[Congressional Record (Bound Edition), Volume 153 (2007), Part 15]
[House]
[Pages 21445-21447]
[From the U.S. Government Publishing Office, www.gpo.gov]




                                 SCHIP

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 18, 2007, the gentleman from Texas (Mr. Burgess) is recognized 
for half the time until midnight as the designee of the minority 
leader.

[[Page 21446]]


  Mr. BURGESS. Madam Speaker, I come to the floor tonight for what was 
to be the leadership hour, but the hour has gotten so late that this 
will really only be a few minutes of discussion on the reauthorization 
of the State Children's Health Insurance Program, the program known as 
SCHIP.
  This program was introduced 10 years ago by a Republican House of 
Representatives. It was a bipartisan plan to help low-income children 
to have health care coverage. This program was to be reauthorized in 10 
years' time. That 10 years is up on September 30, 2 months from 
tonight.
  We all agree, on both sides of the aisle, that we want to make sure 
children of low-income families have the health care coverage that they 
need. But, Madam Speaker, we are also anxious to be certain that we 
don't do so at the expense of senior citizens on Medicare. We would 
like to make sure we don't raise taxes to do this. And a lot of us are 
concerned about permanently expanding yet another entitlement program. 
Anyone who reads the newspaper today knows that we already have trouble 
with the entitlement programs that are already there.
  The problems with the bill that has been introduced by the Democrats 
that we had read in our committee last week: the Democratic bill 
reauthorizes the SCHIP program as a permanent entitlement, $159 billion 
over 10 years. One of the biggest problems is there is no income limit 
for SCHIP eligibility. Current SCHIP guidelines are for families at or 
below 200 percent of the Federal poverty limit. Some States go higher 
than that. But, Madam Speaker, look what happens when you go to these 
higher levels:
  The current authorization, again, is for 200 percent of the Federal 
poverty limit; 50 percent of those children actually already are 
covered under a private insurance or Medicaid. As you go to 
successively higher income limits, between 300 and 400 percent of 
poverty, nearly nine out of ten children are already covered on a 
private insurance plan or Medicaid. The SCHIP program, by expanding it 
to these levels, will crowd these individuals out of private insurance 
and drive them onto government-subsidized health care. I would ask you 
if that is the best expenditure of our Federal health care dollar.
  The open-ended Federal funding in the program proposed by the 
Democrats allows States to go over their budget. It shifts children 
participating in private insurance to government insurance. A child is 
now defined as an individual up to 25 years of age, and, once again, 
adults are covered under this plan, which really has been one of the 
failings of the previous SCHIP authorization.
  A big problem is cutting Medicare Advantage plans by $157 billion, 
denying seniors access to plans that have enjoyed widespread popularity 
in areas where they have been introduced. It cuts Medicare provider 
payments, reduces inpatient hospital payments, cuts skilled nursing 
facilities and home health care, and reduces payments for imaging and 
oxygen or mobility devices.
  It does increase taxes. It creates an entirely new tax, one that has 
yet to be scored by the Congressional Budget Office on all private 
health insurance plans, an assessment, if you will, on private health 
insurance plans. It increases taxpayer liability for immigrants and 
illegal aliens. It eliminates the 5-year waiting period for people who 
are in this country legally to participate in Medicaid and CHIP. 
Wisely, a moratorium for 5 years was placed on SCHIP and Medicaid so 
that people would not seek to come to this country simply to 
participate in the welfare state but would come because they wanted to 
be good citizens and be workers and produce in this country. More 
pernicious, in my opinion, is allowing illegal aliens to receive 
Medicaid and SCHIP by weakening citizen verification standards.
  A net cost of $76 billion over 10 years certainly flies in the face 
of fiscal responsibility. And, more importantly, it repeals the trigger 
that was put in the Medicare Modernization Act 3 years ago that would 
require the President and the Congress to reaffirm if Medicare 
expenditures went above a certain amendment.
  Madam Speaker, there is a right way to do this, and I don't want to 
get too bogged down in process because the time available to me is very 
short, but recently we underwent an FDA reauthorization bill in my 
committee, the Committee on Energy and Commerce. It went through 
subcommittee. It went through full committee. And at the end of the 
day, we had a bill that was much better than the bill that was 
originally delivered to us, the committee print of the bill.
  We weren't allowed to do that on the SCHIP bill. The subcommittee 
legislative markup was completely eliminated. We just bypassed it. We 
didn't even do it. The committee print was dropped on the minority 
members of the committee some 24 hours before we had the legislative 
markup in full committee. There was no time to evaluate this nearly 
500-page bill that had many, many new provisions in it. And as a 
consequence, many of those on my side of the aisle felt it was 
inappropriate to deal with such a large transformational piece of 
legislation in such a short time interval.
  Now, it is important to note that there is a Republican alternative 
out there. It is called the Barton-Deal SCHIP reauthorization, and I 
think this is a balanced approach to actually getting back to the 
original intent of what the State Children's Health Insurance Program 
was, in fact, to be: a program for low-income children. The original 
intent was to cover those children whose parents made too much for them 
to be covered under Medicaid, but not enough to be on private health 
insurance. That gap between 150 percent of poverty and 200 percent of 
poverty was identified as the level at which SCHIP benefits really 
would have the maximum impact.
  And in the Barton-Deal reauthorization legislation, it allows States 
to continue that program, but after a State covers at least 90 percent 
of the children that should be covered, they can then expand that 
coverage up to 250 percent of the Federal poverty level. The Federal 
poverty level for a family of four would be about $41,000 per year at 
the 200 percent of poverty. At 250 percent of poverty, it is about 
$51,000 or $52,000 a year for a family of four
  The SPEAKER pro tempore. The time of the gentleman from Texas has 
expired.
  Mr. BURGESS. Madam Speaker, I ask is there anyone to claim time?
  The SPEAKER pro tempore. There being no Democrats here, the gentleman 
from Texas is recognized for the remaining time until midnight.
  Mr. BURGESS. Madam Speaker, under the Barton-Deal plan, new enrollees 
would be strictly limited to services provided to children and pregnant 
women with household incomes under 200 percent of the Federal poverty 
level. And, again, when those States can demonstrate that they are 
covering the 90 percent of the kids in the bracket, then they could 
expand to the 250 percent of poverty level.
  Under the Barton-Deal plan, it does require citizenship to be 
verified. Many people in my district, certainly many people across the 
country, feel very strongly about this position, and I have heard from 
constituents even just this morning in a community coffee in a small 
town in north Texas. This was something that people were very vocal 
about it.
  Once again, we need to reaffirm that the SCHIP program was designed 
for children who were in need, not for children who had access to 
health care coverage by other means. The Barton-Deal plan does allow 
for some individual choice in health care and really, once again, 
reaffirms that the ``C'' in SCHIP stands for children. And, indeed, 
that is as it should be.
  I also want to draw Members' attention to the fact that in the 
Democratic bill they do attempt to deal with the physician payment cuts 
that many doctors are going to see. The way they have gone about this, 
though, I believe is a flawed process. A much better process is one 
that has been put forth in H.R. 2585, which would actually be a repeal 
of what is called the SGR formula. That is the thing that has been

[[Page 21447]]

bedeviling physicians for years and years, certainly since I first came 
to Congress. This is good legislation that should be looked at. If a 
Member is concerned about being able to provide or postpone or 
eliminate those provider cuts that are going to happen to physicians in 
future years, I don't think the SCHIP bill gets you there. I don't 
think it takes you far enough to where you want to be. Indeed, there 
are exclusions for 2008 and 2009, but what happens after 2010? You 
basically fall off a cliff again. And that is the problem we have had 
year in and year out with doing these 1- or 2-year fixes on physician 
reimbursement. H.R. 2585 is a much more sensible way to go about this 
because it actually puts you on a trajectory for repeal of the SGR and 
getting out from underneath the tyranny of that SGR formula once and 
for all.
  And, again, one of the other final things I would mention is that 
there is nothing in this SCHIP bill that makes any impact on one of the 
fundamental problems we have in the practice of medicine today, and 
that is dealing with the liability crisis that we have had in this 
country and that we still have in this country. My home State of Texas 
has made significant strides towards sensible, commonsense liability 
reform. I was hoping we could see language incorporated via the 
amendment process in the SCHIP reauthorization, but apparently that is 
not to be, either.
  Madam Speaker, I know it has been a long day on the floor of the 
House. I appreciate the indulgence of the Chair in allowing me the 
extra time.

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