bill 2 years ago, we reached a carefully crafted compromise, 
balancing access and program integrity. With this amendment, the 
majority backs away from that compromise further. In 2007, we agreed 
that an express lane application would require a signature from the 
applicant acknowledging they were applying for Medicaid or SCHIP. This 
change eliminates the signature requirement.
  It is not technical, it is substantive, and it is going to lead to 
fraud. We should vote this down because we don't want to promote fraud.
  The PRESIDING OFFICER. The question is on agreeing to amendment No. 
63, as modified.
  Mr. GRASSLEY. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second? There is not a 
sufficient second.
  Mr. GRASSLEY. What do you mean there is not a sufficient second?
  The PRESIDING OFFICER. Now there is a sufficient second.
  The question is on agreeing to amendment No. 63, as modified. The 
clerk will call the roll.
  The legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Massachusetts (Mr. 
Kennedy) is necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 55, nays 43, as follows:

                      [Rollcall Vote No. 29 Leg.]

                                YEAS--55

     Akaka
     Baucus
     Bayh
     Begich
     Bennet
     Bingaman
     Brown
     Burris
     Byrd
     Cantwell
     Cardin
     Carper
     Casey
     Conrad
     Dodd
     Durbin
     Feingold
     Gillibrand
     Hagan
     Harkin
     Inouye
     Johnson
     Kaufman
     Kerry
     Klobuchar
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     Lugar
     McCaskill
     Menendez
     Merkley
     Mikulski
     Murray
     Nelson (FL)
     Nelson (NE)
     Pryor
     Reed
     Reid
     Rockefeller
     Sanders
     Schumer
     Shaheen
     Snowe
     Specter
     Stabenow
     Tester
     Udall (CO)
     Udall (NM)
     Whitehouse
     Wyden

                                NAYS--43

     Alexander
     Barrasso
     Bennett
     Bond
     Boxer
     Brownback
     Bunning
     Burr
     Chambliss
     Coburn
     Cochran
     Collins
     Corker
     Cornyn
     Crapo
     DeMint
     Dorgan
     Ensign
     Enzi
     Feinstein
     Graham
     Grassley
     Gregg
     Hatch
     Hutchison
     Inhofe
     Isakson
     Johanns
     Kyl
     Martinez
     McCain
     McConnell
     Murkowski
     Risch
     Roberts
     Sessions
     Shelby
     Thune
     Vitter
     Voinovich
     Warner
     Webb
     Wicker

                             NOT VOTING--1

       
     Kennedy
       
  The amendment (No. 63), as modified, was agreed to.


                            Amendment No. 93

  The PRESIDING OFFICER. Under the previous order, the Senator from 
Texas is recognized for 1 minute.
  Mrs. HUTCHISON. Mr. President, I call up amendment 93 and ask for its 
immediate consideration.
  The PRESIDING OFFICER. The clerk will report the amendment.
  The assistant legislative clerk read as follows:

       The Senator from Texas [Mrs. Hutchison] proposes an 
     amendment numbered 93.

  Mrs. HUTCHISON. I ask unanimous consent to dispense with the reading 
of the amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

(Purpose: To provide assistance for States with percentages of children 
     with no health insurance coverage above the national average)

       Beginning on page 42, strike line 20 and all that follows 
     through page 43, line 11, and insert the following:
       ``(e) Availability of Amounts Allotted.--
       ``(1) In general.--Except as provided in paragraphs (2) and 
     (3), amounts allotted to a State pursuant to this section--
       ``(A) for each of fiscal years 1998 through 2008, shall 
     remain available for expenditure by the State through the end 
     of the second succeeding fiscal year; and
       ``(B) for fiscal year 2009 and each fiscal year thereafter, 
     shall remain available for expenditure by the State through 
     the end of the succeeding fiscal year.
       ``(2) Special rule extending availability for outreach and 
     enrollment for certain states.--
       ``(A) In general.--In the case of a State described in 
     subparagraph (B), any amounts allotted or redistributed to 
     the State pursuant to this subsection for a fiscal year that 
     are not expended by the State by March 31, 2009, (including 
     any amounts available to the State for the first 2 quarters 
     of fiscal year 2009 from the fiscal year 2009 allotment for 
     the State or from amounts redistributed to the State under 
     subsection (k) or allotted to the State under subsection (l) 
     for such quarters), shall remain available for expenditure by 
     the State through the end of fiscal year 2012, without regard 
     to the limitation on expenditures under section 
     2105(c)(2)(A).
       ``(B) State described.--A State is described in this 
     subparagraph if the State is 1 of the 5 States with the 
     highest percentage of children with no health insurance 
     coverage (as determined by the Secretary on the basis of the 
     most recent data available as of the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2009).
       ``(3) Availability of amounts redistributed.--Amounts 
     redistributed to a State under subsection (f) shall be 
     available for expenditure by the State through the end of the 
     fiscal year in which they are redistributed.''.
       On page 38, line 18, insert ``subject to paragraph (5),'' 
     after ``(3)(A),''.
       On page 42, between lines 15 and 16, insert the following:
       ``(5) Authority to modify required number of enrollment and 
     retention provisions.--Upon the request of a State in which 
     the percentage of children with no health insurance coverage 
     is above the national average (as determined by the Secretary 
     on the basis of the most recent data available as of the date 
     of enactment of the Children's Health Insurance Program 
     Reauthorization Act of 2009), the Secretary may reduce the 
     number of enrollment and retention provisions that the State 
     must satisfy in order to meet the conditions of paragraph (4) 
     for a fiscal year, but not below 2.''.
       On page 84, line 20, insert ``The Secretary shall 
     prioritize implementation of such campaign in States in which 
     the percentage of children with no health insurance coverage 
     is above the national average (as determined by the Secretary 
     on the basis of the most recent data available as of the date 
     of enactment of the Children's Health Insurance Program 
     Reauthorization Act of 2009).'' after ``title XIX.''.

  Mrs. HUTCHISON. I yield for 30 seconds to the Senator from Florida.
  Mr. MARTINEZ. Mr. President, can I ask the Senate be in order?
  The PRESIDING OFFICER. The Senate will be in order.
  The Senator from Florida is recognized for 30 seconds.
  Mr. MARTINEZ. Mr. President, the amendment of the Senator from Texas 
allows the States with the highest percentage of uninsured children to 
be given priority for outreach and enrollment. Most importantly, it 
contains language that ensures the five States with the highest number 
of uninsured kids be given sufficient time to spend their current SCHIP 
allocations and will be given the flexibility for using these funds for 
outreach and enrollment.
  I yield to the Senator from Texas.
  The PRESIDING OFFICER. The Senator from Texas is recognized.
  Mrs. HUTCHISON. Mr. President, the CBO scores this as an actual 
savings. There will be no additional cost to the program and it has no 
impact over any other State's funding.
  I yield the remainder of my time.
  The PRESIDING OFFICER. The Senator from Montana is recognized.
  Mr. BAUCUS. Mr. President, we are prepared to vote in favor of the 
amendment.
  I yield the remainder of my time.
  Mr. GRASSLEY. Mr. President, people on my side asked for a vote. That 
is why I am asking for it.
  I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The question is on agreeing to the amendment.
  The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Massachusetts (Mr. 
Kennedy) is necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 17, nays 81, as follows:

[[Page S1046]]

                      [Rollcall Vote No. 30 Leg.]

                                YEAS--17

     Barrasso
     Baucus
     Bayh
     Bennet
     Bingaman
     Bond
     Cornyn
     Ensign
     Enzi
     Hutchison
     Inhofe
     Inouye
     Martinez
     Nelson (FL)
     Reid
     Udall (CO)
     Udall (NM)

                                NAYS--81

     Akaka
     Alexander
     Begich
     Bennett
     Boxer
     Brown
     Brownback
     Bunning
     Burr
     Burris
     Byrd
     Cantwell
     Cardin
     Carper
     Casey
     Chambliss
     Coburn
     Cochran
     Collins
     Conrad
     Corker
     Crapo
     DeMint
     Dodd
     Dorgan
     Durbin
     Feingold
     Feinstein
     Gillibrand
     Graham
     Grassley
     Gregg
     Hagan
     Harkin
     Hatch
     Isakson
     Johanns
     Johnson
     Kaufman
     Kerry
     Klobuchar
     Kohl
     Kyl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     Lugar
     McCain
     McCaskill
     McConnell
     Menendez
     Merkley
     Mikulski
     Murkowski
     Murray
     Nelson (NE)
     Pryor
     Reed
     Risch
     Roberts
     Rockefeller
     Sanders
     Schumer
     Sessions
     Shaheen
     Shelby
     Snowe
     Specter
     Stabenow
     Tester
     Thune
     Vitter
     Voinovich
     Warner
     Webb
     Whitehouse
     Wicker
     Wyden

                             NOT VOTING--1

       
       Kennedy
       
  The amendment (No. 93) was rejected.
  Mr. REID. Mr. President, I move to reconsider the vote.
  Mr. BAUCUS. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  The PRESIDING OFFICER. The majority leader is recognized.
  Mr. REID. Mr. President, this will be the last vote today. We are 
going to have the Holder debate Monday from 3:15 to 6:15. We will have 
the vote at 6:15. Monday at about 2 o'clock, we are going to lay down 
the economic recovery package. That is the stimulus. That will be the 
Appropriations and Finance pieces. After the Holder vote, we encourage 
Members to speak about the economic recovery package.
  Tuesday, we are going to have a full day of amendments and I hope a 
number of votes.
  On Wednesday, we have a longstanding retreat that the Democrats are 
going to have a short distance from here off campus. We are going to be 
in session, come in at 10:30. We solicit the Republicans, while we are 
in that retreat, to offer amendments. We would hope we would be back by 
4:30 and could start voting on some amendments that were offered that 
day.
  Next week will be a long, hard slog. It is up to us how long this 
takes. We hope we can work things out. I have had a number of 
conversations with the Republican leader on a way to expedite what we 
do. We want to make sure everyone has the opportunity to do what they 
think is appropriate on this bill.
  We are going to have some late nights next week. We will do 
everything we can not to have to work next weekend, but I think that is 
stretching things. But we will certainly try.
  We have had no morning business all week, so, Senators, speak your 
hearts out tomorrow.


                              section 214

  Mr. AKAKA. Mr. President, my understanding is that section 214 of 
H.R. 2 applies to pregnant women and children who are citizens of the 
Republic of Palau, the Republic of the Marshall Islands, or the 
Federated States of Micronesia, and who are lawfully residing in the 
United States under the terms of the Compacts of Free Association 
between the United States and each of these three Pacific island 
nations.
  Mr. INOUYE. I agree with my colleague from Hawaii. Section 214 
applies to pregnant women and children who are nonimmigrants lawfully 
residing in the United States under the terms of the Compacts of Free 
Association.
  Mr. AKAKA. Does the chairman agree with our interpretation?
  Mr. BAUCUS. Mr. President, I agree with the interpretations of the 
Senators from Hawaii regarding section 214.
  Mr. AKAKA. I thank the Senator very much for that clarification.
  Mr. President, I support the Children's Health Insurance Program 
Reauthorization Act of 2009. This legislation increases access to 
health care for an estimated 4.1 million children who are currently 
uninsured. The legislation also includes $100 million in new grant 
opportunities to fund outreach and enrollment efforts to increase the 
participation of children in Medicaid and the Children's Health 
Insurance Program. By increasing access to health insurance, more 
children will be able to learn, be active, and grow into healthy 
adults.
  Mr. President, the legislation will also provide much needed 
assistance to Hawaii hospitals that care for Medicaid beneficiaries and 
the uninsured. Hawaii hospitals continue to struggle to meet the 
increasing demands placed on them by a growing number of uninsured 
patients and rising costs.
  The legislation extends Medicaid disproportionate share Hospital, 
DSH, allotments for Hawaii until December 31, 2011. This additional 
extension authorizes the submission by the State of Hawaii of a State 
plan amendment covering a DSH payment methodology to hospitals that is 
consistent with the requirements of existing law relating to DSH 
payments. The purpose of providing a DSH allotment for Hawaii is to 
provide additional funding to the State of Hawaii to permit a greater 
contribution toward the uncompensated costs of hospitals that are 
providing indigent care. It is not meant to alter existing arrangements 
between the State of Hawaii and the Centers for Medicare and Medicaid 
Services, CMS, or to reduce in any way the level of Federal funding for 
Hawaii's QUEST program. The extension included in this act provides an 
additional $7.5 million for fiscal year 2010, $10 million for fiscal 
year 2011, and $2.5 million for the first quarter of fiscal year 2012. 
These additional DSH resources are intended to strengthen the ability 
of hospitals to meet the increasing health care needs of our 
communities.
  I look forward to the swift enactment of this legislation so that 
children have increased access to health care and so that our hospitals 
in Hawaii are better able to care for the uninsured and Medicaid 
beneficiaries.
  Mr. SPECTER. Mr. President, I seek recognition to voice my support 
for the Children's Health Insurance Program Reauthorization Act. In 
voicing my support, I must note that the bipartisan support that 
accompanied the drafting of this bill's predecessor in the 110th 
Congress was absent in this bill's introduction in the 111th Congress. 
The legislation was revised without working across the aisle, which has 
resulted in a bill that is not as widely supported as its predecessor. 
Children's health is the wrong issue on which to push partisan 
politics.
  When we last debated the Children's Health Insurance Program in the 
110th Congress, I was proud to lend my support to what I believe was a 
good, bipartisan bill. I voted in favor of the legislation twice, on 
August 2, 2007 and again on September 25, 2007. I was very disappointed 
in President Bush's veto of the legislation resulting in the delay of 
critical access to health care for millions of children.
  This important legislation will revise and expand the State 
Children's Health Insurance Program, SCHIP, enabling it to provide 
access to medical coverage to an additional 5.5 million children whose 
parents earn too much to qualify for Medicaid, but not enough to afford 
private health insurance. Nationwide, 7 million children are currently 
enrolled in SCHIP, including 183,981 in Pennsylvania.
  The reauthorized bill will provide an estimated 4.1 million children 
with access to health care coverage. To achieve that increase, the bill 
extends coverage to children in families with an annual income at or 
below 300 percent of the poverty level, or $66,150 for a family of 
four. The triple-the-poverty-level rate would bring the Nation in line 
with Pennsylvania's current plan.
  It is imperative that we take steps to ensure health care coverage 
for our most important resource, our children. In a January 12, 2009, 
column in The Washington Post, E.J. Dionne wrote, ``[S]tates have 
enacted budget cuts that will leave some 275,000 people without health 
coverage . . . By the end of this year, if further proposed [State 
budget] cuts go through, the number losing health coverage nationwide 
could rise to more than 1 million, almost half of them children.'' 
Congress can, and should, act to make sure children's health care does 
not suffer as a result of the economic downturn.
  Throughout my time in the Senate, I have consistently supported 
providing

[[Page S1047]]

quality health care to children, including prenatal care. To improve 
pregnancy outcomes for women at risk of delivering babies of low birth 
weight and reduce infant mortality and the incidence of low-birth-
weight births, I initiated action that led to the creation of the 
Healthy Start program in 1991. Working with the first Bush 
administration and Senator Harkin, as chairman of the Appropriations 
Subcommittee, we allocated $25 million in 1991 for the development of 
15 demonstration projects. For fiscal year 2008, we secured $99.7 
million for 96 projects in this vital program. Health care initiatives 
like the Healthy Start program and the Children's Health Insurance 
Program are key to improving the health and well-being of children in 
this country.
  The health care work of the 111th Congress will not be complete with 
just the reauthorization of the State Children's Health Insurance 
Program. This legislation will address the needs of some of the most 
vulnerable children, but Congress must act in a bipartisan fashion to 
address health reform so that all of America's 47 million uninsured 
have access to adequate health care.
  Mr. COCHRAN. Mr. President, I strongly support the Children's Health 
Insurance Program and its reauthorization, and I am disappointed that 
the Senate did not approve the Kids First Act that was offered as an 
amendment. This legislation would have provided funding to cover low-
income children whose families are otherwise unable to afford coverage. 
Instead of providing health coverage for American children, the Senate 
decided to consider a bill that will expand government programs, 
increase the burden on taxpayers, and shift the focus from the primary 
reason for the creation of the SCHIP, which is the coverage of low-
income children. Before the Senate considers expanding SCHIP, we should 
ensure that all children under 200 percent of the Federal poverty level 
are covered. Under the current program, the State of Mississippi is 
unable to cover all children under the current limit of 200 percent of 
poverty, $44,000 per year. The Senate is now considering legislation 
that will take tax money paid by Mississippians out of the State and 
allow other States to cover children in families making up to $88,000 a 
year. The expansion of benefits to legal immigrant children is also a 
point of serious concern. Under current law, legal immigrants sign a 
statement that they will not use Federal assistance programs such as 
Medicaid and SCHIP for 5 years. This legislation would waive that 5-
year waiting period, thus further expanding this program to 
noncitizens, while American children remain without health coverage. I 
cannot support any legislation that disadvantages the children of 
Mississippi even more. I hope this legislation will be changed in the 
amendment process to reflect the original intent of the legislation and 
ensure that low-income American children are provided health coverage.
  Mr. LEVIN. Mr. President, Americans are fortunate to have access to 
some of the best medical facilities and services in the world. Yet, 
shamefully, 2007 U.S. Census data demonstrated that there are 45.7 
million uninsured people in our country, of which, 8.7 million are 
children, who do not have the access they need to these services. 
Unfortunately, these numbers will likely increase as the Nation 
continues to lose more jobs and the ranks of the unemployed continue to 
rise.
  How to provide everyone in America access to affordable, quality 
health care is the subject of extensive debate. Over the years, though, 
we have made some progress in making sure that the most vulnerable 
members of our communities--including children--can receive basic 
medical services.
  The State Children's Health Insurance Program was created in the 
Balanced Budget Act of 1997 in recognition of the need to provide 
medical services for children from middle-income to lower income 
families and has been widely hailed as a successful program. In the 
past 12 years, we have seen that CHIP coverage leads to better access 
to preventative and primary care services, better quality of care, 
better health outcome and improved performance in school. CHIP 
currently provides health care benefits to more than 7.4 million 
children, of which more than 90 percent are from families with incomes 
below $35,000 a year for a family of three, or 200 percent below the 
Federal poverty level.
  Michigan's CHIP program, called MIChild, has had impressive results: 
Michigan currently has the second lowest rate of uninsured children in 
the Nation, trailing only Massachusetts, which provides universal 
health care coverage.
  While CHIP has been a successful program nationwide, many children 
who qualify for the program are unable to receive insurance because of 
inadequate funding. In Michigan, approximately 50,000 children are 
covered under CHIP every month, but there are still 158,000 uninsured 
children in my home State, and more than 8 million uninsured children 
nationwide.
  To help address this problem, I am pleased that the Senate is taking 
up a bipartisan bill--the Children's Health Insurance Program 
Reauthorization Act of 2009--that would increase funding for the 
program by approximately $32.8 billion over 4\1/2\ years. This bill 
will allow more than 4 million additional children to enroll beyond the 
7.4 million children already in CHIP. For Michigan, this means that 
more than an estimated 80,000 more Michigan children would have access 
to much needed health insurance.
  A hardworking mother from Royal Oak, Michigan, wrote: ``As a single 
working mother, I could not afford the family insurance that my 
employer offered, and definitely could not afford private [insurance]. 
Without this insurance I do not know what I would have done. [CHIP] 
offered us options, doctors instead of emergency rooms, less time 
missed at work and school.''
  We have a moral obligation to provide Americans access to affordable 
and high quality health care. No person, young or old, should be denied 
access to adequate health care, and the expanded and improved 
Children's Health Insurance Program is an important step toward 
achieving that goal.
  Mr. LEAHY. Mr. President, I wish to express my strong support for the 
reauthorization of the Children's Health Insurance Program. At a time 
when our country is moving in a new direction, it is fitting that we 
are considering this important measure among the first bills considered 
this Congress. I believe the extension of CHIP will stand out as one of 
the great accomplishments of this body. By passing this legislation, we 
would state clearly that the health of children in this country is an 
issue too important to be dealt with as business as usual.
  Last time the Senate considered an expansion of CHIP, the measure 
passed with bipartisan support and represented what can happen when 
members from both sides of the aisle come together to form a consensus. 
Unfortunately, providing health coverage for millions of kids was not a 
priority of our former President and he vetoed the measure. By standing 
in the way of this legislation, nearly 4 million children have had to 
wait to receive critical health coverage. With families struggling more 
than ever to make ends meet, passing this legislation is essential to 
protecting our Nation's children.
  This legislation is a matter of priorities, and I see no more 
important issue than caring for our kids. Regrettably, there are some 
who remain opposed to this legislation. I have heard some argue that 
this bill should be opposed because it raises taxes. Anyone who opposes 
the bill on these grounds is choosing big tobacco over children's 
health.
  Others have argued against including a provision that allows States 
to waive the 5-year waiting period for legal immigrant children. These 
children, who are lawful immigrants and who will eventually be U.S. 
citizens, already have the ability to receive CHIP services. Requiring 
kids to wait 5 years for health care is unconscionable and could create 
life-long consequences for children. I have heard some claim that 
allowing legal immigrant children to receive public health care 
services would violate the conditions on which they entered the United 
States. This argument is contrary to the position taken by the U.S. 
Citizenship and Immigration Services, which does not believe an 
immigrant's use of health care services such as Medicaid and SCHIP 
constitutes a violation of these conditions. An immigrant can only 
become a public charge if they receive direct

[[Page S1048]]

cash benefits, such as welfare, for their income. Health benefits are 
expressly removed from this category. During hard economic times, we 
should give states the ability to remove the restrictive barriers for 
legal immigrant children and allow them to receive critical health care 
services. Investing in early health care for all children is sound 
policy.
  I support this bill because I believe it is a travesty that in the 
richest, most powerful, country in the world, there are more than 47 
million people without health insurance. That is an absolutely shocking 
number. It represents roughly one in six people who are going without 
regular trips to the doctor, forgoing needed medications and are forced 
to use the emergency room for care because they have no where else to 
turn. These are our friends, our neighbors, and millions of our 
children.
  The legislation before us will extend and renew health care coverage 
for over 10 million children. After years of increases to the number of 
uninsured in this country, this is a solid step in the right direction. 
Our recent economic crisis has left more Americans jobless and without 
health coverage for themselves and their family members. No one is 
arguing that this bill is the solution to our health care crisis, but 
this bill represents significant progress. It covers 4 million more 
kids and represents the first important step to begin reforming our 
health care system.
  In my home State of Vermont, we have been a national leader on 
children's health care. Even before the creation of CHIP, we knew that 
this was the right thing to do. Because of our early action, Vermont 
has one of the lowest rates for uninsured kids in the country. This 
bill will get us even closer to the goal of covering the thousands of 
eligible kids in our State who remain uninsured. Further, the 
provisions in this bill will reverse the Bush administration policies 
to cut kids off the program and will ensure that thousands of Vermont 
kids will still have health care.
  We are faced with many choices here in the Senate. When it comes to 
our Nation's kids, the choice is clear. This is a must-pass bill that 
takes important steps to cover all children who deserve to have every 
opportunity to lead a healthy and productive life. I urge all my 
colleagues to stand with the children and support this bill.
  Mr. McCONNELL. Mr. President, there is no debate among Republicans 
concerning access to affordable health care for children--we believe 
every child should have access to quality affordable health care.
  Many of us are proud of our role in creating the children's health 
program, SCHIP. We think it ought to be reauthorized responsibly.
  But we are troubled by the direction the program has taken in recent 
years. It has strayed from its original purpose--the purpose 
Republicans support--of providing coverage to low-income, uninsured 
children.
  This bill before us would only exacerbate those troubling trends.
  That is why I offered an alternative--the Kids First Act--to return 
the children's health program to its original purpose of covering low-
income children.
  Senate Republicans also believe we need to focus scarce resources on 
those families who need it most. Mr. Cornyn  offered an amendment to 
use any leftover state funds to help insure children who are eligible, 
but not enrolled, rather than expanding to high-income beneficiaries.
  Senate Republicans believe SCHIP should cover those children who 
don't have insurance yet. Senator Kyl offered a commonsense amendment 
which says kids should be able to keep the coverage they have, freeing 
up resources to enroll more children who don't have insurance.
  Senate Republicans believe that States should cover low-income 
children who are not yet enrolled before they expand subsidies to 
wealthier families. Senators Murkowski, Specter, Collins, and Johanns 
offered an amendment to require just that.
  Regrettably, our friends across the aisle rejected each and every one 
of these commonsense proposals.
  As a result, we are left with a bill that fails to address the 
fundamental problems facing this children's health program--and that I 
cannot support.
  The PRESIDING OFFICER. Under the previous order, the question is on 
the engrossment of the amendments and third reading of the bill.
  The amendments were ordered to be engrossed and the bill to be read a 
third time.
  The bill was read the third time.
  The PRESIDING OFFICER. Under the previous order, there is now 4 
minutes of debate equally divided.
  The Senator from Montana is recognized.
  Mr. BAUCUS. Mr. President, today the Senate can right a wrong. In 
2007, more than 3 million low-income, uninsured American kids were 
waiting to be included in the Children's Health Insurance Program. 
Those millions of low-income, uninsured children needed doctors visits 
and medicines. But in 2007, President Bush wrongly vetoed the 
legislation renewing and expanding the children's health program. The 
chance at health insurance for those 3 million kids was lost.
  We cannot get those 2 years back for those kids, but today the Senate 
can keep all the children currently in CHIP covered--that is nearly 7 
million--and we can reach more than 4 million more low-income, 
uninsured children who are waiting--waiting on us, colleagues--to do 
the right thing, who are waiting on us to fulfill the promise of the 
program.
  I strongly urge all of us to give a big vote. The winners are the 
kids.
  The PRESIDING OFFICER. The Senator from Iowa is recognized.
  Mr. GRASSLEY. Mr. President, we all know the rest of this year in 
health care we have big things ahead of us. We know the bill before us 
today will make the difference for 4 million or so uninsured kids. So 4 
million uninsured Americans down but 42 million uninsured Americans to 
go. That is not going to be an easy task. If we are going to reform our 
health care system to cover all Americans, if we are going to improve 
the quality of care to provide for all Americans, if we are going to 
bring down the cost of health care for all Americans, we need to work 
together.
  If we are going to work together, we need to get a better 
understanding of what bipartisanship really means. It is not, we will 
write 90 percent of the bill together and ask the minority to vote for 
the last 10 percent, like it or not. It is not: here is the bill, does 
the minority want to sign off on it and let us call it bipartisan?
  It is, frankly, very difficult for me to believe we can return to 
true bipartisanship. But we will finish this bill today, and then I am 
going to roll up my sleeves. I am going to sit down with the majority 
to try to improve our health care system for all Americans despite 
recent evidence that true bipartisanship is elusive here in the Senate.
  I know the issues in front of us are too important for me to do 
anything less than my very best for all those Americans out there who 
expect us to solve the problems of the day and make a better America 
for tomorrow's children and all of us.
  The PRESIDING OFFICER. All time is yielded back.
  The question is, Shall the bill, as amended, pass?
  Mr. REID. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Massachusetts (Mr. 
Kennedy), is necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 66, nays 32, as follows:

                      [Rollcall Vote No. 31 Leg.]

                                YEAS--66

     Akaka
     Alexander
     Baucus
     Bayh
     Begich
     Bennet
     Bingaman
     Boxer
     Brown
     Burris
     Byrd
     Cantwell
     Cardin
     Carper
     Casey
     Collins
     Conrad
     Corker
     Dodd
     Dorgan
     Durbin
     Feingold
     Feinstein
     Gillibrand
     Hagan
     Harkin
     Hutchison
     Inouye
     Johnson
     Kaufman
     Kerry
     Klobuchar
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     Lugar
     Martinez
     McCaskill
     Menendez
     Merkley
     Mikulski
     Murkowski
     Murray
     Nelson (FL)
     Nelson (NE)
     Pryor
     Reed
     Reid
     Rockefeller
     Sanders

[[Page S1049]]


     Schumer
     Shaheen
     Snowe
     Specter
     Stabenow
     Tester
     Udall (CO)
     Udall (NM)
     Warner
     Webb
     Whitehouse
     Wyden

                                NAYS--32

     Barrasso
     Bennett
     Bond
     Brownback
     Bunning
     Burr
     Chambliss
     Coburn
     Cochran
     Cornyn
     Crapo
     DeMint
     Ensign
     Enzi
     Graham
     Grassley
     Gregg
     Hatch
     Inhofe
     Isakson
     Johanns
     Kyl
     McCain
     McConnell
     Risch
     Roberts
     Sessions
     Shelby
     Thune
     Vitter
     Voinovich
     Wicker

                             NOT VOTING--1

       
     Kennedy
       
  The bill (H.R. 2), as amended, was passed.
  (The bill will be printed in a future edition of the Record.)
  Mr. BAUCUS. I move to reconsider the vote and to lay that motion on 
the table.
  The motion to lay on the table was agreed to.
  The PRESIDING OFFICER. Under the previous order, the Senate insists 
on its amendments and requests a conference with the House on the 
disagreeing votes on this measure.
  The Presiding Officer appointed Senators Baucus, Rockefeller, Conrad, 
Grassley, and Hatch conferees on the part of the Senate.
  Mr. FEINGOLD. Mr. President, I am pleased that the Senate has 
successfully passed the reauthorization of a popular program that has 
reduced the number of uninsured children in our country by over 7 
million. The Children's Health Insurance Program has helped lower the 
rate of uninsured low-income children by one-third since its enactment 
in 1997. That is a huge accomplishment, and has helped address a 
problem in our country that is unacceptable--the millions of families 
lacking insurance. Moreover, while the bill has a price tag of roughly 
$31 billion over 4\1/2\ years, it is fully offset and would cover over 
4 million more uninsured, low-income children. This program, according 
to CBO and numerous economists, is the most efficient method of getting 
health care insurance to low-income kids and parents, and that means 
CHIP provides the best coverage available for low-income families.
  In my home State of Wisconsin, CHIP is known as BadgerCare and it 
provides health insurance for over 370,000 children and 17,000 pregnant 
women. My State has done a very good job of covering uninsured 
families, and the positive effects of this program are felt at schools, 
in the workforce, and at home. This bill helps support Wisconsin's 
efforts and provides low-income children in my State with better access 
to preventive care, primary care, and affordable care. The end result 
is healthier families. BadgerCare is vital to the well-being of many 
families in Wisconsin and I am very pleased that this bill supports the 
program in my State.
  I am very pleased that Congress has taken a first step to relieve 
States from unnecessary and burdensome barriers to enrolling low-income 
children. The onerous citizenship documentation requirements 
established in the 2005 Deficit Reduction Act, DRA, are keeping 
hundreds of thousands of eligible beneficiaries from the health care 
they need. This provision has created a serious new roadblock to 
coverage. As a result of the provision, which requires U.S. citizens to 
document their citizenship and identity when they apply for Medicaid or 
renew their coverage, a growing number of States are reporting a drop 
in Medicaid enrollment, particularly among children, but also among 
pregnant women and low-income parents. Health care coverage is being 
delayed or denied for tens of thousands of children who are clearly 
citizens and eligible for Medicaid but who cannot produce the limited 
forms of documentation prescribed by the regulations. These children 
are having to go without necessary medical care, essential medicines 
and therapies. In addition, community health centers are reporting a 
decline in the number of Medicaid patients due to the documentation 
requirements and are faced with treating more uninsured patients as a 
result.
  Over the first year and a half that the documentation requirements 
were in effect, the Wisconsin Department of Health Services reported 
that almost 33,000 children and parents lost Medicaid or were denied 
coverage solely because they could not satisfy the Federal 
documentation requirements. About two-thirds of these people are known 
by the State to be U.S. citizens; most of the remainder are likely to 
be citizens as well, but have yet to prove it.
  A study of 300 community health centers, conducted by George 
Washington University, found that the citizenship documentation 
requirements have caused a nationwide disruption in Medicaid coverage. 
Researchers estimate a loss of coverage for as many as 319,500 health 
center patients, which will result in an immediate financial loss of up 
to $85 million in Medicaid revenues. The loss of revenue hampers the 
ability of safety net providers to adequately respond to the medical 
needs of the communities they serve.
  In addition to consequences suffered by eligible U.S. citizens, 
States have reported incurring substantial new administrative costs 
associated with implementing the requirement. They have had to hire 
additional staff, retool computer systems, and pay to obtain birth 
records. States are also reporting that the extra workload imposed by 
the new requirement is diverting time and attention that could be 
devoted to helping more eligible children secure and retain health 
coverage.
  States are in the best position to decide if a documentation 
requirement is needed and, if so, to determine the most effective and 
reasonable ways to implement it. States that do not find it necessary 
to require such documentation could return to the procedures they used 
prior to the DRA and avoid the considerable administrative and 
financial burdens associated with implementing the DRA requirement. 
Most importantly, these States could avoid creating obstacles to 
Medicaid coverage for eligible U.S. citizens.
  Despite significant support for allowing States to determine the best 
way to document citizenship, that complete fix is not included in the 
underlying bill. The restrictions are eased, and this is an important 
first step, but I hope we can continue to move forward on this issue 
and return this requirement to a State option.
  I am also very pleased that this bill will allow States to waive the 
Federal 5-year waiting period for legal immigrant children and legal 
immigrant pregnant women to become eligible to enroll in the Children's 
Health Insurance Program. The idea that a sick child or pregnant woman 
legally in this country must wait 5 years to receive the care they need 
is absurd. Timely coverage means that families will have the 
opportunity to both prevent and treat conditions that can dramatically 
affect a child's daily life, and long-term health. And in those tragic 
incidences where a child suffers from life-threatening illnesses like 
cancer, denying that child necessary health care is unacceptable. 
Giving States the option to waive the 5-year waiting period is a 
positive step towards removing barriers to enrollment that are 
preventing our children from receiving the care they need.
  In the midst of this recession, it is even more important that we 
renew our commitment to this valued program. We know that for every 1 
percent increase in unemployment, approximately 1 million Americans 
become newly eligible for their State's Medicaid or CHIP programs. 
Reauthorization of the Children's Health Insurance Program will help 
millions of children and their families stay afloat and continue to 
receive the health care they need. Over the past few days, my 
colleagues have shared tragic stories of children who have suffered as 
a result of being uninsured, and we have listened to the heartwarming 
stories of families who have--quite literally--been saved by the 
Children's Health Insurance Program. The Children's Health Insurance 
Program Reauthorization marks an important leap forward in getting 
coverage to those who need it. I was pleased to support this bill's 
final passage, and I look forward to the day that everyone in our 
country has access to the basic right of health care.
  Mrs. BOXER. Mr. President, I am pleased that today the Senate voted 
to reauthorize and expand the Children's Health Insurance Program, 
which will extend health care to millions of children across the 
Nation.
  Right now, our Nation faces one of the gravest economic crises in our 
history, and more and more Americans are having difficulty making ends

[[Page S1050]]

meet--especially when it comes to the rising costs of health care. All 
too often it is children who pay the price.
  For almost 12 years, the Children's Health Insurance Program has 
provided health care for millions of children from working families 
that do not qualify for Medicaid but cannot afford private insurance. 
These are the children of working families.
  Millions of Americans have found that as the cost of health insurance 
rises an increasing number of employers are unable or unwilling to 
provide health insurance to their employees and their families. 
Approximately 45 million Americans, including nearly nine million 
children, are living without health insurance, and the number of 
families who do not have health insurance has continued to rise.
  Currently, the Children's Health Insurance Program provides coverage 
for 6.7 million children nationwide. This reauthorization provides 
health care coverage for an additional 4.1 million children who are 
uninsured today.
  This bill is largely based on legislation that was twice vetoed by 
President Bush. This legislation includes several improvements to the 
Children's Health Insurance Program that would fund outreach and 
enrollment efforts, allow States to use information from food stamp 
programs and other initiatives for low-income families to find and 
enroll eligible children, and give States the option to cover pregnant 
women for prenatal care vital to healthy newborn children.
  I also support a provision in this bill that gives States the option 
to cover legal immigrant children and pregnant women under Medicaid and 
CHIP with no waiting period. Under current law, lawfully present 
pregnant women and children who entered the country after August 22, 
1996 are barred from Medicaid and CHIP for the first 5 years they are 
in the country. These restrictions have severely undermined the health 
status of immigrant families across the Nation.
  My home State of California has a higher cost of living than most 
others, a lower rate of employer sponsored coverage, and a higher rate 
of the uninsured. In California, CHIP funds cover approximately 1.4 
million children and pregnant women. Currently, there are approximately 
1.2 million children in California who do not have health insurance, 
and about 694,000 of these children are eligible for CHIP coverage.
  This legislation not only extends this essential program, but gives 
States like California the flexibility they need to design a program 
that best fits the needs of their children.
  I would like to thank Senators Baucus and Rockefeller and the other 
members of the Finance Committee who worked so tirelessly to keep the 
focus of this bill where it should be--on the children.
  There is not a man or woman in this chamber who wouldn't do 
everything within their power to ensure the health of their own 
children--we should do no less for the children of our Nation.
  The PRESIDING OFFICER. The Senator from Montana.

                          ____________________