[Congressional Record (Bound Edition), Volume 149 (2003), Part 5]
[Extensions of Remarks]
[Pages 5873-5874]
[From the U.S. Government Publishing Office, www.gpo.gov]




         INTRODUCING THE MEDIKIDS HEALTH INSURANCE ACT OF 2003

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Tuesday, March 11, 2003

  Mr. STARK. Mr. Speaker, I join with 34 colleagues to introduce the 
MediKids Health Insurance Act of 2003, which will provide universal 
health care for our nation's children through a new Medicare-like 
national program with benefits tailored toward children.
  Sen. Jay Rockefeller is introducing a companion bill in the Senate. I 
am grateful to Senator Rockefeller for his leadership and commitment to 
this issue. We are introducing the bill at this time in recognition of 
the national educational and awareness campaign that has named this 
week ``Cover the Uninsured Week.''
  Despite Medicaid and the implementation of the S-CHIP program, more 
than 9 million children are still without health insurance in America 
today. Now, with states facing severe budget crises, past expansions of 
Medicaid and S-CHIP are in real danger. In fact, with 35 states 
currently facing budget shortfalls that must be resolved this year, the 
number of uninsured children will grow. The outlook for the next fiscal 
year looks even more fiscally challenging for states. Programs like 
Medicaid and S-CHIP are the most vulnerable for eligibility and service 
provision reductions due to fiscal crisis.
  The number of uninsured children is more than a statistic. It 
reflects the harsh reality experienced by many families--80% of whom 
are working families--who are forced to delay or do without needed 
medical care for their precious children. And, what does the research 
tell us about children brought up under these circumstances? Compared 
to those with health insurance, uninsured children have poorer health 
and higher mortality; they miss more school and have lower educational 
achievement; and they are less successful as adults in the workforce.
  The MediKids Health Insurance Act is a real solution to the growing 
problem of children without health insurance. Our bill will guarantee 
health insurance for all children in the United States regardless of 
family income. Importantly, it would be a fully-federal program so that 
children's health care would not change from state to state as it does 
today.
  The program is modeled after Medicare, but the benefits are tailored 
toward children. MediKids is financed like the Medicare Part B program 
with families paying a premium of 25% of the value of the program and 
the rest financed through general revenues. Premiums for MediKids would 
be collected each year when their parents' file their taxes. There is 
also a generous low-income subsidy for families phasing out at 300% of 
poverty.
  MediKids would not override other forms of health insurance for 
children. Parents who have other coverage for their children--employer-
sponsored insurance, individual policies, S-CHIP, Medicaid, or other 
policies--could maintain that coverage. But, if something happens and 
that coverage is no longer available, their children could always rely 
on MediKids for coverage. If the family moves, MediKids follows the 
children across state lines. And, no longer would kids get caught with 
no health insurance coverage if their parents are climbing out of 
welfare.
  Enrollment in MediKids is simple with no complicated paperwork or re-
determination hoops to jump through. When children are born or legally 
immigrate to this country, the parents are automatically given a 
MediKids insurance card and information on the benefits. For those 
children who are already born, the bill authorizes presumptive 
eligibility and enrollment at out-stationed sites such as 
Disproportionate Share Hospitals and Federally Qualified Health Centers 
to simplify outreach efforts. Once the program is fully phased in no 
outreach will be needed because enrollment into the program will be 
automatic.
  Both children's advocates and the health care professionals who care 
for children support our legislation. Endorsing organizations include: 
the American Academy of Pediatrics, the Children's Defense Fund, the 
American Academy of Child and Adolescent Psychiatry, the American 
Nursing Association, FamiliesUSA, the March of Dimes, the National 
Association of Children's Hospitals, the National Association of 
Community Health Centers, the National Association of Public Hospitals 
and Health Systems, the National Health Law Program, and NETWORK: a 
Catholic Social Justice Lobby. These providers and children's advocacy 
groups are united around the concept that children deserve access to 
continuous health insurance. MediKids meets that goal.
  The successful future of our society rests in our ability to provide 
our children with the basic conditions to thrive and become healthy, 
educated and productive adults.
  Guaranteeing continuous health care coverage is a necessary component 
for us to realize the potential of our future. This is not only a good 
investment; it is also a noble goal and obligation that we must 
fulfill. I look forward to working with my colleagues and with the many 
supporting organizations for the passage of the MediKids Health 
Insurance Act of 2003.
  Below is a short summary of the bill.

          Summary of the MediKids Health Insurance Act of 2003

       The MediKids Health Insurance Act provides health insurance 
     for all children in the United States regardless of family 
     income level by 2009. The program is modeled after Medicare, 
     but the benefits are targeted toward children. Families below 
     150 percent of poverty pay no premium or copays, while those 
     between 150 percent and 300 percent of poverty pay a 
     graduated premium up to 5 percent of their income and receive 
     a graduated refundable tax credit for cost sharing expenses.
       The MediKids enrollment process is simple with no re-
     determination hoops to jump through because it is not means 
     tested. MediKids follows children across state lines when 
     fan-Lilies move, and covers them until their parents can 
     enroll them in a new insurance program. Moreover, MediKids 
     fills the gaps when families climbing out of poverty become 
     ineligible for means-tested programs. It provides security 
     for children until their parents can obtain reliable health 
     insurance coverage.


                               ENROLLMENT

       Every child born after 2004 is automatically enrolled in 
     MediKids, and those children already born are enrolled over a 
     5-year phase-in as described below. Children who immigrate to 
     this country are enrolled when they receive their immigration 
     cards. Materials describing the program's benefits, along 
     with a MediKids insurance card, are issued to the parent(s) 
     or legal guardian(s) of each child. Once enrolled, children 
     remain enrolled in MediKids until they reach the age of 23.
  Parents may choose to enroll their children in private plans or 
government programs such as Medicaid or S-CHIP. During periods of 
equivalent alternative coverage, the MediKids premium is waived. 
However, if a lapse in other insurance coverage occurs, MediKids 
automatically covers the children's health insurance needs (and a 
premium will be owed for those months).


                                PHASE-IN

       Year 1 (2005) = the child has not attained age 6.
       Year 2 (2006) = the child has not attained age 11.
       Year 3 (2007) = the child has not attained age 16.
       Year 4 (2008) = the child has not attained age 21.
       Year 5 (2009) = the child has not attained age 23.


                                BENEFITS

       The benefit package is based on Medicare and the Medicaid 
     Early and Periodic Screening, Diagnosis, and Treatment 
     (EPSDT) benefits for children, and includes prescription 
     drugs. The benefits will be reviewed annually and updated by 
     the Secretary of Health and

[[Page 5874]]

     Human Services to reflect age-appropriate benefits as needed 
     with input from the pediatric community.


                   PREMIUMS, DEDUCTIBLES, AND COPAYS

       Families up to 150 percent of poverty pay no premiums or 
     copays. Families between 150 percent and 300 percent of 
     poverty pay a graduated premium up to 5 percent of their 
     income and receive a graduated refundable tax credit for cost 
     sharing expenses. Parents above 300 percent of poverty are 
     responsible for a small premium equal to one fourth of the 
     average annual cost per child. Premiums are collected at the 
     time of income tax filing. There is no cost sharing for 
     preventive and well childcare for any children; all other 
     cost sharing mimics Medicare.


                               FINANCING

       Congress would need to determine initial funding. In future 
     years, the Secretary of Treasury would develop a package of 
     progressive, gradual tax changes to fund the program, as the 
     numbers of enrollees grows.


                                 STATES

       Medicaid and S-CHIP are not altered by MediKids. These 
     programs remain the safety net for children until MediKids is 
     fully implemented and appropriately modified to best serve 
     our nation's children. Once MediKids is fully operational, 
     Congress can revisit the role of these programs in covering 
     children.
       To the extent that the states save money from the 
     enrollment of children into MediKids, states are required to 
     maintain those funding levels in other programs and services 
     directed toward the Medicaid population. This can include 
     expanding eligibility or offering additional services. For 
     example, states could expand eligibility for parents and 
     single individuals, increase payment rates to providers, or 
     enhance quality initiatives in nursing homes.

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