[Congressional Record (Bound Edition), Volume 153 (2007), Part 16]
[Senate]
[Pages 21566-21603]
[From the U.S. Government Publishing Office, www.gpo.gov]




            SMALL BUSINESS TAX RELIEF ACT OF 2007--Continued

  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, I think we are awaiting the arrival of 
Senator Grassley. While he is getting ready, I could not be more 
pleased to have a better partner than Senator Grassley. He and I worked 
very closely together, and he and I and Senators Hatch and Rockefeller 
worked very hard to put this current legislation together. I thank the 
Senator from Iowa for his dedication and public service. He does a good 
job.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. GRASSLEY. I appreciate those kind remarks. I obviously have 
commented many times on this floor in the last 6 years about the close 
working relationship I have had with him and his efforts, because most 
everything that came out of our committee in the last 6 or 7 years has 
been bipartisan.
  As we all know, nothing gets through the Senate that is not 
bipartisan, and so you might as well start at the committee level if 
you are going to get anything done. I think we have gotten a lot done. 
I thank the Senator for his kind comments.
  Obviously everybody knows we are just beginning, yesterday and today 
and probably this week, and hopefully completing work this week, on the 
State Children's Health Insurance Program. So we are going to 
continually refer to the acronym known as SCHIP.
  This, as I said yesterday, is a product back from 1997, now 
sunsetting 10 years later, by a Republican-led Congress. It is a very 
targeted program, because too often some people giving speeches on the 
floor of this body want to leave the impression, or maybe they think it 
actually is, an entitlement program. This is not an entitlement 
program. An entitlement program is when a program goes on forever, and 
if you qualify, there is automatic access to the program, and 
withdrawal from the Federal Treasury. This program is not an 
entitlement program because it is based upon a specific amount of money 
appropriated for the program. That money has got to be divided up among 
all of the States and among all of the participants. So it is not an 
entitlement.
  I think you are going to hear a lot of debate this week that people 
want you to think this is an entitlement. This program, targeted as it 
is, is designed to provide affordable health coverage for low-income 
children in working families. These families make too much to qualify 
for Medicaid, which is one of those entitlement programs--and 
legitimately an entitlement program--but these are families who earn 
too much to qualify for Medicaid but struggle to afford private 
insurance.
  It is important that we reauthorize this very important program 
targeted for children. The Finance Committee's bill proposes a 
reasonable approach for reauthorizing SCHIP that is the product of 
months of bipartisan work in the committee. I emphasize the word 
``bipartisan.'' As I have said so often, this Finance bill is a 
compromise. I think it is the best of what is possible. Clearly folks 
on the left wanted to do more, and if you did what they wanted to do, 
you would have a Democratic bill. My colleagues on the right wanted to 
do less, and if you did and even go in a different direction, if you 
did what they wanted to do, you would have a Republican-only bill. So 
one way or the other, you have got 51 to 49, and nothing is going to 
get done. You have got to have bipartisanship, because it takes 60 
votes around here to shut off debate, to go to finality.
  Neither side got what they wanted. I would suggest to you this is the 
essence of compromise. This compromise bill maintains the focus on low-
income, uninsured children and adds coverage for an additional 3.2 
million low-income children, children who could presently qualify but 
not enough money is available or States were not doing their job of 
outreach to bring these people in.
  I have heard some harping from different quarters about the role 
Senator Hatch and I have played in developing this important piece of 
legislation. Some on my side, meaning the Republican side, have 
suggested our efforts at finding compromise have been inconsistent with 
advancing the Senate Republican agenda. For a person like me who has 
been chairman of a committee for the last 6 years, getting a lot of 
Republican programs through, I take exception to someone who says I am 
not concerned about Republican principles and getting a Republican 
program, so I want to put this harping in context. I wish to remind the 
critics that we would not have made tax relief law if we had not found 
a way to compromise with Democrats who shared some of our tax reduction 
goals. The bipartisan tax relief plans of 2001, 2003, 2004, and 2006 
could not have passed the Senate on Republican votes only.
  During the 4\1/2\ years of my chairmanship, we were able to enact 
almost $2 trillion in broad-based tax relief that was not tax relief as 
an end in itself but was meant to stimulate the economy, and did 
stimulate the economy to a point where we have had $750 billion more 
coming into the Federal Treasury than anticipated as a result, as 
Chairman Greenspan said, of these tax bills expanding the economy and 
producing 8.2 million new jobs in recent years.
  None of that would have happened if Republicans were working by 
ourselves, just by ourselves. It took bipartisanship to get that done. 
So while the temptation is always there for some Members on both sides 
of the aisle to not engage the other side, rarely if ever will that 
policy result in sustaining itself.
  When it comes to the Republican agenda here, I have not heard any 
Republicans say to me in the 5 months we have been talking about 
reauthorizing SCHIP that we should not provide coverage to low-income 
children. I have not heard anyone say we should not reauthorize this 
specific bill. Quite to the contrary.
  First, the President himself made a commitment to covering more 
children. I wish to refer to the Republican National Committee in New 
York City in 2004, and President Bush was very firm in making a point 
on covering children. Let me tell you what he said.

       America's children must also have a healthy start in life. 
     In a new term [meaning when he was reelected] we will lead an 
     aggressive effort to enroll millions of poor children who are 
     eligible but not signed up for the Government's health 
     insurance program. We will not allow a lack of attention or 
     information to stand between these children and the health 
     care that they need.

  That was back in New York City, early September, 2004. Three months 
later the President is reelected, with a mandate. It seems to me the 
President was very clear in his conviction then. Let me repeat his 
words because I think they are important. He said he would lead an 
aggressive effort to enroll millions of poor children in Government 
health insurance programs.
  President Bush, this is your friend Chuck Grassley, helping you keep 
the promise you made in New York City, and helping you keep your 
mandate that you had as a result of the last election. But somewhere 
the priorities of this administration seem to have shifted. The 
Congressional Budget Office reports that the proposal for SCHIP 
included in the President's fiscal year 2008 budget would result in the 
loss of coverage, not an increase of coverage as the administration had 
been advocating for in the year 2004; and that loss of coverage would 
add up to 1.4 million children and pregnant women.
  Secretary of Health and Human Services Mike Leavitt has also 
supported expanding SCHIP. Secretary Leavitt is the President's Cabinet 
member for health care. When Secretary Leavitt was Governor of Utah, he 
favored expanding SCHIP during a public media availability on SCHIP 
following a meeting with the President.
  Here is what he, now Secretary Leavitt, but then Governor, had to say 
about that meeting:

       There was a discussion on children's health care. A lot of 
     celebration among governors and the President on the 
     successes that we have had in implementing the Children's 
     Health Insurance Program. Over the course of the last couple 
     of years, it has been a very successful partnership. And we 
     discussed [I assume that ``we'' means the President and the 
     Governors] ways in which that could be expanded.

  That is Michael Leavitt.

[[Page 21567]]

  Also there was a Governor Glendenning at that time representing the 
Democratic Governors, holding a roundtable with the President.
  Now, however, Secretary Leavitt wrote the Finance Committee to say 
that the President would veto the Finance Committee's SCHIP bill. But 
even in that letter, he does not call for ending SCHIP. He does not 
suggest we should not cover kids through SCHIP, not at all. Here is 
what he said about SCHIP:

       The President and I are committed to reauthorizing a 
     program that has made a significant difference in the health 
     of lower-income children. Through 10 years of experience and 
     bipartisan support the State Children's Health Insurance 
     Program serves as a valuable safety net for children and 
     families who do not have the means to purchase affordable 
     health care. We are committed to its continuation.

  I appreciate this support in the past for expanding SCHIP from both 
the President and Secretary Leavitt. Now, however, some around here say 
we should not update the SCHIP program regardless of what the President 
said in the past in New York City, regardless of what Secretary Leavitt 
said. These people are basically saying the program is fine as it is 
right now. They want a simple continuation of the current program and 
current funding.
  I will soon say what is wrong with that. But the current program does 
not work, and the current levels of funding will not do the job 
everybody says they want to do. Under current law, the current program 
is authorized to spend $25 billion over the next 5 years. That is if 
this program were not sunsetting, just continuing on as is. That is 
what we call a baseline amount. But the Congressional Budget Office 
says the $25 billion baseline amount will not fully fund the program.
  CBO says that without more funding, 800,000 kids would lose coverage. 
To the chagrin of many Republican Senators and even some Democratic 
Senators, the administration in the last 6 years--in fact, in one case 
in Wisconsin, in the last 3 months--has allowed adults to get covered 
under a program for children. That is not what we intended with the 
Children's Health Insurance Program. SCHIP is for kids, not for adults. 
There is no letter ``A'' in the acronym ``SCHIP.'' A simple extension 
of current law, however, means that adults, about whom everybody is 
complaining for being on a program only for children, would stay on the 
program. A simple extension would also mean more adults would be added. 
Of course, the reason for that is that States will continue in the 
future to ask for waivers and, be those waivers granted, they would be 
free to get approval for more childless adults and parents to be on a 
program that was not intended for anything but children. Covering 
adults drains scarce resources away from what we consider a priority--
children's coverage first.
  We may end up having to pass a short-term extension of the current 
law for a few months before work is finished on this reauthorization. I 
hope not, but that is a possibility. This is something we have to live 
with while Congress finishes work on a final version of the 
reauthorization. If that happens, so be it. But hopefully we can avoid 
a long-term extension of current law.
  The SCHIP formula funding in current law doesn't work either. It 
actually gives less money to States that get their kids covered. That 
doesn't make sense. An extension of current law won't fix the formula.
  The current formula also penalizes small rural States. That is 
because uninsured kids are not counted accurately in small rural 
States. That has resulted in funding shortfalls in those States. An 
extension of current law means this inaccurate funding formula would 
continue. That means more shortfalls for these States.
  Another problem with current law is that there isn't enough funding. 
Under a straight extension of current law, there are going to be 
additional State shortfalls. We dealt with that earlier this year. I 
believe 14, 15, 16 States had shortfalls. The Congressional Budget 
Office says those shortfalls would cause 800,000 kids to lose coverage.
  When Congress has faced these shortfalls in the past, what have we 
done? We just handed out more money to the States. Congress did that on 
three separate occasions. So that would keep those 800,000 kids from 
losing coverage, but this wouldn't fix any of the other problems. In 
fact, it would perpetuate the problems about which everybody is 
complaining--the funding coverage of adults, No. 1; and No. 2, a 
fundamentally flawed formula that our legislation takes care of.
  That is why an extension of current law won't work. More adults? 
Think of all the Senators who have been complaining to me because there 
is no ``A'' in ``SCHIP.'' It wasn't meant to cover adults. It just 
leaves things as they are--more adults. We have a broken funding 
formula. We have some States coming up short. So you have to 
appropriate more money. And most importantly, you have 800,000 kids 
losing coverage. So what other options are there?
  Well, there is the President's proposal. I am not here to bad-mouth 
the President's proposal or any of my colleagues on this side of the 
aisle who are working on proposals. I am not going to, obviously, bad-
mouth anything Senator Wyden is doing in the same respect on the 
Democratic side of the aisle. These policies are good. But I am going 
to tell the President: Now is not the time.
  Going back to the President's program on SCHIP, the President's plan 
is in his budget. It proposes a $4.8 billion increase in SCHIP, but it 
does not work either. What many have overlooked is that the President's 
plan assumes a massive redistribution of about $4 billion in SCHIP 
funds that States have in reserve. So the President assumes States will 
willingly relinquish all of those SCHIP reserves. It assumes the 
Secretary will redistribute those funds to States that currently have 
SCHIP shortfalls. As someone who was worried about State SCHIP 
shortfalls before, worrying about SCHIP shortfalls was cool, I tell my 
colleagues: That dog won't hunt. It is robbing Peter to pay Paul. There 
is no way a proposal that sucks $4 billion out of State coffers will 
ever fly around this Senate.
  That is not all. Under the President's plan, 1.4 million children and 
pregnant women would be cut off of the program between now and 2012; 
1.4 million would lose coverage, to emphasize. That is the end result 
of the President's plan: Rob Peter to pay Paul; 1.4 million children 
losing coverage.
  Then we are going to hear about a more comprehensive plan. This is 
the one I was referring to when I referred to Senator Wyden and when I 
was referring to the President having a proposal and some well-meaning 
people on my side of the aisle. Most of the news is from either Senator 
Wyden or from Republican colleagues of mine, a well-meaning approach, a 
proposal to use the Tax Code to cover many millions of uninsured 
children and adults through private health insurance. Again, I don't 
disagree with that policy, but now is not the time for it.
  I said during Finance Committee consideration of this bill that I 
would have liked the debate about SCHIP to focus on a larger effort to 
address the millions of Americans who are uninsured. I think we are 
missing an opportunity by only focusing this debate on SCHIP 
reauthorization. Too many Americans don't have health insurance, and we 
need to address rising health care costs. That approach will help that 
as well. I agree that we should be doing more, and I want to see 
Congress consider proposals to reform the tax treatment of health care 
to increase coverage for tens of millions of the 46 million people who 
don't have insurance today. But in terms of this bill and the whole 
issue of SCHIP reauthorization, that is not realistic.
  I continue to be disappointed by the fact that there isn't bipartisan 
support for trying to do more as part of SCHIP. I urged the 
administration months ago to get bipartisan support--I emphasize 
bipartisan support because that is the only way we get things done in 
the Senate--if they want the President's initiative to be successful. I 
never saw any effort beyond maybe talking to Senator Wyden. It just 
didn't happen. I looked far and wide. I can't find a single Democratic 
Senator who will support a tax reform alternative to the

[[Page 21568]]

SCHIP bill. Even though it won't happen with this bill, we still need 
to work for a broader package to address the more fundamental problems 
of rising health costs and the uninsured.
  Until then, I see SCHIP as a stopgap measure--5 years in duration, 5 
years to do something bigger. The $35 billion we are investing in 
children's health coverage over the next 5 years is a drop in the 
bucket. When I say $35 billion is a drop in the bucket, somebody will 
say: You have been in Washington too long. Let me explain. That is one-
quarter of 1 percent of the $14 trillion that will be spent on health 
care in this entire country, public and private expenditures, between 
now and the end of this authorization, 2012. Economists generally agree 
that if a condition cannot persist, then it won't persist. The current 
spending on health care cannot persist.
  Members on both sides of the aisle have worked on proposals to 
address the broader issues of the uninsured and health reform overall. 
I have already referred to Senator Wyden as a leader among Democrats on 
this issue. He has Senator Bennett of Utah as a Republican working with 
him. They have been championing a more comprehensive approach to cover 
the uninsured. Many Republican Senators want to make changes in the Tax 
Code to help cover tens of millions of Americans of all ages instead of 
the few million kids whom we do with this legislation. I am looking 
forward to a fruitful debate on this issue of health reform and the 
uninsured through the Senate Finance Committee but not until we 
complete action on this bill. SCHIP must be passed.
  Turning back to the Finance Committee bill, meaning the SCHIP bill 
before us, I am rather surprised at the overheated rhetoric that has 
emerged from both sides of the aisle. It has really been pretty 
unbelievable. On one side, I hear that nothing less than $50 billion 
will do the job, and if that number is not reached, children are at 
risk of dying. On the other side, I hear maintaining coverage for kids 
currently on this program and covering about half the kids eligible for 
Medicaid or SCHIP represents a slippery slope that leads us to the 
Government takeover of the entire health care system. Both sides need 
to call time-out to cool down, stop the hysteria, and take a look at 
what we actually have before the Senate in this Finance Committee 
compromise.
  In 1997, SCHIP was conceived as a capped block grant program, not an 
entitlement. That was very important to Republicans. It is our model 
for how a safety net should work. It is not an open-ended entitlement. 
The Finance Committee bill maintains the block grant. It does not 
create an entitlement. I warn my colleagues, they are going to hear 
this too much, and they are going to hear me wake them up that this is 
not an entitlement. I believe they know better, but we know the game 
that is played around here.
  In 1997, SCHIP was intended to encourage public-private partnerships. 
The Finance bill improves and strengthens private coverage options. In 
1997, SCHIP gave States the tools they needed to control costs. These 
tools included allowing waiting lists, adding reasonable cost sharing, 
and limiting enrollment. The Finance bill maintains the flexibility 
which was in that 1997 act.
  In 1997, SCHIP gave States the flexibility to address geographical 
differences in health care costs. States determine eligibility for 
benefits and tailor the benefits to their needs. The Finance bill 
affirms the States' role in managing this program.
  SCHIP is also a humble program when compared to Medicaid. Medicaid is 
the bigger and more expansive entitlement program. Medicaid is a 
program for low-income individuals, pregnant women, and families. The 
bill before us today represents a modest update of the SCHIP program 
created by the 1997 act.
  So what does the bill before the Senate actually accomplish? The bill 
before the Senate extends the program and fixes problems with current 
law, first, by extending the program that would otherwise expire 
September 30, doing away with the sunset or extending the sunset 5 
years; No. 2, eliminating shortfalls that have plagued the program; No. 
3, eliminating enhanced match for coverage of parents and childless 
adults--in other words, saving money so you spend more on kids; and No. 
4, preserving the original SCHIP mission, coverage of low-income 
children.
  The bill before the Senate continues and focuses coverage on low-
income children by doing the following: No. 1, it provides additional 
resources targeted toward covering low-income children. No. 2, it 
extends coverage for the 6.6 million children currently enrolled in 
SCHIP. I want to emphasize, 91 percent of these families have incomes 
below 200 percent of poverty. No. 3, it covers an additional 2.7 
million children already eligible for Medicaid or SCHIP under current 
law. No. 4, it provides coverage for an additional 600,000 uninsured 
low-income children.
  The Finance Committee bill provides targeted incentives to precisely 
and, more importantly, efficiently cover the lowest income children. It 
does this by doing two things: one, by providing precisely targeted 
incentives that use an incentive fund to encourage enrollment of the 
lowest income children--in other words, go after those with the most 
need--and, two, by encouraging States to increase outreach and 
enrollment.
  The Director of the Congressional Budget Office, Dr. Peter Orszag, 
characterized the incentive fund ``as efficient as you can possibly get 
per new dollar spent.''
  The Finance Committee bipartisan bill also removes childless adults 
and limits payments for parents. It eliminates coverage under SCHIP for 
childless adults within 2 years. Those are the people who are already 
on the program. It eliminates the enhanced match for parents covered 
under SCHIP. It prohibits new State waivers to expand coverage for 
parents.
  Now, again, I wish to emphasize this point. It does away with State 
waivers. You get back to every complaint I hear about this bill. You do 
not hear complaints about covering kids under 200 percent of poverty 
from Republicans or Democrats. But you hear an awful lot from both 
Republicans and Democrats about covering adults because there is no 
letter ``A'' in the acronym SCHIP, and those adults are covered because 
the law allows waivers. So this bill does away with waivers, so you do 
not get the adults on the program the way they have gotten there in the 
past.
  Next, it reduces spending on adults by $1.1 billion.
  Finally, the Finance Committee bill spends less than the $50 billion 
authorized in the budget. Now, once again, let me emphasize, there are 
people around here who say $5 billion in addition to what we are 
spending now is enough. Then, you have people who say only $50 billion 
more than what we are spending now is enough. Somewhere in the middle 
is where you end with compromise.
  Now, for Republicans who are irritated because I am here with a 
bipartisan compromise, along with 16 other members of the Finance 
Committee--17 to 4 this bill was voted out--we are $15 billion under 
what a lot of people in this body would like to spend. I think for some 
people maybe $50 billion would not have been enough.
  Continuing SCHIP with static enrollment would cost $14 billion over 5 
years over the baseline anyway. At $35 billion, the SCHIP 
Reauthorization Act will cost $15 billion less than what was included 
in our budget. This additional funding goes toward coverage of lowest 
income children.
  This bill does not include everything on everybody's wish list. I 
worked hard for a responsible, bipartisan agreement because I wish to 
see this bill pass. I think we have done a good job. But I also wish to 
make one more point very clear. My support for this legislation, in the 
end, will depend upon the outcome of the floor debate and the 
conference. I am not going to be able to support a bill that changes 
significantly from what we have in this proposal.
  I appreciate very much the leadership Chairman Baucus has provided. I 
thank him and Senator Rockefeller for what they did to reach a 
bipartisan agreement.

[[Page 21569]]

  I also extend my sincere thanks to Senator Hatch for the hours and 
hours he has put into this effort. Senator Hatch was the main 
Republican sponsor of the bill that created the SCHIP program 10 years 
ago. His commitment to the ideals and fundamentals of the program is 
steadfast, and the program is better for it.
  I also have to say I am disappointed by the way the Democratic 
leadership is handling the process of bringing this bill up for 
consideration on the floor. It does not bode well for the outcome of 
the bill. In the Senate, process matters as much as policy, and this 
process has not been managed in a bipartisan or responsible manner. 
However, the Finance Committee SCHIP bill is still one I can support. 
It is a compromise. It is based upon reality. This bill is for kids.
  So I will end with an analogy from a child's bedtime story. This bill 
is not too big, it is not too small. It is not too hard, it is not too 
soft. It is not too hot, it is not too cold. It is just right.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, since the Senator from Iowa has been 
talking about the efforts of Senator Bennett and I and how it relates 
to the children's health program, I wish to take a few minutes to 
discuss that relationship.
  First, I think Senator Baucus, Senator Rockefeller, Senator Grassley, 
and Senator Hatch--through the hours and hours of effort they have put 
into making the children's health proposal ready for floor action--have 
done a great service. They have done a great service, first and 
foremost, to the country's kids.
  It seems to me every single Member of the Senate can say today we 
cannot afford, in a country as good and strong and rich as ours, to 
have so many kids go to bed at night without decent health care. As a 
result of the bipartisan work of four Members of the Senate--two 
Democrats and two Republicans--we have laid the foundation to take 
steps immediately to help youngsters who are falling between the 
cracks.
  I have long felt the challenge with respect to health care today is 
twofold. First, you act immediately to help those who are the most 
vulnerable in our society. That is, in fact, what four members of the 
Senate Finance Committee have helped the Senate to promote today. 
Second, we ought to be taking steps on a broader basis to fix health 
care in our country.
  We are spending enough money on health care today. We are not 
spending it in the right places. We are spending enough money today on 
American health care to be able to go out and hire a doctor for every 
seven families in the United States. That doctor would do nothing 
except take care of seven families. Pay the doctor $200,000 a year, and 
my guess is, the distinguished Presiding Officer would probably have 
physicians in the State of Delaware come to him and say, ``Where do you 
go to get your seven families?'' because they would all like to be 
practicing physicians again. So we are spending enough money on health 
care today. We are not spending it in the right places.
  At a time when our population is growing so rapidly, when costs are 
skyrocketing out of control, we need to fix American health care. But 
in order to get to the broader health reform effort--an effort that is 
bipartisan, with Senator Bennett joining me in the first bipartisan 
health reform bill in 13 years--you have to take steps to meet the 
needs of youngsters today.
  The Senate has already said that on multiple occasions. We said it 
first by passing the children's health program, and now, through the 
reauthorization effort, we say kids will come first. We also said it, 
in fact, through the budget resolution, where there was an effort to 
look at the relationship between broader health reform and care for 
kids, and the Senate, again, said children will come first.
  So I am very hopeful. I believe consideration of the children's 
health program is, essentially, the opening bell of round one in the 
fight to fix health care. If we can tackle the issue of children's 
health in a bipartisan way--the way the Senate Finance Committee has 
done--it ought to be possible, even in this session of Congress, to 
move on to broader health reform.
  Now, I am very hopeful the Administration will join in this 
bipartisan effort. We have all read about discussions about a possible 
veto message. I am very hopeful the Administration will join 
discussions in the Senate, join discussions in the other body, and help 
us to move quickly on the issue of children's health.
  If we do that, it ought to be possible, as the distinguished Senator 
from Iowa has indicated, to move on to something the Administration 
feels strongly about, where I happen to think, by and large, they are 
correct. The Federal tax rules, as it relates to health care, are a 
mess. Essentially, they reward inefficiency. They disproportionately 
favor the most affluent. If you are a ``high flier'' in our country, 
you can go out and get every manner of deluxe kind of health service 
and write it off on your taxes; but if you are a hard-working woman in 
Delaware or Oregon or around the country and your company does not have 
a health plan, you get virtually nothing.
  So I come to the floor today to say what Democratic economists have 
said, what Republican economists have said, what the administration 
officials have said: There ought to be an effort to fix the Tax Code as 
it relates to health care, and I and Senator Bennett and others want 
to; and we want to fix it in this session of the Congress. But to get 
at that issue you are going to, first, have to meet the needs of 
children.
  I was asked today what the implications of the children's health 
program are for bipartisanship. I think if this body can pick up on the 
bipartisan work of the Senate Finance Committee, there are 
extraordinary opportunities for broader health reform in this session 
of Congress. I do not think the country wants to wait 3 or 4 or 5 more 
years to fix American health care.
  I have heard the discussion about how there is a Presidential 
campaign coming up, and let's wait another 2, 3, 4 years to talk about 
a more comprehensive effort to fix American health care. I do not think 
any of us got sent here to tell businesses that are trying to compete 
in tough global markets, to tell those who cannot afford the 
skyrocketing premiums: Well, we are not going to work on broader health 
care reform for another 3 or 4 years. I think they want to hear how we 
are going to deal, in a bipartisan way, with the premier domestic issue 
of our time. Senators Baucus and Grassley and Hatch and Rockefeller 
have given us an initial dose of bipartisanship, an initial dose of 
bipartisanship in an area the country cares about, and cares about 
strongly, and that is meeting the needs of our children. But in the 
spirit that Senate Finance Committee quartet has worked, I and Senator 
Bennett and others would like to pick up on that kind of bipartisan 
theme and move aggressively to looking at the health care system as a 
whole and taking steps to transform it.
  I will say, I am struck again by how every single day it seems to me 
opportunities for bipartisanship on health care abound. I was very 
pleased that the nominee to head CMS, the agency that deals with 
Medicare and Medicaid, reacted very positively to our ideas on 
preventive health care. The fact is, in this country, we really don't 
have health care at all. We have sick care. We wait until somebody is 
flat on their back in a hospital--and the Medicare Program shows this 
clearly by paying those bills under Part A of Medicare. Part B of 
Medicare, on the other hand, the outpatient part of Medicare, pays 
virtually nothing for prevention, virtually nothing to keep people 
well.
  We have known about the value of prevention for quite some time. The 
distinguished Senator from Iowa, Mr. Harkin, has been talking about the 
value of health care prevention for years and years. What I and Senator 
Bennett have proposed for the first time under Federal law is that 
Medicare would be given the legal authority to go out and lower 
premiums for seniors who reduce their blood pressure

[[Page 21570]]

and reduce their cholesterol and take the kind of preventive steps that 
everyone understands makes sense and helps to prolong an individual's 
good health and also saves money for the Medicare Program. We were very 
pleased that the nominee to head the agency that deals with Medicare 
and Medicaid was supportive of those changes and indicated he wanted to 
work, if confirmed, in a bipartisan way.
  So the fact is, there are great opportunities for bipartisanship on 
health care in this Congress if we can get past this initial effort at 
addressing American health care. The Senate has indicated, through the 
initial authorization of the children's health program and through the 
budget resolution, that this is the program with which it wants to 
begin the debate on health care.
  In the discussions in the Finance Committee, I followed very closely 
all of the different alternatives. It was a big bipartisan lift to get 
a 17-to-4 vote in the Senate Finance Committee. A lot of colleagues 
wanted to spend more. A lot of colleagues thought the program ought to 
be available to other groups of citizens. Some felt there wasn't much 
of a role for Government at all and that even the existing children's 
health program was too expansive. But the committee came together on a 
17-to-4 basis.
  I see the distinguished Senator from Iowa has returned. If we can 
pass this legislation with the kind of bipartisan support that was 
initially demonstrated in the Senate Finance Committee, I think it is 
very possible, in spite of all of the popular wisdom to the contrary, 
this Senate can achieve broader health care reform in this session of 
Congress. I see one poll after another which indicates that health care 
is the premier domestic issue of our time; that it is the most 
important issue to our citizens--in many polls by something like a 2-
to-1 margin. So I think in addressing this issue today--health care for 
children--the Senate can lay a bipartisan foundation for broader 
reforms.
  I think Senator Bennett and I have provided some direction for the 
Senate to go from here, but we would be the first to acknowledge there 
are many Senators with ideas on these issues, and many of them are 
good. I have already indicated I think the Administration has a valid 
point with respect to these tax rules on health care. The distinguished 
chairman of the Finance Committee is back, and he and I have listened 
to one economist after another testify before the Finance Committee--
Democrats and Republicans--talking about how the Tax Code on health 
care makes no sense and largely comes out of the 1940s.
  So we have Senators of both political parties who would like to work 
on broader health care reform, but first we have to pass this 
legislation. I hope we will pass it with a resounding bipartisan 
majority vote so that we could truly lay the foundation for significant 
and comprehensive health reform to be considered by this body.
  I yield the floor.


                Amendment No. 2538 to Amendment No. 2530

  Mr. GRASSLEY. Madam President, for Senator Ensign, I send an 
amendment to the desk and ask for its consideration.
  The PRESIDING OFFICER (Mrs. McCaskill). The clerk will report.
  The bill clerk read as follows:

       The Senator from Iowa [Mr. Grassley], for Mr. Ensign, 
     proposes an amendment numbered 2538 to amendment No. 2530.

  Mr. GRASSLEY. Madam President, I ask unanimous consent that the 
reading of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

   (Purpose: To amend the Internal Revenue Code of 1986 to create a 
         Disease Prevention and Treatment Research Trust Fund)

       At the appropriate place, insert the following:

     SEC. _. DISEASE PREVENTION AND TREATMENT RESEARCH TRUST FUND.

       (a) In General.--Subchapter A of chapter 98 of the Internal 
     Revenue Code of 1986 (relating to establishment of trust 
     funds) is amended by adding at the end the following new 
     section:

     ``SEC. 9511. DISEASE PREVENTION AND TREATMENT RESEARCH TRUST 
                   FUND.

       ``(a) Creation of Trust Fund.--There is established in the 
     Treasury of the United States a trust fund to be known as the 
     `Disease Prevention and Treatment Research Trust Fund', 
     consisting of such amounts as may be appropriated or credited 
     to the Disease Prevention and Treatment Research Trust Fund.
       ``(b) Transfer to Disease Prevention and Treatment Research 
     Trust Fund of Amounts Equivalent to Certain Taxes.--There are 
     hereby appropriated to the Disease Prevention and Treatment 
     Research Trust Fund amounts equivalent to the taxes received 
     in the Treasury attributable to the amendments made by 
     section 701 of the Children's Health Insurance Program 
     Reauthorization Act of 2007.
       ``(c) Expenditures From Trust Fund.--
       ``(1) In general.--Amounts in the Disease Prevention and 
     Treatment Research Trust Fund shall be available, as provided 
     by appropriation Acts, for the purposes of funding the 
     disease prevention and treatment research activities of the 
     National Institutes of Health. Amounts appropriated from the 
     Disease Prevention and Treatment Research Trust Fund shall be 
     in addition to any other funds provided by appropriation Acts 
     for the National Institutes of Health.
       ``(2) Disease prevention and treatment research 
     activities.--Disease prevention and treatment research 
     activities shall include activities relating to:
       ``(A) Cancer.--Disease prevention and treatment research in 
     this category shall include activities relating to pediatric, 
     lung, breast, ovarian, uterine, prostate, colon, rectal, 
     oral, skin, bone, kidney, liver, stomach, bladder, thyroid, 
     pancreatic, brain and nervous system, and blood-related 
     cancers, including leukemia and lymphoma. Priority in this 
     category shall be given to disease prevention and treatment 
     research into pediatric cancers.
       ``(B) Respiratory diseases.--Disease prevention and 
     treatment research in this category shall include activities 
     relating to chronic obstructive pulmonary disease, 
     tuberculosis, bronchitis, asthma, and emphysema.
       ``(C) Cardiovascular diseases.--Disease prevention and 
     treatment research in this category shall include activities 
     relating to peripheral arterial disease, heart disease, valve 
     disease, stroke, and hypertension.
       ``(D) Other diseases, conditions, and disorders.--Disease 
     prevention and treatment research in this category shall 
     include activities relating to autism, diabetes (including 
     type I diabetes, also known as juvenile diabetes, and type II 
     diabetes), muscular dystrophy, Alzheimer's disease, 
     Parkinson's disease, multiple sclerosis, amyotrophic lateral 
     sclerosis, cerebral palsy, cystic fibrosis, spinal muscular 
     atrophy, osteoporosis, human immunodeficiency virus (HIV) and 
     acquired immunodeficiency syndrome (AIDS), depression and 
     other mental health disorders, infertility, arthritis, 
     anaphylaxis, lymphedema, psoriasis, eczema, lupus, cleft lip 
     and palate, fibromyalgia, chronic fatigue and immune 
     dysfunction syndrome, alopecia areata, and sepsis.''.
       (b) Clerical Amendment.--The table of sections for 
     subchapter A of chapter 98 of the Internal Revenue Code of 
     1986 is amended by adding at the end the following new item:

``Sec. 9511. Disease Prevention and Treatment Research Trust Fund.''.

  Mr. GRASSLEY. Madam President, I yield the floor.
  Mr. BAUCUS. Madam President, the Senator from Kentucky, Mr. Bunning, 
is going to be offering an amendment. So I ask unanimous consent that 
the pending amendment be temporarily laid aside so the Senator from 
Kentucky can offer his amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BAUCUS. I also ask unanimous consent that Senator Salazar be 
allowed to speak following Senator Bunning.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Kentucky is recognized.


                Amendment No. 2547 to Amendment No. 2530

  Mr. BUNNING. Madam President, I have an amendment at the desk.
  The PRESIDING OFFICER. The clerk will report.
  The bill clerk read as follows:

       The Senator from Kentucky [Mr. Bunning] proposes an 
     amendment numbered 2547 to amendment No. 2530.

  Mr. BUNNING. I ask unanimous consent that the reading of the 
amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

   (Purpose: To eliminate the exception for certain States to cover 
 children under SCHIP whose income exceeds 300 percent of the Federal 
                             poverty level)

       Beginning on page 79, strike line 21 and all that follows 
     through page 81, line 6, and insert the following:

[[Page 21571]]

       (a) FMAP Applied to Expenditures.--Section 2105(c) (42 
     U.S.C. 1397ee(c)) is amended by adding at the end the 
     following new paragraph:
       ``(8) Limitation on matching rate for expenditures for 
     child health assistance provided to children whose effective 
     family income exceeds 300 percent of the poverty line.--For 
     fiscal years beginning with fiscal year 2008, the Federal 
     medical assistance percentage (as determined under section 
     1905(b) without regard to clause (4) of such section) shall 
     be substituted for the enhanced FMAP under subsection (a)(1) 
     with respect to any expenditures for providing child health 
     assistance or health benefits coverage for a targeted low-
     income child whose effective family income would exceed 300 
     percent of the poverty line but for the application of a 
     general exclusion of a block of income that is not determined 
     by type of expense or type of income.''.
       (b) Conforming Amendment.--Section 2105(a)(1) ( 42 U.S.C. 
     1397dd(a)(1)) is amended, in the matter preceding 
     subparagraph (A), by inserting ``or subsection (c)(8)'' after 
     ``subparagraph (B)''.
       (c) Application of Savings to Grants for Outreach and 
     Enrollment.--
       (1) In general.--Notwithstanding the dollar amount 
     specified in section 2113(g) of the Social Security Act, as 
     added by section 201(a), the dollar amount specified in such 
     section shall be increased by the amount appropriated under 
     paragraph (2).
       (2) Appropriation.--Out of any funds in the Treasury not 
     otherwise appropriated, there is appropriated such amount as 
     the Secretary determines is equal to the amount of additional 
     Federal expenditures for the period of fiscal years 2008 
     through 2012 that would have been made if the enhanced FMAP 
     (as defined in section 2105(b) of the Social Security Act) 
     applied to expenditures for providing child health assistance 
     to targeted low-income children residing in a State that, on 
     the date of enactment of the Children's Health Insurance 
     Program Reauthorization Act of 2007, has an approved State 
     plan amendment or waiver to provide, or has enacted a State 
     law to submit a State plan amendment to provide, expenditures 
     described in section 2105(c)(8) of such Act (as added by 
     subsection (a)). The preceding sentence constitutes budget 
     authority in advance of appropriations Act and represents the 
     obligation of the Federal Government to provide for the 
     payment of such amount to States awarded grants under section 
     2113 of the Social Security Act.

  Mr. BUNNING. Madam President, I offer this amendment to the SCHIP 
bill. This is the same amendment I offered during the Finance 
Committee's consideration of this legislation.
  I have heard a lot of talk about how the Baucus bill puts the focus 
for SCHIP back on low-income children--so much talk, in fact, that one 
would hardly know that the Baucus bill allows certain States to provide 
families making up to $70,000 or $80,000 a year in income with 
Government-run health care.
  Let's start from the beginning. The way the SCHIP and Medicaid 
Program work is States get Federal matching dollars to help fund their 
programs. The SCHIP match from the Federal Government is higher than a 
State's Medicaid match. This means for my State, the Federal 
Government's match for Medicaid is about 70 percent, while the State 
pays the remaining 30 percent. For SCHIP, the Federal match is 80 
percent, while the State match makes up the remaining 20 percent.
  SCHIP was intended to help States provide health care coverage to 
children and families whose incomes were below 200 percent of the 
Federal poverty line. These families were likely working but making too 
much money to qualify for Medicaid and couldn't afford private health 
insurance. I would like to note that 200 percent of the Federal poverty 
level is about $41,000 a year in income for a family of four.
  The Baucus bill allows States to expand their SCHIP programs and 
receive the higher SCHIP matching rate for families with incomes up to 
300 percent of the poverty level, or almost $62,000 for a family of 
four. Personally, I think that in and of itself is too high, especially 
when the national median income in this country was about $46,000 a 
year in 2005. In the Baucus bill, States that choose to go above 300 
percent of poverty would receive their Medicare matching rate for those 
families which, remember, is the lower reimbursement rate.
  However, the Baucus bill thinks families in New Jersey and New York 
deserve special treatment under SCHIP. The bill provides an exemption 
for States that have already gone above or are currently trying to go 
above 300 percent of poverty for SCHIP coverage. New Jersey already 
provides coverage for families up to 350 percent of poverty. New York 
is working to get approval to extend coverage up to 400 percent of 
poverty. I want to make sure everyone understands, 400 percent of 
poverty is $82,600 a year for a family of four; 350 percent of poverty 
is $72,275 per year. Are we really going to be providing Government 
health care for families making $70,000 to $80,000 a year?
  My amendment is fairly simple. It strikes the exemption the Baucus 
bill has given to just New York and New Jersey so they have to play by 
the same rules as every other State. If these two States want to 
provide health care coverage to families above 300 percent of the 
poverty level, they can do so--they just cannot get a higher SCHIP 
matching rate. They would get their Medicaid matching rate. That at 
least leaves the playing field level.
  There will be obviously some small savings from this if my amendment 
passes. My amendment would take these savings and provide additional 
money to outreach and enrollment grants.
  Some people will try to say it is more expensive to live in these two 
States than it is in other States, and that is probably true in certain 
areas. However, SCHIP is a Federal program, and all States should play 
by the same rules. Also, these two States can still cover these higher 
income families if they choose. They just have to get the lower 
Medicaid matching rate to do so.
  If New York and New Jersey feel so strongly about letting families 
making $70,000 or $80,000 a year have Government health care, then the 
States should be willing to pay a little more from their own tax 
revenue. The last time I checked, money doesn't grow on trees around 
here--or at least it very rarely does. The Baucus bill is requiring 
people in other States such as Kentucky, New Mexico, Florida, and Maine 
to pay more so New York and New Jersey can cover families at these 
higher income levels. To me, that is grossly unfair.
  Some people may also try to argue that New York is only thinking 
about going to 400 percent of the poverty level, and they would have to 
get a waiver or a plan approved by the Department of Health and Human 
Services for this increase. OK. So then why give them this special 
protection in the Baucus bill? Why create special rules for New York 
when they haven't even gotten approval yet? To me, it is outrageous 
that a program designed for lower income kids is being expanded to 
include families at 350 percent or 400 percent of the poverty level. 
That is too high, and it is unfair to ask people in other States to pay 
for these types of expenses.
  So with my amendment, you have two options: more money for outreach 
and enrollment efforts and requiring all States to play by the same 
rules or covering kids and families most of us probably don't consider 
low income--those making up to $72,000 or $82,000 a year for a family 
of four.
  Madam President, I reserve the remainder of my time, and I ask for 
the yeas and nays on my amendment when it is appropriate.
  The PRESIDING OFFICER. Is there a sufficient second? There is a 
sufficient second.
  Mr. BUNNING. Madam President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana is recognized.
  Mr. BAUCUS. Madam President, the Senator from Colorado is to be 
recognized next. I say to my friend from Kentucky, I think the Senators 
from the two States that will be directly affected by the amendment 
will be coming to the floor to speak in opposition. When they do, those 
Senators will be recognized. In the meantime, I urge the Chair to 
recognize the Senator from Colorado.
  The PRESIDING OFFICER. The Senator from Colorado is recognized.
  Mr. SALAZAR. Madam President, I rise to support the effort we have on 
the floor to address a national health care imperative, which is 
providing health insurance to 10 million young people in our country 
today.
  For me, when I come to this Senate every day and speak on behalf of 
the

[[Page 21572]]

millions of people in my State of Colorado and around the country, I 
think about the biggest issues we are faced with, the biggest 
challenges of our time, the imperatives of the 21st century, and there 
are three in my mind.
  First is the questions we face in terms of foreign affairs and how we 
protect America and homeland security. We will have other occasions 
where we will deal with the fundamental issue of protecting America and 
making sure our homeland is secure. We took significant steps last week 
in that direction when we adopted the 9/11 Commission recommendations.
  The second issue is how we move forward and embrace a clean energy 
economy for the 21st century. With the committees that have reported 
legislation, including the Energy Committee, which adopted bipartisan 
legislation here, we took a step forward with that international 
imperative.
  The third issue that I think is an imperative of the 21st century is 
how we take the health care crisis we have--a system which is not 
working for the people today--and fix it. Today and this week is an 
opportunity for us, the Senate, to take a very major step toward making 
sure we are moving toward addressing the complex issue of health care 
and providing health care insurance to the 10 million children of 
America who, without this program, would wake up after September 
without the health insurance that provides them with an opportunity to 
live a healthy American life. So this legislation is very important for 
us to move through this body.
  I say also at the outset that we would not be here today had it not 
been for the bipartisan efforts of Senators Baucus and Grassley, in the 
leadership in the Finance Committee, joined by Senators Rockefeller and 
Hatch. The four of them moved this legislation forward today in the 
framework that gives us the great possibility of receiving an 
overwhelming bipartisan vote as we move this legislation out of the 
Senate.
  By all measures, we know our health care system is in crisis. We have 
47 million Americans without health insurance today, and 9 million of 
them are kids. In Colorado, 20 percent of our population--1 in 5, or 
780,000--lacks health coverage; 180,000 of those people in my State of 
Colorado are children.
  These are middle class citizens who are getting squeezed by the 
ballooning costs of health care. Two-thirds of Americans and 70 percent 
of Coloradans without health insurance work full time. They play by the 
rules, but still find coverage out of reach.
  For those who are able to afford health insurance, the picture is 
also grim. Health insurance premiums for family coverage have risen by 
over 70 percent since 2000. An employer-sponsored family coverage plan 
now costs nearly $10,000 a year. This is a huge chunk of a working 
family's income.
  Our health care system is in dire need of triage. We must start with 
those who are most vulnerable, our children, and see to it that they 
have the health care coverage they deserve.
  Covering our kids, providing them preventive care from doctors and 
nurses, ensuring that they grow up healthy and strong--this has been 
the focus of our health care work over the last several months in the 
Senate Finance Committee. This week we bring the bill to the floor with 
the hope that we will pass it swiftly and with broad, bipartisan 
support, so that we can give 10 million more kids the opportunity they 
deserve to live up to their potential.
  The reason we focus our first reforms of the health care system on 
our children is simple: every American child deserves the opportunities 
that come from a healthy start in life.
  The fact that 9 million of our kids--180,000 in Colorado--have no 
coverage is simply unacceptable. It is a massive liability not just for 
the health of our kids, but for their education and for our future 
economic security.
  The impacts of a lack of health coverage are clear: uninsured 
children are 6 times more likely to have unmet medical needs; uninsured 
children are two and a half times more likely to have unmet dental 
needs; one-third of all uninsured children go without any medical care 
for an entire year; uninsured children are less likely to do well in 
school due to absences from unmet health needs; and uninsured children 
are more likely to seek care from hospital emergency rooms, which are 
often the provider of last resort, the most costly venue for care, and 
the least equipped to provide the type of preventive and comprehensive 
follow-up care children need.
  As sobering as these statistics are, the stories of families and 
health care providers are even more compelling. Earlier this year, at 
Senator Baucus' suggestion, I traveled to Greeley, Fort Morgan, Fort 
Collins, Steamboat, Silverthorne, Grand Junction, Durango, Alamosa, 
Pueblo, Colorado Springs, and Denver to meet with health care 
providers, State officials, children's advocacy groups and families 
interested in the reauthorization of the Children's Health Plan.
  I heard harrowing tales about delayed health care that caused 
children's health to worsen. One school nurse told me of a boy who 
injured his leg during a school football game. Because his family could 
not afford to take him to a doctor, they applied ice to his leg and 
prayed it would get better.
  Unfortunately, the boy's leg, which was fractured, grew progressively 
worse, swelling to two times its normal size. The school nurse told me 
of the pain and anguish the child endured because his parents could not 
afford an expensive doctor's visit.
  I heard countless other stories of colds that turned into pneumonia, 
of ear aches that developed into ear infections, and of other illnesses 
that grew worse because parents could not afford to seek medical care 
for their kids. These families eventually had to take their kids to the 
emergency room for treatment, the most expensive venue for care, and 
one which typically doesn't provide the type of preventative or 
comprehensive follow-up care that our kids need.
  For millions of children and their families, for our hospitals, 
clinics and health care providers who can no longer shoulder the burden 
of uncompensated care, the time has come to provide health insurance to 
children in need.
  I am proud of the work that we have done on this bill in the Finance 
Committee. It will cover 10 million uninsured children. It is a huge 
step toward providing coverage for every uninsured child in America, 
and we have done it with overwhelming bipartisan support in committee.
  Unfortunately, the President seems to have a different perspective. 
He has already issued a veto threat. I believe he is wrong. For the 
sake of our children we must reauthorize the Children's Health 
Insurance Program, and we ask the President to help get it done. CHIP 
has become a critical resource to us in Colorado and nationwide, 
providing health care coverage to children who would otherwise go 
uninsured.
  I believe that it is our moral and economic obligation in Washington 
to invest in our children's healthcare, as our investment today, will 
pay off tomorrow. The President should embrace this proposal for 
children across the country, and I strongly urge the President to help 
us get it done.
  I want to take a moment to talk about what the bill does, because the 
veto threat implies a deep misunderstanding about its benefits.
  On the broadest scale, the bill before us provides insurance coverage 
to 3.3 million children who are currently uninsured, while maintaining 
coverage for all 6.6 million low-income children currently enrolled in 
the Children's Health Insurance Program.
  The bill includes significant incentives for States to enroll more 
children onto CHIP, particularly children in rural communities where 
geographic distances and the lack of health infrastructure create 
barriers to enrollment. Twenty percent of all low-income children live 
in rural areas, and a significant percentage of them are uninsured. We 
can do better.
  The CHIP reauthorization also allows States to cover pregnant women. 
Children who are born healthy have a far

[[Page 21573]]

greater chance of a healthy life. Healthy children save Medicaid and 
CHIP significant resources in reduced health care costs. It is sensible 
that they can receive this coverage under our program.
  The bill also provides grants to States to improve dental benefits 
and helps improve coverage for mental health. In order to receive the 
Federal match, States that offer mental health services will be 
required to provide coverage on par with medical and surgical benefits 
under CHIP. Finally, the bill reduces bureaucratic hurdles and improves 
the program's efficiency by setting quality standards, by allowing 
States to verify citizenship through the Social Security 
Administration, and by establishing a pilot program to allow States to 
implement express lane enrollment.
  These are only a few of the key provisions in a bill that 
dramatically increases coverage for uninsured children across America.
  I look forward to a lively week of debate on this bill with the hope 
that we can further strengthen the package.
  Finally, I want to briefly talk about an amendment that I intend to 
offer, which will help States create and expand home visitation 
programs. In a home visitation program a nurse, social workers, 
volunteer, or other professional works with families in their homes to 
provide prenatal care, parenting education, social support, and links 
with public and private community services. Home visitation programs 
have existed in the United States since the 19th century and have a 
long and solid track record in improving children's health.
  My amendment is straightforward. It would create a $100 million grant 
program to fund cost-effective home visitation programs. It would also 
require a study of the cost-effectiveness of adding home visitation 
programs to coverage under CHIP.
  From my experience with these programs in Colorado, I think we will 
find that expanded investment in home visitation programs is a logical 
step toward improving children's health care.
  Nurse Family Partnership, one of our home visitation programs in 
Colorado, is a great example. It operates in 150 sites in 22 States, 
providing 20,000 low-income pregnant women with help from trained 
registered nurses. These nurses work closely with the families to 
increase access to prenatal care, foster child health and development 
and promote parental economic self-sufficiency.
  The statistics prove the success of the program. Nurse Family 
Partnership has been shown to reduce child abuse and neglect by 48 
percent; reduce child arrests by 59 percent; reduce arrests of the 
mother by 61 percent; reduce criminal convictions for the mother by 72 
percent; increase father presence in household by 42 percent; reduce 
subsequent pregnancies by 32 percent; reduce language delays in 21-
month-old children by 50 percent; and reduce behavioral/intellectual 
problems of children at age 6 by 67 percent.
  A report recently released by the Brookings Institute praised Nurse 
Family Partnership as one of the most effective returns on investment 
in the healthy development of the next generation.
  Our amendment builds on the great promise that home visitation 
programs offer and strengthens CHIP's investment in the healthy 
development of our children. I urge my colleagues to support our 
amendment when we offer it.
  I want to again thank Chairman Baucus, Ranking Member Grassley, and 
Senators Rockefeller and Hatch for their bipartisan leadership on this 
bill. This is a giant step forward in our Nation's steady march toward 
providing every child in America the chance to chase their dreams.
  Mr. President, I yield the floor.
  Mr. BAUCUS. Madam President, the amendments are starting to come 
before the Senate and that is good. The other news is that all Senators 
who have lined up to speak at certain specified times are going to have 
to be very accommodating to other Senators and squeeze down the amount 
of time they want to speak. Perhaps they can consult with the floor 
staff to see when they might be able to speak.
  I now ask unanimous consent that the Senator from Oregon, Senator 
Smith, be recognized to speak next and, immediately following him, that 
the Senator from Pennsylvania, Mr. Casey, be recognized to speak. I 
urge both Senators to limit their remarks as much as possible. Please 
try to use a little more brevity so we can get to the next speakers. 
Senator Menendez is also here and he wishes to speak on the amendment 
offered by the Senator from Kentucky.
  I yield the floor.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. CASEY. Madam President, parliamentary inquiry: When the Senator 
said ``limit the time,'' I am not sure what the Senator meant by that.
  Mr. BAUCUS. Well, I have a list of Senators who wish to speak. I have 
times next to the Senators as to when they are going to speak. I also 
have time allocated on how much time they think they are going to 
speak. I am asking all Senators to basically speak for fewer minutes so 
that all Senators can speak at their allotted times.
  Mr. CASEY. My colleague from Montana has been generous with his time 
and has shown great leadership. I want to make sure I have the time I 
want on this, so I will wait. I will play it by ear, depending on my 
colleague from Oregon.
  Mr. BAUCUS. Thank you very much.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. SMITH. Madam President, I wish to assure the manager of the bill 
that I will be as brief as I can on this big issue.
  All of us who are parents know that the health of a child is 
critically important in ensuring they have the opportunity to reach 
their full potential. Yet today in America there are approximately 6 
million children who are eligible for either Medicaid or SCHIP who are 
going without health care nevertheless. In Oregon alone, there are 
approximately 60,000 kids eligible for assistance who are not getting 
the help they need. Therefore, the debate before us is about whether we 
as a country will invest in our young people by providing access to 
health coverage or whether we will leave these children without the 
essential building blocks of health care upon which they can build 
successful lives.
  I believe in the promise that SCHIP represented in 1997. It was one 
of the first bills I worked on, with an amendment in the Budget 
Committee. I urge my colleagues to support the bill the Finance 
Committee has now produced which sees this whole promise of CHIP one 
step closer to fulfillment. This bill will allow States to cover an 
additional 3.3 million children, and in Oregon that would allow an 
additional 100,000 children to receive health care coverage.
  When thinking about our response to the children, I often like to 
quote one of our Nation's health care leaders, the former Surgeon 
General, Dr. C. Everett Koop, who said:

       Life affords no greater responsibility, no greater 
     privilege than the raising of the next generation.

  The reauthorization of the Children's Health Insurance Program 
fulfills the Government's responsibility to take care of our Nation's 
children. It also lives up to the expectations of the American public--
we the people--who want Congress to pass this bill and extend health 
care coverage to America's underprivileged children.
  This bill is also a testament to a bipartisan legacy of the Finance 
Committee. It contains less money and benefits than some desire, while 
more than others have indicated they will support. Yet when you look at 
the actual policy, I believe you will find that it deserves the full 
support of the Senate.
  My colleagues and the American public should know that this bill is 
not, as some have claimed, an expansion, and it is not the 
federalization of health care. In fact, it simply takes a step, a 
reasonable step, toward achieving the original objective, the original 
vision for SCHIP. It will provide adequate funding and make some 
programmatic enhancements to help an additional 3.3 million children 
currently eligible to enroll in the program. I wish to emphasize that 
these children are currently

[[Page 21574]]

eligible. This just makes the program available to them.
  This package which many of us have worked to craft does not create a 
new Government-run health care system. In fact, 48 States, including my 
State of Oregon, utilize private health insurers to deliver the SCHIP 
benefit package. Like Medicare Part D, it is a highly successful 
melding of Government and private sector care.
  I also believe it important to note that SCHIP is an efficient and 
cost-effective health care program. Its overhead ranges from about 5 
percent, compared to the commercial market, which is over 10 percent. 
Perhaps most importantly, this bill returns the focus of the State 
Children's Health Insurance Program to children.
  Many on both sides of the political aisle were amazed and 
disappointed to learn that the administration has allowed States to 
extend coverage under SCHIP to adults. This proposal puts the brakes on 
that practice and says: Enough is enough. Upon enactment of the bill, 
the administration no longer will be able to extend waivers to States 
to cover any adult. Further, by the end of 2009, those States which 
currently cover childless adults will be required to move those people 
into Medicaid, and any parent currently covered will be moved into a 
separate block grant starting in 2010. This represents a bipartisan 
agreement.
  For those of us who have battled over the years to ensure mental 
health parity, I am pleased to report that the committee accepted an 
amendment from me and Senator Kerry, and this bill now delivers a 
victory to those who advocate for mental health parity. It requires 
States that offer access to mental health care to provide coverage that 
is on par with coverage for physical illnesses. As a parent whose child 
battled a mental illness, I know how important it is for our young 
people to have timely access to mental health care treatments.
  Each year in the United States, 30,000 people die by suicide. That is 
more deaths than by drunk driving and homicides combined. Yet, with 
proper treatment, these deaths are preventable. Our Nation and our 
Government simply cannot continue to ignore this problem. That is why 
this amendment was included, so that we will now begin to reverse this 
Federal discrimination as it relates to mental health care. I believe 
that by ensuring equity among mental and physical illnesses, this bill 
takes the first step toward eliminating the discrimination against 
persons with mental illnesses that has existed in our Federal and State 
health care programs for generations. It is an important first step and 
fulfills the promise of SCHIP for all children, including those 
children with a mental illness.
  For those who believe SCHIP will erode health care coverage through 
employers, do not believe it. This bill takes a significant step toward 
offering access to privately delivered options and helps small 
businesses gain access to affordable health care coverage for all of 
their employees.
  I authored a provision that allows States to create an employer 
purchasing pool under the premium assistance section of SCHIP. My 
provision will allow small businesses with less than 250 employees to 
buy health insurance coverage through a State-sponsored employer 
purchasing pool. Employers that participate will have access to a 
choice of privately delivered, quality health insurance products for 
all of their employees and will receive reimbursement for those 
employees or their children who are eligible for SCHIP. It is a win-win 
arrangement that I hope will lead to more extensive coverage among 
employees and small- and medium-sized businesses.
  Finally, this package rightly utilizes the 61-cent increase in the 
tobacco products excise tax, which I proposed during the Senate's 
budget debate, to pay for the cost of reauthorizing SCHIP. Increasing 
the cost of tobacco products not only puts real dollars on the table to 
pay for SCHIP, but over time it will lower the cost of tobacco-related 
illnesses for all Federal and State health care programs and will deter 
young people from smoking.
  Why is this important? My State of Oregon was the first in the Nation 
in 1987 to begin tracking the number of deaths that were related to the 
use of tobacco. In 2005, the most recent year for which data is 
available, there were a total of nearly 7,000 deaths in Oregon due to 
tobacco. This means that tobacco contributed to 22 percent of all 
deaths in the State of Oregon. In fact, from 1996 to 2005, tobacco use 
has consistently contributed to more than one-fifth of all Oregon 
deaths, ranging from 21 percent to 23 percent of the total deaths per 
year.
  Officials in my State explain to me that to determine the death rate 
in the State, they often look at it in terms of the number of deaths 
per 100,000 Oregonians. In 2005, the death rate due to tobacco was 
about 13 times the rate of death from the following causes: alcohol-
induced deaths, drug-induced deaths, motor vehicle accidents, and 
deaths from an infection or parasitic disease. What is more, the State 
estimates that an additional 800 deaths were attributable to secondhand 
smoke in 2005. That means in 1 year, 7,721 Oregonians needlessly died 
because of the use of tobacco.
  So for those who question raising the rate of the Federal tobacco 
excise tax, I say: Look at these numbers. Look at the 7,000 deaths from 
tobacco in the State of Oregon in 2005 alone and understand that this 
Federal rate increase could dramatically lower the death rate from 
tobacco. That is why this bill rightly includes a 61-cent increase in 
the excise tax.
  In closing, Chairman Baucus and Ranking Member Grassley have a long 
working tradition of tackling challenging issues and developing 
bipartisan solutions. The development of the Children's Health 
Improvement Program Reauthorization Act of 2007 is no different. Many 
hurdles were encountered, and many are yet to come, but if the Senate 
can follow the example set by Chairman Baucus and Ranking Member 
Grassley, I am confident we will see SCHIP reauthorized by the end of 
September. Therefore, I urge my colleagues to support this bill.
  I thank the Chair for the time, and I yield the floor.
  Mr. BAUCUS. Madam President, Senator Casey has been seeking 
recognition, and I assured him earlier today that he would be able to 
speak at about this time.
  I ask unanimous consent that Senator Casey be able to speak and that 
following Senator Casey, the Senator from Colorado, Mr. Allard, be 
recognized to offer an amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Pennsylvania is recognized.
  Mr. CASEY. Madam President, I thank the Chair, and I thank Chairman 
Baucus for his leadership and for the way he has conducted the debate 
on this bill.
  I wish to make a couple of points that probably haven't been made 
yet--some have, in different ways--and the first thing I wish to say is 
that this bill, overall, provides what a lot of Americans expect us to 
provide in a bill such as this: It lowers the rates of uninsured 
children in America, just as the original Children's Health Insurance 
Program did some 10 years ago now; it strengthens the program by 
increasing and targeting funding for our children; and it also gives 
States the tools they need to do the outreach that is required to get 
our children enrolled and to do that in a way that spends money wisely.
  One of the things that has been missed in this debate is that this is 
really about all of America. This isn't simply about one State or one 
community. One of the population sectors that I think has been ignored 
often in this discussion by some people who have talked about this is 
rural children. You can see on this chart to my right what children's 
health insurance--this program--means to rural children.
  Rural children are far less likely to have access to employer-based 
health care plans because most of these families that have had to 
struggle are not getting jobs that offer affordable health insurance. 
That number has gone far too high in terms of the number of rural 
families that have lost jobs

[[Page 21575]]

or are seeking jobs with health insurance.
  Secondly, rural children are difficult to enroll in children's health 
insurance even when they are clearly eligible. Outreach and enrollment 
efforts are critically important to those communities. That is why the 
features of this bill that deal with outreach--television advertising 
and other kinds of advertising--are critically important.
  The second point about children who live in rural communities across 
America--and I have to say in Pennsylvania we have literally millions 
of Pennsylvanians who live in communities that are defined 
demographically as rural--is that they are more likely to be poor. 
Nearly half of rural children live in low-income families at or below 
200 percent of the poverty level. So you are talking about a doubling 
of the number, just a little more than $40,000 of family income.
  Additionally, rural children increasingly rely upon children's health 
insurance, this program. In rural America, more than one-third of all 
children--one-third of all rural children--rely upon the Children's 
Health Insurance Program or Medicaid.
  Another point on benefits, if we can go to the next chart. There has 
been a lot of talk about what this program means and how much it costs. 
It is interesting to debate that, but let us get back to what this 
program means to families. It means immunizations, routine checkups, 
prescription drugs, dental care, maternity care, mental health 
benefits, and down the list. You can see what this means to the life of 
a family and to the health of a nation. I think it bears repeating just 
how important those benefits are.
  In the next chart, we focus on an example from Pennsylvania. There 
has been a lot of talk on this floor already, some of it inaccurate 
talk, so let's get back to the facts. This is what the children's 
health insurance income levels mean in Pennsylvania. What we are 
talking about here is $41,300 of income and below, under 200 percent of 
the FPL, the federal poverty level. Care is free for those families, 
and the average premium is, of course, zero. But the next category, 
$41,301 to $61,950, above 200 percent of poverty, up to 300 percent, 
care is provided at a low cost but a cost nonetheless. They pay a 
premium--a range of a premium.
  Finally, looking at the higher income groups and some people, it is 
very misleading. For those with incomes of $61,951 and above, at that 
income level care is provided at cost, and the average premium is $150. 
We should stop misleading people, talking about wealthier families 
making $80,500. Others will discuss this later. We have already had a 
lot of misleading--and I hope it is not deliberate, but there has been 
misleading rhetoric on the Senate floor already about those families.
  Just for the record, not only are there no families at $80,000 in the 
Children's Health Insurance Program, there are only about 3,000 kids 
enrolled in the health care program today out of 6.6 million who have a 
family income of 300 percent of poverty or more. Let's speak the truth 
and adhere to the facts instead of what we have heard already: 
misleading statements on this floor about these income levels.
  One more point about minority children in America. We have heard a 
lot about what this means and whether it is working. We have lots of 
proof already that minority children have already been helped. Since 
the inception of this program 10 years ago, the percent of uninsured 
Hispanic children has decreased by nearly one-third; for African-
American children by almost one-half. So don't tell us this is not 
working. Some people on the other side have made that point. This is 
working for rural kids, and it is working for minority children all 
across the country, not to mention what I have seen in Pennsylvania.
  This will be our last chart. We have heard a lot about what this 
means for the broad spectrum of America. Here is the fact again: 78 
percent of the kids covered by the Children's Health Insurance Program 
are from working families. I think that is an important point to make 
when we talk about who is helped by this program.
  If we want to go the way the President has taken us and cut off kids 
from children's health insurance--1.4 million kids will lose their 
coverage under the President's plan--here is what happens when a child 
doesn't get dental care. We heard this story a couple of months ago. It 
bears repeating again--12-year-old Deamonte Driver, from Prince 
George's County here in Maryland, died because he didn't have coverage 
for a routine $80 dental procedure for his infected tooth. Without that 
simple treatment, the infection spread to Deamonte Driver's brain and 
killed him.
  Let's put aside some of the mythology about what we have heard from 
some people--not everyone but some people in this Chamber--about what 
this means. If that child had received an $80 dental procedure he might 
be alive today. But, of course, we hear political rhetoric in here to 
back up the President. I think it is important to remember why we are 
here.
  I have two more points to make, to keep within my time. John Dilulio, 
Jr., a distinguished Ph.D., worked for President Bush to lead his 
faith-based initiatives in the early part of the administration. He 
wrote an op-ed in the Philadelphia Inquirer a few months ago.
  I ask unanimous consent it be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                    [From the Philadelphia Inquirer]

     Bush's Stand on Insurance Plan Contradicts Words of Compassion

                        (By John J. Dilulio Jr.)

       Eight years ago this week, on July 22, 1999, George W. Bush 
     delivered his first presidential campaign speech, titled 
     ``The Duty of Hope.'' Speaking in Indianapolis, he rejected 
     as ``destructive'' the idea that ``if only government would 
     get out of the way, all our problems would be solved.'' 
     Rather, ``from North Central Philadelphia to South Central 
     Los Angeles,'' government ``must act in the common good, and 
     that good is not common until it is shared by those in 
     need.'' There are ``some things the government should be 
     doing, like Medicaid for poor children.''
       I helped draft the speech and served in 2001 as an adviser 
     to Bush. He has made good on some compassion pledges. For 
     instance, he has increased funding for public schools that 
     serve low-income children. His $150 million program for 
     mentoring 100,000 children of prisoners has made progress. In 
     May, he pledged an additional $30 billion in U.S. aid to 
     combat the global HIV/AIDS epidemic and save Africa's 
     affected children.
       On the other hand, poverty rates have risen in many cities. 
     In 2005, Washington fiddled while New Orleans flooded, and 
     the White House has vacillated in its support for the 
     region's recovery and rebuilding process. Most urban 
     religious nonprofit organizations that provide social 
     services in low-income communities still get no public 
     support whatsoever. Several recent administration positions 
     on social policy contradict the compassion vision Bush 
     articulated in 1999.
       In May, Bush rejected a bipartisan House bill that 
     increased funding for Head Start, a program that benefits 
     millions of low-income preschoolers. His spokesmen claimed 
     the bill was bad because it did not include a provision 
     giving faith-based preschool programs an absolute right to 
     discriminate on religious grounds in hiring.
       That reason reverses a principle Bush proclaimed in his 
     1999 speech: ``We will keep a commitment to pluralism, not 
     discriminating for or against Methodists or Mormons or 
     Muslims, or good people of no faith at all.'' As many studies 
     show, most urban faith-based nonprofits that serve their own 
     needy neighbors do not discriminate against beneficiaries, 
     volunteers or staff on religious grounds. These inner-city 
     churches and grass roots groups would love to expand Head 
     Start in their communities.
       Last week, Bush threatened to veto a bipartisan Senate plan 
     that would add $35 billion over five years to the State 
     Children's Health Insurance Program (SCHIP). The decade-old 
     program insures children in families that are not poor enough 
     to qualify for Medicaid but are too poor to afford private 
     insurance. The extra $7 billion a year offered by the Senate 
     would cover a few million more children. New money for the 
     purpose would come from raising the federal excise tax on 
     cigarettes.
       Several former Bush advisers have urged the White House to 
     accept some such SCHIP plan. So have many governors in both 
     parties and Republican leaders in the Senate. In 2003, Bush 
     supported a Medicare bill that increased government spending 
     on prescription drugs for elderly middle-income citizens by 
     hundreds of billions of dollars. But he has pledged only $1 
     billion a year more for low-income children's health 
     insurance. His spokesmen say doing any more for the 
     ``government-subsidized program'' would encourage families to 
     drop private insurance.
       But the health-insurance market has already priced out 
     working-poor families by

[[Page 21576]]

     the millions. With a growing population of low-income 
     children, $1 billion a year more would be insufficient even 
     to maintain current per capita child coverage levels. Some 
     speculate that SCHIP is now hostage to negotiations over the 
     president's broader plan to expand health coverage via tax 
     cuts and credits. But his plan has no chance in this 
     Congress; besides, treating health insurance for needy 
     children as a political bargaining chip would be wrong.
       Bush should return to Indianapolis. There, SCHIP covers 
     children in families with incomes as high as three times the 
     federal poverty line The Republican governor who signed that 
     program into law is Mitch Daniels, Bush's first budget office 
     director. For compassion's sake, the president should 
     compromise on SCHIP--say, $5 billion a year more--and work to 
     leave no child uninsured.

  Mr. CASEY. I will not read it, but I want to highlight some of what 
he said. He talked about the President and what has been happening with 
this debate on children's health insurance. He made this point in the 
second to the last paragraph:

       Treating health insurance for needy children as a political 
     bargaining chip--

  And he's referring to the President's other health care ideas----

       would be wrong.

  He talks about the fact that Mitch Daniels, who worked in a 
Republican administration--he is the Governor now, Governor of Indiana, 
also a great supporter of this program. Mr. Dilulio concludes this way. 
He says:

       For compassion's sake, the President should compromise on 
     SCHIP . . .

  And allow this to move forward.
  I have to say, some of what we heard in the last couple of days has 
been misleading. In the end it is about this: It is about whether we 
are going to be fair to families across America, not whether the Senate 
likes a program or doesn't like it. This is about whether we are going 
to be fair to families.
  Anyone who has had the experience of being a parent knows when their 
child is born, that parent, whoever they are, falls in love again. My 
wife and I have four daughters, and we know that feeling. So many 
others here do as well. As a parent, you always want to love your 
children and protect them. When a child is injured or gets sick, the 
first instinct of any parent, but especially a mother, is to hug that 
child, to dry their tears, and to soothe their pain immediately--not 
months later, not days later, but immediately. Of course if it is more 
serious you want to get them to a doctor or a hospital.
  But for millions of parents--that is why this bill is so important to 
get done--for millions of parents that hug that they give their son or 
daughter, that warm embrace and the comfort that a hug can bring to a 
child--that will often be all that they have at the end of the road 
because their son or daughter has no health insurance, like the 
millions of children we have talked about in the last couple of days. 
If that child cries in the dark of night from pain or if they endure 
the slow ache of disease or sickness, the mother cannot bring the full 
measure of her love to that child. In essence, the mother is rendered 
powerless because of that. Just think of what that does to a mother and 
to a family.
  When we have debates on this floor about this bill, none of it 
matters--none of the debate in the last couple of days will have 
mattered if it does not result in a total commitment to the children of 
America. Unfortunately, if the President gets his way, we will have 
failed that basic test about a full commitment to our children.
  I will conclude with one line. When my father served as Governor of 
Pennsylvania, it was one of the first States to have a children's 
health insurance program. He knew the benefits of it. His test for 
every public official in every difficult fight was very simple, but it 
is a very tough test: What did you do when you had the power?
  This Senate has the power this week to tell the President that he is 
wrong about children's health insurance, but more important to tell 
America that we have made a full commitment to the children of America. 
If we pass that test we will have done our job. If this body does not, 
it will have failed that test when we had the power to positively 
impact millions of children, to have exercised that power on behalf of 
that child, his or her family, and all of America.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Madam President, I ask unanimous consent that following 
the remarks of Senator Allard, during which he will offer an amendment, 
then the Senator from New Jersey, Mr. Menendez, be recognized; 
following Senator Menendez, Senator Lott be recognized; and following 
Senator Lott, Senator Obama.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Colorado is recognized.


                Amendment No. 2536 to Amendment No. 2530

  Mr. ALLARD. Madam President, I ask the pending amendment be set 
aside, and we call up Allard amendment No. 2536.
  The PRESIDING OFFICER. Without objection, it is so ordered. The clerk 
will report.
  The legislative clerk read as follows:

       The Senator from Colorado [Mr. Allard] proposes an 
     amendment numbered 2536 to amendment No. 2530.

  Mr. ALLARD. I ask unanimous consent the reading of the amendment be 
dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

 (Purpose: To standardize the determination of income for purposes of 
                         eligibility for SCHIP)

       At the end of title I, add the following:

     SEC. __. STANDARDIZATION OF DETERMINATION OF FAMILY INCOME.

       (a) Eligibility Based on Gross Income.--
       (1) In general.--Section 2110 (42 U.S.C. 1397jj) is amended 
     by adding at the end the following new subsection:
       ``(d) Standardization of Determination of Family Income.--A 
     State shall determine family income for purposes of 
     determining income eligibility for child health assistance or 
     other health benefits coverage under the State child health 
     plan (or under a waiver of such plan under section 1115) 
     solely on the basis of the gross income (as defined by the 
     Secretary) of the family.''.
       (2) Prohibition on waiver of requirements.--Section 2107(f) 
     (42 U.S.C. 1397gg(f)), as amended by section 106(a)(2)(A), is 
     amended by adding at the end the following new paragraph:
       ``(3) The Secretary may not approve a waiver, experimental, 
     pilot, or demonstration project with respect to a State after 
     the date of enactment of the Children's Health Insurance 
     Program Reauthorization Act of 2007 that would waive or 
     modify the requirements of section 2110(d) (relating to 
     determining income eligibility on the basis of gross income) 
     and regulations promulgated to carry out such 
     requirements.''.
       (b) Regulations.--Not later than 90 days after the date of 
     enactment of this Act, the Secretary shall promulgate interim 
     final regulations defining gross income for purposes of 
     section 2110(d) of the Social Security Act, as added by 
     subsection (a)(1).
       (c) Application to Current Enrollees.--The interim final 
     regulations promulgated under subsection (b) shall not be 
     used to determine the income eligibility of any individual 
     enrolled in a State child health plan under title XXI of the 
     Social Security Act on the date of enactment of this Act 
     before the date on which such eligibility of the individual 
     is required to be redetermined under the plan as in effect on 
     such date. In the case of any individual enrolled in such 
     plan on such date who, solely as a result of the application 
     of subsection (d) of section 2110 of the Social Security Act 
     (as added by subsection (a)(1))) and the regulations 
     promulgated under subsection (b), is determined to be 
     ineligible for child health assistance under the State child 
     health plan, a State may elect, subject to substitution of 
     the Federal medical assistance percentage for the enhanced 
     FMAP under section 2105(a)(1) of the Social Security Act, to 
     continue to provide the individual with such assistance for 
     so long as the individual otherwise would be eligible for 
     such assistance and the individual's family income, if 
     determined under the income and resource standards and 
     methodologies applicable under the State child health plan on 
     September 30, 2007, would not exceed the income eligibility 
     level applicable to the individual under the State child 
     health plan.

  Mr. ALLARD. Madam President, today I come to the floor to offer an 
amendment for the purpose of upholding the original intent of the State 
Children's Health Insurance Program, which is commonly known as SCHIP. 
In 1997, a Republican-led Congress passed SCHIP to help States provide 
health coverage to low-income children. Current law defines a targeted 
low-income child as one who is under the age of 19 years, uninsured, 
and who would not have been eligible for Medicaid in 1997.
  States may set the upper income eligibility level at 200 percent of 
the Federal poverty level or 50 percentage

[[Page 21577]]

points above the State's Medicaid income level. But that is not what is 
happening today.
  In my State of Colorado, we had a health care summit meeting early on 
in the year. It was very popular, well attended by representatives of 
health providers all over the State of Colorado. They had this to say: 
We think the SCHIP program is successful, and we think it ought to 
provide care to needy children, those who are uninsured. They further 
stated that there needs to be some equity among the various States and 
the money they get for SCHIP.
  Today, anywhere between 12 and 15 States have income thresholds above 
200 percent of the Federal poverty level or 50 percent above the 
State's Medicare income level, which was provided for in the original 
legislation. So we have 12 or 15 States that have figured out how to 
get around that provision. States such as California, Maryland, 
Massachusetts, New York, New Jersey, Pennsylvania, and Vermont use 
income disregards to expand their income thresholds beyond the intent 
of the SCHIP program.
  As of July 2006, just a year ago, New Jersey topped the list at 350 
percent of the Federal poverty level, at $72,275 for a family of four, 
I am told.
  In fiscal year 2005, nearly half of all children in the United States 
were covered by Medicaid or SCHIP. SCHIP was never intended to cover 
all 77 million children in the United States. It was never intended to 
make all children, regardless of income, dependent on Government for 
access to health insurance.
  In April, New York passed its budget which expanded SCHIP to 400 
percent of the Federal poverty level or $82,600 for a family of four. 
By disregarding specific types of incomes, States can ignore earnings 
between 200 percent of Federal poverty level and their upper limit, as 
if that income did not even exist. States should not be disregarding 
large portions of income to avoid SCHIP eligibility levels. Rather than 
returning SCHIP to its true intent, the pending legislation makes a 
deliberate choice to drive up eligibility levels.
  My amendment brings the language back to the original intent of 
SCHIP. My amendment would require that a family's gross income be used 
to determine eligibility for SCHIP, and that the Secretary of Health 
and Human Services would determine new regulations for eligibility for 
SCHIP by establishing what is referred to as ``gross income'' and 
having that defined at a certain level.
  States would still have the opportunity to cover any child who was 
determined to be ineligible for SCHIP based on the changes made by this 
amendment. They would remain eligible for the program, but the State 
would be reimbursed according to the Federal medical assistance 
percentage rate rather than the enhanced Federal medical assistance 
percentage rate.
  So I ask my fellow Senators to support me and fellow Republicans in 
supporting the SCHIP reauthorization. My amendment tracks current law 
that upholds SCHIP's original intent, and that is for low-income 
children. Supporting this alternative is a step toward renewing our 
commitment to America's most vulnerable population; that is, our 
children.
  I will yield the floor.
  Mr. LOTT. Madam President, if the distinguished Senator would 
withhold so I could just address a couple of questions to him on his 
amendment? The amendment would say that the States have to take into 
consideration the gross income of the family, not including certain so-
called income disregards.
  That is the way we talk in Washington, but to the average man and 
woman, what are we talking about? Are we saying, even though we think 
they may have other sources of income--I don't know what that might be, 
and I was going to ask you, are you talking about rental income? Are 
you talking about some part-time income? I wonder, what types of things 
are used by these various States to reduce the gross level of income so 
they can get under this, whatever it is, 350 percent of poverty or--400 
percent of poverty is the newest application, I understand, from New 
York. Do you have any information on that?
  Mr. ALLARD. I thank the Senator from Mississippi for his question. 
Here is what my amendment does. It directs the Secretary of Health and 
Human Services to establish rules and regulations to set a uniform 
gross income among the States. He has 90 days, once the bill becomes 
law, to do that. This will give the States further opportunity to give 
their input to the Secretary, and it gives him some flexibility to 
listen to what their concerns are, but says then these States all have 
to operate under the same rules.
  Some States, for example, when they looked at total gross income, 
have not included income benefits from other programs. Some States 
have. So this amounted to a considerable amount of discrepancy, 
particularly in high-income States where the benefits are running much 
higher.
  So we see some States that are getting a much higher rate of benefit 
through SCHIP than perhaps the more responsible States, such as your 
State of Mississippi, my State of Colorado, for example.
  So this is an important amendment to bring some integrity to the 
program.
  Mr. LOTT. I thank the Senator for his explanation and for his 
amendment because it is clear that through these waivers or through 
moves by various States, without questioning their motives, they have 
been able to develop a system which is very unequal among the States.
  I found, for instance, the reimbursement rate to the States--by the 
States--as required by the States for Medicaid, for instance, varies 
greatly from as low as 50 percent to as high as 80 percent. That is not 
fair, and we need to do something about it. I thank the Senator for 
yielding.
  Mr. ALLARD. I thank the Senator from Mississippi for his question.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Jersey.
  Mr. MENENDEZ. Madam President, I rise in strong opposition to, first, 
the Bunning amendment, which is the one I particularly wish to talk 
about because it is a direct attack on children in New Jersey. I did 
not think I would come to the Senate and see such a refined focus on 
the children of anyone's State. But that is what the Bunning amendment 
does.
  I am sure I could draft amendments that would hone in on the 
interests of any given State, but I do not think that is where we want 
to go as a Congress, as a Senate. I do not think that is particularly 
good public policy. So right now I am fuming.
  Let me start off by saying I thought this was one country. One 
country. There are a lot of things I have voted for in the Senate and 
in my 15 years in the Congress, in the other body before I came here, 
that clearly did not specifically benefit my State, from crop disaster, 
to ethanol, I cannot get an E-85 pump in New Jersey; a whole host of 
things for farmers and the list goes on and on.
  I looked at it, I always looked at it as one country. Sometimes in 
the allocation of resources there are certain needs that get taken care 
of in one part of the country, where in another part there are 
different needs. Those amendments are an attack directly upon that 
notion that this is one country.
  I also think it is very easy to talk about income but never talk 
about costs, as if living in one part of the country automatically 
means that those costs are the same in another part of the country. 
Well, they are not. We recognize that in a variety of laws in which we 
give differentials to a whole host of different elements, from Federal 
employees to differentials for the military to a whole host of people 
based upon where they are stationed, because we recognize that, in 
fact, there are different costs of living in this country.
  So it is interesting to talk about income but not talk about costs. 
You know what I am for? Let's make sure anyone in the Senate--I am sure 
everybody here makes in excess of 350 percent of the Federal poverty 
level. Let's eliminate health care for all of those

[[Page 21578]]

that you ultimately get by virtue of the taxpayers' dollars.
  Do you deserve health care more than children who happen to fall into 
that category? These are the children of working families. They are not 
poor, as in not working, because if they were, they would get Medicaid. 
But they are the children of those individuals who are working, and 
work at some of the toughest jobs, and yet make an income that does not 
allow them to purchase health insurance and their job does not seem to 
offer health insurance.
  There is a great universe of Americans whom we are trying to cover 
under the Children's Health Insurance Program. I agree. What is the 
goal? The goal is to cover children, children who do not have coverage 
otherwise. Well, this is exactly what we seek to do.
  Now, you know, in New Jersey, we do cover 126,000 children. And, yes, 
we cover children up to 350 percent of the Federal poverty level. That 
means there are 3,000 New Jersey children who happen to fall in this 
category who are in the direct aim of the Bunning amendment, 3,000 
children who today get health care who would be knocked out by virtue 
of the Bunning amendment, and there may be one or two other States that 
focus on children as well.
  My question is: Why are you targeting these children? What did they 
do to you? What did they do to you? You know, the difference is, maybe 
if I lived in Kentucky, I could afford to get health care based upon 
the incomes, but first of all, we have heard a lot of numbers bantered 
around here, some of which are clearly not true.
  Three hundred fifty percent of the Federal poverty level is $60,095 
for a family of three. So it is not $82,000, as some suggest, for 
starters. In fact, there is no child in this country, no child in this 
country covered up to that dollar amount--in the entire country. That 
is a scare tactic. It is shameful. We need to cover children up to 350 
percent because New Jersey families face higher living costs.
  They get less of their return on the Federal dollar, so again we 
cannot have a policy that doesn't take all of that into account. But 
let my lay it out for you. At the top of New Jersey's current 
eligibility level, a family might make somewhere around this $4,428.
  Well, when you deduct housing costs in New Jersey, when you deduct 
food costs, when you deduct transportation to get to work, and I think 
a byproduct is that we want to, in our values, make sure we value the 
welfare of these children we are talking about and their health care, 
we also want to value work. One of the things these parents are doing 
is they are working. Now, they could not be working and be on welfare 
and ultimately be eligible for Medicaid. But we want to value work as 
well. They are working.
  So they have to get to work. They have child care costs. Here is what 
the Department of Insurance in New Jersey says is the cost monthly--
monthly--for family care in New Jersey, for family health insurance: 
$2,065. Now, this does not have utility costs, this does not have 
clothing, this does not have any emergency expenses for the family. 
This is no buffer. No buffer. What is the consequence of that to this 
family if they were trying to have health insurance? They would be in 
the red each month by $1,200, which means that they simply will not 
have health insurance, they simply will not have health insurance, and 
these kids would not have health insurance.
  Now, that is the goal of the program, to provide health insurance for 
children who are not so poor that they would get it under Medicaid, 
but, in fact, are in a set of circumstances where because their parents 
work, and not getting insurance at work, they find themselves in that 
category for which there is no coverage and no money to be covered by 
virtue of their family income.
  So it simply does not do it. It simply does not do it. It is basic 
math. That is why New Jersey enrolls children up to 350 percent of the 
Federal poverty level, because if you live in New Jersey with that 
income, without this coverage, children would not have health 
insurance. Purchasing a private plan--no matter the tax incentives, I 
have heard some of the tax incentives that are being offered. There is 
some suggestion of a $5,000 tax credit. Great. Well, that is 2\1/2\ 
months of health care coverage in New Jersey.
  What do we do for the rest of the time? Do we roll the dice? Are we 
supposed to hope for the other 10 months they do not get sick, they do 
not get preventative care? That is what our public policy is all about? 
That is what our values are as a Senate, as a country? I do not think 
so.
  Now, the fact of the matter is, I urge my colleagues to think about 
this, because in New Jersey, you need to have $43,060 to purchase the 
same goods in Kentucky for $32,669. That is about $11,000 more to do 
the same thing as if you are living in Kentucky.
  Now, the realty is, that is why one-size-fits-all does not work. I 
have heard many times on the debates here: States know best, let's have 
flexibility.
  Well, this is a perfect example of how that flexibility has given us 
the wherewithal to cover children. I must say, I wish to warn my 
colleagues that supporting the Bunning amendment is about dumping 
children off the Child Health Insurance Program. It is the beginning of 
a slippery slope. So now we begin to eradicate those who are at 350 
percent, we take them off; so then somebody comes up with another 
amendment, let's do 300 percent, let's eliminate that; then let's bring 
someone else who brings in 275 percent, and then the list goes on and 
on.
  Before you know it, instead of having a program that covers more 
children in our country, we have less children covered. Less children 
covered in our country. I believe that, in fact, what we want to do is 
quite different. That is why I respect what the Senate Finance 
Committee did on a bipartisan basis. They looked at all the issues, all 
the costs, they looked at the goal of achieving, insuring more children 
in our country, keeping those who are in the 6.6 million, adding 
another 3.2 to 3.4 million, trying to reach the goal of insuring all 
our kids and doing it within a fiscal context that would allow it to 
happen. That is what this is about. That is what this is supposed to be 
about.
  So I hope my colleagues do not join on the slippery slope that begins 
to cut back and cut back and cut back, that takes children off health 
care coverage because it would set a precedent that I think none of us 
would want to do at the end of the day, not only on children's health 
but on other issues that may be critical to our States.
  I think this is about a set of values in the Senate. What are our 
values? We hear so much about children are our future. Yet our values 
speak to, if we pass this amendment, cutting children off health care, 
even though clearly there is a far greater cost to living in a State 
such as New Jersey than there is to living in a State such as Kentucky.
  Now, there are a lot of things that go on in the Senate on different 
issues that clearly there is an appeal because of the nature of the 
unique challenges that States face. Well, we face a unique challenge. 
We want to make sure our children who are already on--by the way, these 
are children who already have coverage, who will lose coverage as a 
result of the Bunning amendment.
  I am simply baffled. I thought we were about family values here. I 
thought we were about protecting children. I thought we were about 
increasing opportunity for children to ultimately be covered. I thought 
we were about enhancing the quality of life and protecting life. 
Obviously, it is the lives of children whom we are talking about, whom 
we put at risk by knocking off their coverage.
  So I find it embarrassing that some in Washington, some in the very 
Senate who have about the best health care coverage in the world can 
come and offer amendments that they cannot live under, that they could 
not live under if, in fact, they had to.
  What Member of the Senate does not make more than 350 percent of the 
Federal poverty level? Do you not deserve to have the Government 
subsidizing your health care? You should be out

[[Page 21579]]

then. Let's have the amendment make that happen too before you take 
3,000 kids off the Child Health Insurance Program. It is just 
incredible in my mind.
  So I urge my colleagues, when the time comes, and I hope there will 
be a timeframe when that amendment is to be pursued because I will be 
vigorous in pursuing it on the floor, that we do not head down the 
slope of pitting one part of our Nation against another, pitting the 
realities of the difficulties of living in one part of our Nation 
versus the other, pitting children in one part of the Nation versus the 
other, pitting the very essence of preserving children and their health 
against some simple formula number that ultimately Members of this body 
could not live under themselves.
  I think if it is good enough for us, it is good enough for these 
children. I would not want to see a vote that ultimately undermines the 
ability of thousands of children who presently get health care under 
this program to be eliminated. That would be a dark day in the Senate's 
history.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Madam President, notwithstanding an earlier agreement, I 
ask unanimous consent that Senator Obama be recognized to speak next 
and, following Senator Obama, Senator Lott be recognized.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Illinois.
  Mr. OBAMA. Madam President, let me begin by thanking the Senator from 
Mississippi for allowing me to speak first. I appreciate his courtesy.
  I also congratulate the Senator from New Jersey for his outstanding 
statement, sentiments which I fully share.
  I will be brief.
  As I have traveled across the country during these past several 
months, there are few issues that show a greater disconnect between 
what the American people want and the way Washington works than health 
care. Every single year people put it at the very top of the list of 
their concerns. Every year more people lose their insurance or watch 
their premiums skyrocket or open up medical bills they can't pay. Yet 
whenever the issue actually comes up in Washington, they watch health 
care debates play out that are filled with half truths and scare 
tactics. They see insurance companies run ads telling folks they will 
lose their doctor or wait forever if universal health care is passed. 
They watch the industry spend billions on lobbyists who use undue 
influence to block much needed reform. At the end of the day, nothing 
gets done, and we move on to fight about something else.
  To most Americans, we seem completely disconnected from the reality 
they are living every single day, especially when we have a President 
who has actually said, and I quote:

       I mean, people have access to health care in America. After 
     all, you just go to an emergency room.

  That is what passes for universal health care in the greatest, 
wealthiest country on earth--overcrowded, understaffed emergency rooms 
that raise everyone's premiums and cost taxpayers more money. It is 
shameful. What is even more shameful is that 9 million of the Americans 
who are forced to wait in emergency rooms when they get sick, who have 
no health insurance at all, are children--children who did not choose 
where they were born or how much money their parents have, children 
whose development depends on the care and nourishment they receive in 
those early years, children whom any parent anywhere should want to 
protect at any cost.
  We can shade the truth and pretend there are only 1 million 
uninsured, as the President says. We can make excuses for this neglect, 
we can start getting into an ideological argument, or we can just 
ignore the problem altogether. But as long as there are 9 million 
children in the United States with no health insurance, it is a 
betrayal of the ideals we hold as Americans. It is not who we are, and 
today is our chance to prove it.
  We know CHIP works. Because of CHIP, 6 million children who would 
otherwise be uninsured have health care today. Because of CHIP, 
millions of children are protected when their parents lose their health 
care. Because of CHIP, individual States such as my home State of 
Illinois are building on its success to expand health coverage even 
further. And because of CHIP, millions of children with asthma, 
traumatic injuries, and mental health conditions are able to see a 
doctor and get the treatment they need.
  Even though the uninsured rate among low-income children fell by more 
than one-third in the years after CHIP was enacted, the trend reversed 
2 years ago. Since then, we have seen growing numbers of uninsured 
children. That is why I am always puzzled when we start getting into 
these debates that are ideologically driven about whether Government 
should provide coverage. If market-based solutions provided affordable 
coverage options for these children, then it wouldn't be necessary for 
the Government to help provide coverage, because these children 
wouldn't be uninsured. The reason they are uninsured is because their 
parents can't afford private coverage.
  Uninsured children are twice as likely as insured children to miss 
out on much needed medical care, including doctor visits and checkups. 
One-quarter of uninsured children don't get any medical care at all. 
Those who do get lower quality care. Even with the same illness and 
conditions, whether it is an ear infection or appendicitis, studies 
have found that uninsured children get different treatment and often 
suffer more as a result. One study even found that uninsured children 
who are admitted to a hospital with injuries are twice as likely to die 
as children who are admitted with health insurance.
  To put this problem in the larger context, we know that when a child 
gets sick and can't get treated or receives inadequate treatment, he 
misses more days of school. When he misses more days of school, he 
begins to do worse relative to his peers. That can have long-term 
consequences on his chances in life. That is not something I want for 
either of my two young daughters or for any American child. This body 
should not want it for any child either.
  Let's get serious and solve this problem. Let's reauthorize CHIP. 
Let's make sure that the 6 million children who are now covered through 
the program continue to be covered. Let's extend coverage to an 
additional 3.2 million uninsured children.
  We also know the question of children's health care is tied to the 
larger question of universal care in this country. Because we know that 
when we cover parents, we also cover children. That is something we 
have seen in Illinois. When I was a State senator, I was able to help 
extend health care coverage to an additional 150,000 parents and their 
children. So if we are serious about covering every child, at some 
point we are going to have to cover every parent as well.
  The American people have been waiting for us to act on health care 
for far too long. Starting by covering more children should not be a 
difficult issue to agree on. I urge every Senator to vote for this 
bill. I know the President has threatened to use his veto, which he has 
so sparingly used, to deny health insurance to America's children. I 
urge my colleagues to stand and fight that veto every which way we can. 
There is not a single person here who, if their child were sick and 
they couldn't afford health insurance, wouldn't be begging the 
Government to give them some help. We wouldn't be having these 
arguments. Let's show some empathy for the families out there, many of 
whom are working every single day, sometimes working two jobs and still 
don't have health insurance. Let's make sure they have what every 
parent wants, which is some assurance that if their child gets ill, 
they are going to receive the kind of care they deserve.
  Let's cover our children and remind the American people who we are 
and why they sent us here in the first place.
  I yield the floor and suggest the absence of a quorum.

[[Page 21580]]

  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. LOTT. I ask unanimous consent that the order for the quorum call 
be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. LOTT. Madam President, we were alternating back and forth on both 
sides, but the Senator from Illinois had a need to go forward. I agreed 
that he would go first and then I would follow.
  Let me say on the bill we have here, again, it is very easy to get up 
and talk about children and the need to help children. That affects us 
all. I am a parent. I am a grandparent. There is nothing that excites 
me more in the world than going to see my four little grandchildren. I 
can't stand the thought of children anywhere, regardless of income 
level, not getting the kind of health care they need. That is why I 
voted for SCHIP in 1997. I remember Senator Kennedy was in the debate. 
Senator Phil Gramm of Texas had a little different point of view. 
Senator Hatch was involved. We came to a conclusion. We got a good 
program to help children who did not have health care. I thought we had 
done a good thing.
  The problem here is, we are exploding the program in terms of costs, 
tax increases, or cuts in the House. They are not doing the tobacco tax 
increase. They are cutting Medicare Advantage which affects people at 
the other end of the age schedule, people who need Medicare Advantage 
to get health care in rural areas in States such as mine.
  There is a balance here. Why can't we agree on a reasonable increase 
to make sure we continue to cover children who would not be covered 
otherwise. Also what is happening here is a steady march toward higher 
and higher and higher income level children. You heard Senator Allard 
talk about the fact, now we are up in the range of $73,000 income for a 
family of four. The ultimate goal is for all children to be covered by 
``Mother Washington,'' Washington bureaucracy health care. Why should 
any family have to worry, regardless of income, or any State have to 
worry about children being covered of all ages, forever, for 
everything, including dental care?
  I agree, dental needs can be as damaging healthwise as any other 
illness. I am connected to a family of dentists, dental hygienists, and 
dental technicians. But the question is, how much can the Government 
pay for? Why can't we keep some limits? Why do we want to force people 
off of private insurance? We are going to have children now covered by 
private insurance going into SCHIP or Medicaid. Why are we trying to 
force everybody on to SCHIP?
  This chart shows what is happening. When we started this program in 
1997, the next year, 1998, the children enrollment in Medicaid and 
SCHIP, the children's health program, was 27 percent covered by 
Medicaid, 1 percent was covered by the Children's Health Insurance 
Program, and 72 percent by other programs including private insurance. 
By 2005, it had grown to 37 percent covered by Medicaid, 8 percent by 
the CHIP program, and 55 percent other. With this bill, the underlying 
bill going into effect the way it is now, it will jump to 71 percent of 
all children will be covered by Medicaid and SCHIP, and only 29 percent 
other. You see the steady march toward every child being covered by 
this particular program.
  The problem with this bill can be described with A, B, C. Not only 
have you had the steady march of higher and higher income level 
children being covered, adults are being covered. Where is the ``A'' in 
SCHIP? Again, it is a creeping thing. First, gee whiz, yes, it is 
supposed to be for children, but pregnant mothers should be covered and 
what about parents of children. There are some other adults that maybe 
need some extra consideration, too. So it is not only higher and higher 
income children, it is adults and more adults and even more adults. So 
the first appropriate problem is adults, A.
  B, we are talking billions here. The underlying program is $25 
billion. The Finance Committee adds 35 at a minimum on top of that. And 
in the outyears it expands tremendously, up to, I think in the year 
2012, the number is maybe 37 billion in that single year. Remember, if 
we pass the Finance Committee bill, that 60 billion--25 plus 35, it 
will be 60 billion--the House is going to pass a bill at what, 80, 90, 
100 billion, paid for by taking money away from Medicare beneficiaries 
and we go to conference, if we go to conference. What will happen? What 
always happens, you split the difference. We are at 60; they are at 90. 
How about 75, $75 billion? How is that going to be paid for? It is 
going to be paid for by cutting benefits for the elderly and/or raising 
taxes for all kinds of people.
  We can fix this, though. It gets back to the A, B, C. Keep to the 
core mission, children who are low-income families. We need to get back 
to that. We have some good amendments pending. We should pass the 
Bunning amendment which would eliminate the high income eligibility 
above 300 percent, the Allard amendment which would stop the income 
disregards which drives the income level up steadily, and I understand 
that Senator Gregg will have one that will strike the adult coverage.
  We can fix this. We could get together on a bill that would be 
bipartisan and would help the children who do need it, the ones we 
started out to help before we got the bright idea we will cover 
everybody by the Children's Health Insurance Program.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. KENNEDY. Madam President, I was wondering if the Senator would 
yield for a question.
  Mr. LOTT. Madam President, I am glad to yield.
  Mr. KENNEDY. Madam President, I see the Senator from Wyoming. I want 
to address the Senate for a minute, but I want to inquire of the good 
Senator from Mississippi if I could engage him in a question or two.
  I listened with great interest to the Senator from Mississippi 
talking about the cost of this program and the paying of this program. 
Does the Senator agree with me that every Member of the Senate has a 
health insurance program that is funded and financed 72 percent by the 
Federal taxpayer? Does the Senator agree with me on that?
  Mr. LOTT. Madam President, we do have a program that has input from 
the Treasury, yes.
  Mr. KENNEDY. Well, the input is 72 percent for every Member in our 
health insurance program. Every Member's program, Republican and 
Democrat, is paid for by the American taxpayer, No. 1. Secondly----
  Mr. LOTT. Well, if I can respond, I have a solution. Let's cut that. 
Maybe we are not entitled to that.
  Mr. KENNEDY. If the Senator wants to offer that amendment, fine. I 
hear him talk about children, but I do not hear him talk about that.
  Secondly, would the Senator not agree with me that Members of the 
Senate have access to Bethesda Naval Hospital and Walter Reed Hospital 
and virtually free care at those places, which the children of America 
do not have? Would the Senator not agree with me that we are treating 
Members of Congress one way and the children another way?
  Mr. LOTT. Well, now, Madam President, I might say, the Senator has 
been here much longer than I have, and I presume he would know the 
origin of how these programs were created and voted for or against 
them. But I want to correct something he said right at the beginning. I 
have not advocated cutting children. I advocate covering the children 
who are now covered and making sure we cover the children we have 
committed to. What I am opposed to is the ever increasing income level 
and number of children and adults.
  What about adults who are being covered by this program? If it is 
going to be ``ACHIP,'' adults-children health insurance program, that 
is one thing. But I would like to keep the focus on covering the 
children who really need it and would not be able to get it perhaps 
through a private insurance program or in Medicaid.
  But if the Senator wants to propose we cut the Senator's benefits, I 
will be glad to join him in that.

[[Page 21581]]


  Mr. KENNEDY. I am for having a universal----
  Mr. LOTT. Everything we are doing to ourselves, we might as well do 
that too. That would be fine with me. If we could control the growth of 
this program, I would be more than glad to help pay for it.
  Mr. KENNEDY. If the Senator will yield for one more question. He was 
talking about coverage. We have 9 million children who are not covered. 
All of our children are covered. We have $160,000 in income, and every 
one of our children is covered. Why is the Senator so concerned about 
trying to cover the remaining children who are not covered in this 
country? Under this program, we cover 4 million more. All of our 
children are covered. We have $160,000 in income.
  Mr. LOTT. I am perfectly delighted to do that. Of course, my children 
are grown, and they are not covered at all by this, but I would be 
glad, to control that, to do anything the Senator wants to do to the 
Senate. I suspect it richly deserves it.
  And another thing, what I am saying is, one State is only covering 
children up to 200 percent, other States now have 350 percent, or even 
one of them is now wanting 400 percent of poverty for children and 
adults.
  All I am saying is, stick with the program we intended. Let's not 
turn this into just a Washington bureaucratic health-run program. That 
is what this is all about. This is about moving us toward a system we 
could not get any other way, where the Government will pay for and 
control everything in terms of health coverage in America. I do not 
believe the American people want it.
  I worry about my children and grandchildren in this respect. What 
kind of burden are we putting on their backs in terms of what they will 
have to pay for in the future? Does nobody ever think about that 
anymore? Every program is growing exponentially; every one of them. So 
I worry about my grandchildren having to pay for all the things we are 
coming up with here.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Madam President, the Senate has been very gracious in 
working out times. Two Democratic Senators spoke, and Senator Lott had 
the floor. So I ask consent now that the Senator from Wyoming, Mr. 
Barrasso, be able to speak--that would be two Republicans in a row--and 
following him, if he wishes, that Senator Kennedy be recognized to give 
a statement on the bill for about 15 minutes. I thank the Senator.
  So I ask consent that Senator Barrasso be recognized, and following 
Senator Barrasso that Senator Kennedy be recognized.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. BARRASSO. Thank you, Madam President.
  Today, I rise to speak about health care for children. We are talking 
about the SCHIP program, and I come to the floor with great interest 
because the ``S'' in SCHIP stands for State, and the ``C'' stands for 
children.
  For the last 5 years, I spent time in the Wyoming Legislature on the 
Labor, Health, and Social Services Committee, where we worked closely 
on the issue of children's health, and specifically worked closely with 
SCHIP.
  I have been a fan and a supporter of children's health, and 
specifically of SCHIP. In Wyoming, SCHIP has been a very successful 
program. In Wyoming, right now, there are over 5,000 young people who 
are in this program. Madam President, 5,642 was our count in July. We 
call the program Kid Care. That is because kids can be born with club 
feet. Kids can fall at the playground. Kids can have problems with 
measles or mumps.
  Nationwide, this very successful program has covered over 6 million 
children. It is a good program. Some folks confuse SCHIP with Medicaid. 
They are very different. Medicaid is designed for people below the 
poverty level. SCHIP is for people above the poverty level, but in that 
income range of up to 200 percent of the Federal poverty level. For us, 
that is an income of about $40,000 a year for a family of four.
  In Wyoming, if you talk to anyone in the legislature, from both 
parties, they will tell you this program has been cost effective. It is 
not an entitlement. It is done through a combined partnership with Blue 
Cross-Blue Shield, a public-private partnership. It covers the people 
in Wyoming who are intended to be covered.
  Many Government programs do not work well or produce results. Yet 
SCHIP very successfully achieved what it set out to do about 10 years 
ago when the program began. We have significantly reduced the number of 
uninsured children in America. It has worked. That is why I want to be 
clear from the outset, as we go into this debate, I am 100 percent 
committed to reauthorizing this very important safety net program for 
kids. I strongly supported the program as a State senator. I will 
continue to do so in my capacity as a U.S. Senator.
  Madam President, 5,642 Wyoming children depend on SCHIP right now to 
stay healthy. There are additional young people in our State who are 
eligible for SCHIP but who are not yet enrolled. So I want to do more 
in terms of outreach, working on outreach and enrollment efforts to 
find these people, to target these low-income children, and get them 
enrolled in the program.
  I want to support and enhance public-private collaborations to make 
sure we are doing the most cost-effective, efficient, and quality 
health care possible for these young people, but mostly I want to make 
sure this Senate and this Congress produces a reasonable, commonsense 
piece of legislation that we can send to the President and that he will 
sign.
  I have concerns with the bill that is in front of us. This bill, this 
piece of legislation, reported out of the Finance Committee, takes a 
successful spending program and uses it as a vehicle to create a new 
entitlement. The bill that I look at today covers high-income people, 
covers people who already have insurance, and covers adults. To me, 
this bill should be all about children.
  Well, let's look at those three concerns.
  High-income people: This bill allows families at 400 percent of the 
poverty level to be covered. In New York State, that is an income of 
$82,600 a year. In New Jersey, 350 percent of the poverty level is an 
income of over $72,000 a year. At home in Wyoming, we play by the 
rules. It is 200 percent of the poverty level. That is what we need. 
That is what works.
  Are there kids in New York and New Jersey who need to be covered? Of 
course. There are kids everywhere who need to be covered. But why the 
different rules for different States? And why so many high-income 
people as part of the program?
  So that is No. 1.
  No. 2, people who already have health insurance: When you start to 
cover children in families above that 200 percent of the poverty level, 
many of those children are in families where they already have 
insurance. Madam President, 77 percent of the children in families 
between 200 and 300 percent of the poverty level have private health 
insurance. When you go above that, above the 300 percent level, between 
300 and 400 percent of the Federal poverty level, 89 percent of those 
children are in families where they have private health insurance.
  When you do the math and look at the numbers, people in those 
categories will be financially compelled to take their children off of 
the private, usually employer-sponsored health care plans, and put them 
on the taxpayer-supported plans.
  The Congressional Budget Office looked at this, and they think, with 
this plan, 2.1 million people will move from private coverage to 
Government dependency, if this legislation is enacted.
  This is supposed to be a program to help children, children who do 
not have health insurance. It seems as if some in this body may be 
trying to use this plan to nationalize health insurance.
  The third thing I see that is a concern with this plan is in some 
places it covers adults, not just children. It covers the parents of 
children. Nowhere--nowhere--in the word ``SCHIP'' is there the letter 
``A'' for adults. The ``C'' stands for children.

[[Page 21582]]

  This country does need to have a serious debate on health care, and 
it should not be on the backs of these children covered under SCHIP. In 
the future, we need to debate health care in America, how we pay for 
health care, how we encourage people to better care for themselves, to 
take more responsibility for their own health, what incentives we can 
have for people to stay well, how insurance is used in this Nation. 
Should it be deductible for all, instead of just in businesses and not 
by individuals? Should there be tax credits? Is there a way we can set 
up small business health plans to help people who need insurance?
  I find that people are very thoughtful when it comes to how they 
spend their own money. So often, in the medical world, very few people 
spend the same kind of time making those financial decisions as they do 
when they are spending money out of their own pocket, when it is a 
third-party payer who is doing the spending.
  In the future, we need to have a debate and discussion about how we 
handle medical errors in this country: No. 1, how to prevent them from 
ever happening; and, No. 2, how to deal with the fact that when they 
occur, we want to make sure people are taken care of quickly, and that 
anything that goes to them goes more to the injured party than it does 
to the system.
  We need to find ways to lower the significant cost in America of 
defensive medicine.
  These are all very serious issues. They all deserve a serious 
national debate, and that day will come. But the bill today wrongly 
attempts to massively expand a successful program under excessive 
spending for many people who do not need it, and it avoids a debate we 
need to have on health care in America.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. KENNEDY. Madam President, I believe I have 15 minutes. Am I 
correct?
  The PRESIDING OFFICER. The Senator is not limited.
  Mr. KENNEDY. Well, Madam President, I think the floor manager 
intended to yield me 15 minutes, for which I am very grateful.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Madam President, I ask my friend, how long does he wish 
to speak, 15, 20 minutes?
  Mr. KENNEDY. Fifteen minutes.
  I see the Senator from Connecticut on the floor. I know we had 
accommodated the Senator from Illinois a short while ago. I do not mind 
accommodating him. I see, then, the Senator from Kentucky on the floor.
  Could I ask my friend from Kentucky, if we do not exceed 15 minutes, 
would he mind if I yielded a few minutes to the Senator from 
Connecticut? We basically are going from one side to the other.
  Mr. BUNNING. To the Senator from Connecticut? That would be perfectly 
all right, just so long as I get the time that was allotted to me.
  Mr. KENNEDY. Madam President, if it is agreeable with the floor 
manager, I would take 11 minutes and yield the Senator 4 minutes, if 
that is OK. Would the Chair remind me when I have used 10 minutes and I 
have 1 minute left?
  The PRESIDING OFFICER. The Senator will be notified.
  Mr. KENNEDY. Madam President, many of the best ideas in public policy 
are the simplest.
  The Children's Health Insurance Program is based on one simple and 
powerful idea--that all children deserve a healthy start in life, and 
that no parents should have to worry about whether they can afford to 
take their child to the doctor when the child is sick. CHIP can make 
the difference between a child starting life burdened with disease, or 
a child who is healthy and ready to learn and grow.
  This need not be a partisan issue. My good friend Senator Hatch and I 
worked together in 1997 to create this program that was our shared 
vision for a healthier future for American children. This year we have 
once again worked together to find common ground on covering the 
children who deserve decent, quality health care.
  In Massachusetts in the 1990s we agreed that health care coverage for 
children is a necessity and that action needed to be taken. In 1993, 
the Massachusetts Legislature passed the Children's Medical Security 
Plan, which guaranteed quality health care to children in families 
ineligible for Medicaid and unable to afford health insurance.
  A year later, Massachusetts expanded eligibility for Medicaid and 
financed the expansion through a tobacco tax--the same approach we used 
successfully a few years later for CHIP and he same approach that is 
proposed in the bill before us now.
  Rhode Island followed and other States took similar action and helped 
create a nationwide demand for action by Congress to address the unmet 
needs of vast numbers of children for good health care.
  In 1997, Congress acted on that call, and the result was CHIP. 
Senator Hatch and I worked together then--as we have this year--to 
focus on guaranteeing health care to children who need it. Now, in 
every State in America and in Puerto Rico, CHIP covers the services 
that give children a healthier start in life--well child care, 
vaccinations, doctor visits, emergency services, and many others.
  We know that CHIP works. Children across America depend on it for 
their health care, but there are still too many children that are left 
uninsured.
  In its first year 1997, CHIP enrolled nearly a million children, and 
enrollment has grown ever since. An average of 4 million are now 
covered each month, and 6 million are enrolled each year. In every 
State in America and in Puerto Rico, CHIP covers the services that give 
children a healthier start in life--well child care, vaccinations, 
doctor visits, emergency services, and many others.
  As a result, in the past decade, the percentage of uninsured children 
has dropped from almost 23 percent in 1997 to 14 percent today. That 
reduction is significant, but it is obviously far from enough.
  Children on CHIP are more likely to have a regular source of care 
than uninsured children. Ninety-seven percent of CHIP children can see 
a doctor regularly compared to only 62 percent of uninsured children.
  What does this mean for these children? It means that their overall 
quality of life is improved because they can get the care they need 
when they need it. Their parents are more confident that they can get 
the health care they need, they are more likely to have a real doctor 
and a real place to obtain care, and their parents don't delay seeking 
care when their child needs it. Children on CHIP also have 
significantly more access to preventive care.
  Studies also show that CHIP helps to improve children's school 
performance. After just 1 year on CHIP, children pay better attention 
in class and are more likely to keep up with all school activities. 
When children are receiving the health care they need, they do better 
academically, emotionally, physically and socially. CHIP helps create 
children who will be better prepared to contribute to America.
  CHIP has perhaps had the greatest impact on minority communities. 
Sadly, we still have persistent racial and ethnic health disparities in 
America. African Americans have a lower life expectancy than Whites. 
Many Americans want to believe such disparities don't exist, but 
ignoring them only contributes more to the widening gap between the 
haves and have-nots. Minority children are much more likely to suffer 
from asthma, diabetes, HIV/AIDS and other diseases than their White 
counterparts.
  Minorities are more likely to be uninsured than Whites. More than 
half of all children who receive public health insurance belong to a 
racial and ethnic minority group. The good news is that since the 
beginning of CHIP, the number of uninsured Latino children has 
decreased by nearly one-third and the number of uninsured African-
American children has decreased by almost half.
  Having CHIP works for minority children. CHIP all but eliminates the 
distressing racial and ethnic health disparities for the minority 
children who disproportionately depend on it for

[[Page 21583]]

their coverage. Minority children are more likely to have their health 
care needs met. In other word, they can see the doctor when they need 
to, go to the hospital and get the medicines they need, just like other 
children, when they are on CHIP.
  They are also more likely to have a real doctor--not just sporadic 
visits to the emergency room--when they are covered by CHIP.
  For specific diseases like asthma, children on CHIP have much better 
outcomes than when they were uninsured.
  CHIP's success is even more impressive and important when we realize 
that more and more adults are losing their own insurance coverage, 
because employers reduce it or drop it entirely.
  That is why organizations representing children, or the health care 
professionals who serve them, agree that preserving and strengthening 
CHIP is essential to children's health. The American Academy of 
Pediatrics, First Focus, the American Medical Association, the National 
Association of Children's Hospitals and countless other organizations 
dedicated to children all strongly support CHIP.
  A statement by the American Academy of Pediatrics puts it this way:

       Ennrollment in SCHIP is associated with improved access, 
     continuity, and quality of care, and a reduction in racial/
     ethnic disparities. As pediatricians, we see what happens 
     when children don't receive necessary health care services 
     such as immunizations and well-child visits. Their overall 
     health suffers and expensive emergency room visits increase.

  Today, we are here to dedicate ourselves to carrying on the job begun 
by Congress 10 years ago, and to make sure that the lifeline of CHIP is 
strengthened and extended to many more children.
  Millions of children now eligible for CHIP or Medicaid are not 
enrolled in these programs. Of the 9 million uninsured children, over 
two-thirds--more than 6 million--are already eligible for Medicaid or 
CHIP. These programs are there to help them, but these children are not 
receiving that help either because their parents don't know about the 
programs, or because of needless barriers to enrollment.
  Think about that number--9 million children in the wealthiest and 
most powerful nation on Earth. Nine million children whose only family 
doctor is the hospital emergency room. Nine million children at risk of 
blighted lives and early death because of illnesses that could easily 
be treated if they have a regular source of medical care.
  Nine million uninsured children in America isn't just wrong--it is 
outrageous, and we need to change it as soon as possible.
  We know where the Bush administration stands. The President's 
proposal for CHIP doesn't provide what is needed to cover children who 
are eligible but unenrolled. In fact, the President's proposal is $8 
billion less than what is needed simply to keep children now enrolled 
in CHIP from losing their current coverage--$8 billion short. To make 
matters worse, the President has threatened to veto the Senate bill 
which does the job that needs to be done if we are serious about 
guaranteeing decent health care to children of working families across 
America.
  We cannot rely on the administration to do what is needed. We in 
Congress have to step up to the plate and renew our commitment to CHIP.
  The Senate bill is a genuine bipartisan compromise.
  It provides coverage to 4 million children who would otherwise be 
uninsured.
  It adjusts the financing structure of CHIP so that States that are 
covering their children aren't forced to scramble for additional funds 
from year to year and so that Congress doesn't have to pass a new band-
aid every year to stop the persistent bleeding under the current 
program.
  Importantly, this bill will not allow States to keep their CHIP funds 
if they aren't doing something to actually cover children.
  Equally important, this bill allows each State to cover children at 
income levels that make sense for their State.
  The bill also supports quality improvement and better outreach and 
enrollment efforts for the program. It is a scandal that 6 million 
children today who are eligible for the program are not enrolled in it.
  In sum, this bill moves us forward together, Republicans and 
Democrats alike, to guarantee the children of America the health care 
they need and deserve.
  Our priority should be not merely to hold on to the gains of the 
past, but to see that all children have an access to decent coverage. 
Families with greater means should pay a fair share of the coverage. 
But every parent in America should have the opportunity to meet the 
health care needs of their children.
  In Massachusetts, I met a woman named Dedre Lewis. Her daughter 
Alexsiana developed an eye disease that if left untreated would make 
her go blind. Because of our State CHIP program, Masshealth, Dedre is 
able to get the medicine and doctors visits need to prevent Alexsiana's 
blindness. Dedre said this:

       If I miss a single appointment, I know she could lose her 
     eyesight. If I can't buy her medication, I know she could 
     lose her eyesight. If I didn't have Masshealth, my daughter 
     would be blind.

  This is the impact CHIP has on families across America.
  Let me say that quality health for children isn't just an interesting 
option or a nice idea. It is not just something we wish we could do. It 
is an obligation. It is something we have to do. And it is something we 
can do today. I look forward to working with my colleagues to make sure 
this very important legislation is enacted.
  I want to pick up on a theme I mentioned just a few minutes ago, and 
I stand to be corrected. I would say there is not a single Member of 
the Senate who doesn't take, effectively, the Federal employees 
insurance program, and in our situation, the Federal Government pays 
for 72 percent of it. We have one Member, and I admire him--I have just 
learned of his name, and I will not mention it here; I will ask whether 
I can include it as part of the Record rather than embarrass him--but 
it is a noble act on his part when he said that until we get universal 
coverage, he wasn't going to take this.
  But the idea that all Americans ought to understand now is what we 
are standing for--and I again commend the Senator from Montana and the 
Senator from Iowa and my friend, Senator Hatch, when we worked together 
years ago, and Senator Rockefeller on this program--is a rather simple 
and fundamental concept, and that is this: Every child in America ought 
to have a healthy start.
  Here in the Senate, we are about expressing priorities. Those of us 
on this side of the aisle and a group on the other side--a small group 
on the other side, a courageous group on the other side--have stated 
that same concept, that every child in America should have a healthy 
start, No. 1; and No. 2, that every parent in America should be 
relieved of the anxiety of worrying about whether they have sufficient 
resources to be able to make sure their child is going to receive 
decent quality health care. Those are revolutionary thoughts, are they 
not? Those are surprising concepts; isn't that right?
  Evidently, our friends on the other side of the aisle get all worked 
up about those two concepts--that all children in this country should 
have a healthy start and that mothers and fathers should be relieved of 
the anxiety that when their child has an earache or their child has a 
soar throat or their child has a headache, they have to wonder whether 
their child is 150 dollars or 175 dollars sick because that is what it 
costs to take them to the emergency room. So they wait overnight. They 
let the child get a little sicker. They have a sleepless night. They 
worry. They hope and they pray that their child gets better. Well, we 
in this body say that America can do better.
  I listened to my friend--and he is my friend--from Mississippi 
talking about the cost of this program: $60 billion over 5 years. That 
is what we are spending in 5 months in Iraq--5 months in Iraq. What 
would the American people rather have--coverage for their children or a 
continued conflict in Iraq where we are losing the blood of our

[[Page 21584]]

young men and women? This is the issue. Let's not complicate it. Let's 
not make it difficult. Let's not make it unreasonable. That is what 
this is about.
  Sure, we have listened to the arguments: Oh, someone is going to have 
to pay for it. Yes, it is going to be those who are smoking. What is 
the result of increasing the tobacco tax? What is the direct result? 
Tobacco--cigarettes--when used as advertised increases deaths in 
America. Among whom? Among children. Every day, 2,800 children become 
addicted. Every year, 500,000 people die because of the use of tobacco. 
So what happens if we raise the tax 61 cents on cigarettes? You know 
what happens. Children stop smoking. Oh, they do? Yes, they do. Who 
says so? Who says so? Just look at the history of what has happened 
when we have increased the tax on cigarettes.
  So I commend those on the Finance Committee for finding a revenue 
measure that will ensure--not that all children will stop smoking and 
end it but that this will be a major disincentive for young people to 
smoke. On the other hand, it gives children a healthy start and 
relieves the anxiety for parents.
  So this is a measure which speaks for action. It speaks for justice. 
It speaks for fairness. It speaks for our values. I, for one, strongly 
believe in the concept of comprehensive health care, and we will have 
that debate at another place and at another time.
  I know my children were covered. They are grown now, as others have 
been here, but I know when they needed health care, they were able to 
receive it. I remember very clearly that when my child lost his leg to 
cancer, we saw families in that chamber who were absolutely driven into 
poverty because they couldn't afford the same kind of health care we 
had.
  This is a statement that we in the Senate find children to be a 
priority and find their parents to be a priority and find it to be in 
the interest of children to increase the tobacco tax.
  This legislation makes a great deal of sense, and I again commend the 
sponsors for it.
  Whatever time remains I yield to my friend and colleague from 
Connecticut.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Connecticut is recognized.
  Mr. DODD. Madam President, I wish to begin my comments by thanking 
our colleague from Massachusetts once again for giving heart to an 
argument that sometimes gets lost in statistics and numbers.
  As all of us know, every one of us has watched either fellow Members 
or others--our staffs or constituents--who have gone through the 
dreaded situation of watching a child in need of health care. We know 
how fortunate we are to be Members of Congress, as we receive a 
tremendous amount of support for health care services. The fact that we 
are living in a day and age in the 21st century when so many of our 
children, growing numbers in our society, are without any kind of 
health care coverage at all. It is shameful, to put it mildly. I 
commend the distinguished Senator from Montana, the chair of the 
Finance Committee, and once again the Senator from Massachusetts for 
his tremendous support of this effort.
  I wish to offer an amendment at the appropriate time. As many of my 
colleagues know, over a period of 7 years, three Presidents, and two 
Presidential vetoes, I worked toward passage of the Family Medical 
Leave Act. It finally became law in 1993. Today, more than 50 million 
Americans have been able to take advantage of the protections of that 
law. It is related to the subject matter of the bill at hand, a little 
bit off center, but it's about caring for our families.
  Last week, Senator Dole along with Donna Shalala and others, offered 
recommendations from the President's Commission on Care for America's 
Returning Wounded Warriors. They urged Congress to draft legislation to 
allow up to 6 months of family and medical leave for family members of 
troops who have sustained combat-related injuries and meet the other 
eligibility requirements of the law. We believe this is a worthwhile 
proposal, so I introduced the Support for Injured Servicemembers Act 
last week with several of my colleagues.
  I am very grateful to Senator Dole, a former colleague of ours, and 
the entire Commission for their thoughtful work on this crucial issue.
  For 20 years, we have worked on legislation to extend family and 
medical leave to families in this country. So I hope that at the 
appropriate time, my amendment on this matter will be considered and 
unanimously adopted. There may be an argument on germaneness, but we 
can't wait to help the men and women who are injured in service to our 
country. I can't think of a more appropriate step for us to take than 
to allow these veterans who are recovering from their wounds to have a 
loved one with them during that period of recovery.
  I wanted to lay out for my colleagues the value of this amendment, 
how valuable the protections of family and medical leave have been for 
families. In fact, we have introduced legislation to provide paid 
family and medical leave. I won't be offering that at this juncture, 
but now offer an extended unpaid leave program. My amendment would 
simply extend the period of job protection for up to six months for 
those who care for our returning heroes as they recover from their 
injuries. The reasons are obvious.
  In the Wounded Warriors Commission survey, 33 percent of Active-Duty 
and 22 percent of Reserve components and 37 percent of retired/
separated servicemembers report that family members or close friends 
relocated for extended periods of time to be with them while they were 
in the hospital. Twenty-one percent of Active-Duty, 15 percent of 
Reserve components, and 24 percent of retired/separated servicemembers 
say friends or family gave up a job to be with them or act as their 
caregiver.
  It seems to me they shouldn't have to give up a job in order to be 
with a recuperating servicemember coming back from Iraq or Afghanistan. 
The Commission's findings indicate the critical role that family and 
friends play in the recovery of our wounded servicemembers. Currently 
FMLA provides for 3 months of job-protected unpaid leave to a spouse, 
parent or child acting as a caregiver for a person with a serious 
illness. The report indicates that many servicemembers rely on other 
family members or friends to care for them. My amendment allows these 
other caregivers--siblings, cousins, friends or significant others to 
take leave for up to six months, when our returning heroes need them 
the most, without fear of losing their jobs. My amendment goes beyond 
some other proposals in other ways as well. It covers caregivers 
staying with the recovering servicemember in a military hospital as 
well as those providing care at home. This proposal would apply to all 
individuals currently covered by FMLA, including federal civil 
servants, who might find themselves caring for a wounded warrior.
  My amendment only addresses servicemembers with combat-related 
injuries. This is a narrow universe of individuals who experience 
extraordinary circumstances. Taking care of our soldiers, sailors, 
airman and Marines returning from Iraq and Afghanistan was the point of 
the Commission and the Wounded Warriors Act that we recently passed. I 
can't think of anything more important that we could do this week 
before August break than to pass a proposal that would provide these 
service men and women the opportunity to have a loved one with them as 
they recover.
  I send my amendment to the desk. I thank my colleague from 
Massachusetts for his tireless work, the Senator from Montana, of 
course, and the Senator from Iowa, who have worked hard on children's 
issues, and ask them to consider this amendment at the appropriate 
time.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Kentucky is recognized.
  Mr. BUNNING. Madam President, I would like to talk about the State 
Children's Health Insurance Program, also known as SCHIP.

[[Page 21585]]

  A few weeks ago, the Finance Committee passed the Baucus bill to 
reauthorize this program. I did not support this bill in committee and 
I will not be supporting it on the floor. Today, I would like to take a 
few minutes to explain my concerns with the Baucus bill. I would also 
like to talk about the SCHIP reauthorization bill I will be supporting 
this week and have helped to craft over the past couple of months--the 
Kids First Act.
  This bill is a good piece of legislation that reauthorizes this 
important program in a fiscally sound way and keeps the focus of the 
program on what it was originally for, which is low-income children.
  I have significant concerns with the budget gimmicks used, the SCHIP 
provisions, and the tax increases in the Baucus bill. The budget 
gimmick used to fund the Baucus bill is irresponsible, jeopardizes 
coverage under the program, and basically guarantees another tax 
increase 5 years from now. Under the bill, SCHIP spending in 2012 
reaches $16 billion; however, the very next year, spending drops to 
$3.5 billion. While this strategy helps the drafters hide an additional 
$40 billion in spending, does any Member of the Senate really think 
that SCHIP spending in 2013 will be $3.5 billion? That is below the 
current spending level of $5 billion a year. Does any Member really 
think we will kick millions of kids off this program in 2013 to 
accommodate this lowered spending? Of course, the answer is no. That 
means Congress will have to come up with a significant amount of money 
to pay for the increased spending, which will likely mean reaching into 
the wallets of hard-working Americans again.
  I also believe SCHIP should be a program for low-income children. 
When Congress created the program in 1997, it was intended for children 
without health insurance who lived in families making less than 200 
percent of the Federal poverty limit. For 2007, 200 percent of poverty 
is about $41,000 in income for a family of four.
  Not many people realize adults are now covered under SCHIP. Most 
people rightly think this is a program only for children since it is 
the State Children's Health Insurance Program. That is its name. Over 
the years, the Department of Health and Human Services has approved 
expansions to the program to allow States to cover these adults. These 
expansions should not have been approved in the first place, and it is 
Congress's responsibility in the reauthorization to rein in these 
abuses.
  While the Baucus bill at least ends coverage for childless adults 
currently on SCHIP, it still allows other adults--specifically, 
parents--to stay on the program in certain States, and any State that 
currently covers parents can keep adding new parents to their programs.
  The Kids First Act, which I am supporting, responsibly reauthorizes 
the SCHIP program and keeps the focus on low-income children. This bill 
reauthorizes the program for 5 years at a cost of about $39 billion. 
This would still be a significant but responsible increase over 
spending in the first 10 years of the program.
  The bill would require States that want to cover children and 
pregnant women above 200 percent of the poverty level, or $41,000 for a 
family of four, to pay more from their State coffers than they do now 
to do so.
  The bill also takes steps to limit the number of adults on the SCHIP 
program. While we would not require States to remove any adults 
currently on the program from their rolls, we would reimburse States at 
a lower amount for the childless adults and parents they currently have 
on their programs.
  Also, States could not add any new childless adults or parents to 
their SCHIP rolls. If they want to cover these individuals, then they 
need to do it under their State Medicaid programs.
  The Kids First Act also stops the Department of Health and Human 
Services from approving any more waivers or demonstration projects for 
States that want to cover parents or childless adults.
  The Kids First Act is a good proposal that I hope will get full 
consideration on the Senate floor. It keeps SCHIP focused on low-income 
children, curtails States' ability to add new parents or childless 
adults to the program, and makes sense from a fiscal standpoint. 
Unfortunately, the Baucus bill falls short on these key points.
  Also, the tobacco tax in the Baucus bill is fundamentally unfair to 
my State and the surrounding States. I want to show you a chart I have 
here, which shows the 50 States. This illustrates the real problem. It 
is compiled from data drawn from a CDC database on tobacco consumption 
and projections by Families USA concerning SCHIP spending. You will see 
here that there are big winners in this program, and they are in dark 
green on the chart. You can see Texas, California, Arizona, New Mexico, 
New York, and California, which is $2.564 billion. New York is $1.684 
billion. It shows Kentucky, Tennessee, South Carolina, North Carolina, 
Virginia, Ohio, Indiana, Missouri, Iowa, Wisconsin, and particularly 
Florida; it shows those States as dead net losers--$703 million in 
Florida; $602 million in Kentucky; $517 million in Indiana; $536 
million in North Carolina, and so on. It also shows States that are 
neutral, such as Oregon, Idaho, Nebraska, and some other States that 
are kind of in the middle, such as West Virginia, Georgia, Alabama, 
Mississippi, and so on. You can see from the chart that we pick big 
winners and big losers, some neutral and some lower losers, not big 
such as the ones in dark brown. It is very important that you realize 
that is a completely unfair reason and method of funding SCHIP.
  The problem with the tax is that the money comes from low-income 
smokers in my State and all of the dark brown States on this chart, and 
it is going to pay for an extravagant expansion of SCHIP in California, 
New York, Texas, and the States depicted in green.
  This bill will also, without any doubt, add an enormous boost to 
black-market tobacco smuggling and counterfeiting. The plan would be a 
tremendous gift to organized crime and the black-market kingpins, who 
will profit handsomely from it in future years. There is plenty of past 
evidence of this. In 2002, for example, New York City increased its 
tobacco tax from 8 cents per pack to $1.50 per pack. The city's revenue 
estimators predicted an additional $107 million in revenue. Do you know 
what they got? It brought in $43 million. What is more, the tax 
increase on cigarettes cost the State over $600 million in tax revenue 
due to lower sales at convenience stores throughout New York State. An 
economist found that most of the reduction was due to smuggling, cross 
border sales, Internet sales, and sales on Indian reservations.
  Even supporters of this bill acknowledge that the higher tax will 
have an impact on demand. It will reduce legal consumption of 
cigarettes. It is not likely to reduce total consumption, as the 
supporters of the bill say it will, because it will also increase 
smuggling. But legal consumption is what matters to the United States 
because that is the only part that is taxed.
  The revenue estimate provided by the Joint Committee on Taxation 
shows this. Revenue is projected to decline by $700 million per year by 
the last year of the estimating window. That is right. Understand this 
now. Revenue is expected to go down over time as the number of legal 
sales of tobacco products declines.
  Whatever its other problems, the tobacco tax is a poor foundation for 
SCHIP. We are matching a declining source of revenue with a growing 
Federal problem. This does not make any fiscal sense.
  If we were honest and we truly wanted to fully fund SCHIP spending 
with a tobacco tax, the Federal Government would have to encourage 
people to smoke.
  That is what this next chart shows: additional smokers. The Federal 
Government would need an additional 22.4 million smokers by the year 
2017. Of course, I don't support such an effort, but this highlights 
the budget gap, as you can see, from 2010 up to 2017. The revenue for 
this program is going to have to come from more tax increases down the 
road.

[[Page 21586]]

  We all say we oppose regressive taxes, but what we are considering 
today is a highly regressive tax. In fact, this tax is among the most 
regressive type of tax we could consider.
  In my State of Kentucky, the impact on low-income taxpayers will be 
compounded. It will hit low-income Kentuckians, Kentucky tobacco 
farmers, and every citizen in the Commonwealth of Kentucky. Although 
there has been a dramatic decrease in the amount of tobacco farmers in 
my State due to the tobacco buyout, tobacco continues to play an 
important role in Kentucky's agricultural landscape. Tobacco barns and 
small plots of tobacco still dot the Kentucky landscape. Cash receipts 
for tobacco are projected to contribute between $300 million and $350 
million to Kentucky's economy this year.
  An increase in the excise tax on tobacco will drive down demand for 
consumption, which will result in less tobacco being purchased from 
Kentucky tobacco farmers by manufacturers--both cigarette and non-
cigarette. It will likely force the specialty growers in my State--
Kentucky burley leaf and Kentucky-Wisconsin leaf--completely out of 
business. These are small family farms in rural Kentucky that rely on 
these revenues for their crops. The money they get from the tobacco 
pays for their mortgages, puts their kids through school, and allows 
them to keep farming.
  The CBO has estimated that the SCHIP proposal will result in a 5 to 6 
percent reduction in demand for tobacco during its first year in 
existence. This will likely cause a $5.4 million reduction in payments 
to rural farmers in my State under the master settlement agreement we 
signed a few years ago.
  Some people will say there is nothing wrong with all of this because 
it will force some people to quit smoking and we are using the money to 
help poor children. But who gets credit for this supposed act of 
charity? This plan would take money from one group of poor people and 
give it to another.
  I urge my colleagues to oppose the Baucus SCHIP bill and support the 
Kids First Act.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana is recognized.
  Mr. BAUCUS. Madam President, I have two requests. First, I ask 
unanimous consent that at 5:20 today, the Senate vote in relation to 
the Allard amendment No. 2536, with the time from 5:15 to 5:20 p.m. 
equally divided between Senator Allard and myself or our designees; 
that no second degree amendments be in order to the amendment prior to 
the vote.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. BAUCUS. Madam President, I also ask unanimous consent that 
following the vote on the Allard amendment, Senator Dorgan then be 
recognized.
  Mr. BURR. Madam President, can I ask the Senator to change the 
unanimous consent request to add myself after Senator Dorgan.
  Mr. BAUCUS. Madam President, I so change my request.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The Senator from Colorado is recognized.
  Mr. ALLARD. Madam President, what is the pending amendment?
  The PRESIDING OFFICER. The Allard amendment.
  Mr. ALLARD. Thank you.
  Madam President, I plan on going ahead and, if I understand what we 
have agreed to, I have 2\1/2\ minutes to speak. I plan on spending a 
minute or minute and a half to talk about my amendment, and then I will 
yield and wrap it up later. I would appreciate it if the Chair will 
alert me when I have spoken for about 1\1/2\ minutes.
  Mr. BAUCUS. Madam President, the normal order is that the sponsor of 
the amendment speaks first and those opposed second. If we can maintain 
that, it would be 2\1/2\ and 2\1/2\.
  Mr. ALLARD. That is fine.
  Madam President, I rise to encourage my colleagues in the Senate to 
vote with me on this important amendment. What we see happening now is 
that there is a discrepancy between the calculation of gross income 
between the various States. Because of the way the various States are 
calculating their gross income, some States are getting more benefit 
under SCHIP than others. The State of Colorado, for example, is not one 
of those States. There are 12 to 15 States that have made some 
adjustments in the way they figure gross income, and that entitles them 
to more Federal dollars as far as SCHIP is concerned.
  So what my amendment does, if it is adopted, it will direct the 
Secretary of Health and Human Services to put in regulations the 
definition of gross income. This is going to have a 90-day period in 
order to establish this value, and this will then allow the States an 
opportunity to come and give their input as to what they think the 
calculation of gross income should be. Then, when that rule and 
regulation is enacted, all the States are going to be acting under the 
same rules so they will all be figuring their gross income in the same 
way.
  I think this is an important amendment. I think when we are talking 
about equity of benefits to the various States, it is extremely 
important we make sure they are operating under the same rules. Right 
now we have some of the States that disregarded the original intent of 
SCHIP and, as a result of that, they are receiving considerably more 
benefit as far as SCHIP is concerned than some of the other States.
  My hope is my language will be adopted, and then we can move forward 
with this program. It has been working. We have to create some equity 
among the States.
  I yield the floor and reserve the remainder of my time.
  The PRESIDING OFFICER (Mr. Salazar). The Senator from Montana.
  Mr. BAUCUS. Mr. President, how much time is remaining on both sides?
  The PRESIDING OFFICER. The Senator from Colorado has 12 seconds; the 
Senator from Montana has 2 minutes 30 seconds.
  Mr. BAUCUS. I don't want to belabor the issue, so I will use all my 
time.
  Mr. President, the hallmark of the CHIP program, the Children's 
Health Insurance Program, is block grants, not entitlements. That is 
first. Second, it gives the States flexibility. States design their own 
program. This is a State Children's Health Insurance Program. Different 
States are different. Different States have different needs. Different 
States have different costs of living. Different States are different.
  Many States find themselves in a situation where a law might restrict 
them. If the States did not have flexibility, many people who earn a 
little too much might find they cannot get health insurance, and so 
they quit their jobs. The goal is to get people to work. People want to 
work. The goal is to make sure people have health insurance. People 
need health insurance. But in many States, people are just above the 
level here, and if they can't find health insurance, they quit their 
jobs so they can be in the Children's Health Insurance Program.
  I think States should have the right to make some adjustment to keep 
people working so they get health insurance. Now, if this amendment 
passes, 30 States will be adversely affected. Children in 30 States 
will be adversely affected. I don't think we want to do that. States 
need flexibility. Many Senators in this body have said many times, we 
shouldn't have one size fits all. We need flexibility.
  There are very definite Federal limits on how much States can make an 
adjustment--that is, not include a certain amount of income--so those 
people don't have to quit their jobs and can keep their private health 
insurance.
  So I would say I understand the basic theory, but we can't let 
perfection be the enemy of the good. We cannot. We cannot take away 
health insurance coverage from kids in 30 States. I do think the goal 
is for people to work. We want people to work. We should not adopt 
policies, which this amendment in effect would do, and say: OK, people, 
sorry, you can't work. You can't work so you can qualify for children's 
health

[[Page 21587]]

insurance. I think we want people to work in States so they can get 
health insurance.
  I strongly urge Members to not agree to this amendment. It has 
surface appeal but only surface appeal. If you dig down and find out 
what is happening in many States, I think Senators will realize this is 
not the right thing to do and will oppose the amendment.
  Mr. ALLARD. Mr. President, this is a matter of fairness among the 
States. Any child determined to be ineligible for SCHIP would remain in 
the State program, but the State would be reimbursed according to the 
FMAP rate rather than the enhanced EFMAP reimbursement rate.
  I think this is an important issue as far as equity among the various 
States. I ask Members to join me in voting for this particular 
amendment, and I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second? There appears to 
be a sufficient second.
  The question is on agreeing to the amendment.
  The clerk will call the roll.
  The legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from Delaware (Mr. Biden) and 
the Senator from South Dakota (Mr. Johnson) are necessarily absent.
  Mr. LOTT. The following Senators are necessarily absent: the Senator 
from Kansas (Mr. Brownback) and the Senator from Arizona (Mr. McCain).
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 37, nays 59, as follows:

                      [Rollcall Vote No. 286 Leg.]

                                YEAS--37

     Alexander
     Allard
     Barrasso
     Bennett
     Bunning
     Burr
     Chambliss
     Coburn
     Cochran
     Corker
     Cornyn
     Craig
     Crapo
     DeMint
     Dole
     Ensign
     Enzi
     Graham
     Gregg
     Hagel
     Hutchison
     Inhofe
     Isakson
     Kyl
     Lott
     Lugar
     Martinez
     McConnell
     Murkowski
     Roberts
     Sessions
     Shelby
     Sununu
     Thune
     Vitter
     Voinovich
     Warner

                                NAYS--59

     Akaka
     Baucus
     Bayh
     Bingaman
     Bond
     Boxer
     Brown
     Byrd
     Cantwell
     Cardin
     Carper
     Casey
     Clinton
     Coleman
     Collins
     Conrad
     Dodd
     Domenici
     Dorgan
     Durbin
     Feingold
     Feinstein
     Grassley
     Harkin
     Hatch
     Inouye
     Kennedy
     Kerry
     Klobuchar
     Kohl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     McCaskill
     Menendez
     Mikulski
     Murray
     Nelson (FL)
     Nelson (NE)
     Obama
     Pryor
     Reed
     Reid
     Rockefeller
     Salazar
     Sanders
     Schumer
     Smith
     Snowe
     Specter
     Stabenow
     Stevens
     Tester
     Webb
     Whitehouse
     Wyden

                             NOT VOTING--4

     Biden
     Brownback
     Johnson
     McCain
  The amendment (No. 2536) was rejected.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, what is the regular order?
  The PRESIDING OFFICER. Under the previous order, the Senator from 
North Dakota is to be recognized, followed by the Senator from North 
Carolina.
  The Senator from Montana.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that following 
those two Senators receiving recognition, Senator McCaskill then be 
recognized; that following Senator McCaskill, Senator Gregg be 
recognized for an amendment.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BAUCUS. Mr. President, I yield to the Senator from Ohio for a 
unanimous consent request.
  Mr. BROWN. Mr. President, I ask unanimous consent that amendment 2551 
be modified with the changes at the desk, notwithstanding the fact that 
the amendment is not pending.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Montana.
  Mr. BAUCUS. Mr. President, I think the regular order is to recognize 
the Senator from North Dakota.
  The PRESIDING OFFICER. The Senator is correct. The Senator from North 
Dakota is recognized.
  Mr. DORGAN. Mr. President, first of all, let me thank my colleagues, 
Senator Baucus and Senator Grassley, the chairman and ranking member of 
the Finance Committee, for bringing to the floor the piece of 
legislation called the Children's Health Insurance Program. It is a 
very important bill. It will add several million more children to the 
health insurance rolls and provide important health insurance for kids 
who otherwise would not have it. I believe all of us in this Chamber 
would believe that children's health care should not be a function of 
how much money their parents may have in their pocketbook or their 
checkbook. A sick child needs health care. This legislation moves in 
that direction. I am pleased to support it. I thank my colleagues for 
the work they have done on it.
  I do wish to offer an amendment at this point, and I wish to talk a 
bit about a very important issue that also relates to health care.
  My amendment deals with the Indian Health Care Improvement Act. It is 
true that we will now improve the lives of 3 million children with the 
underlying bill. I fully support that and compliment my colleagues for 
doing that. It is also true that there are at least 2 million American 
Indians in this country living on Indian reservations who are seeing 
health rationing virtually every day of their lives. It is unbelievable 
that that condition continues to exist.
  We have a trust responsibility for those people. The American Indians 
are a group of people in our midst with whom we made treaties, we made 
agreements, and we have the trust responsibility for Indian health 
care. We have not nearly met those responsibilities.
  I would observe that we have a responsibility for the health care of 
those who are incarcerated in Federal prisons. Guess what. We spend 
twice as much per person on health care for Federal prisoners as we do 
in meeting our health care responsibility for American Indians on a per 
capita basis.


                           Amendment No. 2534

 (Purpose: To revise and extend the Indian Health Care Improvement Act)

  Let me say that I have filed amendment No. 2534. Let me call up that 
amendment, which is at the desk. I offer this on behalf of myself, 
Senator Johnson, Senator Murkowski, Senator Bingaman, and Senator 
Stevens.
  Mr. BAUCUS. Mr. President, I ask unanimous consent that the pending 
amendment be set aside.
  The PRESIDING OFFICER. Is there objection?
  Mr. GREGG. Mr. President, reserving the right to object, I was 
wondering if I could ask the Senator from North Dakota how long he 
expects to debate this amendment.
  Mr. DORGAN. I intend to speak about 25 minutes.
  Mr. GREGG. I thank the Senator.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The clerk will report the amendment.
  The legislative clerk read as follows:

       The Senator from North Dakota [Mr. Dorgan], for himself, 
     Mr. Johnson, Ms. Murkowski, Mr. Bingaman, and Mr. Stevens, 
     proposes an amendment numbered 2534.

  Mr. DORGAN. Mr. President, I ask unanimous consent that the reading 
of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The amendment is printed in today's Record under ``Text of 
Amendments.'')
  Mr. DORGAN. Mr. President, let me describe now, if I might, the issue 
of health care for American Indians, which I believe is an urgent 
national need. We have a trust responsibility for their health care. We 
have a piece of legislation that exists in law called the Indian Health 
Care Improvement Act, but it needs to be reauthorized. It has not been 
reauthorized for 15 years. It expired 7 years ago. We need to do this. 
Year after year after year, this Congress postpones it. We have passed 
legislation out of the committee; it does not get to the floor; it does 
not get done.
  Let me show my colleagues a picture of a young 14-year-old girl. This 
precious child--her name is Avis

[[Page 21588]]

Littlewind. Her relatives gave me permission to use her picture. Avis 
is dead. Avis committed suicide. I want to tell you the story about 
Avis because I went to talk to the school officials, the tribal 
officials, the mental health officials, and those who were in the 
extended family.
  This 14-year-old girl took her own life. It probably should not have 
been a surprise to anyone because for 90 days this little girl lay in 
bed in a fetal position, missed school. Something was very wrong. This 
little girl had a sister who, 2 years previous, had committed suicide. 
This little girl had a father who took his own life. This little girl 
had another parent who was a very serious drug abuser. She laid in bed 
90 days before she took her life.
  Now, one might ask the question: Why does this 14-year-old girl just 
fall through the cracks? She thinks she is in a situation that is 
hopeless. She feels helpless and she takes her own life. But this 
little girl had a full life in front of her.
  You know something? On that Indian reservation where Avis Littlewind 
lived, there were no mental health treatment facilities for someone to 
take this young lady, this young girl. One might ask and certainly 
should ask: Why is it in this country that mental health treatment is 
not available to a young child like this? Why is it that the person 
responsible for trying to give this young lady some help did not even 
have a car or any transportation? Even if you could find a mental 
health professional to treat this person, there is no transportation to 
get the person to treatment. Why is it that for 90 days this young lady 
lay in bed, and nobody from the school, nobody from the area, said: All 
right, there must be a big problem here; let's find out what is going 
on.
  The fact is, this is one precious child who took her life. We have 
had clusters of teen suicides on Indian reservations. This is but one 
aspect of the Indian Health Care Improvement Act, but it is not just 
mental health. The bill covers virtually every aspect of Indian health.
  We are told that about 60 percent of Indian health care needs are 
met. That means 40 percent of the health care needs are unmet. There is 
full-scale health care rationing on Indian reservations. If we were to 
debate that on the floor of the Senate, people would be appalled. You 
can't ration health care. Yet, that is what is happening.
  We have a trust responsibility, and yet health care is being rationed 
with respect to Native Americans. American Indians die at higher rates 
with respect to tuberculosis, 6 times the national average; alcoholism, 
5 times the national average; diabetes, 180 percent higher than the 
national average. In Alaska, Native communities in Alaska have fewer 
than 90 doctors for every 100,000 Alaska Natives. That compares to 229 
doctors for every 100,000 Americans. Heart disease, diabetes, blood 
pressure, stroke--you name it. The incidence of most diseases affecting 
our Native Americans are at much higher rates than for non-Indians. 
Cervical cancer for American Indians and Alaska Natives is nearly four 
times higher than cervical cancer for other women in this country.
  I mentioned before that Federal prisoners, for whom we have a 
responsibility for health care, receive twice as much funding per 
person on their health care needs than do American Indians for whom we 
have a trust responsibility. Stated another way, we spend twice as much 
per person on Federal prisoners than we do with respect to American 
Indians, and we have a trust responsibility in law to deal with 
American Indian health issues.
  I want to show a photograph to describe health care rationing. This 
is a photograph of Ardel Hill Baker. She has also allowed me to use her 
photograph. Ardel Hill Baker was having a heart attack. As she was 
having a heart attack, she was taken from the Indian reservation by 
ambulance to a hospital. When they offloaded her from the ambulance 
onto a gurney to take her in the hospital, this woman, at the emergency 
room entrance, having a heart attack, had a piece of paper taped to her 
thigh. The hospital dutifully looked at that piece of paper. The piece 
of paper that was taped to her thigh said that the Indian Health 
Service contract health care is not an entitlement program, meaning 
there are no funds to pay for this service because it is not a life-or-
limb medical condition.
  Let me say that again. Someone is having a heart attack. When they 
are brought to the hospital, they have a big piece of paper taped to 
their leg. It says to the hospital: By the way, if you admit this 
person, you are on your own because our contract health care money is 
gone. In fact, this is the piece of paper which was taped to the leg of 
an Indian patient coming into a hospital, having a heart attack. What 
would anybody in this Chamber think if this were taped to the leg of 
their spouse or their son or their daughter? They are having a heart 
attack, but the hospital is told: You know what, we do not have any 
money for this person; if you admit this person, you are on your own. 
Contract health care. It is called health care rationing.
  Tribal chairmen tell me that the refrain on their reservation is: 
Don't get sick after June because if you get sick after June, there is 
no money in contract health care. By the way, you can get a little help 
still, but it has to be life or limb. You must be threatened with the 
loss of a limb or the loss of your life; if not, tough luck.
  We would be outraged, outraged, every single one of us, if this were 
our relative. But it was not. It was Ardel Hill Baker. She survived, 
but there are plenty who do not.
  This is Lida Bearstail. Lida Bearstail had a serious problem with her 
leg. The bones in her knee were rubbing against each other; cartilage 
was worn away. She was in great pain, in great discomfort.
  The normal treatment for perhaps someone in this Chamber or perhaps 
for a relative of someone in this Chamber would be to get a knee 
replacement, but in Lida Bearstail's case, Lida Bearstail was not given 
the option of getting a knee replacement.
  Despite the great pain, it was not determined to be priority one, 
life or limb. She wasn't going to lose her limb or her life. She could 
just live with the pain. So because it wasn't priority one, life or 
limb, this woman whose bones were rubbing together in the knee in 
unbelievable pain was told: There is no health care available for you.
  We have hearings to talk about all these issues. A doctor comes to 
our hearing and says: I had a patient come to me with a very serious 
problem with a knee. It was a ligament problem, very serious, very 
painful. That patient went to the Indian Health Service and they said: 
Wrap that knee in cabbage leaves for 4 days and you will be OK.
  It is pretty unbelievable. Yet we can't get a bill on the floor of 
the Senate to deal with Indian health care. That is unbelievable. We 
have a responsibility to pass this legislation. I passed it out of the 
Indian Affairs Committee. Now we need to move it through the Senate and 
then the House so we can say to these people who need health care--the 
first Americans, Native Americans that this country understands its 
obligation, understands its trust responsibility, and we are going to 
do what we need to do to pass the legislation.
  It is almost unbelievable that with all the priorities we discuss, we 
can't somehow make this a priority. In my State, we have some wonderful 
Indian tribes. The Three Affiliated Tribes is a wonderful tribe. It 
includes the Mandan, the Hidatsa, and the Arikara Nations. If you get 
sick on that reservation in Twin Buttes, ND, your nearest health 
facility is a little old building with a couple of tiny examination 
rooms. If you are lucky enough to get sick on one of the right days 
when a nurse is there and one of the few days when a doctor might be 
there, you might do OK. But this is a 1-million acre reservation. It is 
a big place. We had testimony from law enforcement the other day on 
that reservation. The first you would expect to be able to get someone 
to come to deal with a law enforcement call, no matter how serious, 
would be about an hour and a quarter to an hour and a half. So call 
while a crime is being committed and, perhaps an hour and a quarter 
later, if you are lucky, someone from law enforcement

[[Page 21589]]

will show up. You might understand then that if you need a prescription 
or if you have a health care emergency, the dilemma Indians face on 
reservations.
  A mother who has a feverish child who needs an antibiotic, or a 
diabetic who needs insulin--who don't have ready access to health care 
facilities, in circumstances such as that, we must find ways to meet 
these health care needs.
  There are some who say--and I agree--we need substantial change. My 
colleague from Oklahoma is here. He talked about the prospect of 
saying: All right, let's have dramatic change. I am perfectly willing 
to work on dramatic change, to say that if we have a trust 
responsibility for someone for health care, let's let them show up at a 
hospital someplace and let's pay the bill so they can go to the 
providers who have the capability. We have the responsibility to do 
that. The problem is, we can't get a bill such as that through this 
Senate. I have offered time and again on the floor to add funding. The 
last time I tried to add $1 billion. It went down on a partisan vote. 
You can't get money added in this Senate to meet the responsibility we 
ought to meet with respect to Indian health care.
  We have worked in a bipartisan way on this legislation in the Indian 
Affairs Committee. The vice chairman of the committee, Senator 
Murkowski of Alaska, is a cosponsor as well. The Indian Health Care 
Improvement Act is legislation that begins to answer and advance the 
interests of providing health care to American Indians and meeting our 
trust responsibility to do so. We would authorize additional tools to 
deal with the issue of teen suicide on Indian reservations.
  I began by talking about Avis Littlewind, but I could have talked 
about many others. I have had several hearings on this subject. The 
bill also includes new provisions to address lack of health care 
services. We have begun trying to find a different construct of 
convenient care for American Indians on reservations. It includes 
several Medicaid provisions that are in the jurisdiction of the Finance 
Committee. The Finance Committee is going to be holding a markup. We 
will talk with the chairman and ranking member about including this 
bill in that markup.
  My point today is very simple. I understand the need to provide 
additional health care opportunities for 3 million American children is 
very important. It is no more important than providing the health care 
we promised we would provide to 2 million American Indians who live on 
reservations for whom we have trust responsibilities. We have broken 
far too many promises to American Indians. We have done it for far too 
many decades. It is time for this Congress and the country to keep its 
word and meet its promise. We don't have a choice, and it is not going 
to break the bank to do that.
  I encourage all my colleagues, go to the Indian reservations. See for 
yourself. See a dentist practicing in an old trailer house for 5,000 
patients, operating out of an old trailer. Go see that. Then ask 
yourself: Is this the kind of health care we promised? Are we 
delivering what we promised? The answer is a resounding no.
  I understand in this Chamber there are priorities. With respect to 
the priorities all of us have, we all have different things we are 
passionate about. We have now on the floor a health care bill. This 
legislation is important. The reason I offer this amendment is, when we 
talk about health care, I think we have a responsibility to address 
Indian health as well. If we can, we need to, either tonight or 
tomorrow, get a commitment on dates to mark up and bring to the floor 
of the Senate the Indian Health Care Improvement Act, which is 7 years 
overdue and 15 years since it was last reauthorized. If we can get that 
commitment, I will know we are going to get this through the Senate. 
That is the goal.
  I am going to visit with Senator Baucus. Let me also make the point, 
Senator Baucus has been a very strong supporter of Indian issues. I 
have been happy to work with him. The Indian Health Care Improvement 
Act was sent to the Indian Affairs Committee. We have moved this out of 
committee. I think we have written it in a way that substantially 
improves Indian health care. Now it waits, as it waited last year, the 
year before and the year before that and the year before that. Every 
single year it is the same thing. I am flat out tired of it. I will not 
let it happen this time. One way or another, this needs to get done by 
this Senate because this Senate has a responsibility to do it. We have 
not met this responsibility for too many years. This year I insist we 
do so. The fact is, kids are dying. Elders are dying because the health 
care doesn't exist that we had previously promised. We have a 
responsibility to do something about it.
  I say to the chairman of the committee, I will visit with Senator 
Reid, and I know Senator Baucus is a strong supporter of Indian issues. 
I hope if I can get a commitment that we can get from the Finance 
Committee a markup--and I know the Senator wants to do that--if I can 
then get a commitment from Senator Reid to bring this to the floor, I 
don't intend to interrupt the children's health insurance bill, but if 
I can't get that commitment, I fully intend to interrupt this bill as 
long as I can interrupt it because it is that important.
  To my colleague from Montana, let me say thank you for allowing me to 
at least at this moment offer this amendment, and let me ask my 
colleague if I can get some hope that the two of us, working with 
others, can move together to get this through the Senate in a 
reasonable time. I am going to ask the same of the majority leader, who 
I know also is very supportive of Indian issues and very much wants to 
get this done.
  The PRESIDING OFFICER (Mr. Menendez). The Senator from Montana.
  Mr. BAUCUS. Mr. President, I commend the Senator from North Dakota. 
If our colleagues could see the conditions of health care on the 
reservations of this country, they would be appalled, absolutely 
appalled. It is as bad as a Third World country. It is disgusting the 
low quality of health care on the reservations. The Senator from North 
Dakota earlier mentioned the life-and-limb provision. Basically, the 
Indian Health Service does not take people unless it is for life and 
limb, unless you have lost a limb or your life is in jeopardy, nothing 
less. That is not entirely true because it depends upon the allocation 
of the various Indian Health Service hospitals around the country. But 
very quickly, those hospitals get to the point where they are at the 
life-and-limb threshold. They have used up what few paltry dollars they 
have. So on the Blackfeet Reservation of Montana, someone is ill, a 
child is ill. If they have reached that reservation and reached the 
life-and-limb limit--which happens, I am told, midway through the 
year--that is it. They don't get any health care. It is an absolute 
outrage.
  We all know the health conditions on Indian reservations are much 
worse. Statistics show it is much worse than the national average. 
About 27 percent of Indian kids don't have any health insurance 
whatsoever. I might also say the tuberculosis rate on the Indian 
reservations is about 7\1/2\ times that of the general population. The 
same is true of the suicide rate and so on. I say to my good friend 
from North Dakota, absolutely, I am committed. We passed this bill out 
of committee. It passed last year. It passed by unanimous vote in 
committee. I am very committed to having a markup. Indeed, I think we 
scheduled September 12 to get this out of committee so we can find a 
way to get this bill enacted this year. I share the conviction. We have 
to find a way to get this done this year. It is an outrage, a total 
outrage in the United States of America to let these conditions 
continue. Frankly, this legislation is only the beginning to bring the 
level totally all the way up to what it should be.
  I thank the Senator for offering this amendment tonight. I am 
committed to find a way to get this enacted into law this year.
  Mr. DORGAN. Mr. President, let me say thank you. If we can get a 
markup

[[Page 21590]]

in the Senate Finance Committee on September 12, that allows the bill 
to move to the floor of the Senate. I am going to talk to Senator Reid, 
who I know is a strong supporter of Indian issues and feels very 
strongly about this. If I can get a commitment, I know he wants to 
provide that commitment to get to the floor of the Senate, then I will 
seek to withdraw the amendment from this bill. But I do want to visit, 
and perhaps in the morning on the floor, with Senator Reid on that 
subject.
  I wished to make two more points, and then I know my colleague from 
North Carolina seeks recognition.
  This chart shows the expenditures per capita relative to other 
Federal health expenditure benchmarks. This deals with Indians versus 
all others--Indians get far less. Here is the expenditure per capita 
for Medicare, the Veterans' Administration, Medicaid, Federal 
prisoners, the Federal Employees Health benefits. Here is Indian Health 
Service. It is unbelievable to me how much less it is. In many ways, 
all of this is intertwined--social services, health care, law 
enforcement, housing, education, it is all intertwined. What got me 
interested and involved in Indian issues--and I am privileged to serve 
as chairman of the Indian Affairs Committee and feel a deep 
responsibility to force us to do the right thing--what got me involved 
one day was a young girl named Tamara.
  Tamara was a young 3-year-old American Indian girl who was put in a 
foster home. But the person who was handling the social services cases 
was handling 150 cases, so they did not bother to check the home this 
little girl was going to be put into. It was not long before, at a 
drunken party, that little girl had her nose broken, her arm broken, 
and her hair pulled out at the roots. It will scar that little girl for 
life. I met her. I met her granddad. I talked to the social worker. I 
fixed that social worker problem by getting additional workers in, so 
that it does not happen again.
  The fact is that should never happen. These incidences should not 
happen. We do not have the resources to do what is necessary, to do 
what needs to be done. Nowhere is that more true than in health care. 
Health care is not a luxury. When there is a sick kid someplace, or a 
sick elder, when somebody has a health problem, we have a 
responsibility to find a way to help.
  For those who might listen to this and say that Indian health care is 
not our responsibility, oh, yes, it is. We signed treaties. We made 
promises, and we broke them every chance we got. Maybe in the year 2007 
we can begin keeping a promise or two. These are promises we have a 
responsibility to keep. It is our trust responsibility.
  There is a lot to do in health care, but there is nothing more 
important than meeting our obligation to provide health care for Native 
Americans because we made that agreement with them, and we need to keep 
that agreement.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. BURR. Mr. President, I rise to speak on the SCHIP bill. I have an 
amendment to the SCHIP bill, but I do not intend to call it up at this 
time. I wish to speak on SCHIP, as well as on my amendment.
  I also take this opportunity to ask unanimous consent to add Senator 
Dole as a cosponsor to the amendment.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. BURR. Mr. President, I think it is safe to say that health care 
is probably one of the most important things this body can debate. I 
think you have to look at our overall health care system today to 
understand why it is so important. It is because we have the best 
health care delivery system in the world, bar none.
  We have seen other countries try to develop a system that fit within 
a budget framework that, over time, as the dollars got tight, 
constricted the level of care delivered, creating waiting lines for 
individuals who had certain health conditions. But the United States 
has always been considered the innovative health care delivery system 
of the world. It was accessible for most, regardless of region. I think 
it is safe to say for a long period of time it was very affordable. But 
that has all changed.
  The U.S. system still provides a level of security if, in fact, you 
are insured. If you are not insured, I am not sure the sense of 
security--just knowing there is a hospital or doctors--necessarily 
provides you with a tremendous amount of security.
  With every day that continues on, the level of choice that exists 
within the United States health care system begins to get less and 
less. Most of us have been here for the debates of the creation of HMOs 
and PPOs, and all the products that employers, insurers, and 
individuals desperately try to create to address this rising cost of 
health care, while maintaining some degree of benefit for the 
individual and for their family. But over time, we have continued to 
see changes to those products, to where there is very little difference 
between the products now except for what we call them. Clearly, that 
has eliminated many of the choices.
  What has happened to the U.S. system, over a very slow period of 
time, maybe the last two decades? Over 50 percent of the American 
people are now on a Government health care plan. It is no longer 
private-sector driven. We are here with this big question mark about 
why market conditions do not affect the cost of health care or the cost 
of premiums or that they do not create choice. In fact, over half of 
the American people are now in a Government-run system, one that 
mirrors more what others in the country have tried, only to find out 
that unless you have an unlimited pool of money, they do not work.
  Well, what do Government systems eventually create? They create a 
system that has less doctors, less nurses, less hospitals, which means 
less care for those in the country.
  I know the ranking member represents a State that is considered to be 
rural. North Carolina is a State considered to be rural. If you have a 
contraction of doctors, if you have a contraction of specialists, if 
you have less nurses in the pool, it means there is not enough to go 
around all the facilities. There are many regional areas of my State 
today where we cannot find OB/GYNs to deliver babies.
  Now, sure, I can look at a pregnant woman and say: Within a 30 or 45-
mile radius, you will be able to get delivery care. But try to explain 
to a mother, when her water breaks and she goes into labor, that the 
person who is going to deliver that baby is 45 miles away. In fact, the 
prenatal care, for that individual who needs it, is now 45 miles away 
because that is where her OB/GYN is, and we are not going to be able to 
get the level of prenatal care in rural America that we want.
  What has the Government controlling more of health care produced? 
Less choices, fewer providers, and less services, and especially for 
those limited amounts of services that are preventive.
  Let me state from the beginning of this debate, I am for 
reauthorizing the SCHIP bill. I will support the substitute that 
Senator McConnell will offer which provides $38.9 billion over 5 years, 
which is an increase of $13.9 billion.
  I also was in the House, on the Energy and Commerce Committee, in 
1997, when we enacted the first SCHIP bill, which was a $40 billion 
Federal commitment over 10 years to those children at 200 percent of 
poverty or less. Many States expanded that SCHIP program to cover 
parents of SCHIP kids and childless adults.
  The McConnell reauthorization protects the original SCHIP program by 
making sure that low-income children are the focus of our effort.
  Now, I will say, North Carolina has one of the best SCHIP programs in 
the United States. I am pleased that Senator McConnell's 
reauthorization will give North Carolina the additional funds it needs 
to continue serving low-income children. But I am, sadly, here today to 
tell you I am not for expanding the rolls of SCHIP. The Finance

[[Page 21591]]

Committee bill adds more than $30 billion to the current SCHIP base 
budget--$25 billion--to, roughly, cover 3.3 million additional 
children.
  Now, CBO scored what the State and Federal Government spending will 
be per child. Let me put that up for everybody: $3,930 per child. Yet, 
today, the average private health care plan in the private sector is 
$1,130. My question is, if we are going to spend $3,900 per child in a 
Government plan, but we can insure them fully in the private sector 
today for $1,130, where is the choice? As a colleague of ours in the 
House used to say: Beam me up, Scotty. Something is wrong here. This 
seems like a no-brainer. This is not an investment that one can make on 
the part of American taxpayers and feel good about.
  In 1997, we spent $40 billion. It was an honorable goal. Quite 
frankly, the program has been very popular. The Baucus reauthorization 
plan, though, would spend $60 billion over the next 5 years.
  Now, people will talk about budget gimmicks. I am not here to talk 
about that. I think they are here. I think it hides millions of dollars 
that I think are extra spending--and maybe they are going to insure 
this 3.3 million, and $3,900 per child is incorrect, or maybe there are 
more people who are going to be covered, and many of them outside of 
the ranks of low-income children--but there is no question the Baucus-
Grassley bill expands SCHIP so much that I feel children who need it 
the most will get lost in a new, larger Government-run program.
  As a matter of fact, if SCHIP works as well as I think it does, why 
would we change it? I think some would tell us we are not here changing 
the SCHIP program. But I would only point to section 606 of the 
Grassley-Baucus bill, where they remove the word ``State'' from the 
name of SCHIP. See, SCHIP is the State Children's Health Insurance 
Program. It was always designed as us being an enhanced share for the 
States, and the States running the program. Now, SCHIP is going to be 
called the Children's Health Insurance Program. It sounds like a big, 
one-size-fits-all Government program to me.
  The solution to our health care crisis is not to put every child in 
America in a Government program. Today, one out of every two children 
in America is in a Government program. They are either enrolled in 
Medicaid or SCHIP.
  The Baucus plan puts more children into Government health care. A 
recent CBO analysis concluded that for every 1 million additional 
children covered under SCHIP, an estimated 250,000 to 500,000 will be 
switched from private insurance to the new public SCHIP coverage.
  Now, let me say that again. CBO estimates--this is not me--CBO 
estimates that for every 1 million new kids we put into SCHIP, 
somewhere between 250,000 to 500,000 will switch from their parents' 
insurance to the new Government plan.
  Now, that is 3.3 million kids, which means 1.65 million could be 
switched from private insurance to Government insurance, at 3,900 and 
some dollars, estimated by CBO. Again, where is the sanity and the 
obligation and fiduciary responsibility we have to the taxpayers? Why 
in the world would we create an avenue for people to go off their 
family's plan and come on a Government plan, where we are committed, as 
CBO said, to spend $3,900, roughly, per child?
  Now, before people think we are all insane--they know I am now--what 
should we be discussing? I believe we should be discussing how do we 
reform the health care system? I do not think I would find much 
opposition except on how we do that because there are 45 million 
uninsured Americans today. If they are sitting at home listening to 
this debate about covering 3 million low-income children, or wherever 
they are on the income scale, for a person sitting at home, who is an 
adult today, they are saying: What about me? What about the fact that I 
do not have insurance?
  If they have no job, and they have no income, we know they are on 
Medicaid. If they have a job, and they do not qualify financially for 
Medicaid, then where do they go? Well, there are 45 million of them out 
there somewhere who are in this classification. Some of them are kids 
and some of them are adults. Every time they access health care, and 
they cannot pay for it, an incredibly predictable thing happens: The 
cost that is unrecovered is shifted to everybody else in the system.
  In North Carolina, there are 1.3 million who are uninsured. Seventeen 
percent of the North Carolina population is uninsured, and 16 percent 
of the American population is uninsured. Yet our debate is limited to 
3.3 million children.
  It is not about how we insure America. It is not about the rising 
cost of health care. It is not about the fact that health care premiums 
have, in fact, doubled in the country since the year 2000. If compared 
with the growth of inflation since 2000--at 18 percent--and the growth 
of wages--at 20 percent--health insurance premiums for family coverage 
have increased 73 percent over the last 5 years. Health care costs are 
rising three times the rate of inflation, and with no corresponding 
rise in quality.
  Now, there is the red flag. We have seen a 73-percent increase in the 
premium. If you could turn to something tangible in the system to say 
that quality has gotten that much better, then one could maybe 
rationalize this increase. But the fact is, there has been no 
corresponding rise in quality. As a matter of fact, today there are no 
health care plans that are focused primarily on wellness and 
prevention.
  I remember when we tried to get mammographies and PSAs covered in 
Medicare, and we tried to get an array of preventive health care, it 
was the hardest thing I have ever worked on in health care to try to 
get added to a system. I guess it is because Medicare beneficiaries are 
old to start with, and why would we do anything preventive. Yet if we 
look at the research that goes on every day, and that we pay for, we 
find the earlier we can detect cancer, the earlier we can detect 
diabetes, the more we can monitor disease management, the better the 
outcome is but, more importantly, from a taxpayer's standpoint, the 
less it costs the system.
  We know that happens in the Government system. We don't implement 
wellness and prevention like we should. If we did, we would require it 
in Medicaid. But we have an opportunity--as we talk about redesigning 
the American health care system, we have an opportunity to build 
wellness and prevention as the main piece of this broken system.
  Today we have a system that only triggers when you get sick. It 
doesn't trigger when you want to stay well. It triggers when you get 
sick. But if you look at companies that have said: There is no way I 
will ever be competitive if, in fact, the health care system doesn't 
change in America--they made a decision that they are going to go 
outside of the insurance products that are available today, and they 
are going to do things that are creative out of the box. And they are 
self-insured and they have gone out and partnered with somebody to 
administer their plan. What do you find? It is Dell Computers, which 
now has about 4 years of experience with disease management and how to 
bring down the overall costs of health care for their employees--not 
just corporately but for their individual costs to their employees--all 
the way to Safeway, that has a model that I know every Member on the 
Hill has probably been briefed on--what Safeway is doing, which is 
giving people control of their care but, more importantly, stressing to 
them that prevention and wellness is something for which they will 
actually receive an incentive.
  People without access to employer-sponsored coverage are severely 
disadvantaged under the current system. I know both of the Senators who 
are in charge of the tax committee probably would agree that we have 
inequities. Ninety-one percent of workers in large firms have health 
insurance. Sixty-six percent of workers in small firms--10 employees or 
less--have health insurance. Twenty-nine percent of the uninsured work 
in small business. The percentage of employers offering coverage has 
dropped 8 percent since the year 2000.

[[Page 21592]]

  Whoa. Global economy. That is what has happened since 2000. There is 
a global economy where it doesn't matter where you manufacture. All 
that matters is where are your customers. Most U.S. businesses have 
changed from a model that was predominantly for domestic consumption to 
a model today where 60 or 70 percent of their business is 
international, and 30 or 40 percent of it is domestic--in the United 
States. We ought to look at some of the decisions they have made and 
wonder: why didn't we have this challenge before this point with those 
employers, looking at their business model and saying: How can I 
continue to pay a health care cost that rises in double-digit ways each 
year with inflation and remain competitive with my global competition 
which doesn't have that cost?
  Well, I am going to put the Senate on notice: This is happening at an 
alarming rate. If U.S. businesses determine that they are not 
competitive in the marketplace they are selling to, which is global, 
and health care cost is the No. 1 issue that makes them noncompetitive, 
in the absence of us reforming the system and creating a way for them 
to provide health care--not that seeks double-digit inflation every 
year but begins a downward pressure on the cost of health care--I will 
assure you they have two choices: they eliminate the benefit or they 
leave the country, and both of them are devastating to the United 
States.
  If we don't reform health care, what happens? Health care becomes 
unaffordable for people. U.S. businesses become uncompetitive. 
Government will have its normal reaction. It will ratchet down the 
reimbursements that we pay through Medicare and Medicaid and the effect 
of that is that private insurance sees that as an opportunity to 
ratchet down the provider reimbursements. Doctors and nurses get paid 
less. More people go on Government health care. Doctors and nurses will 
become Government employees. Hospitals will become Government property. 
Insurance companies will become paper pushers. We must all agree that 
the outcome has to be better for us.
  By the way, taxes will rise too. I am not sure whether it is 
individual or corporate, but let me assure my colleagues, though some 
believe that health care is free, somebody pays for it. Look at the 
systems around the world where the government is in control of their 
health care, and the beneficiaries may think it is free, but one of the 
problems--one of the reasons they are ratcheting back the scope of 
coverage they have is the fact that as the government runs out of money 
and can't find ways to raise revenues, they have a choice. They can tax 
individuals, they can tax corporations, or they can reduce benefits. 
When you look at the prevailing tax rate they have now, you understand 
why their only choice is to cut benefits. The likelihood is that we 
will be faced with the same thing as socialized medicine is just around 
the corner, and I think time is actually running out.
  The current tax structure for health care benefits exists for 
employer-focused plans. Employers get a tax deduction for the amount of 
the health care benefit provided for their employees, but the deduction 
unfortunately doesn't exist for individuals who shop in the 
marketplace. We spend 50 percent more of our GDP--16 percent--on health 
care than the next three spenders--Germany, Japan, and France--but we 
aren't any healthier. It is time we begin to focus on how our system 
becomes more efficient, healthier, and more affordable.
  One out of every four dollars in health care spent in this country 
does nothing to help patients. It is actually wasted on defensive 
medicine, unnecessary paperwork, and outright fraud. When you put 
individuals in charge of their health care--not just constructing it or 
negotiating it, but responsible for whether the system is efficient and 
effective--you would be amazed at how you wring out that 25 percent, 
that one out of four. The source of the problem is runaway health care 
costs which is caused by a lack of choice and a lack of government 
control.
  Now, let me assure you that in Sweden today, heart patients wait 25 
weeks to be seen. In England today, Heritage said cancer patients 
sometimes wait a year between their diagnosis and their chemotherapy 
treatment. Canada's Supreme Court Justice, Beverly McLachlin, said it 
best in a 2005 ruling:

       Access to a waiting list is not access to health care.

  We have a roadmap as to where we are going, and we have an 
opportunity to change that today.
  What happens if the Senate, if the Congress of the United States, 
becomes the visionary body that it needs to be and the reform body that 
it has to be if, in fact, you want to protect the delivery system in 
this country? Americans have to have three things: They have to have 
choice, they have to have ownership, and they have to have control. 
They have to have the ability to construct their insurance policies to 
meet their age, their income, and their health condition. Health care 
needs to be portable, just like a 401(k).
  When you give an individual ownership of a 401(k), they are no longer 
strapped to an employer about their pension or retirement; they have 
the ability to take that money with them to the next job. Well, we have 
reached the point now that health care should be the same thing. It 
should be ownership, and we should have the ability to take that health 
care from employer to employer where we are not locked in, and for the 
first time Americans would have the freedom to make decisions about 
their future and about the future of their families.
  Innovation works. We all know it. A year ago, a 46-inch plasma TV 
cost as much as $11,000, but today you can buy the same TV for $2,839. 
In 1908, Henry Ford made a car for $850. Eight years later, Henry Ford 
produced the same car for $360.
  Innovation also works in health care--don't fool yourself. Between 
1999 and 2004, the cost of LASIK surgery, which is set by the market 
forces and outside the current system, went down 20 percent while 
health care expenditures per person increased by more than 44 percent. 
LASIK surgery is this new surgery that individuals have on their eyes. 
If they have a certain condition, they can have LASIK and throw their 
glasses away. A controversial thing, and innovation brought it. It went 
through and FDA approved it. The cost was very high to begin with, and 
as more people have sought LASIK surgery, the price has come down and 
down and down and down and down. I am sure Dr. Coburn will talk more 
about it as we go through this debate.
  Duke University set up a program to manage congestive heart failure. 
Half of all of the congestive heart failure patients typically have a 
5-year life expectancy, and costs are a total of $22.5 billion for 
congestive heart failure annually in the United States. Duke developed 
a program that integrated the care to develop best practice models for 
congestive heart failure patients. The approach resulted in better 
patient outcomes, increased patient compliance with their doctor's 
recommendations and, most importantly, a 32-percent drop in the cost 
per patient of treating congestive heart failure. Innovation allows 
incredible things to happen but only when we have a marketplace that 
rewards innovation.
  I said when I stood up I had an amendment that I didn't intend to 
call up, and I am not going to call it up. That amendment is the Every 
American Insured Health Act. I want to just briefly talk about it.
  Hopefully, this accomplishes everything I have spent the last 20 
minutes talking about. It provides the resources for every American not 
on a government plan to access the coverage they need. Let me say that 
again. It provides the resources for all the uninsured in America to 
negotiate the coverage they need in the private marketplace.
  No. 2, it eliminates cost shifting. It eliminates that bill we get 
through our premium costs or through the cost of a service delivered 
that we can't figure out who used it, but somebody didn't pay because 
they weren't insured and it got shifted to everybody else. We eliminate 
that by providing the resources for every American to negotiate 
coverage. We estimate that it

[[Page 21593]]

may be $200 billion a year that we eliminate in cost shifting.
  Now, how do we accomplish it? Because one might say: I know how 
expensive SCHIP expansion for 3.3 million children is going to be. Can 
we afford what it is going to cost us to insure everybody who is 
uninsured in America? Well, here is what we do. We address the tax 
inequity. Through that we treat those who get insurance provided by an 
employer the same way we do individuals. Then we turn around to every 
American who is not on a government plan and we do this: We give them a 
refundable, advanced, flat tax credit. For an individual, it is $2,160 
a year. If it is a family, it is $5,400 a year.
  Now, if, in fact, you had tax consequences from this new equality in 
treating individuals and employer plans the same, the likelihood is 
that if your health benefit from your employer doesn't exceed $15,000 
from the employer on a family plan, then $5,400 is more than enough to 
cover the tax consequences.
  If, in fact, you are an individual who is uninsured and you get a 
refundable tax credit on an annual basis of $2,160, then you can go out 
and negotiate in the private sector for health care coverage that on 
average today is between $1,500 and $1,700 nationally for an individual 
plan and about $4,500 to $4,600 for a family plan. You could insure 
yourself as an individual or as a family, and you could do that all 
within the confines of the refundable tax credit we have allowed.
  Now, people have questioned whether there is a little bit of a shift 
in wealth. Yes, there is. We are taking people who have rich health 
care plans, more health care than they need, plans that are priced 
because there are no out-of-pocket costs--there are a lot of things 
that we know we need to do from the standpoint of making sure Americans 
know they have skin in the game every time they go to the doctor's 
office for the facts of utilization--and we are shifting it down to 
where we give people refundable tax credits that are barely over the 
Medicaid qualifications, and we are going to give them a soup-to-nuts 
plan--$2,160 for an individual or $5,400 for a family annually, a 
refundable tax credit that is only good for health care.
  When they sign up with an insurer, the money will go directly from 
the U.S. Government to the insurer. If money is left over, it would 
automatically transfer over into a health savings account for that 
individual to use for other health care benefits, whether it be for 
copayments, deductibles, whatever the structure of the plan is, and 
they are allowed to design a plan that meets their age, their income, 
and their health conditions.
  We give States incentives to make sure that in every marketplace 
there is an affordable plan. It is absolutely crucial that you begin to 
have insurance reform at the same time you are creating a marketplace 
that is driven by individuals.
  Our goals are to give Americans the resources and the right to 
purchase health care in the private marketplace, to end the tax 
discrimination, to encourage individuals to take control, to eliminate 
the current cost shift, so that every American's health care begins to 
come down because of this new benefit, and to ensure the accessibility 
and affordability of high-quality health care.
  By the way, this plan I have just described that did this for the 
first time--insured everybody who is uninsured, provided annually a 
$2,160 refundable tax credit for individuals and $5,400 for a family--I 
still didn't tell you how much it costs. I am like the guy on the 
infomercials who waits until the end to spring on you how great of a 
bargain it is.
  Well, this is budget neutral. It doesn't cost the American taxpayer 
one new dollar. That doesn't take into account that there may be $200 
billion worth of cost-shifting going on in the system. We get no 
scoring for the fact that we could potentially drive $200 billion of 
costs out of the health care for everyone else in the system by making 
sure everybody is insured. We get absolutely no credit for being able 
to put together plans that promote prevention and wellness, that begin 
to drive down utilization and make Americans healthier, that begin to 
create data for us so we know exactly what the right reimbursements are 
for doctors, nurses, hospitals, and community health centers. We pull 
that out of the sky today, and they complain. And they should because 
there is no relation to that in reality.
  This, by creating a real marketplace, real competition from the 
insurer all the way through to the service delivered will begin to 
build the database of information we need to know what reimbursements 
the marketplace says are fair to the people who provide it. Then they 
can make a decision. I believe we will find that every doctor, nurse, 
hospital, and community health center will receive this in a warm way 
because now they believe that this is a system which will evaluate what 
they deliver and what cost they are reimbursed for.
  Mr. President, I am sure the chairman of the committee and the 
ranking member would have preferred to have this solely focused on 
SCHIP tonight. I know that. I think it is also rational to understand 
that when you are talking about expanding the rolls of Government 
insurance coverage to 3.3 million kids, somebody ought to stand up and 
ask: What about the other 45 million Americans? If, in fact, Members 
find there is value to the reform for the entire system, then why would 
we put the 3.3 million kids in a program that CBO already told us would 
cost $3,930 per child, which we can buy in the private marketplace for 
$1,130 worth of coverage today? Why don't we integrate them into the 
last system, which is reform our health care system.
  Let's bring equity to the tax side and provide every American who is 
uninsured with the resources they need to go out and negotiate their 
coverage, whether they are individuals or families. Let's give the 
health care delivery system the confidence of knowing we are willing to 
create a market. This is not an unusual thing for us. We did it with 
Part D Medicare. The chairman of the committee was very instrumental in 
its passage. Today, 1 year after enactment of Part D Medicare, we 
created transparency and competition on what was one of the most price-
sensitive areas: prescription drugs. What has the net result been? 
Premiums reduced 28 percent the first year, and drugs were reduced 33 
percent. It was because we created competition and transparency. We 
made people show their prices and made sure there were multiple plans 
that people could choose from. The net result of that is exactly what 
we are trying to mirror here, but do it in a way that treats health 
care in its entirety. You cannot do that without prevention and 
wellness being the main pieces of it.
  I thank the chairman for the fact that he listened. I appreciate 
that. I plan to be on the floor probably several times this week. I 
will try to do it when it doesn't interrupt the SCHIP debate. I think 
it is an important time to begin to educate our Members, to begin to 
educate America about the need for health care reform and how health 
care reform can actually enhance the future of the very special 
delivery system we have in this country.
  I yield the floor.
  Mr. BAUCUS. Mr. President, many Senators are waiting very patiently 
this evening. I see the Senator from Missouri, who has been extremely 
patient. We have done our best to protect Senators' places in line. 
Many Senators want to come to the floor and speak on this bill.
  I ask unanimous consent that the following Senators be recognized in 
this order after Senator McCaskill and Senator Gregg: Senators 
Whitehouse, Coburn, Brown, Corker, Durbin, Martinez, Klobuchar, Dole, 
and Tester.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The Senator from Missouri is recognized.
  Mrs. McCASKILL. Mr. President, I don't know that anybody could argue 
that the Children's Health Insurance Program hasn't been a success. Of 
course it has been a success. Frankly, successes have not come easily 
in the area of health care availability in this

[[Page 21594]]

country over the last decade. So we have to protect it, we have to make 
sure it continues, and we need to make sure we expand it to as many 
children as possible.
  I think this strong piece of bipartisanship we are debating today, in 
fact, does those things. The interesting thing is, I think back to a 
debate in this Chamber that occurred in November of 2003. In November 
of 2003, there was a piece of legislation concerning prescription 
drugs. Now, children's health insurance and prescription drugs are both 
noble and good causes to the Senate--to try to lower the cost of 
prescription drugs, to try to provide more insurance for children. What 
are the differences between the two debates? It is really interesting 
to look, because that is when that ugly head of politics begins to rear 
and people begin to see that sometimes, unfortunately, in this building 
it is about politics instead of public policy. Both goals of public 
policy, prescription drugs with lower costs and children's health 
insurance--everybody has to be for those goals. But how you get there 
and what complaints you have on the way is where politics come in.
  Medicare Part D was a $400 billion program. Interestingly enough, it 
was passed in November of 2003 as we were approaching a Presidential 
election and a cycle of election. Interestingly enough, the President 
was running for reelection. Not a whisper of a veto threat was heard 
even though it was $400 billion that had no way to be paid for. There 
was no cigarette tax in Medicare Part D. It was guaranteeing a profit 
to the pharmaceutical industry. In fact, it went so far as to make sure 
you could not negotiate for lower prices--a bold thing, for a country 
where the free market is supposed to be something we relish. 
Negotiating for lower prices? That is pretty all-American. But, oh, no, 
we made sure there was no negotiation for lower prices on the part of 
the Government in Medicare Part D. There was no mechanism to pay for 
it.
  Yet I hear Senators today speaking against this bill with righteous 
indignation, saying: Well, the tobacco tax in here is not going to be 
enough. The vast majority of the Republican party voted for Medicare 
Part D. I will note that the Senator who will follow me on the floor 
was one of the brave souls who voted no, and I am willing to bet it was 
because he was trying to be responsible relating to the budget. Most of 
his colleagues didn't agree with him, and certainly the President of 
the United States didn't agree. Not only did he sign the bill, he 
signed it with relish and he campaigned on it, even though the way the 
program is going to be implemented was not going to hit home for 
seniors for years in advance.
  I think we can all be proud that there are some savings with Medicare 
Part D. We have to be honest that the Government is paying a price for 
it, just like we are going to pay a price for enhancing and protecting 
the Children's Health Insurance Program in this country. Other than 
Medicare Part D, we have not lifted a pinky finger in the area of 
health care during this administration.
  Most Americans are now scared. They are scared about getting care for 
their children, getting care for their parents, and they are scared 
about whether they are going to be able to afford health care, knowing 
that any minute their employer may drop their coverage. The expansion 
of this program has more to do with the unavailability of health care 
from an employer than it has to do with some effort on the part of the 
Government to insure every person.
  This is a public-private effort that has been a success. It is a 
block grant, not an entitlement. It allows the States flexibility. It 
is everything a Government program should be. It is getting to a very 
important need. There are so many reasons to be for this bill. I will 
not take the time tonight to go into them all because my colleagues 
will and they have today. I listened for a couple of hours when I was 
sitting in the chair. I am sure this will go on tomorrow with many 
people talking about important things.
  I want to mention one part of the bill that I think is very 
important, which has not been talked about--mental health parity. We 
have spent a lot of time talking about our children being at risk for 
drugs and alcohol. We have talked a lot about how we have to teach them 
the dangers of drugs and alcohol. Truth be known, one of the biggest 
failures in our health care system in this country is the complete 
unavailability of mental health services for children.
  Right now, in America, if you have health insurance and you know 
people and you are educated, it is difficult to find a mental health 
professional that specializes in children. If you are a poor working 
family and your child has gotten involved with drugs or alcohol and you 
want to get them mental health assistance, a treatment program, forget 
about it. It is literally almost impossible to access programs that can 
help adolescents and teens get off drugs and alcohol if they turn down 
that path at a young age.
  This will allow those programs to get the parity they need in the 
States. Speaking from experience, in terms of watching the expensive 
price tag on what happens to these young people if they get addicted to 
drugs or alcohol at a young age, the costs to the Government are huge 
because of what it means down the line in terms of wasted productivity, 
criminal conduct, the prison systems, and other health care costs down 
the line.
  There are very few kids who are addicted to drugs and alcohol who can 
get help when they are young, and a vast majority of them who do not 
end up charging us a heftier pricetag down the line, in terms of 
Government programs and assistance.
  This is a very wise investment of the public dollar, to get not only 
the physical health care but the mental health care to the children of 
this country who desperately need it. We have talked about dental care 
and emergency rooms and broken arms, but I think it is time we realized 
we are abandoning our children when it comes to important mental health 
care services. This bill will go a long way toward fixing it.
  I hope my friends on the other side of the aisle will not be 
situationally worried about the budget. When this was a program that 
was passed in 2003, $400 billion with no offsets, no way to pay for it, 
they lined up to vote for it, and the President signed it gleefully. It 
will be a bitter pill for America's children to swallow if, in a 
responsible way, we move forward to protect this program and this 
President decides to veto it. But if he does, he should know there are 
many of us here who will stand and fight with all the might we can 
muster on behalf of the kids of this country who deserve a chance at 
health care, deserve a chance for peace of mind for their parents.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Mr. GREGG. Mr. President, first, I appreciate the acknowledgment of 
the Senator from Missouri of my views on the Part D proposal. She is 
correct, I did not vote for that proposal because it was not paid for. 
I don't think one expensive program deserves another expensive program, 
especially when the second expensive program is backed with very poor 
policy.
  What I wish to talk about tonight is the policy. The issue, of 
course, should be how we get more children insured and how we get fewer 
people uninsured in this country. There are a variety of ways to do 
that. I have had a number of proposals of my own in this arena. 
However, it is not a good idea to approach this issue of how we get 
more children insured by suggesting that the best way to do it is to 
take a lot of kids off private insurance and move them on to public 
insurance or to, under the nomenclature of protecting children, which 
is, of course, very popular--and we have had lots of pictures on this 
floor already of children who have gone through very serious health 
concerns who need to have the support of the health community, of using 
children and pictures of children and anecdotal stories about children 
for the purposes of using a Federal program which is entitled 
children--to cover adults, some adults who, in fact, do not even have 
children. There are a lot of serious policy problems with this 
initiative.

[[Page 21595]]

  The irony, of course, is this initiative is not about insuring more 
children, although that is a stated goal. The purpose of this 
initiative is to essentially take another large step down the road 
toward Federal control and delivery of health care in this country, 
universal health care, as it is popularly referred to. That is not me 
phrasing that. The chairman of the Finance Committee, who is always 
very forthright, always very honest about what he is doing around here, 
said exactly that: SCHIP is a major step on the road to a universal, 
one-payer, Federal health care system. There are a lot of folks on the 
other side of the aisle who especially believe that should be the 
proper way to insure people in this country or take care of health care 
needs in this country, and I respect that viewpoint.
  However, I do not think it accomplishes what the goal is, which is to 
deliver high-quality health care to the most people in this country, to 
make health care affordable to most people in this country, and to give 
people in this country the opportunity to get good health care. What it 
does is what was described earlier in one of the starkest and most 
effective attacks on universal health care I have heard on this floor, 
when the Senator from North Dakota essentially explained the Indian 
health care program and what a disaster it is.
  What is the Indian health care program? The Indian health care 
program is single-payer Federal health care. He was talking about kids 
not being able to see dentists, kids not being able to get broken arms 
fixed, kids put in serious situations and adults in equally serious 
situations and no resources, no capability to take care of these people 
who are having serious health care problems. Interestingly enough, he 
used the word which is most often associated with those studies which 
have looked at universal health care or federally mandated health care 
or single-payer health care. He used the word ``rationing.'' He said 
rationing was occurring on the Indian reservations. He is right. He is 
right because that is what happens when you go to a single-payer system 
and the Federal Government becomes the payer. That is what they have in 
England, they have rationing. If you have certain situations, if you 
have a hip replacement, you are going to be rationed, depending on your 
age. If you have cancer and you are under a certain age, you are going 
to get hit with rationing. If you have to have some sort of invasive 
procedure which is optional, you are going to get hit with rationing.
  The same thing happens in Canada. Why do you think Canadians come to 
America for health care? In New Hampshire, we see it fairly regularly, 
Canadians coming over the border to get their health care at Boston, at 
one of the many extraordinary medical facilities in Boston or at 
Dartmouth-Hitchcock, one of the best, most extraordinary facilities in 
New England, in the country quite obviously. Why? Because there is 
quality there, because things are being done there that are not being 
done in Canada, and you can get served. You don't have to wait in lines 
2, 3, 4, 5 years for some sort of elective surgery, or if you have to 
have something done that is a major, complicated issue, you don't have 
to worry that the people doing it maybe do not have the expertise you 
need because the Government hasn't paid for the science behind the 
necessary research to produce that service.
  This SCHIP fight is as much a debate about whether we are going to 
move to a single-payer system with the Federal Government taking 
complete control over health care as it is about how we pick up 
coverage of children in this country who don't have coverage.
  Coverage for children in this country is affordable. We can do it 
without going to a single-payer system. We don't need to take 2.2 
million kids off one system and put them on the SCHIP system. We don't 
need to take, I believe it is 1.7 million kids off private insurance 
and put them on public insurance.
  The total amount of children who are going to be covered by this $35 
billion in new program over the next 5 years--do you know how much? Mr. 
President, 4.5 million children. But of that number, 2.2 million 
already have coverage. So actually there are only 2.3 million children 
you are picking up, and it is costing you $35 billion to do that. That 
works out to something akin to $3,200 per child.
  You can go on the Internet today and buy an insurance policy for a 
child for about $1,300. So in the classic way that the Federal 
Government works, we are going to spend twice as much of your tax 
dollars to pay for insurance for children, and we are going to take 
people who are already covered and move them from having the private 
sector bear the cost of that coverage over to the public sector so the 
public sector bears the cost of that coverage. Does that make sense? Is 
that common sense? Is that a good use of resources? Of course, it 
isn't.
  The practical effect is also that under this proposal, the program is 
not paid for. In the second 5 years, in order to avoid the pay-go 
discipline which is allegedly on the other side of the aisle, the Holy 
Grail that is supposed to be followed in every instance--of course, 
they have waived it now nine times on domestic spending they like--they 
take the cost of this program and project that in year 6 of this 
program, a program which will have been built up to $16 billion in 
spending annually will suddenly drop back to $3.5 billion in spending. 
Now that doesn't pass the smell test. That is the laugh test. That is 
absurd on its face. No Federal program ever disappears around here, and 
you don't take one that supposedly is benefiting children and cut it by 
almost $12.35 billion. That is not going to happen, but that is the 
assumption that is made in this bill in order to avoid having to pay 
for this bill.
  So this big white area, which is all the area that isn't covered of 
the projected costs--and this is actually a conservative number, by the 
way, this projected cost, that represents $40 billion, $40 billion that 
is unpaid for--is a cost we pass on to our children, by the way.
  Ironically, we say we are going to insure our children by paying 
twice as much as it costs to insure them and by taking a bunch of kids 
off private insurance and move them to the public sector, and then at 
the same time we are going to create a $40 billion debt which our 
children will have to pay for. I am not sure our children are getting 
all that good a deal, to be very honest with you, in this exercise.
  Plus, the ultimate goal of the exercise--I believe the ultimate goal 
has been stated by the chairman of the committee--the ultimate goal is 
to move toward a universal, single-payer system, where the Federal 
Government pays for health care. Here is the goal: You have all these 
folks on Medicare on one end, the elderly folks--that is me. I 
shouldn't call them too elderly--and then you have all these people on 
SCHIP, taken off private sector and being put in the public sector, 
such as this bill does, you have compressed the number of people 
available in the private insurance market, you are going to crowd out 
the private market. That is the game plan, crowd out the private market 
so you end up with a single-payer plan.
  As I have already gone through, single-payer plans make very little 
sense from a standpoint of quality and rationing. I don't think this 
country will be very comfortable with a single-payer plan, any more 
comfortable than, for example, the Indian population appears to be on 
the Indian reservations, as was explained to us by the Senator from 
North Dakota, who was describing a single-payer plan, otherwise known 
as Indian health care.
  So within this proposal, not only does it have this $40 billion gap 
in funds in spending, which it doesn't pay for in order to avoid the 
pay-go rule, not only does it take a bunch of kids who already have 
private insurance and move them to the public side, 1.7 million kids, 
and then end up paying twice as much to insure them as it is probably 
costing the private sector and sticking themselves with that bill 
because they don't pay for the program in the outyears, not only does 
it do all that, which is terrible policy, but it compounds this by 
taking a program which is supposed to insure children and using it to 
insure adults.

[[Page 21596]]

  Both the predecessor program, State Children's Health Insurance 
Program, and the present program as proposed under this legislation, 
Children's Health Insurance Program, do not say anything in their title 
about insuring adults. They are supposed to be insuring children. That 
is the idea. But some of our States, in a very creative exercise, have 
decided to expand this program to insure adults. That makes some people 
in this body quite happy because it fulfills this exercise of moving 
toward universal health care. You can use the SCHIP program or the CHIP 
program, which is supposed to be for children, to pick up adults, and 
then we will even narrow further the population of people who would be 
available for private sector insurance and, thus, move even more 
aggressively toward public, single-payer insurance, public single-payer 
plans, universal health care, rationing, reduction in quality. It makes 
no sense that this should be allowed to continue.
  Now, actually, the committee knows this. In fact, they sort of 
tacitly recognized it, because they put in place language which 
attempts to partially phase out this coverage of adults. They say over 
3 years these waivers will end that cover adults, but adults will be 
insured, instead of at the rate of Medicaid, which is what the States 
have a right to reimbursement for when they insure adults who qualify, 
they will get some new blended rate that is higher than Medicaid but 
less than what you pay for children. So in a tacit way the committee 
has sort of acknowledged that they shouldn't be insuring adults with a 
program called Children's Health Insurance.
  The only adults who could possibly and appropriately--and I have no 
problem with this--be covered under that would be pregnant women. 
Obviously, there is a clear issue of insuring a child if a woman is 
pregnant. She has a child. She is with child and, therefore, clearly 
that coverage is reasonable. But adults are supposed to be covered, if 
they qualify for Federal coverage, under Medicaid, not under the 
children's health insurance system.
  So the amendment I am offering essentially completes the thought of 
the committee on this point by saying: No, we are not going to 
reimburse States. This isn't about insuring so much as about what the 
reimbursement rate is to the State--what sort of windfall a State gets 
when they move adults on to the SCHIP program.
  There are a lot of State Governors who have figured out, I can get 
more money for my State, which I can use to help me balance my budget, 
if I put more adults under SCHIP because my reimbursement rate from the 
Federal Government is significantly higher. So that is why this 
happens.
  Well, it is not right. It is gaming the Federal system to do that. 
Waivers shouldn't be granted to allow that to happen, and this 
administration bears many of the problems when it comes to that. They 
do not come to this issue with clean hands, that is for sure, because 
they have given a lot of these waivers. But the committee at least 
recognized this was not good policy and has tried to mute it a little 
bit so that States, when they do game this, will only be able to game 
it for another 3 years and then reduce it to about half of what gaming 
goes on in the outyears.
  But there shouldn't be any of this. There is no reason to give States 
a breathing spell here on this issue. There is no reason to encourage 
States to put more adults into the system in the interim or to put more 
adults in the system in the future because you are reimbursing at a 
higher rate than Medicaid reimburses at. No reason at all. There is no 
good policy reason. The States have certainly had a good run of money 
coming in to them that they didn't deserve, because the Children's 
Health Insurance Program was not supposed to insure adults, it was 
supposed to insure children. So we are not doing them a disservice and 
we are not treating them unfairly by saying: All right, that policy 
ends. The SCHIP program, the new CHIP program, will be for children, 
not for adults.
  So my amendment essentially does this. It says: Adults will not be 
covered under this program at the SCHIP rate. They can still be covered 
under the Medicaid rate but not under the SCHIP rate, which seems to be 
a very reasonable approach to a program entitled children's health 
insurance.


                Amendment No. 2587 to Amendment No. 2530

  Mr. President, I send an amendment to the desk, and I ask unanimous 
consent that the pending amendment be set aside and my amendment be 
reported.
  The PRESIDING OFFICER. Without objection, it is so ordered. The clerk 
will report.
  The legislative clerk read as follows:

       The Senator from New Hampshire [Mr. Gregg] proposes an 
     amendment numbered 2587.

  Mr. GREGG. Mr. President, I ask unanimous consent that further 
reading of the amendment be waived.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

 (Purpose: To limit the matching rate for coverage other than for low-
   income children or pregnant women covered through a waiver and to 
  prohibit any new waivers for coverage of adults other than pregnant 
                                 women)

       Beginning on page 42, strike line 4 and all that follows 
     through page 66, line 25, and insert the following:

     SEC. 106. LIMITATIONS ON MATCHING RATES FOR POPULATIONS OTHER 
                   THAN LOW-INCOME CHILDREN OR PREGNANT WOMEN 
                   COVERED THROUGH A SECTION 1115 WAIVER.

       (a) Limitation on Payments.--Section 2105(c) of the Social 
     Security Act (42 U.S.C. 1397ee(c)) is amended by adding at 
     the end the following new paragraph:
       ``(8) Limitations on matching rate for populations other 
     than targeted low-income children or pregnant women covered 
     through a section 1115 waiver.--For child health assistance 
     or health benefits coverage furnished in any fiscal year 
     beginning with fiscal year 2008:
       ``(A) FMAP applied to payments only for nonpregnant 
     childless adults and parents and caretaker relatives enrolled 
     under a section 1115 waiver on the date of enactment of the 
     state children's health insurance program reauthorization of 
     2007.--The Federal medical assistance percentage (as 
     determined under section 1905(b) without regard to clause (4) 
     of such section) shall be substituted for the enhanced FMAP 
     under subsection (a)(1) with respect to payments for child 
     health assistance or health benefits coverage provided under 
     the State child health plan for any of the following:
       ``(i) Parents or caretaker relatives enrolled under a 
     waiver on the date of enactment of the state children's 
     health insurance program reauthorization of 2007.--A 
     nonpregnant parent or a nonpregnant caretaker relative of a 
     targeted low-income child who is enrolled in the State child 
     health plan under a waiver, experimental, pilot, or 
     demonstration project on the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007 and whose family income does not exceed the income 
     eligibility applied under such waiver with respect to that 
     population on such date.
       ``(ii) Nonpregnant childless adults enrolled under a waiver 
     on such date.--A nonpregnant childless adult enrolled in the 
     State child health plan under a waiver, experimental, pilot, 
     or demonstration project described in section 6102(c)(3) of 
     the Deficit Reduction Act of 2005 (42 U.S.C. 1397gg note) on 
     the date of enactment of the Children's Health Insurance 
     Program Reauthorization Act of 2007 and whose family income 
     does not exceed the income eligibility applied under such 
     waiver with respect to that population on such date.
       ``(iii) No replacement enrollees.--Nothing in clauses (i) 
     or (ii) shall be construed as authorizing a State to provide 
     child health assistance or health benefits coverage under a 
     waiver described in either such clause to a nonpregnant 
     parent or a nonpregnant caretaker relative of a targeted low-
     income child, or a nonpregnant childless adult, who is not 
     enrolled under the waiver on the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007.
       ``(B) No federal payment for any new nonpregnant adult 
     enrollees or for such enrollees who no longer satisfy income 
     eligibility requirements.--Payment shall not be made under 
     this section for child health assistance or other health 
     benefits coverage provided under the State child health plan 
     or under a waiver under section 1115 for any of the 
     following:
       ``(i) Parents or caretaker relatives under a section 1115 
     waiver approved after the date of enactment of the state 
     children's health insurance program reauthorization of 
     2007.--A nonpregnant parent or a nonpregnant caretaker 
     relative of a targeted low-income child under a waiver, 
     experimental, pilot, or demonstration project that is 
     approved on or after the date of enactment of the Children's 
     Health Insurance Program Reauthorization Act of 2007.
       ``(ii) Parents, caretaker relatives, and nonpregnant 
     childless adults whose family income exceeds the income 
     eligibility

[[Page 21597]]

     level specified under a section 1115 waiver approved prior to 
     the state children's health insurance program reauthorization 
     of 2007.--Any nonpregnant parent or a nonpregnant caretaker 
     relative of a targeted low-income child whose family income 
     exceeds the income eligibility level referred to in 
     subparagraph (B)(i), and any nonpregnant childless adult 
     whose family income exceeds the income eligibility level 
     referred to in subparagraph (B)(ii).
       ``(iii) Nonpregnant childless adults, parents, or caretaker 
     relatives not enrolled under a section 1115 waiver on the 
     date of enactment of the state children's health insurance 
     program reauthorization of 2007.--Any nonpregnant parent or a 
     nonpregnant caretaker relative of a targeted low-income child 
     who is not enrolled in the State child health plan under a 
     section 1115 waiver, experimental, pilot, or demonstration 
     project referred to in subparagraph (B)(i) on the date of 
     enactment of the Children's Health Insurance Program 
     Reauthorization Act of 2007, and any nonpregnant childless 
     adult who is not enrolled in the State child health plan 
     under a section 1115 waiver, experimental, pilot, or 
     demonstration project referred to in subparagraph (B)(ii)(I) 
     on such date.
       ``(C) Definition of caretaker relative.--In this 
     subparagraph, the term `caretaker relative' has the meaning 
     given that term for purposes of carrying out section 1931.
       ``(D) Rule of construction.--Nothing in this paragraph 
     shall be construed as implying that payments for coverage of 
     populations for which the Federal medical assistance 
     percentage (as so determined) is to be substituted for the 
     enhanced FMAP under subsection (a)(1) in accordance with this 
     paragraph are to be made from funds other than the allotments 
     determined for a State under section 2104.''.
       (b) Conforming Amendment.--Section 2105(a)(1) ( 42 U.S.C. 
     1397dd(a)(1)) is amended, in the matter preceding 
     subparagraph (A), by inserting ``or subsection (c)(8)'' after 
     ``subparagraph (B)''.
       (c) Nonapplication of Certain References.--Subsections (e), 
     (i), (j), and (k) of section 2104 (42 U.S.C. 1397dd), as 
     added by this Act, shall be applied without regard to any 
     reference to section 2111.

     SEC. 107. PROHIBITION ON NEW SECTION 1115 WAIVERS FOR 
                   COVERAGE OF ADULTS OTHER THAN PREGNANT WOMEN.

       (a) In General.--Section 2107(f) (42 U.S.C. 1397gg(f)) is 
     amended--
       (1) by striking ``, the Secretary'' and inserting ``:
       ``(1) The Secretary''; and
       (2) by adding at the end the following new paragraphs:
       ``(2) The Secretary may not approve, extend, renew, or 
     amend a waiver, experimental, pilot, or demonstration project 
     with respect to a State after the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007 that would allow funds made available under this title 
     to be used to provide child health assistance or other health 
     benefits coverage for any other adult other than a pregnant 
     woman whose family income does not exceed the income 
     eligibility level specified for a targeted low-income child 
     in that State under a waiver or project approved as of such 
     date.
       ``(3) The Secretary may not approve, extend, renew, or 
     amend a waiver, experimental, pilot, or demonstration project 
     with respect to a State after the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2007 that would waive or modify the requirements of section 
     2105(c)(8).''.
       (b) Clarification of Authority for Coverage of Pregnant 
     Women.--Section 2106 (42 U.S.C. 1397ff) is amended by adding 
     at the end the following new subsection:
       ``(f) No Authority to Cover Pregnant Women Through State 
     Plan.--For purposes of this title, a State may provide 
     assistance to a pregnant woman under the State child health 
     plan only--
       ``(1) by virtue of a waiver under section 1115; or
       ``(2) through the application of sections 457.10, 
     457.350(b)(2), 457.622(c)(5), and 457.626(a)(3) of title 42, 
     Code of Federal Regulations (as in effect on the date of 
     enactment of the Children's Health Insurance Program 
     Reauthorization Act of 2007.''.
       (c) Assurance of Notice to Affected Enrollees.--The 
     Secretary of Health and Human Services shall establish 
     procedures to ensure that States provide adequate public 
     notice for parents, caretaker relatives, and nonpregnant 
     childless adults whose eligibility for child health 
     assistance or health benefits coverage under a waiver under 
     section 1115 of the Social Security Act will be terminated as 
     a result of the amendments made by subsection (a), and that 
     States otherwise adhere to regulations of the Secretary 
     relating to procedures for terminating waivers under section 
     1115 of the Social Security Act.

  Mr. President, I yield the floor and I suggest the absence of a 
quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. DURBIN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DURBIN. Mr. President, I ask unanimous consent to be allowed to 
take the time already allocated to the Senator from Rhode Island, Mr. 
Whitehouse.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Illinois.
  Mr. DURBIN. Mr. President, what an interesting debate this has been. 
If you want to know how Congress is likely to react to the fact that we 
have 47 million uninsured Americans and millions more with health 
insurance that is almost worthless, if you want to know what Congress 
is likely to say about the plight of families who struggle each year 
with premiums rising and coverage falling, you should listen to this 
debate. Because my friends on the Republican side of the aisle--not all 
of them, but a number of them--want to argue for the proposition that 
we ought to be careful we don't insure too many people in America.
  It is an easy thing for a Member of the Senate to argue. We are some 
of the luckiest people in America. We are covered by the Federal 
Employees Health Benefit Program. That may be the sweetest deal in 
terms of health insurance anyone can dream of. It covers 8 million 
Federal employees, including Congressmen, Senators, and their families, 
and it allows us--if you can believe it, those watching this debate 
across America--it allows us once each year to decide if we want to 
change companies. If we don't like the way we were treated last year, 
if a particular company didn't cover something important to our family, 
we can say: That is it, we are buying a new product. It is like 
shopping for a car and we are in the driver's seat because we have 
options.
  In my State of Illinois, my wife and I can choose from nine different 
health insurance plans. If we want to get more coverage, we can have 
more taken out of my check; less coverage, a lower amount. Our choice. 
Real consumers. Boy, there aren't very many Americans who can say that, 
are there? How few Americans can stand up and say: If I don't like my 
health insurance company, I will buy another. But we can do it. The 
Senators coming to the floor today arguing against children's health 
insurance being extended to too many people have that luxury. They are 
part of the Federal Employees Health Benefit Program.
  Most of us here in the Senate bring our life experience to the floor. 
In this bill, there are two life experiences I have been through that 
come to mind. The first relates to the way we pay for children's health 
insurance, and that is with the tobacco tax. Well, tobacco has been a 
big issue in my congressional career. It was 20 years ago that I 
decided to introduce a bill to ban smoking on airplanes. It was 
considered a radical idea, that we would have no smoking on airplanes. 
Back in those days, they split the plane up, smoking and nonsmoking, 
and argued if you sat in the nonsmoking section that you were 
protected. Everybody knew better, but nobody questioned it. So I 
introduced a bill to take smoking off airplanes. My interest in that 
went beyond the fact that I was a frequent flyer, as most Members of 
Congress are. It even went beyond the fact that I had read the 
statistics about secondhand smoke and the damage it had caused to so 
many innocent people. It went to a personal life experience. My father 
smoked two packs of Camels a day. He was an addicted smoker for as long 
as I knew him, and I didn't know him very long. When I was 14, he died. 
He was 53 years old, and he died of lung cancer. I stood by his bed and 
watched as he took his last breath on November 13, 1959, at noon. I 
didn't swear then and there that I would get even with tobacco 
companies. But looking back, and as a young boy, I never got it out of 
my mind that that product, that tobacco product, had taken his life and 
taken him from me.
  I remembered it whenever I would fight the tobacco companies, and I 
have quite a few times. I would think about all the other young people, 
men and women across America whose lives had been touched by tobacco 
disease.

[[Page 21598]]

  My dad started smoking when he was a kid--most people do. So how do 
we stop kids from making that terrible choice in their lives? There is 
a simple way--raise the cost of the product. The more expensive a pack 
of cigarettes is, the less likely a younger child will start smoking 
and the less likely they will be addicted. That is simple economics. We 
have proven that over and over again.
  We have these charts here that show U.S. cigarette prices versus 
consumption. As the price goes up, the consumption goes down. It is 
that basic. So we pay for this bill for children's health insurance 
across America by imposing a higher tax on tobacco products and 
cigarettes. It is no surprise that my Senate colleagues from tobacco-
producing States don't like the idea at all. For years, they have come 
to the floor of the House and Senate and argued against tobacco taxes 
for a variety of different reasons, but they can't argue against this 
reality. The higher the cost, the lower the consumption. Certainly 
among children it is even more dramatic.
  So for many who have come to argue against our approach to expanding 
children's health insurance, saying it is not fiscally responsible, it 
is as responsible as you can ask for. We are going to pay for it, and 
we pay for it with a tax on a product that claims over half a million 
American lives each year. Tobacco is still the No. 1 preventable cause 
of death and disease in America. Sparing a child from addiction to 
tobacco is sparing them the 1-in-3 likelihood that they will die from 
that addiction.
  The second life experience that brings me to this issue goes back to 
my time in law school here in Washington at Georgetown Law Center. My 
wife and I were married after my first year in law school, and a baby 
came along rather quickly. Our daughter was born at the end of my 
second year, and I didn't have health insurance. I was a law student. 
We were happy to have our little girl, but a little surprised and 
unprepared. So we had to save up the money to pay for her delivery. 
Luckily, in those days, it wasn't as expensive as today, but for a law 
student it was still a lot of money. My wife worked during the 
pregnancy, I tried to save a few dollars, and we had enough money to 
pay the obstetrician and pay the hospital for my daughter's delivery 
while I was still in law school. But something happened 30 days after 
that which made a big difference. My daughter was diagnosed with a 
serious illness. Still, we had no health insurance. I found out what it 
was like to be the parent of a child and to have no health insurance. 
It was a humbling experience. I used to leave law school and drive over 
to Children's Hospital here in Washington, DC, pick up my wife and 
baby, drive over there and sit in the clinic. The clinic was, I guess, 
the place for those of us who didn't have health insurance, and we 
would wait our turns. There were a lot of people in that clinic, and it 
meant waiting a long time. I was glad to wait, because I wanted some 
doctor, some competent physician, to come see my daughter.
  Well, we usually ended up with a resident who took the history, which 
we gave over and over and over again. But that is the price you pay 
when you don't have a regular doctor and a regular appointment. So the 
chart of my daughter's background grew and grew, and I sat there with 
my wife time after time waiting for a doctor to examine my baby. It 
wasn't a reassuring feeling for a father, because you want to believe 
that the doctor who is going to be there for your baby is the best. If 
you don't have health insurance, you may be tossing the dice. I learned 
what it was like. It was a humbling experience. I have never forgotten 
it, and I never will.
  We are talking about children across America now who have no health 
insurance. Of the 47 million who are uninsured in America, about 9 
million are children. We decided about 10 years ago to create a special 
program to provide uninsured kids with healthcare coverage. It worked. 
It worked very well. Over 6 million kids across America today have 
health insurance because of this program, and it is a program that 
people like because Governors and others can work to make it fit into 
their State, to fit their needs. There are Government guidelines, but 
there is flexibility through waivers that are offered. So a lot of 
States are trying different ways to bring more children in and cover 
more uninsured people. I think that is a good thing. I hope that 
whoever the next President of the United States may be--and we all have 
our favorites in this Chamber--whoever it may be, they will start their 
administration by saying they are going to challenge America to 
eliminate the uninsured over a specific period of time. And wouldn't 
they start with the kids?
  The bill that came out of the Finance Committee is a bipartisan bill. 
I want to salute not only Senator Baucus of Montana, the chairman, but 
Senator Grassley of Iowa, the ranking minority member, and others, 
Senator Hatch of Utah, Senator Rockefeller of West Virginia, and 
Senator Snowe of Maine, who have all made a real bipartisan effort. 
What we are trying to do is to take this bill and reauthorize this 
Children's Health Insurance Program so that we cover even more 
children. In fact, we have the opportunity to add another 3.2 million 
to the 6.6 currently covered. That is almost 10 million kids who will 
have health insurance, if we are successful. It will still leave almost 
6 million uninsured. That is still too many, as far as I am concerned. 
But we are moving forward. We are dealing with political realities and 
budget realities and doing the best we can under these circumstances.
  But Senator McConnell, the Republican leader, is going to come to the 
floor and suggest spending dramatically less money on this program. The 
net result of it is that Senator McConnell and others are going to 
argue let's not increase the number of uninsured kids covered by this 
program. At the end of the day it is going to mean that just about 9 
million kids in America will be uninsured instead of the 6 million that 
will remain if we pass this proposal. Senator McConnell has made a 
calculation that he is willing to leave millions of uninsured kids 
behind.
  He doesn't like the tobacco tax. Being from Kentucky, I am not 
surprised. But for many of us it is a small price to pay, increasing 
the cost of tobacco products so that kids have more health insurance. 
The important thing about this debate is it is a precursor of a much 
bigger debate that is to come over whether America is going to get 
serious about the shortcomings when it comes to health insurance.
  I know there are a lot of people with a lot of different theories. I 
see my friend from Oklahoma, a medical doctor. He and I have talked 
about this. He has a much different view about this issue than I do. I 
hope his approach, if it is ever tested, works. But I believe this 
approach will work because what we are doing is taking those who have 
been unfortunate enough not to have health insurance and giving them a 
chance for coverage.
  We know the poorest kids in America are eligible for Medicaid, a 
program that we share with the States all across the Nation. We know 
that the kids from wealthier families usually have health insurance 
through some worker in the household. But what about the kids caught in 
the middle? What about the kids where the parents do go to work but 
don't make enough money? What about the kids from families who, because 
of an existing medical condition or some other complication, can't 
afford health insurance, can't buy health insurance? That is what this 
program is all about.
  There has been a lot of criticism of this program--I have heard it on 
the Senate floor today repeatedly--that it just covers too many 
children. We really ought to cut back on the number of kids covered. 
That really betrays an approach to this issue which I think we will 
hear more of. There are some people who, for a variety of reasons, 
philosophical and economic, would leave a lot of kids and a lot of 
uninsured Americans behind and say: That's life.
  I don't accept that. I don't think that should be life in America. We 
live in a much better nation than that. Our values are stronger than 
that. We exalt family in America. We say that is the

[[Page 21599]]

strength of our Nation. How can you exalt families and say that you 
want to make them stronger and not provide one of the basics in life--
health insurance?
  I know what it is like sitting in that waiting room, worrying about 
my own daughter's care, with no health insurance. I try to think of 
millions of other families who face that every single day. We were 
lucky. We got through it. My daughter is 39 years old now and has her 
own family. We were blessed in many ways.
  But it was a tough experience I wouldn't wish on anybody. Those who 
vote against this proposal are wishing it on millions of Americans. In 
fact, they know millions of Americans will continue to have no health 
insurance and they accept it.
  There is a young teenager in Naperville, IL, I am honored to 
represent. His name is Michael, and he is 17 years old. When he was in 
the fourth grade, he was friends with a young boy named Joey. He used 
to talk about Joey as his friend with the megawatt smile. They shared 
lunch together and kept their secrets safe for one another. But, 
unfortunately, Joey complained a lot about just not feeling right. He 
missed a lot of school. He was tired, his knees hurt, he bruised 
easily.
  It came as a shock one day when Michael was told that Joey had been 
diagnosed with acute lymphocytic leukemia, a devastating, life-
threatening disease. Then they learned another piece of alarming news: 
Joey's dad, who was a house painter, was self-employed and like 
millions of other self-employed Americans, was uninsured.
  In the 4 years that followed, Joey with leukemia, would come to 
school when he could. He lost his hair with the treatment he received. 
He was frail, and he wore his Cubs cap to cover his bald head. 
Sometimes he only stayed for a couple of hours, but all the kids 
remember they were good hours. They were happy to see him.
  Then, on January 8, 2003, the school counselor came in and told 
Michael and his class that Joey was not going to return. That is not an 
unusual story in America--but it should be.
  What does this say about America, that 9 million children do not have 
the most basic health protection in our country? We are so proud of so 
many achievements that we have registered in the course of our history. 
We are so proud of the opportunities in our country. But how would we 
explain to future generations that we would just walk away from those 
kids and this opportunity to provide them with coverage? If Senator 
McConnell's alternative prevails, we will walk away from 9 million 
uninsured children. If the committee proposal prevails, we at least 
will take care of about 3.2 million of those kids. I wish we would take 
care of more.
  We also know that if kids don't receive basic health care, a lot of 
simple things can become complicated; a lot of things that can be 
treated successfully will be ignored and unfortunately become worse. As 
Michael puts it, how many Joeys could be saved if only affordable 
health insurance was available to all children?
  What do Americans think about this general concept of helping States 
cover more uninsured children? In a country that is sharply divided 
along political lines on so many issues, this is one that is 
overwhelmingly popular. Ninety-one percent of the American people get 
it. They think this is the right thing to do, to cover more children. 
Eighty-four percent specifically support covering all uninsured 
children with the Children's Health Insurance Program. It is hard to 
believe that number exists, when you hear some of the speeches against 
this program from the other side of the aisle. With this program we 
have reduced the number of uninsured children in America by a third.
  States have worked to design programs that work best for them. My 
State is one of them. Illinois now provides coverage to over 130,000 
parents under CHIP, and because of the increased outreach and 
enrollment, 250,000 more parents than it did prior to receiving a 
waiver from our Government to offer that coverage.
  You say to yourself, if this is a children's program, why are you 
covering parents? They found the vast majority of parents had no health 
insurance or couldn't afford the health insurance they had, and by 
offering them insurance, it brought their children into coverage as 
well. Some will say it is not what the program is about; it is the 
children's health insurance program. But for these people, they 
consider it somehow a violation of trust that we would expand the 
program to bring in uninsured parents. To me, it is striving to reach a 
national goal, where every American, regardless of their economic 
situation, has health insurance. That is something I support and most 
Americans support, and something this program tries to achieve.
  We give the States such as New Jersey and Illinois and many others 
the option to cover more parents. What is striking is, during the same 
time period that the state covered these parents, Illinois has added 
more than 360,00 children to Medicaid and CHIP coverage, so this 
program has worked. It has become an outreach program to let parents 
know they have an option. They may qualify for Medicaid. They may 
qualify for the Children's Health Insurance Program. It is a 38-percent 
increase in the number of kids covered by health insurance in my State. 
Is that working, a 38-percent increase? I think, frankly, the figures 
are obvious.
  Just last week, Illinois State officials hosted delegations from 
around the country, briefing them on how our program works and maybe 
exchanging some ideas on how to make it better in their States and ours 
as well. Illinois was telling other states how to do it because 
Illinois has a successful model.
  This is not a perfect piece of legislation. I wish it were larger. I 
would spend more than $35 billion. I would raise the tobacco taxes 
higher, if necessary. I would find other ways to offset the cost 
because I think we should be striving for full coverage of all 
uninsured children in America. What a great day that would be. What a 
celebration it would be for us to be able to say, on a bipartisan 
basis, Republicans and Democrats have reached that goal.
  This bill doesn't quite reach the goal. But let's celebrate what it 
does. It moves us forward. It preserves a program which would expire on 
September 30, and it expands it. With these new funds and an accurate 
formula, combined with the incentive bonuses proposed, Illinois could 
cover as many as 123,400 children who are uninsured today over the next 
5 years. That is a dramatic expansion. It is one which I would be happy 
to vote for and will vote for.
  The Finance Committee bill increases eligibility levels for children 
covered under this Children's Health Insurance Program to 300 percent 
of Federal poverty. Some people on the floor have talked about 300 
percent of Federal poverty level as a higher income. Do you know what 
it means to have a family of four and be at 300 percent of poverty? It 
means an income of $62,000 a year. That is a little over $1,000 a week. 
That is maybe a little more than $5,000 a month. It is hard to imagine 
people are living in the lap of luxury, after they pay their taxes and 
their basic expenses, paying for the higher price of gasoline and 
utility bills, paying for whatever it takes to have a safe and sound 
place to live in.
  I think most of us who are blessed with a lot more income should 
reflect on a family of four struggling with $62,000 a year. I don't 
think there are many vacations or trips to the movies with that kind of 
income. For the State of Illinois, this change in eligibility level 
would bring in an additional $26.5 million to cover thousands of 
additional kids, which is certainly a positive step forward.
  I can tell you that Senator McConnell, who is offering a Republican 
alternative--as I mentioned earlier, is not offering an alternative 
embraced by all Republicans. Many support the bipartisan bill that came 
out of the committee and see it as strengthening a successful 
bipartisan program. Senator McConnell sees it as a slippery slope to 
universal coverage.
  The Republican leader yesterday invoked all the right words when he 
described his Republican alternative:

[[Page 21600]]

low-income children, fiscally responsible, providing a safety net. He 
criticized the bill from the committee as a ``dramatic departure from 
current SCHIP law.''
  What he failed to mention is his alternative is the dramatic 
departure. It includes a bare reauthorization of the program and adds 
in small business health plans and health savings account reform. 
Incidentally, the health savings account is the refuge for all of my 
friends on the Republican side of the aisle. When they can't think of 
anything to say about covering more people with health insurance, they 
come in with these health savings accounts--an idea once waltzed out by 
Speaker Gingrich that has gone around the track many times and has not 
shown the success that they promised.
  Here it is again--no surprise. The Republican proposal by Senator 
McConnell would likely cause hundreds of thousands of people to lose 
coverage.
  I am encouraged that the reauthorization bill before us has sparked a 
national conversation, not only about the kids who are uninsured but 
others as well. My counterparts on the other side of the aisle have not 
always been open to that conversation, but that is not what is before 
us. The bill we are considering will reauthorize the Children's Health 
Insurance Program before it expires on September 30.
  This is not the time or vehicle to try to add all kinds of health 
care proposals, but that day should come. This is the time to take care 
of our nation's children and we will pay for it as we go. As I said 
earlier, this new tobacco tax is a smart thing from a health point of 
view. In a poll conducted by the Campaign for Tobacco Free Kids, two-
thirds, 67 percent, of those interviewed favored such a tax increase. 
Only 28 percent opposed it. Moreover nearly half, 49 percent, strongly 
favored it. Only 20 percent strongly opposed it. It is the right thing 
to do. We know what tobacco does to the health of America. Discouraging 
its use is a move in the right direction.
  This is an historic debate, one that is long overdue. We know health 
care is the most important issue to Americans next to the war in Iraq, 
and very rarely if ever do we seriously address it. We know the 
business community is begging us to move forward and expand health 
insurance coverage in this country to help them find a way to move to 
universal coverage which will not be at the expense of competitiveness. 
We know that working families, those in labor unions and those who are 
not, all understand the cost of health insurance and its value to every 
family, and we know from our own personal experiences and the people we 
meet in our States that this is long overdue. It is about time we 
opened up this discussion.
  I am heartened by the work of the Finance Committee. The fact they 
brought this bill to us with strong bipartisan support on the floor of 
the Senate is an indication that there is some promise to this debate. 
I thank my colleagues who worked so hard on the committee to bring this 
bill forward. I hope we can build on it, cover more uninsured children, 
and move to the day that every single American, regardless of their 
income, has basic health insurance coverage so that every American has 
peace of mind when it comes to their health and the health of their 
family, so that no American, whether a law student or someone who has a 
low-income job, has to wait and pray that there will be good 
professional health care for their children.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Brown). The junior Senator from Oklahoma 
is recognized.
  Mr. COBURN. Mr. President, I am going to spend a little bit of time 
first discussing health care in America. I have a little bit of 
experience, having practiced for 24 years. The children the majority 
whip talked about, I delivered 4,000 of them. I cared for well over a 
third of those through their infancy and into childhood.
  Let's be clear about what this debate is. There is no difference. I 
agree with Senator Durbin. I want every person in this country to have 
health insurance. Actually, every problem that Senator Durbin mentioned 
could be solved by equalizing the tax treatment under the Tax Code so 
that everybody is treated the same under the Tax Code in this country.
  Let's talk about where we are in health care in America today, then 
let's talk about what the possible solutions are.
  What we have today is the best health care in the world. It is very 
expensive, there is no question about it. Eighty percent of all of the 
innovation in health care in the world comes out of our health care 
system. We have survival rates on prostate cancer, breast cancer, and 
colon cancer that far exceed anywhere else in the world. Our treatments 
for coronary artery disease are better than anywhere else in the world. 
If you have a heart attack in this country, you are more likely to live 
5 years than anywhere else in the world. But we have a system that is 
designed to treat chronic disease instead of designed to prevent 
disease.
  I know that the President this evening is supportive of prevention in 
terms of how do we change the focus in this country. You see, what we 
have coming to us is a storm. It is not going to be a storm that 
affects myself or the Senator from Ohio; it is going to affect our kids 
and our grandchildren. Here is what the storm is. If you are born 
today, born today, you are born owing $500,000 for the health care of 
everybody who was born before you under Medicare. Think of that. Listen 
to me--$500,000 is the cost we are laying on the next generation for 
the health care system we have under Medicare. That is not talking 
about Medicaid, that is not about SCHIP, that is about Medicare only. 
If you are born today, that is what you are going to bear over and 
above what our present tax rate is. That is called stealing opportunity 
from the next generation.
  We also have a health care system under which 7 percent of the costs 
of health care comes about from tests that are ordered for you that you 
do not need. There is no reason you need them, but the tests get 
ordered because your doctor needs them or your hospital needs them. It 
is a full $170 billion a year we spend on tests that nobody needs 
except the doctors to protect themselves in the case of ``what if.'' 
And this body refuses to look at tort changes that will make us order 
tests based on what you need rather than on the threat of a malpractice 
suit.
  So we have liability costs, we have unfunded costs from Medicare, we 
do not have prevention. We spend tens of billions of dollars a year on 
disease prevention in this country, $7.1 billion at the NIH, $8.4 
billion at the CDC, and then billions more that we can't quantify 
across many Federal agencies where you cannot measure that we did 
anything on prevention.
  The average American does not know that at age 50, they should have a 
colonoscopy; they do not know that at age 35, they should have a 
mammogram; they do not know that if they have a family history of 
breast cancer, they should have that mammogram sooner; they do not know 
that every month, they should be doing a self breast exam; they do not 
know the symptoms of prostate disease in older men; they do not know 
what they need to know about prevention. We are totally inept in the 
programs we have today to communicate that to America.
  So that is where we find ourselves today--the best health care system 
in the world, with the most innovation, but also 50 percent more 
expensive than anywhere else in the world.
  Now, when you match up those two statistics I talked about, in terms 
of greater life expectancy, in terms of all of the cancers, in terms of 
heart disease, against the cost, what is the difference in all the 
countries that have universal, single-payor, government-run, 
bureaucratic-controlled health care? They let you die. That is the 
difference. If you need a knee replacement, like the Senator from North 
Dakota talked about, you do not get it because there is no money. Let's 
talk about some statistics. Average waiting time in Sweden: 25 months 
for heart surgery. How many people do you think live 25 months? How 
about an average of 10 months before the onset of

[[Page 21601]]

chemotherapy for breast cancer in England. The reason their costs are 
down is because they are not caring for people at the end of life.
  We can get all of that back if we emphasize prevention. Prevention. 
For every dollar we spend on prevention in this country, we are going 
to get 100 back. Yet we do not have effective prevention programs. So 
what is this debate really about?
  There is not anybody in this Chamber who does not want to see kids 
have great access to health care, preventative or otherwise. There is 
not anybody in this Chamber who wants anybody not to have available 
health care. What is the real debate? Well, there are actually three.
  The first debate is: Do we want the Government that cannot get you a 
passport, that cannot control the border, that cannot take care of the 
problems associated with a hurricane when we have a major emergency, do 
you want them running your health care? A government that is failing so 
many fronts because the bureaucracy is so big, the oversight is so poor 
from this body, the oversight is so poor, we do not do our jobs. We can 
find lots of ways to spend new money, but we cannot spend the effort to 
find out if money we are spending is working. The oversight is so poor 
that we have ineffective programs all over the place.
  There is a columnist by the name of P.J. O'Rourke. He said, if you 
think health care is expensive now, wait until it is free. And there is 
a lot of truth to that. When it becomes free, it is going to be 
tremendously expensive.
  So the debate is not about whether we should cover children and 
whether children ought to have great health care. They should. We have 
the resources to do it. What the debate is about is whether we are 
going to put into the hands of an incompetent government in many other 
areas your health care. And this is the first step in moving it all in 
that direction.
  Now, the Senator from Illinois talked about the young child with 
acute lymphoblastic leukemia. We have moved to where we have about an 
80-percent cure rate with that right now. We did not do that through 
the Government; we did that through the private sector. But he also 
noted that he did get this care. He did get chemotherapy. He did get 
it. So the other point that needs to be made about--the system we have 
now is shifting a quarter of a trillion dollars a year into a system 
because we are absorbing costs rather than giving individuals their 
care based on freedom.
  The second point is, if we do this expansion of SCHIP, are we getting 
good value for what we are paying? There is a chart I want to put up 
that shows--these are CBO numbers. The reference to the private care 
comes from data about the individual health insurance market. The 
$1,532 comes from average of a $500 deductible added to the average 
premium for a private children's policy: $1,032. One in three will pay 
a $1,500 deductible, two will pay no deductible. So for $1,532, you can 
buy private coverage, but with this bill we are talking about spending 
$3,950 for government care for the same thing. That expense will be 
charged to your children and your grandchildren. I think it is probably 
not a great deal, not great value, for us to do it this way.
  The other thing the Senator from Illinois recognized is that he 
wanted everybody to have insurance. All he has to do is cosponsor the 
Burr-Corker bill because that gives everybody in this country, if you 
are an individual, a $2,160 tax credit, refundable flat tax credit. If 
you are a family, it gives a $5,400 refundable tax credit.
  Now, what does that mean? If you are earning $61,950, a bureaucrat is 
going to decide what your health care is and who your doctor is going 
to be and whether or not you have care versus you deciding. It is about 
freedom to choose.
  So the Senator from Illinois can have every one of the desires he 
listed and meet every one of the goals by us equalizing the benefit 
under the Tax Code for all of us. That means it does not matter if you 
are rich or poor; you get the same treatment under the Tax Code. In 
other words, we are going to guarantee 100 percent universal access for 
everybody in this country, and it is not going to cost a penny.
  The other thing this debate is about is, Do we really want to have a 
debate in this country on health care? If we do, let's have a total 
debate.
  Mr. President, so this debate is about whether we get value, this 
debate is about whether we really are going to fix health care, and 
finally, this debate is about the dishonesty in this bill about how it 
is paid for. And what we are doing--you saw Senator Gregg with the 
chart out here. We are going to assume that in year 6, the cost of this 
is $3.5 billion, but the new program is 12. There has never been a 
program that is going to go down from that. So rather than violate 
their own rules, they cut it down and said it does not exist at the 
same level for the second 5 years of this authorization. That is 
exactly what America has come to expect of us--being intellectually 
dishonest with them about the true costs of programs.
  So, as Senator Gregg said, the debate really is about the starting of 
the debate, about what we are going to do in health care. We have good 
health care. We have 43.6 million Americans who do not have it. This 
bill purports to put 3.3 million of them on SCHIP. The only problem 
with that is 1.1 million of them have insurance now, so there is a 
double cost. So we got back to the $3,900, which is what the American 
taxpayer, one way or the other, is going to pay for $1,532 worth of 
care. How does that make sense? It makes sense only if you are moving 
in a direction to have the Government run it all.
  So if you want the personal freedom to be able to choose what your 
health care should be and you want the Government to equalize the tax 
basis under which we all receive care so that everybody gets the same 
benefit--not the wealthy, one, and the poor, a different one; the 
difference is $2,700 if you are well off and $102 if you are not--that 
is how the Tax Code discriminates against you now. What we do and what 
we suggest is everybody gets the same treatment. And what happens is, 
under this bill, CBO scores that it will add maybe 3.3 million kids. 
Under the Burr-Corker, we add 24 million people in coverage over the 
first 10 years of that program, according to JCT.
  So if this is about covering all of the children and about covering 
those who do not have health care, we ought to be addressing it in a 
totally different way. We ought to be saying we want a universal flat 
tax credit that is refundable to everyone in this country so they can 
all have access.
  Senator Wyden has proposed that on the other side with some minor 
differences in what we are suggesting through the Burr-Corker bill. But 
the fact is, you cannot have it both ways. Which way is better? Do you 
want the freedom to choose or do you want an organization that right 
now has proven to be terribly incompetent?
  Some statistics about the incompetence: the doctor shortage in this 
country 15 years from now is going to be 200,000 doctors. Why is that? 
Why are the best and brightest not going into medicine today?
  Why is that? It is the same reason that you see all the European 
single-payer systems moving toward what we have, as we try to move 
toward them. We are going in exactly the opposite direction. The reason 
is, by the time you finish 12 years of college and graduate and 
postgraduate and post-postgraduate education, you can't earn enough 
under Medicare or Medicaid to even repay your loans. So what is 
happening is, our best and brightest, instead of going into medicine, 
are going into other areas where they can be remunerated for their 
investment in education. This drives us further that away.
  What is the statistic behind it? Fifty percent of the doctors don't 
see Medicare or Medicaid patients now. If you move to a new city and 
you are on Medicare, good luck on finding a new Medicare doctor. Why? 
Because the reimbursement is about 50 percent of what they can earn 
seeing somebody who is not on Medicare. So we will have a shrinking 
number of doctors, a government-run program that is going to control 
cost by saying, as the Senator from North Dakota said: Here is

[[Page 21602]]

the amount of money. Guess what. We are not paying for it. It is going 
to get rationed. That is exactly what is going to happen to us. 
Consequently, we are going to take the best health care system in the 
world, with all its defects, and we are going to turn it on its ear. We 
are going to take the system that develops 80 percent of all new 
innovations in health care and run it away.
  Example: M.D. Anderson Clinic spends more on research in health care 
than all of Canada. Think about that. One private outfit in this 
country spends more than the whole nation of Canada on health research. 
Why? Because we have a system that rewards innovation. We are going to 
kill that system. We are going to destroy it. The question is not 
whether children ought to be covered. Sure, they should. But so should 
their parents and everybody else but not in a way that destroys the 
system. The system will work if we create access for everyone. The 
system will work without raising a tax dollar to anybody. We will give 
everyone free choice to have what is best for them.
  The numbers don't lie. If you doubt what I am saying about this being 
a step toward national health care, here is what they say. Question: Is 
this the first step toward a government-run, bureaucratic-controlled 
single-payer health care system? Senate Finance Committee: Absolutely 
not.
  Now let's hear what the chairman said:

       We're the only country in the industrialized world that 
     does not have universal coverage. I think the Children's 
     Health Insurance Program is another step to move toward 
     universal coverage.

  AKA government-run health care in this country. So the system that 
gives us great innovation, that creates 80 percent of the new drugs, 
new techniques, new technologies, we are going to poke our finger in 
its eye because of what it has done.
  We heard the Senator from Illinois say all the big businesses want to 
solve this. They have made commitments to health care. They now want to 
dump on the American public rather than on their shareholders. General 
Motors, Ford, Chrysler, they want us to pay for it. They had an 
obligation for it. They took plenty of bonuses when the profits were 
good. Now they want you as taxpayers to pay for it. That is why all the 
Governors want the SCHIP program, because it is going to expand their 
ability to solve their other budget problems. But what we are charged 
with is doing what is best for the country in the long run. I will 
promise you, a government-run, bureaucratic-controlled health care 
system is not the best thing for this country. And that is what we will 
get. What we to have do is go back and use a little common sense and 
look at what is happening.
  In my State of Oklahoma, we have 117,000 kids on SCHIP. Oklahoma 
chose to make it a Medicaid expansion. The problem is, Medicaid doesn't 
pay enough so kids can't get access in Oklahoma under the rates which 
they pay. So have we given children access? We have a SCHIP program. 
Can they get care on a timely basis, can they get the same thing 
somebody through a private insurance firm can get? No. Is that the kind 
of care we want? I want everybody to have the same access. I don't want 
a Medicaid stamp on anybody's forehead. I want them to be treated 
equally under the Tax Code so they have exactly the same opportunity 
for access to care that the richest or the best union member or the 
best business offers. We can do that, but we can't do it by going in 
this direction.
  We heard from the majority whip that we don't like kids. I don't care 
how much tobacco is taxed. The problem is their numbers are foolish, 
because we know as we raise the tax, the amount of volume goes down or 
it goes to the black market or it goes through Indian tribes who don't 
pay the Federal excise tax even though they owe it.
  So what we know is the way we are going to fund this isn't going to 
work, but we are going to be on the hook anyhow. Except it is not us on 
the hook. It is your kids. The very kids we are going to insure, we are 
going to come back and say: By the way, you have to pay for your 
insurance through increased tax rates.
  We should be very careful about what we are doing. I care dearly 
about children. I have four grandchildren, 10 and under. I look at 
them, and I see all the kids I have delivered through the last 20-some 
years. I see all the kids I have cared for, diagnosed major diseases 
on, treated broken bones, taken their appendix out. I look at all 
those, and not once were they ever turned down. The vast majority of 
physicians don't turn somebody down in need, but we are coming to a 
screeching halt. No longer can we continue to cut the incentive to have 
people going into the medical field. Take 200,000 doctors and see what 
would happen if, in fact, we had them there in the future.
  The biggest problem facing hospitals today, they can't find a nurse. 
Why? Because the reimbursement rates are so low we can't incentivize 
enough people to go into nursing because they can't pay the costs to do 
it and the hours are terrible. You work four 12-hour shifts. You are 
off for 3 days, and you come back and work four 12-hour shifts. It is 
not a great life. So the people in medicine today, the vast majority, 
care deeply about kids, but they also care deeply about having some 
rest, having access to a normal life outside of that. My nurse added it 
up. During my 20 years, my average time in practicing medicine was over 
80 hours a week. That is not uncommon in this country. It is not 
uncommon for doctors to spend 80 hours a week taking care of folks. But 
we are going to be short 200,000 because we are going to see less 
dedication because there is not the financial reward for people to 
invest that much time and their assets to get the education they need.
  Let's talk about who is going to get on the system and who is not. 
Under the old system with this expansion, we are going to add 4.1 
million kids. But we are going to take 2.1 million off private 
insurance. So in Oklahoma, I don't know what the exact numbers will be, 
but we are going to take kids off private insurance and then put them 
on a Medicaid system they can't get access to. We will feel good. We 
gave them insurance. We give them coverage, but they don't have access. 
Unless you are getting seen, it is not access.
  Also under the new system, the newly eligible, they will add 600,000 
kids, but there is a 1-for-1 trade. We will take 600,000 off private 
insurance. So tell me what we are doing? We are shrinking the pie so 
that the cost for everybody in private insurance is going to go up. 
That is what is going to happen. We are going to move it over to a 
government-run system that doesn't reimburse at a rate to give you 
access. Why would we do that? Why would we pay 2.5 times what it costs 
to get it in the private sector?
  There are a lot of changes that need to happen in health care. We 
need to complete transparency as far as price and quality so you as a 
consumer can make a decision. I am for that. We need true insurance 
market reform so that instead of big health insurance companies taking 
40 percent of the premium dollars you pay and keeping it through 
administration of profits, we actually put it into health care.
  We need a change in the insurance industry, where a bureaucrat 
sitting at a computer, either at Medicaid, Medicare or an insurance 
firm, isn't denying your care because they have never put their hands 
on you to say you need this or not.
  What we are talking about is giving individuals the freedom to handle 
their own health care, the freedom to choose, the security to know that 
through this tax credit, everyone will have access in this country, no 
matter who you are, no matter what you make. You are equal footing with 
everybody else.
  When the majority whip comes out and says that is what he wants, my 
challenge to him is, sign on to the Burr-Corker bill. That is exactly 
what it does. It gives equal access to everyone. Instead of an 
additional 130,000 kids in Illinois, he will have all the kids covered. 
Instead of the adults who are not covered in Illinois, he will have 
them all covered. He would not raise taxes on a soul. Will it shift 
some? Sure.

[[Page 21603]]

  The question is, are our kids worth it? That is the question that has 
been raised by the Finance Committee and Senator Durbin and those who 
have spoken. I say they are. But if you go back to the numbers, which 
is $3,950, and you apply that and you take the 4.2 million children, we 
could cover all of the uninsured children if we did it at the cost of 
the private sector right now. If we said we will take the same amount 
of money we are going to spend under the SCHIP program and we will buy 
them all a private policy, we can cover every kid who is not covered 
today because we spend 2.5 times more doing a government program than 
the same thing you can do on your own in the private sector. Why 
wouldn't we do that?
  We wouldn't do that because this is the first step in moving toward 
universal, government-run, bureaucratic-controlled health care.
  One other point I wish to make. We have a Medicaid program today. We 
have a SCHIP program today. There are 680,000 kids right now who are 
not covered who are eligible for those programs. Tell me how effective 
we are at covering those 680,000 kids. They are eligible, but we don't 
have them? That is because of the failure of the Government bureaucracy 
to fully get a benefit out to those who are deserving of the benefit. 
So what do we do? We are going to go in the opposite direction.
  The other important point is, what SCHIP does is separate you from 
your family. If you make $60,900 in this country--that is higher than 
the average family income in 21 of our States--your child is going to 
be eligible for SCHIP. So your child is going to go on SCHIP. They will 
have a different insurance plan than you. They will have different 
doctors. There is not going to be a family doctor who cares for the 
whole family. The child will have one, and the parents will have a 
different one. We will separate them and divide them. We are going to 
totally separate them. Then guess what is going to happen. Parents are 
saying: I could put my kid on SCHIP, and I will get a decline in my 
premium. But it would not decline because we would not have done any 
insurance market reform. We will not have created a competitive market 
where they have to bid for your care. We will not have done what we 
need to do to fix health care.
  So I welcome this debate. This is a debate we ought to have in this 
country. Health care is important, and it is one of the things that is 
limiting our competition. But the reason it is limiting competition is 
because we aren't investing in prevention and nearly $1 out of every $3 
spent in health care does not go toward helping anybody get well. The 
reason it is that way is because we have the Government in the middle 
of the market. We are about to make that worse.
  What we do know in this country is markets work. Individuals in this 
country figure out how to buy a car that is good for them. They figure 
out how to buy auto insurance. They figure out how to buy homeowners 
insurance. But we assume if we give everybody a level playing field, 
they are not capable. How arrogant of us. Markets work.
  What we will see is this $250 billion--this quarter of a trillion 
dollars in transfer payments, cost shifting--go completely out. The 
$250 billion will drop everybody's insurance cost in this country by 
$1,000 per person. So not only will we insure everybody who is not 
insured, we will lower their cost of insurance by $1,000, by 
eliminating the cost shifting, and we are paying for that already. So 
we will have great benefits if, in fact, we move to a true competitive 
market.
  The last thing I will say is, if we do a tax credit--a flat tax 
credit, a refundable tax credit--it keeps families together. It keeps 
mama and papa and brothers and sisters going to the same clinic, with 
the same doctors, with constancy of care, knowledge of their history, 
knowledge that is important in terms of giving great care.
  I look forward to this debate. I plan on being on the floor. I plan 
on asking questions. The fact is, this is the issue this country is 
dealing with both in terms of how hard it is to get health care in this 
country and how expensive it is. There are two ways of solving it. One 
says the Government is going to run it and the bureaucrats are going to 
control it and we are going to control the costs by rationing the care. 
The other way says we are going to let vibrant markets create 
transparent information and competition that lowers the cost and 
increases the quality for everybody. On the way, we are not going to be 
inefficient in the way we spend money, spending $3,950 for $1,500 worth 
of product. That is what we typically do up here. There is no reason we 
should do that again.

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