[Congressional Record Volume 155, Number 171 (Wednesday, November 18, 2009)]
[Senate]
[Pages S11457-S11459]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. CASEY. Thank you very much, Madam President.
  I rise this afternoon to speak about health care. We all have been 
concentrating on this issue for many months, and we are now into a 
period of time when we will be getting a bill very soon to the floor. 
That is our hope and our expectation.
  One of the parts of the Health, Education, Labor, and Pensions 
Committee bill that I voted on, as did the Presiding Officer this 
summer back in July when we passed our bill out of committee, one of 
the real priorities in that bill, and what I believe will continue to 
be a priority in the final legislation before the Senate, is children 
and what happens to children as a result of health care reform. We have 
a lot to be positive about in terms of legislation over the last decade 
or more as it relates to children, and I will speak about that.
  In terms of that guiding principle, I have a very strong belief--and 
I think it is the belief of a lot of people in this Chamber and across 
the country--that every child in America--every child in America--is 
born with a light inside them. For some children, that light is limited 
by circumstances or their own personal limitations, but no matter what 
that light is, we have to make sure the light for their potential burns 
as brightly as we can possibly ensure. For some children, of course, 
that light is almost boundless. You almost can't measure it because the 
child has advantages other children don't have or they have a family 
circumstance that allows them to grow and to develop and, therefore, to 
learn and to be very successful. But I believe every child in America 
is born with a light, and whatever the potential is for that child, we 
have to make sure he or she realizes it. We have a direct role to play. 
Those of us who are legislators, those of us who are working on the 
health care bill have an obligation, I believe, to make sure that light 
shines ever brightly.
  One of the other themes under this effort to expand health care for 
Americans is to focus on children who happen to be either poor or who 
have special needs. I believe the goal of this legislation, as it 
relates to those children, those who are poor or children with special 
needs, is four words: ``No child worse off.'' We need to ensure that a

[[Page S11458]]

poor child isn't worse off at the end of this debate and enactment of 
health care reform and that a child with special needs is not worse 
off. I think that is the least we should do when it comes to protecting 
our children.
  There are at least two programs--one older than the other but both 
very important--that relate to our children. The older of the two 
programs is the Medicaid Program. It has been around for more than 40 
years now. Medicaid, as it pertains to children, is a program we have 
come to rely upon to provide children with very good medical care, the 
best medical care, in some ways, that a child can have. We have to make 
sure we pay attention to how Medicaid is treated in this bill. We will 
talk a little bit more about that in a moment.
  In Pennsylvania, the State I represent, we have a 15-year experiment 
with the Children's Health Insurance Program or CHIP. The one thing we 
know about CHIP is it works. It works very well for children. As we 
know, in a general sense, the Children's Health Insurance Program is 
for children of low- and middle-income families in America who can't 
get coverage from their employer, for one reason or another, and don't 
have a family income that is low enough to qualify for Medicaid. So it 
fills a gap that had been there for years. We know, with regard to the 
Children's Health Insurance Program, today there are about 7.8 million 
children covered. That is wonderful. I am very proud and happy about 
that, but we are even happier and more positive about the future 
because the reauthorization of the Children's Health Insurance Program 
means that by 2013, 7.8 million children covered will rise to 14.1 
million children. So an easy way to think about children's health 
insurance is 14 and 13: 14 million kids covered in the year 2013. That 
is a tremendous achievement--historic in American history. We have 
never had anything close to that, to have 14 million children covered 
in a good program such as CHIP.
  The caveat to that is we still have millions--by some estimates 8 
million--of children who will not be covered even in 2013. One of the 
reasons we are debating health care reform is to make sure we are doing 
everything possible to strengthen the Children's Health Insurance 
Program and do not allow it to be weakened in any way.
  One way to weaken it--and fortunately the Senate Finance Committee 
did not do this in their final bill--is to take a stand-alone, 
successful, effective Children's Health Insurance Program and put it in 
the health insurance exchange. It may sound good--within one system--
but I believe, and many others believe, it would be very bad. The 
Finance Committee, led by Senator Rockefeller, worked very hard to make 
it possible to keep the Children's Health Insurance Program as a 
separate stand-alone program. I believe we have to do that.
  As we know, legislation passed recently in the House. The health care 
bill got through not just the committees but through the House itself. 
One of the problems with the House bill is it would end the Children's 
Health Insurance Program in 2013. We don't want to do that. We want to 
make sure, in the Senate, we do it differently than the House did.
  One component that is good about the House bill on this subject, 
however, is it does expand Medicaid. The House bill expands Medicaid 
for children to 150 percent of poverty for all States, and States would 
get assistance in paying for this expanded population. But then there 
is another caveat in terms of what I think has to be improved upon in 
the Senate. Children above 150 percent of poverty will go into a new 
exchange, which I think is, as I said before, the wrong way to go. We 
want to make sure, if something such as that were to happen, they would 
have cost-sharing protections and better benefits. Unfortunately, if 
they go into that exchange, they would not. This could have a direct 
impact on a State such as Pennsylvania. By one estimate, in 
Pennsylvania alone, this means that nearly 100,000 children who 
currently have children's health insurance coverage would lose it 
because of that change. So we want to make sure we don't go in the 
direction the House did as it relates to this issue of children's 
health insurance and the exchange--keeping it out of the exchange.
  We do need to expand Medicaid for children and we need to maintain 
CHIP as a stand-alone program. What are some of the numbers here? We 
are talking about nationally, in the Medicaid Program, 30 million 
children enrolled in Medicaid. As I said before, enrolled in CHIP are 
7.8 million kids. Putting them together we have one-third of all 
children in America covered by those two programs. But as I said 
before, we still have plenty--millions and millions--of children who 
still are not covered by either program.
  We hear a lot of acronyms around here, but one important acronym for 
this debate, as it relates to children and to health care, is EPSDT: 
early pediatric screening diagnosis and treatment. The American Academy 
of Pediatrics has called EPSDT the ``gold standard'' for children's 
health care. This is essential that we keep that kind of standard in 
place. That means Medicaid, for example, covers all medically necessary 
treatment for children, including preventive care, primary care, 
dental, hearing, vision, and it goes down the list.
  Unfortunately, sometimes people say: Well, under commercial coverage 
you will get as much coverage for children of the same quality. 
Unfortunately, that is not true. There may be advantages to provider 
networks of commercial coverage for families who are wealthy enough, 
have the means to afford it and who can get out of the network and pay 
for something extra, but, of course, many families don't have that 
benefit.
  I wish to spend a couple moments on EPSDT. I will go to the first 
chart. The Commonwealth Fund and George Washington University did an 
excellent comparison of the benefits between commercial insurance and 
Medicaid. The first benefit we have on this chart is called 
developmental assessment. Some of these terms get a little long and 
there is a lot of policy jargon. One of the most important things for 
any child, especially very young children, is to have regular and high-
quality developmental assessments, so we can catch anything that might 
be going wrong at an early enough age and give that child the benefit 
of early intervention and treatment in the dawn of their lives, in the 
early months and years of their lives. We can see, under Medicaid, for 
example, that this developmental assessment is covered. We can also see 
that under the Federal Employees Health Benefits Plan, there is a lot 
of verbiage there which I will not read, but suffice it to say it is 
limited. It is not covered to the extent it is in Medicaid.

  Another example is this phrase down here: ``Anticipatory guidance,'' 
another fancy term of policy, but it is this simple: It is helping 
parents understand what they should be expecting from their child 
physically, emotionally, and developmentally so they can get help, as I 
said before, early enough in the life of that child. This kind of 
guidance, again, is covered under Medicaid but not explicitly covered 
under the Federal Employees Health Benefit Program, which, as a 
beneficiary of that program, is a great health insurance program for 
Federal employees, but even something that significant, in terms of 
coverage and quality, would not be, in my judgment, good enough for 
poor children who should be covered in terms of developmental and 
anticipatory guidance with their parents under Medicaid. So Medicaid is 
better for poor children than even something as significantly good as 
the Federal employees plan.
  Let me go to the next chart. I know we are getting close to our time 
and I will be observing that. This chart shows EPSDT as it relates to 
physical, speech, and related therapies. We have heard horror stories 
from mothers of children with disabilities--either mild or severe. 
Physical therapy, speech therapy, and occupational therapy, these are 
all critical to a child who may have a disability. Sometimes early 
intervention can help a child recover to normal functioning and 
sometimes it is a disability that persists throughout a child's life. 
Under Medicaid, again, beyond the medically necessary threshold, basic 
therapies, such as physical, speech, and occupational therapy, are 
covered without limitation. I think it is vitally important we ensure 
that under Medicaid we continue to fortify that program so our children 
can get that kind of quality coverage.
  Let me conclude with a couple thoughts, very briefly. No. 1 is, at 
the

[[Page S11459]]

end of this process of getting a health care bill enacted, I believe we 
have to live up to that basic standard of four words for poor kids: 
``No child worse off'' at the end of the road. Dr. Judith Palfrey, a 
pediatrician, child advocate, and president-elect to the American 
Academy of Pediatrics, spoke at one of our hearings earlier this year, 
and here is what she said:

       Sometimes, we as child advocates find it hard to understand 
     why children's needs are such an afterthought and why, 
     because children are little, policymakers and insurers think 
     that it should take less effort and resources to provide them 
     with health care.

  I think that challenges all of us to make sure children are not 
second-class citizens when it comes to health care reform and what we 
do.
  Let me conclude with this thought: As I said before about that bright 
light inside every child who is born, we have to do everything possible 
to make sure that at the end of the road, at the end of this debate, 
and at the end of voting on this bill, we ensure that that light burns 
ever brightly, especially for children who happen to be poor or have 
special needs.
  With that, I yield the floor and note the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. INHOFE. 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. INHOFE. Madam President, I understand that according to the 
unanimous consent agreement, I have the floor for a period of time now.
  The PRESIDING OFFICER. The Senator is correct.

                          ____________________