[Congressional Record (Bound Edition), Volume 146 (2000), Part 7]
[House]
[Pages 9590-9596]
[From the U.S. Government Publishing Office, www.gpo.gov]



                   HEALTH CARE FOR CHILDREN IN TEXAS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 1999, the gentlewoman from Texas (Ms. Eddie Bernice Johnson) 
is recognized for 60 minutes as the designee of the minority leader.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, for the 60 minutes, 
we plan to address the House on health care for children in Texas. I 
will be joined by several Members.
  My colleagues can see, Mr. Speaker, that this ad has a child that has 
on boxing gloves. Our children should not have to fight to get health 
care coverage that they truly deserve.
  A child born in the year 2000 is far more likely to grow up healthy 
and to reach adulthood than a child that was born in 1900. Over the 
past 100 years, our Nation's scientific, technological, and financial 
resources have built the most advanced health care system in the world. 
But the doors of health care still remain shut to some.
  Millions of children have inadequate medical care. Ensuring that 
every child in our Nation receives the best possible health care, we 
must have a top priority in this Nation. To a large extent, health 
status is still determined by race, language, culture, geography, and 
economics.
  In general, children in low-income communities get sick more often 
from preventable acute and infectious illnesses, such as measles, 
conjunctivitis, and ear infections. Low-income children and teens are 
also more likely to suffer from chronic medical conditions, such as 
diabetes and asthma. These are the leading causes of school absences.
  In fact, the sharpest increases in asthma rates are among the urban 
youth. Very prevalent. Despite the tremendous advances in medical 
technology and public health, millions of children have less of a 
chance to grow up healthy and strong because of unequal access to 
health care.
  Texas is a perfect example. Children without health insurance or a 
regular source of health care are more likely to seek care from 
emergency rooms and clinics, which have long waits to see a provider, 
limited follow-up, and little to no health education about preventive 
strategies or ways to manage a chronic illness.
  Compared with insured children, uninsured children are up to eight 
times less likely to have a regular source of care, four times more 
likely to delay seeking care, nearly three times less likely to have 
seen a provider in the last past year, and five times more likely to 
use emergency room as a regular place of care.
  There is no question that insurance is key to maintaining health. 
When Medicaid was initiated in 1965, infant mortality rates began to 
decrease, and that continues today.
  The health insurance status of children through age 18 in Texas 
compared to that of the rest of the country. On this next chart, 
imagine 100 children from Texas standing in front of us, 54 of these 
children are insured through private employer-based policies; 24 
percent are uninsured; 22 percent are covered through Medicaid. This 
equals to about 1.4 million of the 6 million children in Texas without 
health insurance.
  On our next chart, just imagine 100 children from all over the 
country standing in front of us. Sixty-four percent of these children 
are insured through private employer-based programs; 21 are covered 
through Medicare; 15 are uninsured.
  Why is it that Texas's percentage of uninsured children is higher 
than the Nation's average? The reason is due to a Texas Government that 
chooses not to take advantage of the government funding that will allow 
many children to be insured.
  I just read a news clipping here talking about the millions of 
dollars that is turned back or unused in the Federal Government simply 
because we have not enrolled these children. It is unfortunate that we 
have a Government so benign in Texas that will not enroll the children.

                              {time}  1915

  As a matter of fact, Texas can expand its Medicaid coverage to the 
age of 18 and cover those whose income is up to 300 percent of the 
Federal poverty level. Presently, Texas only covers children up to age 
18 and whose income is 100 percent of the Federal poverty level with 
title XXI funds. There is something grossly inadequate about how we 
take care of our children and their health care in Texas. Over half of 
all States have expanded the coverage to 200 percent and beyond.
  The next chart shows income eligibility levels for children 1 and 
older in Medicaid and separate State programs. This chart shows that 
most States have expanded health care coverage to children in title XXI 
funds. This coverage is provided through Medicaid expansions and/or 
separate insurance programs. Why, then, Texas? Ten States offer 
Medicaid to those with incomes up to 150 percent of the Federal poverty 
level. Texas falls within that category. Texas falls at the bottom. Our 
children fall at the bottom.

[[Page 9591]]

  There are several colleagues that I have here, Mr. Speaker, who will 
also make comments on whether or not our children are being treated 
fairly if they have to simply fight for the health care they deserve.
  I yield to the gentleman from Texas.
  Mr. HINOJOSA. Mr. Speaker, I thank the gentlewoman from Texas (Ms. 
Eddie Bernice Johnson) for the work that she is doing, and I agree with 
her opening remarks that our children should not have to fight to get 
the health care coverage that they deserve.
  Mr. Speaker, I am happy to announce that for the first time, a 
Children's Health Insurance Program, or CHIP, is available in South 
Texas. CHIP is low-cost health insurance provided under a State-
subsidized insurance program. Any Texas uninsured children, newborns 
through age 18, are eligible. All costs are flexible and based on 
family income. For example, a family of four qualifies if the household 
income is $34,000 or less. If they make more than that, they can 
qualify for greatly reduced insurance through another program, Texas 
Healthy Kids.
  The CHIP operates like a health maintenance organization, or HMO. It 
is run by the TexCare Partnership which partners with all 254 Texas 
counties to sponsor services through one of three different plans. One 
is CHIP, two is Medicaid, and three is the Texas Healthy Kids. CHIP 
provides services such as hospital care, surgery, x-rays, therapies, 
prescription drugs, mental health and substance abuse treatment, 
emergency services, eye tests and glasses, dental care and regular 
health care checkups and vaccinations.
  For Texas, CHIP is funded from the proceeds of our tobacco settlement 
with the tobacco companies a couple of years ago. It is critically 
important in our State because Texas has the highest rate of uninsured 
in the country. Unfortunately, Texas has the Nation's second highest 
number of uninsured children. The worst problem we have is that not 
enough parents are using this great program.
  South Texas, in particular, has carried the burden of uninsured 
children for many years. About 1.4 million of Texas' 5.8 million 
children lack health insurance, but 470,000 of them are now eligible 
for coverage under CHIP. Almost one-fourth, or 109,000, of the newly-
eligible kids live on the Texas-Mexico border. When children do not 
have the health insurance, they have to rely on costly medical 
treatment at the last minute. This threatens the child's future well-
being. But now we have a true opportunity to change that. CHIP will 
give a lot of children the opportunity to lead healthy lives without 
the fear of getting sick.
  Let me share a quote from a lady from my district who recently went 
through the enrollment process. She said: ``My husband and I are 
hardworking middle-income people who were disqualified from Medicaid 
because I became employed. We have two incomes, and we can't afford 
insurance. Now we are told by the TexCare Partnership we will have 
insurance for our children with low premiums and low copayments that we 
can afford. My children have health care when they need it.''
  CHIP was first implemented in 1998 to address a national crisis, 
almost 12 million children that were without insurance. In Texas, we 
are now able to offer insurance to approximately half a million 
children that otherwise would have none. While we can make this offer, 
it is up to each parent or guardian to enroll or at least inquire about 
getting their children in this program.
  Believe it or not, the hardest part of the CHIP program is getting 
parents to enroll their children. Most parents need to take advantage 
of this genuinely great program. I want to stress that even if a parent 
has never qualified for health insurance for their children before, now 
they can. CHIP solves the cost problem for many Texas families. In 
CHIP, many families will only pay an annual fee of $15 to cover all 
their children in this plan. Some higher-income families will pay 
monthly premiums of $15 or maybe $18 which covers all children in the 
family. Most families will also have copayments for doctor/dental 
visits, prescription drugs, and emergency care. And families must 
reenroll their children once a year.
  Mr. Speaker, children can only get this insurance if their parents 
apply. I hope all parents listening will take the initiative and make 
certain their children are enrolled. The application process is simple 
and straightforward. Any Texan can call my office in McAllen or in 
Beeville to get the number for the CHIP hotline. If parents want local 
assistance or information in my congressional district, they can call 
my office for that number or visit any public library in Hidalgo County 
or in Bee County to pick up a bilingual brochure and application.
  Ms. EDDIE BERNICE JOHNSON of Texas. Could the gentleman tell me why 
we are just beginning to talk about this information since this has 
been available for a while?
  Mr. HINOJOSA. It has been a fight to get the Texas leadership in the 
legislature to move the decision-makers to get this enrollment process 
going. I know that in my office we have been fighting on this for at 
least 18 months. I can assure the gentlewoman that I am delighted to 
see it finally get started, because it will stop the suffering of many 
of the working families that I represent in the 15th District.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I yield to the 
gentleman from Texas (Mr. Lampson).
  Mr. LAMPSON. I thank the gentlewoman from Texas for yielding. Mr. 
Speaker, I rise to address this issue of children's health insurance. I 
want to commend the gentlewoman from Texas (Ms. Eddie Bernice Johnson) 
for the work that she is doing in this regard, the gentleman from Texas 
(Mr. Hinojosa), and the other Members that we are going to be hearing 
from. As a government worker, I am guaranteed that my children will 
have access to quality health care. This knowledge brings me some peace 
of mind. As it stands, many parents in my home State of Texas do not 
have this same peace of mind. In fact, many children who are eligible 
for State or Federal programs are needlessly foregoing quality health 
care or receiving care in expensive emergency situations only.
  As a Member of Congress and as a father, I believe that every family 
deserves to share the peace of mind that I have today. That is why I am 
working to reform the current children's health care insurance system. 
Medicaid and the new State Children's Health Insurance Program, S-CHIP, 
are the two key publicly funded health insurance programs that offer 
coverage for low-income adolescents in Texas today. Medicaid provides 
health insurance coverage for more than 40 million individuals, mostly 
women, children and adolescents, at an annual cost of about $154 
billion in combined Federal and State funds.
  In addition to these funds, S-CHIP made available approximately $48 
billion in Federal funds over 10 years to help States expand health 
insurance coverage to low-income children and youth. S-CHIP works to 
subsidize families with income levels not covered by the Medicaid 
program. Funded with Federal block grant dollars and State matching 
dollars, S-CHIP is a health insurance program for children in families 
who make too much money to be eligible for Medicaid but who cannot 
afford other private insurance options.
  Mr. Speaker, Texas gained a major victory during the 1999 legislative 
session when it passed S-CHIP. This State program will help affordable 
health insurance for families earning up to 200 percent of the Federal 
poverty level. The Federal Government currently allows coverage to 
children as high as 300 percent. Together, these programs provide many 
uninsured children in Texas with quality health care.
  While the combination of S-CHIP and Medicaid offers powerful 
opportunities to reduce the percentage of uninsured children in the 
United States, we can do more. Despite the recently passed S-CHIP 
program, my home State still has the second highest rate of uninsured 
children in the country. At the present time, there is a pressing and 
undisputable need for eligibility reforms and aggressive outreach to 
low-income families in Texas. Statistics show that Texas is ineffective 
in retaining low-income kids on Medicaid.

[[Page 9592]]

Part of this failure can be attributed to the red tape that 
unnecessarily burdens the neediest families in Texas. The bureaucratic 
hurdles that must be overcome to receive Medicaid eligibility in Texas 
include a face-to-face interview, an assets test, no continuous 
eligibility, and no presumptive eligibility.
  Fortunately, Texas has been given the opportunity to adopt less 
restrictive methods for counting income and assets for family Medicaid. 
Without these changes, enrollment will continue to be difficult and 
complex for applicant families that are referred to Medicaid, many of 
whom will have a child eligible for CHIP and another one eligible for 
Medicaid.
  Texas can make the system more navigable by implementing a few simple 
changes. These changes include eliminating the assets test for 
children's Medicaid, ending the requirement for face-to-face 
application, adopting uniform statewide documentation and verification 
options for Medicaid and Texas CHIP, and, finally, adopting 12-month 
continuous eligibility for children's Medicaid.
  At a time of unprecedented prosperity, it is untenable for children 
to not have access to basic health care. Even more absurd is the fact 
that many of these sick children are eligible for State and Federal 
health insurance programs. The time to act is now. We cannot sit idly 
by and watch our children suffer needlessly. The solution is in our 
hands.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, this has been 
available now for at least 2 years. We have already talked about the 
fact that when people have a language problem or they live a long ways 
from where they might be able to get health care relief, it is usually 
the lowest income which means usually the least well educated.
  Has Texas taken on any leadership or responsibility to try to be sure 
that we can spread the word to the persons who are eligible?
  Mr. LAMPSON. We certainly should be. We need to spread that word, 
because what it is doing it is encouraging people to go into the most 
expensive areas to seek the care that they need. That may be a hospital 
emergency room. A hospital in my hometown and other hospitals within my 
district are grossly strapped right now because of the closing of so 
many, just as an example, rural health care facilities that have lost 
their ability to continue to offer services across this country.
  As this group of people, the children about which we are speaking 
right now, also find their way into these same facilities, we are 
driving the cost of health care up to the point where it is causing 
others not to have access. Where we can do something about it and help 
fix this problem and make it easier for those to gain the access that 
they so richly deserve and that we want them to have so that their 
health does not have an adverse effect on the rest of us in society, 
then certainly we ought to be taking the opportunity to do it.

                              {time}  1930

  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, according to the New 
York Times, on Sunday, May 21 of this year, Texas had not spent any of 
the dollars allocated to take care of these children that are poor.
  Mr. LAMPSON. Mr. Speaker, if the gentlewoman will yield, that is 
obviously very, very, very wrong. We have the opportunity to help 
children, we have the opportunity to help people, and if we cannot 
reach out and let them know, and make certain that they know about the 
programs that can provide a better quality of life, then we make 
serious mistakes. That is why I commend the gentlewoman for the work 
that she is doing in trying to accomplish just that task.
  We can make a difference in people's lives if the word can reach 
them, if we can do the things that help make their task a little bit 
easier in getting the quality of care that they need and deserve. I 
thank the gentlewoman for doing that, and I thank her for sharing the 
time this evening.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I yield to the 
gentlewoman from Texas (Ms. Jackson-Lee).
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the gentlewoman for 
this emphasis on a very important issue. To even begin to think of the 
great need of children with respect to health care and not respond to 
their need seems to be a travesty and a tragedy.
  I could not help but listen to the dialogue that the gentlewoman had 
with our colleague, the gentleman from Texas (Mr. Lampson). It seems 
certainly that there has been a problem with the leadership from the 
executive of the State of Texas and particularly the Texas Department 
of Health. Although there may be other issues that they have excelled 
on, this is one that has seen a great vacuum in leadership.
  I remember following the work of the State legislature, and many of 
the legislators from the urban centers had to work very hard to ensure 
that the funding for the CHIPs program included children beyond the age 
of 12. The initial effort by the Texas Department of Health and the 
governor's office was to only provide these CHIP monies for children up 
to 12, and many of them with the encouragement of many of us in 
Congress and the questioning of many of us in Congress, asked the 
question: Do you mean a child does not get sick after age 13?
  It seems to me an outrage. I want to applaud those legislators who 
took the leadership and demanded that they address the question of the 
needs of good health care, like Sylvester Turner and Rodney Ellis and 
Garnett Coleman and I am sure that I am leaving out many others around 
the State, who were actively involved in pressing the point that we 
needed to have this kind of funding for children beyond the age of 
children.
  Mr. Speaker, it has already been said that Texas is at the bottom of 
retaining low-income kids on Medicaid since welfare reform in 1996. It 
also has been noted that Texas has the highest rate of uninsured in the 
country, and Texas has the second highest rate of uninsured children in 
the Nation. But what also needs to be noted is that right now in the 
State of Texas, some 500,000 children qualify for CHIP, and that means, 
that symbol that the gentlewoman has, the picture of that baby that 
says, do our children have to really fight, or should our children have 
to really fight to get good health care. With 500,000 children already 
qualifying for CHIP, it seems that we are behind the times in moving 
forward to ensure that this program works. It is well known that Texas 
has been slow compared to other States in implementing CHIP.
  This is not to say that we do not have some very committed health 
professionals in our own local communities who have been begging for 
the CHIP program to be implemented. Children enrolled in Texas CHIP can 
get a comprehensive benefits package which include eye exams and 
glasses, prescription drugs and limited dental checkups and therapy, 
all of the items that provide for a healthy child.
  Just last week in my district, Senator Paul Wellstone and myself held 
hearings on mental health. I know we do not have mental health parity, 
but to hear the parents of children come forward and cry out for needed 
services in mental health for diagnostic services, for counseling 
services, knowing full well that we need to keep working toward parity, 
that is also health care that parents need.
  So we can see that the CHIPS program is long overdue in our 
community. To avoid a logistical nightmare for both the State and 
parents, Texas should act as quickly as possible to implement changes 
in children's Medicare eligibility. To reinforce what has been said, we 
need to eliminate the access test for children's Medicaid. Texas now 
makes parents of Medicaid-eligible children document not just income, 
but also the value of savings, IRAs, automobiles, and valuables. There 
is a lot better way to do it, and we can utilize the Federal law that 
is used by the Federal Government in 40 States, plus the District of 
Columbia.
  It is important to drop the requirement for face-to-face 
applications, recertification interviews, because we realize that 
parents are very busy. We

[[Page 9593]]

should allow mail-in applications. This is not required by Federal law. 
Thirty-eight States, plus the District of Columbia, allow mail-ins. So 
it is important that as we deal with the elimination of assets which 
are not required by the Federal Government, nor required by 40 States, 
we can then make more easier, if you will, the ability for these 
parents to apply and become eligible for CHIP.
  The main point that I think we are trying to impress upon our State 
and the focus of this Special Order that I think is so very important 
is our children are voiceless. Their parents are fighting for them, but 
they are the ones who every time a ballot is cast, a child cannot vote, 
yet they are in need of the good health care that this CHIPS program 
would allow.
  Mr. Speaker, I would hope that the State of Texas would see the value 
of responding to the needs of our children and quickly eliminate the 
complicated process that keeps this CHIPS program from being 
implemented. I think it is important that we get leadership from the 
State, and I think it is most important that the Texas Department of 
Health establish a focus that says in a certain period of time, we will 
ensure that the CHIPS program is working throughout the entire State, 
and that that needs to be done now.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, reclaiming my time, 
statistics tell us that more and more children are being absent from 
school because of asthma, and yet, it has been determined that we have 
one of the worst environments in the Nation, so bad that Oklahoma is 
complaining that we are polluting parts of Oklahoma. If we have this 
available and not making any effort to cover the children while we are 
also providing an environment that is conducive to making them even 
more unhealthy, what does this tell us? Is there any compassion in 
Texas?
  Ms. JACKSON-LEE of Texas. Mr. Speaker, if the gentlewoman will yield, 
it seems like we are lacking a great deal of compassion, and the 
gentlewoman has hit the nail on the head. Healthy children make healthy 
adults. Children are apt to get all manner of childhood diseases and 
ailments. Asthma is one of the most devastating childhood diseases that 
lead into adult asthma. We do have a problem in our respective 
communities with air quality. We are fighting that problem well now. In 
fact, as the gentlewoman well knows, she was one of the supporters, and 
I continue to support, the Mickey Leland Toxic Center that is located 
in the Texas Medical Center that deals with air quality standards and 
does the research on respiratory diseases. We find that many children 
have them.
  I believe that there is no compassion in this State if we cannot get 
the CHIPS program implemented to provide for the children of this State 
when the program has been passed by this Congress under the Balanced 
Budget Act since 1997. This is now the year 2000. Why does not the 
State of Texas, 43rd, if you will, in the care of mental health and 
some very low number, I know, in the care of health period having the 
highest number of uninsured cannot provide the CHIPS program for their 
children. I think that we need to show a great deal more compassion on 
behalf of Texas children and the Nation's children and ensure that 
these children do have insurance to make them healthy children and then 
healthy adults.
  Mr. Speaker, I am happy to rise in support of our nation's increased 
investment in childcare in the form of insurance coverage. A serious 
oversight has occurred when studies and statistics show a large portion 
of children that are not covered by medical insurance.
  Nationally, over 11 million of our nation's children--one in seven of 
those children living in the United States are uninsured. Two-thirds of 
these children live in families with income below 200 percent of the 
poverty level ($33,400 for a family of four in 1999).
  Many escape through the cracks simply because they do not fit the 
description policy makers have in regards to poverty. Low-income 
uninsured children typically live in two-parent, working households and 
have little contact with the welfare system.
  In the same instance, families who are below standard income have the 
misfortune of being undereducated regarding the health benefits they 
and their children have access to through their entitled aide. Forty-
one percent of parents of these eligible uninsured children postponed 
seeking medical care for their offspring because they could not afford 
it.
  A much-needed solution for adolescents who need insurance comes in 
the form of Medicaid and the new State Children's Health Insurance 
Program (CHIP). These two key organizations are publicly funded health 
insurance programs that offer coverage for low-income adolescents.
  These programs enacted by Congress more than thirty years apart, both 
augment and complement each other. While each has distinctly different 
characteristics, together they offer a powerful opportunity to reduce 
the percentage of uninsured adolescents in the United States and to 
increase adolescents' access to health care.
  I must ask that as my colleagues deliberate this week on the real and 
necessary benefits of the defense appropriations to our nation's 
security, that they also consider the benefit to domestic security, 
which is created by their support of health care for all of our 
nation's youth.
  Medicaid provides health insurance coverage for more than 40 million 
individuals--most are women, children, and adolescents--at an annual 
cost of about $154 billion in combined federal and state funds.
  Eligibility for Medicaid is determined by each state according to its 
specific guidelines. However, the federal government specifies the 
mandatory eligibility categories and the optional eligibility 
categories.
  Medicaid is significantly affected by several of the mandatory and 
optional eligibility categories.
  The State Children's Health Insurance Program made available 
approximately $48 billion in federal funds over ten years to help 
states expand health insurance coverage to low-income children and 
youth.
  Federal law permits states to use CHIP funds to expand coverage in 
three ways: through Medicaid expansions; state-designed, non-Medicaid 
programs; or a combination of these two approaches.
  SCHIP, is funded with federal block grant dollars and state matching 
dollars, as a health insurance program for children in families who 
make too much money for Medicaid, but who cannot afford other private 
insurance options.
  SCHIP has extended coverage to an additional 2 million children who 
do not qualify for Medicaid. Yet millions of children are believed to 
be eligible for these programs, but remain uninsured.
  Uninsured youth will benefit from Medicaid and CHIP only if the 
states in which they live chose to extend eligibility and if states 
then work to enroll them. This requires more than working with funding 
for these programs. It entails communicating to the community that 
needs the service that something is available.
  SCHIP benefits depend heavily on program design and state discretion. 
States currently cover children whose family incomes range generally 
from below the Federal poverty level (FPL) to as high as 300 percent of 
poverty.
  Even when adolescents are enrolled in insurance programs that provide 
comprehensive benefits, a number of other factors influenced whether 
adolescents actually receive the services they need. These include 
affordability, confidentiality, and availability of providers with 
expertise and experience in caring for adolescents.
  In Texas the rate of uninsured is higher than any other state in the 
country. In particular Texas has the second highest rate of uninsured 
children in the nation. In an attempt to combat this high rating the 
state of Texas has combined the options available to states in order to 
expand health insurance coverage. This combination includes expansion 
of Medicaid and state-designed, non-Medicaid programs.
  Texas covers children whose family incomes range from below the FPL 
to 200 percent of poverty. The Federal government allows coverage to 
children as high as 300 percent.


                           Texas--Statistics

  Texas has the highest rate of uninsured in the country.
  Texas has the second highest rate of uninsured children in the 
nation.
  There are 1.4 million uninsured children in Texas--600,000 are 
eligible for, but not in Medicaid; nearly 500,000 qualify for CHIP.
  Texas attempt to combats the number of uninsured children by 
combining the options available to states in order to expand health 
insurance coverage. Texas' combination includes the expansion of 
Medicaid and state-designed, non-Medicaid programs.
  At present time, there is a need for eligibility reforms and 
aggressive outreach for low-income health programs in Texas.

[[Page 9594]]

  Texas is at the bottom of retaining low-income kids on Medicaid since 
welfare reform in 1996.
  193,400 Texas children fell off the Medicaid rolls during the past 
three years, a 14.2 percent decline.
  Medicaid data collected finds an increase in the number of people 
enrolled in Medicaid in June 1999 compared to June 1998, but the 
magnitude of this success rate is dampened due to the decline of 
Medicaid in nine states--one of them was Texas.
  The status quo in Texas is that children (up to age 19) in families 
with incomes at or under 100 percent of the federal poverty income 
level (FPL, $14,140 for a family of 3) can qualify for Medicaid.
  Drop the requirement for face-to-face application/re-certification 
interviews for children's Medicaid. (Allow mail-in applications.) This 
is not required by federal law, and 38 states plus the District of 
Columbia allow mail-in application for children. Three states also 
allow community-based enrollment outside the welfare office.
  Adopt and publicize for children's Medicaid the same simple, flexible 
documentation and verification options used for Texas CHIP. To make a 
joint mail-in application feasible, children's Medicaid and CHIP must 
accept the same documents for income and other required verifications. 
Children's Medicaid documentation should be identical statewide, to 
make a true joint CHIP-Medicaid mail-in application possible. Federal 
law allows states to reduce income documentation for children's 
Medicaid in any way, or even to eliminate it in favor of using third-
party verification. Seven states require no income documentation for 
children's Medicaid.
  To avoid a logistical nightmare for both the state and parents, Texas 
should as quickly as possible implement changes in children's Medicaid 
eligibility. Without these critical changes, enrollment will be 
difficult and complex for the many applicant families that are referred 
to Medicaid--many of whom will have one child eligible for CHIP, and 
another eligible for Medicaid. States already implementing CHIP report 
that large proportions of applicants end up in Medicaid. The changes 
needed are as follows:
  Eliminate the assets test for children's Medicaid. Texas now makes 
parents of Medicaid-eligible children document not just income, but 
also the value of savings, IRAs, automobiles, and valuables, etc. The 
test is not required by federal law, and 40 states plus the District of 
Columbia have already dropped in for children.
  Recent federal law changes allow states to cover parents in families 
with children up to any income limit the state chooses.
  Texas has been given the choice to adopt less restrictive methods for 
counting income and assets for family Medicaid; for example, states can 
increase earned income disregards, and alter or eliminate asset tests.
  Texas has been slow compared to other states in implementing CHIP.
  Children enrolled in Texas CHIP will get a comprehensive benefits 
package--includes eye exams and glasses, prescription drugs, and 
limited dental check-ups, and therapy.
  CHIP does not serve as an alternative to Medicaid for those families, 
who based on their income, are eligible for Medicaid.
  Adopt 12-month continuous eligibility for children's Medicaid. 
Children enrolled in Texas CHIP stay enrolled for 12 months, regardless 
of any changes in income during that period. In Texas Medicaid, parents 
must report any income change within 10 days, and Medicaid is cut off 
the next month if the new family income is too high for Medicaid. 
Twelve-month eligibility for Children's Medicaid is a state option 
Congress created when it passed CHIP. This was done in an effort to 
allow for identical policies in Medicaid and CHIP, and promote 
continuity of health care. Fifteen states have adopted continuous 
eligibility for Children's Medicaid, and Ohio will begin the policy 
July 2000.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I thank the 
gentlewoman very much.
  I yield to the gentleman from Texas (Mr. Bentsen).
  Mr. BENTSEN. Mr. Speaker, I thank the gentlewoman for yielding.
  Let me first start out by commending the gentlewoman for having this 
Special Order to talk about the CHIPs program and the need for greater 
access to health care for children in this country. As the gentlewoman 
knows, back in 1997, we were part of an effort to start the CHIPs 
program, this was a Federal effort. I was pleased to be a member of the 
House Committee on the Budget when the 1997 Balanced Budget Act, the 
reconciliation bill, was crafted and ultimately passed and signed by 
the President. I think there is a certain amount of credit that is due 
the President as well for his steadfast support for this program.
  It is correct that unfortunately, our State, and as a proud Texan I 
have to say it is unfortunate that our State was a little late in 
getting a CHIPs program up and running. The legislature, which meets 
biennially, did not get a chance to take this up or did not choose to 
take this up until 1999.
  I think it is a little ironic when some of us were saying that the 
legislature should move on this, that the governor perhaps should call 
a special session to address this very popular bipartisan program, that 
with fear that Texas might ultimately lose some funds, we now see that 
the other body has decided to borrow from some of the funds that 
Congress set aside back in 1997 from the tobacco tax for this. We do 
know that Congresses have a way sometimes of borrowing and failing to 
repay those funds. So I am a little nervous that Texas might lose out 
as a result of that.
  Mr. Speaker, I watched with great interest when our legislature had 
the debate over whether to cover at 150 percent or 200 percent of the 
poverty level. I think the legislature, under the leadership of Speaker 
Pete Laney, did the right thing in going to 200 percent, and that will 
begin to address what is really a health care crisis in Texas and a 
health care crisis across the country with uninsured children.
  When we were doing the 1997 act, we estimated that there were 10 
million children across the country without insurance; about 3 million 
of those are Medicaid-eligible children and the rest are children of 
working families who make too much money to be in the Medicaid program 
but do not get health insurance through the workforce or choose not to 
take it but cannot afford to buy it on their own.
  Now, with respect to that, as my colleague from Houston just talked 
about, in terms of the Medicaid program, there is no question that we 
could do a much better job of enrolling children in Medicaid. I have 
offered, and I think the gentlewoman is a cosponsor, a bill, H.R. 1298, 
that would give schools the ability to grant presumptive eligibility 
for children who might be eligible, who are eligible for Medicaid, in 
the same way that the 1997 act gave that to Federal health care 
workers.
  Our colleague, the gentlewoman from Colorado (Ms. DeGette) has a bill 
that would extend that same ability to grant presumptive eligibility to 
what are called SCHIP workers, State Children'S Health Insurance 
workers as well, so that we would have the ability of not only 
enrolling children in the CHIPs program, but also enrolling those 
children who are Medicaid eligible in the Medicaid program.
  One of the unfortunate facts of our home State of Texas is that we 
lead the Nation in the number of Medicaid-eligible children who are not 
enrolled in the program, about 800,000 kids in Texas who should be in 
the Medicaid program.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, reclaiming my time, 
there has been a whole legislative session that has come and gone since 
these dollars have been available, and as of May 21 of this year, we 
had not used any of the dollars allocated for Texas. Can the gentleman 
think of any reason why we have denied these children the right to 
health care when there is nothing standing in the way between them and 
health care enrollment?
  Mr. BENTSEN. Mr. Speaker, if the gentlewoman would yield, we hear 
from some that we should not be passing new laws, we ought to be 
enforcing the laws that we have, but sometimes we find from some of the 
people who say that they are not enforcing the laws that are on their 
books, and this is one that ought to be enforced.
  That gets to the point that I was making on Medicaid, why this is 
important. I represent the largest medical center in the world, has the 
largest children's hospital, Texas Children's Hospital, in my district. 
They have an emergency room that was built I think for something along 
the lines of 20,000 emergency room visits a year. They get about 
60,000. Why do they get so many? They get so many because they have a

[[Page 9595]]

lot of children who do not have health insurance who are getting 
ambulatory care, who are getting primary care in the emergency room.
  What is wrong about that? Well, one, it overwhelms the system, but 
the other problem is the cost structure. As the gentlewoman well knows 
from her professional career before Congress, the cost structure is 
much higher in the emergency room. A lot of these kids who could have 
gotten more preventive care if they had been receiving regular primary 
care, and from the Federal standpoint, and this is something that those 
of us in the Congress, as stewards of the Federal taxpayer and the 
budget, should be concerned about is the way that is funded are two 
ways.
  One, it is funded by the hospitals picking up the cost any way they 
can, and the other is the Federal Government picks up 100 percent of 
the tab through the disproportionate share program.

                              {time}  1945

  This becomes a big problem, because the States share the Medicaid 
program with the Federal government, as the gentlewoman knows, and at 
least they could be picking up 40 percent of the tab for these 800,000 
kids in Texas who ought to be in the program, rather than having the 
Federal government pick up the entire tab.
  As the gentlewoman knows, we reduced the Medicaid DSH program in the 
1997 Act. We were able to hold the line in Texas because of the good 
work she did and others in the delegation. But it only makes sense that 
we ought to enroll these kids in the Medicaid program, we ought to get 
full enrollment in the CHIP program. In the long run, it will be 
cheaper than having to continue to fund huge dollars through the DSH 
program.
  Beyond the bottom line aspect, it is the right thing to do, because 
we want to have healthy kids in Texas, we want to have healthy kids 
across this country. It is the compassionate conservative thing to do, 
but it is not enough to care. It is to care enough to do it.
  The gentlewoman is on the right track with her special order. We have 
much more work to do in this area. We need the leadership to get this 
done, to get these kids enrolled, to make the changes in the Medicaid 
law so that we can get more kids in there, and we will have a healthier 
and a stronger society by it. I commend the gentlewoman for having this 
special order.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, the gentleman from 
Texas (Mr. Green) could not be here, but he left a statement. I notice 
in the statement, in his congressional district, which is also in the 
Houston area, at least 70 percent of the children in the Aldine School 
District rely on the school nurse for primary health care services, or 
as their initial health care provider. That does not have to be, and it 
should not have to be.
  We have too many children who are not getting any kind of attention 
in Texas. We cannot allow this to continue. It is ironic that we talk 
about how great we are, this big, wonderful State, with the greatest 
prosperity in the history of the State. We have all of these children 
starting out, without the availability of health care, a full life 
perhaps with chronic illnesses because they do not have access to the 
care that they deserve, and they can have it. They would have it if we 
had a Texas government that had enough compassion to enroll them in the 
program.
  Nobody wishes to be poor, no one wishes to be uneducated, no one 
wishes to be a long ways from various health care outlets. But when 
that happens, the entire State ought to have access to that care. They 
need to be informed and they need to be enrolled. This is simply not 
the time to turn our heads and pretend this is not going on. It is not 
the time to simply say to poor kids, get back, be quiet, you might make 
us look bad.
  We have got to give attention to these poor kids who are kids of 
working parents, low-income parents, who do not have access to health 
care that taxpayers are willing to pay for. The money is available. 
Texas has access to the money and refuses to use it. Is that 
compassion, I ask the Members? Is this America? This is not what we 
stand here and fight for, and what we fund each day.
  We tried to be very sure that when welfare reform came, that our poor 
kids would not fall through the cracks. We did our part at this level. 
It is time for the State of Texas to look up and acknowledge that 
though we have much wealth, we have the largest number of poor kids 
being neglected. In a State where you can hardly breathe the air, we 
have kids who are getting their lungs injured every day simply because 
they do not have access to care that has been paid for. We simply 
refuse to use it.
  Mr. Speaker, I call upon all of my colleagues to join me in making a 
plea to the State of Texas, my home State. I was born in the State and 
I know the State. I served there in the House and in the Senate. This 
callousness must not continue, and certainly we must not allow it to 
spread in this Nation.
  Mr. Speaker, I include for the Record the statement of the gentleman 
from Texas (Mr. Green).
  The statement referred to is as follows:
  Mr. GREEN of Texas. Mr. Speaker, it is hard to believe that, here in 
the world's richest country, one in seven American children does not 
have health insurance.
  Yet, in the midst of our Nation's longest and strongest economic 
expansion, the health of over 11 million of our children is being 
jeopardized.
  In the Houston region, over a quarter million children are uninsured.
  In my Congressional district, at least 70% of children in the Aldine 
Independent School District rely on the school nurse for primary 
healthcare services or as their initial healthcare provider.
  Our children deserve better.
  Congress created Medicaid, and later the new Children's Health 
Insurance Program (CHIP), to offer coverage for low-income children.
  These two programs are an investment in good health--an investment 
that pays dividends in the long term because prevention saves taxpayers 
money.
  They have reduced the percentage of uninsured children and parents in 
the United States. And, they have increased access to quality health 
care services.
  Medicaid provides health insurance coverage for more than 40 million 
individuals--mostly women, children, and adolescents--at an annual cost 
of about $154 billion in combined federal and state funds.
  Eligibility for Medicaid is determined by each state according to its 
specific guidelines.
  States have wide discrepancy in determining what optional benefits 
will be given, who will be eligible for those benefits and the 
procedure used to grant the benefits.
  While Medicaid has benefited the poorest of the poor, it has not been 
able to address a second group of uninsured--the working poor.
  In 1997, Congress passed the Children's Health Insurance Program or 
CHIP, which made available approximately $48 billion in federal funds 
over ten years to help states expand health insurance coverage to low-
income children and youth.
  Federal law permits states to use CHIP funds to expand coverage in 
three ways: through Medicaid expansions; state-designed, non-Medicaid 
programs; or a combination of these two approaches.
  CHIP, funded with federal block grant dollars and state matching 
dollars, is a health insurance program for children in families who 
make too much money for Medicaid, but who cannot afford other private 
insurance options.
  CHIP has extended coverage to an additional 2 million children who do 
not qualify for Medicaid. Yet millions of children are believed to be 
eligible for these programs, but remain uninsured.
  Uninsured children will benefit from Medicaid and CHIP only if the 
states in which they live chose to extend eligibility and if states 
then work to enroll them.
  States currently cover children whose family incomes range generally 
from below the Federal poverty level (FPL) to as high as 300% of 
poverty.
  While some states moved very quickly to insure low-income children, 
Texas did not. In the first year in which funds were available, the 
State of Texas expanded Medicaid coverage for children at or below 100 
percent of the federal poverty line.
  This resulted in 58,286 children ages 15-18 having insurance. More 
than 102,000 remained uninsured, even though they were eligible for 
coverage under the old federal Medicaid rules. This was a very slow 
start.
  However, thanks to the efforts of the Texas Legislature during the 
76th Legislative Session, our state is making progress.

[[Page 9596]]

  Because of the efforts of Senator John Whitmore and Representative 
Kevin Bailey, Texas created a separate children's health insurance 
program for children at or below 200 percent of the federal poverty 
line.
  This will provide health insurance for 500,124 Texas children through 
age 18. In my region, this means 90,802 children will have health 
insurance.
  While this is a good development, we still have a long way to go.
  Other states are further along in providing health coverage for 
children. In the first year of the program, Texas expanded coverage for 
58,286 children. By comparison, Alabama enrolled 38,980 children; 
California enrolled 222,351 children; Florida enrolled 154,594 
children; Georgia enrolled 47,581 children; Massachusetts enrolled 
67,852 children; Missouri enrolled 49,529 children; New Jersey enrolled 
75,652 children; New York 521,301 children; North Carolina enrolled 
57,300 children; Ohio enrolled 83,688 children; and South Carolina 
enrolled 45,737 children.
  Of the states that chose to create a separate children's health 
program, many are extending coverage to more children than is Texas, 
including California at 250 percent; Connecticut at 300 percent; New 
Jersey at 350 percent; Vermont at 300 percent; and Washington at 250 
percent.
  Texas can do more. And we should do more. We have the highest rate of 
uninsured persons in the country.
  And, Texas has the second highest rate of uninsured children in the 
nation. Over 41% of parents of eligible uninsured children postponed 
seeking medical care for their child because they could not afford it.
  There are 1.4 million uninsured children in Texas--600,000 are 
eligible for, but not in Medicaid; nearly 500,000 qualify for CHIP.
  Texas covers children whose family incomes range from below the 
federal poverty level to 200% of the federal poverty level. Yet the 
Federal government allows coverage to children as high as 300%.
  Texas, like the rest of the nation, could do more to conduct an 
aggressive outreach to ensure that eligible children receive the 
services they need.
  New outreach is clearly needed--now, more than ever. Like many 
states, after federal welfare reform was enacted in 1996, we saw a huge 
drop in the number of persons applying for and participating in 
Medicaid. 193,400 Texas children fell off the Medicaid rolls during the 
past three years, a 14.2% decline.
  Because these two programs are no longer linked, many lower-income 
persons do not realize that they are eligible for health insurance.
  Unfortunately, Texas is the worst state in the Nation in terms of 
retaining low-income kids on Medicaid.
  And, a recent New York Times article shows that Texas has used none 
of the federal funds it is entitled to for outreach. We can do better.
  Why are so many persons not receiving the Medicaid and CHIP services 
they're entitled to?
  Red tape burdens the neediest families in Texas.
  Medicaid program eligibility requirements in Texas include:
  A Face-to-face interview
  An Asset test
  No continuous eligibility--families must periodically re-enroll
  No presumptive eligibility--even if families have proven that they 
are eligible for another program with the same income guidelines, they 
must go seven states (Texas included) expanded coverage to only 100 
percent of the as quickly as possible implement changes in Children's 
Medicaid eligibility.
  Texas can take steps now to reduce it's state government bureaucracy. 
For example, the state could:
  Eliminate the assets test for children's Medicaid. Texas now makes 
parents of Medicaid-eligible children document not just income, but 
also the value of savings, IRAs, automobiles, and valuables.
  The test is not required by federal law, and 40 states plus the 
District to Columbia have already dropped it for children.
  Texas could also drop the requirement for face-to-face application/
recertification interviews for children's Medicaid and allow mail-in 
applications.
  Thirty-eight states plus the District of Columbia allow mail-in 
application for children. Three states also allow community-based 
enrollment outside the welfare office.
  Texas could adopt for children's Medicaid the same simple, flexible 
documentation and verification options used for Texas CHIP. To make a 
joint mail-in application feasible, children's Medicaid and CHIP must 
accept the same documents for income and other required verifications.
  Federal law allows states to reduce income documentation for 
children's Medicaid in any way, or even to eliminate it in favor of 
using third-party verification. Seven states require no income 
documentation for children's Medicaid.
  The state could adopt 12-month continuous eligibility for children's 
Medicaid. Children enrolled in Texas CHIP stay enrolled for 12 months, 
regardless of any changes in income during that period.
  In Texas Medicaid, parents must report any income change within 10 
days, and Medicaid is cut off the next month if the new family income 
is too high for Medicaid.
  Texas could also adopt twelve-month eligibility for Children's 
Medicaid--this continuous eligibility is a state option Congress 
created when it passed CHIP. Fifteen states have adopted continuous 
eligibility for Children's Medicaid, and Ohio will begin the policy in 
July 2000.
  Hopefully, my colleagues in the state legislature will consider some 
of these ideas as they continue their push to expand health care to the 
uninsured.
  Thanks to their efforts, Texas has done many good things in the past 
year to reduce the number of uninsured children. We can certainly do 
more. I am hopeful that successful state partnerships like Medicaid and 
CHIP will be used by the state to their full potential.

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