[Congressional Record (Bound Edition), Volume 155 (2009), Part 1]
[Senate]
[Pages 1465-1467]
[From the U.S. Government Publishing Office, www.gpo.gov]




    CHILDREN'S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT OF 2009

  The PRESIDING OFFICER. The Senate will now proceed to the 
consideration of H.R. 2, which the clerk will report.
  The legislative clerk read as follows:

       A bill (H.R. 2) to amend title XXI of the Social Security 
     Act to extend and improve the Children's Health Insurance 
     Program, and for other purposes.

  Mr. REID. Mr. President, 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. REID. I ask unanimous consent that the order for the quorum call 
be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. REID. Mr. President, I ask unanimous consent that the 
consideration of H.R. 2 be for debate only during today's session. 
There will be no amendments in order tonight.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BAUCUS. The author Lois McMaster Bujold wrote:

       Children might or might not be a blessing, but to create 
     them and then fail them was surely damnation.

  Before 1997, we largely failed the children of the working poor. The 
Children's Health Insurance Program changed that. For millions of 
working families, the Children's Health Insurance Program has truly 
been a blessing.
  Before 1997, kids of the working poor had nowhere to go to get health 
insurance--nowhere. Their parents' employers did not offer health 
insurance benefits, and the individual market offered only low-quality 
insurance options at unaffordable prices. Without health insurance, 
kids could not see the doctor for a checkup, they could not get a 
prescription for an earache, and they could not get treatment for 
common chronic conditions such as asthma. Unhealthy kids cannot run and 
play, they cannot do well in school, and they cannot grow into healthy 
and productive adults.
  In 1997, Congress took action to address this problem. We established 
the Children's Health Insurance Program. Today, we finally move forward 
to keep the program going. The Children's Health Insurance Program has 
bipartisan roots, and it has achieved what we created it to do; namely, 
it covers low-income, uninsured kids.
  Congress enacted the Children's Health Insurance Program as a 
bipartisan compromise. Members of Congress wanted to address the rising 
number of children without health insurance, and Senator Rockefeller, 
Senator Hatch, Senator Kennedy, and the late Senator John Chafee led 
the way. I am proud to have helped write and pass the Children's Health 
Insurance Program 12 years ago. It has been a tremendous success.
  The Finance Committee reached a compromise that allowed States to set 
up children's health insurance programs that would meet their unique 
needs. States can choose whether they want to participate in the 
program. Within 2 years of CHIP's creation, every State decided to 
participate. It was a no-brainer. Every State wanted to address the 
health care needs of our most vulnerable children.
  In its first decade, CHIP cut the number of uninsured children by 
more than one-third. Today, because of CHIP, nearly 7 million children 
get the doctors visits and medicines they need. Those healthier 
childhoods will enable those 7 million kids to become healthy, 
productive adults.
  Health insurance is important. It is more than important; it is 
critical. Children with health coverage are more likely to get the 
health care they need, when they need it. Because of CHIP, 7 million 
kids have regular checkups, see doctors when they get sick, and get the 
prescription medications they need.
  The task before us is to reauthorize this important program. Many 
will recall that we started this process back in the year 2007.
  Congress worked hard, very hard to pass a bipartisan reauthorization 
package. I can tell my colleagues, Senators Hatch, Rockefeller and 
myself and Senator Grassley worked hours on end. I cannot tell you the 
number of hours we met and how hard it was, but we worked together and 
got that compromise. We got it passed on the floor, passed the House. 
But President Bush vetoed it twice. Times have changed. President Obama 
is looking forward to signing the Children's Health Insurance Program 
bill, and Congress is prepared to act.
  Americans overwhelmingly support covering kids. The bill before us 
today will keep coverage for all children currently in the program, and 
we will start to reach more than 4 million additional uninsured, low-
income kids. In drafting this legislation, we relied heavily on the two 
vetoed bills. We keep CHIP focused on kids. That is the focus. 
Childless adults whom CHIP covers today will transition out of the 
program. This is focused on kids. This bill will not allow new waivers 
for CHIP coverage of childless adults. Low-income parents whom CHIP 
covers today will ultimately transition out of CHIP to Medicaid, with 
its lower match rate. This bill precludes new waivers for coverage of 
parents in CHIP. We cover low-income kids first. We agree that low-
income kids are our first priority, but we do not limit State 
flexibility in designing CHIP programs. States choosing to cover kids 
above 300 percent of poverty will receive the lower Medicaid match for 
those kids. If they want to do so, they can, but they will get the 
lower match rate. We also included bonuses for States that meet 
enrollment targets for kids in Medicaid. Nearly three-quarters of 
uninsured kids are eligible for either Medicaid or CHIP but have not 
enrolled. We encourage States to improve their outreach practices to 
streamline enrollment procedures to keep them enrolled. We maintain 
State flexibility. We have given States the option to cover legal 
immigrant children and pregnant women during their first 5 years in the 
United States. States can decide whether they want to cover those 
children. Currently, Federal law prevents States from covering legal 
immigrants on Medicaid or CHIP until they have been in the country for 
5 years. But some States have found this provision to be too 
restrictive. Those States have chosen to use their own money to meet 
the needs of their residents.
  In 2008, for example, 18 States chose to cover legal immigrant 
children, and 23 States chose to cover legal immigrant pregnant women, 
rather than deny them the health care they need for 5 years. The 
Federal Government should not penalize States for trying to help needy 
populations who are here legally. This bill would allow States the 
option to cover legal immigrant children and pregnant women in Medicaid 
or CHIP and receive the appropriate Federal match.
  More broadly, we have also created a State option that allows States 
to designate CHIP funds to offer premium assistance. Premium assistance 
can help families to afford private coverage offered by employers or 
other sources. We improve the quality of children's health insurance. 
Discussions about

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health insurance often get bogged down in talk about cost and coverage 
but we ignore quality. Discussions about quality often ignore the 
unique needs of children. Our CHIP bill launches a substantially new 
initiative to improve children's health quality. This initiative will 
invest $45 million a year for 5 years to develop national core measures 
for children's health quality, improve data collection in CHIP and 
Medicaid, and promote the use of electronic records. These efforts will 
help to improve the quality of care available in CHIP and Medicaid.
  We pay for what we do. Like the vetoed bills, this legislation will 
increase the Federal tax on a pack of cigarettes by 61 cents. We also 
make proportional increases for other tobacco products. Increasing the 
cigarette tax will discourage smoking, particularly among teens, and 
that will be good for kids as well.
  The bill we are considering today is a good bill. In putting together 
the Finance Committee's bill, we worked to cover as many low-income, 
uninsured kids as possible. We respected our budgetary limits, and we 
made compromises in good faith with our Republican colleagues. In 
committee, we made further compromises which I hope have strengthened 
this bill even more. I prefer to be standing here today with all my 
colleagues beside me, especially my good friends, Senators Grassley and 
Hatch. But we could not agree on everything. I hope the remaining 
disagreements do not prevent Senators from doing the right thing. Let 
us not fail the children of the working poor. Let us get these kids to 
doctors visits and medications they need, and let us continue the 
blessing that is the Children's Health Insurance Program.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. ROCKEFELLER. 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. ROCKEFELLER. Mr. President, following along on the lines of the 
distinguished chairman of the Finance Committee, it has been a very 
long journey to reach this day. A year and a half ago both Houses of 
Congress passed two CHIP reauthorization bills with overwhelmingly 
bipartisan support. As I recall, the numbers were somewhere around 69 
in the Senate on each bill. These two bills would have given 4 million 
more uninsured children a healthy start in life. For those of us in 
Appalachia and for those who live almost anywhere in the country, there 
are parts of their inner cities and rural areas where this is 
absolutely crucial.
  No one was more disappointed or, frankly, angry than I was when our 
bipartisan legislation was twice vetoed by President Bush. I could not 
understand it. I didn't know what the reason was. But my anger toward 
that pales in comparison to the heartache and the anguish felt by the 
millions of children and families who would have directly benefited 
from this legislation had it passed in either of its forms. But it did 
not.
  So today we are here once again to debate providing health coverage 
to 4 million uninsured children. But this time there is a big 
difference. President Bush no longer stands in the way of providing 
health care to children. President Obama decided, very early in his 
campaign, this is something he cared about. This time victory for 
children is guaranteed. All we have to do is pass it. We should all be 
extremely excited that this bill will finally be signed into law, and 
more than 11 million children will be enrolled in CHIP each year.
  Unfortunately, some of my colleagues are less than thrilled about the 
bill before us. I want to put the 11 million children in context. 
People say there are anywhere from 42 to 48 million uninsured 
Americans. If we do our job, about a quarter of our uninsured will 
disappear and will be insured. So this is a monumental task on which we 
are, in fact, proceeding. Some of my colleagues have tried to raise 
suspicion and doubt about our intentions on this most recent CHIP bill. 
I regret that. I want my colleagues to know there is no reason for 
suspicion or doubt on any account. It was called by some ``political.'' 
I will explain that in a moment and why it is a fallacious argument and 
should be understood by my colleagues as that. Our intentions are 
exactly the same as they were in 2007--to make sure that children in 
America have the health care they need and deserve.
  I remember this very well, as the Presiding Officer knows, from my 
early days in West Virginia when I was working in coalfields of 
southern West Virginia where no children had any health care insurance. 
The legislation we are considering this week is virtually identical to 
the second and to the more conservative CHIP bill that we passed in the 
fall of 2007. However, this legislation also reflects the fact that our 
country is not in the same economic situation as was the case at that 
time. Working families at all income levels are hurting because of the 
economy. This bill gives the States additional Federal funding and the 
flexibility to cover children in need.
  One important and necessary change in the legislation before us gives 
the States the option to eliminate the 5-year waiting period that 
prevents legal immigrant children and legal immigrant pregnant women 
from getting timely health care. Allow me to repeat myself. This 
legislation gives States the option to eliminate the 5-year waiting 
period for legal immigrants. It is not, therefore, a requirement. It 
also does not provide health care for illegal immigrants or their 
children. Anyone who says differently is incorrect. Thence rises the 
argument that this is playing politics, as if God had some kind of a 
different view about children who are here and have been here for a 
number of years and are trying to live out their life as best they can 
but they have no health insurance. What is it? Where is it written that 
these are not children to the equal of yours or mine? It is not 
written, because it is not so. All of us are equal.
  In fact, our legislation has language specifically prohibiting 
Medicaid and CHIP coverage for illegal immigrants. I could take it out 
of the bill and read it to you, but that would be unnecessary.
  There is no acceptable reason for this 5-year waiting period to 
remain in place. All lawfully present children should have timely 
access to health care in the United States. We are doing our best to 
achieve that and will achieve that through this bill. Five years later, 
if we kept on that requirement, is a lifetime for young children who 
may have bad teeth or early cases of cancer or any other life-
threatening illness or disability, to make them wait 5 years because we 
don't think maybe they measure up. They measure up. They are kids. They 
are children. That is what we are fighting for.
  Those who oppose removing this arbitrary waiting period will come to 
the floor and offer all sorts of unrelated arguments about immigration. 
This is not about immigration. It is about health care for kids who 
need it, something that a lot of us have been fighting for since the 
mid-1990s. These arguments are nothing more than a smokescreen. The 
bottom line is that both U.S. citizen children and children in this 
country legally should have timely access to health care, period. This 
legislation covers both those objectives.
  In closing, I hope we will have the same bipartisan commitment in 
passing this legislation as we did in 2007. Those who look upon one 
amendment, which is highly moral, highly deserved and entirely right, 
will pass it with the same margins we did in 2007. Four million 
children are waiting for us to finish the task at hand.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. ROCKEFELLER. Mr. President, I ask unanimous consent that the 
order for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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