[Congressional Record (Bound Edition), Volume 148 (2002), Part 14]
[Senate]
[Pages 19423-19429]
[From the U.S. Government Publishing Office, www.gpo.gov]




                   UNANIMOUS CONSENT REQUEST--S. 724

  Mr. BINGAMAN. Mr. President, today, once again, I will rise for the 
purpose of asking unanimous consent to take up and pass S. 724. I will 
withhold doing that until Senator Nickles is able to come to the floor. 
I understand he wishes to address the issue.
  This is a subject I raised last week here in the Senate. S. 724 is 
the Mothers and Newborns Health Insurance Act of 2001. It was reported 
by the Senate Finance Committee unanimously in July. It is legislation 
which was introduced by Senators Bond and Breaux and would simply give 
States the option of covering pregnant women in the State Children's 
Health Insurance Program, or the CHIP program, for the full range of 
pre- and postpartum care.
  This legislation did pass out of the Senate Finance Committee by 
unanimous vote. It includes language we incorporated in an earlier 
bill, S. 1016, which was the Start Healthy, Stay Healthy Act of 2001 
introduced by me and supported by Senators Lugar, McCain, Corzine, 
Lincoln, Chafee, Miller, and Landrieu, and it provides children with 
continuous health care coverage throughout the first and most fragile 
year of life.
  According to the Centers for Disease Control, the United States ranks 
21st in the world in infant mortality and 26th in the world in maternal 
mortality. For a nation as wealthy as ours, these statistics are simply 
unacceptable.
  Unfortunately, the regulation the administration issued last week to 
allow unborn children to be covered by the State Children's Health 
Insurance Program, or CHIP, leaves pregnant women out of that equation. 
That is contrary

[[Page 19424]]

to the clinical guidelines of the American College of Obstetricians and 
Gynecologists. It is contrary to the guidelines of the American Academy 
of Pediatrics. Both organizations indicate that the woman and the 
unborn child need to be treated together.
  If you are covering only the fetus, as this regulation that came out 
last week purports to do, this eliminates important aspects of coverage 
for women during all the stages of birth, pregnancy, delivery, and 
postpartum care. The various health services that pregnant women could 
be denied, without passage of this legislation, were elaborated on the 
Senate floor earlier. We need to do better by our Nation's mothers than 
we have done so far. This legislation will do that.
  Let me also make it clear, though, that this bill is about children's 
health. Senator Bond's bill appropriately is called the Mothers and 
Newborns Health Insurance Act. It is given that title for a very good 
reason. We all know the importance of an infant's first year of life. 
Senator Bond's legislation, as amended in our committee, the Finance 
Committee, provides 12 months of continuous coverage for children after 
they are born.
  Again, the United States ranks 21st in the world in infant mortality. 
We need to do a better job by our Nation's newborn infants just as we 
need to do a better job by our Nation's mothers. The rule that was 
passed last week does provide an option for 12 months continuous 
enrollment to States, but it makes the time for that 12 months 
retroactive to the period that the child was in the womb. Therefore, if 
9 months of pregnancy were covered, the child would lose coverage in 
the third month after birth. Potentially lost would be a number of 
well-baby visits, immunizations, and access to pediatric caregivers.
  This legislation, S. 724, which was introduced by Senator Bond, has a 
large number of bipartisan cosponsors. Senator Daschle is a cosponsor. 
Senator Lott is a cosponsor. Many others of my colleagues are 
cosponsors.
  Last Wednesday, we tried to pass S. 724 and objections were raised. 
Senator Nickles asked a number of questions, and Senator Lincoln and I 
prepared some detailed responses. We made several points in those 
responses. Let me just summarize those.
  First, with regard to the cost of this legislation, the bill is 
almost entirely offset over the first 5 years it would be in existence, 
and it actually saves money over the 10-year period.
  With regard to whether the administration supports the bill, 
Secretary Thompson has repeatedly expressed support for passage of 
legislation, including specifically mentioning support for S. 724 and 
companion legislation in the House. He has done that on two occasions.
  With regard to whether the regulation eliminates the need for 
legislation, the regulation itself notes that it leaves many gaps in 
coverage that the rule creates, including denials of care for pregnant 
women through pregnancy, through delivery, and through postpartum care.
  With regard to the burden this bill could place on States, the 
legislation would simply allow States the option to expand coverage to 
pregnant women through the CHIP program, or not to expand that 
coverage, as they choose. States that do not wish to expand coverage 
would not be compelled to do so. The National Governors Association 
believes all States should have that option. Therefore, the NGA has 
specific policy in support of expanding options to cover pregnant women 
through this CHIP program.
  I ask unanimous consent to have printed in the Record the more 
detailed response Senator Lincoln and I sent to Senator Nickles with 
respect to the objections and questions he raised on the floor last 
Wednesday.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                  U.S. Senate,

                                  Washington, DC, October 4, 2002.
     Hon. Don Nickles,
     Assistant Minority Leader,
     Capitol, Washington, DC.
       Dear Senator Nickles: On Wednesday, October 2, 2002, we 
     tried to pass by unanimous consent bipartisan legislation by 
     Senators Bond and Breaux, the ``Mothers and Newborns Health 
     Insurance Act'' (S. 724), which passed the Senate Finance 
     Committee in July by unanimous consent. The legislation has a 
     number of bipartisan cosponsors, including Senators Daschle 
     and Lott.
       We were unable to proceed with passage of this important 
     legislation to cover pregnant women due to the objection you 
     raised, which, you stated, were based on questions you wanted 
     answered prior to passage. Through this letter and 
     attachment, we have addressed all the issues that you raised. 
     Therefore, we will once again ask for unanimous consent to 
     proceed to passage next week, and we hope we can count on 
     your support.
       Thank you for your immediate consideration. The health of 
     many of our nation's mothers and children await this 
     important action by the Senate.
           Sincerely,
     Jeff Bingaman.
     Blanche L. Lincoln.
       Attachment.

                   Questions and Answers About S. 724

       Question. How much does the bill cost and what is the 
     offset?
       The CBO estimate of the pregnant women bill was $611 
     million over five years and $1.08 billion over 10 years prior 
     to the issuance of the rule. The legislation also uses SSI 
     pre-effectuation reviews as the offset, with a savings of 
     $279 million over 5 years and $1.34 billion over 10 years. 
     Over ten years, there is a net savings to the passage of this 
     legislation.
       However, according to the Administration, the cost of their 
     rule is $330 million between fiscal years 2003 and 2007. With 
     that taken into account, the cost of passage of pregnant 
     women coverage would drop to $281 million over five years. As 
     a result, the overall net cost of the bill would be almost 
     nothing over five years and would save money over the 10-year 
     period.
       Question. . . . It's just my understanding that Secretary 
     Thompson has promulgated a reg[ulation] which I believe he 
     thinks satisfies a lot of the unmet health care needs of 
     children, including unborn children, and . . . so he supports 
     the reg[ulation] that he's promulgated and is now effective 
     and does not support the legislation which goes far beyond 
     the reg[ulation] that he's just promulgated . . . Maybe he 
     did make a statement that was supportive in March but he may 
     well feel like that was accomplished in the reg[ulation].
       Department of Health and Human Services (HHS) Secretary 
     Tommy Thompson has stated repeatedly his support for the 
     passage of legislation to allow states the option to cover 
     the full range of health services to pregnant women through 
     the State Children's Health Insurance Program (SCHIP), and 
     specifically mentioned S. 724 on at least one occasion.
       In a statement issued on January 31, 2002, Secretary 
     Thompson praised Senators Bond, Breaux and Collins for 
     ``bipartisan leadership in supporting S. 724, a bill that 
     would allow states to provide prenatal coverage for low-
     income women through the SCHIP program. We support this 
     legislative effort in this Congress.''
       In testimony before the Senate Finance Committee on 
     February 14, 2002, Secretary Thompson expressed support for 
     legislation expanding coverage to pregnant women rather than 
     states having to seek waivers.
       In testimony before the House Labor-HHS Appropriations 
     Subcommittee on March 6, 2002, Secretary Thompson said, ``And 
     so, if you can pass the bill [the House companion bill to S. 
     724 introduced by Representatives Hyde and Lowey], we don't 
     need the rule.'' He added, ``Let's pass the legislation.''
       In a letter to Senator Bingaman dated April 12, 2002, 
     Secretary Thompson wrote:
       ``Prenatal care for women and their babies is a crucial 
     part of medical care. These services can be a vital, life-
     long determinant of health, and we should do everything we 
     can to make this care available for all pregnant women. It is 
     one of the most important investments we can make for the 
     long-term good health of our nation.
       ``As I testified recently at a hearing held by the Health 
     Subcommittee of the House Energy and Commerce Committee, I 
     also support legislation to expand SCHIP to cover pregnant 
     women. However, because legislation has not moved and because 
     of the importance of prenatal care, I felt it was important 
     to take this action [of issuing regulations].''
       Repeatedly, Secretary Thompson has expressed support for 
     legislation over the past year. As to whether he now thinks 
     the rule eliminates the need for legislation, it is important 
     to note that HHS issued a waiver on September 27, 2002, to 
     Colorado requested by Republican Governor Bill Owens to cover 
     pregnant women through SCHIP. The Colorado waiver was issued 
     on the same day the Secretary issued a press release on the 
     rule to allow coverage to ``unborn children'' through SCHIP. 
     As Secretary Thompson is quoted, ``Approved this waiver means 
     that thousands of uninsured women and their babies will be 
     able to get health care coverage.'' This is the third wavier 
     granted by Secretary Thompson to cover not just ``unborn 
     children'' but pregnant women, as previous waivers were given 
     to Rhode Island and

[[Page 19425]]

     New Jersey. Clearly, the Republic Governor of Colorado did 
     not think the rule fully covered their desire to provide 
     coverage to pregnant women.
       HHS acknowledges in the regulation that the rule covering 
     ``unborn children'' does not fully cover pregnant women and 
     is in lieu of legislation being passed by Congress to provide 
     care to pregnant women. The regulation also acknowledges that 
     despite the rule that ``there are still gaps'' and that 
     waivers are not a fully acceptable way to address them. As 
     the rule reads:
       ``This regulation bridges a gap in eligibility between the 
     Medicaid and the SCHIP programs that has now existed for five 
     years. Members of the Congress have also recognized this gap 
     and have introduced various pieces of legislation over the 
     years to address this gap. The opportunity to expand vital 
     health insurance coverage during a critical time is at hand.
       ``We welcome all of these suggestions for expanding health 
     insurance coverage and indeed States and the Secretary have 
     already used the flexibility in current regulations. However, 
     there are still gaps. We also welcome support for the actions 
     of the Secretary in granting waivers to States . . . But the 
     Secretary's ability to intervene through one mechanism (a 
     wavier) should not be the sole option for States and may in 
     fact be an inferior option. Waivers are discretionary on the 
     part of the Secretary and time limited while State plan 
     amendments are permanent, and are subject to allotment 
     neutrality.''
       The rule explains what gaps still exist. For example, the 
     rule highlights what cannot be covered for women via care to 
     ``unborn children.'' If you only are covering the fetus, this 
     eliminates important aspects of coverage for pregnant women 
     during all the stages of a birth--pregnancy, delivery, and 
     postpartum care. Among other things, pregnant women would not 
     be covered during their pregnancy for cancer, medical 
     emergencies, accidents, broken bones, or mental illness. Even 
     life-saving surgery for a mother would appear to be denied 
     coverage.
       Further, during delivery, coverage for epidurals is a state 
     option and is justified only if the health of the child is 
     affected. On the other hand, anesthesia is covered for 
     Caesarean sections. The rule would wrongly push women and 
     providers toward performing C-sections to ensure coverage.
       And finally, during the postpartum period, women would be 
     denied all health coverage from the moment the child is born. 
     Important care and treatment, including but not limited to 
     the treatment of hemorrhage, infection, episiotomy repair, C-
     section repair, family planning counseling, treatment of 
     complications after delivery (including, once again, life-
     saving surgery), and postpartum depression would not be 
     covered.
       Question. I'm also going to check with the states, because 
     I also believe this is an expansion of Medicaid, which I know 
     my state is struggling to pay. As a matter of fact, actually 
     reducing payments in some cases in Medicaid because they just 
     don't have the budget. And, our state health director . . . 
     has told us don't increase any new expansions on Medicaid 
     because we can't afford it . . . Pregnant women [are eligible 
     for Medicaid] with incomes less than 185% of poverty . . . 
     and I believe this legislation would take that up to 300%. 
     So, it would make many more people eligible for Medicaid 
     which would also increase the costs to the states, which some 
     states can't afford it.
       The legislation provides for an expansion of coverage for 
     pregnant women, at a state option, through the State 
     Children's Health Insurance Program (SCHIP).
       As the Committee report (Senate Report 107-233) reads:
       ``The Committee bill allows states to cover additional 
     pregnant women under SCHIP. The SCHIP expansion group 
     includes pregnant women with family income above the state's 
     Medicaid financial eligibility standard for pregnant women in 
     effect on January 1, 2002, up to the income eligibility for 
     SCHIP children in effect as of January 1, 2002 . . .
       ``Current federal law enables low-income pregnant women to 
     receive coverage under SCHIP through age 18, but it does not 
     provide such coverage to women ages 19 and above. While 
     states have the ability to add SCHIP coverage for pregnant 
     women over age 18 through Section 1115 waivers, states find 
     this process to be both time-consuming and administratively 
     burdensome. The Committee bill allows states to cover 
     pregnant women through the simpler state plan amendment 
     process. The committee bill also eliminates the disparity in 
     coverage levels between pregnant women and infants that has 
     been created through SCHIP, enabling both mothers and their 
     newborn children to immediately receive health coverage under 
     the program.''
       According to the Congressional Research Service (CRS), 38 
     states and the District of Columbia provide coverage up to 
     200% of poverty or less. States cannot exceed those levels of 
     coverage through SCHIP beyond the levels of poverty covered 
     for children.
       Also, if a state cannot afford an expansion of coverage to 
     additional pregnant women, they do not have to. It is a state 
     option. However, it allows those states that choose to expand 
     coverage to pregnant women to do so without having to seek a 
     waiver, just as the regulation has done for ``unborn 
     children.''
       As a result, there is strong support for this legislation 
     from the National Governors' Association. Their policy 
     position (H.R.-15. ``The State Children's Health Insurance 
     Program (S-CHIP) Policy'') expresses strong support for 
     passage of such legislation. As it reads:
       ``The Governors have a long tradition of expanding coverage 
     options for pregnant women through the Medicaid program. 
     However, pregnant women in working families are not eligible 
     for SCHIP coverage. The Governors call on Congress to create 
     a state option that would allow states to provide health 
     coverage to income-eligible pregnant women under SCHIP. This 
     small shift in federal policy would allow states to provide 
     critical prenatal care and would increase the likelihood that 
     children born to SCHIP mothers would have a healthy start.''
       States are partners with the federal government in Medicaid 
     and SCHIP. They are asking for additional state flexibility 
     in coverage options here that should be granted by the 
     passage of S. 724. The ``Mothers and Newborns Health 
     Insurance Act of 2002.''

  Mr. BINGAMAN. Mr. President, again, at the appropriate time, once 
Senator Nickles has arrived in the Chamber, I will rise once again to 
seek unanimous consent that we be allowed to bring up and pass S. 724, 
as passed out of the Finance Committee.
  Mr. President, I am informed Senator Nickles will not be able to come 
to the floor in the near future. Therefore, I will go ahead and make 
the unanimous consent request at this time.
  I ask unanimous consent that the Senate proceed to the immediate 
consideration of Calendar No. 541, S. 724; that the committee 
substitute be agreed to, the bill be read a third time and passed, the 
title amendment be agreed to, the motions to reconsider be laid on the 
table, with no intervening action or debate, and that any statements 
related to the bill be printed in the Record.
  The ACTING PRESIDENT pro tempore. Is there objection?
  Mr. THOMAS. Mr. President, on behalf of several of our Members who 
want to talk, I object.
  The ACTING PRESIDENT pro tempore. Objection is heard.
  Mr. BINGAMAN. Mr. President, I see my colleague from New Jersey is 
here to speak. He has been a strong supporter of this legislation from 
the time it was first introduced. I will yield the floor at this time 
so he may speak.
  The ACTING PRESIDENT pro tempore. The Senator from New Jersey.
  Mr. CORZINE. Mr. President, I, too, rise in support of the efforts 
about which Senator Bingaman was speaking. Senator Bond, Senator 
Lincoln, and the Presiding Officer have also been supportive of working 
to expand the access to prenatal care for pregnant women. I thank all 
those involved for efforts to pass this legislation.
  I have to say I am disappointed we are not able to get this unanimous 
consent, given the overwhelming support in the Finance Committee. There 
was unanimous passage there of all the elements Senator Bingaman just 
spoke about with regard to funding. I will speak to it a bit myself.
  But this is something that, given our record as a nation, being 21st 
in the world with regard to deaths of children at birth, just is hard 
to understand--why we are not taking the steps to address this fact and 
give those States the flexibility to deal with it.
  As I said, I am pleased the Finance Committee unanimously passed the 
legislation, S. 724, which includes, as the Senator from New Mexico 
mentioned, the major provisions of legislation we introduced about 18 
months ago called Start Healthy, Stay Healthy. Many of us have been 
supportive of that legislation.
  The bipartisan bill, as it now stands, seeks to expand pregnancy-
related care to low-income women who fall above Medicaid eligibility 
levels. Under this bill, pregnant women would be eligible for the full 
spectrum of prenatal and postpartum care, as recommended by the 
American Academy of Pediatrics and the American College of 
Obstetricians and Gynecologists.
  Unfortunately, what many of us believe is noncontroversial 
legislation is being held up for reasons of which I am not completely 
certain. There were a number of questions raised last week by the 
Senator from Oklahoma which

[[Page 19426]]

have been answered in detail in a letter about which the Senator from 
New Mexico spoke. But the main objection is that it somehow contradicts 
a rule published by the Bush administration to expand health insurance 
to unborn children but not to pregnant women.
  Actually, many of us believe this legislation complements the 
administration's rule and will result in pregnant women receiving more 
comprehensive pre- and postnatal care, which will clearly result in 
healthier births and give newborns a better start in life.
  Furthermore, S. 724, as amended, guarantees health coverage to 
children born to eligible women until age 1 regardless of income 
eligibility. The administration's rule would only guarantee that health 
care for 3 months of their lives. So we think it does an outstanding 
job of broadening the coverage to make sure that kids really do start 
healthy and that they will stay healthy as they go forward in their 
lives.
  The administration has stated that the goal of its new rule is to 
increase a woman's access to prenatal care. I think all of us applaud 
that. I certainly do. Why, then, is the woman explicitly left out of 
that rule? For example, under the administration's rule, it is 
uncertain whether pregnant women will be offered treatment for ailments 
that may not be directly related to pregnancy.
  For instance, under the administration's rule, a pregnant woman would 
not be eligible to receive care for cancer, diabetes, medical 
emergencies, accidents, broken bones, or mental illness. It is also 
unclear whether or not a woman would be provided certain types of care 
during delivery. In order to have an epidural covered, for instance, a 
doctor would have to certify that it was in the best interest of the 
fetus.
  Finally, the rule provides for absolutely no postpregnancy care. 
Treatment of postpartum complications, including hemorrhaging, 
infection, and postpartum depression, would be inaccessible to the 
mother.
  These things are hard to put in the context of what is the desire of, 
I think, most of us to see that there is a good continuum, a good start 
for our children. I think there are some conflicts that are put in 
place by the regulations that would be very hard to enforce and could 
be endangering to both the child and certainly to the mother's health. 
I think they do not meet the commonsense test.
  It contradicts also ACOG's standard of care, which views pregnancy-
related care as including prenatal, labor and delivery, and postpartum 
care. Second, surely we can agree that neglecting the mother's health 
is not the best way to give a newborn a healthy start in life.
  If the administration and Members of Congress are serious about 
providing meaningful health care to pregnant women and their children, 
I believe we should support passage of the bipartisan initiative, S. 
724. This legislation gives the States the option to enroll low-income 
pregnant women into their CHIP programs, a proposal that HHS Secretary 
Thompson has endorsed verbally and in writing many times, which is 
indicated in the letter Senator Bingaman has forwarded to Senator 
Nickles.
  This legislation will provide for all of the care related to the 
fetus outlined under the administration's rule, but it will also 
provide full access to prenatal and postpartum health care, other 
essential health care for pregnant women, and 1 year of continuous 
coverage for newborns.
  Let me be clear, States will still have the option of expanding care 
to fetuses under the administration's rule. But by passing this 
legislation, we would also give the States the option of expanding care 
to pregnant women along the lines of what I talked about earlier.
  My own State of New Jersey has already received a waiver from HHS, 
and a number of other States have; a number are applying. It is 
actually a very complicated and onerous process to get these waiver 
procedures in place. I think we ought to make it legislatively 
appropriate, statutorily appropriate, for all States, so they have the 
choice of moving in this direction if they so choose.
  Every week in our country 8,500 children are born to mothers who lack 
access to prenatal care. This is one of those areas where insurance 
coverage can actually be provided and make a big difference, so we do 
not end up paying more for health care for children who are brought 
into the world in poor health conditions, who then end up costing 
society even more because they have had poor prenatal care. Every day 
we wait to pass this legislation, more children will be born with 
serious health problems because their mothers cannot afford health 
care.
  I hope we can address this issue. There is strong bipartisan support. 
I think it is time to move. I very strongly support the efforts of all 
my colleagues who are pushing for S. 724 and hope we can put the 
politics aside and vote today to pass this important legislation.
  Mr. President, I 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.
  Mrs. LINCOLN. 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.
  Mrs. LINCOLN. Mr. President, I rise today to speak again on the 
importance of passing S. 724, the Mothers and Newborns Health Insurance 
Act, as soon as possible. It is beyond me why in the world we cannot 
move forward on such a practical piece of legislation. This bill will 
make a real difference in the health of thousands of low-income women 
and their babies across our great Nation, not to mention the money it 
is going to save this Nation, because we all know that for every $1 we 
invest in prenatal care, we save anywhere from $5 to $6 down the road. 
It is not only compassionate and good policy, it is also good 
economics.
  Last Wednesday, Senator Bingaman asked for unanimous consent to pass 
this bipartisan bill, but Senator Nickles from Oklahoma objected. Since 
then, Senator Bingaman and I have sent Senator Nickles a letter 
answering the questions he had about this particular legislation.
  It is so important Members understand how critically important this 
piece of legislation is, and that these questions can be answered. With 
those questions answered, it is my hope that we can pass S. 724 today.
  This bill, which we unanimously approved in the Finance Committee, 
gives States the option. They can simply take the option, if they 
choose, of covering pregnant women under the State's Children's Health 
Insurance program. Most importantly, the bill allows coverage for 
prenatal care, delivery, and postpartum care. These are all complete 
parts of delivering healthy children. It is not just one opportunity to 
care for a fetus that is being carried by a woman; it is, more 
importantly, the opportunity to bring that child into the world 
healthy. We all know to do that, we must look at the health of the 
mother in a prenatal situation. We have to look at the delivery, and we 
also have to look at the postpartum care, which is essential for women 
to care for and maintain healthy children.
  I am so pleased we are joined on the floor by some of our colleagues 
who work so hard to improve the health of women and children: Senator 
Corzine, Senators Landrieu and Clinton are leaders in this area. I am 
glad they have all been here or will be here to speak. I understand 
Senator Mikulski, Senator Feinstein, and Senator Lugar have submitted 
statements for their support of S. 724.
  Some of us talk a lot about the importance of process in the Senate. 
Sometimes it does not translate to our colleagues or friends and 
constituents out there in the greater part of our Nation. Some of us 
complain when bills do not go through the regular process of committee 
markups and on to the Senate floor. When we are talking about such an 
important issue, people do understand, when the Senate does not act on 
something that is this critical to the well-being of their life, 
particularly to the health of their children.

[[Page 19427]]

  This bill went through the classic Senate process, as is described in 
Government textbooks. As Senators Bingaman, Bond, and I discussed last 
week, S. 724 unanimously passed the Finance Committee and is now on the 
legislative calendar under general orders. Even better, it has strong 
bipartisan support. Both the majority leader and minority leader have 
cosponsored it. That is because the idea of ensuring a healthy start in 
life is a sound policy, it is good fiscal policy, and it is not a 
partisan issue. I have no earthly idea why we are trying to make it 
one. If we really care about life, the Senate needs to pass this 
commonsense bill.
  I want to make an important point about the necessity of S. 724 in 
light of the administration's regulation that provides CHIP coverage to 
unborn fetuses. This regulation fails to cover the full range of 
medical services needed by a woman during and after pregnancy. Simply 
put, it flies in the face of the Guidelines for Prenatal Care Fourth 
Edition, established by the American College of Obstetricians and 
Gynecologists and the American Academy of Pediatrics, guidelines that 
are used by doctors all across our country.
  Under the regulation, doctors will not be reimbursed for providing 
care they are ethically obligated to provide. In the modern practice of 
obstetrics, postpartum care is absolutely a critical part of the 
overall care and the treatment the women receive prenatally and during 
labor and delivery. Postpartum care is essential for any of us who have 
gone through pregnancies and who have been so blessed to have had good 
prenatal care, who have seen what it can do in the delivery room, by 
providing the ability to go through a healthy delivery, and then, when 
you come out of that delivery, to be blessed and fortunate enough to go 
home within 2 days with your children because you have had good care. 
It is so common sense.
  It is so positive for everybody concerned: The taxpayers who may be 
paying the tax bill or the medical bills, for the individual who wants 
to get off to the right start, the mother who wants to get off to the 
right start, the child who needs to get off to a healthy start.
  We have learned so much about early development in children and what 
it means later on in life in their ability to succeed and learn, how 
critical it is they not be in that neonatal unit, but that they can be 
born healthy, and they can all go home together to start that life off 
correctly.
  We have an opportunity to make a difference in each and every newborn 
life. There is no excuse that we should not move quickly. With rising 
medical malpractice rates, particularly for obstetricians and 
gynecologists, these doctors may simply decide to stop serving CHIP 
patients. This regulation may become another disincentive for doctors 
to participate in programs serving our low-income population.
  Failing to pass S. 724 leaves doctors choosing between following 
clinical guidelines which we know, through research, is the most proper 
care women need; they have to choose between following these clinical 
guidelines they know and trust or getting paid. These decisions will be 
especially hard for doctors who serve high-risk women, given the fact 
postpartum care is even more critical for women who have preexisting 
medical conditions such as diabetes or hypertension--any of these.
  Under the President's order, these women wouldn't get care. They 
could only care for the unborn fetus they are carrying. It makes no 
sense whatsoever that the pregnant woman could not even get the care 
she needed, and the doctor, if giving it ethically, cannot even be 
reimbursed.
  This bill does not overturn the administration's regulation. It 
simply complements it. It makes the regulation better. It clarifies 
that doctors will get reimbursed for the clinical care they provide, 
and it will ensure pregnant women get the full scope of medical care 
they need.
  S. 724 is supported by 25 national organizations, including the 
American Academy of Pediatrics, the American College of Obstetricians 
and Gynecologists, and the March of Dimes. Each of these organizations 
has expressed serious concern with the administration's regulation, and 
believes this bill is better.
  I ask unanimous consent that a complete list of the organizations be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

       Organizations supporting S. 24:
       American Association of University Affiliated Programs;
       American Academy of Pediatrics;
       American College of Nurse Midwives;
       American College of Obstetricians & Gynecologists;
       American College of Osteopathic Pediatricians;
       American Hospital Association;
       American Medical Association;
       American Osteopathic Association;
       American Public Health Association;
       Association of Women's Health, Obstetric and Neonatal 
     Nurses;
       Association of Maternal and Child Health Programs;
       Catholic Health Association;
       Council of Women's & Infants' Specialty Hospitals;
       Easter Seals;
       Family Voices;
       Greater New York Hospital Association;
       March of Dimes;
       National Association of Children's Hospitals;
       National Association of Public Hospitals & Health Systems;
       National Women's Health Network;
       National Association of County & City Health Officials;
       Society for Maternal-Fetal Medicine;
       Spina Bifida Association of America;
       The Alan Guttmacher Institute;
       United Cerebral Palsy Associations.
  Ms. LINCOLN. Mr. President, I thank my colleagues who have joined me. 
In the last few days of the session, let us prove to the American 
people we in the Senate do understand what goes on in their everyday 
lives, we do care, and we can act in ways that will actually make a 
difference in their lives; that we won't sit here and talk about 
process.
  This bill has been through every piece of process there is. Let us 
come together in a partisan way and move forward at least this piece of 
legislation that will make a difference in not only a child's life, a 
woman's life, an entire family's life, a community's life, but in this 
Nation's success.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Louisiana.
  Ms. LANDRIEU. Mr. President, I understand several of my colleagues 
have come to the floor to speak in favor of this piece of legislation 
Senator Lincoln is championing so well and appropriately. I rise to 
take a moment to add my words of support for this very important 
measure.
  I understand the Senator from Missouri will be following me, if 
possible.
  Last year in Louisiana, there were about 67,000 children born. If you 
think about a medium-sized town, that is like a medium-sized town born 
every year.
  The ACTING PRESIDENT pro tempore. The time of the majority has 
expired.
  Ms. LANDRIEU. Mr. President, I ask unanimous consent for 2 minutes.
  Mr. REID. Mr. President, that is fine, as long as the minority gets 
an extra 2 minutes.
  Mr. BOND. Reserving the right to object, I did not hear that.
  Mr. REID. I said as long as the minority gets an extra 2 minutes.
  Mr. BOND. I appreciate that.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Ms. LANDRIEU. Mr. President, 67,000 babies were born in Louisiana 
last year. It would be most certainly in the interest not only of those 
particular children and those particular families but the community 
that reaches out, in the broader sense, to the people of our Nation to 
make sure those new babies, and their moms who are delivering them, are 
coming into the world in the healthiest way possible. Not only does 
that help us across the board in health issues, it helps us because 
then we are better able to educate those children because they have 
been born in a healthy manner, we are more able to reach out and 
prevent all sorts of illnesses and diseases and mental health problems, 
and save the taxpayers of this country billions of dollars.

[[Page 19428]]

  So the Senator from Arkansas is so right. The rule proposed in the 
House falls short. Let us pass this bill that encompasses the health of 
children and their mothers and give them the prenatal care they need to 
get these children born healthy for their own benefit and for the 
benefit of the taxpayers in our Nation.
  I thank the Senator from Missouri for his strong leadership on this 
issue as well.
  I yield the floor.
  The PRESIDING OFFICER (Ms. Landrieu). The Senator from Missouri is 
recognized.
  Mr. BOND. Mr. President, I thank my colleagues for giving me the 
opportunity to rise today in support of the unanimous consent request 
to consider and pass S. 724, the Mothers and Newborns Health Insurance 
Act of 2001. I believe the bill is essential to the health care of 
children and pregnant women in America. Thus, I am proud to be an 
original sponsor of the legislation with Senator Breaux and Senator 
Collins.
  The goal of the legislation is quite simple: To make sure more 
pregnant women and more children are covered by health insurance so 
they have access to the health care services they need to be healthy.
  This legislation would simply give the States the option and 
flexibility to cover low-income pregnant women in the State Children's 
Health Insurance program, which we call SCHIP, for the full range of 
necessary prenatal, delivery, and postpartum care.
  Let me reiterate, this is a choice for the States, should they choose 
to exercise it. No State, under this bill, is required, or forced, to 
expand coverage to additional pregnant women. This bill merely provides 
States the option.
  This bill will complement the administration's final rule that allows 
States to expand SCHIP coverage to an ``unborn child'' by covering 
additional vital health care services for the pregnant mother that the 
rule, unfortunately, does not cover.
  The rule attempts to treat the unborn child without treating the 
mother. This approach is in direct conflict with the clinical 
guidelines set forth by the American College of Obstetricians and 
Gynecologists and the American Academy of Pediatrics, which state a 
pregnant woman and the ``unborn child'' must be treated together. It 
certainly makes common sense to a layperson, but there is a 
professional opinion that the two cannot be treated separately.
  It is simply counterintuitive to deny coverage for disease 
management, medical emergencies, accidents, broken bones, mental 
illness, or surgeries for the mother during pregnancy. Failure to treat 
the mother in such circumstances will have a direct and profound effect 
on the health and development of her unborn child.
  In addition, under the rule, during delivery, coverage for epidurals 
is a State option and is justified only if the health of the child is 
affected. On the other hand, anaesthesia is covered for Caesarean 
sections. The rule would wrongly push women and providers toward 
performing more C-sections to ensure coverage for epidurals--a choice 
which is more expensive and, in most cases, a much harder road to 
recovery for the mother.
  Finally, after delivery, women would be denied all health coverage 
from the moment the child is born. Important care and treatment, 
including the treatment of hemorrhage, infection, episiotomy repair, C-
section repair, and the treatment of complications after delivery would 
not be covered.
  This bill will work hand in hand with the administration's rule by 
giving States the flexibility and option to treat the mother and child 
together and provide the full range of necessary prenatal, delivery, 
and postpartum care--care which is essential to the health and well-
being of both the mother and the baby.
  No health care program that ignores this fact can fully address the 
issue of children's health care. This bill will eliminate the illogical 
disconnect between pregnant women and babies.
  This bill has strong bipartisan support in both the Senate and the 
House, as well as the endorsement of the National Governors Association 
and 25 other national organizations, including the March of Dimes, 
American Academy of Pediatrics, American Public Health Association, 
National Association of Children's Hospitals, American College of 
Obstetricians and Gynecologists, and the Catholic Health Association.
  In addition, Secretary Thompson, in the past, has voiced his strong 
support for this legislation.
  In fact, in a January 31, 2002, press release on the administration's 
rule, Secretary Thompson congratulated Senators for ``bipartisan 
leadership in supporting S. 724, a bill that would allow States to 
provide prenatal coverage for low-income women through the SCHIP 
program.'' He went on to say, ``We support this legislative effort in 
Congress.''
  All women need prenatal care. Young or old, first baby or fifth, all 
mothers-to-be benefit from regular care during pregnancy.
  Studies have shown that an uninsured pregnant woman is much less 
likely to get critical prenatal care that reduces the risk of health 
problems for both the woman and the child. Babies whose mothers receive 
no prenatal care or late prenatal care are at-risk for many health 
problems, including birth defects, premature births, and low birth-
weight.
  We know prenatal care improves birth outcomes and can save money. 
According to the National Center for Health Statistics, infants born to 
mothers who receive no prenatal care or late prenatal care are nearly 
twice as likely to be low birth weight.
  Moreover, low birth weight and pre-term births are one of the most 
expensive reasons for a hospital stay in the United States with 
hospital charges averaging $50,000--an especially serious financial 
issue for families without health insurance.
  A report by the IOM entitled Health is a Family Matter notes, 
``Infants of uninsured women are more likely to die than are those of 
insured women. In one region of West Virginia, the fetal death rate 
dropped from 35.4 to 7.0 per 1,000 live births after introduction of a 
prenatal care program for the uninsured.''
  In addition to ensuring better health outcomes, research and state 
experience suggests that covering pregnant women is a highly successful 
outreach mechanism for enrolling children.
  I thank Senator Bingaman for his leadership in the Finance Committee 
on this issue. With his help, this bill passed the Finance Committee in 
the beginning of August by unanimous consent.
  Madam President, studies have shown time and time again that babies 
born to mothers receiving late or no prenatal care are more likely to 
face complications--which results in hospitalization, expensive medical 
treatments and ultimately increased costs to public programs. We must 
close the gap in coverage between pregnant mothers and their children 
to improve the health of both and to address more fully the issue of 
children's healthcare.
  This is crucial legislation, and urge my colleagues to join me in 
support of it so that we can pass this bill.
  I yield the floor.
  Mrs. FEINSTEIN. Mr. President, I rise today to voice my support for 
immediate passage of the Mothers and Newborns Health Insurance Act of 
2001, as reported by the Senate Finance Committee in July.
  This important legislation would simply give States the option to 
provide health insurance coverage to pregnant women under the State 
Children's Health Insurance Program. Such coverage would include the 
full range of care, both during pregnancy and postpartum.
  This means that a pregnant women would have access to epidurals 
during the birthing process and any health-related services necessary 
postpartum. It also means that a pregnant women who has other health 
conditions, such as diabetes or high blood pressure, would be able to 
receive treatment for such disorders. Even life saving surgery for a 
pregnant woman appears to be not covered under the propose rule.
  Keeping the mother healthy is not only in her best interest, but 
clearly in

[[Page 19429]]

the best interest of the child. Providing a mother with access to 
health care services could help ensure that her child will have the 
opportunity to be raised by a healthy mother who will hopefully live a 
long life.
  Additionally, providing the mother with access to health care 
services during pregnancy could also help eliminate complications 
during childbirth and postpartum. This could potentially cut down on 
health care costs.
  Passage of this legislation is particularly important since last week 
the administration issued a final proposed rule that would give States 
the option to provide health insurance through SCHIP to a fetus. No 
mention is made of providing the same coverage to the woman carrying 
the fetus. Woman are completely left out of the equation. It simply 
makes no sense to issue a regulation that provides for health insurance 
for a fetus but not the woman preparing to give birth. In my mind, it 
makes more sense to simply expand access to prenatal and postpartum 
care.
  In a country as prosperous as the United States, it is disturbing 
that we still rank 26th in the world in maternal mortality. This could 
all be avoided if we only did a better job of ensuring that all 
pregnant women, regardless of their income or status, had access to the 
full-range of health care services throughout the continuum of their 
pregnancy.
  Currently under SCHIP, only women under the age of 19 are covered for 
pregnancy-related services. However, what happens to a woman who turns 
20 halfway through her pregnancy? A 20-year old woman would not be able 
to access the same services under current law but would certainly need 
access to prenatal and postpartum care to ensure a safe pregnancy and 
maximize the chances of giving birth to a healthy child. This 
legislation would eliminate this discrepancy.
  States can currently apply for a waiver to provide coverage to 
pregnant women. Many States have applied for such a waiver. The waiver 
process is often burdensome and timely. Why not just give all States 
the option to provide such coverage?
  HHS Secretary Thompson himself said on March 6, 2002, before the 
House Labor-HHS Appropriations Subcommittee: ``And so, if you can pass 
the bill, we don't need the rule. Let's pass the legislation.''
  I echo Secretary Thompson's sentiment. In the remaining days of 
Congress, let's pass this commonsense legislation. It is a good 
investment. It will help protect our Nation's pregnant women by 
providing them with access to vital health care services, and will help 
ensure that our Nation's children are born to healthy mothers who have 
been given the foundation necessary to lead a long and healthy life.

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