[Congressional Record (Bound Edition), Volume 155 (2009), Part 1]
[House]
[Pages 701-757]
[From the U.S. Government Publishing Office, www.gpo.gov]




    CHILDREN'S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT OF 2009

  Mr. PALLONE. Madam Speaker, pursuant to House Resolution 52, I call 
up the 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, and ask for its immediate consideration in the House.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                                 H.R. 2

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT; 
                   REFERENCES; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Children's 
     Health Insurance Program Reauthorization Act of 2009''.
       (b) Amendments to Social Security Act.--Except as otherwise 
     specifically provided, whenever in this Act an amendment is 
     expressed in terms of an amendment to or repeal of a section 
     or other provision, the reference shall be considered to be 
     made to that section or other provision of the Social 
     Security Act.
       (c) References to CHIP; Medicaid; Secretary.--In this Act:
       (1) CHIP.--The term ``CHIP'' means the State Children's 
     Health Insurance Program established under title XXI of the 
     Social Security Act (42 U.S.C. 1397aa et seq.).
       (2) Medicaid.--The term ``Medicaid'' means the program for 
     medical assistance established under title XIX of the Social 
     Security Act (42 U.S.C. 1396 et seq.).
       (3) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (d) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; amendments to Social Security Act; references; 
              table of contents.
Sec. 2. Purpose.
Sec. 3. General effective date; exception for State legislation; 
              contingent effective date; reliance on law.

[[Page 702]]

                           TITLE I--FINANCING

                          Subtitle A--Funding

Sec. 101. Extension of CHIP.
Sec. 102. Allotments for States and territories for fiscal years 2009 
              through 2013.
Sec. 103. Child Enrollment Contingency Fund.
Sec. 104. CHIP performance bonus payment to offset additional 
              enrollment costs resulting from enrollment and retention 
              efforts.
Sec. 105. Two-year initial availability of CHIP allotments.
Sec. 106. Redistribution of unused allotments.
Sec. 107. Option for qualifying States to receive the enhanced portion 
              of the CHIP matching rate for Medicaid coverage of 
              certain children.
Sec. 108. One-time appropriation.
Sec. 109. Improving funding for the territories under CHIP and 
              Medicaid.

      Subtitle B--Focus on Low-Income Children and Pregnant Women

Sec. 111. State option to cover low-income pregnant women under CHIP 
              through a State plan amendment.
Sec. 112. Phase-out of coverage for nonpregnant childless adults under 
              CHIP; conditions for coverage of parents.
Sec. 113. Elimination of counting Medicaid child presumptive 
              eligibility costs against title XXI allotment.
Sec. 114. Limitation on matching rate for States that propose to cover 
              children with effective family income that exceeds 300 
              percent of the poverty line.
Sec. 115. State authority under Medicaid.

                   TITLE II--OUTREACH AND ENROLLMENT

             Subtitle A--Outreach and Enrollment Activities

Sec. 201. Grants and enhanced administrative funding for outreach and 
              enrollment.
Sec. 202. Increased outreach and enrollment of Indians.
Sec. 203. State option to rely on findings from an Express Lane agency 
              to conduct simplified eligibility determinations.

              Subtitle B--Reducing Barriers to Enrollment

Sec. 211. Verification of declaration of citizenship or nationality for 
              purposes of eligibility for Medicaid and CHIP.
Sec. 212. Reducing administrative barriers to enrollment.
Sec. 213. Model of Interstate coordinated enrollment and coverage 
              process.
Sec. 214. Permitting States to ensure coverage without a 5-year delay 
              of certain children and pregnant women under the Medicaid 
              program and CHIP.

      TITLE III--REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE

  Subtitle A--Additional State Option for Providing Premium Assistance

Sec. 301. Additional State option for providing premium assistance.
Sec. 302. Outreach, education, and enrollment assistance.

   Subtitle B--Coordinating Premium Assistance With Private Coverage

Sec. 311. Special enrollment period under group health plans in case of 
              termination of Medicaid or CHIP coverage or eligibility 
              for assistance in purchase of employment-based coverage; 
              coordination of coverage.

      TITLE IV--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES

Sec. 401. Child health quality improvement activities for children 
              enrolled in Medicaid or CHIP.
Sec. 402. Improved availability of public information regarding 
              enrollment of children in CHIP and Medicaid.
Sec. 403. Application of certain managed care quality safeguards to 
              CHIP.

                 TITLE V--IMPROVING ACCESS TO BENEFITS

Sec. 501. Dental benefits.
Sec. 502. Mental health parity in CHIP plans.
Sec. 503. Application of prospective payment system for services 
              provided by Federally-qualified health centers and rural 
              health clinics.
Sec. 504. Premium grace period.
Sec. 505. Clarification of coverage of services provided through 
              school-based health centers.

     TITLE VI--PROGRAM INTEGRITY AND OTHER MISCELLANEOUS PROVISIONS

           Subtitle A--Program Integrity and Data Collection

Sec. 601. Payment error rate measurement (``PERM'').
Sec. 602. Improving data collection.
Sec. 603. Updated Federal evaluation of CHIP.
Sec. 604. Access to records for IG and GAO audits and evaluations.
Sec. 605. No Federal funding for illegal aliens.

              Subtitle B--Miscellaneous Health Provisions

Sec. 611. Deficit Reduction Act technical corrections.
Sec. 612. References to title XXI.
Sec. 613. Prohibiting initiation of new health opportunity account 
              demonstration programs.
Sec. 614. Adjustment in computation of Medicaid FMAP to disregard an 
              extraordinary employer pension contribution.
Sec. 615. Clarification treatment of regional medical center.
Sec. 616. Extension of Medicaid DSH allotments for Tennessee and 
              Hawaii.

                      Subtitle C--Other Provisions

Sec. 621. Outreach regarding health insurance options available to 
              children.
Sec. 622. Sense of the Senate regarding access to affordable and 
              meaningful health insurance coverage.
Sec. 623. Limitation on Medicare exception to the prohibition on 
              certain physician referrals for hospitals.

                     TITLE VII--REVENUE PROVISIONS

Sec. 701. Increase in excise tax rate on tobacco products.
Sec. 702. Administrative improvements.
Sec. 703. Treasury study concerning magnitude of tobacco smuggling in 
              the United States.
Sec. 704. Time for payment of corporate estimated taxes.

     SEC. 2. PURPOSE.

       It is the purpose of this Act to provide dependable and 
     stable funding for children's health insurance under titles 
     XXI and XIX of the Social Security Act in order to enroll all 
     six million uninsured children who are eligible, but not 
     enrolled, for coverage today through such titles.

     SEC. 3. GENERAL EFFECTIVE DATE; EXCEPTION FOR STATE 
                   LEGISLATION; CONTINGENT EFFECTIVE DATE; 
                   RELIANCE ON LAW.

       (a) General Effective Date.--Unless otherwise provided in 
     this Act, subject to subsections (b) through (d), this Act 
     (and the amendments made by this Act) shall take effect on 
     April 1, 2009, and shall apply to child health assistance and 
     medical assistance provided on or after that date.
       (b) Exception for State Legislation.--In the case of a 
     State plan under title XIX or State child health plan under 
     XXI of the Social Security Act, which the Secretary of Health 
     and Human Services determines requires State legislation in 
     order for the respective plan to meet one or more additional 
     requirements imposed by amendments made by this Act, the 
     respective plan shall not be regarded as failing to comply 
     with the requirements of such title solely on the basis of 
     its failure to meet such an additional requirement before the 
     first day of the first calendar quarter beginning after the 
     close of the first regular session of the State legislature 
     that begins after the date of enactment of this Act. For 
     purposes of the previous sentence, in the case of a State 
     that has a 2-year legislative session, each year of the 
     session shall be considered to be a separate regular session 
     of the State legislature.
       (c) Coordination of CHIP Funding for Fiscal Year 2009.--
     Notwithstanding any other provision of law, insofar as funds 
     have been appropriated under section 2104(a)(11), 2104(k), or 
     2104(l) of the Social Security Act, as amended by section 201 
     of Public Law 110-173, to provide allotments to States under 
     CHIP for fiscal year 2009--
       (1) any amounts that are so appropriated that are not so 
     allotted and obligated before April 1, 2009, are rescinded; 
     and
       (2) any amount provided for CHIP allotments to a State 
     under this Act (and the amendments made by this Act) for such 
     fiscal year shall be reduced by the amount of such 
     appropriations so allotted and obligated before such date.
       (d) Reliance on Law.--With respect to amendments made by 
     this Act (other than title VII) that become effective as of a 
     date--
       (1) such amendments are effective as of such date whether 
     or not regulations implementing such amendments have been 
     issued; and
       (2) Federal financial participation for medical assistance 
     or child health assistance furnished under title XIX or XXI, 
     respectively, of the Social Security Act on or after such 
     date by a State in good faith reliance on such amendments 
     before the date of promulgation of final regulations, if any, 
     to carry out such amendments (or before the date of guidance, 
     if any, regarding the implementation of such amendments) 
     shall not be denied on the basis of the State's failure to 
     comply with such regulations or guidance.

                           TITLE I--FINANCING

                          Subtitle A--Funding

     SEC. 101. EXTENSION OF CHIP.

       Section 2104(a) (42 U.S.C. 1397dd(a)) is amended--

[[Page 703]]

       (1) in paragraph (10), by striking ``and'' at the end;
       (2) by amending paragraph (11), by striking ``each of 
     fiscal years 2008 and 2009'' and inserting ``fiscal year 
     2008''; and
       (3) by adding at the end the following new paragraphs:
       ``(12) for fiscal year 2009, $10,562,000,000;
       ``(13) for fiscal year 2010, $12,520,000,000;
       ``(14) for fiscal year 2011, $13,459,000,000;
       ``(15) for fiscal year 2012, $14,982,000,000; and
       ``(16) for fiscal year 2013, for purposes of making 2 semi-
     annual allotments--
       ``(A) $3,000,000,000 for the period beginning on October 1, 
     2012, and ending on March 31, 2013, and
       ``(B) $3,000,000,000 for the period beginning on April 1, 
     2013, and ending on September 30, 2013.''.

     SEC. 102. ALLOTMENTS FOR STATES AND TERRITORIES FOR FISCAL 
                   YEARS 2009 THROUGH 2013.

       Section 2104 (42 U.S.C. 1397dd) is amended--
       (1) in subsection (b)(1), by striking ``subsection (d)'' 
     and inserting ``subsections (d) and (m)'';
       (2) in subsection (c)(1), by striking ``subsection (d)'' 
     and inserting ``subsections (d) and (m)(4)''; and
       (3) by adding at the end the following new subsection:
       ``(m) Allotments for Fiscal Years 2009 Through 2013.--
       ``(1) For fiscal year 2009.--
       ``(A) For the 50 states and the district of columbia.--
     Subject to the succeeding provisions of this paragraph and 
     paragraph (4), the Secretary shall allot for fiscal year 2009 
     from the amount made available under subsection (a)(12), to 
     each of the 50 States and the District of Columbia 110 
     percent of the highest of the following amounts for such 
     State or District:
       ``(i) The total Federal payments to the State under this 
     title for fiscal year 2008, multiplied by the allotment 
     increase factor determined under paragraph (5) for fiscal 
     year 2009.
       ``(ii) The amount allotted to the State for fiscal year 
     2008 under subsection (b), multiplied by the allotment 
     increase factor determined under paragraph (5) for fiscal 
     year 2009.
       ``(iii) The projected total Federal payments to the State 
     under this title for fiscal year 2009, as determined on the 
     basis of the February 2009 projections certified by the State 
     to the Secretary by not later than March 31, 2009.
       ``(B) For the commonwealths and territories.--Subject to 
     the succeeding provisions of this paragraph and paragraph 
     (4), the Secretary shall allot for fiscal year 2009 from the 
     amount made available under subsection (a)(12) to each of the 
     commonwealths and territories described in subsection (c)(3) 
     an amount equal to the highest amount of Federal payments to 
     the commonwealth or territory under this title for any fiscal 
     year occurring during the period of fiscal years 1999 through 
     2008, multiplied by the allotment increase factor determined 
     under paragraph (5) for fiscal year 2009, except that 
     subparagraph (B) thereof shall be applied by substituting 
     `the United States' for `the State'.
       ``(C) Adjustment for qualifying states.--In the case of a 
     qualifying State described in paragraph (2) of section 
     2105(g), the Secretary shall permit the State to submit a 
     revised projection described in subparagraph (A)(iii) in 
     order to take into account changes in such projections 
     attributable to the application of paragraph (4) of such 
     section.
       ``(2) For fiscal years 2010 through 2012.--
       ``(A) In general.--Subject to paragraphs (4) and (6), from 
     the amount made available under paragraphs (13) through (15) 
     of subsection (a) for each of fiscal years 2010 through 2012, 
     respectively, the Secretary shall compute a State allotment 
     for each State (including the District of Columbia and each 
     commonwealth and territory) for each such fiscal year as 
     follows:
       ``(i) Growth factor update for fiscal year 2010.--For 
     fiscal year 2010, the allotment of the State is equal to the 
     sum of--

       ``(I) the amount of the State allotment under paragraph (1) 
     for fiscal year 2009; and
       ``(II) the amount of any payments made to the State under 
     subsection (k), (l), or (n) for fiscal year 2009,

     multiplied by the allotment increase factor under paragraph 
     (5) for fiscal year 2010.
       ``(ii) Rebasing in fiscal year 2011.--For fiscal year 2011, 
     the allotment of the State is equal to the Federal payments 
     to the State that are attributable to (and countable towards) 
     the total amount of allotments available under this section 
     to the State in fiscal year 2010 (including payments made to 
     the State under subsection (n) for fiscal year 2010 as well 
     as amounts redistributed to the State in fiscal year 2010), 
     multiplied by the allotment increase factor under paragraph 
     (5) for fiscal year 2011.
       ``(iii) Growth factor update for fiscal year 2012.--For 
     fiscal year 2012, the allotment of the State is equal to the 
     sum of--

       ``(I) the amount of the State allotment under clause (ii) 
     for fiscal year 2011; and
       ``(II) the amount of any payments made to the State under 
     subsection (n) for fiscal year 2011,

     multiplied by the allotment increase factor under paragraph 
     (5) for fiscal year 2012.
       ``(3) For fiscal year 2013.--
       ``(A) First half.--Subject to paragraphs (4) and (6), from 
     the amount made available under subparagraph (A) of paragraph 
     (16) of subsection (a) for the semi-annual period described 
     in such paragraph, increased by the amount of the 
     appropriation for such period under section 108 of the 
     Children's Health Insurance Program Reauthorization Act of 
     2009, the Secretary shall compute a State allotment for each 
     State (including the District of Columbia and each 
     commonwealth and territory) for such semi-annual period in an 
     amount equal to the first half ratio (described in 
     subparagraph (D)) of the amount described in subparagraph 
     (C).
       ``(B) Second half.--Subject to paragraphs (4) and (6), from 
     the amount made available under subparagraph (B) of paragraph 
     (16) of subsection (a) for the semi-annual period described 
     in such paragraph, the Secretary shall compute a State 
     allotment for each State (including the District of Columbia 
     and each commonwealth and territory) for such semi-annual 
     period in an amount equal to the amount made available under 
     such subparagraph, multiplied by the ratio of--
       ``(i) the amount of the allotment to such State under 
     subparagraph (A); to
       ``(ii) the total of the amount of all of the allotments 
     made available under such subparagraph.
       ``(C) Full year amount based on rebased amount.--The amount 
     described in this subparagraph for a State is equal to the 
     Federal payments to the State that are attributable to (and 
     countable towards) the total amount of allotments available 
     under this section to the State in fiscal year 2012 
     (including payments made to the State under subsection (n) 
     for fiscal year 2012 as well as amounts redistributed to the 
     State in fiscal year 2012), multiplied by the allotment 
     increase factor under paragraph (5) for fiscal year 2013.
       ``(D) First half ratio.--The first half ratio described in 
     this subparagraph is the ratio of--
       ``(i) the sum of--

       ``(I) the amount made available under subsection 
     (a)(16)(A); and
       ``(II) the amount of the appropriation for such period 
     under section 108 of the Children's Health Insurance Program 
     Reauthorization Act of 2009; to

       ``(ii) the sum of the--

       ``(I) amount described in clause (i); and
       ``(II) the amount made available under subsection 
     (a)(16)(B).

       ``(4) Proration rule.--If, after the application of this 
     subsection without regard to this paragraph, the sum of the 
     allotments determined under paragraph (1), (2), or (3) for a 
     fiscal year (or, in the case of fiscal year 2013, for a semi-
     annual period in such fiscal year) exceeds the amount 
     available under subsection (a) for such fiscal year or 
     period, the Secretary shall reduce each allotment for any 
     State under such paragraph for such fiscal year or period on 
     a proportional basis.
       ``(5) Allotment increase factor.--The allotment increase 
     factor under this paragraph for a fiscal year is equal to the 
     product of the following:
       ``(A) Per capita health care growth factor.--1 plus the 
     percentage increase in the projected per capita amount of 
     National Health Expenditures from the calendar year in which 
     the previous fiscal year ends to the calendar year in which 
     the fiscal year involved ends, as most recently published by 
     the Secretary before the beginning of the fiscal year.
       ``(B) Child population growth factor.--1 plus the 
     percentage increase (if any) in the population of children in 
     the State from July 1 in the previous fiscal year to July 1 
     in the fiscal year involved, as determined by the Secretary 
     based on the most recent published estimates of the Bureau of 
     the Census before the beginning of the fiscal year involved, 
     plus 1 percentage point.
       ``(6) Increase in allotment to account for approved program 
     expansions.--In the case of one of the 50 States or the 
     District of Columbia that--
       ``(A) has submitted to the Secretary, and has approved by 
     the Secretary, a State plan amendment or waiver request 
     relating to an expansion of eligibility for children or 
     benefits under this title that becomes effective for a fiscal 
     year (beginning with fiscal year 2010 and ending with fiscal 
     year 2013); and
       ``(B) has submitted to the Secretary, before the August 31 
     preceding the beginning of the fiscal year, a request for an 
     expansion allotment adjustment under this paragraph for such 
     fiscal year that specifies--
       ``(i) the additional expenditures that are attributable to 
     the eligibility or benefit expansion provided under the 
     amendment or waiver described in subparagraph (A), as 
     certified by the State and submitted to the Secretary by not 
     later than August 31 preceding the beginning of the fiscal 
     year; and
       ``(ii) the extent to which such additional expenditures are 
     projected to exceed the allotment of the State or District 
     for the year,
     subject to paragraph (4), the amount of the allotment of the 
     State or District under this subsection for such fiscal year 
     shall be increased by the excess amount described in 
     subparagraph (B)(i). A State or District may only obtain an 
     increase under this paragraph for an allotment for fiscal 
     year 2010 or fiscal year 2012.
       ``(7) Availability of amounts for semi-annual periods in 
     fiscal year 2013.--Each

[[Page 704]]

     semi-annual allotment made under paragraph (3) for a period 
     in fiscal year 2013 shall remain available for expenditure 
     under this title for periods after the end of such fiscal 
     year in the same manner as if the allotment had been made 
     available for the entire fiscal year.''.

     SEC. 103. CHILD ENROLLMENT CONTINGENCY FUND.

       Section 2104 (42 U.S.C. 1397dd), as amended by section 102, 
     is amended by adding at the end the following new subsection:
       ``(n) Child Enrollment Contingency Fund.--
       ``(1) Establishment.--There is hereby established in the 
     Treasury of the United States a fund which shall be known as 
     the `Child Enrollment Contingency Fund' (in this subsection 
     referred to as the `Fund'). Amounts in the Fund shall be 
     available without further appropriations for payments under 
     this subsection.
       ``(2) Deposits into fund.--
       ``(A) Initial and subsequent appropriations.--Subject to 
     subparagraphs (B) and (D), out of any money in the Treasury 
     of the United States not otherwise appropriated, there are 
     appropriated to the Fund--
       ``(i) for fiscal year 2009, an amount equal to 20 percent 
     of the amount made available under paragraph (12) of 
     subsection (a) for the fiscal year; and
       ``(ii) for each of fiscal years 2010 through 2012 (and for 
     each of the semi-annual allotment periods for fiscal year 
     2013), such sums as are necessary for making payments to 
     eligible States for such fiscal year or period, but not in 
     excess of the aggregate cap described in subparagraph (B).
       ``(B) Aggregate cap.--The total amount available for 
     payment from the Fund for each of fiscal years 2010 through 
     2012 (and for each of the semi-annual allotment periods for 
     fiscal year 2013), taking into account deposits made under 
     subparagraph (C), shall not exceed 20 percent of the amount 
     made available under subsection (a) for the fiscal year or 
     period.
       ``(C) Investment of fund.--The Secretary of the Treasury 
     shall invest, in interest bearing securities of the United 
     States, such currently available portions of the Fund as are 
     not immediately required for payments from the Fund. The 
     income derived from these investments constitutes a part of 
     the Fund.
       ``(D) Availability of excess funds for performance 
     bonuses.--Any amounts in excess of the aggregate cap 
     described in subparagraph (B) for a fiscal year or period 
     shall be made available for purposes of carrying out section 
     2105(a)(3) for any succeeding fiscal year and the Secretary 
     of the Treasury shall reduce the amount in the Fund by the 
     amount so made available.
       ``(3) Child enrollment contingency fund payments.--
       ``(A) In general.--If a State's expenditures under this 
     title in fiscal year 2009, fiscal year 2010, fiscal year 
     2011, fiscal year 2012, or a semi-annual allotment period for 
     fiscal year 2013, exceed the total amount of allotments 
     available under this section to the State in the fiscal year 
     or period (determined without regard to any redistribution it 
     receives under subsection (f) that is available for 
     expenditure during such fiscal year or period, but including 
     any carryover from a previous fiscal year) and if the average 
     monthly unduplicated number of children enrolled under the 
     State plan under this title (including children receiving 
     health care coverage through funds under this title pursuant 
     to a waiver under section 1115) during such fiscal year or 
     period exceeds its target average number of such enrollees 
     (as determined under subparagraph (B)) for that fiscal year 
     or period, subject to subparagraph (D), the Secretary shall 
     pay to the State from the Fund an amount equal to the product 
     of--
       ``(i) the amount by which such average monthly caseload 
     exceeds such target number of enrollees; and
       ``(ii) the projected per capita expenditures under the 
     State child health plan (as determined under subparagraph (C) 
     for the fiscal year), multiplied by the enhanced FMAP (as 
     defined in section 2105(b)) for the State and fiscal year 
     involved (or in which the period occurs).
       ``(B) Target average number of child enrollees.--In this 
     paragraph, the target average number of child enrollees for a 
     State--
       ``(i) for fiscal year 2009 is equal to the monthly average 
     unduplicated number of children enrolled in the State child 
     health plan under this title (including such children 
     receiving health care coverage through funds under this title 
     pursuant to a waiver under section 1115) during fiscal year 
     2008 increased by the population growth for children in that 
     State for the year ending on June 30, 2007 (as estimated by 
     the Bureau of the Census) plus 1 percentage point; or
       ``(ii) for a subsequent fiscal year (or semi-annual period 
     occurring in a fiscal year) is equal to the target average 
     number of child enrollees for the State for the previous 
     fiscal year increased by the child population growth factor 
     described in subsection (m)(5)(B) for the State for the prior 
     fiscal year.
       ``(C) Projected per capita expenditures.--For purposes of 
     subparagraph (A)(ii), the projected per capita expenditures 
     under a State child health plan--
       ``(i) for fiscal year 2009 is equal to the average per 
     capita expenditures (including both State and Federal 
     financial participation) under such plan for the targeted 
     low-income children counted in the average monthly caseload 
     for purposes of this paragraph during fiscal year 2008, 
     increased by the annual percentage increase in the projected 
     per capita amount of National Health Expenditures (as 
     estimated by the Secretary) for 2009; or
       ``(ii) for a subsequent fiscal year (or semi-annual period 
     occurring in a fiscal year) is equal to the projected per 
     capita expenditures under such plan for the previous fiscal 
     year (as determined under clause (i) or this clause) 
     increased by the annual percentage increase in the projected 
     per capita amount of National Health Expenditures (as 
     estimated by the Secretary) for the year in which such 
     subsequent fiscal year ends.
       ``(D) Proration rule.--If the amounts available for payment 
     from the Fund for a fiscal year or period are less than the 
     total amount of payments determined under subparagraph (A) 
     for the fiscal year or period, the amount to be paid under 
     such subparagraph to each eligible State shall be reduced 
     proportionally.
       ``(E) Timely payment; reconciliation.--Payment under this 
     paragraph for a fiscal year or period shall be made before 
     the end of the fiscal year or period based upon the most 
     recent data for expenditures and enrollment and the 
     provisions of subsection (e) of section 2105 shall apply to 
     payments under this subsection in the same manner as they 
     apply to payments under such section.
       ``(F) Continued reporting.--For purposes of this paragraph 
     and subsection (f), the State shall submit to the Secretary 
     the State's projected Federal expenditures, even if the 
     amount of such expenditures exceeds the total amount of 
     allotments available to the State in such fiscal year or 
     period.
       ``(G) Application to commonwealths and territories.--No 
     payment shall be made under this paragraph to a commonwealth 
     or territory described in subsection (c)(3) until such time 
     as the Secretary determines that there are in effect methods, 
     satisfactory to the Secretary, for the collection and 
     reporting of reliable data regarding the enrollment of 
     children described in subparagraphs (A) and (B) in order to 
     accurately determine the commonwealth's or territory's 
     eligibility for, and amount of payment, under this 
     paragraph.''.

     SEC. 104. CHIP PERFORMANCE BONUS PAYMENT TO OFFSET ADDITIONAL 
                   ENROLLMENT COSTS RESULTING FROM ENROLLMENT AND 
                   RETENTION EFFORTS.

       Section 2105(a) (42 U.S.C. 1397ee(a)) is amended by adding 
     at the end the following new paragraphs:
       ``(3) Performance bonus payment to offset additional 
     medicaid and chip child enrollment costs resulting from 
     enrollment and retention efforts.--
       ``(A) In general.--In addition to the payments made under 
     paragraph (1), for each fiscal year (beginning with fiscal 
     year 2009 and ending with fiscal year 2013), the Secretary 
     shall pay from amounts made available under subparagraph (E), 
     to each State that meets the condition under paragraph (4) 
     for the fiscal year, an amount equal to the amount described 
     in subparagraph (B) for the State and fiscal year. The 
     payment under this paragraph shall be made, to a State for a 
     fiscal year, as a single payment not later than the last day 
     of the first calendar quarter of the following fiscal year.
       ``(B) Amount for above baseline medicaid child enrollment 
     costs.--Subject to subparagraph (E), the amount described in 
     this subparagraph for a State for a fiscal year is equal to 
     the sum of the following amounts:
       ``(i) First tier above baseline medicaid enrollees.--An 
     amount equal to the number of first tier above baseline child 
     enrollees (as determined under subparagraph (C)(i)) under 
     title XIX for the State and fiscal year, multiplied by 15 
     percent of the projected per capita State Medicaid 
     expenditures (as determined under subparagraph (D)) for the 
     State and fiscal year under title XIX.
       ``(ii) Second tier above baseline medicaid enrollees.--An 
     amount equal to the number of second tier above baseline 
     child enrollees (as determined under subparagraph (C)(ii)) 
     under title XIX for the State and fiscal year, multiplied by 
     62.5 percent of the projected per capita State Medicaid 
     expenditures (as determined under subparagraph (D)) for the 
     State and fiscal year under title XIX.
       ``(C) Number of first and second tier above baseline child 
     enrollees; baseline number of child enrollees.--For purposes 
     of this paragraph:
       ``(i) First tier above baseline child enrollees.--The 
     number of first tier above baseline child enrollees for a 
     State for a fiscal year under title XIX is equal to the 
     number (if any, as determined by the Secretary) by which--

       ``(I) the monthly average unduplicated number of qualifying 
     children (as defined in subparagraph (F)) enrolled during the 
     fiscal year under the State plan under title XIX, 
     respectively; exceeds
       ``(II) the baseline number of enrollees described in clause 
     (iii) for the State and fiscal year under title XIX, 
     respectively;

     but not to exceed 10 percent of the baseline number of 
     enrollees described in subclause (II).
       ``(ii) Second tier above baseline child enrollees.--The 
     number of second tier above

[[Page 705]]

     baseline child enrollees for a State for a fiscal year under 
     title XIX is equal to the number (if any, as determined by 
     the Secretary) by which--

       ``(I) the monthly average unduplicated number of qualifying 
     children (as defined in subparagraph (F)) enrolled during the 
     fiscal year under title XIX as described in clause (i)(I); 
     exceeds
       ``(II) the sum of the baseline number of child enrollees 
     described in clause (iii) for the State and fiscal year under 
     title XIX, as described in clause (i)(II), and the maximum 
     number of first tier above baseline child enrollees for the 
     State and fiscal year under title XIX, as determined under 
     clause (i).

       ``(iii) Baseline number of child enrollees.--Subject to 
     subparagraph (H), the baseline number of child enrollees for 
     a State under title XIX--

       ``(I) for fiscal year 2009 is equal to the monthly average 
     unduplicated number of qualifying children enrolled in the 
     State plan under title XIX during fiscal year 2007 increased 
     by the population growth for children in that State from 2007 
     to 2008 (as estimated by the Bureau of the Census) plus 4 
     percentage points, and further increased by the population 
     growth for children in that State from 2008 to 2009 (as 
     estimated by the Bureau of the Census) plus 4 percentage 
     points;
       ``(II) for each of fiscal years 2010, 2011, and 2012, is 
     equal to the baseline number of child enrollees for the State 
     for the previous fiscal year under title XIX, increased by 
     the population growth for children in that State from the 
     calendar year in which the respective fiscal year begins to 
     the succeeding calendar year (as estimated by the Bureau of 
     the Census) plus 3.5 percentage points;
       ``(III) for each of fiscal years 2013, 2014, and 2015, is 
     equal to the baseline number of child enrollees for the State 
     for the previous fiscal year under title XIX, increased by 
     the population growth for children in that State from the 
     calendar year in which the respective fiscal year begins to 
     the succeeding calendar year (as estimated by the Bureau of 
     the Census) plus 3 percentage points; and
       ``(IV) for a subsequent fiscal year is equal to the 
     baseline number of child enrollees for the State for the 
     previous fiscal year under title XIX, increased by the 
     population growth for children in that State from the 
     calendar year in which the fiscal year involved begins to the 
     succeeding calendar year (as estimated by the Bureau of the 
     Census) plus 2 percentage points.

       ``(D) Projected per capita state medicaid expenditures.--
     For purposes of subparagraph (B), the projected per capita 
     State Medicaid expenditures for a State and fiscal year under 
     title XIX is equal to the average per capita expenditures 
     (including both State and Federal financial participation) 
     for children under the State plan under such title, including 
     under waivers but not including such children eligible for 
     assistance by virtue of the receipt of benefits under title 
     XVI, for the most recent fiscal year for which actual data 
     are available (as determined by the Secretary), increased 
     (for each subsequent fiscal year up to and including the 
     fiscal year involved) by the annual percentage increase in 
     per capita amount of National Health Expenditures (as 
     estimated by the Secretary) for the calendar year in which 
     the respective subsequent fiscal year ends and multiplied by 
     a State matching percentage equal to 100 percent minus the 
     Federal medical assistance percentage (as defined in section 
     1905(b)) for the fiscal year involved.
       ``(E) Amounts available for payments.--
       ``(i) Initial appropriation.--Out of any money in the 
     Treasury not otherwise appropriated, there are appropriated 
     $3,225,000,000 for fiscal year 2009 for making payments under 
     this paragraph, to be available until expended.
       ``(ii) Transfers.--Notwithstanding any other provision of 
     this title, the following amounts shall also be available, 
     without fiscal year limitation, for making payments under 
     this paragraph:

       ``(I) Unobligated national allotment.--

       ``(aa) Fiscal years 2009 through 2012.--As of December 31 
     of fiscal year 2009, and as of December 31 of each succeeding 
     fiscal year through fiscal year 2012, the portion, if any, of 
     the amount appropriated under subsection (a) for such fiscal 
     year that is unobligated for allotment to a State under 
     subsection (m) for such fiscal year or set aside under 
     subsection (a)(3) or (b)(2) of section 2111 for such fiscal 
     year.
       ``(bb) First half of fiscal year 2013.--As of December 31 
     of fiscal year 2013, the portion, if any, of the sum of the 
     amounts appropriated under subsection (a)(16)(A) and under 
     section 108 of the Children's Health Insurance 
     Reauthorization Act of 2009 for the period beginning on 
     October 1, 2012, and ending on March 31, 2013, that is 
     unobligated for allotment to a State under subsection (m) for 
     such fiscal year or set aside under subsection (b)(2) of 
     section 2111 for such fiscal year.
       ``(cc) Second half of fiscal year 2013.--As of June 30 of 
     fiscal year 2013, the portion, if any, of the amount 
     appropriated under subsection (a)(16)(B) for the period 
     beginning on April 1, 2013, and ending on September 30, 2013, 
     that is unobligated for allotment to a State under subsection 
     (m) for such fiscal year or set aside under subsection (b)(2) 
     of section 2111 for such fiscal year.

       ``(II) Unexpended allotments not used for redistribution.--
     As of November 15 of each of fiscal years 2010 through 2013, 
     the total amount of allotments made to States under section 
     2104 for the second preceding fiscal year (third preceding 
     fiscal year in the case of the fiscal year 2006, 2007, and 
     2008 allotments) that is not expended or redistributed under 
     section 2104(f) during the period in which such allotments 
     are available for obligation.
       ``(III) Excess child enrollment contingency funds.--As of 
     October 1 of each of fiscal years 2010 through 2013, any 
     amount in excess of the aggregate cap applicable to the Child 
     Enrollment Contingency Fund for the fiscal year under section 
     2104(n).
       ``(IV) Unexpended transitional coverage block grant for 
     nonpregnant childless adults.--As of October 1, 2011, any 
     amounts set aside under section 2111(a)(3) that are not 
     expended by September 30, 2011.

       ``(iii) Proportional reduction.--If the sum of the amounts 
     otherwise payable under this paragraph for a fiscal year 
     exceeds the amount available for the fiscal year under this 
     subparagraph, the amount to be paid under this paragraph to 
     each State shall be reduced proportionally.
       ``(F) Qualifying children defined.--For purposes of this 
     subsection, the term `qualifying children' means children who 
     meet the eligibility criteria (including income, categorical 
     eligibility, age, and immigration status criteria) in effect 
     as of July 1, 2008, for enrollment under title XIX, taking 
     into account criteria applied as of such date under title XIX 
     pursuant to a waiver under section 1115. Such term does not 
     include any children for whom the State has made an election 
     to provide medical assistance under section 1903(v)(4).
       ``(G) Application to commonwealths and territories.--The 
     provisions of subparagraph (G) of section 2104(n)(3) shall 
     apply with respect to payment under this paragraph in the 
     same manner as such provisions apply to payment under such 
     section.
       ``(H)  Application to states that implement a Medicaid 
     expansion for children after fiscal year 2008.--In the case 
     of a State that provides coverage under section 115 of the 
     Children's Health Insurance Program Reauthorization Act of 
     2009 for any fiscal year after fiscal year 2008--
       ``(i) any child enrolled in the State plan under title XIX 
     through the application of such an election shall be 
     disregarded from the determination for the State of the 
     monthly average unduplicated number of qualifying children 
     enrolled in such plan during the first 3 fiscal years in 
     which such an election is in effect; and
       ``(ii) in determining the baseline number of child 
     enrollees for the State for any fiscal year subsequent to 
     such first 3 fiscal years, the baseline number of child 
     enrollees for the State under title XIX for the third of such 
     fiscal years shall be the monthly average unduplicated number 
     of qualifying children enrolled in the State plan under title 
     XIX for such third fiscal year.
       ``(4) Enrollment and retention provisions for children.--
     For purposes of paragraph (3)(A), a State meets the condition 
     of this paragraph for a fiscal year if it is implementing at 
     least 4 of the following enrollment and retention provisions 
     (treating each subparagraph as a separate enrollment and 
     retention provision) throughout the entire fiscal year:
       ``(A) Continuous eligibility.--The State has elected the 
     option of continuous eligibility for a full 12 months for all 
     children described in section 1902(e)(12) under title XIX 
     under 19 years of age, as well as applying such policy under 
     its State child health plan under this title.
       ``(B) Liberalization of asset requirements.--The State 
     meets the requirement specified in either of the following 
     clauses:
       ``(i) Elimination of asset test.--The State does not apply 
     any asset or resource test for eligibility for children under 
     title XIX or this title.
       ``(ii) Administrative verification of assets.--The State--

       ``(I) permits a parent or caretaker relative who is 
     applying on behalf of a child for medical assistance under 
     title XIX or child health assistance under this title to 
     declare and certify by signature under penalty of perjury 
     information relating to family assets for purposes of 
     determining and redetermining financial eligibility; and
       ``(II) takes steps to verify assets through means other 
     than by requiring documentation from parents and applicants 
     except in individual cases of discrepancies or where 
     otherwise justified.

       ``(C) Elimination of in-person interview requirement.--The 
     State does not require an application of a child for medical 
     assistance under title XIX (or for child health assistance 
     under this title), including an application for renewal of 
     such assistance, to be made in person nor does the State 
     require a face-to-face interview, unless there are 
     discrepancies or individual circumstances justifying an in-
     person application or face-to-face interview.
       ``(D) Use of joint application for medicaid and chip.--The 
     application form and supplemental forms (if any) and 
     information verification process is the same for purposes of 
     establishing and renewing eligibility for

[[Page 706]]

     children for medical assistance under title XIX and child 
     health assistance under this title.
       ``(E) Automatic renewal (use of administrative renewal).--
       ``(i) In general.--The State provides, in the case of 
     renewal of a child's eligibility for medical assistance under 
     title XIX or child health assistance under this title, a pre-
     printed form completed by the State based on the information 
     available to the State and notice to the parent or caretaker 
     relative of the child that eligibility of the child will be 
     renewed and continued based on such information unless the 
     State is provided other information. Nothing in this clause 
     shall be construed as preventing a State from verifying, 
     through electronic and other means, the information so 
     provided.
       ``(ii) Satisfaction through demonstrated use of ex parte 
     process.--A State shall be treated as satisfying the 
     requirement of clause (i) if renewal of eligibility of 
     children under title XIX or this title is determined without 
     any requirement for an in-person interview, unless sufficient 
     information is not in the State's possession and cannot be 
     acquired from other sources (including other State agencies) 
     without the participation of the applicant or the applicant's 
     parent or caretaker relative.
       ``(F) Presumptive eligibility for children.--The State is 
     implementing section 1920A under title XIX as well as, 
     pursuant to section 2107(e)(1), under this title.
       ``(G) Express lane.--The State is implementing the option 
     described in section 1902(e)(13) under title XIX as well as, 
     pursuant to section 2107(e)(1), under this title.''.

     SEC. 105. TWO-YEAR INITIAL AVAILABILITY OF CHIP ALLOTMENTS.

       Section 2104(e) (42 U.S.C. 1397dd(e)) is amended to read as 
     follows:
       ``(e) Availability of Amounts Allotted.--
       ``(1) In general.--Except as provided in paragraph (2), 
     amounts allotted to a State pursuant to this section--
       ``(A) for each of fiscal years 1998 through 2008, shall 
     remain available for expenditure by the State through the end 
     of the second succeeding fiscal year; and
       ``(B) for fiscal year 2009 and each fiscal year thereafter, 
     shall remain available for expenditure by the State through 
     the end of the succeeding fiscal year.
       ``(2) Availability of amounts redistributed.--Amounts 
     redistributed to a State under subsection (f) shall be 
     available for expenditure by the State through the end of the 
     fiscal year in which they are redistributed.''.

     SEC. 106. REDISTRIBUTION OF UNUSED ALLOTMENTS.

       (a) Beginning With Fiscal Year 2007.--
       (1) In general.--Section 2104(f) (42 U.S.C. 1397dd(f)) is 
     amended--
       (A) by striking ``The Secretary'' and inserting the 
     following:
       ``(1) In general.--The Secretary'';
       (B) by striking ``States that have fully expended the 
     amount of their allotments under this section.'' and 
     inserting ``States that the Secretary determines with respect 
     to the fiscal year for which unused allotments are available 
     for redistribution under this subsection, are shortfall 
     States described in paragraph (2) for such fiscal year, but 
     not to exceed the amount of the shortfall described in 
     paragraph (2)(A) for each such State (as may be adjusted 
     under paragraph (2)(C)).''; and
       (C) by adding at the end the following new paragraph:
       ``(2) Shortfall states described.--
       ``(A) In general.--For purposes of paragraph (1), with 
     respect to a fiscal year, a shortfall State described in this 
     subparagraph is a State with a State child health plan 
     approved under this title for which the Secretary estimates 
     on the basis of the most recent data available to the 
     Secretary, that the projected expenditures under such plan 
     for the State for the fiscal year will exceed the sum of--
       ``(i) the amount of the State's allotments for any 
     preceding fiscal years that remains available for expenditure 
     and that will not be expended by the end of the immediately 
     preceding fiscal year;
       ``(ii) the amount (if any) of the child enrollment 
     contingency fund payment under subsection (n); and
       ``(iii) the amount of the State's allotment for the fiscal 
     year.
       ``(B) Proration rule.--If the amounts available for 
     redistribution under paragraph (1) for a fiscal year are less 
     than the total amounts of the estimated shortfalls determined 
     for the year under subparagraph (A), the amount to be 
     redistributed under such paragraph for each shortfall State 
     shall be reduced proportionally.
       ``(C) Retrospective adjustment.--The Secretary may adjust 
     the estimates and determinations made under paragraph (1) and 
     this paragraph with respect to a fiscal year as necessary on 
     the basis of the amounts reported by States not later than 
     November 30 of the succeeding fiscal year, as approved by the 
     Secretary.''.
       (2) Effective date.--The amendments made by paragraph (1) 
     shall apply to redistribution of allotments made for fiscal 
     year 2007 and subsequent fiscal years.
       (b) Redistribution of Unused Allotments for Fiscal Year 
     2006.--Section 2104(k) (42 U.S.C. 1397dd(k)) is amended--
       (1) in the subsection heading, by striking ``the First 2 
     Quarters of'';
       (2) in paragraph (1), by striking ``the first 2 quarters 
     of''; and
       (3) in paragraph (6)--
       (A) by striking ``the first 2 quarters of''; and
       (B) by striking ``March 31'' and inserting ``September 
     30''.

     SEC. 107. OPTION FOR QUALIFYING STATES TO RECEIVE THE 
                   ENHANCED PORTION OF THE CHIP MATCHING RATE FOR 
                   MEDICAID COVERAGE OF CERTAIN CHILDREN.

       (a) In General.--Section 2105(g) (42 U.S.C. 1397ee(g)) is 
     amended--
       (1) in paragraph (1)(A), as amended by section 201(b)(1) of 
     Public Law 110-173--
       (A) by inserting ``subject to paragraph (4),'' after 
     ``Notwithstanding any other provision of law,''; and
       (B) by striking ``2008, or 2009'' and inserting ``or 
     2008''; and
       (2) by adding at the end the following new paragraph:
       ``(4) Option for allotments for fiscal years 2009 through 
     2013.--
       ``(A) Payment of enhanced portion of matching rate for 
     certain expenditures.--In the case of expenditures described 
     in subparagraph (B), a qualifying State (as defined in 
     paragraph (2)) may elect to be paid from the State's 
     allotment made under section 2104 for any of fiscal years 
     2009 through 2013 (insofar as the allotment is available to 
     the State under subsections (e) and (m) of such section) an 
     amount each quarter equal to the additional amount that would 
     have been paid to the State under title XIX with respect to 
     such expenditures if the enhanced FMAP (as determined under 
     subsection (b)) had been substituted for the Federal medical 
     assistance percentage (as defined in section 1905(b)).
       ``(B) Expenditures described.--For purposes of subparagraph 
     (A), the expenditures described in this subparagraph are 
     expenditures made after the date of the enactment of this 
     paragraph and during the period in which funds are available 
     to the qualifying State for use under subparagraph (A), for 
     the provision of medical assistance to individuals residing 
     in the State who are eligible for medical assistance under 
     the State plan under title XIX or under a waiver of such plan 
     and who have not attained age 19 (or, if a State has so 
     elected under the State plan under title XIX, age 20 or 21), 
     and whose family income equals or exceeds 133 percent of the 
     poverty line but does not exceed the Medicaid applicable 
     income level.''.
       (b) Repeal of Limitation on Availability of Fiscal Year 
     2009 Allotments.--Paragraph (2) of section 201(b) of the 
     Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public 
     Law 110-173) is repealed.

     SEC. 108. ONE-TIME APPROPRIATION.

       There is appropriated to the Secretary, out of any money in 
     the Treasury not otherwise appropriated, $11,406,000,000 to 
     accompany the allotment made for the period beginning on 
     October 1, 2012, and ending on March 31, 2013, under section 
     2104(a)(16)(A) of the Social Security Act (42 U.S.C. 
     1397dd(a)(16)(A)) (as added by section 101), to remain 
     available until expended. Such amount shall be used to 
     provide allotments to States under paragraph (3) of section 
     2104(m) of the Social Security Act (42 U.S.C. 1397dd(i)), as 
     added by section 102, for the first 6 months of fiscal year 
     2013 in the same manner as allotments are provided under 
     subsection (a)(16)(A) of such section 2104 and subject to the 
     same terms and conditions as apply to the allotments provided 
     from such subsection (a)(16)(A).

     SEC. 109. IMPROVING FUNDING FOR THE TERRITORIES UNDER CHIP 
                   AND MEDICAID.

       (a) Removal of Federal Matching Payments for Data Reporting 
     Systems From the Overall Limit on Payments to Territories 
     Under Title XIX.--Section 1108(g) (42 U.S.C. 1308(g)) is 
     amended by adding at the end the following new paragraph:
       ``(4) Exclusion of certain expenditures from payment 
     limits.--With respect to fiscal years beginning with fiscal 
     year 2009, if Puerto Rico, the Virgin Islands, Guam, the 
     Northern Mariana Islands, or American Samoa qualify for a 
     payment under subparagraph (A)(i), (B), or (F) of section 
     1903(a)(3) for a calendar quarter of such fiscal year, the 
     payment shall not be taken into account in applying 
     subsection (f) (as increased in accordance with paragraphs 
     (1), (2), and (3) of this subsection) to such commonwealth or 
     territory for such fiscal year.''.
       (b) GAO Study and Report.--Not later than September 30, 
     2010, the Comptroller General of the United States shall 
     submit a report to the Committee on Finance of the Senate and 
     the Committee on Energy and Commerce of the House of 
     Representatives regarding Federal funding under Medicaid and 
     CHIP for Puerto Rico, the United States Virgin Islands, Guam, 
     American Samoa, and the Northern Mariana Islands. The report 
     shall include the following:
       (1) An analysis of all relevant factors with respect to--
       (A) eligible Medicaid and CHIP populations in such 
     commonwealths and territories;
       (B) historical and projected spending needs of such 
     commonwealths and territories and

[[Page 707]]

     the ability of capped funding streams to respond to those 
     spending needs;
       (C) the extent to which Federal poverty guidelines are used 
     by such commonwealths and territories to determine Medicaid 
     and CHIP eligibility; and
       (D) the extent to which such commonwealths and territories 
     participate in data collection and reporting related to 
     Medicaid and CHIP, including an analysis of territory 
     participation in the Current Population Survey versus the 
     American Community Survey.
       (2) Recommendations regarding methods for the collection 
     and reporting of reliable data regarding the enrollment under 
     Medicaid and CHIP of children in such commonwealths and 
     territories.
       (3) Recommendations for improving Federal funding under 
     Medicaid and CHIP for such commonwealths and territories.

      Subtitle B--Focus on Low-Income Children and Pregnant Women

     SEC. 111. STATE OPTION TO COVER LOW-INCOME PREGNANT WOMEN 
                   UNDER CHIP THROUGH A STATE PLAN AMENDMENT.

       (a) In General.--Title XXI (42 U.S.C. 1397aa et seq.), as 
     amended by section 112(a), is amended by adding at the end 
     the following new section:

     ``SEC. 2112. OPTIONAL COVERAGE OF TARGETED LOW-INCOME 
                   PREGNANT WOMEN THROUGH A STATE PLAN AMENDMENT.

       ``(a) In General.--Subject to the succeeding provisions of 
     this section, a State may elect through an amendment to its 
     State child health plan under section 2102 to provide 
     pregnancy-related assistance under such plan for targeted 
     low-income pregnant women.
       ``(b) Conditions.--A State may only elect the option under 
     subsection (a) if the following conditions are satisfied:
       ``(1) Minimum income eligibility levels for pregnant women 
     and children.--The State has established an income 
     eligibility level--
       ``(A) for pregnant women under subsection 
     (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) of 
     section 1902 that is at least 185 percent (or such higher 
     percent as the State has in effect with regard to pregnant 
     women under this title) of the poverty line applicable to a 
     family of the size involved, but in no case lower than the 
     percent in effect under any such subsection as of July 1, 
     2008; and
       ``(B) for children under 19 years of age under this title 
     (or title XIX) that is at least 200 percent of the poverty 
     line applicable to a family of the size involved.
       ``(2) No chip income eligibility level for pregnant women 
     lower than the state's medicaid level.--The State does not 
     apply an effective income level for pregnant women under the 
     State plan amendment that is lower than the effective income 
     level (expressed as a percent of the poverty line and 
     considering applicable income disregards) specified under 
     subsection (a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or 
     (l)(1)(A) of section 1902, on the date of enactment of this 
     paragraph to be eligible for medical assistance as a pregnant 
     woman.
       ``(3) No coverage for higher income pregnant women without 
     covering lower income pregnant women.--The State does not 
     provide coverage for pregnant women with higher family income 
     without covering pregnant women with a lower family income.
       ``(4) Application of requirements for coverage of targeted 
     low-income children.--The State provides pregnancy-related 
     assistance for targeted low-income pregnant women in the same 
     manner, and subject to the same requirements, as the State 
     provides child health assistance for targeted low-income 
     children under the State child health plan, and in addition 
     to providing child health assistance for such women.
       ``(5) No preexisting condition exclusion or waiting 
     period.--The State does not apply any exclusion of benefits 
     for pregnancy-related assistance based on any preexisting 
     condition or any waiting period (including any waiting period 
     imposed to carry out section 2102(b)(3)(C)) for receipt of 
     such assistance.
       ``(6) Application of cost-sharing protection.--The State 
     provides pregnancy-related assistance to a targeted low-
     income woman consistent with the cost-sharing protections 
     under section 2103(e) and applies the limitation on total 
     annual aggregate cost sharing imposed under paragraph (3)(B) 
     of such section to the family of such a woman.
       ``(7) No waiting list for children.--The State does not 
     impose, with respect to the enrollment under the State child 
     health plan of targeted low-income children during the 
     quarter, any enrollment cap or other numerical limitation on 
     enrollment, any waiting list, any procedures designed to 
     delay the consideration of applications for enrollment, or 
     similar limitation with respect to enrollment.
       ``(c) Option To Provide Presumptive Eligibility.--A State 
     that elects the option under subsection (a) and satisfies the 
     conditions described in subsection (b) may elect to apply 
     section 1920 (relating to presumptive eligibility for 
     pregnant women) to the State child health plan in the same 
     manner as such section applies to the State plan under title 
     XIX.
       ``(d) Definitions.--For purposes of this section:
       ``(1) Pregnancy-related assistance.--The term `pregnancy-
     related assistance' has the meaning given the term `child 
     health assistance' in section 2110(a) with respect to an 
     individual during the period described in paragraph (2)(A).
       ``(2) Targeted low-income pregnant woman.--The term 
     `targeted low-income pregnant woman' means an individual--
       ``(A) during pregnancy and through the end of the month in 
     which the 60-day period (beginning on the last day of her 
     pregnancy) ends;
       ``(B) whose family income exceeds 185 percent (or, if 
     higher, the percent applied under subsection (b)(1)(A)) of 
     the poverty line applicable to a family of the size involved, 
     but does not exceed the income eligibility level established 
     under the State child health plan under this title for a 
     targeted low-income child; and
       ``(C) who satisfies the requirements of paragraphs (1)(A), 
     (1)(C), (2), and (3) of section 2110(b) in the same manner as 
     a child applying for child health assistance would have to 
     satisfy such requirements.
       ``(e) Automatic Enrollment for Children Born to Women 
     Receiving Pregnancy-Related Assistance.--If a child is born 
     to a targeted low-income pregnant woman who was receiving 
     pregnancy-related assistance under this section on the date 
     of the child's birth, the child shall be deemed to have 
     applied for child health assistance under the State child 
     health plan and to have been found eligible for such 
     assistance under such plan or to have applied for medical 
     assistance under title XIX and to have been found eligible 
     for such assistance under such title, as appropriate, on the 
     date of such birth and to remain eligible for such assistance 
     until the child attains 1 year of age. During the period in 
     which a child is deemed under the preceding sentence to be 
     eligible for child health or medical assistance, the child 
     health or medical assistance eligibility identification 
     number of the mother shall also serve as the identification 
     number of the child, and all claims shall be submitted and 
     paid under such number (unless the State issues a separate 
     identification number for the child before such period 
     expires).
       ``(f) States Providing Assistance Through Other Options.--
       ``(1) Continuation of other options for providing 
     assistance.--The option to provide assistance in accordance 
     with the preceding subsections of this section shall not 
     limit any other option for a State to provide--
       ``(A) child health assistance 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 after the final rule adopted by the Secretary and set 
     forth at 67 Fed. Reg. 61956-61974 (October 2, 2002)), or
       ``(B) pregnancy-related services through the application of 
     any waiver authority (as in effect on June 1, 2008).
       ``(2) Clarification of authority to provide postpartum 
     services.--Any State that provides child health assistance 
     under any authority described in paragraph (1) may continue 
     to provide such assistance, as well as postpartum services, 
     through the end of the month in which the 60-day period 
     (beginning on the last day of the pregnancy) ends, in the 
     same manner as such assistance and postpartum services would 
     be provided if provided under the State plan under title XIX, 
     but only if the mother would otherwise satisfy the 
     eligibility requirements that apply under the State child 
     health plan (other than with respect to age) during such 
     period.
       ``(3) No inference.--Nothing in this subsection shall be 
     construed--
       ``(A) to infer congressional intent regarding the legality 
     or illegality of the content of the sections specified in 
     paragraph (1)(A); or
       ``(B) to modify the authority to provide pregnancy-related 
     services under a waiver specified in paragraph (1)(B).''.
       (b) Additional Conforming Amendments.--
       (1) No cost sharing for pregnancy-related benefits.--
     Section 2103(e)(2) (42 U.S.C. 1397cc(e)(2)) is amended--
       (A) in the heading, by inserting ``or pregnancy-related 
     assistance'' after ``preventive services''; and
       (B) by inserting before the period at the end the 
     following: ``or for pregnancy-related assistance''.
       (2) No waiting period.--Section 2102(b)(1)(B) (42 U.S.C. 
     1397bb(b)(1)(B)) is amended--
       (A) in clause (i), by striking ``, and'' at the end and 
     inserting a semicolon;
       (B) in clause (ii), by striking the period at the end and 
     inserting ``; and''; and
       (C) by adding at the end the following new clause:
       ``(iii) may not apply a waiting period (including a waiting 
     period to carry out paragraph (3)(C)) in the case of a 
     targeted low-income pregnant woman provided pregnancy-related 
     assistance under section 2112.''.

     SEC. 112. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS 
                   ADULTS UNDER CHIP; CONDITIONS FOR COVERAGE OF 
                   PARENTS.

       (a) Phase-Out Rules.--

[[Page 708]]

       (1) In general.--Title XXI (42 U.S.C. 1397aa et seq.) is 
     amended by adding at the end the following new section:

     ``SEC. 2111. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS 
                   ADULTS; CONDITIONS FOR COVERAGE OF PARENTS.

       ``(a) Termination of Coverage for Nonpregnant Childless 
     Adults.--
       ``(1) No new chip waivers; automatic extensions at state 
     option through fiscal year 2010.--Notwithstanding section 
     1115 or any other provision of this title, except as provided 
     in this subsection--
       ``(A) the Secretary shall not on or after the date of the 
     enactment of the Children's Health Insurance Program 
     Reauthorization Act of 2009, approve or renew a waiver, 
     experimental, pilot, or demonstration project that would 
     allow funds made available under this title to be used to 
     provide child health assistance or other health benefits 
     coverage to a nonpregnant childless adult; and
       ``(B) notwithstanding the terms and conditions of an 
     applicable existing waiver, the provisions of paragraphs (2) 
     and (3) shall apply for purposes of any period beginning on 
     or after October 1, 2010, in determining the period to which 
     the waiver applies, the individuals eligible to be covered by 
     the waiver, and the amount of the Federal payment under this 
     title.
       ``(2) Termination of chip coverage under applicable 
     existing waivers at the end of fiscal year 2010.--
       ``(A) In general.--No funds shall be available under this 
     title for child health assistance or other health benefits 
     coverage that is provided to a nonpregnant childless adult 
     under an applicable existing waiver after September 30, 2010.
       ``(B) Extension upon state request.--If an applicable 
     existing waiver described in subparagraph (A) would otherwise 
     expire before October 1, 2010, and the State requests an 
     extension of such waiver, the Secretary shall grant such an 
     extension, but only through September 30, 2011.
       ``(C) Application of enhanced fmap.--The enhanced FMAP 
     determined under section 2105(b) shall apply to expenditures 
     under an applicable existing waiver for the provision of 
     child health assistance or other health benefits coverage to 
     a nonpregnant childless adult during fiscal year 2010.
       ``(3) Optional 1-year transitional coverage block grant 
     funded from state allotment.--Subject to paragraph (4)(B), 
     each State for which coverage under an applicable existing 
     waiver is terminated under paragraph (2)(A) may elect to 
     provide nonpregnant childless adults who were provided child 
     health assistance or health benefits coverage under the 
     applicable existing waiver at any time during fiscal year 
     2010 with such assistance or coverage during fiscal year 
     2011, as if the authority to provide such assistance or 
     coverage under an applicable existing waiver was extended 
     through that fiscal year, but subject to the following terms 
     and conditions:
       ``(A) Block grant set aside from state allotment.--The 
     Secretary shall set aside for the State an amount equal to 
     the Federal share of the State's projected expenditures under 
     the applicable existing waiver for providing child health 
     assistance or health benefits coverage to all nonpregnant 
     childless adults under such waiver for fiscal year 2010 (as 
     certified by the State and submitted to the Secretary by not 
     later than August 31, 2010, and without regard to whether any 
     such individual lost coverage during fiscal year 2010 and was 
     later provided child health assistance or other health 
     benefits coverage under the waiver in that fiscal year), 
     increased by the annual adjustment for fiscal year 2011 
     determined under section 2104(m)(5)(A). The Secretary may 
     adjust the amount set aside under the preceding sentence, as 
     necessary, on the basis of the expenditure data for fiscal 
     year 2010 reported by States on CMS Form 64 or CMS Form 21 
     not later than November 30, 2010, but in no case shall the 
     Secretary adjust such amount after December 31, 2010.
       ``(B) No coverage for nonpregnant childless adults who were 
     not covered during fiscal year 2010.--
       ``(i) FMAP applied to expenditures.--The Secretary shall 
     pay the State for each quarter of fiscal year 2011, from the 
     amount set aside under subparagraph (A), an amount equal to 
     the Federal medical assistance percentage (as determined 
     under section 1905(b) without regard to clause (4) of such 
     section) of expenditures in the quarter for providing child 
     health assistance or other health benefits coverage to a 
     nonpregnant childless adult but only if such adult was 
     enrolled in the State program under this title during fiscal 
     year 2010 (without regard to whether the individual lost 
     coverage during fiscal year 2010 and was reenrolled in that 
     fiscal year or in fiscal year 2011).
       ``(ii) Federal payments limited to amount of block grant 
     set-aside.--No payments shall be made to a State for 
     expenditures described in this subparagraph after the total 
     amount set aside under subparagraph (A) for fiscal year 2011 
     has been paid to the State.
       ``(4) State option to apply for medicaid waiver to continue 
     coverage for nonpregnant childless adults.--
       ``(A) In general.--Each State for which coverage under an 
     applicable existing waiver is terminated under paragraph 
     (2)(A) may submit, not later than June 30, 2011, an 
     application to the Secretary for a waiver under section 1115 
     of the State plan under title XIX to provide medical 
     assistance to a nonpregnant childless adult whose coverage is 
     so terminated (in this subsection referred to as a `Medicaid 
     nonpregnant childless adults waiver').
       ``(B) Deadline for approval.--The Secretary shall make a 
     decision to approve or deny an application for a Medicaid 
     nonpregnant childless adults waiver submitted under 
     subparagraph (A) within 90 days of the date of the submission 
     of the application. If no decision has been made by the 
     Secretary as of September 30, 2011, on the application of a 
     State for a Medicaid nonpregnant childless adults waiver that 
     was submitted to the Secretary by June 30, 2011, the 
     application shall be deemed approved.
       ``(C) Standard for budget neutrality.--The budget 
     neutrality requirement applicable with respect to 
     expenditures for medical assistance under a Medicaid 
     nonpregnant childless adults waiver shall--
       ``(i) in the case of fiscal year 2012, allow expenditures 
     for medical assistance under title XIX for all such adults to 
     not exceed the total amount of payments made to the State 
     under paragraph (3)(B) for fiscal year 2011, increased by the 
     percentage increase (if any) in the projected nominal per 
     capita amount of National Health Expenditures for calendar 
     year 2012 over 2011, as most recently published by the 
     Secretary; and
       ``(ii) in the case of any succeeding fiscal year, allow 
     such expenditures to not exceed the amount in effect under 
     this subparagraph for the preceding fiscal year, increased by 
     the percentage increase (if any) in the projected nominal per 
     capita amount of National Health Expenditures for the 
     calendar year that begins during the fiscal year involved 
     over the preceding calendar year, as most recently published 
     by the Secretary.
       ``(b) Rules and Conditions for Coverage of Parents of 
     Targeted Low-Income Children.--
       ``(1) Two-year transition period; automatic extension at 
     state option through fiscal year 2011.--
       ``(A) No new chip waivers.--Notwithstanding section 1115 or 
     any other provision of this title, except as provided in this 
     subsection--
       ``(i) the Secretary shall not on or after the date of the 
     enactment of the Children's Health Insurance Program 
     Reauthorization Act of 2009 approve or renew a waiver, 
     experimental, pilot, or demonstration project that would 
     allow funds made available under this title to be used to 
     provide child health assistance or other health benefits 
     coverage to a parent of a targeted low-income child; and
       ``(ii) notwithstanding the terms and conditions of an 
     applicable existing waiver, the provisions of paragraphs (2) 
     and (3) shall apply for purposes of any fiscal year beginning 
     on or after October 1, 2011, in determining the period to 
     which the waiver applies, the individuals eligible to be 
     covered by the waiver, and the amount of the Federal payment 
     under this title.
       ``(B) Extension upon state request.--If an applicable 
     existing waiver described in subparagraph (A) would otherwise 
     expire before October 1, 2011, and the State requests an 
     extension of such waiver, the Secretary shall grant such an 
     extension, but only, subject to paragraph (2)(A), through 
     September 30, 2011.
       ``(C) Application of enhanced fmap.--The enhanced FMAP 
     determined under section 2105(b) shall apply to expenditures 
     under an applicable existing waiver for the provision of 
     child health assistance or other health benefits coverage to 
     a parent of a targeted low-income child during the third and 
     fourth quarters of fiscal year 2009 and during fiscal years 
     2010 and 2011.
       ``(2) Rules for fiscal years 2012 through 2013.--
       ``(A) Payments for coverage limited to block grant funded 
     from state allotment.--Any State that provides child health 
     assistance or health benefits coverage under an applicable 
     existing waiver for a parent of a targeted low-income child 
     may elect to continue to provide such assistance or coverage 
     through fiscal year 2012 or 2013, subject to the same terms 
     and conditions that applied under the applicable existing 
     waiver, unless otherwise modified in subparagraph (B).
       ``(B) Terms and conditions.--
       ``(i) Block grant set aside from state allotment.--If the 
     State makes an election under subparagraph (A), the Secretary 
     shall set aside for the State for each such fiscal year an 
     amount equal to the Federal share of 110 percent of the 
     State's projected expenditures under the applicable existing 
     waiver for providing child health assistance or health 
     benefits coverage to all parents of targeted low-income 
     children enrolled under such waiver for the fiscal year (as 
     certified by the State and submitted to the Secretary by not 
     later than August 31 of the preceding fiscal year). In the 
     case of fiscal year 2013, the set aside for any State shall 
     be computed separately for each period described in 
     subparagraphs (A) and (B) of section 2104(a)(16) and any 
     reduction in the allotment for either such period under 
     section 2104(m)(4) shall be allocated on a pro rata basis to 
     such set aside.

[[Page 709]]

       ``(ii) Payments from block grant.--The Secretary shall pay 
     the State from the amount set aside under clause (i) for the 
     fiscal year, an amount for each quarter of such fiscal year 
     equal to the applicable percentage determined under clause 
     (iii) or (iv) for expenditures in the quarter for providing 
     child health assistance or other health benefits coverage to 
     a parent of a targeted low-income child.
       ``(iii) Enhanced fmap only in fiscal year 2012 for states 
     with significant child outreach or that achieve child 
     coverage benchmarks; fmap for any other states.--For purposes 
     of clause (ii), the applicable percentage for any quarter of 
     fiscal year 2012 is equal to--

       ``(I) the enhanced FMAP determined under section 2105(b) in 
     the case of a State that meets the outreach or coverage 
     benchmarks described in any of subparagraph (A), (B), or (C) 
     of paragraph (3) for fiscal year 2011; or
       ``(II) the Federal medical assistance percentage (as 
     determined under section 1905(b) without regard to clause (4) 
     of such section) in the case of any other State.

       ``(iv) Amount of federal matching payment in 2013.--For 
     purposes of clause (ii), the applicable percentage for any 
     quarter of fiscal year 2013 is equal to--

       ``(I) the REMAP percentage if--

       ``(aa) the applicable percentage for the State under clause 
     (iii) was the enhanced FMAP for fiscal year 2012; and
       ``(bb) the State met either of the coverage benchmarks 
     described in subparagraph (B) or (C) of paragraph (3) for 
     2012; or

       ``(II) the Federal medical assistance percentage (as so 
     determined) in the case of any State to which subclause (I) 
     does not apply.

     For purposes of subclause (I), the REMAP percentage is the 
     percentage which is the sum of such Federal medical 
     assistance percentage and a number of percentage points equal 
     to one-half of the difference between such Federal medical 
     assistance percentage and such enhanced FMAP.
       ``(v) No federal payments other than from block grant set 
     aside.--No payments shall be made to a State for expenditures 
     described in clause (ii) after the total amount set aside 
     under clause (i) for a fiscal year has been paid to the 
     State.
       ``(vi) No increase in income eligibility level for 
     parents.--No payments shall be made to a State from the 
     amount set aside under clause (i) for a fiscal year for 
     expenditures for providing child health assistance or health 
     benefits coverage to a parent of a targeted low-income child 
     whose family income exceeds the income eligibility level 
     applied under the applicable existing waiver to parents of 
     targeted low-income children on the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2009.
       ``(3) Outreach or coverage benchmarks.--For purposes of 
     paragraph (2), the outreach or coverage benchmarks described 
     in this paragraph are as follows:
       ``(A) Significant child outreach campaign.--The State--
       ``(i) was awarded a grant under section 2113 for fiscal 
     year 2011;
       ``(ii) implemented 1 or more of the enrollment and 
     retention provisions described in section 2105(a)(4) for such 
     fiscal year; or
       ``(iii) has submitted a specific plan for outreach for such 
     fiscal year.
       ``(B) High-performing state.--The State, on the basis of 
     the most timely and accurate published estimates of the 
     Bureau of the Census, ranks in the lowest \1/3\ of States in 
     terms of the State's percentage of low-income children 
     without health insurance.
       ``(C) State increasing enrollment of low-income children.--
     The State qualified for a performance bonus payment under 
     section 2105(a)(3)(B) for the most recent fiscal year 
     applicable under such section.
       ``(4) Rules of construction.--Nothing in this subsection 
     shall be construed as prohibiting a State from submitting an 
     application to the Secretary for a waiver under section 1115 
     of the State plan under title XIX to provide medical 
     assistance to a parent of a targeted low-income child that 
     was provided child health assistance or health benefits 
     coverage under an applicable existing waiver.
       ``(c) Applicable Existing Waiver.--For purposes of this 
     section--
       ``(1) In general.--The term `applicable existing waiver' 
     means a waiver, experimental, pilot, or demonstration project 
     under section 1115, grandfathered under section 6102(c)(3) of 
     the Deficit Reduction Act of 2005, or otherwise conducted 
     under authority that--
       ``(A) would allow funds made available under this title to 
     be used to provide child health assistance or other health 
     benefits coverage to--
       ``(i) a parent of a targeted low-income child;
       ``(ii) a nonpregnant childless adult; or
       ``(iii) individuals described in both clauses (i) and (ii); 
     and
       ``(B) was in effect during fiscal year 2009.
       ``(2) Definitions.--
       ``(A) Parent.--The term `parent' includes a caretaker 
     relative (as such term is used in carrying out section 1931) 
     and a legal guardian.
       ``(B) Nonpregnant childless adult.--The term `nonpregnant 
     childless adult' has the meaning given such term by section 
     2107(f).''.
       (2) Conforming amendments.--
       (A) Section 2107(f) (42 U.S.C. 1397gg(f)) is amended--
       (i) by striking ``, the Secretary'' and inserting ``:
       ``(1) The Secretary'';
       (ii) in the first sentence, by inserting ``or a parent (as 
     defined in section 2111(c)(2)(A)), who is not pregnant, of a 
     targeted low-income child'' before the period;
       (iii) by striking the second sentence; and
       (iv) by adding at the end the following new paragraph:
       ``(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 
     2009 that would waive or modify the requirements of section 
     2111.''.
       (B) Section 6102(c) of the Deficit Reduction Act of 2005 
     (Public Law 109-171; 120 Stat. 131) is amended by striking 
     ``Nothing'' and inserting ``Subject to section 2111 of the 
     Social Security Act, as added by section 112 of the 
     Children's Health Insurance Program Reauthorization Act of 
     2009, nothing''.
       (b) GAO Study and Report.--
       (1) In general.--The Comptroller General of the United 
     States shall conduct a study of whether--
       (A) the coverage of a parent, a caretaker relative (as such 
     term is used in carrying out section 1931), or a legal 
     guardian of a targeted low-income child under a State health 
     plan under title XXI of the Social Security Act increases the 
     enrollment of, or the quality of care for, children, and
       (B) such parents, relatives, and legal guardians who enroll 
     in such a plan are more likely to enroll their children in 
     such a plan or in a State plan under title XIX of such Act.
       (2) Report.--Not later than 2 years after the date of the 
     enactment of this Act, the Comptroller General shall report 
     the results of the study to the Committee on Finance of the 
     Senate and the Committee on Energy and Commerce of the House 
     of Representatives, including recommendations (if any) for 
     changes in legislation.

     SEC. 113. ELIMINATION OF COUNTING MEDICAID CHILD PRESUMPTIVE 
                   ELIGIBILITY COSTS AGAINST TITLE XXI ALLOTMENT.

       (a) In General.--Section 2105(a)(1) (42 U.S.C. 
     1397ee(a)(1)) is amended--
       (1) in the matter preceding subparagraph (A), by striking 
     ``(or, in the case of expenditures described in subparagraph 
     (B), the Federal medical assistance percentage (as defined in 
     the first sentence of section 1905(b)))''; and
       (2) by striking subparagraph (B) and inserting the 
     following new subparagraph:
       ``(B) [reserved]''.
       (b) Amendments to Medicaid.--
       (1) Eligibility of a newborn.--Section 1902(e)(4) (42 
     U.S.C. 1396a(e)(4)) is amended in the first sentence by 
     striking ``so long as the child is a member of the woman's 
     household and the woman remains (or would remain if pregnant) 
     eligible for such assistance''.
       (2) Application of qualified entities to presumptive 
     eligibility for pregnant women under medicaid.--Section 
     1920(b) (42 U.S.C. 1396r-1(b)) is amended by adding after 
     paragraph (2) the following flush sentence:
     ``The term `qualified provider' also includes a qualified 
     entity, as defined in section 1920A(b)(3).''.

     SEC. 114. LIMITATION ON MATCHING RATE FOR STATES THAT PROPOSE 
                   TO COVER CHILDREN WITH EFFECTIVE FAMILY INCOME 
                   THAT EXCEEDS 300 PERCENT OF THE POVERTY LINE.

       (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.--
       ``(A) FMAP applied to expenditures.--Except as provided in 
     subparagraph (B), for fiscal years beginning with fiscal year 
     2009, 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) Exception.--Subparagraph (A) shall not apply to any 
     State that, on the date of enactment of the Children's Health 
     Insurance Program Reauthorization Act of 2009, 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 such subparagraph under 
     the State child health plan.''.
       (b) Rule of Construction.--Nothing in the amendments made 
     by this section shall be construed as--
       (1) changing any income eligibility level for children 
     under title XXI of the Social Security Act; or
       (2) changing the flexibility provided States under such 
     title to establish the income eligibility level for targeted 
     low-income children under a State child health plan and the

[[Page 710]]

     methodologies used by the State to determine income or assets 
     under such plan.

     SEC. 115. STATE AUTHORITY UNDER MEDICAID.

       Notwithstanding any other provision of law, including the 
     fourth sentence of subsection (b) of section 1905 of the 
     Social Security Act (42 U.S.C. 1396d) or subsection (u) of 
     such section, at State option, the Secretary shall provide 
     the State with the Federal medical assistance percentage 
     determined for the State for Medicaid with respect to 
     expenditures described in section 1905(u)(2)(A) of such Act 
     or otherwise made to provide medical assistance under 
     Medicaid to a child who could be covered by the State under 
     CHIP.

                   TITLE II--OUTREACH AND ENROLLMENT

             Subtitle A--Outreach and Enrollment Activities

     SEC. 201. GRANTS AND ENHANCED ADMINISTRATIVE FUNDING FOR 
                   OUTREACH AND ENROLLMENT.

       (a) Grants.--Title XXI (42 U.S.C. 1397aa et seq.), as 
     amended by section 111, is amended by adding at the end the 
     following:

     ``SEC. 2113. GRANTS TO IMPROVE OUTREACH AND ENROLLMENT.

       ``(a) Outreach and Enrollment Grants; National Campaign.--
       ``(1) In general.--From the amounts appropriated under 
     subsection (g), subject to paragraph (2), the Secretary shall 
     award grants to eligible entities during the period of fiscal 
     years 2009 through 2013 to conduct outreach and enrollment 
     efforts that are designed to increase the enrollment and 
     participation of eligible children under this title and title 
     XIX.
       ``(2) Ten percent set aside for national enrollment 
     campaign.--An amount equal to 10 percent of such amounts 
     shall be used by the Secretary for expenditures during such 
     period to carry out a national enrollment campaign in 
     accordance with subsection (h).
       ``(b) Priority for Award of Grants.--
       ``(1) In general.--In awarding grants under subsection (a), 
     the Secretary shall give priority to eligible entities that--
       ``(A) propose to target geographic areas with high rates 
     of--
       ``(i) eligible but unenrolled children, including such 
     children who reside in rural areas; or
       ``(ii) racial and ethnic minorities and health disparity 
     populations, including those proposals that address cultural 
     and linguistic barriers to enrollment; and
       ``(B) submit the most demonstrable evidence required under 
     paragraphs (1) and (2) of subsection (c).
       ``(2) Ten percent set aside for outreach to indian 
     children.--An amount equal to 10 percent of the funds 
     appropriated under subsection (g) shall be used by the 
     Secretary to award grants to Indian Health Service providers 
     and urban Indian organizations receiving funds under title V 
     of the Indian Health Care Improvement Act (25 U.S.C. 1651 et 
     seq.) for outreach to, and enrollment of, children who are 
     Indians.
       ``(c) Application.--An eligible entity that desires to 
     receive a grant under subsection (a) shall submit an 
     application to the Secretary in such form and manner, and 
     containing such information, as the Secretary may decide. 
     Such application shall include--
       ``(1) evidence demonstrating that the entity includes 
     members who have access to, and credibility with, ethnic or 
     low-income populations in the communities in which activities 
     funded under the grant are to be conducted;
       ``(2) evidence demonstrating that the entity has the 
     ability to address barriers to enrollment, such as lack of 
     awareness of eligibility, stigma concerns and punitive fears 
     associated with receipt of benefits, and other cultural 
     barriers to applying for and receiving child health 
     assistance or medical assistance;
       ``(3) specific quality or outcomes performance measures to 
     evaluate the effectiveness of activities funded by a grant 
     awarded under this section; and
       ``(4) an assurance that the eligible entity shall--
       ``(A) conduct an assessment of the effectiveness of such 
     activities against the performance measures;
       ``(B) cooperate with the collection and reporting of 
     enrollment data and other information in order for the 
     Secretary to conduct such assessments; and
       ``(C) in the case of an eligible entity that is not the 
     State, provide the State with enrollment data and other 
     information as necessary for the State to make necessary 
     projections of eligible children and pregnant women.
       ``(d) Dissemination of Enrollment Data and Information 
     Determined From Effectiveness Assessments; Annual Report.--
     The Secretary shall--
       ``(1) make publicly available the enrollment data and 
     information collected and reported in accordance with 
     subsection (c)(4)(B); and
       ``(2) submit an annual report to Congress on the outreach 
     and enrollment activities conducted with funds appropriated 
     under this section.
       ``(e) Maintenance of Effort for States Awarded Grants; No 
     State Match Required.--In the case of a State that is awarded 
     a grant under this section--
       ``(1) the State share of funds expended for outreach and 
     enrollment activities under the State child health plan shall 
     not be less than the State share of such funds expended in 
     the fiscal year preceding the first fiscal year for which the 
     grant is awarded; and
       ``(2) no State matching funds shall be required for the 
     State to receive a grant under this section.
       ``(f) Definitions.--In this section:
       ``(1) Eligible entity.--The term `eligible entity' means 
     any of the following:
       ``(A) A State with an approved child health plan under this 
     title.
       ``(B) A local government.
       ``(C) An Indian tribe or tribal consortium, a tribal 
     organization, an urban Indian organization receiving funds 
     under title V of the Indian Health Care Improvement Act (25 
     U.S.C. 1651 et seq.), or an Indian Health Service provider.
       ``(D) A Federal health safety net organization.
       ``(E) A national, State, local, or community-based public 
     or nonprofit private organization, including organizations 
     that use community health workers or community-based doula 
     programs.
       ``(F) A faith-based organization or consortia, to the 
     extent that a grant awarded to such an entity is consistent 
     with the requirements of section 1955 of the Public Health 
     Service Act (42 U.S.C. 300x-65) relating to a grant award to 
     nongovernmental entities.
       ``(G) An elementary or secondary school.
       ``(2) Federal health safety net organization.--The term 
     `Federal health safety net organization' means--
       ``(A) a Federally-qualified health center (as defined in 
     section 1905(l)(2)(B));
       ``(B) a hospital defined as a disproportionate share 
     hospital for purposes of section 1923;
       ``(C) a covered entity described in section 340B(a)(4) of 
     the Public Health Service Act (42 U.S.C. 256b(a)(4)); and
       ``(D) any other entity or consortium that serves children 
     under a federally funded program, including the special 
     supplemental nutrition program for women, infants, and 
     children (WIC) established under section 17 of the Child 
     Nutrition Act of 1966 (42 U.S.C. 1786), the Head Start and 
     Early Head Start programs under the Head Start Act (42 U.S.C. 
     9801 et seq.), the school lunch program established under the 
     Richard B. Russell National School Lunch Act, and an 
     elementary or secondary school.
       ``(3) Indians; indian tribe; tribal organization; urban 
     indian organization.--The terms `Indian', `Indian tribe', 
     `tribal organization', and `urban Indian organization' have 
     the meanings given such terms in section 4 of the Indian 
     Health Care Improvement Act (25 U.S.C. 1603).
       ``(4) Community health worker.--The term `community health 
     worker' means an individual who promotes health or nutrition 
     within the community in which the individual resides--
       ``(A) by serving as a liaison between communities and 
     health care agencies;
       ``(B) by providing guidance and social assistance to 
     community residents;
       ``(C) by enhancing community residents' ability to 
     effectively communicate with health care providers;
       ``(D) by providing culturally and linguistically 
     appropriate health or nutrition education;
       ``(E) by advocating for individual and community health or 
     nutrition needs; and
       ``(F) by providing referral and followup services.
       ``(g) Appropriation.--There is appropriated, out of any 
     money in the Treasury not otherwise appropriated, 
     $100,000,000 for the period of fiscal years 2009 through 
     2013, for the purpose of awarding grants under this section. 
     Amounts appropriated and paid under the authority of this 
     section shall be in addition to amounts appropriated under 
     section 2104 and paid to States in accordance with section 
     2105, including with respect to expenditures for outreach 
     activities in accordance with subsections (a)(1)(D)(iii) and 
     (c)(2)(C) of that section.
       ``(h) National Enrollment Campaign.--From the amounts made 
     available under subsection (a)(2), the Secretary shall 
     develop and implement a national enrollment campaign to 
     improve the enrollment of underserved child populations in 
     the programs established under this title and title XIX. Such 
     campaign may include--
       ``(1) the establishment of partnerships with the Secretary 
     of Education and the Secretary of Agriculture to develop 
     national campaigns to link the eligibility and enrollment 
     systems for the assistance programs each Secretary 
     administers that often serve the same children;
       ``(2) the integration of information about the programs 
     established under this title and title XIX in public health 
     awareness campaigns administered by the Secretary;
       ``(3) increased financial and technical support for 
     enrollment hotlines maintained by the Secretary to ensure 
     that all States participate in such hotlines;
       ``(4) the establishment of joint public awareness outreach 
     initiatives with the Secretary of Education and the Secretary 
     of Labor regarding the importance of health insurance to 
     building strong communities and the economy;

[[Page 711]]

       ``(5) the development of special outreach materials for 
     Native Americans or for individuals with limited English 
     proficiency; and
       ``(6) such other outreach initiatives as the Secretary 
     determines would increase public awareness of the programs 
     under this title and title XIX.
       ``(i) Grants for Outreach and Enrollment of Native American 
     Beneficiaries.--
       ``(1) In general.--To overcome language and cultural 
     barriers to program access by Native Americans, the Secretary 
     shall establish grant programs to conduct outreach and 
     enrollment efforts to increase the enrollment and 
     participation of eligible individuals in programs of the 
     Social Security Act (42 U.S.C. 1397aa et seq.) and other 
     Federal health and social service programs.
       ``(2) Use of tribal benefits-counselors model.--The grant 
     program under this subsection shall incorporate expansion and 
     stabilization of the tribal benefits-counselors model 
     developed in the State of Washington to overcome language and 
     cultural barriers to Federal programs.
       ``(3) Recipients.--In order to qualify for a grant under 
     this subsection, an applicant shall be a national, nonprofit 
     organization with successful and verifiable experience in 
     assisting Native Americans access Federal programs.
       ``(4) Report.--At the end of the period of funding provided 
     under subsection (f), the Secretary shall submit to Congress 
     a report on the grants made under this subsection, including 
     the efficacy of outreach efforts and the cost effectiveness 
     of projects funded by such grants in improving access to 
     Federal programs by Native Americans.''.
       (b) Enhanced Administrative Funding for Translation or 
     Interpretation Services Under CHIP and Medicaid.--
       (1) CHIP.--Section 2105(a)(1) (42 U.S.C. 1397ee(a)(1)), as 
     amended by section 113, is amended--
       (A) in the matter preceding subparagraph (A), by inserting 
     ``(or, in the case of expenditures described in subparagraph 
     (D)(iv), the higher of 75 percent or the sum of the enhanced 
     FMAP plus 5 percentage points)'' after ``enhanced FMAP''; and
       (B) in subparagraph (D)--
       (i) in clause (iii), by striking ``and'' at the end;
       (ii) by redesignating clause (iv) as clause (v); and
       (iii) by inserting after clause (iii) the following new 
     clause:
       ``(iv) for translation or interpretation services in 
     connection with the enrollment of, retention of, and use of 
     services under this title by, individuals for whom English is 
     not their primary language (as found necessary by the 
     Secretary for the proper and efficient administration of the 
     State plan); and''.
       (2) Medicaid.--
       (A) Use of medicaid funds.--Section 1903(a)(2) (42 U.S.C. 
     1396b(a)(2)) is amended by adding at the end the following 
     new subparagraph:
       ``(E) an amount equal to 75 percent of so much of the sums 
     expended during such quarter (as found necessary by the 
     Secretary for the proper and efficient administration of the 
     State plan) as are attributable to translation or 
     interpretation services in connection with the enrollment of, 
     retention of, and use of services under this title by, 
     children of families for whom English is not the primary 
     language; plus''.
       (B) Use of community health workers for outreach 
     activities.--
       (i) In general.--Section 2102(c)(1) of such Act (42 U.S.C. 
     1397bb(c)(1)) is amended by inserting ``(through community 
     health workers and others)'' after ``Outreach''.
       (ii) In federal evaluation.--Section 2108(c)(3)(B) of such 
     Act (42 U.S.C. 1397hh(c)(3)(B)) is amended by inserting 
     ``(such as through community health workers and others)'' 
     after ``including practices''.

     SEC. 202. INCREASED OUTREACH AND ENROLLMENT OF INDIANS.

       (a) In General.--Section 1139 (42 U.S.C. 1320b-9) is 
     amended to read as follows:

     ``SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE 
                   FOR INDIANS UNDER TITLES XIX AND XXI.

       ``(a) Agreements With States for Medicaid and CHIP Outreach 
     On or Near Reservations To Increase the Enrollment of Indians 
     in Those Programs.--
       ``(1) In general.--In order to improve the access of 
     Indians residing on or near a reservation to obtain benefits 
     under the Medicaid and State children's health insurance 
     programs established under titles XIX and XXI, the Secretary 
     shall encourage the State to take steps to provide for 
     enrollment on or near the reservation. Such steps may include 
     outreach efforts such as the outstationing of eligibility 
     workers, entering into agreements with the Indian Health 
     Service, Indian Tribes, Tribal Organizations, and Urban 
     Indian Organizations to provide outreach, education regarding 
     eligibility and benefits, enrollment, and translation 
     services when such services are appropriate.
       ``(2) Construction.--Nothing in paragraph (1) shall be 
     construed as affecting arrangements entered into between 
     States and the Indian Health Service, Indian Tribes, Tribal 
     Organizations, or Urban Indian Organizations for such 
     Service, Tribes, or Organizations to conduct administrative 
     activities under such titles.
       ``(b) Requirement To Facilitate Cooperation.--The 
     Secretary, acting through the Centers for Medicare & Medicaid 
     Services, shall take such steps as are necessary to 
     facilitate cooperation with, and agreements between, States 
     and the Indian Health Service, Indian Tribes, Tribal 
     Organizations, or Urban Indian Organizations with respect to 
     the provision of health care items and services to Indians 
     under the programs established under title XIX or XXI.
       ``(c) Definition of Indian; Indian Tribe; Indian Health 
     Program; Tribal Organization; Urban Indian Organization.--In 
     this section, the terms `Indian', `Indian Tribe', `Indian 
     Health Program', `Tribal Organization', and `Urban Indian 
     Organization' have the meanings given those terms in section 
     4 of the Indian Health Care Improvement Act.''.
       (b) Nonapplication of 10 Percent Limit on Outreach and 
     Certain Other Expenditures.--Section 2105(c)(2) (42 U.S.C. 
     1397ee(c)(2)) is amended by adding at the end the following:
       ``(C) Nonapplication to certain expenditures.--The 
     limitation under subparagraph (A) shall not apply with 
     respect to the following expenditures:
       ``(i) Expenditures to increase outreach to, and the 
     enrollment of, indian children under this title and title 
     xix.--Expenditures for outreach activities to families of 
     Indian children likely to be eligible for child health 
     assistance under the plan or medical assistance under the 
     State plan under title XIX (or under a waiver of such plan), 
     to inform such families of the availability of, and to assist 
     them in enrolling their children in, such plans, including 
     such activities conducted under grants, contracts, or 
     agreements entered into under section 1139(a).''.

     SEC. 203. STATE OPTION TO RELY ON FINDINGS FROM AN EXPRESS 
                   LANE AGENCY TO CONDUCT SIMPLIFIED ELIGIBILITY 
                   DETERMINATIONS.

       (a) Application Under Medicaid and CHIP Programs.--
       (1) Medicaid.--Section 1902(e) (42 U.S.C. 1396a(e)) is 
     amended by adding at the end the following:
       ``(13) Express Lane Option.--
       ``(A) In general.--
       ``(i) Option to use a finding from an express lane 
     agency.--At the option of the State, the State plan may 
     provide that in determining eligibility under this title for 
     a child (as defined in subparagraph (G)), the State may rely 
     on a finding made within a reasonable period (as determined 
     by the State) from an Express Lane agency (as defined in 
     subparagraph (F)) when it determines whether a child 
     satisfies one or more components of eligibility for medical 
     assistance under this title. The State may rely on a finding 
     from an Express Lane agency notwithstanding any differences 
     in budget unit, disregard, deeming or other methodology, if 
     the following requirements are met:
       ``(I) Prohibition on determining children ineligible for 
     coverage.--If a finding from an Express Lane agency would 
     result in a determination that a child does not satisfy an 
     eligibility requirement for medical assistance under this 
     title and for child health assistance under title XXI, the 
     State shall determine eligibility for assistance using its 
     regular procedures.
       ``(II) Notice requirement.--For any child who is found 
     eligible for medical assistance under the State plan under 
     this title or child health assistance under title XXI and who 
     is subject to premiums based on an Express Lane agency's 
     finding of such child's income level, the State shall provide 
     notice that the child may qualify for lower premium payments 
     if evaluated by the State using its regular policies and of 
     the procedures for requesting such an evaluation.
       ``(III) Compliance with screen and enroll requirement.--The 
     State shall satisfy the requirements under subparagraphs (A) 
     and (B) of section 2102(b)(3) (relating to screen and enroll) 
     before enrolling a child in child health assistance under 
     title XXI. At its option, the State may fulfill such 
     requirements in accordance with either option provided under 
     subparagraph (C) of this paragraph.
       ``(IV) Verification of citizenship, nationality status, or 
     qualified alien status.--The State shall satisfy the 
     requirements of sections 1137(d) and 1902(a)(46)(B) for 
     verifications of citizenship, nationality status, or 
     qualified alien status.
       ``(V) Coding.--The State meets the requirements of 
     subparagraph (E).
       ``(ii) Option to apply to renewals and redeterminations.--
     The State may apply the provisions of this paragraph when 
     conducting initial determinations of eligibility, 
     redeterminations of eligibility, or both, as described in the 
     State plan.
       ``(B) Rules of construction.--Nothing in this paragraph 
     shall be construed--
       ``(i) to relieve a State of the obligation to determine 
     components of eligibility that are not the subject of an 
     Express Lane agency's finding, as described in subparagraph 
     (A);
       ``(ii) to limit or prohibit a State from taking any actions 
     otherwise permitted under this title or title XXI in 
     determining eligibility for or enrolling children into 
     medical assistance under this title or child health 
     assistance under title XXI; or
       ``(iii) to modify the limitations in section 1902(a)(5) 
     concerning the agencies that may

[[Page 712]]

     make a determination of eligibility for medical assistance 
     under this title.
       ``(C) Options for satisfying the screen and enroll 
     requirement.--
       ``(i) In general.--With respect to a child whose 
     eligibility for medical assistance under this title or for 
     child health assistance under title XXI has been evaluated by 
     a State agency using an income finding from an Express Lane 
     agency, a State may carry out its duties under subparagraphs 
     (A) and (B) of section 2102(b)(3) (relating to screen and 
     enroll) in accordance with either clause (ii) or clause 
     (iii).
       ``(ii) Establishing a screening threshold.--
       ``(I) In general.--Under this clause, the State establishes 
     a screening threshold set as a percentage of the Federal 
     poverty level that exceeds the highest income threshold 
     applicable under this title to the child by a minimum of 30 
     percentage points or, at State option, a higher number of 
     percentage points that reflects the value (as determined by 
     the State and described in the State plan) of any differences 
     between income methodologies used by the program administered 
     by the Express Lane agency and the methodologies used by the 
     State in determining eligibility for medical assistance under 
     this title.
       ``(II) Children with income not above threshold.--If the 
     income of a child does not exceed the screening threshold, 
     the child is deemed to satisfy the income eligibility 
     criteria for medical assistance under this title regardless 
     of whether such child would otherwise satisfy such criteria.
       ``(III) Children with income above threshold.--If the 
     income of a child exceeds the screening threshold, the child 
     shall be considered to have an income above the Medicaid 
     applicable income level described in section 2110(b)(4) and 
     to satisfy the requirement under section 2110(b)(1)(C) 
     (relating to the requirement that CHIP matching funds be used 
     only for children not eligible for Medicaid). If such a child 
     is enrolled in child health assistance under title XXI, the 
     State shall provide the parent, guardian, or custodial 
     relative with the following:

       ``(aa) Notice that the child may be eligible to receive 
     medical assistance under the State plan under this title if 
     evaluated for such assistance under the State's regular 
     procedures and notice of the process through which a parent, 
     guardian, or custodial relative can request that the State 
     evaluate the child's eligibility for medical assistance under 
     this title using such regular procedures.
       ``(bb) A description of differences between the medical 
     assistance provided under this title and child health 
     assistance under title XXI, including differences in cost-
     sharing requirements and covered benefits.

       ``(iii) Temporary enrollment in chip pending screen and 
     enroll.--
       ``(I) In general.--Under this clause, a State enrolls a 
     child in child health assistance under title XXI for a 
     temporary period if the child appears eligible for such 
     assistance based on an income finding by an Express Lane 
     agency.
       ``(II) Determination of eligibility.--During such temporary 
     enrollment period, the State shall determine the child's 
     eligibility for child health assistance under title XXI or 
     for medical assistance under this title in accordance with 
     this clause.
       ``(III) Prompt follow up.--In making such a determination, 
     the State shall take prompt action to determine whether the 
     child should be enrolled in medical assistance under this 
     title or child health assistance under title XXI pursuant to 
     subparagraphs (A) and (B) of section 2102(b)(3) (relating to 
     screen and enroll).
       ``(IV) Requirement for simplified determination.--In making 
     such a determination, the State shall use procedures that, to 
     the maximum feasible extent, reduce the burden imposed on the 
     individual of such determination. Such procedures may not 
     require the child's parent, guardian, or custodial relative 
     to provide or verify information that already has been 
     provided to the State agency by an Express Lane agency or 
     another source of information unless the State agency has 
     reason to believe the information is erroneous.
       ``(V) Availability of chip matching funds during temporary 
     enrollment period.--Medical assistance for items and services 
     that are provided to a child enrolled in title XXI during a 
     temporary enrollment period under this clause shall be 
     treated as child health assistance under such title.
       ``(D) Option for automatic enrollment.--
       ``(i) In general.--The State may initiate and determine 
     eligibility for medical assistance under the State Medicaid 
     plan or for child health assistance under the State CHIP plan 
     without a program application from, or on behalf of, the 
     child based on data obtained from sources other than the 
     child (or the child's family), but a child can only be 
     automatically enrolled in the State Medicaid plan or the 
     State CHIP plan if the child or the family affirmatively 
     consents to being enrolled through affirmation and signature 
     on an Express Lane agency application, if the requirement of 
     clause (ii) is met.
       ``(ii) Information requirement.--The requirement of this 
     clause is that the State informs the parent, guardian, or 
     custodial relative of the child of the services that will be 
     covered, appropriate methods for using such services, premium 
     or other cost sharing charges (if any) that apply, medical 
     support obligations (under section 1912(a)) created by 
     enrollment (if applicable), and the actions the parent, 
     guardian, or relative must take to maintain enrollment and 
     renew coverage.
       ``(E) Coding; application to enrollment error rates.--
       ``(i) In general.--For purposes of subparagraph (A)(iv), 
     the requirement of this subparagraph for a State is that the 
     State agrees to--
       ``(I) assign such codes as the Secretary shall require to 
     the children who are enrolled in the State Medicaid plan or 
     the State CHIP plan through reliance on a finding made by an 
     Express Lane agency for the duration of the State's election 
     under this paragraph;
       ``(II) annually provide the Secretary with a statistically 
     valid sample (that is approved by Secretary) of the children 
     enrolled in such plans through reliance on such a finding by 
     conducting a full Medicaid eligibility review of the children 
     identified for such sample for purposes of determining an 
     eligibility error rate (as described in clause (iv)) with 
     respect to the enrollment of such children (and shall not 
     include such children in any data or samples used for 
     purposes of complying with a Medicaid Eligibility Quality 
     Control (MEQC) review or a payment error rate measurement 
     (PERM) requirement);
       ``(III) submit the error rate determined under subclause 
     (II) to the Secretary;
       ``(IV) if such error rate exceeds 3 percent for either of 
     the first 2 fiscal years in which the State elects to apply 
     this paragraph, demonstrate to the satisfaction of the 
     Secretary the specific corrective actions implemented by the 
     State to improve upon such error rate; and
       ``(V) if such error rate exceeds 3 percent for any fiscal 
     year in which the State elects to apply this paragraph, a 
     reduction in the amount otherwise payable to the State under 
     section 1903(a) for quarters for that fiscal year, equal to 
     the total amount of erroneous excess payments determined for 
     the fiscal year only with respect to the children included in 
     the sample for the fiscal year that are in excess of a 3 
     percent error rate with respect to such children.
       ``(ii) No punitive action based on error rate.--The 
     Secretary shall not apply the error rate derived from the 
     sample under clause (i) to the entire population of children 
     enrolled in the State Medicaid plan or the State CHIP plan 
     through reliance on a finding made by an Express Lane agency, 
     or to the population of children enrolled in such plans on 
     the basis of the State's regular procedures for determining 
     eligibility, or penalize the State on the basis of such error 
     rate in any manner other than the reduction of payments 
     provided for under clause (i)(V).
       ``(iii) Rule of construction.--Nothing in this paragraph 
     shall be construed as relieving a State that elects to apply 
     this paragraph from being subject to a penalty under section 
     1903(u), for payments made under the State Medicaid plan with 
     respect to ineligible individuals and families that are 
     determined to exceed the error rate permitted under that 
     section (as determined without regard to the error rate 
     determined under clause (i)(II)).
       ``(iv) Error rate defined.--In this subparagraph, the term 
     `error rate' means the rate of erroneous excess payments for 
     medical assistance (as defined in section 1903(u)(1)(D)) for 
     the period involved, except that such payments shall be 
     limited to individuals for which eligibility determinations 
     are made under this paragraph and except that in applying 
     this paragraph under title XXI, there shall be substituted 
     for references to provisions of this title corresponding 
     provisions within title XXI.
       ``(F) Express lane agency.--
       ``(i) In general.--In this paragraph, the term `Express 
     Lane agency' means a public agency that--
       ``(I) is determined by the State Medicaid agency or the 
     State CHIP agency (as applicable) to be capable of making the 
     determinations of one or more eligibility requirements 
     described in subparagraph (A)(i);
       ``(II) is identified in the State Medicaid plan or the 
     State CHIP plan; and
       ``(III) notifies the child's family--

       ``(aa) of the information which shall be disclosed in 
     accordance with this paragraph;
       ``(bb) that the information disclosed will be used solely 
     for purposes of determining eligibility for medical 
     assistance under the State Medicaid plan or for child health 
     assistance under the State CHIP plan; and
       ``(cc) that the family may elect to not have the 
     information disclosed for such purposes; and

       ``(IV) enters into, or is subject to, an interagency 
     agreement to limit the disclosure and use of the information 
     disclosed.
       ``(ii) Inclusion of specific public agencies.--Such term 
     includes the following:
       ``(I) A public agency that determines eligibility for 
     assistance under any of the following:

       ``(aa) The temporary assistance for needy families program 
     funded under part A of title IV.
       ``(bb) A State program funded under part D of title IV.
       ``(cc) The State Medicaid plan.
       ``(dd) The State CHIP plan.

[[Page 713]]

       ``(ee) The Food and Nutrition Act of 2008 (7 U.S.C. 2011 et 
     seq.).
       ``(ff) The Head Start Act (42 U.S.C. 9801 et seq.).
       ``(gg) The Richard B. Russell National School Lunch Act (42 
     U.S.C. 1751 et seq.).
       ``(hh) The Child Nutrition Act of 1966 (42 U.S.C. 1771 et 
     seq.).
       ``(ii) The Child Care and Development Block Grant Act of 
     1990 (42 U.S.C. 9858 et seq.).
       ``(jj) The Stewart B. McKinney Homeless Assistance Act (42 
     U.S.C. 11301 et seq.).
       ``(kk) The United States Housing Act of 1937 (42 U.S.C. 
     1437 et seq.).
       ``(ll) The Native American Housing Assistance and Self-
     Determination Act of 1996 (25 U.S.C. 4101 et seq.).

       ``(II) A State-specified governmental agency that has 
     fiscal liability or legal responsibility for the accuracy of 
     the eligibility determination findings relied on by the 
     State.
       ``(III) A public agency that is subject to an interagency 
     agreement limiting the disclosure and use of the information 
     disclosed for purposes of determining eligibility under the 
     State Medicaid plan or the State CHIP plan.
       ``(iii) Exclusions.--Such term does not include an agency 
     that determines eligibility for a program established under 
     the Social Services Block Grant established under title XX or 
     a private, for-profit organization.
       ``(iv) Rules of construction.--Nothing in this paragraph 
     shall be construed as--
       ``(I) exempting a State Medicaid agency from complying with 
     the requirements of section 1902(a)(4) relating to merit-
     based personnel standards for employees of the State Medicaid 
     agency and safeguards against conflicts of interest); or
       ``(II) authorizing a State Medicaid agency that elects to 
     use Express Lane agencies under this subparagraph to use the 
     Express Lane option to avoid complying with such requirements 
     for purposes of making eligibility determinations under the 
     State Medicaid plan.
       ``(v) Additional definitions.--In this paragraph:
       ``(I) State.--The term `State' means 1 of the 50 States or 
     the District of Columbia.
       ``(II) State chip agency.--The term `State CHIP agency' 
     means the State agency responsible for administering the 
     State CHIP plan.
       ``(III) State chip plan.--The term `State CHIP plan' means 
     the State child health plan established under title XXI and 
     includes any waiver of such plan.
       ``(IV) State medicaid agency.--The term `State Medicaid 
     agency' means the State agency responsible for administering 
     the State Medicaid plan.
       ``(V) State medicaid plan.--The term `State Medicaid plan' 
     means the State plan established under title XIX and includes 
     any waiver of such plan.
       ``(G) Child defined.--For purposes of this paragraph, the 
     term `child' means an individual under 19 years of age, or, 
     at the option of a State, such higher age, not to exceed 21 
     years of age, as the State may elect.
       ``(H) Application.--This paragraph shall not apply to with 
     respect to eligibility determinations made after September 
     30, 2013.''.
       (2) CHIP.--Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)) is 
     amended by redesignating subparagraphs (B), (C), and (D) as 
     subparagraphs (C), (D), and (E), respectively, and by 
     inserting after subparagraph (A) the following new 
     subparagraph:
       ``(B) Section 1902(e)(13) (relating to the State option to 
     rely on findings from an Express Lane agency to help evaluate 
     a child's eligibility for medical assistance).''.
       (b) Evaluation and Report.--
       (1) Evaluation.--The Secretary shall conduct, by grant, 
     contract, or interagency agreement, a comprehensive, 
     independent evaluation of the option provided under the 
     amendments made by subsection (a). Such evaluation shall 
     include an analysis of the effectiveness of the option, and 
     shall include--
       (A) obtaining a statistically valid sample of the children 
     who were enrolled in the State Medicaid plan or the State 
     CHIP plan through reliance on a finding made by an Express 
     Lane agency and determining the percentage of children who 
     were erroneously enrolled in such plans;
       (B) determining whether enrolling children in such plans 
     through reliance on a finding made by an Express Lane agency 
     improves the ability of a State to identify and enroll low-
     income, uninsured children who are eligible but not enrolled 
     in such plans;
       (C) evaluating the administrative costs or savings related 
     to identifying and enrolling children in such plans through 
     reliance on such findings, and the extent to which such costs 
     differ from the costs that the State otherwise would have 
     incurred to identify and enroll low-income, uninsured 
     children who are eligible but not enrolled in such plans; and
       (D) any recommendations for legislative or administrative 
     changes that would improve the effectiveness of enrolling 
     children in such plans through reliance on such findings.
       (2) Report to congress.--Not later than September 30, 2012, 
     the Secretary shall submit a report to Congress on the 
     results of the evaluation under paragraph (1).
       (3) Funding.--
       (A) In general.--Out of any funds in the Treasury not 
     otherwise appropriated, there is appropriated to the 
     Secretary to carry out the evaluation under this subsection 
     $5,000,000 for the period of fiscal years 2009 through 2012.
       (B) Budget authority.--Subparagraph (A) 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 conduct the evaluation under this 
     subsection.
       (c) Electronic Transmission of Information.--Section 1902 
     (42 U.S.C. 1396a) is amended by adding at the end the 
     following new subsection:
       ``(dd) Electronic Transmission of Information.--If the 
     State agency determining eligibility for medical assistance 
     under this title or child health assistance under title XXI 
     verifies an element of eligibility based on information from 
     an Express Lane Agency (as defined in subsection (e)(13)(F)), 
     or from another public agency, then the applicant's signature 
     under penalty of perjury shall not be required as to such 
     element. Any signature requirement for an application for 
     medical assistance may be satisfied through an electronic 
     signature, as defined in section 1710(1) of the Government 
     Paperwork Elimination Act (44 U.S.C. 3504 note). The 
     requirements of subparagraphs (A) and (B) of section 
     1137(d)(2) may be met through evidence in digital or 
     electronic form.''.
       (d) Authorization of Information Disclosure.--
       (1) In general.--Title XIX is amended by adding at the end 
     the following new section:

     ``SEC. 1942. AUTHORIZATION TO RECEIVE RELEVANT INFORMATION.

       ``(a) In General.--Notwithstanding any other provision of 
     law, a Federal or State agency or private entity in 
     possession of the sources of data directly relevant to 
     eligibility determinations under this title (including 
     eligibility files maintained by Express Lane agencies 
     described in section 1902(e)(13)(F), information described in 
     paragraph (2) or (3) of section 1137(a), vital records 
     information about births in any State, and information 
     described in sections 453(i) and 1902(a)(25)(I)) is 
     authorized to convey such data or information to the State 
     agency administering the State plan under this title, to the 
     extent such conveyance meets the requirements of subsection 
     (b).
       ``(b) Requirements for Conveyance.--Data or information may 
     be conveyed pursuant to subsection (a) only if the following 
     requirements are met:
       ``(1) The individual whose circumstances are described in 
     the data or information (or such individual's parent, 
     guardian, caretaker relative, or authorized representative) 
     has either provided advance consent to disclosure or has not 
     objected to disclosure after receiving advance notice of 
     disclosure and a reasonable opportunity to object.
       ``(2) Such data or information are used solely for the 
     purposes of--
       ``(A) identifying individuals who are eligible or 
     potentially eligible for medical assistance under this title 
     and enrolling or attempting to enroll such individuals in the 
     State plan; and
       ``(B) verifying the eligibility of individuals for medical 
     assistance under the State plan.
       ``(3) An interagency or other agreement, consistent with 
     standards developed by the Secretary--
       ``(A) prevents the unauthorized use, disclosure, or 
     modification of such data and otherwise meets applicable 
     Federal requirements safeguarding privacy and data security; 
     and
       ``(B) requires the State agency administering the State 
     plan to use the data and information obtained under this 
     section to seek to enroll individuals in the plan.
       ``(c) Penalties for Improper Disclosure.--
       ``(1) Civil money penalty.--A private entity described in 
     the subsection (a) that publishes, discloses, or makes known 
     in any manner, or to any extent not authorized by Federal 
     law, any information obtained under this section is subject 
     to a civil money penalty in an amount equal to $10,000 for 
     each such unauthorized publication or disclosure. The 
     provisions of section 1128A (other than subsections (a) and 
     (b) and the second sentence of subsection (f)) shall apply to 
     a civil money penalty under this paragraph in the same manner 
     as such provisions apply to a penalty or proceeding under 
     section 1128A(a).
       ``(2) Criminal penalty.--A private entity described in the 
     subsection (a) that willfully publishes, discloses, or makes 
     known in any manner, or to any extent not authorized by 
     Federal law, any information obtained under this section 
     shall be fined not more than $10,000 or imprisoned not more 
     than 1 year, or both, for each such unauthorized publication 
     or disclosure.
       ``(d) Rule of Construction.--The limitations and 
     requirements that apply to disclosure pursuant to this 
     section shall not be construed to prohibit the conveyance or 
     disclosure of data or information otherwise permitted under 
     Federal law (without regard to this section).''.
       (2) Conforming amendment to title xxi.--Section 2107(e)(1) 
     (42 U.S.C. 1397gg(e)(1)), as amended by subsection (a)(2), is 
     amended by adding at the end the following new subparagraph:
       ``(F) Section 1942 (relating to authorization to receive 
     data directly relevant to eligibility determinations).''.

[[Page 714]]

       (3) Conforming amendment to provide access to data about 
     enrollment in insurance for purposes of evaluating 
     applications and for chip.--Section 1902(a)(25)(I)(i) (42 
     U.S.C. 1396a(a)(25)(I)(i)) is amended--
       (A) by inserting ``(and, at State option, individuals who 
     apply or whose eligibility for medical assistance is being 
     evaluated in accordance with section 1902(e)(13)(D))'' after 
     ``with respect to individuals who are eligible''; and
       (B) by inserting ``under this title (and, at State option, 
     child health assistance under title XXI)'' after ``the State 
     plan''.
       (e) Authorization for States Electing Express Lane Option 
     To Receive Certain Data Directly Relevant To Determining 
     Eligibility and Correct Amount of Assistance.--The Secretary 
     shall enter into such agreements as are necessary to permit a 
     State that elects the Express Lane option under section 
     1902(e)(13) of the Social Security Act to receive data 
     directly relevant to eligibility determinations and 
     determining the correct amount of benefits under a State 
     child health plan under CHIP or a State plan under Medicaid 
     from the following:
       (1) The National Directory of New Hires established under 
     section 453(i) of the Social Security Act (42 U.S.C. 653(i)).
       (2) Data regarding enrollment in insurance that may help to 
     facilitate outreach and enrollment under the State Medicaid 
     plan, the State CHIP plan, and such other programs as the 
     Secretary may specify.
       (f) Effective Date.--The amendments made by this section 
     are effective on the date of the enactment of this Act.

              Subtitle B--Reducing Barriers to Enrollment

     SEC. 211. VERIFICATION OF DECLARATION OF CITIZENSHIP OR 
                   NATIONALITY FOR PURPOSES OF ELIGIBILITY FOR 
                   MEDICAID AND CHIP.

       (a) Alternative State Process for Verification of 
     Declaration of Citizenship or Nationality for Purposes of 
     Eligibility for Medicaid.--
       (1) Alternative to documentation requirement.--
       (A) In general.--Section 1902 (42 U.S.C. 1396a), as amended 
     by section 203(c), is amended--
       (i) in subsection (a)(46)--

       (I) by inserting ``(A)'' after ``(46)'';
       (II) by adding ``and'' after the semicolon; and
       (III) by adding at the end the following new subparagraph:

       ``(B) provide, with respect to an individual declaring to 
     be a citizen or national of the United States for purposes of 
     establishing eligibility under this title, that the State 
     shall satisfy the requirements of--
       ``(i) section 1903(x); or
       ``(ii) subsection (ee);''; and
       (ii) by adding at the end the following new subsection:
       ``(ee)(1) For purposes of subsection (a)(46)(B)(ii), the 
     requirements of this subsection with respect to an individual 
     declaring to be a citizen or national of the United States 
     for purposes of establishing eligibility under this title, 
     are, in lieu of requiring the individual to present 
     satisfactory documentary evidence of citizenship or 
     nationality under section 1903(x) (if the individual is not 
     described in paragraph (2) of that section), as follows:
       ``(A) The State submits the name and social security number 
     of the individual to the Commissioner of Social Security as 
     part of the program established under paragraph (2).
       ``(B) If the State receives notice from the Commissioner of 
     Social Security that the name or social security number, or 
     the declaration of citizenship or nationality, of the 
     individual is inconsistent with information in the records 
     maintained by the Commissioner--
       ``(i) the State makes a reasonable effort to identify and 
     address the causes of such inconsistency, including through 
     typographical or other clerical errors, by contacting the 
     individual to confirm the accuracy of the name or social 
     security number submitted or declaration of citizenship or 
     nationality and by taking such additional actions as the 
     Secretary, through regulation or other guidance, or the State 
     may identify, and continues to provide the individual with 
     medical assistance while making such effort; and
       ``(ii) in the case such inconsistency is not resolved under 
     clause (i), the State--
       ``(I) notifies the individual of such fact;
       ``(II) provides the individual with a period of 90 days 
     from the date on which the notice required under subclause 
     (I) is received by the individual to either present 
     satisfactory documentary evidence of citizenship or 
     nationality (as defined in section 1903(x)(3)) or resolve the 
     inconsistency with the Commissioner of Social Security (and 
     continues to provide the individual with medical assistance 
     during such 90-day period); and
       ``(III) disenrolls the individual from the State plan under 
     this title within 30 days after the end of such 90-day period 
     if no such documentary evidence is presented or if such 
     inconsistency is not resolved.
       ``(2)(A) Each State electing to satisfy the requirements of 
     this subsection for purposes of section 1902(a)(46)(B) shall 
     establish a program under which the State submits at least 
     monthly to the Commissioner of Social Security for comparison 
     of the name and social security number, of each individual 
     newly enrolled in the State plan under this title that month 
     who is not described in section 1903(x)(2) and who declares 
     to be a United States citizen or national, with information 
     in records maintained by the Commissioner.
       ``(B) In establishing the State program under this 
     paragraph, the State may enter into an agreement with the 
     Commissioner of Social Security--
       ``(i) to provide, through an on-line system or otherwise, 
     for the electronic submission of, and response to, the 
     information submitted under subparagraph (A) for an 
     individual enrolled in the State plan under this title who 
     declares to be citizen or national on at least a monthly 
     basis; or
       ``(ii) to provide for a determination of the consistency of 
     the information submitted with the information maintained in 
     the records of the Commissioner through such other method as 
     agreed to by the State and the Commissioner and approved by 
     the Secretary, provided that such method is no more 
     burdensome for individuals to comply with than any burdens 
     that may apply under a method described in clause (i).
       ``(C) The program established under this paragraph shall 
     provide that, in the case of any individual who is required 
     to submit a social security number to the State under 
     subparagraph (A) and who is unable to provide the State with 
     such number, shall be provided with at least the reasonable 
     opportunity to present satisfactory documentary evidence of 
     citizenship or nationality (as defined in section 1903(x)(3)) 
     as is provided under clauses (i) and (ii) of section 
     1137(d)(4)(A) to an individual for the submittal to the State 
     of evidence indicating a satisfactory immigration status.
       ``(3)(A) The State agency implementing the plan approved 
     under this title shall, at such times and in such form as the 
     Secretary may specify, provide information on the percentage 
     each month that the inconsistent submissions bears to the 
     total submissions made for comparison for such month. For 
     purposes of this subparagraph, a name, social security 
     number, or declaration of citizenship or nationality of an 
     individual shall be treated as inconsistent and included in 
     the determination of such percentage only if--
       ``(i) the information submitted by the individual is not 
     consistent with information in records maintained by the 
     Commissioner of Social Security;
       ``(ii) the inconsistency is not resolved by the State;
       ``(iii) the individual was provided with a reasonable 
     period of time to resolve the inconsistency with the 
     Commissioner of Social Security or provide satisfactory 
     documentation of citizenship status and did not successfully 
     resolve such inconsistency; and
       ``(iv) payment has been made for an item or service 
     furnished to the individual under this title.
       ``(B) If, for any fiscal year, the average monthly 
     percentage determined under subparagraph (A) is greater than 
     3 percent--
       ``(i) the State shall develop and adopt a corrective plan 
     to review its procedures for verifying the identities of 
     individuals seeking to enroll in the State plan under this 
     title and to identify and implement changes in such 
     procedures to improve their accuracy; and
       ``(ii) pay to the Secretary an amount equal to the amount 
     which bears the same ratio to the total payments under the 
     State plan for the fiscal year for providing medical 
     assistance to individuals who provided inconsistent 
     information as the number of individuals with inconsistent 
     information in excess of 3 percent of such total submitted 
     bears to the total number of individuals with inconsistent 
     information.
       ``(C) The Secretary may waive, in certain limited cases, 
     all or part of the payment under subparagraph (B)(ii) if the 
     State is unable to reach the allowable error rate despite a 
     good faith effort by such State.
       ``(D) Subparagraphs (A) and (B) shall not apply to a State 
     for a fiscal year if there is an agreement described in 
     paragraph (2)(B) in effect as of the close of the fiscal year 
     that provides for the submission on a real-time basis of the 
     information described in such paragraph.
       ``(4) Nothing in this subsection shall affect the rights of 
     any individual under this title to appeal any disenrollment 
     from a State plan.''.
       (B) Costs of implementing and maintaining system.--Section 
     1903(a)(3) (42 U.S.C. 1396b(a)(3)) is amended--
       (i) by striking ``plus'' at the end of subparagraph (E) and 
     inserting ``and'', and
       (ii) by adding at the end the following new subparagraph:
       ``(F)(i) 90 percent of the sums expended during the quarter 
     as are attributable to the design, development, or 
     installation of such mechanized verification and information 
     retrieval systems as the Secretary determines are necessary 
     to implement section 1902(ee) (including a system described 
     in paragraph (2)(B) thereof), and
       ``(ii) 75 percent of the sums expended during the quarter 
     as are attributable to the operation of systems to which 
     clause (i) applies, plus''.
       (2) Limitation on waiver authority.--Notwithstanding any 
     provision of section 1115 of the Social Security Act (42 
     U.S.C. 1315), or any other provision of law, the Secretary

[[Page 715]]

     may not waive the requirements of section 1902(a)(46)(B) of 
     such Act (42 U.S.C. 1396a(a)(46)(B)) with respect to a State.
       (3) Conforming amendments.--Section 1903 (42 U.S.C. 1396b) 
     is amended--
       (A) in subsection (i)(22), by striking ``subsection (x)'' 
     and inserting ``section 1902(a)(46)(B)''; and
       (B) in subsection (x)(1), by striking ``subsection 
     (i)(22)'' and inserting ``section 1902(a)(46)(B)(i)''.
       (4) Appropriation.--Out of any money in the Treasury of the 
     United States not otherwise appropriated, there are 
     appropriated to the Commissioner of Social Security 
     $5,000,000 to remain available until expended to carry out 
     the Commissioner's responsibilities under section 1902(ee) of 
     the Social Security Act, as added by subsection (a).
       (b) Clarification of Requirements Relating to Presentation 
     of Satisfactory Documentary Evidence of Citizenship or 
     Nationality.--
       (1) Acceptance of documentary evidence issued by a 
     federally recognized indian tribe.--Section 1903(x)(3)(B) (42 
     U.S.C. 1396b(x)(3)(B)) is amended--
       (A) by redesignating clause (v) as clause (vi); and
       (B) by inserting after clause (iv), the following new 
     clause:
       ``(v)(I) Except as provided in subclause (II), a document 
     issued by a federally recognized Indian tribe evidencing 
     membership or enrollment in, or affiliation with, such tribe 
     (such as a tribal enrollment card or certificate of degree of 
     Indian blood).
       ``(II) With respect to those federally recognized Indian 
     tribes located within States having an international border 
     whose membership includes individuals who are not citizens of 
     the United States, the Secretary shall, after consulting with 
     such tribes, issue regulations authorizing the presentation 
     of such other forms of documentation (including tribal 
     documentation, if appropriate) that the Secretary determines 
     to be satisfactory documentary evidence of citizenship or 
     nationality for purposes of satisfying the requirement of 
     this subsection.''.
       (2) Requirement to provide reasonable opportunity to 
     present satisfactory documentary evidence.--Section 1903(x) 
     (42 U.S.C. 1396b(x)) is amended by adding at the end the 
     following new paragraph:
       ``(4) In the case of an individual declaring to be a 
     citizen or national of the United States with respect to whom 
     a State requires the presentation of satisfactory documentary 
     evidence of citizenship or nationality under section 
     1902(a)(46)(B)(i), the individual shall be provided at least 
     the reasonable opportunity to present satisfactory 
     documentary evidence of citizenship or nationality under this 
     subsection as is provided under clauses (i) and (ii) of 
     section 1137(d)(4)(A) to an individual for the submittal to 
     the State of evidence indicating a satisfactory immigration 
     status.''.
       (3) Children born in the united states to mothers eligible 
     for medicaid.--
       (A) Clarification of rules.--Section 1903(x) (42 U.S.C. 
     1396b(x)), as amended by paragraph (2), is amended--
       (i) in paragraph (2)--

       (I) in subparagraph (C), by striking ``or'' at the end;
       (II) by redesignating subparagraph (D) as subparagraph (E); 
     and
       (III) by inserting after subparagraph (C) the following new 
     subparagraph:

       ``(D) pursuant to the application of section 1902(e)(4) 
     (and, in the case of an individual who is eligible for 
     medical assistance on such basis, the individual shall be 
     deemed to have provided satisfactory documentary evidence of 
     citizenship or nationality and shall not be required to 
     provide further documentary evidence on any date that occurs 
     during or after the period in which the individual is 
     eligible for medical assistance on such basis); or''; and
       (ii) by adding at the end the following new paragraph:
       ``(5) Nothing in subparagraph (A) or (B) of section 
     1902(a)(46), the preceding paragraphs of this subsection, or 
     the Deficit Reduction Act of 2005, including section 6036 of 
     such Act, shall be construed as changing the requirement of 
     section 1902(e)(4) that a child born in the United States to 
     an alien mother for whom medical assistance for the delivery 
     of such child is available as treatment of an emergency 
     medical condition pursuant to subsection (v) shall be deemed 
     eligible for medical assistance during the first year of such 
     child's life.''.
       (B) State requirement to issue separate identification 
     number.--Section 1902(e)(4) (42 U.S.C. 1396a(e)(4)) is 
     amended by adding at the end the following new sentence: 
     ``Notwithstanding the preceding sentence, in the case of a 
     child who is born in the United States to an alien mother for 
     whom medical assistance for the delivery of the child is made 
     available pursuant to section 1903(v), the State immediately 
     shall issue a separate identification number for the child 
     upon notification by the facility at which such delivery 
     occurred of the child's birth.''.
       (4) Technical amendments.--Section 1903(x)(2) (42 U.S.C. 
     1396b(x)) is amended--
       (A) in subparagraph (B)--
       (i) by realigning the left margin of the matter preceding 
     clause (i) 2 ems to the left; and
       (ii) by realigning the left margins of clauses (i) and 
     (ii), respectively, 2 ems to the left; and
       (B) in subparagraph (C)--
       (i) by realigning the left margin of the matter preceding 
     clause (i) 2 ems to the left; and
       (ii) by realigning the left margins of clauses (i) and 
     (ii), respectively, 2 ems to the left.
       (c) Application of Documentation System to CHIP.--
       (1) In general.--Section 2105(c) (42 U.S.C. 1397ee(c)), as 
     amended by section 114(a), is amended by adding at the end 
     the following new paragraph:
       ``(9) Citizenship documentation requirements.--
       ``(A) In general.--No payment may be made under this 
     section with respect to an individual who has, or is, 
     declared to be a citizen or national of the United States for 
     purposes of establishing eligibility under this title unless 
     the State meets the requirements of section 1902(a)(46)(B) 
     with respect to the individual.
       ``(B) Enhanced payments.--Notwithstanding subsection (b), 
     the enhanced FMAP with respect to payments under subsection 
     (a) for expenditures described in clause (i) or (ii) of 
     section 1903(a)(3)(F) necessary to comply with subparagraph 
     (A) shall in no event be less than 90 percent and 75 percent, 
     respectively.''.
       (2) Nonapplication of administrative expenditures cap.--
     Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)(C)), as amended 
     by section 202(b), is amended by adding at the end the 
     following:
       ``(ii) Expenditures to comply with citizenship or 
     nationality verification requirements.--Expenditures 
     necessary for the State to comply with paragraph (9)(A).''.
       (d) Effective Date.--
       (1) In general.--
       (A) In general.--Except as provided in subparagraph (B), 
     the amendments made by this section shall take effect on 
     October 1, 2009.
       (B) Technical amendments.--The amendments made by--
       (i) paragraphs (1), (2), and (3) of subsection (b) shall 
     take effect as if included in the enactment of section 6036 
     of the Deficit Reduction Act of 2005 (Public Law 109-171; 120 
     Stat. 80); and
       (ii) paragraph (4) of subsection (b) shall take effect as 
     if included in the enactment of section 405 of division B of 
     the Tax Relief and Health Care Act of 2006 (Public Law 109-
     432; 120 Stat. 2996).
       (2) Restoration of eligibility.--In the case of an 
     individual who, during the period that began on July 1, 2006, 
     and ends on October 1, 2009, was determined to be ineligible 
     for medical assistance under a State Medicaid plan, including 
     any waiver of such plan, solely as a result of the 
     application of subsections (i)(22) and (x) of section 1903 of 
     the Social Security Act (as in effect during such period), 
     but who would have been determined eligible for such 
     assistance if such subsections, as amended by subsection (b), 
     had applied to the individual, a State may deem the 
     individual to be eligible for such assistance as of the date 
     that the individual was determined to be ineligible for such 
     medical assistance on such basis.
       (3) Special transition rule for indians.--During the period 
     that begins on July 1, 2006, and ends on the effective date 
     of final regulations issued under subclause (II) of section 
     1903(x)(3)(B)(v) of the Social Security Act (42 U.S.C. 
     1396b(x)(3)(B)(v)) (as added by subsection (b)(1)(B)), an 
     individual who is a member of a federally-recognized Indian 
     tribe described in subclause (II) of that section who 
     presents a document described in subclause (I) of such 
     section that is issued by such Indian tribe, shall be deemed 
     to have presented satisfactory evidence of citizenship or 
     nationality for purposes of satisfying the requirement of 
     subsection (x) of section 1903 of such Act.

     SEC. 212. REDUCING ADMINISTRATIVE BARRIERS TO ENROLLMENT.

       Section 2102(b) (42 U.S.C. 1397bb(b)) is amended--
       (1) by redesignating paragraph (4) as paragraph (5); and
       (2) by inserting after paragraph (3) the following new 
     paragraph:
       ``(4) Reduction of administrative barriers to enrollment.--
       ``(A) In general.--Subject to subparagraph (B), the plan 
     shall include a description of the procedures used to reduce 
     administrative barriers to the enrollment of children and 
     pregnant women who are eligible for medical assistance under 
     title XIX or for child health assistance or health benefits 
     coverage under this title. Such procedures shall be 
     established and revised as often as the State determines 
     appropriate to take into account the most recent information 
     available to the State identifying such barriers.
       ``(B) Deemed compliance if joint application and renewal 
     process that permits application other than in person.--A 
     State shall be deemed to comply with subparagraph (A) if the 
     State's application and renewal forms and supplemental forms 
     (if any) and information verification process is the same for 
     purposes of establishing and renewing eligibility for 
     children and pregnant women for medical assistance under 
     title XIX and child health assistance under this

[[Page 716]]

     title, and such process does not require an application to be 
     made in person or a face-to-face interview.''.

     SEC. 213. MODEL OF INTERSTATE COORDINATED ENROLLMENT AND 
                   COVERAGE PROCESS.

       (a) In General.--In order to assure continuity of coverage 
     of low-income children under the Medicaid program and the 
     State Children's Health Insurance Program (CHIP), not later 
     than 18 months after the date of the enactment of this Act, 
     the Secretary of Health and Human Services, in consultation 
     with State Medicaid and CHIP directors and organizations 
     representing program beneficiaries, shall develop a model 
     process for the coordination of the enrollment, retention, 
     and coverage under such programs of children who, because of 
     migration of families, emergency evacuations, natural or 
     other disasters, public health emergencies, educational 
     needs, or otherwise, frequently change their State of 
     residency or otherwise are temporarily located outside of the 
     State of their residency.
       (b) Report to Congress.--After development of such model 
     process, the Secretary of Health and Human Services shall 
     submit to Congress a report describing additional steps or 
     authority needed to make further improvements to coordinate 
     the enrollment, retention, and coverage under CHIP and 
     Medicaid of children described in subsection (a).

     SEC. 214. PERMITTING STATES TO ENSURE COVERAGE WITHOUT A 5-
                   YEAR DELAY OF CERTAIN CHILDREN AND PREGNANT 
                   WOMEN UNDER THE MEDICAID PROGRAM AND CHIP.

       (a) Purpose.--In order to promote the health of needy 
     children and pregnant women residing lawfully in the United 
     States, States should be permitted to waive certain 
     restrictions which result in a 5-year delay for coverage of 
     necessary health services for such children and women under 
     the Medicaid program and CHIP.
       (b) Medicaid Program.--Section 1903(v) of the Social 
     Security Act (42 U.S.C. 1396b(v)) is amended--
       (1) in paragraph (1), by striking ``paragraph (2)'' and 
     inserting ``paragraphs (2) and (4)''; and
       (2) by adding at the end the following new paragraph:
       ``(4)(A) A State may elect (in a plan amendment under this 
     title) to provide, notwithstanding sections 401(a), 402(b), 
     403, and 421 of Public Law 104-193, medical assistance under 
     a State plan under this title to children and pregnant women 
     who are lawfully residing in the United States (including 
     battered individuals described in section 431(c) of such Act) 
     and are otherwise eligible for such assistance.
       ``(B) Such election may be made only with respect to either 
     or both of the following categories of individuals:
       ``(i) Children.
       ``(ii) Pregnant women.
       ``(C) In this paragraph:
       ``(i) The term `pregnant women' means women during 
     pregnancy (and during the 60-day period beginning on the last 
     day of the pregnancy).
       ``(ii) The term `children' means individuals under age 19 
     (or such higher age as the State has elected under section 
     1902(l)(1)(D)), including optional targeted low-income 
     children described in section 1905(u)(2)(B).''.
       (c) CHIP.--Section 2107(e)(1) of such Act (42 U.S.C. 
     1397gg(e)(1)), as amended by section 203(a)(2) and 203(d)(2), 
     is amended by redesignating subparagraphs (E) and (F) as 
     subparagraphs (F) and (G), respectively and by inserting 
     after subparagraph (D) the following new subparagraph:
       ``(E) Paragraph (4) of section 1903(v), insofar as it 
     relates to the category of children or pregnant women (as 
     such terms are defined in such paragraph), but only if the 
     State has elected to apply such paragraph with respect to 
     such category of children or pregnant women under title XIX 
     and only if, in the case of pregnant women, the State has 
     elected the option under section 2111 to provide assistance 
     for pregnant women under this title.''.
       (d) Conforming Amendment.--Section 423(d)(1) of Public Law 
     104-193 is amended by inserting before the period the 
     following: ``and medical or child health assistance furnished 
     under section 1903(v)(4) or 2107(e)(1)(E), respectively, of 
     the Social Security Act''.
       (e) Effective Date.--The amendments made by this section 
     take effect on the date of the enactment of this Act.

      TITLE III--REDUCING BARRIERS TO PROVIDING PREMIUM ASSISTANCE

  Subtitle A--Additional State Option for Providing Premium Assistance

     SEC. 301. ADDITIONAL STATE OPTION FOR PROVIDING PREMIUM 
                   ASSISTANCE.

       (a) CHIP.--
       (1) In general.--Section 2105(c) (42 U.S.C. 1397ee(c)), as 
     amended by sections 114(a) and 211(c), is amended by adding 
     at the end the following:
       ``(10) State option to offer premium assistance.--
       ``(A) In general.--A State may elect to offer a premium 
     assistance subsidy (as defined in subparagraph (C)) for 
     qualified employer-sponsored coverage (as defined in 
     subparagraph (B)) to all targeted low-income children who are 
     eligible for child health assistance under the plan and have 
     access to such coverage in accordance with the requirements 
     of this paragraph. No subsidy shall be provided to a targeted 
     low-income child under this paragraph unless the child (or 
     the child's parent) voluntarily elects to receive such a 
     subsidy. A State may not require such an election as a 
     condition of receipt of child health assistance.
       ``(B) Qualified employer-sponsored coverage.--
       ``(i) In general.--Subject to clause (ii), in this 
     paragraph, the term `qualified employer-sponsored coverage' 
     means a group health plan or health insurance coverage 
     offered through an employer--

       ``(I) that qualifies as creditable coverage as a group 
     health plan under section 2701(c)(1) of the Public Health 
     Service Act;
       ``(II) for which the employer contribution toward any 
     premium for such coverage is at least 40 percent; and
       ``(III) that is offered to all individuals in a manner that 
     would be considered a nondiscriminatory eligibility 
     classification for purposes of paragraph (3)(A)(ii) of 
     section 105(h) of the Internal Revenue Code of 1986 (but 
     determined without regard to clause (i) of subparagraph (B) 
     of such paragraph).

       ``(ii) Exception.--Such term does not include coverage 
     consisting of--

       ``(I) benefits provided under a health flexible spending 
     arrangement (as defined in section 106(c)(2) of the Internal 
     Revenue Code of 1986); or
       ``(II) a high deductible health plan (as defined in section 
     223(c)(2) of such Code), without regard to whether the plan 
     is purchased in conjunction with a health savings account (as 
     defined under section 223(d) of such Code).

       ``(C) Premium assistance subsidy.--
       ``(i) In general.--In this paragraph, the term `premium 
     assistance subsidy' means, with respect to a targeted low-
     income child, the amount equal to the difference between the 
     employee contribution required for enrollment only of the 
     employee under qualified employer-sponsored coverage and the 
     employee contribution required for enrollment of the employee 
     and the child in such coverage, less any applicable premium 
     cost-sharing applied under the State child health plan 
     (subject to the limitations imposed under section 2103(e), 
     including the requirement to count the total amount of the 
     employee contribution required for enrollment of the employee 
     and the child in such coverage toward the annual aggregate 
     cost-sharing limit applied under paragraph (3)(B) of such 
     section).
       ``(ii) State payment option.--A State may provide a premium 
     assistance subsidy either as reimbursement to an employee for 
     out-of-pocket expenditures or, subject to clause (iii), 
     directly to the employee's employer.
       ``(iii) Employer opt-out.--An employer may notify a State 
     that it elects to opt-out of being directly paid a premium 
     assistance subsidy on behalf of an employee. In the event of 
     such a notification, an employer shall withhold the total 
     amount of the employee contribution required for enrollment 
     of the employee and the child in the qualified employer-
     sponsored coverage and the State shall pay the premium 
     assistance subsidy directly to the employee.
       ``(iv) Treatment as child health assistance.--Expenditures 
     for the provision of premium assistance subsidies shall be 
     considered child health assistance described in paragraph 
     (1)(C) of subsection (a) for purposes of making payments 
     under that subsection.
       ``(D) Application of secondary payor rules.--The State 
     shall be a secondary payor for any items or services provided 
     under the qualified employer-sponsored coverage for which the 
     State provides child health assistance under the State child 
     health plan.
       ``(E) Requirement to provide supplemental coverage for 
     benefits and cost-sharing protection provided under the state 
     child health plan.--
       ``(i) In general.--Notwithstanding section 2110(b)(1)(C), 
     the State shall provide for each targeted low-income child 
     enrolled in qualified employer-sponsored coverage, 
     supplemental coverage consisting of--

       ``(I) items or services that are not covered, or are only 
     partially covered, under the qualified employer-sponsored 
     coverage; and
       ``(II) cost-sharing protection consistent with section 
     2103(e).

       ``(ii) Record keeping requirements.--For purposes of 
     carrying out clause (i), a State may elect to directly pay 
     out-of-pocket expenditures for cost-sharing imposed under the 
     qualified employer-sponsored coverage and collect or not 
     collect all or any portion of such expenditures from the 
     parent of the child.
       ``(F) Application of waiting period imposed under the 
     state.--Any waiting period imposed under the State child 
     health plan prior to the provision of child health assistance 
     to a targeted low-income child under the State plan shall 
     apply to the same extent to the provision of a premium 
     assistance subsidy for the child under this paragraph.
       ``(G) Opt-out permitted for any month.--A State shall 
     establish a process for permitting the parent of a targeted 
     low-income child receiving a premium assistance subsidy to 
     disenroll the child from the qualified employer-sponsored 
     coverage and enroll the child in, and receive child health 
     assistance under, the State child health plan, effective

[[Page 717]]

     on the first day of any month for which the child is eligible 
     for such assistance and in a manner that ensures continuity 
     of coverage for the child.
       ``(H) Application to parents.--If a State provides child 
     health assistance or health benefits coverage to parents of a 
     targeted low-income child in accordance with section 2111(b), 
     the State may elect to offer a premium assistance subsidy to 
     a parent of a targeted low-income child who is eligible for 
     such a subsidy under this paragraph in the same manner as the 
     State offers such a subsidy for the enrollment of the child 
     in qualified employer-sponsored coverage, except that--
       ``(i) the amount of the premium assistance subsidy shall be 
     increased to take into account the cost of the enrollment of 
     the parent in the qualified employer-sponsored coverage or, 
     at the option of the State if the State determines it cost-
     effective, the cost of the enrollment of the child's family 
     in such coverage; and
       ``(ii) any reference in this paragraph to a child is deemed 
     to include a reference to the parent or, if applicable under 
     clause (i), the family of the child.
       ``(I) Additional state option for providing premium 
     assistance.--
       ``(i) In general.--A State may establish an employer-family 
     premium assistance purchasing pool for employers with less 
     than 250 employees who have at least 1 employee who is a 
     pregnant woman eligible for assistance under the State child 
     health plan (including through the application of an option 
     described in section 2112(f)) or a member of a family with at 
     least 1 targeted low-income child and to provide a premium 
     assistance subsidy under this paragraph for enrollment in 
     coverage made available through such pool.
       ``(ii) Access to choice of coverage.--A State that elects 
     the option under clause (i) shall identify and offer access 
     to not less than 2 private health plans that are health 
     benefits coverage that is equivalent to the benefits coverage 
     in a benchmark benefit package described in section 2103(b) 
     or benchmark-equivalent coverage that meets the requirements 
     of section 2103(a)(2) for employees described in clause (i).
       ``(iii) Clarification of payment for administrative 
     expenditures.--Nothing in this subparagraph shall be 
     construed as permitting payment under this section for 
     administrative expenditures attributable to the establishment 
     or operation of such pool, except to the extent that such 
     payment would otherwise be permitted under this title.
       ``(J) No effect on premium assistance waiver programs.--
     Nothing in this paragraph shall be construed as limiting the 
     authority of a State to offer premium assistance under 
     section 1906 or 1906A, a waiver described in paragraph (2)(B) 
     or (3), a waiver approved under section 1115, or other 
     authority in effect prior to the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2009.
       ``(K) Notice of availability.--If a State elects to provide 
     premium assistance subsidies in accordance with this 
     paragraph, the State shall--
       ``(i) include on any application or enrollment form for 
     child health assistance a notice of the availability of 
     premium assistance subsidies for the enrollment of targeted 
     low-income children in qualified employer-sponsored coverage;
       ``(ii) provide, as part of the application and enrollment 
     process under the State child health plan, information 
     describing the availability of such subsidies and how to 
     elect to obtain such a subsidy; and
       ``(iii) establish such other procedures as the State 
     determines necessary to ensure that parents are fully 
     informed of the choices for receiving child health assistance 
     under the State child health plan or through the receipt of 
     premium assistance subsidies.
       ``(L) Application to qualified employer-sponsored benchmark 
     coverage.--If a group health plan or health insurance 
     coverage offered through an employer is certified by an 
     actuary as health benefits coverage that is equivalent to the 
     benefits coverage in a benchmark benefit package described in 
     section 2103(b) or benchmark-equivalent coverage that meets 
     the requirements of section 2103(a)(2), the State may provide 
     premium assistance subsidies for enrollment of targeted low-
     income children in such group health plan or health insurance 
     coverage in the same manner as such subsidies are provided 
     under this paragraph for enrollment in qualified employer-
     sponsored coverage, but without regard to the requirement to 
     provide supplemental coverage for benefits and cost-sharing 
     protection provided under the State child health plan under 
     subparagraph (E).
       ``(M) Satisfaction of cost-effectiveness test.--Premium 
     assistance subsidies for qualified employer-sponsored 
     coverage offered under this paragraph shall be deemed to meet 
     the requirement of subparagraph (A) of paragraph (3).''.
       (2) Determination of cost-effectiveness for premium 
     assistance or purchase of family coverage.--
       (A) In general.--Section 2105(c)(3)(A) (42 U.S.C. 
     1397ee(c)(3)(A)) is amended by striking ``relative to'' and 
     all that follows through the comma and inserting ``relative 
     to
       ``(i) the amount of expenditures under the State child 
     health plan, including administrative expenditures, that the 
     State would have made to provide comparable coverage of the 
     targeted low-income child involved or the family involved (as 
     applicable); or
       ``(ii) the aggregate amount of expenditures that the State 
     would have made under the State child health plan, including 
     administrative expenditures, for providing coverage under 
     such plan for all such children or families.''.
       (B) Nonapplication to previously approved coverage.--The 
     amendment made by subparagraph (A) shall not apply to 
     coverage the purchase of which has been approved by the 
     Secretary under section 2105(c)(3) of the Social Security Act 
     prior to the date of enactment of this Act.
       (b) Medicaid.--Title XIX is amended by inserting after 
     section 1906 the following new section:


                ``premium assistance option for children

       ``Sec. 1906A.  (a) In General.--A State may elect to offer 
     a premium assistance subsidy (as defined in subsection (c)) 
     for qualified employer-sponsored coverage (as defined in 
     subsection (b)) to all individuals under age 19 who are 
     entitled to medical assistance under this title (and to the 
     parent of such an individual) who have access to such 
     coverage if the State meets the requirements of this section.
       ``(b) Qualified Employer-Sponsored Coverage.--
       ``(1) In general.--Subject to paragraph (2)), in this 
     paragraph, the term `qualified employer-sponsored coverage' 
     means a group health plan or health insurance coverage 
     offered through an employer--
       ``(A) that qualifies as creditable coverage as a group 
     health plan under section 2701(c)(1) of the Public Health 
     Service Act;
       ``(B) for which the employer contribution toward any 
     premium for such coverage is at least 40 percent; and
       ``(C) that is offered to all individuals in a manner that 
     would be considered a nondiscriminatory eligibility 
     classification for purposes of paragraph (3)(A)(ii) of 
     section 105(h) of the Internal Revenue Code of 1986 (but 
     determined without regard to clause (i) of subparagraph (B) 
     of such paragraph).
       ``(2) Exception.--Such term does not include coverage 
     consisting of--
       ``(A) benefits provided under a health flexible spending 
     arrangement (as defined in section 106(c)(2) of the Internal 
     Revenue Code of 1986); or
       ``(B) a high deductible health plan (as defined in section 
     223(c)(2) of such Code), without regard to whether the plan 
     is purchased in conjunction with a health savings account (as 
     defined under section 223(d) of such Code).
       ``(3) Treatment as third party liability.--The State shall 
     treat the coverage provided under qualified employer-
     sponsored coverage as a third party liability under section 
     1902(a)(25).
       ``(c) Premium Assistance Subsidy.--In this section, the 
     term `premium assistance subsidy' means the amount of the 
     employee contribution for enrollment in the qualified 
     employer-sponsored coverage by the individual under age 19 or 
     by the individual's family. Premium assistance subsidies 
     under this section shall be considered, for purposes of 
     section 1903(a), to be a payment for medical assistance.
       ``(d) Voluntary Participation.--
       ``(1) Employers.--Participation by an employer in a premium 
     assistance subsidy offered by a State under this section 
     shall be voluntary. An employer may notify a State that it 
     elects to opt-out of being directly paid a premium assistance 
     subsidy on behalf of an employee.
       ``(2) Beneficiaries.--No subsidy shall be provided to an 
     individual under age 19 under this section unless the 
     individual (or the individual's parent) voluntarily elects to 
     receive such a subsidy. A State may not require such an 
     election as a condition of receipt of medical assistance. 
     State may not require, as a condition of an individual under 
     age 19 (or the individual's parent) being or remaining 
     eligible for medical assistance under this title, apply for 
     enrollment in qualified employer-sponsored coverage under 
     this section.
       ``(3) Opt-out permitted for any month.--A State shall 
     establish a process for permitting the parent of an 
     individual under age 19 receiving a premium assistance 
     subsidy to disenroll the individual from the qualified 
     employer-sponsored coverage.
       ``(e) Requirement To Pay Premiums and Cost-Sharing and 
     Provide Supplemental Coverage.--In the case of the 
     participation of an individual under age 19 (or the 
     individual's parent) in a premium assistance subsidy under 
     this section for qualified employer-sponsored coverage, the 
     State shall provide for payment of all enrollee premiums for 
     enrollment in such coverage and all deductibles, coinsurance, 
     and other cost-sharing obligations for items and services 
     otherwise covered under the State plan under this title 
     (exceeding the amount otherwise permitted under section 1916 
     or, if applicable, section 1916A). The fact that an 
     individual under age 19 (or a parent) elects to enroll in 
     qualified employer-sponsored coverage under this section 
     shall not change the individual's (or parent's) eligibility 
     for medical assistance under the State plan, except insofar 
     as section 1902(a)(25) provides that

[[Page 718]]

     payments for such assistance shall first be made under such 
     coverage.''.
       (c) GAO Study and Report.--Not later than January 1, 2010, 
     the Comptroller General of the United States shall study cost 
     and coverage issues relating to any State premium assistance 
     programs for which Federal matching payments are made under 
     title XIX or XXI of the Social Security Act, including under 
     waiver authority, and shall submit a report to the Committee 
     on Finance of the Senate and the Committee on Energy and 
     Commerce of the House of Representatives on the results of 
     such study.

     SEC. 302. OUTREACH, EDUCATION, AND ENROLLMENT ASSISTANCE.

       (a) Requirement To Include Description of Outreach, 
     Education, and Enrollment Efforts Related to Premium 
     Assistance Subsidies in State Child Health Plan.--Section 
     2102(c) (42 U.S.C. 1397bb(c)) is amended by adding at the end 
     the following new paragraph:
       ``(3) Premium assistance subsidies.--In the case of a State 
     that provides for premium assistance subsidies under the 
     State child health plan in accordance with paragraph (2)(B), 
     (3), or (10) of section 2105(c), or a waiver approved under 
     section 1115, outreach, education, and enrollment assistance 
     for families of children likely to be eligible for such 
     subsidies, to inform such families of the availability of, 
     and to assist them in enrolling their children in, such 
     subsidies, and for employers likely to provide coverage that 
     is eligible for such subsidies, including the specific, 
     significant resources the State intends to apply to educate 
     employers about the availability of premium assistance 
     subsidies under the State child health plan.''.
       (b) Nonapplication of 10 Percent Limit on Outreach and 
     Certain Other Expenditures.--Section 2105(c)(2)(C) (42 U.S.C. 
     1397ee(c)(2)(C)), as amended by section 211(c)(2), is amended 
     by adding at the end the following new clause:
       ``(iii) Expenditures for outreach to increase the 
     enrollment of children under this title and title xix through 
     premium assistance subsidies.--Expenditures for outreach 
     activities to families of children likely to be eligible for 
     premium assistance subsidies in accordance with paragraph 
     (2)(B), (3), or (10), or a waiver approved under section 
     1115, to inform such families of the availability of, and to 
     assist them in enrolling their children in, such subsidies, 
     and to employers likely to provide qualified employer-
     sponsored coverage (as defined in subparagraph (B) of such 
     paragraph), but not to exceed an amount equal to 1.25 percent 
     of the maximum amount permitted to be expended under 
     subparagraph (A) for items described in subsection 
     (a)(1)(D).''.

   Subtitle B--Coordinating Premium Assistance With Private Coverage

     SEC. 311. SPECIAL ENROLLMENT PERIOD UNDER GROUP HEALTH PLANS 
                   IN CASE OF TERMINATION OF MEDICAID OR CHIP 
                   COVERAGE OR ELIGIBILITY FOR ASSISTANCE IN 
                   PURCHASE OF EMPLOYMENT-BASED COVERAGE; 
                   COORDINATION OF COVERAGE.

       (a) Amendments to Internal Revenue Code of 1986.--Section 
     9801(f) of the Internal Revenue Code of 1986 (relating to 
     special enrollment periods) is amended by adding at the end 
     the following new paragraph:
       ``(3) Special rules relating to medicaid and chip.--
       ``(A) In general.--A group health plan shall permit an 
     employee who is eligible, but not enrolled, for coverage 
     under the terms of the plan (or a dependent of such an 
     employee if the dependent is eligible, but not enrolled, for 
     coverage under such terms) to enroll for coverage under the 
     terms of the plan if either of the following conditions is 
     met:
       ``(i) Termination of medicaid or chip coverage.--The 
     employee or dependent is covered under a Medicaid plan under 
     title XIX of the Social Security Act or under a State child 
     health plan under title XXI of such Act and coverage of the 
     employee or dependent under such a plan is terminated as a 
     result of loss of eligibility for such coverage and the 
     employee requests coverage under the group health plan not 
     later than 60 days after the date of termination of such 
     coverage.
       ``(ii) Eligibility for employment assistance under medicaid 
     or chip.--The employee or dependent becomes eligible for 
     assistance, with respect to coverage under the group health 
     plan under such Medicaid plan or State child health plan 
     (including under any waiver or demonstration project 
     conducted under or in relation to such a plan), if the 
     employee requests coverage under the group health plan not 
     later than 60 days after the date the employee or dependent 
     is determined to be eligible for such assistance.
       ``(B) Employee outreach and disclosure.--
       ``(i) Outreach to employees regarding availability of 
     medicaid and chip coverage.--

       ``(I) In general.--Each employer that maintains a group 
     health plan in a State that provides medical assistance under 
     a State Medicaid plan under title XIX of the Social Security 
     Act, or child health assistance under a State child health 
     plan under title XXI of such Act, in the form of premium 
     assistance for the purchase of coverage under a group health 
     plan, shall provide to each employee a written notice 
     informing the employee of potential opportunities then 
     currently available in the State in which the employee 
     resides for premium assistance under such plans for health 
     coverage of the employee or the employee's dependents. For 
     purposes of compliance with this clause, the employer may use 
     any State-specific model notice developed in accordance with 
     section 701(f)(3)(B)(i)(II) of the Employee Retirement Income 
     Security Act of 1974 (29 U.S.C. 1181(f)(3)(B)(i)(II)).
       ``(II) Option to provide concurrent with provision of plan 
     materials to employee.--An employer may provide the model 
     notice applicable to the State in which an employee resides 
     concurrent with the furnishing of materials notifying the 
     employee of health plan eligibility, concurrent with 
     materials provided to the employee in connection with an open 
     season or election process conducted under the plan, or 
     concurrent with the furnishing of the summary plan 
     description as provided in section 104(b) of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1024).

       ``(ii) Disclosure about group health plan benefits to 
     states for medicaid and chip eligible individuals.--In the 
     case of a participant or beneficiary of a group health plan 
     who is covered under a Medicaid plan of a State under title 
     XIX of the Social Security Act or under a State child health 
     plan under title XXI of such Act, the plan administrator of 
     the group health plan shall disclose to the State, upon 
     request, information about the benefits available under the 
     group health plan in sufficient specificity, as determined 
     under regulations of the Secretary of Health and Human 
     Services in consultation with the Secretary that require use 
     of the model coverage coordination disclosure form developed 
     under section 311(b)(1)(C) of the Children's Health Insurance 
     Program Reauthorization Act of 2009, so as to permit the 
     State to make a determination (under paragraph (2)(B), (3), 
     or (10) of section 2105(c) of the Social Security Act or 
     otherwise) concerning the cost-effectiveness of the State 
     providing medical or child health assistance through premium 
     assistance for the purchase of coverage under such group 
     health plan and in order for the State to provide 
     supplemental benefits required under paragraph (10)(E) of 
     such section or other authority.''.
       (b) Conforming Amendments.--
       (1) Amendments to employee retirement income security 
     act.--
       (A) In general.--Section 701(f) of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1181(f)) is amended by 
     adding at the end the following new paragraph:
       ``(3) Special rules for application in case of medicaid and 
     chip.--
       ``(A) In general.--A group health plan, and a health 
     insurance issuer offering group health insurance coverage in 
     connection with a group health plan, shall permit an employee 
     who is eligible, but not enrolled, for coverage under the 
     terms of the plan (or a dependent of such an employee if the 
     dependent is eligible, but not enrolled, for coverage under 
     such terms) to enroll for coverage under the terms of the 
     plan if either of the following conditions is met:
       ``(i) Termination of medicaid or chip coverage.--The 
     employee or dependent is covered under a Medicaid plan under 
     title XIX of the Social Security Act or under a State child 
     health plan under title XXI of such Act and coverage of the 
     employee or dependent under such a plan is terminated as a 
     result of loss of eligibility for such coverage and the 
     employee requests coverage under the group health plan (or 
     health insurance coverage) not later than 60 days after the 
     date of termination of such coverage.
       ``(ii) Eligibility for employment assistance under medicaid 
     or chip.--The employee or dependent becomes eligible for 
     assistance, with respect to coverage under the group health 
     plan or health insurance coverage, under such Medicaid plan 
     or State child health plan (including under any waiver or 
     demonstration project conducted under or in relation to such 
     a plan), if the employee requests coverage under the group 
     health plan or health insurance coverage not later than 60 
     days after the date the employee or dependent is determined 
     to be eligible for such assistance.
       ``(B) Coordination with medicaid and chip.--
       ``(i) Outreach to employees regarding availability of 
     medicaid and chip coverage.--

       ``(I) In general.--Each employer that maintains a group 
     health plan in a State that provides medical assistance under 
     a State Medicaid plan under title XIX of the Social Security 
     Act, or child health assistance under a State child health 
     plan under title XXI of such Act, in the form of premium 
     assistance for the purchase of coverage under a group health 
     plan, shall provide to each employee a written notice 
     informing the employee of potential opportunities then 
     currently available in the State in which the employee 
     resides for premium assistance under such plans for health 
     coverage of the employee or the employee's dependents.
       ``(II) Model notice.--Not later than 1 year after the date 
     of enactment of the Children's Health Insurance Program 
     Reauthorization Act of 2009, the Secretary and the Secretary

[[Page 719]]

     of Health and Human Services, in consultation with Directors 
     of State Medicaid agencies under title XIX of the Social 
     Security Act and Directors of State CHIP agencies under title 
     XXI of such Act, shall jointly develop national and State-
     specific model notices for purposes of subparagraph (A). The 
     Secretary shall provide employers with such model notices so 
     as to enable employers to timely comply with the requirements 
     of subparagraph (A). Such model notices shall include 
     information regarding how an employee may contact the State 
     in which the employee resides for additional information 
     regarding potential opportunities for such premium 
     assistance, including how to apply for such assistance.
       ``(III) Option to provide concurrent with provision of plan 
     materials to employee.--An employer may provide the model 
     notice applicable to the State in which an employee resides 
     concurrent with the furnishing of materials notifying the 
     employee of health plan eligibility, concurrent with 
     materials provided to the employee in connection with an open 
     season or election process conducted under the plan, or 
     concurrent with the furnishing of the summary plan 
     description as provided in section 104(b).

       ``(ii) Disclosure about group health plan benefits to 
     states for medicaid and chip eligible individuals.--In the 
     case of a participant or beneficiary of a group health plan 
     who is covered under a Medicaid plan of a State under title 
     XIX of the Social Security Act or under a State child health 
     plan under title XXI of such Act, the plan administrator of 
     the group health plan shall disclose to the State, upon 
     request, information about the benefits available under the 
     group health plan in sufficient specificity, as determined 
     under regulations of the Secretary of Health and Human 
     Services in consultation with the Secretary that require use 
     of the model coverage coordination disclosure form developed 
     under section 311(b)(1)(C) of the Children's Health Insurance 
     Program Reauthorization Act of 2009, so as to permit the 
     State to make a determination (under paragraph (2)(B), (3), 
     or (10) of section 2105(c) of the Social Security Act or 
     otherwise) concerning the cost-effectiveness of the State 
     providing medical or child health assistance through premium 
     assistance for the purchase of coverage under such group 
     health plan and in order for the State to provide 
     supplemental benefits required under paragraph (10)(E) of 
     such section or other authority.''.
       (B) Conforming amendment.--Section 102(b) of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1022(b)) is 
     amended--
       (i) by striking ``and the remedies'' and inserting ``, the 
     remedies''; and
       (ii) by inserting before the period the following: ``, and 
     if the employer so elects for purposes of complying with 
     section 701(f)(3)(B)(i), the model notice applicable to the 
     State in which the participants and beneficiaries reside''.
       (C) Working group to develop model coverage coordination 
     disclosure form.--
       (i) Medicaid, chip, and employer-sponsored coverage 
     coordination working group.--

       (I) In general.--Not later than 60 days after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services and the Secretary of Labor shall jointly establish a 
     Medicaid, CHIP, and Employer-Sponsored Coverage Coordination 
     Working Group (in this subparagraph referred to as the 
     ``Working Group''). The purpose of the Working Group shall be 
     to develop the model coverage coordination disclosure form 
     described in subclause (II) and to identify the impediments 
     to the effective coordination of coverage available to 
     families that include employees of employers that maintain 
     group health plans and members who are eligible for medical 
     assistance under title XIX of the Social Security Act or 
     child health assistance or other health benefits coverage 
     under title XXI of such Act.
       (II) Model coverage coordination disclosure form 
     described.--The model form described in this subclause is a 
     form for plan administrators of group health plans to 
     complete for purposes of permitting a State to determine the 
     availability and cost-effectiveness of the coverage available 
     under such plans to employees who have family members who are 
     eligible for premium assistance offered under a State plan 
     under title XIX or XXI of such Act and to allow for 
     coordination of coverage for enrollees of such plans. Such 
     form shall provide the following information in addition to 
     such other information as the Working Group determines 
     appropriate:

       (aa) A determination of whether the employee is eligible 
     for coverage under the group health plan.
       (bb) The name and contract information of the plan 
     administrator of the group health plan.
       (cc) The benefits offered under the plan.
       (dd) The premiums and cost-sharing required under the plan.
       (ee) Any other information relevant to coverage under the 
     plan.
       (ii) Membership.--The Working Group shall consist of not 
     more than 30 members and shall be composed of representatives 
     of--

       (I) the Department of Labor;
       (II) the Department of Health and Human Services;
       (III) State directors of the Medicaid program under title 
     XIX of the Social Security Act;
       (IV) State directors of the State Children's Health 
     Insurance Program under title XXI of the Social Security Act;
       (V) employers, including owners of small businesses and 
     their trade or industry representatives and certified human 
     resource and payroll professionals;
       (VI) plan administrators and plan sponsors of group health 
     plans (as defined in section 607(1) of the Employee 
     Retirement Income Security Act of 1974);
       (VII) health insurance issuers; and
       (VIII) children and other beneficiaries of medical 
     assistance under title XIX of the Social Security Act or 
     child health assistance or other health benefits coverage 
     under title XXI of such Act.

       (iii) Compensation.--The members of the Working Group shall 
     serve without compensation.
       (iv) Administrative support.--The Department of Health and 
     Human Services and the Department of Labor shall jointly 
     provide appropriate administrative support to the Working 
     Group, including technical assistance. The Working Group may 
     use the services and facilities of either such Department, 
     with or without reimbursement, as jointly determined by such 
     Departments.
       (v) Report.--

       (I) Report by working group to the secretaries.--Not later 
     than 18 months after the date of the enactment of this Act, 
     the Working Group shall submit to the Secretary of Labor and 
     the Secretary of Health and Human Services the model form 
     described in clause (i)(II) along with a report containing 
     recommendations for appropriate measures to address the 
     impediments to the effective coordination of coverage between 
     group health plans and the State plans under titles XIX and 
     XXI of the Social Security Act.
       (II) Report by secretaries to the congress.--Not later than 
     2 months after receipt of the report pursuant to subclause 
     (I), the Secretaries shall jointly submit a report to each 
     House of the Congress regarding the recommendations contained 
     in the report under such subclause.

       (vi) Termination.--The Working Group shall terminate 30 
     days after the date of the issuance of its report under 
     clause (v).
       (D) Effective dates.--The Secretary of Labor and the 
     Secretary of Health and Human Services shall develop the 
     initial model notices under section 701(f)(3)(B)(i)(II) of 
     the Employee Retirement Income Security Act of 1974, and the 
     Secretary of Labor shall provide such notices to employers, 
     not later than the date that is 1 year after the date of 
     enactment of this Act, and each employer shall provide the 
     initial annual notices to such employer's employees beginning 
     with the first plan year that begins after the date on which 
     such initial model notices are first issued. The model 
     coverage coordination disclosure form developed under 
     subparagraph (C) shall apply with respect to requests made by 
     States beginning with the first plan year that begins after 
     the date on which such model coverage coordination disclosure 
     form is first issued.
       (E) Enforcement.--Section 502 of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1132) is amended--
       (i) in subsection (a)(6), by striking ``or (8)'' and 
     inserting ``(8), or (9)''; and
       (ii) in subsection (c), by redesignating paragraph (9) as 
     paragraph (10), and by inserting after paragraph (8) the 
     following:
       ``(9)(A) The Secretary may assess a civil penalty against 
     any employer of up to $100 a day from the date of the 
     employer's failure to meet the notice requirement of section 
     701(f)(3)(B)(i)(I). For purposes of this subparagraph, each 
     violation with respect to any single employee shall be 
     treated as a separate violation.
       ``(B) The Secretary may assess a civil penalty against any 
     plan administrator of up to $100 a day from the date of the 
     plan administrator's failure to timely provide to any State 
     the information required to be disclosed under section 
     701(f)(3)(B)(ii). For purposes of this subparagraph, each 
     violation with respect to any single participant or 
     beneficiary shall be treated as a separate violation.''.
       (2) Amendments to public health service act.--Section 
     2701(f) of the Public Health Service Act (42 U.S.C. 300gg(f)) 
     is amended by adding at the end the following new paragraph:
       ``(3) Special rules for application in case of medicaid and 
     chip.--
       ``(A) In general.--A group health plan, and a health 
     insurance issuer offering group health insurance coverage in 
     connection with a group health plan, shall permit an employee 
     who is eligible, but not enrolled, for coverage under the 
     terms of the plan (or a dependent of such an employee if the 
     dependent is eligible, but not enrolled, for coverage under 
     such terms) to enroll for coverage under the terms of the 
     plan if either of the following conditions is met:
       ``(i) Termination of medicaid or chip coverage.--The 
     employee or dependent is covered under a Medicaid plan under 
     title XIX of the Social Security Act or under a State child 
     health plan under title XXI of such Act

[[Page 720]]

     and coverage of the employee or dependent under such a plan 
     is terminated as a result of loss of eligibility for such 
     coverage and the employee requests coverage under the group 
     health plan (or health insurance coverage) not later than 60 
     days after the date of termination of such coverage.
       ``(ii) Eligibility for employment assistance under medicaid 
     or chip.--The employee or dependent becomes eligible for 
     assistance, with respect to coverage under the group health 
     plan or health insurance coverage, under such Medicaid plan 
     or State child health plan (including under any waiver or 
     demonstration project conducted under or in relation to such 
     a plan), if the employee requests coverage under the group 
     health plan or health insurance coverage not later than 60 
     days after the date the employee or dependent is determined 
     to be eligible for such assistance.
       ``(B) Coordination with medicaid and chip.--
       ``(i) Outreach to employees regarding availability of 
     medicaid and chip coverage.--

       ``(I) In general.--Each employer that maintains a group 
     health plan in a State that provides medical assistance under 
     a State Medicaid plan under title XIX of the Social Security 
     Act, or child health assistance under a State child health 
     plan under title XXI of such Act, in the form of premium 
     assistance for the purchase of coverage under a group health 
     plan, shall provide to each employee a written notice 
     informing the employee of potential opportunities then 
     currently available in the State in which the employee 
     resides for premium assistance under such plans for health 
     coverage of the employee or the employee's dependents. For 
     purposes of compliance with this subclause, the employer may 
     use any State-specific model notice developed in accordance 
     with section 701(f)(3)(B)(i)(II) of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1181(f)(3)(B)(i)(II)).
       ``(II) Option to provide concurrent with provision of plan 
     materials to employee.--An employer may provide the model 
     notice applicable to the State in which an employee resides 
     concurrent with the furnishing of materials notifying the 
     employee of health plan eligibility, concurrent with 
     materials provided to the employee in connection with an open 
     season or election process conducted under the plan, or 
     concurrent with the furnishing of the summary plan 
     description as provided in section 104(b) of the Employee 
     Retirement Income Security Act of 1974.

       ``(ii) Disclosure about group health plan benefits to 
     states for medicaid and chip eligible individuals.--In the 
     case of an enrollee in a group health plan who is covered 
     under a Medicaid plan of a State under title XIX of the 
     Social Security Act or under a State child health plan under 
     title XXI of such Act, the plan administrator of the group 
     health plan shall disclose to the State, upon request, 
     information about the benefits available under the group 
     health plan in sufficient specificity, as determined under 
     regulations of the Secretary of Health and Human Services in 
     consultation with the Secretary that require use of the model 
     coverage coordination disclosure form developed under section 
     311(b)(1)(C) of the Children's Health Insurance 
     Reauthorization Act of 2009, so as to permit the State to 
     make a determination (under paragraph (2)(B), (3), or (10) of 
     section 2105(c) of the Social Security Act or otherwise) 
     concerning the cost-effectiveness of the State providing 
     medical or child health assistance through premium assistance 
     for the purchase of coverage under such group health plan and 
     in order for the State to provide supplemental benefits 
     required under paragraph (10)(E) of such section or other 
     authority.''.

      TITLE IV--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES

     SEC. 401. CHILD HEALTH QUALITY IMPROVEMENT ACTIVITIES FOR 
                   CHILDREN ENROLLED IN MEDICAID OR CHIP.

       (a) Development of Child Health Quality Measures for 
     Children Enrolled in Medicaid or Chip.--Title XI (42 U.S.C. 
     1301 et seq.) is amended by inserting after section 1139 the 
     following new section:

     ``SEC. 1139A. CHILD HEALTH QUALITY MEASURES.

       ``(a) Development of an Initial Core Set of Health Care 
     Quality Measures for Children Enrolled in Medicaid or Chip.--
       ``(1) In general.--Not later than January 1, 2010, the 
     Secretary shall identify and publish for general comment an 
     initial, recommended core set of child health quality 
     measures for use by State programs administered under titles 
     XIX and XXI, health insurance issuers and managed care 
     entities that enter into contracts with such programs, and 
     providers of items and services under such programs.
       ``(2) Identification of initial core measures.--In 
     consultation with the individuals and entities described in 
     subsection (b)(3), the Secretary shall identify existing 
     quality of care measures for children that are in use under 
     public and privately sponsored health care coverage 
     arrangements, or that are part of reporting systems that 
     measure both the presence and duration of health insurance 
     coverage over time.
       ``(3) Recommendations and dissemination.--Based on such 
     existing and identified measures, the Secretary shall publish 
     an initial core set of child health quality measures that 
     includes (but is not limited to) the following:
       ``(A) The duration of children's health insurance coverage 
     over a 12-month time period.
       ``(B) The availability and effectiveness of a full range 
     of--
       ``(i) preventive services, treatments, and services for 
     acute conditions, including services to promote healthy 
     birth, prevent and treat premature birth, and detect the 
     presence or risk of physical or mental conditions that could 
     adversely affect growth and development; and
       ``(ii) treatments to correct or ameliorate the effects of 
     physical and mental conditions, including chronic conditions, 
     in infants, young children, school-age children, and 
     adolescents.
       ``(C) The availability of care in a range of ambulatory and 
     inpatient health care settings in which such care is 
     furnished.
       ``(D) The types of measures that, taken together, can be 
     used to estimate the overall national quality of health care 
     for children, including children with special needs, and to 
     perform comparative analyses of pediatric health care quality 
     and racial, ethnic, and socioeconomic disparities in child 
     health and health care for children.
       ``(4) Encourage voluntary and standardized reporting.--Not 
     later than 2 years after the date of enactment of the 
     Children's Health Insurance Program Reauthorization Act of 
     2009, the Secretary, in consultation with States, shall 
     develop a standardized format for reporting information and 
     procedures and approaches that encourage States to use the 
     initial core measurement set to voluntarily report 
     information regarding the quality of pediatric health care 
     under titles XIX and XXI.
       ``(5) Adoption of best practices in implementing quality 
     programs.--The Secretary shall disseminate information to 
     States regarding best practices among States with respect to 
     measuring and reporting on the quality of health care for 
     children, and shall facilitate the adoption of such best 
     practices. In developing best practices approaches, the 
     Secretary shall give particular attention to State 
     measurement techniques that ensure the timeliness and 
     accuracy of provider reporting, encourage provider reporting 
     compliance, encourage successful quality improvement 
     strategies, and improve efficiency in data collection using 
     health information technology.
       ``(6) Reports to congress.--Not later than January 1, 2011, 
     and every 3 years thereafter, the Secretary shall report to 
     Congress on--
       ``(A) the status of the Secretary's efforts to improve--
       ``(i) quality related to the duration and stability of 
     health insurance coverage for children under titles XIX and 
     XXI;
       ``(ii) the quality of children's health care under such 
     titles, including preventive health services, health care for 
     acute conditions, chronic health care, and health services to 
     ameliorate the effects of physical and mental conditions and 
     to aid in growth and development of infants, young children, 
     school-age children, and adolescents with special health care 
     needs; and
       ``(iii) the quality of children's health care under such 
     titles across the domains of quality, including clinical 
     quality, health care safety, family experience with health 
     care, health care in the most integrated setting, and 
     elimination of racial, ethnic, and socioeconomic disparities 
     in health and health care;
       ``(B) the status of voluntary reporting by States under 
     titles XIX and XXI, utilizing the initial core quality 
     measurement set; and
       ``(C) any recommendations for legislative changes needed to 
     improve the quality of care provided to children under titles 
     XIX and XXI, including recommendations for quality reporting 
     by States.
       ``(7) Technical assistance.--The Secretary shall provide 
     technical assistance to States to assist them in adopting and 
     utilizing core child health quality measures in administering 
     the State plans under titles XIX and XXI.
       ``(8) Definition of core set.--In this section, the term 
     `core set' means a group of valid, reliable, and evidence-
     based quality measures that, taken together--
       ``(A) provide information regarding the quality of health 
     coverage and health care for children;
       ``(B) address the needs of children throughout the 
     developmental age span; and
       ``(C) allow purchasers, families, and health care providers 
     to understand the quality of care in relation to the 
     preventive needs of children, treatments aimed at managing 
     and resolving acute conditions, and diagnostic and treatment 
     services whose purpose is to correct or ameliorate physical, 
     mental, or developmental conditions that could, if untreated 
     or poorly treated, become chronic.
       ``(b) Advancing and Improving Pediatric Quality Measures.--
       ``(1) Establishment of pediatric quality measures 
     program.--Not later than January 1, 2011, the Secretary shall 
     establish a pediatric quality measures program to--

[[Page 721]]

       ``(A) improve and strengthen the initial core child health 
     care quality measures established by the Secretary under 
     subsection (a);
       ``(B) expand on existing pediatric quality measures used by 
     public and private health care purchasers and advance the 
     development of such new and emerging quality measures; and
       ``(C) increase the portfolio of evidence-based, consensus 
     pediatric quality measures available to public and private 
     purchasers of children's health care services, providers, and 
     consumers.
       ``(2) Evidence-based measures.--The measures developed 
     under the pediatric quality measures program shall, at a 
     minimum, be--
       ``(A) evidence-based and, where appropriate, risk adjusted;
       ``(B) designed to identify and eliminate racial and ethnic 
     disparities in child health and the provision of health care;
       ``(C) designed to ensure that the data required for such 
     measures is collected and reported in a standard format that 
     permits comparison of quality and data at a State, plan, and 
     provider level;
       ``(D) periodically updated; and
       ``(E) responsive to the child health needs, services, and 
     domains of health care quality described in clauses (i), 
     (ii), and (iii) of subsection (a)(6)(A).
       ``(3) Process for pediatric quality measures program.--In 
     identifying gaps in existing pediatric quality measures and 
     establishing priorities for development and advancement of 
     such measures, the Secretary shall consult with--
       ``(A) States;
       ``(B) pediatricians, children's hospitals, and other 
     primary and specialized pediatric health care professionals 
     (including members of the allied health professions) who 
     specialize in the care and treatment of children, 
     particularly children with special physical, mental, and 
     developmental health care needs;
       ``(C) dental professionals, including pediatric dental 
     professionals;
       ``(D) health care providers that furnish primary health 
     care to children and families who live in urban and rural 
     medically underserved communities or who are members of 
     distinct population sub-groups at heightened risk for poor 
     health outcomes;
       ``(E) national organizations representing children, 
     including children with disabilities and children with 
     chronic conditions;
       ``(F) national organizations representing consumers and 
     purchasers of children's health care;
       ``(G) national organizations and individuals with expertise 
     in pediatric health quality measurement; and
       ``(H) voluntary consensus standards setting organizations 
     and other organizations involved in the advancement of 
     evidence-based measures of health care.
       ``(4) Developing, validating, and testing a portfolio of 
     pediatric quality measures.--As part of the program to 
     advance pediatric quality measures, the Secretary shall--
       ``(A) award grants and contracts for the development, 
     testing, and validation of new, emerging, and innovative 
     evidence-based measures for children's health care services 
     across the domains of quality described in clauses (i), (ii), 
     and (iii) of subsection (a)(6)(A); and
       ``(B) award grants and contracts for--
       ``(i) the development of consensus on evidence-based 
     measures for children's health care services;
       ``(ii) the dissemination of such measures to public and 
     private purchasers of health care for children; and
       ``(iii) the updating of such measures as necessary.
       ``(5) Revising, strengthening, and improving initial core 
     measures.--Beginning no later than January 1, 2013, and 
     annually thereafter, the Secretary shall publish recommended 
     changes to the core measures described in subsection (a) that 
     shall reflect the testing, validation, and consensus process 
     for the development of pediatric quality measures described 
     in subsection paragraphs (1) through (4).
       ``(6) Definition of pediatric quality measure.--In this 
     subsection, the term `pediatric quality measure' means a 
     measurement of clinical care that is capable of being 
     examined through the collection and analysis of relevant 
     information, that is developed in order to assess 1 or more 
     aspects of pediatric health care quality in various 
     institutional and ambulatory health care settings, including 
     the structure of the clinical care system, the process of 
     care, the outcome of care, or patient experiences in care.
       ``(7) Construction.--Nothing in this section shall be 
     construed as supporting the restriction of coverage, under 
     title XIX or XXI or otherwise, to only those services that 
     are evidence-based.
       ``(c) Annual State Reports Regarding State-Specific Quality 
     of Care Measures Applied Under Medicaid or Chip.--
       ``(1) Annual state reports.--Each State with a State plan 
     approved under title XIX or a State child health plan 
     approved under title XXI shall annually report to the 
     Secretary on the--
       ``(A) State-specific child health quality measures applied 
     by the States under such plans, including measures described 
     in subparagraphs (A) and (B) of subsection (a)(6); and
       ``(B) State-specific information on the quality of health 
     care furnished to children under such plans, including 
     information collected through external quality reviews of 
     managed care organizations under section 1932 of the Social 
     Security Act (42 U.S.C. 1396u-4) and benchmark plans under 
     sections 1937 and 2103 of such Act (42 U.S.C. 1396u-7, 
     1397cc).
       ``(2) Publication.--Not later than September 30, 2010, and 
     annually thereafter, the Secretary shall collect, analyze, 
     and make publicly available the information reported by 
     States under paragraph (1).
       ``(d) Demonstration Projects for Improving the Quality of 
     Children's Health Care and the Use of Health Information 
     Technology.--
       ``(1) In general.--During the period of fiscal years 2009 
     through 2013, the Secretary shall award not more than 10 
     grants to States and child health providers to conduct 
     demonstration projects to evaluate promising ideas for 
     improving the quality of children's health care provided 
     under title XIX or XXI, including projects to--
       ``(A) experiment with, and evaluate the use of, new 
     measures of the quality of children's health care under such 
     titles (including testing the validity and suitability for 
     reporting of such measures);
       ``(B) promote the use of health information technology in 
     care delivery for children under such titles;
       ``(C) evaluate provider-based models which improve the 
     delivery of children's health care services under such 
     titles, including care management for children with chronic 
     conditions and the use of evidence-based approaches to 
     improve the effectiveness, safety, and efficiency of health 
     care services for children; or
       ``(D) demonstrate the impact of the model electronic health 
     record format for children developed and disseminated under 
     subsection (f) on improving pediatric health, including the 
     effects of chronic childhood health conditions, and pediatric 
     health care quality as well as reducing health care costs.
       ``(2) Requirements.--In awarding grants under this 
     subsection, the Secretary shall ensure that--
       ``(A) only 1 demonstration project funded under a grant 
     awarded under this subsection shall be conducted in a State; 
     and
       ``(B) demonstration projects funded under grants awarded 
     under this subsection shall be conducted evenly between 
     States with large urban areas and States with large rural 
     areas.
       ``(3) Authority for multistate projects.--A demonstration 
     project conducted with a grant awarded under this subsection 
     may be conducted on a multistate basis, as needed.
       ``(4) Funding.--$20,000,000 of the amount appropriated 
     under subsection (i) for a fiscal year shall be used to carry 
     out this subsection.
       ``(e) Childhood Obesity Demonstration Project.--
       ``(1) Authority to conduct demonstration.--The Secretary, 
     in consultation with the Administrator of the Centers for 
     Medicare & Medicaid Services, shall conduct a demonstration 
     project to develop a comprehensive and systematic model for 
     reducing childhood obesity by awarding grants to eligible 
     entities to carry out such project. Such model shall--
       ``(A) identify, through self-assessment, behavioral risk 
     factors for obesity among children;
       ``(B) identify, through self-assessment, needed clinical 
     preventive and screening benefits among those children 
     identified as target individuals on the basis of such risk 
     factors;
       ``(C) provide ongoing support to such target individuals 
     and their families to reduce risk factors and promote the 
     appropriate use of preventive and screening benefits; and
       ``(D) be designed to improve health outcomes, satisfaction, 
     quality of life, and appropriate use of items and services 
     for which medical assistance is available under title XIX or 
     child health assistance is available under title XXI among 
     such target individuals.
       ``(2) Eligibility entities.--For purposes of this 
     subsection, an eligible entity is any of the following:
       ``(A) A city, county, or Indian tribe.
       ``(B) A local or tribal educational agency.
       ``(C) An accredited university, college, or community 
     college.
       ``(D) A Federally-qualified health center.
       ``(E) A local health department.
       ``(F) A health care provider.
       ``(G) A community-based organization.
       ``(H) Any other entity determined appropriate by the 
     Secretary, including a consortia or partnership of entities 
     described in any of subparagraphs (A) through (G).
       ``(3) Use of funds.--An eligible entity awarded a grant 
     under this subsection shall use the funds made available 
     under the grant to--
       ``(A) carry out community-based activities related to 
     reducing childhood obesity, including by--
       ``(i) forming partnerships with entities, including schools 
     and other facilities providing

[[Page 722]]

     recreational services, to establish programs for after school 
     and weekend community activities that are designed to reduce 
     childhood obesity;
       ``(ii) forming partnerships with daycare facilities to 
     establish programs that promote healthy eating behaviors and 
     physical activity; and
       ``(iii) developing and evaluating community educational 
     activities targeting good nutrition and promoting healthy 
     eating behaviors;
       ``(B) carry out age-appropriate school-based activities 
     that are designed to reduce childhood obesity, including by--
       ``(i) developing and testing educational curricula and 
     intervention programs designed to promote healthy eating 
     behaviors and habits in youth, which may include--

       ``(I) after hours physical activity programs; and
       ``(II) science-based interventions with multiple components 
     to prevent eating disorders including nutritional content, 
     understanding and responding to hunger and satiety, positive 
     body image development, positive self-esteem development, and 
     learning life skills (such as stress management, 
     communication skills, problemsolving and decisionmaking 
     skills), as well as consideration of cultural and 
     developmental issues, and the role of family, school, and 
     community;

       ``(ii) providing education and training to educational 
     professionals regarding how to promote a healthy lifestyle 
     and a healthy school environment for children;
       ``(iii) planning and implementing a healthy lifestyle 
     curriculum or program with an emphasis on healthy eating 
     behaviors and physical activity; and
       ``(iv) planning and implementing healthy lifestyle classes 
     or programs for parents or guardians, with an emphasis on 
     healthy eating behaviors and physical activity for children;
       ``(C) carry out educational, counseling, promotional, and 
     training activities through the local health care delivery 
     systems including by--
       ``(i) promoting healthy eating behaviors and physical 
     activity services to treat or prevent eating disorders, being 
     overweight, and obesity;
       ``(ii) providing patient education and counseling to 
     increase physical activity and promote healthy eating 
     behaviors;
       ``(iii) training health professionals on how to identify 
     and treat obese and overweight individuals which may include 
     nutrition and physical activity counseling; and
       ``(iv) providing community education by a health 
     professional on good nutrition and physical activity to 
     develop a better understanding of the relationship between 
     diet, physical activity, and eating disorders, obesity, or 
     being overweight; and
       ``(D) provide, through qualified health professionals, 
     training and supervision for community health workers to--
       ``(i) educate families regarding the relationship between 
     nutrition, eating habits, physical activity, and obesity;
       ``(ii) educate families about effective strategies to 
     improve nutrition, establish healthy eating patterns, and 
     establish appropriate levels of physical activity; and
       ``(iii) educate and guide parents regarding the ability to 
     model and communicate positive health behaviors.
       ``(4) Priority.--In awarding grants under paragraph (1), 
     the Secretary shall give priority to awarding grants to 
     eligible entities--
       ``(A) that demonstrate that they have previously applied 
     successfully for funds to carry out activities that seek to 
     promote individual and community health and to prevent the 
     incidence of chronic disease and that can cite published and 
     peer-reviewed research demonstrating that the activities that 
     the entities propose to carry out with funds made available 
     under the grant are effective;
       ``(B) that will carry out programs or activities that seek 
     to accomplish a goal or goals set by the State in the Healthy 
     People 2010 plan of the State;
       ``(C) that provide non-Federal contributions, either in 
     cash or in-kind, to the costs of funding activities under the 
     grants;
       ``(D) that develop comprehensive plans that include a 
     strategy for extending program activities developed under 
     grants in the years following the fiscal years for which they 
     receive grants under this subsection;
       ``(E) located in communities that are medically 
     underserved, as determined by the Secretary;
       ``(F) located in areas in which the average poverty rate is 
     at least 150 percent or higher of the average poverty rate in 
     the State involved, as determined by the Secretary; and
       ``(G) that submit plans that exhibit multisectoral, 
     cooperative conduct that includes the involvement of a broad 
     range of stakeholders, including--
       ``(i) community-based organizations;
       ``(ii) local governments;
       ``(iii) local educational agencies;
       ``(iv) the private sector;
       ``(v) State or local departments of health;
       ``(vi) accredited colleges, universities, and community 
     colleges;
       ``(vii) health care providers;
       ``(viii) State and local departments of transportation and 
     city planning; and
       ``(ix) other entities determined appropriate by the 
     Secretary.
       ``(5) Program design.--
       ``(A) Initial design.--Not later than 1 year after the date 
     of enactment of the Children's Health Insurance Program 
     Reauthorization Act of 2009, the Secretary shall design the 
     demonstration project. The demonstration should draw upon 
     promising, innovative models and incentives to reduce 
     behavioral risk factors. The Administrator of the Centers for 
     Medicare & Medicaid Services shall consult with the Director 
     of the Centers for Disease Control and Prevention, the 
     Director of the Office of Minority Health, the heads of other 
     agencies in the Department of Health and Human Services, and 
     such professional organizations, as the Secretary determines 
     to be appropriate, on the design, conduct, and evaluation of 
     the demonstration.
       ``(B) Number and project areas.--Not later than 2 years 
     after the date of enactment of the Children's Health 
     Insurance Program Reauthorization Act of 2009, the Secretary 
     shall award 1 grant that is specifically designed to 
     determine whether programs similar to programs to be 
     conducted by other grantees under this subsection should be 
     implemented with respect to the general population of 
     children who are eligible for child health assistance under 
     State child health plans under title XXI in order to reduce 
     the incidence of childhood obesity among such population.
       ``(6) Report to congress.--Not later than 3 years after the 
     date the Secretary implements the demonstration project under 
     this subsection, the Secretary shall submit to Congress a 
     report that describes the project, evaluates the 
     effectiveness and cost effectiveness of the project, 
     evaluates the beneficiary satisfaction under the project, and 
     includes any such other information as the Secretary 
     determines to be appropriate.
       ``(7) Definitions.--In this subsection:
       ``(A) Federally-qualified health center.--The term 
     `Federally-qualified health center' has the meaning given 
     that term in section 1905(l)(2)(B).
       ``(B) Indian tribe.--The term `Indian tribe' has the 
     meaning given that term in section 4 of the Indian Health 
     Care Improvement Act (25 U.S.C. 1603).
       ``(C) Self-assessment.--The term `self-assessment' means a 
     form that--
       ``(i) includes questions regarding--

       ``(I) behavioral risk factors;
       ``(II) needed preventive and screening services; and
       ``(III) target individuals' preferences for receiving 
     follow-up information;

       ``(ii) is assessed using such computer generated assessment 
     programs; and
       ``(iii) allows for the provision of such ongoing support to 
     the individual as the Secretary determines appropriate.
       ``(D) Ongoing support.--The term `ongoing support' means--
       ``(i) to provide any target individual with information, 
     feedback, health coaching, and recommendations regarding--

       ``(I) the results of a self-assessment given to the 
     individual;
       ``(II) behavior modification based on the self-assessment; 
     and
       ``(III) any need for clinical preventive and screening 
     services or treatment including medical nutrition therapy;

       ``(ii) to provide any target individual with referrals to 
     community resources and programs available to assist the 
     target individual in reducing health risks; and
       ``(iii) to provide the information described in clause (i) 
     to a health care provider, if designated by the target 
     individual to receive such information.
       ``(8) Authorization of appropriations.--There is authorized 
     to be appropriated to carry out this subsection, $25,000,000 
     for the period of fiscal years 2009 through 2013.
       ``(f) Development of Model Electronic Health Record Format 
     for Children Enrolled in Medicaid or CHIP.--
       ``(1) In general.--Not later than January 1, 2010, the 
     Secretary shall establish a program to encourage the 
     development and dissemination of a model electronic health 
     record format for children enrolled in the State plan under 
     title XIX or the State child health plan under title XXI that 
     is--
       ``(A) subject to State laws, accessible to parents, 
     caregivers, and other consumers for the sole purpose of 
     demonstrating compliance with school or leisure activity 
     requirements, such as appropriate immunizations or physicals;
       ``(B) designed to allow interoperable exchanges that 
     conform with Federal and State privacy and security 
     requirements;
       ``(C) structured in a manner that permits parents and 
     caregivers to view and understand the extent to which the 
     care their children receive is clinically appropriate and of 
     high quality; and
       ``(D) capable of being incorporated into, and otherwise 
     compatible with, other standards developed for electronic 
     health records.
       ``(2) Funding.--$5,000,000 of the amount appropriated under 
     subsection (i) for a fiscal year shall be used to carry out 
     this subsection.
       ``(g) Study of Pediatric Health and Health Care Quality 
     Measures.--
       ``(1) In general.--Not later than July 1, 2010, the 
     Institute of Medicine shall study and report to Congress on 
     the extent and quality of efforts to measure child health 
     status and the quality of health care for children across the 
     age span and in relation to

[[Page 723]]

     preventive care, treatments for acute conditions, and 
     treatments aimed at ameliorating or correcting physical, 
     mental, and developmental conditions in children. In 
     conducting such study and preparing such report, the 
     Institute of Medicine shall--
       ``(A) consider all of the major national population-based 
     reporting systems sponsored by the Federal Government that 
     are currently in place, including reporting requirements 
     under Federal grant programs and national population surveys 
     and estimates conducted directly by the Federal Government;
       ``(B) identify the information regarding child health and 
     health care quality that each system is designed to capture 
     and generate, the study and reporting periods covered by each 
     system, and the extent to which the information so generated 
     is made widely available through publication;
       ``(C) identify gaps in knowledge related to children's 
     health status, health disparities among subgroups of 
     children, the effects of social conditions on children's 
     health status and use and effectiveness of health care, and 
     the relationship between child health status and family 
     income, family stability and preservation, and children's 
     school readiness and educational achievement and attainment; 
     and
       ``(D) make recommendations regarding improving and 
     strengthening the timeliness, quality, and public 
     transparency and accessibility of information about child 
     health and health care quality.
       ``(2) Funding.--Up to $1,000,000 of the amount appropriated 
     under subsection (i) for a fiscal year shall be used to carry 
     out this subsection.
       ``(h) Rule of Construction.--Notwithstanding any other 
     provision in this section, no evidence based quality measure 
     developed, published, or used as a basis of measurement or 
     reporting under this section may be used to establish an 
     irrebuttable presumption regarding either the medical 
     necessity of care or the maximum permissible coverage for any 
     individual child who is eligible for and receiving medical 
     assistance under title XIX or child health assistance under 
     title XXI.
       ``(i) Appropriation.--Out of any funds in the Treasury not 
     otherwise appropriated, there is appropriated for each of 
     fiscal years 2009 through 2013, $45,000,000 for the purpose 
     of carrying out this section (other than subsection (e)). 
     Funds appropriated under this subsection shall remain 
     available until expended.''.
       (b) Increased Matching Rate for Collecting and Reporting on 
     Child Health Measures.--Section 1903(a)(3)(A) (42 U.S.C. 
     1396b(a)(3)(A)), is amended--
       (1) by striking ``and'' at the end of clause (i); and
       (2) by adding at the end the following new clause:
       ``(iii) an amount equal to the Federal medical assistance 
     percentage (as defined in section 1905(b)) of so much of the 
     sums expended during such quarter (as found necessary by the 
     Secretary for the proper and efficient administration of the 
     State plan) as are attributable to such developments or 
     modifications of systems of the type described in clause (i) 
     as are necessary for the efficient collection and reporting 
     on child health measures; and''.

     SEC. 402. IMPROVED AVAILABILITY OF PUBLIC INFORMATION 
                   REGARDING ENROLLMENT OF CHILDREN IN CHIP AND 
                   MEDICAID.

       (a) Inclusion of Process and Access Measures in Annual 
     State Reports.--Section 2108 (42 U.S.C. 1397hh) is amended--
       (1) in subsection (a), in the matter preceding paragraph 
     (1), by striking ``The State'' and inserting ``Subject to 
     subsection (e), the State''; and
       (2) by adding at the end the following new subsection:
       ``(e) Information Required for Inclusion in State Annual 
     Report.--The State shall include the following information in 
     the annual report required under subsection (a):
       ``(1) Eligibility criteria, enrollment, and retention data 
     (including data with respect to continuity of coverage or 
     duration of benefits).
       ``(2) Data regarding the extent to which the State uses 
     process measures with respect to determining the eligibility 
     of children under the State child health plan, including 
     measures such as 12-month continuous eligibility, self-
     declaration of income for applications or renewals, or 
     presumptive eligibility.
       ``(3) Data regarding denials of eligibility and 
     redeterminations of eligibility.
       ``(4) Data regarding access to primary and specialty 
     services, access to networks of care, and care coordination 
     provided under the State child health plan, using quality 
     care and consumer satisfaction measures included in the 
     Consumer Assessment of Healthcare Providers and Systems 
     (CAHPS) survey.
       ``(5) If the State provides child health assistance in the 
     form of premium assistance for the purchase of coverage under 
     a group health plan, data regarding the provision of such 
     assistance, including the extent to which employer-sponsored 
     health insurance coverage is available for children eligible 
     for child health assistance under the State child health 
     plan, the range of the monthly amount of such assistance 
     provided on behalf of a child or family, the number of 
     children or families provided such assistance on a monthly 
     basis, the income of the children or families provided such 
     assistance, the benefits and cost-sharing protection provided 
     under the State child health plan to supplement the coverage 
     purchased with such premium assistance, the effective 
     strategies the State engages in to reduce any administrative 
     barriers to the provision of such assistance, and, the 
     effects, if any, of the provision of such assistance on 
     preventing the coverage provided under the State child health 
     plan from substituting for coverage provided under employer-
     sponsored health insurance offered in the State.
       ``(6) To the extent applicable, a description of any State 
     activities that are designed to reduce the number of 
     uncovered children in the State, including through a State 
     health insurance connector program or support for innovative 
     private health coverage initiatives.''.
       (b) Standardized Reporting Format.--
       (1) In general.--Not later than 1 year after the date of 
     enactment of this Act, the Secretary shall specify a 
     standardized format for States to use for reporting the 
     information required under section 2108(e) of the Social 
     Security Act, as added by subsection (a)(2).
       (2) Transition period for states.--Each State that is 
     required to submit a report under subsection (a) of section 
     2108 of the Social Security Act that includes the information 
     required under subsection (e) of such section may use up to 3 
     reporting periods to transition to the reporting of such 
     information in accordance with the standardized format 
     specified by the Secretary under paragraph (1).
       (c) Additional Funding for the Secretary To Improve 
     Timeliness of Data Reporting and Analysis for Purposes of 
     Determining Enrollment Increases Under Medicaid and CHIP.--
       (1) Appropriation.--There is appropriated, out of any money 
     in the Treasury not otherwise appropriated, $5,000,000 to the 
     Secretary for fiscal year 2009 for the purpose of improving 
     the timeliness of the data reported and analyzed from the 
     Medicaid Statistical Information System (MSIS) for purposes 
     of providing more timely data on enrollment and eligibility 
     of children under Medicaid and CHIP and to provide guidance 
     to States with respect to any new reporting requirements 
     related to such improvements. Amounts appropriated under this 
     paragraph shall remain available until expended.
       (2) Requirements.--The improvements made by the Secretary 
     under paragraph (1) shall be designed and implemented 
     (including with respect to any necessary guidance for States 
     to report such information in a complete and expeditious 
     manner) so that, beginning no later than October 1, 2009, 
     data regarding the enrollment of low-income children (as 
     defined in section 2110(c)(4) of the Social Security Act (42 
     U.S.C. 1397jj(c)(4)) of a State enrolled in the State plan 
     under Medicaid or the State child health plan under CHIP with 
     respect to a fiscal year shall be collected and analyzed by 
     the Secretary within 6 months of submission.
       (d) GAO Study and Report on Access to Primary and 
     Speciality Services.--
       (1) In general.--The Comptroller General of the United 
     States shall conduct a study of children's access to primary 
     and specialty services under Medicaid and CHIP, including--
       (A) the extent to which providers are willing to treat 
     children eligible for such programs;
       (B) information on such children's access to networks of 
     care;
       (C) geographic availability of primary and specialty 
     services under such programs;
       (D) the extent to which care coordination is provided for 
     children's care under Medicaid and CHIP; and
       (E) as appropriate, information on the degree of 
     availability of services for children under such programs.
       (2) Report.--Not later than 2 years after the date of 
     enactment of this Act, the Comptroller General shall submit a 
     report to the Committee on Finance of the Senate and the 
     Committee on Energy and Commerce of the House of 
     Representatives on the study conducted under paragraph (1) 
     that includes recommendations for such Federal and State 
     legislative and administrative changes as the Comptroller 
     General determines are necessary to address any barriers to 
     access to children's care under Medicaid and CHIP that may 
     exist.

     SEC. 403. APPLICATION OF CERTAIN MANAGED CARE QUALITY 
                   SAFEGUARDS TO CHIP.

       (a) In General.--Section 2103(f) of Social Security Act (42 
     U.S.C. 1397bb(f)) is amended by adding at the end the 
     following new paragraph:
       ``(3) Compliance with managed care requirements.--The State 
     child health plan shall provide for the application of 
     subsections (a)(4), (a)(5), (b), (c), (d), and (e) of section 
     1932 (relating to requirements for managed care) to coverage, 
     State agencies, enrollment brokers, managed care entities, 
     and managed care organizations under this title in the same 
     manner as such subsections apply to coverage and such 
     entities and organizations under title XIX.''.

[[Page 724]]

       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to contract years for health plans beginning on 
     or after July 1, 2009.

                 TITLE V--IMPROVING ACCESS TO BENEFITS

     SEC. 501. DENTAL BENEFITS.

       (a) Coverage.--
       (1) In general.--Section 2103 (42 U.S.C. 1397cc) is 
     amended--
       (A) in subsection (a)--
       (i) in the matter before paragraph (1), by striking 
     ``subsection (c)(5)'' and inserting ``paragraphs (5) and (7) 
     of subsection (c)''; and
       (ii) in paragraph (1), by inserting ``at least'' after 
     ``that is''; and
       (B) in subsection (c)--
       (i) by redesignating paragraph (5) as paragraph (7); and
       (ii) by inserting after paragraph (4), the following:
       ``(5) Dental benefits.--
       ``(A) In general.--The child health assistance provided to 
     a targeted low-income child shall include coverage of dental 
     services necessary to prevent disease and promote oral 
     health, restore oral structures to health and function, and 
     treat emergency conditions.
       ``(B) Permitting use of dental benchmark plans by certain 
     states.--A State may elect to meet the requirement of 
     subparagraph (A) through dental coverage that is equivalent 
     to a benchmark dental benefit package described in 
     subparagraph (C).
       ``(C) Benchmark dental benefit packages.--The benchmark 
     dental benefit packages are as follows:
       ``(i) FEHBP children's dental coverage.--A dental benefits 
     plan under chapter 89A of title 5, United States Code, that 
     has been selected most frequently by employees seeking 
     dependent coverage, among such plans that provide such 
     dependent coverage, in either of the previous 2 plan years.
       ``(ii) State employee dependent dental coverage.--A dental 
     benefits plan that is offered and generally available to 
     State employees in the State involved and that has been 
     selected most frequently by employees seeking dependent 
     coverage, among such plans that provide such dependent 
     coverage, in either of the previous 2 plan years.
       ``(iii) Coverage offered through commercial dental plan.--A 
     dental benefits plan that has the largest insured commercial, 
     non-medicaid enrollment of dependent covered lives of such 
     plans that is offered in the State involved.''.
       (2) Assuring access to care.--Section 2102(a)(7)(B) (42 
     U.S.C. 1397bb(c)(2)) is amended by inserting ``and services 
     described in section 2103(c)(5)'' after ``emergency 
     services''.
       (3) Effective date.--The amendments made by paragraph (1) 
     shall apply to coverage of items and services furnished on or 
     after October 1, 2009.
       (b) Dental Education for Parents of Newborns.--The 
     Secretary shall develop and implement, through entities that 
     fund or provide perinatal care services to targeted low-
     income children under a State child health plan under title 
     XXI of the Social Security Act, a program to deliver oral 
     health educational materials that inform new parents about 
     risks for, and prevention of, early childhood caries and the 
     need for a dental visit within their newborn's first year of 
     life.
       (c) Provision of Dental Services Through FQHCs.--
       (1) Medicaid.--Section 1902(a) (42 U.S.C. 1396a(a)) is 
     amended--
       (A) by striking ``and'' at the end of paragraph (70);
       (B) by striking the period at the end of paragraph (71) and 
     inserting ``; and''; and
       (C) by inserting after paragraph (71) the following new 
     paragraph:
       ``(72) provide that the State will not prevent a Federally-
     qualified health center from entering into contractual 
     relationships with private practice dental providers in the 
     provision of Federally-qualified health center services.''.
       (2) CHIP.--Section 2107(e)(1) (42 U.S.C. 1397g(e)(1)), as 
     amended by subsections (a)(2) and (d)(2) of section 203, is 
     amended by inserting after subparagraph (B) the following new 
     subparagraph (and redesignating the succeeding subparagraphs 
     accordingly):
       ``(C) Section 1902(a)(72) (relating to limiting FQHC 
     contracting for provision of dental services).''.
       (3) Effective date.--The amendments made by this subsection 
     shall take effect on January 1, 2009.
       (d) Reporting Information on Dental Health.--
       (1) Medicaid.--Section 1902(a)(43)(D)(iii) (42 U.S.C. 
     1396a(a)(43)(D)(iii)) is amended by inserting ``and other 
     information relating to the provision of dental services to 
     such children described in section 2108(e)'' after 
     ``receiving dental services,''.
       (2) CHIP.--Section 2108 (42 U.S.C. 1397hh) is amended by 
     adding at the end the following new subsection:
       ``(e) Information on Dental Care for Children.--
       ``(1) In general.--Each annual report under subsection (a) 
     shall include the following information with respect to care 
     and services described in section 1905(r)(3) provided to 
     targeted low-income children enrolled in the State child 
     health plan under this title at any time during the year 
     involved:
       ``(A) The number of enrolled children by age grouping used 
     for reporting purposes under section 1902(a)(43).
       ``(B) For children within each such age grouping, 
     information of the type contained in questions 12(a)-(c) of 
     CMS Form 416 (that consists of the number of enrolled 
     targeted low income children who receive any, preventive, or 
     restorative dental care under the State plan).
       ``(C) For the age grouping that includes children 8 years 
     of age, the number of such children who have received a 
     protective sealant on at least one permanent molar tooth.
       ``(2) Inclusion of information on enrollees in managed care 
     plans.--The information under paragraph (1) shall include 
     information on children who are enrolled in managed care 
     plans and other private health plans and contracts with such 
     plans under this title shall provide for the reporting of 
     such information by such plans to the State.''.
       (3) Effective date.--The amendments made by this subsection 
     shall be effective for annual reports submitted for years 
     beginning after date of enactment.
       (e) Improved Accessibility of Dental Provider Information 
     to Enrollees Under Medicaid and CHIP.--The Secretary shall--
       (1) work with States, pediatric dentists, and other dental 
     providers (including providers that are, or are affiliated 
     with, a school of dentistry) to include, not later than 6 
     months after the date of the enactment of this Act, on the 
     Insure Kids Now website (http://www.insurekidsnow.gov/) and 
     hotline (1-877-KIDS-NOW) (or on any successor websites or 
     hotlines) a current and accurate list of all such dentists 
     and providers within each State that provide dental services 
     to children enrolled in the State plan (or waiver) under 
     Medicaid or the State child health plan (or waiver) under 
     CHIP, and shall ensure that such list is updated at least 
     quarterly; and
       (2) work with States to include, not later than 6 months 
     after the date of the enactment of this Act, a description of 
     the dental services provided under each State plan (or 
     waiver) under Medicaid and each State child health plan (or 
     waiver) under CHIP on such Insure Kids Now website, and shall 
     ensure that such list is updated at least annually.
       (f) Inclusion of Status of Efforts To Improve Dental Care 
     in Reports on the Quality of Children's Health Care Under 
     Medicaid and CHIP.--Section 1139A(a), as added by section 
     401(a), is amended--
       (1) in paragraph (3)(B)(ii), by inserting ``and, with 
     respect to dental care, conditions requiring the restoration 
     of teeth, relief of pain and infection, and maintenance of 
     dental health'' after ``chronic conditions''; and
       (2) in paragraph (6)(A)(ii), by inserting ``dental care,'' 
     after ``preventive health services,''.
       (g) GAO Study and Report.--
       (1) Study.--The Comptroller General of the United States 
     shall provide for a study that examines--
       (A) access to dental services by children in underserved 
     areas;
       (B) children's access to oral health care, including 
     preventive and restorative services, under Medicaid and CHIP, 
     including--
       (i) the extent to which dental providers are willing to 
     treat children eligible for such programs;
       (ii) information on such children's access to networks of 
     care, including such networks that serve special needs 
     children; and
       (iii) geographic availability of oral health care, 
     including preventive and restorative services, under such 
     programs; and
       (C) the feasibility and appropriateness of using qualified 
     mid-level dental health providers, in coordination with 
     dentists, to improve access for children to oral health 
     services and public health overall.
       (2) Report.--Not later than 18 months year after the date 
     of the enactment of this Act, the Comptroller General shall 
     submit to Congress a report on the study conducted under 
     paragraph (1). The report shall include recommendations for 
     such Federal and State legislative and administrative changes 
     as the Comptroller General determines are necessary to 
     address any barriers to access to oral health care, including 
     preventive and restorative services, under Medicaid and CHIP 
     that may exist.

     SEC. 502. MENTAL HEALTH PARITY IN CHIP PLANS.

       (a) Assurance of Parity.--Section 2103(c) (42 U.S.C. 
     1397cc(c)), as amended by section 501(a)(1)(B), is amended by 
     inserting after paragraph (5), the following:
       ``(6) Mental health services parity.--
       ``(A) In general.--In the case of a State child health plan 
     that provides both medical and surgical benefits and mental 
     health or substance use disorder benefits, such plan shall 
     ensure that the financial requirements and treatment 
     limitations applicable to such mental health or substance use 
     disorder benefits comply with the requirements of section 
     2705(a) of the Public Health Service Act in the same manner 
     as such requirements apply to a group health plan.
       ``(B) Deemed compliance.--To the extent that a State child 
     health plan includes coverage with respect to an individual 
     described in section 1905(a)(4)(B) and covered under the 
     State plan under section 1902(a)(10)(A) of the

[[Page 725]]

     services described in section 1905(a)(4)(B) (relating to 
     early and periodic screening, diagnostic, and treatment 
     services defined in section 1905(r)) and provided in 
     accordance with section 1902(a)(43), such plan shall be 
     deemed to satisfy the requirements of subparagraph (A).''.
       (b) Conforming Amendments.--Section 2103 (42 U.S.C. 1397cc) 
     is amended--
       (1) in subsection (a), as amended by section 
     501(a)(1)(A)(i), in the matter preceding paragraph (1), by 
     inserting ``, (6),'' after ``(5)''; and
       (2) in subsection (c)(2), by striking subparagraph (B) and 
     redesignating subparagraphs (C) and (D) as subparagraphs (B) 
     and (C), respectively.

     SEC. 503. APPLICATION OF PROSPECTIVE PAYMENT SYSTEM FOR 
                   SERVICES PROVIDED BY FEDERALLY-QUALIFIED HEALTH 
                   CENTERS AND RURAL HEALTH CLINICS.

       (a) Application of Prospective Payment System.--
       (1) In general.--Section 2107(e)(1) (42 U.S.C. 
     1397gg(e)(1)), as amended by section 501(c)(2) is amended by 
     inserting after subparagraph (C) the following new 
     subparagraph (and redesignating the succeeding subparagraphs 
     accordingly):
       ``(D) Section 1902(bb) (relating to payment for services 
     provided by Federally-qualified health centers and rural 
     health clinics).''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall apply to services provided on or after October 1, 2009.
       (b) Transition Grants.--
       (1) Appropriation.--Out of any funds in the Treasury not 
     otherwise appropriated, there is appropriated to the 
     Secretary for fiscal year 2009, $5,000,000, to remain 
     available until expended, for the purpose of awarding grants 
     to States with State child health plans under CHIP that are 
     operated separately from the State Medicaid plan under title 
     XIX of the Social Security Act (including any waiver of such 
     plan), or in combination with the State Medicaid plan, for 
     expenditures related to transitioning to compliance with the 
     requirement of section 2107(e)(1)(D) of the Social Security 
     Act (as added by subsection (a)) to apply the prospective 
     payment system established under section 1902(bb) of the such 
     Act (42 U.S.C. 1396a(bb)) to services provided by Federally-
     qualified health centers and rural health clinics.
       (2) Monitoring and report.--The Secretary shall monitor the 
     impact of the application of such prospective payment system 
     on the States described in paragraph (1) and, not later than 
     October 1, 2011, shall report to Congress on any effect on 
     access to benefits, provider payment rates, or scope of 
     benefits offered by such States as a result of the 
     application of such payment system.

     SEC. 504. PREMIUM GRACE PERIOD.

       (a) In General.--Section 2103(e)(3) (42 U.S.C. 
     1397cc(e)(3)) is amended by adding at the end the following 
     new subparagraph:
       ``(C) Premium grace period.--The State child health plan--
       ``(i) shall afford individuals enrolled under the plan a 
     grace period of at least 30 days from the beginning of a new 
     coverage period to make premium payments before the 
     individual's coverage under the plan may be terminated; and
       ``(ii) shall provide to such an individual, not later than 
     7 days after the first day of such grace period, notice--

       ``(I) that failure to make a premium payment within the 
     grace period will result in termination of coverage under the 
     State child health plan; and
       ``(II) of the individual's right to challenge the proposed 
     termination pursuant to the applicable Federal regulations.

     For purposes of clause (i), the term `new coverage period' 
     means the month immediately following the last month for 
     which the premium has been paid.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to new coverage periods beginning on or after the 
     date of the enactment of this Act.

     SEC. 505. CLARIFICATION OF COVERAGE OF SERVICES PROVIDED 
                   THROUGH SCHOOL-BASED HEALTH CENTERS.

       Section 2103(c) (42 U.S.C. 1397cc(c)), as amended by 
     section 501(a)(1)(B), is amended by adding at the end the 
     following new paragraph:
       ``(8) Availability of coverage for items and services 
     furnished through school-based health centers.--Nothing in 
     this title shall be construed as limiting a State's ability 
     to provide child health assistance for covered items and 
     services that are furnished through school-based health 
     centers.''.

     TITLE VI--PROGRAM INTEGRITY AND OTHER MISCELLANEOUS PROVISIONS

           Subtitle A--Program Integrity and Data Collection

     SEC. 601. PAYMENT ERROR RATE MEASUREMENT (``PERM'').

       (a) Expenditures Related to Compliance With Requirements.--
       (1) Enhanced payments.--Section 2105(c) (42 U.S.C. 
     1397ee(c)), as amended by section 301(a), is amended by 
     adding at the end the following new paragraph:
       ``(11) Enhanced payments.--Notwithstanding subsection (b), 
     the enhanced FMAP with respect to payments under subsection 
     (a) for expenditures related to the administration of the 
     payment error rate measurement (PERM) requirements applicable 
     to the State child health plan in accordance with the 
     Improper Payments Information Act of 2002 and parts 431 and 
     457 of title 42, Code of Federal Regulations (or any related 
     or successor guidance or regulations) shall in no event be 
     less than 90 percent.''.
       (2) Exclusion of from cap on administrative expenditures.--
     Section 2105(c)(2)(C) (42 U.S.C. 1397ee(c)(2)C)), as amended 
     by section 302(b)), is amended by adding at the end the 
     following:
       ``(iv) Payment error rate measurement (perm) 
     expenditures.--Expenditures related to the administration of 
     the payment error rate measurement (PERM) requirements 
     applicable to the State child health plan in accordance with 
     the Improper Payments Information Act of 2002 and parts 431 
     and 457 of title 42, Code of Federal Regulations (or any 
     related or successor guidance or regulations).''.
       (b) Final Rule Required To Be in Effect for All States.--
     Notwithstanding parts 431 and 457 of title 42, Code of 
     Federal Regulations (as in effect on the date of enactment of 
     this Act), the Secretary shall not calculate or publish any 
     national or State-specific error rate based on the 
     application of the payment error rate measurement (in this 
     section referred to as ``PERM'') requirements to CHIP until 
     after the date that is 6 months after the date on which a new 
     final rule (in this section referred to as the ``new final 
     rule'') promulgated after the date of the enactment of this 
     Act and implementing such requirements in accordance with the 
     requirements of subsection (c) is in effect for all States. 
     Any calculation of a national error rate or a State specific 
     error rate after such new final rule in effect for all States 
     may only be inclusive of errors, as defined in such new final 
     rule or in guidance issued within a reasonable time frame 
     after the effective date for such new final rule that 
     includes detailed guidance for the specific methodology for 
     error determinations.
       (c) Requirements for New Final Rule.--For purposes of 
     subsection (b), the requirements of this subsection are that 
     the new final rule implementing the PERM requirements shall--
       (1) include--
       (A) clearly defined criteria for errors for both States and 
     providers;
       (B) a clearly defined process for appealing error 
     determinations by--
       (i) review contractors; or
       (ii) the agency and personnel described in section 
     431.974(a)(2) of title 42, Code of Federal Regulations, as in 
     effect on September 1, 2007, responsible for the development, 
     direction, implementation, and evaluation of eligibility 
     reviews and associated activities; and
       (C) clearly defined responsibilities and deadlines for 
     States in implementing any corrective action plans; and
       (2) provide that the payment error rate determined for a 
     State shall not take into account payment errors resulting 
     from the State's verification of an applicant's self-
     declaration or self-certification of eligibility for, and the 
     correct amount of, medical assistance or child health 
     assistance, if the State process for verifying an applicant's 
     self-declaration or self-certification satisfies the 
     requirements for such process applicable under regulations 
     promulgated by the Secretary or otherwise approved by the 
     Secretary.
       (d) Option for Application of Data for States in First 
     Application Cycle Under the Interim Final Rule.--After the 
     new final rule implementing the PERM requirements in 
     accordance with the requirements of subsection (c) is in 
     effect for all States, a State for which the PERM 
     requirements were first in effect under an interim final rule 
     for fiscal year 2007 or under a final rule for fiscal year 
     2008 may elect to accept any payment error rate determined in 
     whole or in part for the State on the basis of data for that 
     fiscal year or may elect to not have any payment error rate 
     determined on the basis of such data and, instead, shall be 
     treated as if fiscal year 2010 or fiscal year 2011 were the 
     first fiscal year for which the PERM requirements apply to 
     the State.
       (e) Harmonization of MEQC and PERM.--
       (1) Reduction of redundancies.--The Secretary shall review 
     the Medicaid Eligibility Quality Control (in this subsection 
     referred to as the ``MEQC'') requirements with the PERM 
     requirements and coordinate consistent implementation of both 
     sets of requirements, while reducing redundancies.
       (2) State option to apply perm data.--A State may elect, 
     for purposes of determining the erroneous excess payments for 
     medical assistance ratio applicable to the State for a fiscal 
     year under section 1903(u) of the Social Security Act (42 
     U.S.C. 1396b(u)) to substitute data resulting from the 
     application of the PERM requirements to the State after the 
     new final rule implementing such requirements is in effect 
     for all States for data obtained from the application of the 
     MEQC requirements to the State with respect to a fiscal year.
       (3) State option to apply meqc data.--For purposes of 
     satisfying the requirements of subpart Q of part 431 of title 
     42, Code of Federal Regulations, relating to Medicaid 
     eligibility reviews, a State may elect to substitute data 
     obtained through MEQC reviews

[[Page 726]]

     conducted in accordance with section 1903(u) of the Social 
     Security Act (42 U.S.C. 1396b(u)) for data required for 
     purposes of PERM requirements, but only if the State MEQC 
     reviews are based on a broad, representative sample of 
     Medicaid applicants or enrollees in the States.
       (f) Identification of Improved State-Specific Sample 
     Sizes.--The Secretary shall establish State-specific sample 
     sizes for application of the PERM requirements with respect 
     to State child health plans for fiscal years beginning with 
     fiscal year 2009, on the basis of such information as the 
     Secretary determines appropriate. In establishing such sample 
     sizes, the Secretary shall, to the greatest extent 
     practicable--
       (1) minimize the administrative cost burden on States under 
     Medicaid and CHIP; and
       (2) maintain State flexibility to manage such programs.

     SEC. 602. IMPROVING DATA COLLECTION.

       (a) Increased Appropriation.--Section 2109(b)(2) (42 U.S.C. 
     1397ii(b)(2)) is amended by striking ``$10,000,000 for fiscal 
     year 2000'' and inserting ``$20,000,000 for fiscal year 
     2009''.
       (b) Use of Additional Funds.--Section 2109(b) (42 U.S.C. 
     1397ii(b)), as amended by subsection (a), is amended--
       (1) by redesignating paragraph (2) as paragraph (4); and
       (2) by inserting after paragraph (1), the following new 
     paragraphs:
       ``(2) Additional requirements.--In addition to making the 
     adjustments required to produce the data described in 
     paragraph (1), with respect to data collection occurring for 
     fiscal years beginning with fiscal year 2009, in appropriate 
     consultation with the Secretary of Health and Human Services, 
     the Secretary of Commerce shall do the following:
       ``(A) Make appropriate adjustments to the Current 
     Population Survey to develop more accurate State-specific 
     estimates of the number of children enrolled in health 
     coverage under title XIX or this title.
       ``(B) Make appropriate adjustments to the Current 
     Population Survey to improve the survey estimates used to 
     determine the child population growth factor under section 
     2104(m)(5)(B) and any other data necessary for carrying out 
     this title.
       ``(C) Include health insurance survey information in the 
     American Community Survey related to children.
       ``(D) Assess whether American Community Survey estimates, 
     once such survey data are first available, produce more 
     reliable estimates than the Current Population Survey with 
     respect to the purposes described in subparagraph (B).
       ``(E) On the basis of the assessment required under 
     subparagraph (D), recommend to the Secretary of Health and 
     Human Services whether American Community Survey estimates 
     should be used in lieu of, or in some combination with, 
     Current Population Survey estimates for the purposes 
     described in subparagraph (B).
       ``(F) Continue making the adjustments described in the last 
     sentence of paragraph (1) with respect to expansion of the 
     sample size used in State sampling units, the number of 
     sampling units in a State, and using an appropriate 
     verification element.
       ``(3) Authority for the secretary of health and human 
     services to transition to the use of all, or some combination 
     of, acs estimates upon recommendation of the secretary of 
     commerce.--If, on the basis of the assessment required under 
     paragraph (2)(D), the Secretary of Commerce recommends to the 
     Secretary of Health and Human Services that American 
     Community Survey estimates should be used in lieu of, or in 
     some combination with, Current Population Survey estimates 
     for the purposes described in paragraph (2)(B), the Secretary 
     of Health and Human Services, in consultation with the 
     States, may provide for a period during which the Secretary 
     may transition from carrying out such purposes through the 
     use of Current Population Survey estimates to the use of 
     American Community Survey estimates (in lieu of, or in 
     combination with the Current Population Survey estimates, as 
     recommended), provided that any such transition is 
     implemented in a manner that is designed to avoid adverse 
     impacts upon States with approved State child health plans 
     under this title.''.

     SEC. 603. UPDATED FEDERAL EVALUATION OF CHIP.

       Section 2108(c) (42 U.S.C. 1397hh(c)) is amended by 
     striking paragraph (5) and inserting the following:
       ``(5) Subsequent evaluation using updated information.--
       ``(A) In general.--The Secretary, directly or through 
     contracts or interagency agreements, shall conduct an 
     independent subsequent evaluation of 10 States with approved 
     child health plans.
       ``(B) Selection of states and matters included.--Paragraphs 
     (2) and (3) shall apply to such subsequent evaluation in the 
     same manner as such provisions apply to the evaluation 
     conducted under paragraph (1).
       ``(C) Submission to congress.--Not later than December 31, 
     2011, the Secretary shall submit to Congress the results of 
     the evaluation conducted under this paragraph.
       ``(D) Funding.--Out of any money in the Treasury of the 
     United States not otherwise appropriated, there are 
     appropriated $10,000,000 for fiscal year 2010 for the purpose 
     of conducting the evaluation authorized under this paragraph. 
     Amounts appropriated under this subparagraph shall remain 
     available for expenditure through fiscal year 2012.''.

     SEC. 604. ACCESS TO RECORDS FOR IG AND GAO AUDITS AND 
                   EVALUATIONS.

       Section 2108(d) (42 U.S.C. 1397hh(d)) is amended to read as 
     follows:
       ``(d) Access to Records for IG and GAO Audits and 
     Evaluations.--For the purpose of evaluating and auditing the 
     program established under this title, or title XIX, the 
     Secretary, the Office of Inspector General, and the 
     Comptroller General shall have access to any books, accounts, 
     records, correspondence, and other documents that are related 
     to the expenditure of Federal funds under this title and that 
     are in the possession, custody, or control of States 
     receiving Federal funds under this title or political 
     subdivisions thereof, or any grantee or contractor of such 
     States or political subdivisions.''.

     SEC. 605. NO FEDERAL FUNDING FOR ILLEGAL ALIENS.

       Nothing in this Act allows Federal payment for individuals 
     who are not lawfully residing in the United States. Titles 
     XI, XIX, and XXI of the Social Security Act provide for the 
     disallowance of Federal financial participation for erroneous 
     expenditures under Medicaid and under CHIP, respectively.

              Subtitle B--Miscellaneous Health Provisions

     SEC. 611. DEFICIT REDUCTION ACT TECHNICAL CORRECTIONS.

       (a) Clarification of Requirement To Provide EPSDT Services 
     for All Children in Benchmark Benefit Packages Under 
     Medicaid.--Section 1937(a)(1) (42 U.S.C. 1396u-7(a)(1)), as 
     inserted by section 6044(a) of the Deficit Reduction Act of 
     2005 (Public Law 109-171, 120 Stat. 88), is amended--
       (1) in subparagraph (A)--
       (A) in the matter before clause (i)--
       (i) by striking ``Notwithstanding any other provision of 
     this title'' and inserting ``Notwithstanding section 
     1902(a)(1) (relating to statewideness), section 
     1902(a)(10)(B) (relating to comparability) and any other 
     provision of this title which would be directly contrary to 
     the authority under this section and subject to subsection 
     (E)''; and
       (ii) by striking ``enrollment in coverage that provides'' 
     and inserting ``coverage that'';
       (B) in clause (i), by inserting ``provides'' after ``(i)''; 
     and
       (C) by striking clause (ii) and inserting the following:
       ``(ii) for any individual described in section 
     1905(a)(4)(B) who is eligible under the State plan in 
     accordance with paragraphs (10) and (17) of section 1902(a), 
     consists of the items and services described in section 
     1905(a)(4)(B) (relating to early and periodic screening, 
     diagnostic, and treatment services defined in section 
     1905(r)) and provided in accordance with the requirements of 
     section 1902(a)(43).'';
       (2) in subparagraph (C)--
       (A) in the heading, by striking ``wrap-around'' and 
     inserting ``additional''; and
       (B) by striking ``wrap-around or''; and
       (3) by adding at the end the following new subparagraph:
       ``(E) Rule of construction.--Nothing in this paragraph 
     shall be construed as--
       ``(i) requiring a State to offer all or any of the items 
     and services required by subparagraph (A)(ii) through an 
     issuer of benchmark coverage described in subsection (b)(1) 
     or benchmark equivalent coverage described in subsection 
     (b)(2);
       ``(ii) preventing a State from offering all or any of the 
     items and services required by subparagraph (A)(ii) through 
     an issuer of benchmark coverage described in subsection 
     (b)(1) or benchmark equivalent coverage described in 
     subsection (b)(2); or
       ``(iii) affecting a child's entitlement to care and 
     services described in subsections (a)(4)(B) and (r) of 
     section 1905 and provided in accordance with section 
     1902(a)(43) whether provided through benchmark coverage, 
     benchmark equivalent coverage, or otherwise.''.
       (b) Correction of Reference to Children in Foster Care 
     Receiving Child Welfare Services.--Section 
     1937(a)(2)(B)(viii) (42 U.S.C. 1396u-7(a)(2)(B)(viii)), as 
     inserted by section 6044(a) of the Deficit Reduction Act of 
     2005, is amended by striking ``aid or assistance is made 
     available under part B of title IV to children in foster care 
     and individuals'' and inserting ``child welfare services are 
     made available under part B of title IV on the basis of being 
     a child in foster care or''.
       (c) Transparency.--Section 1937 (42 U.S.C. 1396u-7), as 
     inserted by section 6044(a) of the Deficit Reduction Act of 
     2005, is amended by adding at the end the following:
       ``(c) Publication of Provisions Affected.--With respect to 
     a State plan amendment to provide benchmark benefits in 
     accordance with subsections (a) and (b) that is approved by 
     the Secretary, the Secretary shall publish on the Internet 
     website of the Centers for Medicare & Medicaid Services, a 
     list of the provisions of this title that the Secretary has 
     determined do not apply in order to enable the State to carry 
     out the plan amendment and the reason for each such 
     determination on the date such approval is made, and shall 
     publish such list in

[[Page 727]]

     the Federal Register and not later than 30 days after such 
     date of approval.''.
       (d) Effective Date.--The amendments made by subsections 
     (a), (b), and (c) of this section shall take effect as if 
     included in the amendment made by section 6044(a) of the 
     Deficit Reduction Act of 2005.

     SEC. 612. REFERENCES TO TITLE XXI.

       Section 704 of the Medicare, Medicaid, and SCHIP Balanced 
     Budget Refinement Act of 1999, as enacted into law by 
     division B of Public Law 106-113 (113 Stat. 1501A-402) is 
     repealed.

     SEC. 613. PROHIBITING INITIATION OF NEW HEALTH OPPORTUNITY 
                   ACCOUNT DEMONSTRATION PROGRAMS.

       After the date of the enactment of this Act, the Secretary 
     of Health and Human Services may not approve any new 
     demonstration programs under section 1938 of the Social 
     Security Act (42 U.S.C. 1396u-8).

     SEC. 614. ADJUSTMENT IN COMPUTATION OF MEDICAID FMAP TO 
                   DISREGARD AN EXTRAORDINARY EMPLOYER PENSION 
                   CONTRIBUTION.

       (a) In General.--Only for purposes of computing the FMAP 
     (as defined in subsection (e)) for a State for a fiscal year 
     (beginning with fiscal year 2006) and applying the FMAP under 
     title XIX of the Social Security Act, any significantly 
     disproportionate employer pension or insurance fund 
     contribution described in subsection (b) shall be disregarded 
     in computing the per capita income of such State, but shall 
     not be disregarded in computing the per capita income for the 
     continental United States (and Alaska) and Hawaii.
       (b) Significantly Disproportionate Employer Pension and 
     Insurance Fund Contribution.--
       (1) In general.--For purposes of this section, a 
     significantly disproportionate employer pension and insurance 
     fund contribution described in this subsection with respect 
     to a State is any identifiable employer contribution towards 
     pension or other employee insurance funds that is estimated 
     to accrue to residents of such State for a calendar year 
     (beginning with calendar year 2003) if the increase in the 
     amount so estimated exceeds 25 percent of the total increase 
     in personal income in that State for the year involved.
       (2) Data to be used.--For estimating and adjustment a FMAP 
     already calculated as of the date of the enactment of this 
     Act for a State with a significantly disproportionate 
     employer pension and insurance fund contribution, the 
     Secretary shall use the personal income data set originally 
     used in calculating such FMAP.
       (3) Special adjustment for negative growth.--If in any 
     calendar year the total personal income growth in a State is 
     negative, an employer pension and insurance fund contribution 
     for the purposes of calculating the State's FMAP for a 
     calendar year shall not exceed 125 percent of the amount of 
     such contribution for the previous calendar year for the 
     State.
       (c) Hold Harmless.--No State shall have its FMAP for a 
     fiscal year reduced as a result of the application of this 
     section.
       (d) Report.--Not later than May 15, 2009, the Secretary 
     shall submit to the Congress a report on the problems 
     presented by the current treatment of pension and insurance 
     fund contributions in the use of Bureau of Economic Affairs 
     calculations for the FMAP and for Medicaid and on possible 
     alternative methodologies to mitigate such problems.
       (e) FMAP Defined.--For purposes of this section, the term 
     ``FMAP'' means the Federal medical assistance percentage, as 
     defined in section 1905(b) of the Social Security Act (42 
     U.S.C. 1396(d)).

     SEC. 615. CLARIFICATION TREATMENT OF REGIONAL MEDICAL CENTER.

       (a) In General.--Nothing in section 1903(w) of the Social 
     Security Act (42 U.S.C. 1396b(w)) shall be construed by the 
     Secretary of Health and Human Services as prohibiting a 
     State's use of funds as the non-Federal share of expenditures 
     under title XIX of such Act where such funds are transferred 
     from or certified by a publicly-owned regional medical center 
     located in another State and described in subsection (b), so 
     long as the Secretary determines that such use of funds is 
     proper and in the interest of the program under title XIX.
       (b) Center Described.--A center described in this 
     subsection is a publicly-owned regional medical center that--
       (1) provides level 1 trauma and burn care services;
       (2) provides level 3 neonatal care services;
       (3) is obligated to serve all patients, regardless of 
     ability to pay;
       (4) is located within a Standard Metropolitan Statistical 
     Area (SMSA) that includes at least 3 States;
       (5) provides services as a tertiary care provider for 
     patients residing within a 125-mile radius; and
       (6) meets the criteria for a disproportionate share 
     hospital under section 1923 of such Act (42 U.S.C. 1396r-4) 
     in at least one State other than the State in which the 
     center is located.

     SEC. 616. EXTENSION OF MEDICAID DSH ALLOTMENTS FOR TENNESSEE 
                   AND HAWAII.

       Section 1923(f)(6) (42 U.S.C. 1396r-4(f)(6)), as amended by 
     section 202 of the Medicare Improvements for Patients and 
     Providers Act of 2008 (Public Law 110-275) is amended--
       (1) in the paragraph heading, by striking ``2009 and the 
     first calendar quarter of fiscal year 2010'' and inserting 
     ``2011 and the first calendar quarter of fiscal year 2012'';
       (2) in subparagraph (A)--
       (A) in clause (i)--
       (i) in the second sentence--

       (I) by striking ``and 2009'' and inserting ``, 2009, 2010, 
     and 2011''; and
       (II) by striking ``such portion of''; and

       (ii) in the third sentence, by striking ``2010 for the 
     period ending on December 31, 2009'' and inserting ``2012 for 
     the period ending on December 31, 2011'';
       (B) in clause (ii), by striking ``or for a period in fiscal 
     year 2010'' and inserting ``2010, 2011, or for period in 
     fiscal year 2012''; and
       (C) in clause (iv)--
       (i) in the clause heading, by striking ``2009 and the first 
     calendar quarter of fiscal year 2010'' and inserting ``2011 
     and the first calendar quarter of fiscal year 2012''; and
       (ii) in each of subclauses (I) and (II), by striking `` or 
     for a period in fiscal year 2010'' and inserting ``2010, 
     2011, or for a period in fiscal year 2012''; and
       (3) in subparagraph (B)--
       (A) in clause (i)--
       (i) in the first sentence, by striking ``2009'' and 
     inserting ``2011''; and
       (ii) in the second sentence, by striking ``2010 for the 
     period ending on December 31, 2009'' and inserting ``2012 for 
     the period ending on December 31, 2011''.

                      Subtitle C--Other Provisions

     SEC. 621. OUTREACH REGARDING HEALTH INSURANCE OPTIONS 
                   AVAILABLE TO CHILDREN.

       (a) Definitions.--In this section--
       (1) the terms ``Administration'' and ``Administrator'' 
     means the Small Business Administration and the Administrator 
     thereof, respectively;
       (2) the term ``certified development company'' means a 
     development company participating in the program under title 
     V of the Small Business Investment Act of 1958 (15 U.S.C. 695 
     et seq.);
       (3) the term ``Medicaid program'' means the program 
     established under title XIX of the Social Security Act (42 
     U.S.C. 1396 et seq.);
       (4) the term ``Service Corps of Retired Executives'' means 
     the Service Corps of Retired Executives authorized by section 
     8(b)(1) of the Small Business Act (15 U.S.C. 637(b)(1));
       (5) the term ``small business concern'' has the meaning 
     given that term in section 3 of the Small Business Act (15 
     U.S.C. 632);
       (6) the term ``small business development center'' means a 
     small business development center described in section 21 of 
     the Small Business Act (15 U.S.C. 648);
       (7) the term ``State'' has the meaning given that term for 
     purposes of title XXI of the Social Security Act (42 U.S.C. 
     1397aa et seq.);
       (8) the term ``State Children's Health Insurance Program'' 
     means the State Children's Health Insurance Program 
     established under title XXI of the Social Security Act (42 
     U.S.C. 1397aa et seq.);
       (9) the term ``task force'' means the task force 
     established under subsection (b)(1); and
       (10) the term ``women's business center'' means a women's 
     business center described in section 29 of the Small Business 
     Act (15 U.S.C. 656).
       (b) Establishment of Task Force.--
       (1) Establishment.--There is established a task force to 
     conduct a nationwide campaign of education and outreach for 
     small business concerns regarding the availability of 
     coverage for children through private insurance options, the 
     Medicaid program, and the State Children's Health Insurance 
     Program.
       (2) Membership.--The task force shall consist of the 
     Administrator, the Secretary of Health and Human Services, 
     the Secretary of Labor, and the Secretary of the Treasury.
       (3) Responsibilities.--The campaign conducted under this 
     subsection shall include--
       (A) efforts to educate the owners of small business 
     concerns about the value of health coverage for children;
       (B) information regarding options available to the owners 
     and employees of small business concerns to make insurance 
     more affordable, including Federal and State tax deductions 
     and credits for health care-related expenses and health 
     insurance expenses and Federal tax exclusion for health 
     insurance options available under employer-sponsored 
     cafeteria plans under section 125 of the Internal Revenue 
     Code of 1986;
       (C) efforts to educate the owners of small business 
     concerns about assistance available through public programs; 
     and
       (D) efforts to educate the owners and employees of small 
     business concerns regarding the availability of the hotline 
     operated as part of the Insure Kids Now program of the 
     Department of Health and Human Services.
       (4) Implementation.--In carrying out this subsection, the 
     task force may--
       (A) use any business partner of the Administration, 
     including--
       (i) a small business development center;
       (ii) a certified development company;
       (iii) a women's business center; and
       (iv) the Service Corps of Retired Executives;
       (B) enter into--
       (i) a memorandum of understanding with a chamber of 
     commerce; and

[[Page 728]]

       (ii) a partnership with any appropriate small business 
     concern or health advocacy group; and
       (C) designate outreach programs at regional offices of the 
     Department of Health and Human Services to work with district 
     offices of the Administration.
       (5) Website.--The Administrator shall ensure that links to 
     information on the eligibility and enrollment requirements 
     for the Medicaid program and State Children's Health 
     Insurance Program of each State are prominently displayed on 
     the website of the Administration.
       (6) Report.--
       (A) In general.--Not later than 2 years after the date of 
     enactment of this Act, and every 2 years thereafter, the 
     Administrator shall submit to the Committee on Small Business 
     and Entrepreneurship of the Senate and the Committee on Small 
     Business of the House of Representatives a report on the 
     status of the nationwide campaign conducted under paragraph 
     (1).
       (B) Contents.--Each report submitted under subparagraph (A) 
     shall include a status update on all efforts made to educate 
     owners and employees of small business concerns on options 
     for providing health insurance for children through public 
     and private alternatives.

     SEC. 622. SENSE OF THE SENATE REGARDING ACCESS TO AFFORDABLE 
                   AND MEANINGFUL HEALTH INSURANCE COVERAGE.

       (a) Findings.--The Senate finds the following:
       (1) There are approximately 45 million Americans currently 
     without health insurance.
       (2) More than half of uninsured workers are employed by 
     businesses with less than 25 employees or are self-employed.
       (3) Health insurance premiums continue to rise at more than 
     twice the rate of inflation for all consumer goods.
       (4) Individuals in the small group and individual health 
     insurance markets usually pay more for similar coverage than 
     those in the large group market.
       (5) The rapid growth in health insurance costs over the 
     last few years has forced many employers, particularly small 
     employers, to increase deductibles and co-pays or to drop 
     coverage completely.
       (b) Sense of the Senate.--The Senate--
       (1) recognizes the necessity to improve affordability and 
     access to health insurance for all Americans;
       (2) acknowledges the value of building upon the existing 
     private health insurance market; and
       (3) affirms its intent to enact legislation this year that, 
     with appropriate protection for consumers, improves access to 
     affordable and meaningful health insurance coverage for 
     employees of small businesses and individuals by--
       (A) facilitating pooling mechanisms, including pooling 
     across State lines, and
       (B) providing assistance to small businesses and 
     individuals, including financial assistance and tax 
     incentives, for the purchase of private insurance coverage.

     SEC. 623. LIMITATION ON MEDICARE EXCEPTION TO THE PROHIBITION 
                   ON CERTAIN PHYSICIAN REFERRALS FOR HOSPITALS.

       (a) In General.--Section 1877 (42 U.S.C. 1395nn) is 
     amended--
       (1) in subsection (d)(2)--
       (A) in subparagraph (A), by striking ``and'' at the end;
       (B) in subparagraph (B), by striking the period at the end 
     and inserting ``; and''; and
       (C) by adding at the end the following new subparagraph:
       ``(C) in the case where the entity is a hospital, the 
     hospital meets the requirements of paragraph (3)(D).'';
       (2) in subsection (d)(3)--
       (A) in subparagraph (B), by striking ``and'' at the end;
       (B) in subparagraph (C), by striking the period at the end 
     and inserting ``; and''; and
       (C) by adding at the end the following new subparagraph:
       ``(D) the hospital meets the requirements described in 
     subsection (i)(1).''; and
       (3) by adding at the end the following new subsection:
       ``(i) Requirements for Hospitals To Qualify for Rural 
     Provider and Hospital Exception to Ownership or Investment 
     Prohibition.--
       ``(1) Requirements described.--For purposes of subsection 
     (d)(3)(D), the requirements described in this paragraph for a 
     hospital are as follows:
       ``(A) Provider agreement.--The hospital had--
       ``(i) physician ownership or investment on January 1, 2009; 
     and
       ``(ii) a provider agreement under section 1866 in effect on 
     such date.
       ``(B) Prohibition on physician ownership or investment.--
     The percentage of the total value of the ownership or 
     investment interests held in the hospital, or in an entity 
     whose assets include the hospital, by physician owners or 
     investors in the aggregate does not exceed such percentage as 
     of the date of enactment of this subsection.
       ``(C) Prohibition on expansion of facility capacity.--
     Except as provided in paragraph (3), the number of operating 
     rooms, procedure rooms, and beds of the hospital at any time 
     on or after the date of the enactment of this subsection are 
     no greater than the number of operating rooms, procedure 
     rooms, and beds as of such date.
       ``(D) Preventing conflicts of interest.--
       ``(i) The hospital submits to the Secretary an annual 
     report containing a detailed description of--

       ``(I) the identity of each physician owner and physician 
     investor and any other owners or investors of the hospital; 
     and
       ``(II) the nature and extent of all ownership and 
     investment interests in the hospital.

       ``(ii) The hospital has procedures in place to require that 
     any referring physician owner or investor discloses to the 
     patient being referred, by a time that permits the patient to 
     make a meaningful decision regarding the receipt of care, as 
     determined by the Secretary--

       ``(I) the ownership or investment interest, as applicable, 
     of such referring physician in the hospital; and
       ``(II) if applicable, any such ownership or investment 
     interest of the treating physician.

       ``(iii) The hospital does not condition any physician 
     ownership or investment interests either directly or 
     indirectly on the physician owner or investor making or 
     influencing referrals to the hospital or otherwise generating 
     business for the hospital.
       ``(iv) The hospital discloses the fact that the hospital is 
     partially owned by physicians--

       ``(I) on any public website for the hospital; and
       ``(II) in any public advertising for the hospital.

       ``(E) Ensuring bona fide ownership and investment.--
       ``(i) Any ownership or investment interests that the 
     hospital offers to a physician owner or investor are not 
     offered on more favorable terms than the terms offered to a 
     person who is not a physician owner or investor.
       ``(ii) The hospital (or any investors in the hospital) does 
     not directly or indirectly provide loans or financing for any 
     physician owner or investor in the hospital.
       ``(iii) The hospital (or any investors in the hospital) 
     does not directly or indirectly guarantee a loan, make a 
     payment toward a loan, or otherwise subsidize a loan, for any 
     individual physician owner or investor or group of physician 
     owners or investors that is related to acquiring any 
     ownership or investment interest in the hospital.
       ``(iv) Ownership or investment returns are distributed to 
     each owner or investor in the hospital in an amount that is 
     directly proportional to the ownership or investment interest 
     of such owner or investor in the hospital.
       ``(v) Physician owners and investors do not receive, 
     directly or indirectly, any guaranteed receipt of or right to 
     purchase other business interests related to the hospital, 
     including the purchase or lease of any property under the 
     control of other owners or investors in the hospital or 
     located near the premises of the hospital.
       ``(vi) The hospital does not offer a physician owner or 
     investor the opportunity to purchase or lease any property 
     under the control of the hospital or any other owner or 
     investor in the hospital on more favorable terms than the 
     terms offered to an individual who is not a physician owner 
     or investor.
       ``(F) Patient safety.--The hospital has the capacity to--
       ``(i) provide assessment and initial treatment for 
     patients; and
       ``(ii) refer and transfer patients to hospitals with the 
     capability to treat the needs of the patient involved.
       ``(G) Limitation on application to certain converted 
     facilities.--The hospital was not converted from an 
     ambulatory surgical center to a hospital on or after the date 
     of enactment of this subsection.
       ``(2) Publication of information reported.--The Secretary 
     shall publish, and update on an annual basis, the information 
     submitted by hospitals under paragraph (1)(D)(i) on the 
     public Internet website of the Centers for Medicare & 
     Medicaid Services.
       ``(3) Exception to prohibition on expansion of facility 
     capacity.--
       ``(A) Process.--
       ``(i) Establishment.--The Secretary shall establish and 
     implement a process under which an applicable hospital (as 
     defined in subparagraph (E)) may apply for an exception from 
     the requirement under paragraph (1)(C).
       ``(ii) Opportunity for community input.--The process under 
     clause (i) shall provide individuals and entities in the 
     community in which the applicable hospital applying for an 
     exception is located with the opportunity to provide input 
     with respect to the application.
       ``(iii) Timing for implementation.--The Secretary shall 
     implement the process under clause (i) on July 1, 2010.
       ``(iv) Regulations.--Not later than June 1, 2010, the 
     Secretary shall promulgate regulations to carry out the 
     process under clause (i).
       ``(B) Frequency.--The process described in subparagraph (A) 
     shall permit an applicable hospital to apply for an exception 
     up to once every 2 years.
       ``(C) Permitted increase.--
       ``(i) In general.--Subject to clause (ii) and subparagraph 
     (D), an applicable hospital

[[Page 729]]

     granted an exception under the process described in 
     subparagraph (A) may increase the number of operating rooms, 
     procedure rooms, and beds of the applicable hospital above 
     the baseline number of operating rooms, procedure rooms, and 
     beds of the applicable hospital (or, if the applicable 
     hospital has been granted a previous exception under this 
     paragraph, above the number of operating rooms, procedure 
     rooms, and beds of the hospital after the application of the 
     most recent increase under such an exception).
       ``(ii) 100 percent increase limitation.--The Secretary 
     shall not permit an increase in the number of operating 
     rooms, procedure rooms, and beds of an applicable hospital 
     under clause (i) to the extent such increase would result in 
     the number of operating rooms, procedure rooms, and beds of 
     the applicable hospital exceeding 200 percent of the baseline 
     number of operating rooms, procedure rooms, and beds of the 
     applicable hospital.
       ``(iii) Baseline number of operating rooms, procedure 
     rooms, and beds.--In this paragraph, the term `baseline 
     number of operating rooms, procedure rooms, and beds' means 
     the number of operating rooms, procedure rooms, and beds of 
     the applicable hospital as of the date of enactment of this 
     subsection.
       ``(D) Increase limited to facilities on the main campus of 
     the hospital.--Any increase in the number of operating rooms, 
     procedure rooms, and beds of an applicable hospital pursuant 
     to this paragraph may only occur in facilities on the main 
     campus of the applicable hospital.
       ``(E) Applicable hospital.--In this paragraph, the term 
     `applicable hospital' means a hospital--
       ``(i) that is located in a county in which the percentage 
     increase in the population during the most recent 5-year 
     period (as of the date of the application under subparagraph 
     (A)) is at least 150 percent of the percentage increase in 
     the population growth of the State in which the hospital is 
     located during that period, as estimated by Bureau of the 
     Census and available to the Secretary;
       ``(ii) whose annual percent of total inpatient admissions 
     that represent inpatient admissions under the program under 
     title XIX is equal to or greater than the average percent 
     with respect to such admissions for all hospitals located in 
     the county in which the hospital is located;
       ``(iii) that does not discriminate against beneficiaries of 
     Federal health care programs and does not permit physicians 
     practicing at the hospital to discriminate against such 
     beneficiaries;
       ``(iv) that is located in a State in which the average bed 
     capacity in the State is less than the national average bed 
     capacity; and
       ``(v) that has an average bed occupancy rate that is 
     greater than the average bed occupancy rate in the State in 
     which the hospital is located.
       ``(F) Procedure rooms.--In this subsection, the term 
     `procedure rooms' includes rooms in which catheterizations, 
     angiographies, angiograms, and endoscopies are performed, 
     except such term shall not include emergency rooms or 
     departments (exclusive of rooms in which catheterizations, 
     angiographies, angiograms, and endoscopies are performed).
       ``(G) Publication of final decisions.--Not later than 60 
     days after receiving a complete application under this 
     paragraph, the Secretary shall publish in the Federal 
     Register the final decision with respect to such application.
       ``(H) Limitation on review.--There shall be no 
     administrative or judicial review under section 1869, section 
     1878, or otherwise of the process under this paragraph 
     (including the establishment of such process).
       ``(4) Collection of ownership and investment information.--
     For purposes of subparagraphs (A)(i) and (B) of paragraph 
     (1), the Secretary shall collect physician ownership and 
     investment information for each hospital.
       ``(5) Physician owner or investor defined.--For purposes of 
     this subsection, the term `physician owner or investor' means 
     a physician (or an immediate family member of such physician) 
     with a direct or an indirect ownership or investment interest 
     in the hospital.
       ``(6) Patient safety requirement.--In the case of a 
     hospital to which the requirements of paragraph (1) apply, 
     insofar as the hospital described in this subsection admits a 
     patient and does not have any physician available on the 
     premises to provide services during all hours in which the 
     hospital is providing services to such patient, before 
     admitting the patient--
       ``(A) the hospital shall disclose such fact to a patient; 
     and
       ``(B) following such disclosure, the hospital shall receive 
     from the patient a signed acknowledgment that the patient 
     understands such fact.
       ``(7) Clarification.--Nothing in this subsection shall be 
     construed as preventing the Secretary from revoking a 
     hospital's provider agreement if not in compliance with 
     regulations implementing section 1866.''.
       (b) Enforcement.--
       (1) Ensuring compliance.--The Secretary of Health and Human 
     Services shall establish policies and procedures to ensure 
     compliance with the requirements described in subsections 
     (i)(1) and (i)(7) of section 1877 of the Social Security Act, 
     as added by subsection (a)(3), beginning on the date such 
     requirements first apply. Such policies and procedures may 
     include unannounced site reviews of hospitals.
       (2) Audits.--Beginning not later than July 1, 2011, the 
     Secretary of Health and Human Services shall conduct audits 
     to determine if hospitals violate the requirements referred 
     to in paragraph (1).

                     TITLE VII--REVENUE PROVISIONS

     SEC. 701. INCREASE IN EXCISE TAX RATE ON TOBACCO PRODUCTS.

       (a) Cigars.--
       (1) Small cigars.--Paragraph (1) of section 5701(a) of the 
     Internal Revenue Code of 1986 is amended to read as follows:
       ``(1) Small cigars.--On cigars, weighing not more than 3 
     pounds per thousand, the amount determined in accordance with 
     the following table:


------------------------------------------------------------------------
                                                               Tax Rate
          ``Cigars Removed During Calendar Year--                Per
                                                              Thousand--
------------------------------------------------------------------------
2009 or 2010...............................................       $12.50
2011 or 2012...............................................       $25.00
2013 or 2014...............................................       $37.50
2015 or thereafter.........................................   $50.00.''.
------------------------------------------------------------------------

       (2) Large cigars.--Paragraph (2) of section 5701(a) of such 
     Code is amended--
       (A) by striking ``20.719 percent (18.063 percent on cigars 
     removed during 2000 or 2001)'' and inserting ``52.4 
     percent'', and
       (B) by striking ``$48.75 per thousand ($42.50 per thousand 
     on cigars removed during 2000 or 2001)'' and inserting ``40 
     cents per cigar''.
       (b) Cigarettes.--Section 5701(b) of such Code is amended--
       (1) by striking ``$19.50 per thousand ($17 per thousand on 
     cigarettes removed during 2000 or 2001)'' in paragraph (1) 
     and inserting ``$50.00 per thousand'', and
       (2) by striking ``$40.95 per thousand ($35.70 per thousand 
     on cigarettes removed during 2000 or 2001)'' in paragraph (2) 
     and inserting ``$105.00 per thousand''.
       (c) Cigarette Papers.--Section 5701(c) of such Code is 
     amended by striking ``1.22 cents (1.06 cents on cigarette 
     papers removed during 2000 or 2001)'' and inserting ``3.13 
     cents''.
       (d) Cigarette Tubes.--Section 5701(d) of such Code is 
     amended by striking ``2.44 cents (2.13 cents on cigarette 
     tubes removed during 2000 or 2001)'' and inserting ``6.26 
     cents''.
       (e) Smokeless Tobacco.--Section 5701(e) of such Code is 
     amended--
       (1) by striking ``58.5 cents (51 cents on snuff removed 
     during 2000 or 2001)'' in paragraph (1) and inserting 
     ``$1.50'', and
       (2) by striking ``19.5 cents (17 cents on chewing tobacco 
     removed during 2000 or 2001)'' in paragraph (2) and inserting 
     ``50 cents''.
       (f) Pipe Tobacco.--Section 5701(f) of such Code is amended 
     by striking ``$1.0969 cents (95.67 cents on pipe tobacco 
     removed during 2000 or 2001)'' and inserting ``$2.8126''.
       (g) Roll-Your-Own Tobacco.--Section 5701(g) of such Code is 
     amended by striking ``$1.0969 cents (95.67 cents on roll-
     your-own tobacco removed during 2000 or 2001)'' and inserting 
     ``$24.62''.
       (h) Floor Stocks Taxes.--
       (1) Imposition of tax.--On tobacco products (other than 
     cigars described in section 5701(a)(2) of the Internal 
     Revenue Code of 1986) and cigarette papers and tubes 
     manufactured in or imported into the United States which are 
     removed before any tax increase date and held on such date 
     for sale by any person, there is hereby imposed a tax in an 
     amount equal to the excess of--
       (A) the tax which would be imposed under section 5701 of 
     such Code on the article if the article had been removed on 
     such date, over
       (B) the prior tax (if any) imposed under section 5701 of 
     such Code on such article.
       (2) Credit against tax.--Each person shall be allowed as a 
     credit against the taxes imposed by paragraph (1) an amount 
     equal to $500. Such credit shall not exceed the amount of 
     taxes imposed by paragraph (1) on such date, for which such 
     person is liable.
       (3) Liability for tax and method of payment.--
       (A) Liability for tax.--A person holding tobacco products, 
     cigarette papers, or cigarette tubes on any tax increase 
     date, to which any tax imposed by paragraph (1) applies shall 
     be liable for such tax.
       (B) Method of payment.--The tax imposed by paragraph (1) 
     shall be paid in such manner as the Secretary shall prescribe 
     by regulations.
       (C) Time for payment.--
       (i) In general.--The tax imposed by paragraph (1) shall be 
     paid on or before August 1, 2009.
       (ii) Special rule for small cigars.--In the case of small 
     cigars, the tax imposed by paragraph (1) on or after January 
     1, 2011, shall be paid on or before April 1 following any tax 
     increase date.
       (4) Articles in foreign trade zones.--Notwithstanding the 
     Act of June 18, 1934 (commonly known as the Foreign Trade 
     Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.) or any other 
     provision of law, any article which is located in a foreign 
     trade zone on any tax increase date shall be subject to the 
     tax imposed by paragraph (1) if--

[[Page 730]]

       (A) internal revenue taxes have been determined, or customs 
     duties liquidated, with respect to such article before such 
     date pursuant to a request made under the 1st proviso of 
     section 3(a) of such Act, or
       (B) such article is held on such date under the supervision 
     of an officer of the United States Customs and Border 
     Protection of the Department of Homeland Security pursuant to 
     the 2d proviso of such section 3(a).
       (5) Definitions.--For purposes of this subsection--
       (A) In general.--Any term used in this subsection which is 
     also used in section 5702 of the Internal Revenue Code of 
     1986 shall have the same meaning as such term has in such 
     section.
       (B) Tax increase date.--The term ``tax increase date'' 
     means April 1, 2009, January 1, 2011, January 1, 2013, and 
     January 1, 2015.
       (C) Secretary.--The term ``Secretary'' means the Secretary 
     of the Treasury or the Secretary's delegate.
       (6) Controlled groups.--Rules similar to the rules of 
     section 5061(e)(3) of such Code shall apply for purposes of 
     this subsection.
       (7) Other laws applicable.--All provisions of law, 
     including penalties, applicable with respect to the taxes 
     imposed by section 5701 of such Code shall, insofar as 
     applicable and not inconsistent with the provisions of this 
     subsection, apply to the floor stocks taxes imposed by 
     paragraph (1), to the same extent as if such taxes were 
     imposed by such section 5701. The Secretary may treat any 
     person who bore the ultimate burden of the tax imposed by 
     paragraph (1) as the person to whom a credit or refund under 
     such provisions may be allowed or made.
       (i) Effective Date.--The amendments made by this section 
     shall apply to articles removed (as defined in section 
     5702(j) of the Internal Revenue Code of 1986) after March 31, 
     2009.

     SEC. 702. ADMINISTRATIVE IMPROVEMENTS.

       (a) Permit, Inventories, Reports, and Records Requirements 
     for Manufacturers and Importers of Processed Tobacco.--
       (1) Permit.--
       (A) Application.--Section 5712 of the Internal Revenue Code 
     of 1986 is amended by inserting ``or processed tobacco'' 
     after ``tobacco products''.
       (B) Issuance.--Section 5713(a) of such Code is amended by 
     inserting ``or processed tobacco'' after ``tobacco 
     products''.
       (2) Inventories, reports, and packages.--
       (A) Inventories.--Section 5721 of such Code is amended by 
     inserting ``, processed tobacco,'' after ``tobacco 
     products''.
       (B) Reports.--Section 5722 of such Code is amended by 
     inserting ``, processed tobacco,'' after ``tobacco 
     products''.
       (C) Packages, marks, labels, and notices.--Section 5723 of 
     such Code is amended by inserting ``, processed tobacco,'' 
     after ``tobacco products'' each place it appears.
       (3) Records.--Section 5741 of such Code is amended by 
     inserting ``, processed tobacco,'' after ``tobacco 
     products''.
       (4) Manufacturer of processed tobacco.--Section 5702 of 
     such Code is amended by adding at the end the following new 
     subsection:
       ``(p) Manufacturer of Processed Tobacco.--
       ``(1) In general.--The term `manufacturer of processed 
     tobacco' means any person who processes any tobacco other 
     than tobacco products.
       ``(2) Processed tobacco.--The processing of tobacco shall 
     not include the farming or growing of tobacco or the handling 
     of tobacco solely for sale, shipment, or delivery to a 
     manufacturer of tobacco products or processed tobacco.''.
       (5) Conforming amendment.--Sections 5702(j), 5702(k), and 
     5704(h) of such Code is amended by inserting ``, or any 
     processed tobacco,'' after ``nontaxpaid tobacco products or 
     cigarette papers or tubes''.
       (6) Effective date.--The amendments made by this subsection 
     shall take effect on April 1, 2009.
       (b) Basis for Denial, Suspension, or Revocation of 
     Permits.--
       (1) Denial.--Paragraph (3) of section 5712 of such Code is 
     amended to read as follows:
       ``(3) such person (including, in the case of a corporation, 
     any officer, director, or principal stockholder and, in the 
     case of a partnership, a partner)--
       ``(A) is, by reason of his business experience, financial 
     standing, or trade connections or by reason of previous or 
     current legal proceedings involving a felony violation of any 
     other provision of Federal criminal law relating to tobacco 
     products, processed tobacco, cigarette paper, or cigarette 
     tubes, not likely to maintain operations in compliance with 
     this chapter,
       ``(B) has been convicted of a felony violation of any 
     provision of Federal or State criminal law relating to 
     tobacco products, processed tobacco, cigarette paper, or 
     cigarette tubes, or
       ``(C) has failed to disclose any material information 
     required or made any material false statement in the 
     application therefor.''.
       (2) Suspension or revocation.--Subsection (b) of section 
     5713 of such Code is amended to read as follows:
       ``(b) Suspension or Revocation.--
       ``(1) Show cause hearing.--If the Secretary has reason to 
     believe that any person holding a permit--
       ``(A) has not in good faith complied with this chapter, or 
     with any other provision of this title involving intent to 
     defraud,
       ``(B) has violated the conditions of such permit,
       ``(C) has failed to disclose any material information 
     required or made any material false statement in the 
     application for such permit,
       ``(D) has failed to maintain his premises in such manner as 
     to protect the revenue,
       ``(E) is, by reason of previous or current legal 
     proceedings involving a felony violation of any other 
     provision of Federal criminal law relating to tobacco 
     products, processed tobacco, cigarette paper, or cigarette 
     tubes, not likely to maintain operations in compliance with 
     this chapter, or
       ``(F) has been convicted of a felony violation of any 
     provision of Federal or State criminal law relating to 
     tobacco products, processed tobacco, cigarette paper, or 
     cigarette tubes,

     the Secretary shall issue an order, stating the facts 
     charged, citing such person to show cause why his permit 
     should not be suspended or revoked.
       ``(2) Action following hearing.--If, after hearing, the 
     Secretary finds that such person has not shown cause why his 
     permit should not be suspended or revoked, such permit shall 
     be suspended for such period as the Secretary deems proper or 
     shall be revoked.''.
       (3) Effective date.--The amendments made by this subsection 
     shall take effect on the date of the enactment of this Act.
       (c) Application of Internal Revenue Code Statute of 
     Limitations for Alcohol and Tobacco Excise Taxes.--
       (1) In general.--Section 514(a) of the Tariff Act of 1930 
     (19 U.S.C. 1514(a)) is amended by striking ``and section 520 
     (relating to refunds)'' and inserting ``section 520 (relating 
     to refunds), and section 6501 of the Internal Revenue Code of 
     1986 (but only with respect to taxes imposed under chapters 
     51 and 52 of such Code)''.
       (2) Effective date.--The amendment made by this subsection 
     shall apply to articles imported after the date of the 
     enactment of this Act.
       (d) Expansion of Definition of Roll-Your-Own Tobacco.--
       (1) In general.--Section 5702(o) of the Internal Revenue 
     Code of 1986 is amended by inserting ``or cigars, or for use 
     as wrappers thereof'' before the period at the end.
       (2) Effective date.--The amendment made by this subsection 
     shall apply to articles removed (as defined in section 
     5702(j) of the Internal Revenue Code of 1986) after March 31, 
     2009.
       (e) Time of Tax for Unlawfully Manufactured Tobacco 
     Products.--
       (1) In general.--Section 5703(b)(2) of such Code is amended 
     by adding at the end the following new subparagraph:
       ``(F) Special rule for unlawfully manufactured tobacco 
     products.--In the case of any tobacco products, cigarette 
     paper, or cigarette tubes manufactured in the United States 
     at any place other than the premises of a manufacturer of 
     tobacco products, cigarette paper, or cigarette tubes that 
     has filed the bond and obtained the permit required under 
     this chapter, tax shall be due and payable immediately upon 
     manufacture.''.
       (2) Effective date.--The amendment made by this subsection 
     shall take effect on the date of the enactment of this Act.
       (f) Disclosure.--
       (1) In general.--Paragraph (1) of section 6103(o) of such 
     Code is amended by designating the text as subparagraph (A), 
     moving such text 2 ems to the right, striking ``Returns'' and 
     inserting ``(a) in general.--Returns'', and by inserting 
     after subparagraph (A) (as so redesignated) the following new 
     subparagraph:
       ``(B) Use in certain proceedings.--Returns and return 
     information disclosed to a Federal agency under subparagraph 
     (A) may be used in an action or proceeding (or in preparation 
     for such action or proceeding) brought under section 625 of 
     the American Jobs Creation Act of 2004 for the collection of 
     any unpaid assessment or penalty arising under such Act.''.
       (2) Conforming amendment.--Section 6103(p)(4) of such Code 
     is amended by striking ``(o)(1)'' both places it appears and 
     inserting ``(o)(1)(A)''.
       (3) Effective date.--The amendments made by this subsection 
     shall apply on or after the date of the enactment of this 
     Act.
       (g) Transitional Rule.--Any person who--
       (1) on April 1 is engaged in business as a manufacturer of 
     processed tobacco or as an importer of processed tobacco, and
       (2) before the end of the 90-day period beginning on such 
     date, submits an application under subchapter B of chapter 52 
     of such Code to engage in such business, may, notwithstanding 
     such subchapter B, continue to engage in such business 
     pending final action on such application. Pending such final 
     action, all provisions of such chapter 52 shall apply to such 
     applicant in the same manner and to the same extent as if 
     such applicant were a holder of a permit under such chapter 
     52 to engage in such business.

     SEC. 703. TREASURY STUDY CONCERNING MAGNITUDE OF TOBACCO 
                   SMUGGLING IN THE UNITED STATES.

       Not later than one year after the date of the enactment of 
     this Act, the Secretary of

[[Page 731]]

     the Treasury shall conduct a study concerning the magnitude 
     of tobacco smuggling in the United States and submit to 
     Congress recommendations for the most effective steps to 
     reduce tobacco smuggling. Such study shall also include a 
     review of the loss of Federal tax receipts due to illicit 
     tobacco trade in the United States and the role of imported 
     tobacco products in the illicit tobacco trade in the United 
     States.

     SEC. 704. TIME FOR PAYMENT OF CORPORATE ESTIMATED TAXES.

       The percentage under subparagraph (C) of section 401(1) of 
     the Tax Increase Prevention and Reconciliation Act of 2005 in 
     effect on the date of the enactment of this Act is increased 
     by 1 percentage point.

  The SPEAKER pro tempore. Pursuant to House Resolution 52, the 
gentleman from New Jersey (Mr. Pallone), the gentleman from Missouri 
(Mr. Blunt), the gentleman from New York (Mr. Rangel), and the 
gentleman from California (Mr. Herger) each will control 15 minutes.
  The Chair recognizes the gentleman from New Jersey.


                             General Leave

  Mr. PALLONE. Madam Speaker, I ask unanimous consent that every Member 
have 5 legislative days in which to revise and extend their remarks and 
include extraneous material on the legislation now before us.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Madam Speaker, I yield myself 1 minute.
  Madam Speaker, we have been working to reauthorize the Children's 
Health Insurance Program for the past 2 years. In the last Congress, we 
passed legislation that enjoyed bipartisan support in both the House 
and Senate as well as the support of the American people. 
Unfortunately, it did not enjoy the support of the President, who 
vetoed our bill not once, but twice, and went on to proclaim that 
uninsured children can simply go to the emergency room to have their 
medical needs met.
  But this is a new day in Washington. Soon we will have a new 
President who has committed himself to reforming our Nation's health 
care system so every American can access affordable and quality health 
care. The bill we are considering today makes a down payment on that 
promise by putting the health and well-being of our children first.
  Madam Speaker, this bill will make critical improvements to CHIP. 
There will be more resources for States to enroll eligible children. 
There will be better benefits. As a result, there will be 11 million 
children who will have access to the quality health coverage they need 
and deserve.

                              {time}  1230

  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. PALLONE. Madam Speaker, I yield myself another 15 seconds.
  After 2 years of trying to get this bill enacted, we are now nearing 
the finish line and with not a moment to spare. As the Nation moves 
deeper into a recession and unemployment rates continue to rise, 
millions of Americans are joining the ranks of the uninsured, many of 
whom are children. We can't delay. We must enact this legislation now.
  Madam Speaker, I reserve the balance of my time.
  Mr. BLUNT. Madam Speaker, I yield myself 2 minutes.
  As I have returned to a more active role in the Energy and Commerce 
Committee, Madam Speaker, in this Congress, I will say I was surprised 
not to have a markup of this bill.
  We don't have to reauthorize this program until April. Certainly I'm 
for, as almost all the Members are for, a reauthorization of the 
current program and even for discussing how we can make that program 
better. But we didn't have a markup. We didn't see the bill, at least I 
haven't seen it, until today. And I have concerns about this bill. 
Certainly there are several reasons to look at this bill and think we 
could have improved it, bring it to the floor.
  Poor kids first, poor children first being served was the reason to 
have SCHIP, for children whose families couldn't afford insurance. This 
bill doesn't require the States to meet any kind of threshold standard 
that would ensure that States were doing everything they could to find 
kids who needed insurance before they begin to spend money to find kids 
who may not have the same need.
  Under the bill several thousands of American families would be poor 
enough to qualify for SCHIP and have the government pay for their 
health care, but they'd be rich enough to still be required to pay the 
alternative minimum tax. The bill changes welfare participation laws by 
eliminating the 5-year waiting period for legal immigrants to lawfully 
reside in the country before they can participate in this program. The 
bill significantly weakens provisions in current law requiring 
citizenship verification standards before an individual can be enrolled 
in this particular program. The bill will ship 2.4 million privately 
insured children to a government-run program.
  We think we have a better response. While there will be debate about 
how this bill is paid for, the biggest problem in the paid-for is in 
the 10th year, the final year, we assume that 65 percent of the people 
who are receiving the benefit----
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. BLUNT. Madam Speaker, I yield myself 30 more seconds.
  In the final bill, we assume that 65 percent of the children 
receiving the benefit wouldn't get the benefit anymore.
  It seems to me this bill needs more work, would have benefited from a 
committee hearing. It doesn't prioritize poor kids to ensure that they 
get health care first.
  I look forward to the debate today.
  Madam Speaker, I reserve the balance of my time.
  Mr. RANGEL. Madam Speaker, I yield myself such time as I may consume, 
and that won't be long.
  This is a great opportunity for Members who have returned to this 
Congress, but it's a better opportunity for the new Members.
  I won't be speaking on this bill because so many people want to be 
associated with this on our side. And I'm convinced it's not a 
Republican/Democratic issue. It's an issue of whether the families of 
11 million kids are going to get health care. You cannot say in dollars 
and cents what it's worth. We had overwhelming support in the other 
Congress. Now we don't have the threat of a veto.
  So I hope that you consider the children and not technical things 
that you're seeking in perfection.
  Madam Speaker, I yield the balance of my time over to Pete Stark, who 
for over a year has attempted to perfect this bill to reach the 
popularity and support it's gained on both sides of the aisle. I thank 
Chairman Waxman for the work that his committee and Mr. Dingell have 
made to make certain that we all read from the same page. And I look 
forward to this being the beginning where one day this Congress can say 
that no child will be able to say they're not covered by a decent 
health care program. So by unanimous consent I do hope that you will 
allow me to turn the balance of my time and my thanks to Chairman 
Stark, who brought us to this point once again.
  The SPEAKER pro tempore. Without objection, the gentleman from 
California will control the time.
  There was no objection.
  Mr. BLUNT. Madam Speaker, I yield 1 minute to a member of the Health 
Subcommittee of the full committee, Mr. Shadegg from Arizona.
  Mr. SHADEGG. Madam Speaker, this is a sad day. It's a sad day because 
we are about to adopt a radically different bill than the bills that 
were before with no hearings and no amendments. I would suggest 
democracy deserves better.
  About an hour ago, the Democratic majority leader told the tragic 
story of Deamonte Driver, a 12-year-old Maryland boy who died in 2007 
from complications resulting from what started as a simple toothache. 
The majority leader used Deamonte's story to argue that we need to 
expand SCHIP.
  Stunningly, however, Deamonte Driver's story is a story of a 
government health care program that failed. This was a child that went 
into a government health care program. It failed him so miserably, he 
died.

[[Page 732]]

  Several colleagues on the opposite side of the aisle argue that 
Republicans don't care about health care. That's dead wrong. We care 
about health care for America's poor and America's children. What we 
are against and adamantly against is promising Americans health care 
but failing to live up to that promise. That is what this bill will do.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. BLUNT. Madam Speaker, I yield the gentleman an additional 30 
seconds.
  Mr. SHADEGG. The Republican alternative is to give every single 
American family, every single one, the ability to buy a health care 
plan of their choice, not just the rich, not just the poor, but even 
those who don't respond to a government request that they enroll. We 
want to put them in a position to buy the health care they need by 
their choice from the doctor they choose.
  That's not good enough for the other side. They want to expand 
government programs that in the tragic story of Deamonte Driver 
resulted in the death of a 12-year-old boy from a problem that started 
as a toothache.
  Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentleman from 
California, the chairman of the Energy and Commerce Committee (Mr. 
Waxman).
  Mr. WAXMAN. Madam Speaker, I want to thank the gentleman from New 
Jersey, a very able chairman of the subcommittee of the Energy and 
Commerce Committee, for his authorship and managing this bill today.
  This is an important bill, and I want to commend Chairman Emeritus 
John Dingell for all the work he has done on this legislation.
  This bill and everything that's in it has already passed the House in 
the last 2 years; so we're not talking about anything new. What we are 
talking about is legislation that President Bush vetoed twice even 
though there was a strong bipartisan majority in the House and the 
Senate to try to get this legislation into law. The original program 
was a bipartisan program adopted in 1998, and it's going to be 
expiring; so we need to reauthorize it.
  This bill is a down payment, a down payment on health care for all 
Americans. But at least we will start covering millions of low-income 
children, children who are right above the poverty line.
  I urge support for the legislation.
  Ten years ago, a Democratic President and Republican Congress worked 
together to pass a landmark program to provide health care to children 
who had fallen through the cracks of our health care system.
  That program--CHIP--expires in less than 3 months. This bill extends 
and improves that program and makes the largest investment in 
children's health since the original CHIP law was enacted.
  It provides new outreach tools and bonus payments to States that find 
and enroll these children.
  The bill provides a new option to cover pregnant women in CHIP. It 
provides states the ability to ensure that children don't have to wait 
5 years for health care just because they are legal immigrants residing 
in this country.
  This bill is not the end but the beginning of a health reform effort 
that will ensure all children and all Americans will have health care 
coverage.
  I urge my colleagues to support this bill. Let's send to incoming 
President Obama legislation that will make all the difference in the 
lives of millions of children across this Nation.
  Mr. BLUNT. Madam Speaker, I yield 1 minute to the gentleman from 
Texas, Dr. Burgess, who is on our committee and on the subcommittee.
  Mr. BURGESS. I thank the gentleman for yielding.
  Madam Speaker, the bill before us today is going to harm access to 
high-quality hospital care by prohibiting physician ownership of 
hospitals.
  In past Congresses there have been attempts to prohibit physician 
ownership, and they have been struck down due in large part by the 
recognition of many Members of Congress across the aisle and on this 
side that these few physician-owned hospitals are doing a great job. 
Patients like going there. Physicians and nurses like working there. 
And I will just tell you as someone who has worked in a physician-owned 
facility, there's nothing like the pride of ownership in helping you 
deliver first class care.
  The bill before us today will put rural Americans at risk. Physician-
owned hospitals also provide care in many rural areas of this country 
where patients have few health care options.
  The attack on physician-owned hospitals will hurt the economy in a 
number of States. It's estimated up to $4 billion is generated in 
activity in these facilities in eight States in the country including 
my own home State of Texas.
  During this time of economic downturn, it is simply irresponsible to 
shut down a strong stream of economic activity in these States while 
shutting down patient access to care.
  Mr. STARK. Madam Speaker, I am delighted to yield 1 minute to the 
distinguished gentleman from Washington, Dr. McDermott.
  Mr. McDERMOTT. Madam Speaker, I rise in strong support for SCHIP 
reauthorization legislation, and I want to thank Speaker Pelosi for her 
leadership in bringing this bill to the floor as the first bill.
  H.R. 2 clearly says that change has arrived for our country and our 
children. Instead of a veto pen that was used last year by the outgoing 
President to deny health care to children, our new President will sign 
this legislation and in so doing to begin a new chapter in America's 
commitment to its children and our future.
  H.R. 2 is a real down payment on our efforts to get universal access 
to affordable health care for all Americans. It builds on a successful 
model that has expanded access to millions of children nationwide.
  Health care should be a right, not a privilege for the rich in 
America. This legislation affirms the commitment of the new Congress to 
serve all the people, not merely those with means who can pay any price 
for health care while the Nation pays a steep price for not covering 
its children. H.R. 2 represents an additional 4 million children who 
will get health care.
  It's time to act, now.
  H.R. 2 means an additional 4 million children will have access to 
health care. It will provide access to preventive health care and this 
alone means America will raise healthier children who will grow to 
become healthier and more productive adults.
  The American people have spoken. They want a more compassionate 
response to our Nation's problems. Today, we are voting with our heads 
and hearts to do just that. This is not about ideology or party. It is 
about providing health care to children. H.R. 2 represents real change.
  l am proud to represent a State that took the lead on expanded access 
for children. In 1994, 3 years before the enactment of the original 
SCHIP, Washington State expanded access to children up to 200 percent 
of the Federal poverty level.
  This was a huge commitment and clearly my State took the lead. As a 
result we have fewer children uninsured. We have a healthier population 
and more integrated primary care. It's a commitment that worked for all 
of us in the State.
  H.R. 2 recognizes Washington State's efforts and includes language 
that will allow the State to access a more than $30 million to maintain 
this commitment. H.R. 2 rewards States like Washington who knew early 
on that providing quality affordable health care to children was a 
sound and humane investment.
  H.R. 2 will also allow Washington State to expand our successful 
program to cover more uninsured children in working families. The bill 
provides greater flexibility and will allow the State to meet the needs 
of our low income working families.
  I am also grateful that this legislation includes important access 
for legal immigrant children who are currently denied coverage--
children who are born in the U.S. and are legal U.S. citizens. In 
Washington State we have provided coverage for these children. But the 
State is doing this alone without the full partnership of the Federal 
Government. H.R. 2 corrects this error and will allow Washington State 
to maintain coverage for more than 3,000 children.
  Madam Speaker, we need to do the right thing. Providing universal 
coverage for children is an objective that we should all support. This 
legislation takes us one step closer to meeting this goal. I urge my 
colleagues to support this bill.
  Mr. BLUNT. Madam Speaker, I yield 1 minute to the gentleman from 
Texas, a member of the Ways and Means Committee (Mr. Culberson).

[[Page 733]]


  Mr. CULBERSON. Madam Speaker, the most open, allegedly transparent 
Congress in the history of America has begun this session by throwing 
out a bill that may cost upwards of $100 billion over 10 years that was 
written in secret. This bill has never had a committee hearing, not 
allowed amendments. There are no amendments allowed on the floor of the 
House.
  No one would consider buying a house, buying a car without reading 
the contract; yet you're asking the American people to spend borrowed 
money, up to $100 billion of borrowed money--every dollar we spend from 
this day forward is borrowed money--asking us to spend up to $100 
billion over 10 years and not knowing what's in the bill. This is a 
blind ``yes'' vote for all of you.
  We all support health insurance for children, but we must remember 
the $62 trillion of unfunded liability that our children and 
grandchildren are facing today. The money we spend today is going to be 
passed on to future generations, and it's essential that the public be 
given the right to read these bills. This bill was not even posted up 
on the Web site publicly until about 24 hours ago. What are you afraid 
of?
  Let the sunshine in and let the public read your legislation.
  Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentleman from 
Michigan, the chairman emeritus of the Energy and Commerce Committee 
(Mr. Dingell).
  Mr. DINGELL. I thank the gentleman for yielding.
  Madam Speaker, I stand in strong support of H.R. 2, the Children's 
Health Insurance Program Reauthorization Act of 2009. This bill was 
passed twice last year by overwhelming votes, with the support of large 
numbers of my Republican colleagues.
  Since its inception CHIP has covered more than 7 million children who 
otherwise would not have had health care. H.R. 2 would extend coverage 
to 4 million more children identically situated.
  Since last year when this bill passed, more than 1 million children 
have lost their health coverage because parents were laid off and lost 
employer-based coverage. My own State is particularly hard hit with 
over 150,000 uninsured children. These children are our treasure and we 
must see to it that they are protected, educated, nurtured, and 
properly fed.
  The bill is only a beginning. I look forward to working with the new 
administration towards reforming our health care system. We must not 
stop until all Americans qualify for quality, affordable health care.
  I urge my colleagues to vote again for the CHIP Reauthorization Act 
of 2009. This bill will be signed into law, and it will help 4 million 
kids that without this bill would have no health care.
  Mr. BLUNT. Madam Speaker, I yield 1 minute to the gentleman from 
Michigan, a member of the Health Subcommittee, Mr. Rogers.

                              {time}  1245

  Mr. ROGERS of Michigan. Madam Speaker, we have seen pictures of 
children on the floor, certainly touched our hearts. We have heard 
stories, I think from the new gentleman, the new Member from Colorado, 
who talked about the 100,000 kids who are eligible and not enrolled.
  But what we haven't heard today, or we haven't seen, are the faces of 
hundreds of thousands of senior citizens who will be told, when this is 
signed into law, you cannot go get your cancer care. You cannot go get 
your pain care at the hospital of your choice that your doctor has 
referred you to.
  We found one hospital in Washington where 90,000 Medicare seniors 
will not be able to get the care that they have and the relationship 
that they have with their doctors. We can do better.
  We should not pit kids against seniors. We don't have to do that. And 
what you say to that family in Colorado is, you may be a family of four 
making $21,000, and we haven't found you yet to get connected to the 
services you deserve, but we think we are going to go out and find that 
family in New Jersey making $80,000. Apparently that $80,000 family is 
more important than that Colorado $21,000 family.
  Let's get our priorities right. Let's not pit kids against seniors.
  I would urge a strong ``no'' vote against the bill.


                Announcement By the Speaker Pro Tempore

  The SPEAKER pro tempore. Members are reminded to heed the gavel and 
conclude their remarks within the time yielded.
  Mr. STARK. Madam Speaker, I am pleased to recognize the distinguished 
gentleman from Georgia (Mr. Lewis) for 1 minute, and Mr. Lewis 
understands that the AARP has endorsed this bill.
  Mr. LEWIS of Georgia. Madam Speaker, I want to thank the chairman for 
yielding.
  Madam Speaker, at long last we will do what is right for our Nation's 
poorest children. Today we will expand SCHIP to 4 million more 
children. We have a mission, an obligation and a mandate to provide 
health insurance for all Americans and now we have a Congress and a 
President who will meet that obligation for our children.
  It has taken too long. This Nation has been wrong to choose war and 
greed over children and health. Children need our help. They have a 
right to health care.
  Today we will do what is right and pass this expansion of SCHIP.
  Mr. BLUNT. Madam Speaker, I yield 1 minute to the newest member of 
our committee, who is going to add a lot on health care issues, Dr. 
Gingrey from Georgia.
  Mr. GINGREY of Georgia. Madam Speaker, I rise in opposition to H.R. 
2, not because of the 4 million children expansion, as my colleague 
from Georgia on the other side of the aisle, the distinguished 
Representative John Lewis just said. It's not that; it's that we are 
expanding beyond the original intent of the bill. And the chairman, Mr. 
Waxman, said in his remarks, right above the poverty line.
  Indeed, 200 percent of the Federal poverty level is the intent of the 
bill, and yet there are States, 13 of them, who are using a gimmick 
called ``income disregard'' to lower the income of a family so that 
they become eligible, not only for this program but for Medicaid. 
That's wrong. That's gaming the system.
  If you had allowed a modified open rule so that we could have brought 
amendments to correct that and other things, then I would certainly be 
very comfortable and enthusiastic in supporting this bill and 
supporting the expansion. But, no, you wouldn't allow that, so I am 
going to have to regretfully oppose the bill.
  Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentlewoman from 
Colorado, the vice chair of our committee, Ms. DeGette.
  Ms. DeGETTE. Madam Speaker, 6 million children in this country who 
are currently eligible for SCHIP and Medicaid do not have health 
insurance. These children's parents work, but they cannot afford to 
ensure that their children have well-child care, and they have to 
resort to the emergency room for even the most basic services, like 
treatment for an ear infection. This is wrong.
  Today's bill will help these families, but with a number of changes 
that vastly improve the legislation. It allows States to give coverage 
to pregnant women and people who are here legally. It preserves 
simplified outreach and enrollment procedures.
  Madam Speaker, in the face of the current economic downturn, it is 
even more vital that we enact this bill. Sharp increases in 
unemployment are adding to the ranks of the uninsured, while at the 
same time State budgets are shrinking, and the safety net is struggling 
to meet this increased demand.
  Because, Madam Speaker, we need to provide this care for our kids 
because in the most civilized country in the world, no child should go 
without health care.
  Mr. BLUNT. Madam Speaker, I yield 1 minute to the gentlelady from 
Tennessee (Mrs. Blackburn).
  Mrs. BLACKBURN. Madam Speaker, you know, it is so interesting as we 
have this debate, SCHIP, as it was originally put in place, is 
something that we are all for. That program as a block grant program 
worked well.

[[Page 734]]

  But, Madam Speaker, here is a 285-page bill that the Democrat 
majority laid on the table yesterday about 1:00.
  In that bill, it allows for expansion of coverage to adults. We know 
that there were over 700,000 adults on this program at some point in 
2006. We also know I had an amendment that would have removed, phased 
out all non-pregnant adults from this program and that amendment was 
not allowed.
  This bill, this bill, will actually crowd out a lot of the low-income 
children who have benefited from being on the SCHIP program, and I find 
that very unfortunate that we will reduce the amount of health care 
available to the children of the working poor and allow the expansion 
of adults and middle-income children.
  Mr. STARK. Madam Speaker, I am pleased to yield 1 minute to the 
distinguished gentleman from New Jersey (Mr. Pascrell) who understands 
that many of the adults on the program last year were pregnant women.
  Mr. PASCRELL. Madam Speaker, you can't have it both ways. You can't 
be for it and then you are going to vote against it.
  I am listening to the many people on the other side. Substance is 
more important than process. You don't get it. You don't understand it.
  So I am in strong support as a proud cosponsor of the Children's 
Health Insurance Program which does reauthorize and is fiscally 
responsible, reasonable. This is long overdue.
  Ensuring health coverage for our Nation's children is a critical 
first step in any health reform effort. In fact, it's the least we can 
do. If we can't have universal care automatically right now, then we 
need to at least take care of the children of our country. You say you 
agree with it, then you ought to vote for it.
  Taking swift and decisive action on this legislation has become 
critically important. As unemployment climbs, the ranks of the 
uninsured swell, and the roles of our safety-net programs grow. I am 
particularly proud that this bill provides flexibility in determining 
eligibility criteria that makes sense for individual States.
  Higher income eligibilities, for example, are common sense in States 
like New Jersey where a dollar simply doesn't go as far.
  In New Jersey, we have set out on an ambitious endeavor to cover 
every child by July of this year, including the 267,000 currently 
uninsured children in our State.
  It is estimated that as many as 130,000 of these children are 
eligible for FamilyCare, New Jersey's CHIP plan, but are not currently 
enrolled.
  Passing the important legislation that is before us will help States 
like mine to take the steps necessary to ensure that every child has 
access to affordable, quality health care.
  The stakes are bigger now than ever, so it is time to cast aside 
political games and pass this bill.
  Mr. BLUNT. Madam Speaker, I yield 1 minute to the gentleman from 
Nebraska, a member of our committee, Mr. Terry.
  Mr. TERRY. Madam Speaker, under this legislation, physician-owned 
hospitals would be banned in the future. This includes the Bellevue 
Medical Center currently under construction in my congressional 
district.
  This first photo is a view of the finished--this is 48 hours old, 
this photo here, showing a nice steel structure and a half-completed 
building. If this bill would pass today, construction on this facility 
has to stop because it's 40 percent owned by physicians. The other 
partner in here is a hospital. We have two facilities like this in my 
district.
  Now, not only is it appalling that we are going to have to shut down 
construction on it or else not accept Medicare patients, but the fact 
is the community that this is being built in is a town, it's 
incorporated within the Omaha area, about 50, 60,000 people and also 
has a base, an Air Force base on it. There are no other medical 
facilities in this general area. This will be it, and we will be 
shutting this down.
  Madam Speaker, I rise today in opposition to this SCHIP bill.
  Under this legislation, physician-owned hospitals would be banned in 
the future. This includes the Bellevue Medical Center currently under 
construction in my congressional district. Also, the Midwest 
Neuroscience Center and Nebraska Orthopedic Hospital, which are both 
specialty hospitals that would not be allowed to expand under this 
legislation. The Bellevue Medical Center, to be located at Highway 370 
and 25th Street in Bellevue, will have 60 inpatient and observation 
beds which will all be private rooms. Potential future expansion can 
allow for additional 60 beds. In addition to general medical services, 
the hospital will provide labor and delivery care, emergency care, 
inpatient and outpatient surgery and intensive care. Facilities will 
feature state-of-the-art diagnostic services and equipment, including a 
cardiac catheterization lab, radiology, lab testing and pharmacy on 
premises. There will be a medical office building adjacent to hospital 
which will house patient clinics.
  Construction of the Bellevue Medical Center is ongoing. It started 
late in 2007 and is expected to be completed later this year with a 
total cost of $135 million. Sixty percent of this hospital will be 
owned by the Nebraska Medical Center, which is a community hospital, 
and up to 40 percent of this hospital will be owned by community 
physicians and faculty of the University of Nebraska College of 
Medicine. Unfortunately, under Sec. 623, Bellevue Medical Center would 
have had to have their Medicare Agreement signed by January 1, 2009, in 
order to be compliant. This is very unfortunate for a number of 
reasons, but none larger than the community in which this hospital will 
serve.
  The location in which the hospital is being built is an ideal 
location for a new hospital since there is a population of almost 
100,000 people who can take advantage of it. This would include the 
city of Bellevue, Offutt Air Force Base and Plattsmouth. In particular, 
the Bellevue Medical Center would have a strong focus on serving the 
healthcare needs of the following military related personnel in the 
Bellevue area: 10,000 active duty personnel, 20,000 dependents of 
active duty personnel and 11,000 military retirees.
  Bellevue's other medical facility, Ehrling Bergquist Clinic, located 
at Offutt Air Force Base, no longer has inpatient services and has 
limited outpatient services. Operations at this clinic include same-day 
surgery, and urgent care. As a result, the Bellevue Medical Center is 
needed to meet the hospital needs of the Offutt community. The Bellevue 
Medical Center will also serve as a training area for Air Force 
physicians, including approximately one-third of the Air Forces's 
complement of family practice physicians.
  This hospital is also needed to serve the fast-growing population of 
Sarpy county, which according to the U.S. Census Bureau, is the fastest 
growing county by population in Nebraska and western Iowa. Nebraska 
Governor Dave Heineman and the Bellevue Chamber of Commerce support the 
Bellevue Medical Center.
  Madam Speaker, this is one of the major reasons that I cannot support 
this legislation and will be voting against it today.
  Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentlewoman from 
California (Ms. Eshoo).
  Ms. ESHOO. Madam Speaker, I thank the chairman of our subcommittee, 
Mr. Pallone, also Mr. Dingell, Mr. Waxman, and everyone that's been 
involved in shaping this legislation.
  Senator Hubert Humphrey was very fond of saying that a society is 
measured on how it treats those in the autumn of their lives and how it 
treats those in the spring of their lives.
  Today we rise to honor the young in our country with legislation that 
will provide for them what is one of the great necessities of life, and 
that is health care. We will not have healthy adults in our country 
unless we have healthy children.
  Today we put down a magnificent down payment to ensure health care 
for 11 million children in our country. This is a smartly drafted bill. 
Why? Because it is responsible, because it is paid for.
  Over 90 percent of the providers are private sector. So I think today 
is not only a profound moment in the Congress, but a sacred one. I look 
forward to its passage and what it will do to strengthen our country 
and strengthening our country's children.
  Mr. BLUNT. Madam Speaker, I yield 1 minute to the gentleman from 
Indiana (Mr. Buyer).
  Mr. BUYER. I thank the gentleman for yielding.
  Madam Speaker, a lot of my colleagues, some of whom were here in 
1997, voted against the Balanced Budget Act of 1997, actually voted 
against the SCHIP program.
  So you are coming here to the floor now accusing Republicans saying 
if you

[[Page 735]]

are going to go vote against this you are voting against children.
  When we passed this on a bipartisan basis, please don't do that. I am 
not going to come here to the floor and say, oh, you were against 
children because you voted against the Balanced Budget Act. So let's be 
really accurate with regard to our language.
  One thing that does concern me right now is when you look at the 
number of adults that are on the SCHIP program, every time an adult is 
in that program, over 700,000 of them, it costs more money.
  So what we should be doing is saying in agreement here SCHIP is a 
good program. Republicans created the SCHIP program. When we worked 
with Bill Clinton in doing welfare reform, we said we are going to put 
people to work. We are going to take care of those children.
  The States then got all overeager and excited in a good economy and 
expanded the eligibility.
  Now, as the economy turns down, now we have President-elect Obama----
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. BLUNT. Madam Speaker, I yield the gentleman an additional 30 
seconds.
  Mr. BUYER. He is now proposing in the stimulus plan to say well, gee, 
let's go to the Federal Government. We don't want to change our 
program. Let's go to the Federal Government and ask for 200 billion-
plus to bail out those judgments of the past.
  So what, we are going to stimulate the past as now we are going to 
add to exacerbate the problem here on the House floor? Let's stop and 
pause and think about what we are doing here, folks. Let's look at this 
program to actually cover children. You are about to say of the 700,000 
adults that are on the program, by 2013 we could have over 1.4 million 
in the program.
  For every adult that is in this program, we are taking away more 
money that actually could cover children.
  Mr. STARK. Madam Speaker, I am delighted to yield 1 minute to the 
distinguished Congresswoman from Florida (Ms. Kosmas).
  Ms. KOSMAS. Thank you, Mr. Chairman.
  Madam Speaker, I am pleased today to rise, my first time on the floor 
of the House, to speak in favor of the State Children's Health 
Insurance Program Reauthorization Act.
  This bill, for me, is an opportunity for working families in my 
district to provide health care to their children. Let me say it again, 
it's an opportunity for parents to provide health care, working 
families to provide health care for their children. In these tough 
economic times, we have more and more families which are unemployed or 
underemployed, and this gives them an opportunity to give their 
children the health care that they need and deserve.
  With many of them providing health care to their children through 
emergency rooms, as opposed to having this access to quality care, we 
are losing both an efficiency factor and an economic factor.
  So I rise again, as I say, to speak in favor of this bill. Providing 
health care to children is not just the right thing to do, but this is 
an economic investment that we are making in the future of those who 
will carry us forward into the next generation.
  Mr. BLUNT. Madam Speaker, I yield 1 minute to the gentleman from 
Indiana (Mr. Burton).
  Mr. BURTON of Indiana. I don't want to discuss things that have 
already been discussed, but the things that concern me are things like 
this will be a magnet for more illegal aliens coming into this country 
because it's going to provide a mechanism for illegals to get coverage 
under this bill.
  It's going to cost $44 billion more than the baseline. It's going to 
involve a tax increase.
  You know, one of the things that really concerns me about what we are 
doing is we passed a bailout bill for $700 billion. We are going to 
pass another bill here, a supplemental, it's going to be $1.2 trillion. 
We spent $14 billion for the auto industry.
  This is going to cost $44 billion over the baseline. Where do you 
think all this money is coming from? And I wish my colleagues would 
start thinking about the kids in the future as well as what we are 
talking about today. Because the inflation problem they are going to 
face is going to be huge.
  You have got to print this money. It has got to come from someplace. 
And the kids of kids of today and tomorrow are going to have to pay 
through the nose for the things we are doing today. We don't have all 
the money to do these things, and yet we are spending. That will lead 
to hyperinflation down the road and severe economic problems.

                              {time}  1300

  Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentleman from 
Texas (Mr. Gene Green).
  Mr. GENE GREEN of Texas. Madam Speaker, I thank our Chair of our 
subcommittee.
  I rise in strong support and as a cosponsor of H.R. 2, the Children's 
Health Insurance Program Reauthorization Act, or CHIPRA. During the 
110th Congress, we made two attempts to reauthorize the SCHIP program. 
Unfortunately, both these bills were vetoed by the President.
  With 6 million American children currently eligible yet unenrolled, 
the passage of this bill is overdue. CHIPRA reauthorizes SCHIP through 
2013 and extends SCHIP coverage to 7 million children already enrolled, 
but the SCHIP program covers 4 million more children. Eleven million 
children will be covered under SCHIP when we pass this bill.
  The bill includes a provision that I am proud is in there, H.R. 465, 
the Immigrant Children's Health Improvement Act, which gives the States 
the option to cover children and pregnant women of lawfully residing 
children in our country. These are not illegal immigrants. They are 
children who go to school and go to daycare with our children and our 
grandchildren. Those children ought to have health care to protect our 
own children.
  CHIPRA also includes language from another bill of mine, H.R. 1238, 
which provides one year of emergency Medicaid coverage for children 
born in the U.S. and their mothers, which is crucial in protecting the 
health and wellness of newborns born in this country.
  I do have to express my disappointment that the bill did not include 
the provision that was included in the first SCHIP bill we passed which 
would guarantee that children in families earning less than 200 percent 
of the poverty level will have 12 months of continuous eligibility 
under SCHIP.
  The outreach and enrollment package includes an incentive for States 
to provide this eligibility guarantee.
  But for a State like mine, we need to ensure that the State of Texas 
does right by Texas children and doesn't use the flexibility inherent 
in the program to kick them off the rolls on a budgetary whim.
  The 175,000 Texas children who were kicked off the rolls in 2003 know 
all too well of the State's willingness to balance the State budget on 
their backs, and I hoped that this bill would take away the State's 
ability to do that in the future.
  However, the need to reauthorize SCHIP before the program expires on 
March 31st is more important than political battles.
  I hope my colleagues will join me in supporting this legislation and 
sending a strong message to the President that we must abandon partisan 
politics and reauthorize SCHIP for America's low-income children.
  Mr. BLUNT. Madam Speaker, I yield 1 minute to the gentleman from Iowa 
(Mr. Latham).
  Mr. LATHAM. Madam Speaker, I thank the gentleman.
  Madam Speaker, there is no question the State Children's Health 
Insurance Program needs to be reauthorized to provide the funds 
necessary to maintain current coverage and enroll currently eligible 
low-income children.
  In the past I have supported bipartisan legislation that represented 
the input of both parties to reauthorize the SCHIP program, H.R. 976 
and H.R. 3963, including legislation that was vetoed by President Bush. 
However, I cannot support this partisan legislation before us today 
because Democrats have radically departed from the bipartisan agreement 
that had been reached.
  First, they have removed the provision that would have capped 
eligibility

[[Page 736]]

for SCHIP for families making over 300 percent of the Federal poverty 
line, or roughly $63,000 per family of four, allowing unlimited 
expansion of the program in the future. Furthermore, there are no 
requirements that a certain level of coverage for low-income children 
be met before expanding eligibility to higher income groups.
  Second, they have rescinded a requirement in current law that 
noncitizens who are here must legally wait 5 years to become eligible 
for the SCHIP program.
  The bill also reduces citizenship verification requirements for the 
Medicaid program, potentially allowing illegal aliens to game the 
system to obtain taxpayer-funded welfare benefits.
  At a time when nearly 70 percent of uninsured American children are 
already eligible for Medicaid or SCHIP, our economy is weak and the 
budget deficit is soaring, it makes no sense to put non-citizens or 
wealthier children ahead of poor American children from hard-working, 
tax paying families who desperately need access to these programs.''
  Mr. STARK. Madam Speaker, I yield 1 minute to the distinguished 
gentleman from Maryland (Mr. Van Hollen).
  Mr. VAN HOLLEN. I thank my colleague.
  Madam Speaker, this is a moment of important substance and important 
symbolism. The substance and merits of this bill are clear. We are 
going to preserve health coverage for 7 million American children and 
expand it to another 4 million children from working families who earn 
too much to qualify for Medicaid, but do not earn enough to be able to 
afford the very high costs of private health insurance.
  Taking this bill up right now also sends a very important signal that 
change has come to Washington, DC as a result of the last election. 
President Bush twice vetoed this legislation on children's health. We 
will soon have a new President, President Barack Obama, who as one of 
his first acts as President will sign this legislation, a President who 
understands the hardships American families are struggling under at a 
time when more than 2 million Americans have lost their jobs in just 2 
months.
  The difference could not be clearer. The current President used his 
mighty veto pen to say ``no,'' to veto and protect the status quo. The 
new President will use that pen to say ``yes,'' to change the status 
quo and provide health care to 4 million new American children as we 
continue to protect 7 million American children. That is change we can 
believe in.
  Mr. BLUNT. Can I ask how much time is remaining on each side?
  The SPEAKER pro tempore. The gentleman from Missouri (Mr. Blunt) has 
90 seconds remaining; the gentleman from California (Mr. Herger) has 15 
minutes remaining; the gentleman from New Jersey (Mr. Pallone) has 8\3/
4\ minutes remaining; and the gentleman from California (Mr. Stark) has 
9 minutes remaining.
  Mr. BLUNT. I reserve the balance of my time.
  Mr. HERGER. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, I rise in support of SCHIP and believe its 
reauthorization is critical to millions of children, but I am opposed 
to the bill before us today. This legislation does nothing to make 
private health coverage more affordable. By expanding a program that 
severely underpays doctors in my State of California, it may result in 
higher costs for private coverage. And assuming that the increased 
tobacco tax achieves the goal of discouraging smoking, it commits an 
irrational policy of financing a growing program through a declining 
revenue source.
  In addition, this new version would effectively shut down physician-
owned hospitals currently under construction, including a $40 million 
project in my district in Yuba City, California, scheduled to open in a 
couple of months. This will be a severe blow to a small county that has 
long had one of the highest unemployment rates in California.
  Madam Speaker, in the middle of the worst economic downturn in 
decades, this provision would destroy jobs in Yuba City and in dozens 
of other cities across America.
  I would urge all of my colleagues to ask themselves, do you believe 
that a corporate board halfway across the country would do a better job 
of holding down costs and ensuring high quality care than a team of 
local doctors, and, if so, are you certain enough that you are willing 
to deny your constituents the opportunity to make that choice?
  I urge rejection of this misguided provision and a ``no'' vote.
  I reserve the balance of my time.
  Mr. PALLONE. Madam Speaker, I yield to the gentlewoman from New York 
(Mrs. Maloney) for the purpose of a unanimous consent request.
  Mrs. MALONEY. Madam Speaker, I rise in strong support of this bill.
  Madam Speaker, if history is any guide, the current recession will 
lead to a substantial increase in the demand for children's health care 
coverage under SCHIP and Medicaid.
  Rising unemployment and staggering job losses have left many families 
without health insurance. The high cost of private coverage means more 
and more Americans are turning to state programs for assistance.
  But state budgets are already strained by the recession, and many 
have already enacted budget cuts that would reduce funding for these 
programs.
  My home state of New York has been forced to propose such cuts.
  Unprecedented need combined with a shortage of funding is creating a 
perfect storm--a storm that can only be avoided if Congress votes to 
reauthorize the Children's Health Insurance Program.
  Over the next 4\1/2\ years, our bill, H.R. 2, would preserve coverage 
for the more than 7 million children currently covered by SCHIP, and 
extend coverage to nearly 4 million children who are currently 
uninsured.
  Passing SCHIP reauthorization would guarantee sufficient funding 
levels for the Children's Health Insurance Program to serve future 
enrollment needs. It would bring much needed stability to the program, 
giving states fiscal security to plan for expansions and make 
improvements in advance of broader health care reform.
  This legislation will make covering children the top priority for 
SCHIP, while also giving states the option to enroll mothers during 
pregnancy. And under the bill all children enrolled in SCHIP will have 
dental coverage and access to mental health services.
  We are in an economic crisis as serious as any this nation has ever 
faced. As families struggle to make ends meet, and states are forced to 
make difficult budget cuts, we cannot afford to leave millions of 
children without the health insurance they so critically need.
  We have the opportunity now to make good on our commitment to helping 
America's families in these tough economic times.
  I urge my colleagues to vote ``yes'' on H.R. 2.
  Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentleman from 
Georgia (Mr. Barrow).
  Mr. BARROW. Madam Speaker, I thank the gentleman.
  Madam Speaker, I am proud to be up here today to support H.R. 2, the 
Children's Health Insurance Program Reauthorization Act of 2009. It has 
been a long time coming. I am glad we are considering this bill on the 
floor so early in this Congress, when we spent most of the last 2 years 
trying to enact it. I think it says something very positive about the 
commitment of this new Congress and of our new President to improving 
health care for all Americans.
  H.R. 2 will allow us to enroll 4 million more kids in programs like 
Georgia's PeachCare who are just as eligible as the 7 million kids 
already enrolled. It is not a free lunch. Parents will still have to 
pay what they can afford to pay, but the kids will be able to go to the 
doctor, where they get good preventive care at the lowest cost, and 
keep them out of the emergency room, where they get the least effective 
care at the greatest possible cost to the taxpayer. That is more health 
care, better outcomes, at less cost. It is not only the right thing to 
do, it is the smart thing to do, and that is why I am proud to be a 
cosponsor of this legislation and urge all of my colleagues to support 
it.
  Mr. HERGER. Madam Speaker, I yield 2 minutes to the gentleman from 
Texas (Mr. Sam Johnson), a member of the Health Subcommittee.
  Mr. SAM JOHNSON of Texas. Madam Speaker, I rise today in strong 
opposition to a provision in this bill that

[[Page 737]]

would have drastic consequences for hospitals in my district and 
hospitals around the Nation. Everyone in this Chamber can agree that 
health care in this country needs transformation. America has always 
been a leader when it comes to medical research, training the best, the 
brightest, and providing superior care. We need to make sure that 
tradition continues.
  Physicians across the country have decided they can provide better 
health care to more people by engaging in the process. Some doctors 
have decided to play a role in the care delivered in the hospitals in 
their community, and studies show that this has resulted in higher 
quality care and higher patient satisfaction.
  Physician-owned hospitals employ highly skilled workers. They are an 
engine in the local economy, and language in this bill will devastate 
most of them. I say most, because a handful of hospitals located in 
special congressional districts will have rights that hospitals in my 
district and the majority of others will not. Why do only a handful of 
Members of Congress receive the privilege of a carve-out for their 
hospitals?
  Many facilities have poured millions of dollars into constructing 
hospitals that will be forced to shut down because of this bill. Baylor 
Hospital in particular in my district is in the process of adding 
additional operating rooms and hospital beds to serve the community 
needs. This local hospital won't be able to complete the project 
because of this bill.
  I ask my colleagues on both sides of the aisle to work with me to see 
that all existing hospitals and those under development are treated the 
same in this legislation. No carve-outs, no special privileges. It has 
to be all fair and all the same. Physician-owned hospitals have proven 
over and over again they spur greater choice and offer higher quality 
care to patients. These hospitals all deserve the right to be able to 
continue to serve their community. That is the American way.
  Mr. STARK. Madam Speaker, at this time I am pleased to yield 1 minute 
to the distinguished gentlewoman from Nevada (Ms. Berkley).
  Ms. BERKLEY. I thank the gentleman for yielding.
  I rise in support of this long-overdue legislation. Coming from a 
State with one of the highest percentages of uninsured children, it is 
essential to reauthorize SCHIP to extend the program to cover more low-
income uninsured children.
  In 2007, more than 40,000 youngsters benefited from the Nevada Check 
Up program. This bill will enable Nevada to continue coverage for these 
children and to reach out to a portion of the 70,000 children currently 
eligible who remain uninsured. This bill also includes funding to 
improve outreach to eligible populations. Increased funding and the 
focus on outreach and enrollment will help extend coverage to thousands 
of additional Nevada children and an additional 4 million kids 
nationwide.
  I urge my colleagues to support this bill. I look forward to having a 
President in the White House that is anxious to sign it.
  Mr. HERGER. Madam Speaker, I yield 2 minutes to the gentleman from 
Wisconsin (Mr. Ryan), a member of the Health Subcommittee.
  Mr. RYAN of Wisconsin. Madam Speaker, today is the beginning of a new 
Congress. Our new President hasn't even taken the oath of office and we 
are throwing fiscal discipline out the door. This whole idea of PAYGO 
is gone. It doesn't exist. It is a charade.
  Let's take a look at what this bill actually does. This bill proposes 
to add all these new kids on the SCHIP program, and then in the out-
years it shoves them off a cliff, taking 7 million children off of the 
SCHIP program. They do this only to carve and jam this bill into 
compliance with PAYGO.
  I received a letter from the CBO just this morning that if this bill 
was actually carried through, if you didn't kick all of these children 
off of this program, it would cost $42 billion more. This bill has a 
$42 billion deficit hole in it. The spending increase in SCHIP in this 
bill increases on average 23 percent a year. Madam Speaker, Medicare is 
going bankrupt according to the trustees, and that increases at 6.5 
percent a year.
  We are being deprived of a bipartisan opportunity to extend the 
current SCHIP program, which would have an enormous vote here if you 
brought a bipartisan bill to the table. That is not what is happening. 
Budget gimmicks, fiscal irresponsibility, a $42 billion deficit, and 
the creation of a brand new entitlement program. And what is worse, we 
are committing our taxpayer dollars, which are so precious in this 
difficult economic time, to pay for insurance that people already have. 
2.4 million people who already have private health insurance are going 
to get kicked off of their private health insurance and the taxpayers 
are going to pick up the tab. That is not fiscal responsibility.
  Let's solve the uninsured problem. Let's come together and fix the 
health care problems in America. Let's not bankrupt the country. Let's 
not play budget gimmicks. Let's not throw PAYGO out the window. And 
let's not take away the health insurance that people already have and 
make them have government-sponsored health insurance. We should reject 
this bill.

                                                    U.S. Congress,


                                  Congressional Budget Office,

                                 Washington, DC, January 14, 2009.
     Hon. Paul Ryan,
     Ranking Member, Committee on the Budget, House of 
         Representatives, Washington, DC.
       Dear Congressman: As you requested, the Congressional 
     Budget Office (CBO) has estimated the budgetary effects of 
     modifying H.R. 2, the Children's Health Insurance Program 
     Reauthorization Act of 2009, to extend the program's 
     authorization through 2019 in a manner that would provide 
     sufficient funding to allow states to meet demand for 
     increasing enrollment within the program's parameters. If 
     H.R. 2 were changed to authorize the Children's Health 
     Insurance Program (CHIP) through 2019 and to provide 
     sufficient funding for such increasing enrollment throughout 
     that period, CBO estimates that enacting that alternative 
     version of the bill would increase deficits by $41.6 billion 
     over the 2009-2019 period. In contrast, CBO estimates that 
     the version of H.R. 2 introduced in the House of 
     Representatives on January 13, 2009, would result in a net 
     reduction in deficits of $0.4 billion over that 11-year 
     period.
       The introduced version of H.R. 2 would authorize CHIP 
     through 2013 and would provide significant funding increases 
     over the next few years, leading up to a total funding level 
     of $17.4 billion in 2013. The program's funding for the 
     second half of fiscal year 2013 would be $3 billion. Under 
     baseline rules, that amount annualized--$6 billion--would be 
     projected for each subsequent year. The estimated cost of the 
     bill assumes that funding level for CHIP for fiscal years 
     2014 through 2019. On that basis, CBO estimates that the 
     introduced version of H.R. 2 would increase federal direct 
     spending by $73.3 billion through 2019, including the costs 
     of other provisions in the bill. (That spending would be 
     offset by increases in federal tax revenues totaling $73.6 
     billion over the same period, primarily from increases in the 
     excise taxes levied on tobacco products.)
       As an alternative to the introduced version of H.R. 2, you 
     requested that CBO assume the CHIP rules and structure as 
     currently delineated in H.R. 2 would remain unchanged through 
     2019 and that sufficient funding would be made available 
     after 2013 to accommodate projected enrollment growth. The 
     projected enrollment growth is based on expected growth in 
     the total population, as well as changes in the health 
     insurance market and the economy as a whole. Under those 
     assumptions, CBO estimates that average monthly enrollment in 
     CHIP would rise from about 9 million in 2013 to about 12 
     million in 2019.
       Based on the assumptions you specified, CBO estimates total 
     changes in direct spending of $115.2 billion, as compared 
     with the $73.3 billion increase we estimate for the 
     introduced version of H.R. 2. (Revenue increases would remain 
     unchanged.) Thus, the net budget impact of a modified version 
     of H.R. 2, as you specified, would be an increase in deficits 
     totaling $41.6 billion over the 2009-2019 period.
       If you wish further details on this estimate, we will be 
     pleased to provide them. The CBO staff contacts are Robert 
     Stewart and Sean Dunbar.
           Sincerely,
                                               Robert A. Sunshine,
                                                  Acting Director.

  Mr. PALLONE. Madam Speaker, I yield 30 seconds to the gentlewoman 
from California (Mrs. Capps).
  Mrs. CAPPS. Madam Speaker, I have 30 seconds to explain why H.R. 2, 
the

[[Page 738]]

State Children's Health Insurance Program, means everything to a school 
nurse.

                              {time}  1315

  And I'll just tell you, I can see the faces of the children I cared 
for as best as I could who would have benefited so dramatically from 
this program. And I'll tell you what this feels like now, as so many 
moms and dads are losing their jobs and need this program even more. 
And my State, California, is cutting even the children who presently 
are served so dramatically.
  And give States the option of covering pregnant women. That is the 
greatest thing we can do for the health of a child is to cover the mom.
  Mr. HERGER. Madam Speaker, I yield 3 minutes to the ranking member of 
the Ways and Means Committee, the gentleman from Michigan (Mr. Camp).
  Mr. CAMP. Madam Speaker, I believe every child in America should have 
access to quality health care. The Children's Health Insurance Program 
has done just that for those in families without the means to provide 
or buy insurance on their own.
  SCHIP was created as a bipartisan program, and it was one I was proud 
to support. The bill before us today, however, not only threatens the 
core mission of the program, which is providing health care to low-
income children, but creates a new entitlement that will demand higher 
taxes on all Americans in just a few short years.
  Let me first state the obvious problem with this bill. A children's 
health program should not be used to cover adults, noncitizens, 
potentially illegal immigrants and those making $80,000 a year.
  There's another problem with the bill, one the majority hopes you 
ignore. This bill blatantly attempts to hide the true cost of the bill 
to the American taxpayer. It's irresponsible and untenable to fund a 
children's health program with the revenue stream that's fast drying 
up. Increasing the cigarette tax, regardless of your support for such 
an idea, does not, will not, and cannot cover the cost of this program.
  The Democrats are blowing a giant cloud of smoke into the face of the 
American taxpayers, and I believe the impending tax increases that must 
come to cover this program will have us all in a severe coughing fit.
  The Democrats want you to ignore the fact that the percentage of 
Americans who smoke has been dropping for decades. But research and 
logic both show that raising the prices of cigarettes will lead to less 
smoking and fewer tax dollars coming into the Federal Treasury. Yet, 
the only way for this funding scheme to work is if the majority finds 
22.4 million new smokers. I can't wait to see the look on Senator 
Daschle's face when the Speaker tells the soon to be Health and Human 
Services Secretary that little tidbit.
  But in all seriousness, with its funding base declining, SCHIP costs 
will increase exponentially. CBO predicts that SCHIP spending will more 
than double under the Democrats proposal. The resulting gap between 
program spending and revenue becomes staggering, a gap the Democrats 
will soon ask the American taxpayers to fill.
  In closing, I'd like to add one final note. This bill represents a 
broken promise to lower- and middle-income Americans. President-elect 
Obama promised that no one making less than $250,000 per year would see 
their taxes go up; yet, under this proposal, a working-class family 
with two adult smokers would face hundreds of dollars in additional 
Federal tobacco taxes each year.
  We haven't made it to Inauguration Day, and House leaders are already 
breaking this campaign promise. That might be a record, even here in 
Washington, D.C.
  Let's keep SCHIP focused on low-income children. Let's not ask 22.4 
million Americans to start smoking, and let's demand a better 
bipartisan bill.
  I ask my colleagues to vote ``no'' on this bill.
  Mr. STARK. Madam Speaker, I am pleased to recognize Mr. Schauer from 
Michigan for 1 minute.
  Mr. SCHAUER. Madam Speaker, I came to Washington to be a voice for 
those in my State who are hurting.
  H.R. 2 will help children and families who are victims of our 
economic crisis; 100,000 children in Michigan lack health insurance. 
That is immoral and weakens our economy. This bill ensures 
comprehensive health care coverage for children, and is an investment 
in prevention and approved overall health status for America.
  With Michigan's economy in crisis, with our Nation's economy 
struggling, with our families losing health insurance due to this 
recession and unfair trade, now is exactly the right time, colleagues, 
to act, to cover 11 million children with the health care coverage they 
deserve and need.
  Mr. HERGER. Madam Speaker, I yield 1 minute to the gentleman from 
Louisiana (Mr. Boustany), who is a physician.
  Mr. BOUSTANY. Madam Speaker, as a physician, we all recognize the 
importance of high quality health care for all children in this 
country. In addition to the declining source of revenue as a means to 
pay for this, which I believe is an irresponsible way to legislate on 
health care, there's a serious other problem that needs to be discussed 
and that is, does this bill provide real access to quality health care?
  Too often children on Medicaid and SCHIP receive fewer visits from 
primary care providers than those with private coverage. That's clear. 
And they are much more likely to seek care in the emergency room when 
it's late. They don't get the necessary screenings and vaccinations.
  GAO criticized government-run programs like SCHIP for disregarding 
patients' access problems.
  It's disappointing to me, as a physician, that the majority rushed 
this flawed bill to the floor without permitting any opportunity for 
improvements. I offered an amendment that went to Rules which was not 
allowed, which would have encouraged States to measure and report 
provider access problems for SCHIP programs. It would also require 
States to report their plans to limit ``crowd out'' of private 
coverage.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. BOUSTANY. I would like to include the rest of my statement in the 
Record.
  In section 402 of their bill, Majority leaders failed to address the 
access problems I brought to their attention last year.
  Their vague language does not require states to uniformly report 
primary care visits.
  It does not mention surveying parents on whether sick children 
received needed care quickly.
  It also fails to require states to describe their plans to avoid 
displacing children's private coverage.
  We need to help poor children first.
  A plastic government coverage card that delays access to needed care 
is an insult to low-income families.
  Congress has a duty to help enrolled children who--despite being 
covered--still can't find a doctor to treat them when they're sick.
  Mr. PALLONE. Madam Speaker, I would yield 1 minute to the gentleman 
from New York (Mr. Engel).
  Mr. ENGEL. Madam Speaker, I rise in strong support of the bill. I am 
so proud that under our new administration we'll finally enact a 
comprehensive, robust reauthorization of the SCHIP program which will 
provide health care to over 11 million low-income children. No more 
playing politics with our children, no more Presidential vetoes of this 
bill. We are finally going to do what is right for our Nation.
  It simply makes economic sense to cover the uninsured. When we fail 
to provide our citizens with primary and preventive care, routine 
health problems compound into emergency conditions.
  New York, my home State, operates a separate stand-alone program 
under SCHIP called Child Health Plus. As of December 2006, nearly 
400,000 children were enrolled and receiving comprehensive health care 
coverage in the program. As the third largest SCHIP program in the 
Nation, New York reduced the number of uninsured children in the State 
by 40 percent. We are only one of seven States to do that. And New 
York's program has increased enrollment by over a quarter of a million 
children since the start of SCHIP.

[[Page 739]]

SCHIP also contributed to a nearly 30 percent increase in children 
enrolled in Medicaid.
  This is necessary. It is good. We should all support this bill.
  The SPEAKER pro tempore. The gentleman from California (Mr. Herger) 
has 5 minutes remaining. The gentleman from New Jersey (Mr. Pallone) 
has 6\1/4\ minutes remaining. The gentleman from California (Mr. Stark) 
has 7 minutes remaining.
  Mr. HERGER. Madam Speaker, I yield 1 minute to the gentleman from 
Georgia (Mr. Linder).
  Mr. LINDER. Madam Speaker, when SCHIP first passed about a dozen 
years ago, Georgia's program was called Peach Care. It was open to 
large numbers of people, and millions signed up, many of whom came off 
private health insurance to do so. A friend of mine, who made $150,000 
a year, signed up too. She never used it. But you could sign up by the 
Internet.
  Some of that's been tightened up, but this bill opens that back up 
again. You're eligible by just stating your Social Security Number, no 
need to prove who you are.
  The 5-year waiting period that's always been in place for legal 
immigrants who come here sponsored, is erased. And we all know that 
sooner or later we're going to have an amnesty for those 20 million 
illegals, and that will dwarf this system.
  I was in dental school in 1966 when Lyndon Johnson delivered the 
Great Society speech; and he said, using easily quantifiable user 
statistics, we know that by 1990, Medicare will cost $9 billion, and 
Medicaid will cost $1 billion. He was wrong. And this will be abused 
also.
  Mr. STARK. Madam Speaker, at this time I am delighted to yield 1 
minute to the distinguished gentleman from California (Mr. Thompson).
  Mr. THOMPSON of California. Madam Speaker, I rise in strong support 
of this bill because investing in children's health care is one of the 
wisest choices we can make. Children have to be healthy to get an 
education and to achieve their full potential as adults. When kids see 
the doctor more regularly, they receive the preventive services that 
keep them healthier longer, and they are less likely to end up in the 
emergency room, which saves everyone money.
  Almost a quarter of a million children in my State of California are 
uninsured. That's simply not acceptable. In contrast to President 
Bush's multiple vetoes of similar bills, today, with President-elect 
Obama's enthusiastic support, the House will vote to provide coverage 
for 4 million, 4 million additional children.
  Madam Speaker, that truly is change we can believe in.
  Mr. HERGER. How much time do we have, Madam Speaker?
  The SPEAKER pro tempore. The gentleman from California (Mr. Herger) 
has 4 minutes remaining; the gentleman from New Jersey has 6\1/4\ 
minutes; the gentleman from California (Mr. Stark) has 6 minutes; and 
the gentleman from Missouri has 90 seconds.
  Mr. PALLONE. Madam Speaker, I yield 30 seconds to the gentlewoman 
from the Virgin Islands (Mrs. Christensen).
  Mrs. CHRISTENSEN. Madam Speaker, I am proud today to rise for the 11 
million children who will have health coverage when we pass H.R. 2 for 
the first time and it's finally signed into law by the incoming 
President.
  CHIPRA will make a significant downpayment on President-elect Obama's 
and our promise to insure all of our children. And it rightfully 
refuses to leave out children and pregnant woman legally admitted into 
our country.
  It includes dental and mental health care, and will help eliminate 
health disparities because many of those covered children will be 
children of color. Healthy children have a better chance to also become 
healthy adults.
  It's the right thing to do. It should not have taken this long, and I 
urge my colleagues to pass it for the good of our children and the good 
of our country.
  Mr. HERGER. Madam Speaker, I continue to reserve my time.
  Mr. STARK. Madam Speaker, I am delighted to yield 1 minute to the 
distinguished gentlewoman from Colorado (Ms. Markey).
  Ms. MARKEY of Colorado. Madam Speaker, I rise today in support of 
H.R. 2, the reauthorization of SCHIP.
  When our Nation faces tough economic times, we must look beyond the 
grim statistics to see the true cost of our struggles. Seven percent of 
this Nation is unemployed, which leaves too many families without 
health insurance. 170,000 children in Colorado alone have no health 
coverage. That's more than one in eight.
  How we as a Nation approach health care for our children speaks not 
just to our economic priorities but to our moral priorities.
  Colorado ranks seventh worst nationally in the rate of uninsured 
children. As the mother of three kids who knows the worry and heartache 
that comes with caring late into the night for a sick child, that is 
one statistic I hope I have a hand in changing.
  I urge all of my colleagues on both sides of the aisle to pledge 
their support for our children and vote for this bill.
  Mr. STARK. Madam Speaker, at this time I am delighted to yield 1 
minute to the distinguished gentleman from Georgia (Mr. Scott).
  Mr. SCOTT of Georgia. Madam Speaker, I represent Georgia, which has 
300,000 children who badly need coverage in this legislation. Let me 
take a part of my moment here, if I may, to respond to what I think are 
some misstatements from the other side because this is, indeed, a 
children's health program, and they've mentioned about adults being on 
this program.
  One category of adults, Madam Speaker, is pregnant women. Of all 
adults, a pregnant woman with child in her womb, they need care. They 
should be and are covered in this.
  As far as the other category, here's what the bill says as far as 
parents. No new waivers to cover parents in the CHIP program will be 
allowed. That's in this bill.
  What about childless adults who don't have? The bill says the current 
law, that prohibition on waivers to cover coverage of childless adults 
is retained. Childless adults are prohibited in this law.
  Issue of illegal immigration; only legal immigrant children and their 
pregnant immigrant legal immigrant women are covered under this bill.

                              {time}  1330

  Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentleman from 
Illinois (Mr. Foster).
  Mr. FOSTER. Madam Speaker, I rise in strong support of H.R. 2, the 
Children's Health Insurance Program Reauthorization Act of 2009.
  This historic legislation renews and improves SCHIP. It extends 
coverage to 4 million uninsured children who are currently eligible for 
but who are not enrolled in SCHIP and in Medicaid.
  As a fiscal conservative, I am also proud that even in today's 
financial storm and even under scoring rules that do not fully reflect 
the long-term fiscal benefits of providing adequate health care to 
children that the bill is fully paid for. With a modest increase in 
tobacco sales tax providing a bulk of the funding, we are able to 
provide coverage to millions of children and not add to the deficit.
  This bill honors our moral commitment to help our youngest children 
in their health while ensuring that this legislation does not hinder 
their future by saddling them with huge debts.
  The bill could not come at a better time. Our economy continues to 
worsen, and more and more people are at risk of losing their health 
care. This program will help give millions of parents the peace of mind 
that their children at least will have access to health care.
  Mr. HERGER. Madam Speaker, I yield 1 minute to the gentlewoman from 
Florida (Ms. Ginny Brown-Waite).
  Ms. GINNY BROWN-WAITE of Florida. Madam Speaker, first of all, let me 
state that I support health insurance for children. As a matter of 
fact, it was my bill on the floor of the Senate where we created 
KidCare.

[[Page 740]]

  Where did the money come from? It was from a historic vote that I 
cast to be able to go after the tobacco companies for settlement. 
That's where the money came from originally for the SCHIP program, but 
the bill we have before us today is not a bill that taxpayers can 
support.
  First of all, there is no prohibition against crowd-out. In other 
words, it pushes children off of private insurance onto the government 
program, and it does allow States to continue for at least 2 years the 
enrollment of adults. It actually does nothing to prohibit illegal 
aliens from being on the program, and that's something that taxpayers 
are very concerned about. Additionally, Madam Speaker, there is no 
incentive here, really, to go after and to have low-income children 
covered by this bill.
  For those reasons, I oppose it.
  Mr. STARK. Madam Speaker, I reserve the balance of my time.
  Mr. PALLONE. Madam Speaker, I would yield 30 seconds to the 
gentlewoman from New Hampshire (Ms. Shea-Porter).
  Ms. SHEA-PORTER. Madam Speaker, I support H.R. 2, the Children's 
Health Insurance Program Reauthorization Act of 2009.
  We have children in New Hampshire and in America who need us to fight 
for them. Unemployment is rising. Even working families are losing 
their health insurance. Providing more money now will give 4 million 
more children health insurance. This is a moral issue. We are the only 
nation in the world that does not provide health care to all of its 
children. This is simply unconscionable.
  I am proud to support this legislation to help New Hampshire's 
children and America's children.
  Mr. HERGER. Madam Speaker, I yield 2 minutes to the Republican whip, 
the gentleman from Virginia (Mr. Cantor).
  Mr. CANTOR. Madam Speaker, I rise today to underscore that all of us, 
Republicans and Democrats alike, desire to ensure that all children of 
low-income working families have access to high-quality, affordable 
health care. But at this time in our economy when deficits threaten to 
climb to $1.6 trillion, without Republican input or without any debate, 
the majority has rushed a bill to the floor that substantially expands 
the reach of this program beyond its original intended purpose. All the 
while, a substantial portion of the existing target population has 
never been reached.
  It is with much disappointment that I stand in opposition to this 
bill today, because it could have had significant bipartisan support 
had the majority opened the process to our substantive ideas.
  Before our ideas and solutions were shut out at the Rules Committee, 
we sent President-elect Obama and Speaker Pelosi a letter which 
outlined four central issues that we had hoped would be addressed.
  First: We believe that the SCHIP bill should follow the original 
intent of the law. That is to cover children in low-income working 
families.
  Second: We Republicans believe that expanding SCHIP should not shift 
children away from private health insurance options into government-run 
programs that are funded exclusively by the taxpayers. Instead, we 
should be providing families who are currently uninsured with more 
affordable options to better meet their needs, not a one-size-fits-all 
government solution.
  Third: We Republicans believe that the legislation should include 
meaningful provisions to prevent fraudulent activity by those who seek 
to illegally gain access to this program.
  Finally, Madam Speaker, when Congress reauthorizes the program, we 
must do so responsibly. The budget gimmicks included in this bill 
suggest that the majority is not seriously trying to comply with PAYGO. 
This bill will only put the States and the Federal Government into 
further debt. I don't think there is any question that many in this 
House want to do the right thing. Unfortunately, Madam Speaker, I feel 
this bill doesn't quite reach this mark.
  Mr. PALLONE. Madam Speaker, we inquire of the time that is remaining.
  The SPEAKER pro tempore. The gentleman from New Jersey has 4\1/4\ 
minutes remaining. The gentleman from California (Mr. Stark) has 4 
minutes remaining. The gentleman from California (Mr. Herger) has 1 
minute remaining. The gentleman from Missouri has 90 seconds remaining.
  Mr. PALLONE. Madam Speaker, at this time, I would yield 30 seconds to 
the gentleman from New York (Mr. Massa).
  Mr. MASSA. Madam Speaker, I am compelled to observe that, while Rome 
burns, my friends and colleagues across the aisle argue process.
  We were elected to come here and make a difference in the lives of 
the people who we represent. Today, I will proudly cast a vote in the 
affirmative for the expanded State Children's Health Insurance Program 
Reauthorization Act of 2009 to do exactly that.
  We are in a time of financial and economic crisis, and we cannot 
ignore the individuals who have sent us here to help them. It is a 
plain and clear call to action. It is wrong to say that you support 
children's health care and, at the same time, vote against it. This is 
not about process. It is about standing with America's children, and I 
am proud to do so today.
  The SPEAKER pro tempore. The Chair will recognize in reverse order 
the managers for closing comments. That would be Mr. Herger, followed 
by Mr. Stark, followed by Mr. Blunt, followed by Mr. Pallone.
  Mr. PALLONE. Madam Speaker, I have some additional speakers, though.
  I yield 30 seconds to the gentleman from Virginia (Mr. Connolly).
  Mr. CONNOLLY of Virginia. Madam Speaker, this vote is about values. 
If you are an uninsured kid in America and you have appendicitis, the 
chance of death is five times that of a kid who is insured. This is 
about values. We are the only developed country in the world that does 
not extend full health insurance to its children. History has shown no 
nation can truly consider itself great without providing for the well-
being of its most vulnerable.
  I urge my colleagues to support this legislation.
  Madam Speaker, I rise in support of the bill. It is clear that the 
Congress sees value in this critical investment in our Nation's 
children, having passed a similar measure not once but twice in its 
last session. Thankfully, we will now have a President who shares that 
same compassion and commitment to our low- and middle-income working 
families.
  Given the ongoing economic crisis, the number of at-risk children 
will only continue to increase. The number of Americans who are now 
unemployed, and ostensibly now without health care, has increased by 
more than half in the past year, from 4.7 percent to 7.2 percent 
nationally. When you factor in the skyrocketing costs of health care, 
coupled with the economic pinch being placed on people's pocketbooks, 
today's American families are being bled dry and countless children are 
being left without health care. In that context, we are making a 
critical investment in the health of our Nation by adding these 4 
million children to the 7 million already covered by SCHIP.
  The long-term risk of not making this investment now will surely cost 
us more. Let me cite just one example: It is my understanding that an 
uninsured child diagnosed with appendicitis is 5 times more likely to 
die as a result of lack of access to medical attention than a child who 
is has been insured. By expanding access to more working families, we 
begin to lay the foundation for the principles by which we hope to 
overhaul our Nation's health care system.
  As my colleagues may be aware, the United States is the only 
developed nation in the world that does not provide health care for all 
of its children. That is unconscionable. As history has proven, no 
nation can truly consider itself great without providing for the well-
being of its most vulnerable.
  Mr. PALLONE. Madam Speaker, I would yield 30 seconds to the gentleman 
from Iowa (Mr. Loebsack).
  Mr. LOEBSACK. Madam Speaker, we have voted for similar SCHIP measures 
in the past, but those efforts were thwarted time and time again. I 
believe today is a new day.
  Today, we will send a clear message to those who need our help the 
most--our children. This Congress and the new administration will tell 
the 38,000 uninsured children in Iowa and the millions more across the 
country that we

[[Page 741]]

care and that we will no longer leave them without the health care they 
need.
  I look forward to casting my vote in strong support of this 
legislation. I urge my colleagues to do the same.
  Mr. STARK. Madam Speaker, at this time, I am delighted to recognize 
for 1 minute the distinguished gentleman from Illinois (Mr. Davis).
  Mr. DAVIS of Illinois. Madam Speaker, I am pleased to rise in strong 
support of the Children's Health Insurance Program Reauthorization Act 
of 2009.
  I am pleased to note that my State, the State of Illinois, has made 
it possible for every child to receive access to health care and to see 
that this action takes place across the country so that every child, no 
matter who he or she might be, has an opportunity to grow and develop 
to become the kind of person that his or her potential provides.
  It is a great day for the United States of America. It is a great day 
for this Congress. It is a great day for all of the children in 
America.
  Mr. STARK. Madam Speaker, if I may, I will yield myself 2 minutes.
  I just want to rise and ask my colleagues to support H.R. 2. It has 
done a lot of things. It expands insurance coverage to another 4 
million children. You can argue one way or the other that they may have 
insurance someplace else, but this will guarantee that those 4 million 
additional children will get the medical care or the insurance and, 
without which, they will not get first-class medical care in this 
country.
  We've passed this bill in several different forms in the past, and I 
want to thank the 40 or 50 Members from across the aisle who have 
supported it in the past. We've made some changes, and we've 
acknowledged the legitimacy of all legal residents in our Nation by 
giving States the option to cover them if they choose.
  I am glad to report that the bill is fully financed. We can argue 
about what happens 4 or 5 years out, but I am sure we'll have more of 
an argument on whether the very rich should enjoy escaping the capital 
gains tax or whether we should do away with the inheritance tax, which 
will bother many of the opponents much more than the idea of the 
tobacco tax or, indeed, the prohibition on the unethical kickbacks that 
physicians receive from ownership hospitals, most of which are of 
questionable safety and quality. This legislation expands health 
coverage to our Nation's children, and it is worthy of our support.
  I would like to take just a moment to thank the staff members who 
have worked so hard over the past almost 2 years. From the staff on the 
Committee on Energy and Commerce: Bridgett Taylor, Karen Nelson, Andy 
Schneider, Amy Hall, Purvee Kempf, Tim Gronninger, Hasan Sansour, and 
Bobby Clark.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. STARK. Madam Speaker, I yield myself an additional 10 seconds.
  From our own staff on the Committee on Ways and Means Health 
Subcommittee: our staff director--Cybele Bjorklund--Jennifer Friedman, 
Debbie Curtis, Karen McAfee, Chiquita Brooks-LaSure, and Drew Dawson.
  I urge the passage of H.R. 2.
  I reserve the balance of my time.
  Mr. BLUNT. Inquiring, does the gentleman have any additional speakers 
besides his closing comments?
  Mr. PALLONE. I do not, but I was going to ask how much time remains.
  The SPEAKER pro tempore. The gentleman from Missouri has 90 seconds 
remaining. The gentleman from California (Mr. Herger) has 1 minute 
remaining. The gentleman from California (Mr. Stark) has 1 minute 
remaining. The gentleman from New Jersey has 2\3/4\ minutes remaining.
  Mr. PALLONE. Madam Speaker, I would yield myself a minute and a half.
  I just want to stress how important this bill is and also that it is, 
essentially, the same bill that we passed in the last Congress. It was 
bipartisan. It was passed in both houses with a fairly large margin. 
The only thing that stood in the way was President Bush's veto.
  Now we do have a new President. We know that he has supported the 
legislation. It is so crucial for the children of this country, for the 
4 million or so now who are eligible but for whom there is no funding, 
who will be covered by this legislation. It is fully paid for.
  Particularly now, when we have a recession and when we know that so 
many people are losing their jobs and, as a consequence, their health 
insurance for themselves and for their families, what could be more 
important than making sure that those families' children are covered by 
this legislation?

                              {time}  1345

  I must say I'm very proud of the fact that we are here in the first 
week, essentially, of this new Congress passing this bill. I know the 
other body is about to pass it as well and that we will be able to send 
it to the President and have it be one of the first accomplishments of 
his Presidency and of this Congress.
  I know Mr. Stark already thanked the various staff members, so I 
won't thank them again. But I do want to pay particular attention to 
Bridgett Taylor because I know that she worked on this legislation for 
2 years or more and was even there when we first passed the SCHIP bill 
10 years before that. And it has always been one of the things that she 
cares so much about. But I want to thank all of the staff people and 
all of my colleagues for all of the work that they've done on this 
legislation.
  Mr. HERGER. Madam Speaker, I reserve the 1 minute I have to close, 
but I would yield to the gentleman from Missouri (Mr. Blunt) for the 
time that he has that he controls.
  Mr. BLUNT. Madam Speaker, I yield my minute-and-a-half to the ranking 
member of the Health Subcommittee on Energy and Commerce, the gentleman 
from Georgia (Mr. Deal).
  Mr. DEAL of Georgia. I appreciate the gentleman yielding.
  Madam Speaker, very few bills come to the floor of this House with so 
much rhetoric disassociated from facts as we have heard in this bill.
  Now, let's talk about a few of the real facts.
  First of all, the program was designed, at its outset, to insure 
children that were above the Medicaid level of poverty but below 200 
percent of poverty. All of the stories that we have heard today--from 
both sides of the aisle, quite frankly--as to examples of children who 
are uninsured, in almost every one of those instances are children that 
should have been insured under the current law under either SCHIP or 
Medicaid but are unenrolled.
  One of the amendments that I offered that was not allowed was an 
amendment that said before you can go up the poverty scale, you should 
have a 90-percent saturation of those children that are below 200 
percent of poverty. Many States that are well above the 300 percent of 
poverty still have not covered a quarter of their children that are 
below the 200 percent of poverty level.
  So ``poor children first'' is not in this bill.
  Secondly, with regard to the issue of illegal immigration. Now, you 
can say that illegal immigrants will not be allowed, but you are 
removing the requirements of certification of eligibility. And by the 
way, pregnant women, regardless of their immigration status, are 
considered ``children'' under the SCHIP bill in everybody's version of 
the law.
  Now, if you're not acknowledging that illegals are going to be 
enrolled in this program by virtue of the change you're making in this 
bill, then you ought to talk to CBO because CBO says in the next 10 
years that the Federal Government will spend $5.1 billion and States 
will spend $3.85 billion on people who are illegally in this country.
  Mr. STARK. Madam Speaker, I'm delighted to recognize the Speaker of 
the House, the distinguished gentlelady from California (Ms. Pelosi).
  The SPEAKER pro tempore. The gentlewoman from California is 
recognized for 1 minute.
  Ms. PELOSI. Madam Speaker, I thank the gentleman from California for 
yielding.
  My colleagues, this is a day of triumph for America's children. With 
what I expect to be a strong bipartisan

[[Page 742]]

vote, the House will bring us one step closer to providing health care 
for 11 million children in America.
  With this action and with the legislation last week to ensure equal 
pay for equal work for women, Congress makes clear that we put women 
and children first. It is important that we have this legislation up so 
soon in this new Congress because children are our top priority. We 
like to be considered a Congress for the children, a Congress for the 
future.
  At a time of economic crisis, nothing could be more essential than 
ensuring that children of hardworking families receive the quality 
health care they deserve. Many of these children are from families of 
hardworking Americans who have lost their jobs through no fault of 
their own. It's sad to say that America lost 2.6 million jobs last 
year. Over half a million jobs were lost in the month of December--
500,000 jobs in the month of December alone. It was actually 526,000 
jobs. Each month, until we have an economic recovery initiative, we 
will continue to lose at least 500,000 jobs per month.
  With such job loss, America sees the health care coverage that we all 
need for our children disappear. For every 1 percent increase in the 
unemployment rate, it is estimated that as many as 1.5 million 
Americans will lose their health care coverage. A record 47 million 
Americans, including nearly 9 million children, are without health 
insurance now.
  Ensuring that children have access to affordable health care just 
makes sense. It's not just about addressing their health needs when 
they are sick. It's about keeping them healthy in advance. It's about 
prevention. It's about diet, not diabetes; it's about prevention, not 
amputation. It's about a healthier America.
  Contrary to the views of some, an emergency room is not good health 
care on a regular basis. An emergency room is, as it describes, for 
emergencies--not for ongoing health care. So for those who say that all 
people in our country have access to health care, that they can go to 
an emergency room, I don't know what they could be thinking.
  By ensuring health care coverage for 11 million children, families 
will have regular doctor visits and preventative care. We will ensure 
that children get the care they need and the health care costs are not 
inflated due to expensive emergency room care.
  That is why more than 80 percent of the American people support this 
legislation. It's bipartisan. It is fully paid for by a 61-cent tax on 
a pack of cigarettes as the major part of its funding, and it 
represents a new direction because, again, it is good health care for 
America's children. It is paid for.
  We have fought in the last Congress together, Democrats and 
Republicans, in the House and in the Senate to pass this legislation--
which we did--but it was vetoed. At the time, President Bush said that 
we could not afford this legislation, that we could not afford to 
insure America's children. Forty days in Iraq equals over 10 million 
children in America insured for 1 year. Forty days in Iraq, 1 year 
insuring over 10 million children. We certainly can afford to do that.
  We look forward to bringing this legislation to President Obama's 
desk as one of the first bills that he will sign. And when we do, we 
owe a great deal of gratitude to Chairman Henry Waxman of the Energy 
and Commerce Committee, Chairman Rangel of the Ways and Means 
Committee, Chairman Emeritus John Dingell, who's worked on this issue 
for a very long time and engineered it through the last Congress. Thank 
you, Mr. Dingell. Congressman Pallone, the Chair of the subcommittee; 
Congressman Stark, the Chair of the appropriate Committee on Ways and 
Means; the Congressional Hispanic Caucus, which led the fight to make 
sure that legal immigrant children are covered under this legislation, 
and our Congressional Black Caucus. All elements of our Congress, a 
coalition, and on the outside, because we could not succeed with just 
our inside maneuvering on legislation so important and so pervasive in 
its impact.
  Without the support of more than 300 organizations, from AARP to the 
YMCA and everything in between, the March of Dimes, Easter Seals, 
almost every organization you can name supports this SCHIP; and they 
support providing quality, affordable health care to America's 
children, and they support doing it by the passage of the State 
Children's Health Insurance Program legislation that we have before us 
today.
  So I thank all of those in the Congress for their leadership in 
making this important day possible for America's children. It's 
important to children because of their health. It's important because 
it's paid for. We do something great for children without adding to our 
deficit and delivering mountains of debt to future generations.
  So this, all in all, is great for kids. Let's keep our reputation 
going as a Congress for children and give a strong bipartisan vote to 
this important legislation.
  Mr. HERGER. Madam Speaker, I yield the remainder of our time to the 
minority leader, the gentleman from Ohio (Mr. Boehner).
  The SPEAKER pro tempore. The gentleman from Ohio is recognized for 1 
minute.
  Mr. BOEHNER. Madam Speaker, let me thank my colleague from California 
for yielding.
  I rise today in opposition to this bill, frankly because of my strong 
support for the SCHIP program.
  In 1997, Republicans here in Congress worked with our Democrat 
colleagues to create the State Children's Health Insurance Program. I 
was there, and many of you were here as well. And throughout that 
process it was bipartisan, it was fair, and open discussion and open 
debate. And unfortunately today, the voices of millions of Americans 
who want to provide input into this proposal have been silenced in the 
process.
  Earlier this week, I wrote to Speaker Pelosi and President-elect 
Obama expressing our willingness to work together on this critical 
issue. We outlined our principles for this program's reauthorization. 
The principles are nothing new. In fact, they're the same principles 
that led to the creation of SCHIP in 1997.
  And they are this: This program ought to cover poor children first. 
Unfortunately in many States, more than two-thirds of those enrolled in 
the SCHIP program are adults. And there is nothing in this bill that 
really does ensure that poor children will be brought into the program 
first.
  Secondly, taxpayer funds for this program should not be used to fund 
benefits for illegal immigrants. And there's been this big debate about 
whether it does or it doesn't, but the fact is that while the bill says 
we will not cover illegal immigrants in this bill, the whole 
verification process that should be in here to ensure that only 
American citizens and legal residents are entitled to these benefits, 
no verification to speak of is contained in the bill.
  And we also believe that SCHIP should not force children with private 
insurance into a State-run health insurance program. Last year in this 
proposal, there was language that made it clear that children with a 
private health insurance program, that they should stay in that private 
program and not be pushed into the State-run program. Unfortunately, 
the bill before us does not reflect these principles, the same ones 
that have guided this program since its creation.
  I believe that the bill before us would undermine the original intent 
of the SCHIP program by expanding the program to adults, illegal 
immigrants, and upper-income families who already have access to 
private health insurance.

                              {time}  1400

  I think taxpayers deserve better, and, more importantly, our Nation's 
children deserve better. That's why today Republicans will offer a 
better way.
  I said on the opening day, when I gave the gavel to Ms. Pelosi, that 
Republicans would not just be the party of ``no,'' that we would come 
to this

[[Page 743]]

floor with better solutions. And the better solution that we will offer 
here soon is a program that would reauthorize SCHIP for 7 years, not 
the 4\1/2\ years that we see in the majority's bill; it will reflect 
our principles, and make it clear that poor children should be covered 
first; and it will fully fund the SCHIP program without raising taxes 
on American families across our country.
  Madam Speaker, Federal funds targeted for low-income children should 
benefit low-income children, period. Only one measure on the floor 
today will serve those children's interests, and that's what the motion 
to recommit will contain. So I would urge my colleagues to vote ``yes'' 
on the motion to recommit and ``no'' on the underlying bill.
  Mr. MARKEY of Massachusetts. Madam Speaker, I rise today in strong 
support of the Children's Health Insurance Program Reauthorization Act 
of 2009.
  I am proud to be an original cosponsor of this important legislation 
to expand the highly successful State Children's Health Insurance 
Program (SCHIP). This bill will allow the program to provide health 
insurance to an additional 4 million low-income children on top of the 
nearly 7 million who already benefit from the program.
  In my home State, SCHIP enrollment is part of the reason why 
Massachusetts has the lowest rate of uninsured children in the country. 
More than 180,000 Massachusetts children receive health coverage 
through SCHIP, and this reauthorization will allow the state to cover 
even more children who currently do not have health insurance.
  It is unfortunate that the previous two attempts to reauthorize SCHIP 
were vetoed by President Bush, who chose to side with big corporations 
over children. With the current economic crisis causing significant job 
losses, millions of Americans also are losing their health coverage, 
making today's vote even more urgent.
  While President Bush twice dashed the hopes of millions of low-income 
families in need of health care for their children, the incoming Obama 
administration recognizes the value of ensuring that all low-income 
children get the health care they need.
  I urge my colleagues to stand with the hard working families who want 
to provide their children with the health care they need. Vote yes on 
this critical legislation.
  Mrs. BACHMANN. Madam Speaker, today I rise in opposition to H.R. 2, 
the Children's Health Insurance Reauthorization Act of 2009. While I 
support the State Children's Health Insurance Program, SCHIP, and its 
continued reauthorization, the proposal before the House today 
reauthorizes this program in an irresponsible manner, at a time when 
the American people need responsible government more than ever.
  As you know, I recently joined many of my Republican colleagues in a 
letter to you, Madam Speaker, and to President-elect Obama asking that 
any reauthorization of SCHIP contain commonsense provisions to ensure 
that the program's mission is fulfilled. For instance, SCHIP is meant 
to ensure that children without means can gain access to health care. 
The program is designed to cover them first, before extending coverage 
to children whose families may be able to afford coverage. 
Unfortunately, the bill with which we have been presented includes no 
requirement that states focus the funds in this bill on low-income 
children. There is a likelihood that the failure to include such a 
provision will lead to funds being diverted from the children who need 
them most, particularly in the states that have expanded their SCHIP 
programs most dramatically.
  Another concern that I have is the impact of this legislation on the 
private insurance market and the families who depend upon it. In 
scoring this legislation, the Congressional Budget Office (CBO) 
estimated that 2.4 million people will drop their existing private 
insurance, opting instead for the public program. This ``crowding out'' 
will constrict the health insurance pool and further increase the cost 
of private insurance for millions more. Given the ranks of Americans 
who already cannot afford health insurance, this is the last thing the 
American people need.
  There are other concerns that I have with this bill and with the way 
it is being pushed through with so little debate and no opportunity for 
amendment. While the House leadership has again promised that it will 
work in a bipartisan fashion, bringing both sides of the aisle together 
to build consensus legislation, this promise has turned out to be 
nothing more than empty to the American public. I urge my colleagues to 
join me in opposing this legislation.
  Mr. POMEROY. Madam Speaker, I rise today in strong support of H.R. 2, 
the Children's Health Insurance Program Reauthorization Act of 2009.
  We were all deeply disappointed that President Bush vetoed bipartisan 
legislation that would have reauthorized the popular State Children's 
Health Insurance Program, SCHIP, not once, but twice during the 110th 
Congress. However, under a new Congress and a new incoming President, I 
am pleased that we can finally move forward with bringing health care 
to 11 million needy low-income children.
  In my own State of North Dakota, there are roughly 14,000 children 
who lack health care coverage. Under this legislation, the nearly 3,600 
children who are already covered under the Healthy Steps program will 
continue to obtain the care they need and there is the potential to 
cover many more given the $100 million in outreach and enrollment 
grants as well as the $3.2 billion in performance grants to states to 
help enroll needy children who are eligible but currently enrolled in 
SCHIP.
  Our Nation's current economic crisis illustrates just how urgent the 
need is to reauthorize SCHIP. With 2 million jobs lost in 2008, more 
and more needy children are finding themselves without health care 
coverage this year. That is why I urge my colleagues to join me in 
standing up for 11 million children and pass this important bipartisan 
piece of legislation.
  Ms. EDDIE-BERNICE JOHNSON of Texas. Madam Speaker, I rise in support 
of H.R. 2, the Children's Health Insurance Program Reauthorization Act 
of 2009.
  Texas ranks last in the Nation in terms of taking care of its 
children. A report released in 2009 by the organization called, 
``Texans Care for Children'' contains dismal statistics.
  For example:
  Texas continues to rank 50th out of 50 among the States in health 
coverage for children.
  Infant mortality rates have steadily climbed in Texas this decade, 
while remaining unchanged in the Nation as a whole.
  Texas still ranks near the bottom in child hunger, child poverty, and 
child deaths from abuse or neglect.
  The State of Texas continues to be ineffective at resolving the 
problem of uninsured children in our State.
  I am sympathetic to States' needs to avoid revenue shortfalls 
regarding SCHIP, and so I support Congress allocating the funds needed 
to cover children in need.
  Today's legislation is similar to a bill passed by Congress in 2007 
and vetoed by the President.
  It would provide health care coverage to 11 million children in this 
country who currently have none.
  I support a generous expansion of this program.
  Children with health insurance are more likely to be up to date on 
immunizations and to receive treatment for sore throats, ear aches and 
other illnesses.
  Good health means fewer sick days and better school performance--and 
less burden on our emergency rooms.
  As a nurse, I can not over-emphasize how important it is for young 
people to have a medical home.
  Having a family physician can prevent so many minor illnesses from 
developing into serious, expensive illnesses.
  Health care coverage of children just makes good sense.
  I urge my colleagues to avoid delay in passing this bill, as it is 
critical for the health of so many children.
  Mr. MORAN of Virginia. Madam Speaker, I rise today in strong support 
of H.R. 2, the Children's Health Insurance Program Reauthorization Act 
of 2009. Truly, we face a health care crisis in this country--in the 
richest country on Earth; 47 million Americans do not have health 
insurance, including 9 million children. The need is even greater in 
these sad economic times. With rising unemployment, more families are 
losing their health insurance. This bill will go a long way to provide 
health care for uninsured children and fulfilling our moral obligation 
to them.
  In my home State of Virginia, the CHIP program currently provides 
coverage to 144,163 low-income children each year. The CHIP 
Reauthorization Act will help us cover an additional 75,000 children. 
It will ensure that these children have access to high quality health 
care, including the preventative services that children need to be 
healthy and successful in school and later in life. This bill will 
provide dental and mental health benefits on par with medical and 
surgical services--truly ensuring that the whole child's health is 
provided for.
  The CHIP Reauthorization Act does this without increasing the 
deficit, primarily by increasing the Federal excise tax on cigarettes.

[[Page 744]]

In my view as Chairman of the Congressional Prevention Caucus, an 
increase in the Federal tobacco tax is sound public health policy. It 
provides a reliable revenue source to offset the costs of expanding 
coverage to low-income children and it will reduce health care costs in 
this country by reducing the prevalence of chronic disease.
  In the past, there has been misleading and false information 
regarding the bill's treatment of illegal aliens. Critics of the 
legislation seem to ignore existing Federal law and provisions in the 
CHIP Reauthorization Act that prevent federal funds from being spent to 
provide benefits for illegal immigrants. What H.R. 2 does do is offer 
an opportunity for States to waive a five year waiting period on legal 
non citizens. Current law requires a five-year waiting period before 
legal immigrants are eligible for CHIP. Allowing State flexibility in 
this regard is sound public health policy that would enable thousands 
of American children access to vital health services to help them live 
better, healthier, and more productive lives. The bill does not mandate 
the change, but leaves it to the states to make their own decisions.
  Reauthorizing SCHIP is sound public health policy--research shows 
that children who have access to health insurance are substantially 
more likely to access key preventative services, miss fewer days of 
school due to illness, get better grades, and grow to become healthy 
and productive adults. Moreover, the financial benefits of covering 
children vastly outweigh the costs--one need only compare the cost of a 
visit to a primary care provider to the cost of a night spent in the 
emergency room. Ultimately, covering all our children is a moral 
imperative--it is the only possible humane, responsible course of 
action. I urge a yes vote on H.R. 2.
  Mr. CARSON of Indiana. Madam Speaker, I rise today on behalf of the 
thousands of uninsured children in Indianapolis, Indiana.
  In this recession, many of my constituents can no longer afford the 
skyrocketing cost of health care. Without checkups or medication for 
their children, they sit powerless.
  So, I implore those who oppose this bill to think of the uninsured 
children in their congressional districts. Should they be made to 
suffer from rising health care costs and an unstable job market? And 
should your constituents suffer because their children hang between 
Medicaid and private insurance? The answer to both of these questions 
should be an unwavering no.
  There are few opportunities in this body where the right decision is 
so obvious. Support our children by voting yes on SCHIP.
  Mr. SMITH of Texas. Madam Speaker, I oppose this bill for many 
reasons. In my role as the ranking member of the Judiciary Committee I 
want to point out a few immigration provisions that undermine personal 
responsibility and burden American taxpayers.
  In the Personal Responsibility and Work Opportunity Reconciliation 
Act of 1996, Congress, with the overwhelming support of the American 
people, required that legal immigrants wait 5 years after coming to the 
United States before receiving welfare benefits.
  It's only fair that American taxpayers not foot the medical bills of 
foreign nationals who arrive with a sponsor's pledge not to become a 
``public charge.''
  H.R. 2, changes current law and allows immigrants to get medical 
benefits at the expense of U.S. taxpayers.
  Immigrants, both legal and illegal, already have a federally mandated 
right to emergency medical care. That mandate has helped bankrupt 
hospitals all over the United States.
  Federal law requires that the American sponsor of new immigrants sign 
an affidavit of support stating that they will be responsible for any 
public costs incurred by the immigrant. Unfortunately, those affidavits 
have never been enforced and immigrant sponsors know they will not be 
held accountable if the immigrants receive welfare and become public 
charges.
  The 5-year waiting period for immigrants to receive government 
benefits is the last line of defense for the U.S. taxpayer. It should 
not be repealed or altered in any way
  Prior to laws enacted in 1996, the cost of welfare for immigrants had 
jumped to $8 billion a year. The number of noncitizens on Supplemental 
Security Income increased more than 600 percent between 1982 and 1995. 
Both of those numbers will be much higher if H.R. 2 is enacted.
  At a time when government spending is out of control, and when 
States, cities and American citizens are struggling to make ends meet, 
the last thing we need is to change good policy and further burden U.S. 
taxpayers.
  This legislation should be opposed.
  Mr. KLEIN of Florida. Madam Speaker, I rise in strong support of the 
Children's Health Insurance Program Reauthorization Act of 2009. This 
critical legislation will take care of unfinished business from the 
110th Congress by providing health insurance coverage to 11 million 
children along with enacting needed reforms to the CHIP program.
  I applaud Speaker Pelosi for bringing this bill to the floor so 
quickly and President-Elect Obama for calling on Congres to have this 
legislation ready when he takes office. To be frank, this bill can't 
come fast enough for the millions of children without basic healthcare 
coverage and for the low-income families struggling to make ends meet.
  Never in my life has our country been in such a precarious state. Our 
once soaring economy is teetering, with unemployment at 7.2 percent, 
and the traditional pillars of our economy are struggling to stay in 
business. Now more than ever, the government must fill its role by 
helping the most vulnerable in our society meet their basic needs like 
healthcare.
  Madam Speaker, we're not asking my colleagues to take a leap of faith 
on some untested program. Created a decade ago, the State Children's 
Health Insurance Program is a product of true bipartisanship. A 
Republican Congress passed it, and a Democratic President signed it 
into law. And it is not an entitlement program; it is an empowerment 
program that encourages enrollment into private health insurance 
programs and a sliding scale for premiums based on a working family's 
ability to pay.
  In my home State of Florida, CHIP is administered through the Healthy 
Kids Program. During my tenure in the Florida State Senate, I helped 
oversee its implementation while serving on various committees. While 
we ran into some roadblocks with enrollment, I can say that people from 
both parties as well as the business community felt it was an 
innovative way to provide health care coverage to hundreds of thousands 
of low income children in Florida.
  Madam Speaker, passing CHIP legislation today is our first test of 
leadership in the 111th Congress. If we fail--if we fail our children--
then we must ask ourselves what leadership means in a time of crisis 
and whether we deserve the trust of the American people.
  Mrs. CHRISTENSEN. Madam Speaker, I rise today for 11 million 
reasons--the 7 million children whose insurance will continue and the 
more than 4 million other children who will be insured for the first 
time--many of whom are children of color--with the passage of H.R. 2.
  I must commend Chairmen Pallone, Waxman and Dingell--whose steadfast 
efforts to expand health coverage to millions of American Children and 
whose unwillingness to accept mediocrity is why we are here today.
  If we are all having dejavu, it is because we have done this twice 
before. And we are here today not just because of the charm on the 
third try, but because this year we will have a new president who will 
finally sign it into law.
  H.R. 2 will not only make a significant down payment on President 
elect Obama's and our promise to insure all of our country's children, 
it rightfully refuses to leave out children and pregnant women who have 
been legally admitted into our country. Doing this is not only the 
right thing to do it is the least we can do to insure the health of all 
of our children.
  This bill also includes important expansions to the program for 
screening and prevention as well as dental and mental health care, 
addressing child health in a more holistic way
  Because more than half of all uninsured children are racial and 
ethnic minorities, this bill will help to eliminate health disparities 
in this most vulnerable group and improve the outlook for their health 
later in adulthood.
  Today we have the opportunity to reach across the political aisle to 
do the right thing--to make the health and health care needs of our 
nation's children the priority they must be--to make sure that every 
child has the opportunity to reach their fullest potential, so that our 
Nation can too.
  I urge all of my colleagues to vote for H.R. 2--to vote for America's 
children. It is nothing less than a vote for the future of our country.
  Mr. CUELLAR. Madam Speaker, I rise today in strong support of the 
Children's Health Insurance Program.
  Growing up as the son of migrant parents, I was among the millions of 
American children who had no health insurance. When someone in our 
family got sick, seeing a doctor simply wasn't an option.
  I got lucky. Even without health insurance, I grew up into a healthy 
adult. But I could just as easily have ended up going untreated for a 
chronic disease or serious injury, and a lifetime of opportunities 
would have evaporated. It is unacceptable that 1.4 million Texas kids 
continue to bear that risk today.
  When I served in the Texas State House, I had the honor of launching 
the first CHIP program in Texas at Farias Elementary School in Laredo. 
The program later expanded statewide, and today, it has helped millions 
of Texas families--families like the one I grew up with--afford to see 
a doctor.

[[Page 745]]

  In these difficult economic times, as millions of Texas families 
struggle with job losses and pay cuts, CHIP is more important than 
ever. For families living on the financial edge, CHIP is a critical 
source of care, support, and peace of mind.
  Mr. HONDA. Madam Speaker, I rise today in support of H.R. 2, the 
State Children's Health Insurance Program Reauthorization Act of 2009. 
Over the last 2 years, it has become necessary to fund the Children's 
Health Insurance Program in some States through supplemental 
appropriations as program wait-lists grew and children waited for care. 
Now, with the country in the midst of the severest financial crisis in 
decades, parents are more concerned than ever about the health and 
well-being of their children. The bill before us today represents an 
investment in our Nation's safety net; by preserving and expanding the 
program to provide coverage for 11 million children over the next 4\1/
2\ years, the bill alleviates some of the stress placed on men and 
women faced with unemployment.
  My home county of Santa Clara was the first in the Nation to ensure 
that every child with parents at or below 300 percent of the federal 
poverty level has real access to regular health care as a result of 
being insured. The county's Children's Health Initiative raises its own 
money to add to State and Federal funding in order to keep all the 
children of my district healthy--last year, the program enrolled over 
144,000 children and serves as a model for 17 other California 
counties.
  This innovation is threatened by the county's $220 million projected 
budget deficit for fiscal year 2009; and we in Santa Clara County face 
the possibility of deep cuts in our healthcare system totaling nearly 
$100 million. The budget woes of the State of California limit the 
assistance it can provide, and so without this reauthorization of 
SCHIP, the financial burden on the county would be significantly 
heavier. I'm proud to vote today for legislation that will provide our 
program and our county's children with much needed stability for the 
next 4\1/2\ years.
  As the chairman of the Congressional Asian Pacific American Caucus, 
it is particularly gratifying to see the inclusion of a provision in 
this bill that will allow States to waive the 5-year waiting period for 
Medicaid and SCHIP imposed on pregnant women and children who are 
legally present in the United States. It is morally unconscionable that 
pregnant women and innocent children have been made victims of a 
raucous and frequently misleading immigration debate. Hundreds of 
thousands of people from Asian countries immigrated legally to the 
United States in 2007 and 2008; at the very least the children in those 
families deserve to have health insurance and access to care. CAPAC has 
consistently joined with the Congressional Black Caucus and 
Congressional Hispanic Caucus in advocating for protection of this 
vulnerable population and I thank Speaker Pelosi and our other House 
leadership for redressing this injustice.
  The passage of this bill protects the health of millions of American 
children. It is the first step in a long journey toward repairing our 
healthcare system and providing universal coverage, care, and access to 
the people of our Nation, and I look forward to working with my 
colleagues to complete that journey. I urge the Senate to act in as 
swift and responsible manner as we do today and pass this bill.
  Mr. BARTON of Texas. Madam Speaker, as we debate this new SCHIP bill, 
I think it is important to figure out what we know about the bill and 
the undemocratic methods that produced it.
  First, we know that few, if any, Members of Congress actually have 
read the bill. Despite the promises made by Majority Leader Hoyer on 
Friday that we would get at least 48 hours to review the bill, the new, 
285 page SCHIP bill only turned up yesterday at 11:20. The 48 hours 
that Majority Leader Hoyer promised somehow shrank to less than 24 
hours. The Rules Committee met without an official score from the 
Congressional Budget Office. I will stipulate that Members may not 
always read the legislation they vote on, but most of us at least read 
the summaries and analyses that our staff members prepare. And every 
one of us has a right to the time required to know what these bills 
contain.
  That's what the regular legislative process is all about--listening, 
thinking, proposing, thinking some more, amending and debating. 
Implicit in normal process is the notion that all useful ideas may not 
reside exclusively in the minds of the Speaker's assistants.
  And all this careful listening and critical thinking by House Members 
is supposed to happen before we vote. Democrats seem to think that's 
got it backwards. They want to vote first and think later. It's all 
about bills written in private, delivered at night, and ramrodded 
through here with the blink of an eye. Now, I recognize that a strong 
majority can do things that way, and Republicans aren't without sin. 
But when secrecy and arrogance are combined with perfect efficiency, 
the country always seems to pay a heavy price.
  On this bill especially, I've been treated better by used car 
salesmen. They didn't want me looking too closely at their products, 
but they didn't dump a wreck on my front lawn after sundown and tell me 
I had to buy it or else. The Democrats don't want anyone to inspect 
their product, either, and maybe that's because it has the qualities of 
a used Edsel.
  There has been no process, much less any fair process. Evidently 
changes have been made to the bill from 2 years ago, but what are they? 
There have still been no committee markups on any SCHIP legislation and 
no legislative hearings. And I can't find evidence that a single one of 
the numerous suggested improvements to past SCHIP bills has been 
incorporated into this one. The majority is interested in what it wants 
and nothing else.
  We also know, Madam Speaker, that today is largely a political 
exercise. The Senate is actually going to have a real markup in the 
Senate Finance Committee. I'll say that again to make sure my friends 
on the other side of the aisle heard what I said: The Senate is 
actually going to put their SCHIP bill through the full committee 
process, including considering ideas from people not on the Democrat 
leadership staff.
  It's possible to legislate the right way, and it's pitiful that the 
people's House is reduced to taking lessons in democracy from our 
friends in the Senate.
  Over here, the tricks don't stop with tactics. Every Member of this 
body understands that they will be vilified if they don't fall in line 
and support this bill. If you don't vote for the Democrats' SCHIP bill, 
your constituents will be told that you hate kids. Your people will be 
told that the only way to ensure that kids get health care is by 
supporting the bill produced by the Democrat leadership without a 
whisper of a complaint. They want the people to believe that there are 
no other ideas and no other options.
  Well, Madam Speaker, I want to make clear to the American people that 
my Republican colleagues and I do want to reauthorize the SCHIP 
program. We have repeatedly reached out to the Democrats and have asked 
for a chance to sit down with them and work on a compromise that can 
become law. Last year, we heard many impassioned speeches about how 
important it was to override the President's veto of the Democrats' 
bills, but after these votes those same people were literally 
applauding when the veto was not overridden. That's right, Madam 
Speaker, there were Democrats applauding on the floor of the House when 
the bill they supported was rejected. That's more than partisan 
politics, that is cynicism and deception at their ugliest.
  Madam Speaker, when the Democrats stop making this about political 
advantage at the expense of low-income children, and decide to actually 
produce a serious, passable SCHIP program, I am still ready to work 
with them.
  As it stands now, I urge all Members to reject this cynical ploy and 
vote ``no'' on this deeply flawed and highly partisan bill.
  Mr. KUCINICH. Madam Speaker, I rise in strong support of H.R. 2, 
which will provide health care for 4 million previously uninsured 
children. In Ohio, it will make the difference for up to 50,000 kids.
  Ohio has had to suspend its efforts to expand eligibility to children 
because of tight State budgets. At the same time, the number of 
eligible children is growing rapidly as more parents lose their jobs or 
simply watch the premiums of private health insurance companies 
skyrocket beyond their means. This bill is needed more than ever.
  The bill also includes mental health parity as well as dental 
coverage. Dental coverage is a topic I explored in the Domestic Policy 
Subcommittee of the Oversight and Government Reform Committee in a 7-
month investigation into the death of 12-year-old Deamonte Driver. He 
died of a brain infection caused by tooth decay.
  Finally, the bill allows states the option to cover children born 
outside the U.S. but now here legally. This provision will not only 
give these children the health care they deserve but will also save 
States money by allowing them to move routine care from the emergency 
room to the doctors office where it belongs. I fought for this 
provision in a previous version of this bill when it was excluded. I am 
glad to see that it has been retained this time and look forward to its 
passage.
  Every child has a right to health care. This bill is a step in the 
right direction.
  I urge my colleagues to pass the SCHIP reauthorization.
  Mrs. CAPPS. Madam Speaker, I rise in strong support of this 
legislation to strengthen

[[Page 746]]

SCHIP and in strong support of America's children.
  As a former school nurse, I consider it a crime that there are 
children in America who cannot access all of the healthcare services 
they need.
  And today we have an opportunity to fix this injustice.
  The excellent bill we have before us will ensure that millions of 
children in working families can get the proper preventive and primary 
care they need to ensure a healthy childhood.
  I am also pleased to see that this bill preserves State options to 
cover pregnant women.
  After all, the health of a mother is the greatest contributor to a 
child's health.
  The current economic climate only adds to the urgency of this 
legislation.
  States are experiencing budget shortfalls which threaten the status 
of children already enrolled in SCHIP.
  And as parents lose their jobs; their health coverage is lost, too.
  So I hope every one of my colleagues will join me in voting ``yes'' 
on this bill today and secure a better future for the health of our 
children and grandchildren.
  Ms. HIRONO. Madam Speaker, I rise today in strong support of H.R. 2, 
the Children's Health Insurance Program (CHIP) Reauthorization Act of 
2009.
  I believe our Nation must show true compassion for the most 
vulnerable among us, and CHIP is a program that helps millions of low-
income American children to receive health care so they can grow up in 
good health.
  Since its creation in 1997, CHIP has been successful in providing 
vital health care coverage for children in families who cannot afford 
private insurance yet earn too much to qualify for Medicaid. There are 
now 6.6 million children enrolled in the program, which includes 20,000 
keiki (children) from my home State of Hawaii.
  Regrettably twice in 110th Congress, President George W. Bush vetoed 
bipartisan bills that would have reauthorized and improved CHIP in 
order to provide secure health coverage for millions of uninsured 
children in working families. These vetoes were made despite the fact 
that the bills had passed in both the House and Senate with strong 
bipartisan majorities. As a result of these vetoes, Congress was only 
able to provide a short-term extension of CHIP, through March of 2009, 
but was not able to enact program improvements to help States reach 
additional uninsured children.
  The bill before us today is based on the two previously vetoed 
bipartisan bills. It also offers the 111th Congress the opportunity to 
right the wrongs of the out-going administration. President-elect Obama 
has previously expressed strong support for CHIP because it provides a 
much-needed down-payment on children's health. By extending health 
coverage to millions more children, this legislation is an important 
first step in stemming the rising tide of the uninsured.
  I urge my colleagues to join me and vote in support of this bill and 
of the health and well-being of children most in need of our help.
  Ms. TSONGAS. Madam Speaker, today, I rise in support of legislation 
we will be considering today to expand the Children's Health Insurance 
Program.
  This bill provides coverage to children whose families cannot afford 
private insurance, and would expand access to health insurance for 
millions of children nationally--over 200,000 living in Massachusetts.
  I first voted to override the President Bush's veto of similar 
legislation on the day I was sworn into office. It was my first vote 
and one of which I am enormously proud. Tens of thousands of people 
from my District, and millions more across the country, both 
Republicans and Democrats, have made their support for this program 
resoundingly clear.
  This program is also important to my State of Massachusetts, where 
the program was first developed, because it is a critical component of 
the groundbreaking universal Massachusetts Health Care Plan.
  Today, I stand with a strong bipartisan majority ready to give our 
Nation's children a chance at a healthy childhood and I urge my 
colleagues to do the same.
  Mr. SIRES. Madam Speaker, I rise today to speak about the State 
Children's Health Insurance Program or SCHIP. This is a successful, 
popular, bipartisan program that currently provides private health care 
coverage for more than 6 million children who would otherwise go 
without care. I am very proud to stand here today and say I will vote 
for a bill that provides health care to children in need, and that 
President-elect Obama said he would sign into law.
  Our action could not come at a better time. With rising unemployment, 
many families can no longer afford their health insurance. This bill 
brings them needed relief. Now parents can find comfort knowing their 
children will have access to health care while they look for a new job. 
This is particularly important in my home State of New Jersey. 
FamilyCare in New Jersey serves 122,000 children every year, a small 
percentage of which come from families with incomes up to 350 percent 
of the poverty line. It is expensive to live in my State, and even 
these families need help getting by. I am happy that this bill 
maintains the State's right to serve these families.
  Today we get to make a real impact on the lives of many struggling 
families. I am proud to support H.R. 2, the SCHIP Reauthorization Act 
of 2009.
  Mr. BARTON of Texas. Madam Speaker, I rise today to discuss an 
unrelated issue that has been neatly tucked into this bill. The issue 
is timely access to quality hospital care in our Nation's communities.
  The Majority says we don't need any regular legislative process with 
this bill because everyone knows what's in it. Well, my staff received 
this 285-page bill at 11:20 a.m. yesterday. Even with full knowledge of 
what went into previous versions of this legislation, it isn't 
reasonable to expect that people will be able to gain a good 
understanding of the new bill with that sort of time constraint. I 
would also note that since the last time the House voted on an SCHIP 
bill, we've added more than 60 new Members.
  This is politics as usual, and it should give every new Member great 
pause before voting for this bill, or any bill. I don't believe that 
any of our new Members comes from a background where they were expected 
to approve a major policy on the basis of the idea that, well, it's 
been here before, so we don't need to read it or understand it. In 
fact, didn't most of us run against that sort of deceptive politics in 
Washington?
  I want to point out to the new Members that your vote today could 
also cause hospitals in your district to close. Hospitals that are 
under construction now and intended to serve your constituents soon may 
never see a patient. And why will that happen? Because a few Members of 
your conference with clout believe physicians in your communities 
shouldn't own hospitals. They say that the people who care for and 
about their communities, who have a personal stake in the care that is 
delivered, those people should not be trusted.
  We have had no hearings on the issue of physician ownership of 
hospitals in the last two Congresses. The Health Subcommittee did have 
one hearing last year to discuss health disparities and we heard from a 
physician from Louisiana. His story illustrates what can happen when 
physicians are able to help their communities. After Katrina, hospitals 
were closing and residents couldn't get care. The doctors in these 
communities made a difference by coming together to make sure people 
could continue to receive health care. Why on earth would we want to 
eliminate people's ability to serve their community?
  Why are the opponents of physician-owned hospitals so antagonistic? 
I'm not sure, because these hospitals provide higher quality care at 
lower costs than other hospitals. They have higher patient satisfaction 
rates and don't experience workforce shortages like other hospitals do.
  I offered an amendment along with Congressman Johnson and Dr. Burgess 
to strike the section that was written to eliminate physician-owned 
hospitals. Unfortunately, the Rules Committee rejected that idea. 
Congressman Boren and Congresswoman Jackson-Lee proposed a very fair 
amendment that would have delayed the implementation of Section 623 to 
July 1, 2010, so hospitals that are currently under construction could 
finish being completed and serve patients. That amendment also was 
rejected.
  Last week, the House changed the rules on motions to recommit stating 
we could continue to have the committee and amendment process to voice 
our concerns. Madam Speaker, this has had neither, and it is a shame 
because the provision of quality hospital care is too important to be 
eliminated due to some philosophical bent of a couple of your senior 
Members.
  New Members, this is an early to important test: do you vote your 
district or do you vote your leadership? Do you vote your hospitals or 
do you vote for a policy that was concocted in private in Washington.
  Madam Speaker, in 1997, the Republican Congress enacted the State 
Children's Health Insurance Program to help children's families near 
poverty. But now, true to their big government agenda, the Democrat 
Congress wants to send the President-elect a massive increase in the 
SCHIP Program that will usher in a new era of socialized medicine in 
America.

[[Page 747]]

  This bill will take a program designed to help children near the 
poverty level and expand it to include families with incomes of up to 
$84,000 a year.
  And Democrats will pay for this middle class entitlement with a 61 
cent--$1 per pack tax increase on cigarettes.
  Let's provide health insurance for children of the poor, but let's 
reject a liberal Democratic Congress attempt to create middle class 
entitlements on the backs of American smokers.
  Since Congress has already reauthorized and fully funded SCHIP 
through March 31, 2009, we should work in a bipartisan manner to 
thoughtfully develop a longer-term reauthorization of the State 
Children's Health Insurance Program.
  While I have been pleased to support SCHIP in the past, and continue 
to support its original intention to cover needy children who do not 
qualify for Medicaid, the bill being considered today hardly resembles 
the bipartisan compromise reached in 1997.
  My Republican colleagues and I are eager to work with Democrats--as 
we did more than 10 years ago--to ensure that needy children receive 
health care coverage. As the program expands, health care for needy 
children is jeopardized. Republicans will work tirelessly to see that 
every currently eligible child is covered first and that taxes are not 
raised on the poorest among us.
  The Democrats' SCHIP bill spends billions of dollars to substitute 
private health insurance coverage with government-run healthcare 
coverage. The Democrats' SCHIP bill taxes the poor to benefit the 
middle class. The bill uses the funding gained from taxing the poor to 
pay for expanding SCHIP eligibility to higher-income families. The 
Democrats' SCHIP bill focuses on enrolling higher-income kids instead 
of low-income, uninsured kids. The Democrats' SCHIP bill enables 
illegal aliens to fraudulently enroll in Medicaid and SCHIP.
  Short of finding at least 22.4 million new smokers (the number 
required to adequately fund SCHIP) Democrats will be forced to either 
kick millions of children off of health insurance or raise taxes on all 
of us by tens of billions of dollars.
  It is irresponsible to fund a children's health program, particularly 
one targeted at vulnerable children, with a declining revenue stream.
  The revenue to fund this expansion will soon disappear, causing all 
of us to pay more in taxes.
  The percentage of Americans who smoke has been dropping for decades. 
And research and logic both show that raising the prices of cigarettes 
will lead to less smoking, and therefore less revenue.
  The Democrat expansion of SCHIP takes money from taxpayers in States 
like Indiana to pay for middle class children in wealthier States.
  I oppose this legislation and urge my colleagues to do the same.
  Mr. LARSON of Connecticut. Madam Speaker, I rise today in support of 
the reauthorization of SCHIP, an important piece of legislation that 
has become even more necessary now than it was when we started working 
on it 2 years ago. I commend my colleagues, Congressman Pallone, 
Congressman Waxman, the dean of the House, Congressman John Dingell, 
Congressman Rangel, Congressman Stark, and many others for their 
tireless efforts on this bill.
  Madam Speaker, by passing this bill today we will provide health care 
for 11 million children. This is not just a bipartisan achievement, it 
is the right thing to do.
  With the economic downturn and some of the worst unemployment numbers 
we've seen in decades, rising health insurance costs are making it 
increasingly difficult for families to afford health care for their 
children. States faced with the constitutional responsibility of 
balancing their budgets have been cutting programs that provide 
children with access to health care. Some states have already cut 
thousands of children from their CHIP programs and more States are 
considering drastic action. By reauthorizing SCHIP, we will enable 
States to prevent the loss in health coverage for many of these 
children and allow more uninsured families to participate in the 
program. In Connecticut alone this legislation will mean thousands of 
our 43,000 uninsured children will now be covered.
  One story that has been brought to my attention is the story of the 
Farr family in Manchester, CT. Joseph and Danielle Farr are in their 
early thirties. They are hardworking citizens who have a young child 
soon to turn 1. They have a household income that is just $15 above 
Medicaid. But they qualify for SCHIP, which they call a ``godsend'' for 
their family.
  The Farrs just learned that Joe is likely to be laid off from his job 
in March--a story familiar to many Americans. But, thanks to SCHIP, 
their son will continue to get the health care he needs. By 
reauthorizing SCHIP we will make sure that families like the Farrs will 
continue to have health care for their child even if they do fall 
victim to the economic downturn.
  This bill will increase outreach efforts targeted at children 
currently eligible but not enrolled in the program and also give 
pregnant women access to health care through SCHIP. While we still have 
many more miles to travel on the road to fulfilling the promise of 
health care reform, this, Madam Speaker, is a down-payment on that 
effort. I am proud to support this legislation and urge my colleagues 
to stand with us, to stand with our children, and pass this bill.
  Ms. LEE of California. Madam Speaker, I rise in strong support of 
H.R. 2, the State Children's Health Insurance Program (SCHIP) 
Reauthorization bill.
  I want to thank Chairman Waxman and Chairman Pallone and all the 
staff for their work in ensuring that this bill moves forward as one of 
our highest priorities in the 111th Congress.
  Today we will take the long overdue step to expand health insurance 
coverage to over 11 million children throughout the country.
  As our Nation remains mired in the depths of the worst economic 
crisis since the Great Depression, the action we take now could not be 
more important or more necessary.
  The fact is that the economic policies of the outgoing administration 
have left our Nation in worse shape than we were 8 years ago.
  Today, more people are living in poverty, more people are living 
without health insurance, and more people are unemployed than they were 
8 years ago.
  As always, it is the most vulnerable, the children, who suffer the 
greatest during tough economic times like these.
  Passage of the SCHIP legislation today will at least help to make 
life a little easier for 4 million more children who will receive 
health coverage under this expanded program.
  Although I strongly support this legislation, I believe it can still 
be improved, most immediately by removing the citizenship verification 
requirements that remain in this bill.
  Ultimately we must move our Nation towards a universal health care 
system to cover all children and all Americans. Nonetheless this bill 
is an important step forward.
  Madam Speaker, the Nation's children have waited far too long for 
this moment. I urge my colleagues to pass this bill.
  Ms. JACKSON-LEE of Texas. Madam Speaker, I rise today in strong 
support for the ``Children's Health Insurance Program Reauthorization 
Act of 2009.'' We stand today, closer to helping 4 million children 
without health insurance. No longer will these children be forced to 
live with fear of getting sick.
  Today is a great day. Today we can bring 4 million children into the 
fold. Today we can tell those 4 million children that are begging for 
help that Yes We Can!


                        NATIONALLY AND IN TEXAS

  There are an estimated 8.9 million uninsured children in America. 
Overall, about 11.3 percent of children in the United States are 
uninsured, but the percentage of uninsured children in each State 
varies widely. Based on a 3-year average, there were an estimated 20.9 
percent of uninsured children (under 19 years of age) in the Texas, 
representing 1,454,000 of the State's children.
  According to the Institute of Medicine, uninsured people are less 
likely to use preventive services and receive regular care. They are 
also more likely to delay care, resulting in poorer health and 
outcomes. Texas has the highest uninsured rates of all 50 States and 
the District of Columbia (2005-2007). Almost one-quarter, 24.4 percent, 
of Texans are uninsured compared to 15.3 percent of the general U.S. 
population.
  Data show that virtually all the net reduction in SCHIP enrollment 
has been among children in families with incomes below 150 percent FPL. 
The number of below-poverty children has dropped by more than 68 
percent, and the number of children between 101-150 percent FPL has 
dropped by more than one-third since September 2003. I want to share 
with you just some of the scary health statistics that are affecting 
children:
  74 percent of uninsured children eligible for SCHIP or Medicaid but 
not enrolled.
  11 percent of uninsured children in families not eligible for 
Medicaid or SCHIP with incomes below.
  15 percent of uninsured children in families with incomes over 300 
percent of the Federal poverty level who are ineligible for Medicaid 
and SCHIP.
  90 percent of uninsured children that come from families where at 
least one parent works.
  50 percent of two-parent families of uninsured children in which both 
parents work.
  3.4 million uninsured children who are white, non-Hispanic.

[[Page 748]]

  1.6 million uninsured children who are African American.
  3.3 million uninsured children who are Hispanic.
  670,000 uninsured children of other racial and ethnic backgrounds.
  In the great State of Texas, there is a young man named Jason who had 
SCHIP health insurance for years, and the coverage was life saving.
  When he was in a car accident over a year ago, SCHIP covered his 
treatment and all the medical bills. His family needs SCHIP because 
they cannot afford private health coverage. The parents work hard, but 
the father's employment in pest control is seasonal and provides only 
about $35,000 annually. Jason's mother is wheelchair-bound with 
multiple sclerosis and has significant health care expenses.
  When Jason lost SCHIP a year ago, his mother suspected they had been 
denied because of the 2003 Ford truck the family purchased so that she 
could transport her wheelchair. Prior to last year, she had never had 
problems renewing coverage, and the family's income had not change. But 
the income guidelines had changed.
  New SCHIP guidelines that took effect in December 2005 do not count 
children over 18 years of age as family members. Although their full-
time student daughter lives at home, she is not counted as part of the 
family, and, as a result, they are about $50 a month above the income 
limit for a family of three. So now the entire family is uninsured. 
This lack of coverage means that when Jason gets sick or hurt, they 
have to delay paying other bills to pay for medical care.
  Lack of coverage also has affected Jason's performance in school. He 
has been sick quite a bit in the past few years with allergies and has 
missed many days of school because his eyes become swollen and he is 
unable to breathe. School officials had reprimanded the mother about 
his absences but now realize that Jason has some serious health issues. 
Finally we will be able to help people like Jason and assuage his 
mothers concerns. We are able to insure those who need it most.


                       PHYSICIAN-OWNED HOSPITALS

  Sadly, there is one portion of this bill I did have some trouble 
with, the restrictions on physician-owned hospitals. Yesterday, my dear 
friend from Oklahoma, Congressman Boren, and I were able to voice a 
very real concern that we had with the prohibition on physician-owned 
hospitals.
  As the bill was originally written there was a provision in the bill 
that would have drastically affected the quality of care available to 
Houston residents and people in urban communities across the entire 
country.


                         JACKSON-LEE AMENDMENT

  Yesterday, I put forth an amendment that would have exempted General 
Acute Care Full Service Physician-Owned Hospitals from section 1877 of 
the Social Security Act, as added by section 623 in SCHIP. There is no 
direct evidence that demonstrates that overutilization of services and 
improper self-referrals are in any more excess at General Acute Care 
Full Service Physician-Owned Hospitals.
  My amendment would have exempted responsible and efficient physician-
owned hospitals to develop, purchase, sell, and/or transfer their 
interests.


                      BOREN/JACKSON-LEE AMENDMENT

  My amendment with Congressman Boren would have provided an extension 
for the January 1, 2009 grandfather clause for physician-owned 
hospitals to allow physician-owned hospitals currently under 
construction to be completed.
  At least 85 hospitals across the Nation have been affected. Boren/
Jackson-Lee does not differentiate between General Acute Care, Full 
Service, and Specialty Hospitals.
  The exceptions that exist to grandfather in certain physician owned 
hospitals are inadequate and will affect more than 85 hospitals that 
are currently in development and under construction. It will also 
restrict sales and transfers of many responsible physician-owned 
hospitals.
  In my district of Houston, TX the population has grown close to 4.5 
million people, and there are only approximately 16,000 beds available 
in the city. Eliminating physician ownership in general acute care 
hospitals would only contribute to this ever growing problem.
  While many specialty hospitals are accused of turning away uninsured 
and Medicaid patients and practicing only profitable healthcare, 
responsible physician-owned hospitals do just the opposite.
  Physician-owned hospitals like St. Joseph Medical Center in my 
district provide essential emergency, maternity, and psychiatric care 
for their patients. They delivered over 6,000 babies in 2008, of which 
3,700 were insured by Medicaid. Currently they provide $14M in 
uninsured care in the Houston market. A Houston institution for 120 
years, St. Joseph Medical Center is also a major provider of 
psychiatric beds as it currently operates 102 of the 800 licensed beds 
in Houston.
  While Members of the Texas delegation have continued to support 
general acute-care hospitals and their future development; we still 
believe that general acute-care hospitals still need to be able to:
  Maintain a minimum number of physicians available at all times to 
provide service;
  Provide a significant amount of charity care;
  Treat at least 1/6 of its outpatient visits for emergency medical 
conditions on an urgent basis without requiring a previously scheduled 
appointment;
  Maintain at least ten full time interns or residents-in-training in a 
teaching program;
  Advertise or present themselves to the public as a place which 
provides emergency care;
  Serve as a disproportionate share provider, serving a low income 
community with a disproportionate share of low income patients; and
  Have at least 90 hospital beds available to patients.
  This issue is of the utmost importance to me because I, like others 
in the Democratic Caucus, have hospitals and hospital systems such as 
University Hospital Systems of Houston in my district that would have 
been greatly affected by this provision.


                       ST. JOSEPH MEDICAL CENTER

  In 2006, St. Joseph Medical Center, downtown Houston's first and only 
teaching hospital, was on the verge of closing its doors. When I 
learned that they were going to shut down this hospital and turn it 
into high-end condominiums, I personally worked with the hospital 
board, community leaders, and local government to ensure this did not 
take place. Eventually, after I was assured that it would be 
responsibly managed and its doors would remain open, I was able to help 
a hospital corporation, in partnership with physicians, which has 
purchased the hospital and has made it the premier hospital in the 
region to keep open St. Joseph's doors including its qualified 
emergency room responsive to a heavily populated downtown Houston.
  This formerly troubled medical center is now in the process of 
reopening Houston Heights Hospital, the fourth oldest acute care 
hospital in Houston. Without language that specifically addresses this 
distinction, this project too will come to an end.
  Sadly, it remains unclear if CHIP provides for physician-owned 
hospitals to still be considered grandfathered if have a sale or 
transfer at the same ownership rate or at a different physician-
ownership rate.
  Between December 2007 and December 2008, the U.S. economy shed about 
2.6 million jobs, while Texas made significant gains. Texas' nonfarm 
employment registered a stable 2.1 percent growth rate over the year, 
even as the Nation's job losses reached their worst level since 2003. 
CBO forecasts the following:
  A marked contraction in the U.S. economy in calendar year 2009, with 
real (inflation adjusted) gross domestic product (GDP) falling by 2.2 
percent;
  A slow recovery in 2010, with real GDP growing by only 1.5 percent;
  An unemployment rate that will exceed 9 percent early in 2010.
  The U.S. Bureau of Labor Statistics announced on November 21, 2009, 
that October's unemployment rate was 6.5 percent, a jump of 0.4 
percent, which was double what most economists expected and its highest 
level in 14 years. The economy has now lost 1.2 million jobs since the 
beginning of the year, with nearly half of those losses occurring in 
the last 3 months alone, pointing to acceleration in the pace of 
erosion in labor markets. It is more important than ever in this 
economy that children's health care is not sacrificed.
  Madam Speaker, my faith is renewed in the process that is so often 
maligned in the media. Thoughtful and deliberate actions were taken to 
improve this legislation that would not only help the children of my 
district and many others across the nation, but also it was able to 
address concerns that many of us, myself included have on these 
specialty hospitals.
  I look forward to a day when every child is covered and can play on 
football fields and jungle gyms without their parents fearing a 
bankrupting injury to their child. This legislation is piece of mind to 
4 million families, and I will joyfully cast my vote for passage of 
this important legislation.
  Mr. LEVIN. Madam Speaker, some of the issues we debate in Congress 
are complicated. This one is quite simple. Americans want the children 
of this country covered by health insurance.
  The State Children's Health Insurance Program currently covers about 
7 million children,

[[Page 749]]

including 114,000 kids in my home State of Michigan. However, there are 
still about 9 million children in our country who are uninsured. This 
is unconscionable. No mother should have to worry about whether she can 
pay for the health care her child needs. No father should have to take 
his son to the emergency room because he does not have insurance to 
visit a primary care doctor. No society should allow a child to go 
without the security health insurance provides.
  Congress passed two SCHIP bills last session. Both pieces of 
legislation were bipartisan, and both cleared the House and Senate with 
large majorities. Unfortunately, President Bush vetoed these bills.
  As economic conditions have worsened over the course of the last year 
and more and more children have lost health insurance, this bill has 
become even more vital to ensuring that children do not fall through 
the cracks of our current health care system. The legislation under 
consideration today would extend coverage to another 4 million low-
income children. It is an important step toward the goal of ensuring 
that all Americans, especially children, have the quality and 
affordable health care they need.
  President-elect Obama strongly supports this SCHIP legislation. I can 
think of no better beginning to the next 4 years than to send the new 
President this critical investment in children's health. I urge my 
colleagues to vote for passage of H.R. 2, the Children's Health 
Insurance Program Reauthorization Act of 2009.
  Mr. POSEY. Mr. Speaker, I rise to express both my support for the 
State Children's Health Insurance Program, SCHIP, and my reservations 
about the particular SCHIP bill, H.R. 2, that is before us today. I 
would also add that I am pleased to support an alternative version that 
will be offered as a substitute today. This alternative focuses SCHIP 
on low income children and addresses the problems with the underlying 
bill.
  Our nation faces very serious financial challenges. The Congressional 
Budget Office, CBO, projects that this year's Federal budget deficit 
will be nearly $1.2 trillion dollars. In other words one out of every 
three dollars that the Federal Government will spend this year will be 
borrowed from future generations. Given that our children and 
grandchildren will have to pay back everything that this generation 
borrows, we must give the greatest scrutiny to each and every dollar 
that is spent.
  I am committed to working to assist lower-income children who lack 
insurance. SCHIP was established as a bipartisan program to insure 
children in families too poor to pay for insurance but not poor enough 
to qualify for Medicaid. If that was what the bill before us did, I 
would be voting for it. Unfortunately, H.R. 2 goes well beyond focusing 
specifically on these children.
  H.R. 2 expands SCHIP to extend taxpayer subsidies to the children of 
those living in, for example, New Jersey and making more than $80,000 
per year, 400 percent of the poverty level.
  The CBO estimates that 2.4 million of the new enrollees in SCHIP will 
be children who simply dropped private coverage to enroll in SCHIP. 
Given our massive Federal deficit, does it make sense to borrow money 
from our children and grandchildren in order to enroll in SCHIP 
children who currently have other private insurance?
  H.R. 2 continues to allow states to enroll single adults in SCHIP. 
Over 600,000 are enrolled in the SCHIP program and three states have 
more adults enrolled in SCHIP than children. This is particularly 
troubling given that in many states with large numbers of adults 
enrolled in SCHIP, many qualified children remain uninsured. This is a 
misappropriation of limited resources and children should not have to 
sit on the sidelines while able-bodied adults take their benefits.
  H.R. 2 also repeals safeguards that were put in place to ensure that 
illegal immigrants were not enrolled in taxpayer subsidized SCHIP. 
Removing these safeguards will actually encourage illegal immigration 
by offering taxpayer funded benefits to people who bypass our laws and 
enter the U.S. illegally. In a sense, it gives foreign nationals an 
incentive to break our immigration laws.
  Finally, in an admission by the sponsors of H.R. 2 that the bill is 
unaffordable, the bill assumes that millions of children will be 
dropped from the SCHIP program in 2013 in order to meet the technical 
requirements of Federal budget rules. Does anyone really believe that 
the Congress would kick millions of people out of SCHIP in 2013? It's 
time for this Congress to be honest with the American people and this 
bill does not meet that test. By employing this budget gimmick, the 
sponsors of H.R. 2 are admitting that the bill is unaffordable.
  I am fully supportive of legislation that would focus on ensuring 
that lower income children are able to enroll in SCHIP. This bill falls 
far short of that goal.
  In conclusion let me say that we have until March 31 to reauthorize 
SCHIP. Congress should use that time wisely to further examine the 
effectiveness of this program to date and address these shortcomings. I 
am disappointed that this 286-page bill is being rushed to the House 
floor under a closed process that denies Members of the House the 
opportunity to have an up or down vote on amendments that would address 
these concerns. I believe that America's children deserve better.
  Mr. ABERCROMBIE. Madam Speaker, I rise today to address an issue 
raised by my colleagues regarding Hawaii's Keiki Care program as a 
reason not to expand SCHIP. It was suggested earlier today that the 
Keiki (meaning ``child'') Care program was cancelled due to perceived 
crowd-out, a situation where parents drop their children's private 
insurance in order to enroll into a free government program.
  I have supported the State Legislature's efforts to expand health 
care coverage for children and followed the implementation of Keiki 
Care closely. The statements made about a crowd-out problem leading to 
the program's demise were baseless. The Keiki Care program had no 
problems with crowd-out. First of all, it was intentionally designed to 
prevent such behavior in requiring that children who wish to enroll 
must be uninsured continuously for 6 months. Secondly, if parents were 
indeed hoping to drop their insurance and wait 6 months to enroll, then 
Keiki Care would have seen a spike in enrollment. Blue Cross Blue 
Shield Hawaii, the health insurance provider for Keiki Care, did not 
see any spikes in enrollment and have no evidence to believe crowd-out 
occurred.
  Furthermore, there was little incentive for parents to switch to the 
Keiki Care program from any private health plan. The health insurance 
plan offered under Keiki Care was basic preventative care. This means 
that parents would have had to pay for expanded care costs out of 
pocket. In looking closer at the Keiki Care program, it is evident that 
a parent with a full coverage plan for their child would have no 
incentive to drop a private insurance for this basic, prevention-
centered plan.
  The State Administration has given various explanations regarding the 
decision to end Keiki Care, including a growing budget deficit. 
However, the facts about the program are clear. There was never a 
problem regarding crowd-out and if continued, the program would have 
helped to cover more of Hawaii's uninsured children. Therefore, Madam 
Speaker, it is my hope that by clarifying the details regarding Keiki 
Care, it will no longer be used as a rationale that has no basis in 
fact against SCHIP or other efforts to expand health insurance to 
children and the uninsured.
  Mr. BACA. Madam Speaker, I rise today in strong support of H.R. 2, to 
extend and improve the Children's Health Insurance Program.
  Families in my district in San Bernardino, California, are struggling 
to make ends meet and bring food to the table.
  Congress must answer to these and other families across America.
  SCHIP is a vital component of our country's health system, allowing 
for individual states to take care of our most vulnerable, America's 
children.
  A facility in my district, the Community Hospital of San Bernardino 
is about to rip apart at the seams.
  Without SCHIP, they will either have to turn away or eat the cost of 
4,000 families enrolled in Healthy Families, California's version of 
SCHIP.
  If SCHIP is not reauthorized, these alarming figures will jump even 
higher, further jeopardizing their ability to provide care for our 
community.
  This problem is even worse when you consider the impact of the 
recession, and the growing number of unemployed and without health 
insurance.
  I urge my colleagues to help these families, do the responsible thing 
and vote for SCHIP.
  Mr. DINGELL. Madam Speaker, I stand in strong support of H.R. 2, the 
Children's Health Insurance Program, CHIP, Reauthorization Act of 2009.
  In 1997, a Republican Congress and Democratic President passed a 
landmark program to reach children who had fallen through the cracks of 
our healthcare system. These kids weren't poor enough to qualify for 
Medicaid, and their parents--most of whom worked--couldn't afford 
health insurance. The CHIP program has proven to be a major success--
covering more than 7 million children who otherwise would not have 
health coverage.
  Last year, my colleagues and I tried, on two occasions, to 
reauthorize this program and expand it to provide care for many more 
kids in

[[Page 750]]

need of its services. Unfortunately, President Bush stood in our way--
not once, but twice. I am confident President-elect Obama has his 
priorities straight and will do what President Bush refused to do--
provide much needed health care for our nation's children.
  The current economic crisis increases the importance of the CHIP 
program. More than 1 million children have lost their health coverage 
because their parents were laid off and lost their employer-based 
coverage over the past year.
  This is especially true in Michigan, which has over 150,000 children 
uninsured. While Michigan has one of the lowest rates of uninsured 
children in the country, I fear that the number of uninsured will 
worsen as Michigan's unemployment rate continues to increase. Recent 
reports suggest that Michigan's unemployment rate will reach 11.3 
percent by the end of the year.
  H.R. 2 is critical in this regard because it not only will continue 
to provide coverage for the 7 million kids already participating in the 
CHIP program, but will extend health care to 4 million more.
  H.R. 2 is for every child out there who needs a vaccination, a cavity 
filled, chemotherapy, insulin, antidepressants and more life sustaining 
health care.
  This bill is a great first step as we begin our work to reform the 
nation's health care system and provide health coverage for 47 million 
uninsured Americans. I look forward to working with my colleagues, 
Senator Daschle, and President-elect Obama to continue the work. We 
will not stop until all Americans have access to quality, affordable 
healthcare.
  I encourage all of my colleagues to vote for the children in your 
district, and for all of America's children. Vote for H.R. 2, the 
Children's Health Insurance Program, CHIP, Reauthorization Act of 2009.
  Mr. LANGEVIN. Madam Speaker, I rise today in strong support of H.R. 
2, the Children's Health Insurance Program Reauthorization Act. This 
legislation represents a crucial and long overdue investment in the 
health and wellbeing of our nation's most valuable assets--our 
children.
  Since 1997, the State Children's Health Insurance Program (SCHIP) has 
successfully provided health coverage to millions of low income 
children across the country who would not otherwise be able to access 
these services. I have been especially proud of the Rite Care program 
in my home state of Rhode Island, which covered approximately 24,000 
children last year under both the SCHIP and Medicaid programs. However, 
too many children and their families remain without access to proper 
health services. We must reaffirm our commitment at the federal level 
to ensure states have the means to address the health care needs of our 
constituents, particularly in the midst of an economic crisis that has 
resulted in dramatic increases in unemployment levels.
  H.R. 2 will ensure health coverage for a total of 11 million American 
children by reauthorizing SCHIP for four and a half years and extending 
coverage to an additional 4 million uninsured children who are 
currently eligible for, but not enrolled in, SCHIP and Medicaid. Two-
thirds of uninsured children are eligible for coverage through SCHIP 
and Medicaid, but better outreach and adequate funding are needed to 
identify and enroll them. This bill provides $100 million in grants for 
new outreach activities to states, local governments, schools, 
community-based organizations and other safety-net providers. It also 
improves SCHIP by ensuring dental coverage for children, mental health 
services on par with medical and surgical benefits, as well as improved 
access to private coverage options through premium assistance 
subsidies.
  Finally, H.R. 2 reauthorizes and improves SCHIP without adding to our 
ballooning federal deficit. Since the cost of the bill is completely 
offset, it will allow us to make a much-needed investment in the health 
of our children without requiring them to pay for it in the future.
  As many of my colleagues know, universal access to health care has 
been a top priority of mine throughout my tenure in Congress. I can 
think of no better place to start than by guaranteeing that children 
across the country receive the health care services they both require 
and deserve. I, therefore, urge all of my colleagues to support passage 
of this measure.
  Ms. McCOLLUM. Madam Speaker, I rise today to express my strong 
support for the Children's Health Insurance Program Reauthorization Act 
of 2009 which will provide health care coverage for an additional 4.1 
million children. Every child in America should have the right to 
health care, and this bill will bring us one step closer to that goal.
  It is unacceptable that more than 47 million Americans, including 11 
percent of American children, are without health insurance. Many hard-
working families in Minnesota and across the nation have lost their 
jobs, 2.6 million jobs in the last year. For every 1 percent increase 
in the unemployment rate, it is estimated that as many as 1.5 million 
Americans will lose their health care coverage. Expanding SCHIP will 
expand health care access for children at a time when too many American 
families are losing employer-sponsored health care. In these tough 
economic times, by helping families gain access to health care, we can 
give families the resources they need to give their children a better 
future.
  The bill provides access to health care for 4 million children in 
America who are currently uninsured and preserves the coverage for all 
7.1 million children currently covered by SCHIP. It is supported by 80 
percent of the American people and over 300 organizations--including 
large majorities of Democrats, Independents and Republicans. The bill 
will extend coverage to 4.1 million additional low-income, uninsured 
children, covering a total of 11 million, and is likely to be one of 
the first signed into law by President Barack Obama. Last year, 
President Bush vetoed this vital health legislation that was passed by 
both chambers of Congress.
  The State Children's Health Insurance Program (SCHIP) was created in 
1997 to provide health care coverage for children in families that earn 
too little to afford health insurance for their children themselves but 
too much to qualify for Medicaid. This bill will give states the 
resources and incentives necessary to reach and cover millions of 
uninsured children who are currently eligible, but not enrolled. It 
will also improve SCHIP benefits-ensuring dental coverage and mental 
health parity. This bill is largely paid for by increasing the tobacco 
tax by 61 cents, and will help keep kids and families healthy while 
saving taxpayers money in the long-run.
  Expanding SCHIP is an important step forward, but we still must keep 
fight to make healthcare available and affordable for all Americans. As 
we reform our health care system, we need to focus on accessible, 
patient-centered care that focuses on wellness and prevention, while 
improving the quality of patient care. will continue to fight to expand 
SCHIP and make health care available and affordable for Minnesota 
children and their parents.
  As we start the new Congress and the new administration I can think 
of no better way to bring about change than by investing in our 
children's health care. It is morally right, and crucial for the future 
of our Nation. I urge my colleagues to join me in voting for this 
important bill.
  Ms. WOOLSEY. Madam Speaker, I rise in strong support of H.R. 2, the 
Children's Health Insurance Program Reauthorization Act of 2009. In 
2007, more than 8 million children were uninsured, and with the growing 
recession, this number will only grow. Passing this bill will ensure 
that 4 million of those children will receive CHIP, bringing the total 
number of children covered by CHIP to 11 million.
  Expanding health care coverage for our most vulnerable populations, 
including legal immigrant children and some pregnant women, is an 
obligation we cannot afford to ignore. Nearly 400,000 legal immigrant 
children come from families with incomes below 200 percent of the 
Federal poverty level and are ineligible for CHIP solely because they 
are recent immigrants. These families, uninsured and unable to purchase 
private health insurance on their own, are left to fend for themselves 
when they desperately need health care for their children. This is 
unacceptable, and with this legislation, we will reverse this shameful 
practice by providing States with the option of covering these 
deserving low-income families.
  The passage of this bill is a great start, but we must do better. 
While this bill extends coverage to an additional 4 million children, 
including legal immigrants, over 4 million children will still suffer 
without health care coverage. In addition, nearly 90 million people 
went without health coverage for all or part of 2006 and 2007, most of 
them in working families. These numbers are disgraceful. This Congress, 
I look forward to working with my colleagues to ensure that our 
children and their families have access to high quality, affordable 
healthcare as a basic human right, not as a luxury.
  Mr. SCHIFF. Madam Speaker, today I rise in support of the Children's 
Health Insurance Program Reauthorization Act. This is a landmark 
measure which will extend the life-changing benefit of health insurance 
to an additional 4 million American children. That means millions of 
parents won't have to bring their child to the emergency room because 
they're running a fever and have nowhere else to go. Millions of 
parents who can take their

[[Page 751]]

child to a dentist if their teeth hurt. Millions of parents who can 
take care of their children in a way most families take for granted--
that when they're sick, they can go to the doctor.
  SCHIP has been an incredible success story, extending the benefits of 
health care to 7 million children, and more than 750,000 in California 
alone. These are children whose families have incomes that are too high 
to qualify for Medicaid but who do not receive health insurance through 
their employment and can't afford it on their own. SCHIP is based on a 
simple premise--that insuring kids' health care is the right thing to 
do. It's much cheaper to insure children, and this investment will 
yield healthier generations of adults, improved quality of life, and 
long-term health care savings. The experience of the 11 years since 
SCHIP was originally created proves the wisdom and prudence of 
providing care for prevention and wellness in our children.
  In addition to reauthorizing the program, this bill improves SCHIP by 
creating new incentives to seek out millions of children around the 
nation who are eligible but not enrolled. Two-thirds of uninsured 
children are currently eligible for coverage through SCHIP or 
Medicaid--this bill provides greater funding in grants for new outreach 
activities to States, local governments, schools, community-based 
organizations, and others. With this bill, more kids who are eligible 
will get enrolled and stay enrolled for a benefit that they are 
entitled.
  The legislation is fully paid for by an increase in the tax on 
cigarettes--a provision that I hope will also help discourage youth 
smoking.
  During these trying economic times, and with rising unemployment, the 
need for this SCHIP bill has become more critical now than ever before. 
This recession has forced more and more American parents to face 
difficult choices--finding affordable health insurance for their 
children shouldn't be one of them.
  A vote for this bill is a vote for an America that takes care of its 
children. In the richest nation in the history of the world, it is 
simply wrong that millions of children, our most vulnerable citizens, 
go without basic access to health care. With a yes vote, 4 million more 
children will enjoy the benefits of a healthy future and a real chance 
in life. I urge a ``yes'' vote.
  Ms. LORETTA SANCHEZ of California. Madam Speaker, I rise today to 
congratulate my colleagues on the passage of H.R. 2.
  H.R. 2 is a critical piece of legislation that renews and improves 
the State Children's Health Insurance Program (SCHIP) that ensures 
health care coverage for over 11 million American children--including 
the addition of 4 million, previously uninsured.
  This legislation also improves SCHIP benefits by ensuring coverage 
for dental and mental health services.
  H.R. 2 will reauthorize SCHIP through FY 2013 and will be fully paid 
for through an increase in the tobacco tax.
  Raising the tobacco tax discourages children from smoking. According 
to the Campaign for Tobacco-Free Kids, the tobacco tax increase will 
prevent nearly 2 million children from starting to smoke.
  I am hopeful that the Senate will also pass H.R. 2 and I look forward 
to this important legislation becoming law under the new administration 
of President Obama.
  Mr. ETHERIDGE. Madam Speaker, I rise today in support of H.R. 2, 
Children's Health Insurance Program Reauthorization Act of 2009. This 
bill will ensure that health coverage continues for the 7 million 
children currently covered under the Children's Health Insurance 
Program, and will extend coverage to an additional 4 million children 
who are currently uninsured. Without the legislation, the CHIP would 
end on March 31, 2009.
  CHIP provides health care coverage for children in families that earn 
too much to qualify for Medicaid, but not enough to afford private 
insurance. In 2007, more than 240,000 children in North Carolina 
received health coverage through North Carolina's CHIP, NC Health 
Choice for Children. Under the legislation, North Carolina's allotment 
would increase by 81 percent over the current level from $136 million 
to $245 million. North Carolina has 296,000 uninsured children, the 
sixth-largest number in the country. Two-thirds of uninsured children 
in North Carolina live in a home where at least one parent works full 
time.
  As North Carolina's former Superintendent of Public Instruction, I 
have seen first hand that healthy children are better prepared for 
learning and success. The Children's Health Insurance Program ensures 
that America's children are as healthy and productive as possible and 
that they can grow up to fulfill their potential. Untreated illnesses 
can have long-term consequences, and access to health care can head off 
expensive treatments down the road. As a Nation, we must protect our 
most vulnerable citizens.
  I still regret that the bill will be funded by a tobacco-tax 
increase. The tax in H.R. 2 falls disproportionately on North Carolina, 
and on the Second District in particular. I understand the burden this 
will place on farmers who work hard to build a better life for their 
own children, and I will continue to work to support these families as 
they adjust to transformations in the global economy. However, with one 
out of eight children in North Carolina lacking health insurance I will 
vote for this legislation.
  Madam Speaker, I urge my colleagues to join me in voting for the 
children of America's working families.
  Mr. DAVIS of Illinois. Madam Speaker, I rise today in strong, 
unwavering, and steadfast support of the reauthorization of SCHIP to 
provide healthcare for millions of uninsured children. SCHIP is a 
critical safety net for children. As Chief Justice Thurgood Marshall 
once said, ``The measure of a country's greatness is its ability to 
retain compassion in times of crisis.'' Providing healthcare for low-
income children, especially during this economic crisis, reflects a 
commitment to the least among us as well as sound economic policy. A 
healthy child is prepared for school and life. A healthy child does not 
require costly emergency room visits. I applaud House leaders for 
including mental health parity and dental coverage for children.
  In Fiscal Year 2007, SCHIP provided health care to over 345,000 
children in Illinois. Unfortunately, due to overwhelming need, Illinois 
faced a shortfall in federal spending last year. This bill does much to 
address this gap. Specifically, in addition to preserving coverage for 
the 7 million children currently in the program, this bill expands 
coverage to another 4 million children in need.
  I want to briefly mention the efforts of Chicago Public Schools in 
helping low income families overcome many of the barriers that often 
prevent them from enrolling in SCHIP. The Children and Family Benefits 
Unit assisted approximately 60 schools in a recent 12 month period, 
helping over 4,200 families' complete applications to enroll into the 
Illinois CHIP, including Medicaid. I am proud of this effort in 
Chicago, and I am pleased that this bill will continue to support such 
programs.
  In closing, this bill will provide much-needed health care for low-
income children in Chicago, Illinois, and the nation, and I look 
forward to this bill being signed into law in the near future.
  Mr. HOLT. Madam Speaker, I voted in support of our Nation's children 
and for passage of the Children's Health Insurance Program 
Reauthorization Act of 2009, H.R. 2.
  More than 7.1 million children have health insurance because of the 
creation, a decade ago, of the State Children's Health Insurance 
Program, SCHIP. However, these children will lose access to good, 
affordable health insurance if Congress does not act to reauthorize the 
SCHIP program by March 31, 2009.
  The House approved the Children's Health Insurance Program 
Reauthorization Act of 2009, which would expand the SCHIP program to 
ensure even more children have access to the health care their parents 
cannot afford or who work in jobs that do not provide health care 
benefits. The House of Representatives has passed similar legislation 
twice before to extend and expand SCHIP, only to have those bills 
vetoed by President Bush. I hope that on the third consideration of 
this legislation to improve children's health that this bill will be 
signed into law.
  The expansion of this program is even more important today as many 
workers are losing their health insurance and face great economic 
hardships during the recent recession. The Kaiser Family Foundation 
projects that the current unemployment level of 7 percent would 
increase Medicaid and SCHIP enrollment by 2.4 million people and an 
additional 2.6 million people would become uninsured. The number of 
uninsured will rise higher should the unemployment rates climb even 
further. This legislation would reduce the size of this uninsured 
population by expanding SCHIP to include an additional 4 million 
children who currently have no health insurance. Sending a child to the 
emergency room is not an alternative to having comprehensive health 
insurance. Especially at a time when millions of families are facing 
economic hardships, we must ensure that children have the care they 
need.
  This bill would provide parity for mental health for children. I long 
have fought for mental health parity, and was pleased that last year we 
could improve mental health coverage for private insurance plans and 
Medicare. I am encouraged that we have now extended this to the SCHIP 
program.
  According to the Henry J. Kaiser Family Foundation, more than 45 
million Americans lack health care coverage, including more than

[[Page 752]]

16 percent of New Jersey's residents. Many of these Americans are 
children, the vast majority of whom come from working families. It is 
simply unconscionable that here in the United States of America 
millions of children are uninsured. The reauthorization and expansion 
of the SCHIP program presents an historic opportunity to put an end to 
the morally unacceptable fact that 8.6 million American children live 
every day without insurance. It is time for Congress to preserve and 
expand this program that has proven successful at insuring our nation's 
most vulnerable children.
  The SCHIP program is strongly supported by our nation's governors who 
have managed the State-run programs over the past decade and understand 
that SCHIP allows States to cover low-income children who lack health 
insurance in families of the working poor. This bill also would provide 
the tools needed and create incentives for States to reach the millions 
of children who are eligible but not currently enrolled in the SCHIP 
program.
  New Jersey uses its SCHIP funds to run a program called FamilyCare. 
Our State is a leader in extending FamilyCare eligibility. Currently, 
150,000 children and approximately 100,000 low income-parents are 
enrolled in New Jersey's program. Without SCHIP, all of these residents 
of New Jersey would again be uninsured.
  This legislation would allow States like New Jersey to continue to 
set income eligibility for SCHIP. Because the cost of living is so high 
in New Jersey, it is important that our State has the flexibility 
needed to establish realistic eligibility guidelines.
  Additionally, this bill would allow New Jersey to continue to enroll 
parents along with their children. According to research by the 
Institute of Medicine of the National Academies of Sciences, one highly 
effective way of boosting coverage among low-income children is to 
broaden health insurance to their parents. Currently, New Jersey is one 
of 11 States to cover low-income parents.
  Because we are committed to balanced budgets and opposed to deficit 
spending, this bill pays for this historic commitment to our children 
with an appropriate increase in the Federal tobacco tax and by imposing 
restrictions on self-referral to physician-owned hospitals. According 
to the Campaign for Tobacco-free Kids, the 61 cent-per-pack increase in 
the cigarette tax that is included in this bill would result in 
substantially fewer youth smokers, as every 10 percent increase in the 
price of cigarettes would reduce youth smoking by approximately 7 
percent. This would improve their health and result in longterm 
healthcare savings.
  There are 11 million reasons to vote for this bill, each one a child 
who will move out of the ranks of the uninsured with the health care 
provided in the Children's Health Insurance Program Reauthorization 
Act. A measure of a nation's greatness is how it treats its most 
vulnerable citizens. By making health insurance available for 11 
million children, we live up to our moral obligation to keep children 
healthy and we make our society stronger.
  Mr. McHUGH. Madam Speaker, I rise today in support of H.R. 2, the 
Children's Health Insurance Program Reauthorization Act of 2009. Given 
the importance of the State Children's Health Insurance Program (SCHIP) 
to my constituents, I am pleased that the House is working to extend 
SCHIP through Fiscal Year 2013.
  Every bill that works its way through Congress has provisions that 
are less than ideal and this bill is no exception. Clearly, if given 
the opportunity, I would write much of this bill in a different way. 
That opportunity, of course, will not materialize.
  However, accessibility to quality health care is one of the great 
challenges we face as a Nation. It is a particularly acute problem in 
Northern and Central New York, which I have the privilege of 
representing. According to one source, there are currently over 400,000 
children without health insurance in New York State.
  The importance of the SCHIP program to my district is hard to 
overstate. In fact, nearly 20,000 children in the 11 counties I 
represent are currently enrolled in the Child Health Plus as the SCHIP 
program is known in New York State.
  The bill before the House today would strengthen and expand the SCHIP 
program by providing an additional $35 billion over the next four and a 
half years. As a result of this increase in funding, an additional 4 
million children--267,000 in New York State--are projected to be 
enrolled in the program, thereby ensuring that a total of 11 million 
children nationwide have access to health care. Thus, I will support 
this measure.
  Mr. YARMUTH. Madam Speaker, Modern medicine can prevent an 
inconvenient infection from ballooning into a debilitating illness with 
a relatively simple physician's visit and subsequent treatment. And 
here in America, with the best medical practices and practitioners in 
the history of the world, we have the capabilities to keep our Nation's 
children healthy and their futures bright.
  But we aren't doing it.
  Up to now, we've chosen not to guarantee the health of our children, 
instead forcing upon millions of parents the difficult choice of 
seeking treatment for an ailing child or buying food. Making that 
potentially life-saving doctor's visit or keeping the lights on.
  Today, we have the opportunity to erase that awful dilemma for the 
working mothers and fathers of more than 4 million children, including 
tens of thousands in my home State of Kentucky, by extending the State 
Children's Health Insurance Program. By supporting the SCHIP expansion 
we help guarantee the inalienable rights of America's children to 
survive, thrive, and grow up to become healthy adults.
  By expanding SCHIP we can prevent the future health problems of our 
youngest generation so that they never grow up to be burdens on the 
system. It makes economic sense, but more importantly, it is our moral 
obligation. I urge my colleagues to join me in supporting this 
important legislation, as we fight to ensure that a sick child in this 
great Nation never has to go without care.
  Ms. ROYBAL-ALLARD. Madam Speaker, I rise in support of H.R. 2, the 
Children's Health Insurance Program Reauthorization Act of 2009. This 
bill represents a strong bipartisan first step to reform our broken 
health care system by guaranteeing that millions of uninsured children 
will have the health care that they need. Its passage will bring a 
symbolic end to the broken promises of the Bush Administration, which 
twice chose to deny coverage to 4 million children in desperate need of 
health care.
  Over the past decade the State Children's Health Insurance Program 
(SCHIP) has helped reduce the number of uninsured children by one-third 
and has made significant progress in improving the health of low-income 
children. H.R. 2 will reauthorize this critical program until 2013, 
ensuring that 7 million children currently covered by SCHIP continue to 
receive health coverage. Equally as important, this bill will extend 
health coverage to an additional 4 million low-income children who are 
currently uninsured.
  The Children's Health Insurance Program Reauthorization Act of 2009 
strengthens SCHIP by including incentives for states to develop 
effective outreach and enroll more eligible children. In addition, the 
bill improves access to both mental health services and dental health 
care, and offers states the option to cover targeted low-income 
pregnant women as a way to provide the essential prenatal care that can 
help reduce birth defects.
  I am particularly grateful that our leadership has chosen to include 
the provisions of the Immigrant Children's Health Improvement Act in 
this SCHIP reauthorization. This provision will restore the states' 
option to provide coverage to legal immigrant children who meet all 
other eligibility criteria, thereby seizing the opportunity to address 
health disparities in communities of color that historically have had 
very poor access to health care.
  Madam Speaker, I believe this bill takes a giant step forward in 
honoring our moral imperative to ensure that age, race and income do 
not determine the health status of our children. I am proud to vote for 
its passage today, to protect our commitment to our children, and to 
offer them the promise of a healthier tomorrow.
  Mr. PALLONE. Madam Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. All time for debate has expired.
  Pursuant to House Resolution 52, the bill is considered read and the 
previous question is ordered.
  The question is on the engrossment and third reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.


                           Motion to Recommit

  Mr. DEAL of Georgia. Madam Speaker, I have a motion at the desk.
  The SPEAKER pro tempore. Is the gentleman opposed to the bill?
  Mr. DEAL of Georgia. I am in its current form.
  Mr. WAXMAN. Madam Speaker, I reserve a point of order.
  The SPEAKER pro tempore. A point of order is reserved.
  The Clerk will report the motion to recommit.
  The Clerk read as follows:
       Mr. Deal of Georgia moves to recommit the bill, H.R. 2, to 
     the Committee on Energy and Commerce with instructions to 
     report the

[[Page 753]]

     same back to the House forthwith with the following 
     amendment:
       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``SCHIP Full Funding Extension 
     Act of 2009''.

     SEC. 2. EXTENDING SCHIP FUNDING THROUGH FISCAL YEAR 2015.

       (a) Through Fiscal Year 2015.--
       (1) In general.--Section 2104 of the Social Security Act 
     (42 U.S.C. 1397dd), as amended by section 201 of the 
     Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public 
     Law 110-173), is amended--
       (A) in subsection (a)(11), by striking ``and 2009'' and 
     inserting ``, 2009, 2010, 2011, 2012, 2013, 2014, and 2015''; 
     and
       (B) in subsection (c)(4)(B), by striking ``through 2009'' 
     and inserting ``through 2015''.
       (2) Availability of extended funding.--Funds made available 
     from any allotment made from funds appropriated under 
     subsection (a)(11) or (c)(4)(B) of section 2104 of the Social 
     Security Act (42 U.S.C. 1397dd) for fiscal year 2009, 2010, 
     2011, 2012, 2013, 2014, or 2015 shall not be available for 
     child health assistance for items and services furnished 
     after September 30, 2015.
       (b) Extension of Treatment of Qualifying States.--
       (1) In general.--Section 2105(g)(1)(A) of the Social 
     Security Act (42 U.S.C. 1397ee(g)(1)(A)), as amended by 
     section 201(b) of the Medicare, Medicaid, and SCHIP Extension 
     Act of 2007 (Public Law 110-173), is amended by striking ``or 
     2009'' and inserting ``2009, 2010, 2011, 2012, 2013, 2014, or 
     2015''.
       (2) Conforming amendment.--Section 201(b) of such Public 
     Law is amended by striking paragraph (2).
       (c) Additional Allotments To Maintain SCHIP Programs 
     Through Fiscal Year 2015.--Section 2104 of the Social 
     Security Act (42 U.S.C. 1397dd) is amended by striking 
     subsection (l) and inserting the following new subsections:
       ``(l) Additional Allotments To Maintain SCHIP Programs for 
     Fiscal Year 2009.--
       ``(1) Appropriation; allotment authority.--For the purpose 
     of providing additional allotments described in subparagraphs 
     (A) and (B) of paragraph (3), there is appropriated, out of 
     any money in the Treasury not otherwise appropriated, such 
     sums as may be necessary, not to exceed $3,000,000,000 for 
     fiscal year 2009.
       ``(2) Shortfall states described.--For purposes of 
     paragraph (3), a shortfall State described in this paragraph 
     is a State with a State child health plan approved under this 
     title for which the Secretary estimates, on the basis of the 
     most recent data available to the Secretary, that the Federal 
     share amount of the projected expenditures under such plan 
     for such State for fiscal year 2009 will exceed the sum of--
       ``(A) the amount of the State's allotments for each of 
     fiscal years 2007 and 2008 that will not be expended by the 
     end of fiscal year 2008;
       ``(B) the amount, if any, that is to be redistributed to 
     the State during fiscal year 2009 in accordance with 
     subsection (i); and
       ``(C) the amount of the State's allotment for fiscal year 
     2009.
       ``(3) Allotments.--In addition to the allotments provided 
     under subsections (b) and (c), subject to paragraph (4), of 
     the amount available for the additional allotments under 
     paragraph (1) for fiscal year 2009, the Secretary shall 
     allot--
       ``(A) to each shortfall State described in paragraph (2) 
     not described in subparagraph (B), such amount as the 
     Secretary determines will eliminate the estimated shortfall 
     described in such paragraph for the State; and
       ``(B) to each commonwealth or territory described in 
     subsection (c)(3), an amount equal to the percentage 
     specified in subsection (c)(2) for the commonwealth or 
     territory multiplied by 1.05 percent of the sum of the 
     amounts determined for each shortfall State under 
     subparagraph (A).
       ``(4) Proration rule.--If the amounts available for 
     additional allotments under paragraph (1) are less than the 
     total of the amounts determined under subparagraphs (A) and 
     (B) of paragraph (3), the amounts computed under such 
     subparagraphs shall be reduced proportionally.
       ``(5) Retrospective adjustment.--The Secretary may adjust 
     the estimates and determinations made to carry out this 
     subsection as necessary on the basis of the amounts reported 
     by States not later than November 30, 2008, on CMS Form 64 or 
     CMS Form 21, as the case may be, and as approved by the 
     Secretary.
       ``(6) One-year availability; no redistribution of 
     unexpended additional allotments.--Notwithstanding 
     subsections (e) and (f), amounts allotted to a State pursuant 
     to this subsection for fiscal year 2009, subject to paragraph 
     (5), shall only remain available for expenditure by the State 
     through September 30, 2009. Any amounts of such allotments 
     that remain unexpended as of such date shall not be subject 
     to redistribution under subsection (f).
       ``(m) Additional Allotments To Maintain SCHIP Programs for 
     Fiscal Year 2010.--
       ``(1) Appropriation; allotment authority.--For the purpose 
     of providing additional allotments described in subparagraphs 
     (A) and (B) of paragraph (3), there is appropriated, out of 
     any money in the Treasury not otherwise appropriated, such 
     sums as may be necessary, not to exceed $4,000,000,000 for 
     fiscal year 2010.
       ``(2) Shortfall states described.--For purposes of 
     paragraph (3), a shortfall State described in this paragraph 
     is a State with a State child health plan approved under this 
     title for which the Secretary estimates, on the basis of the 
     most recent data available to the Secretary, that the Federal 
     share amount of the projected expenditures under such plan 
     for such State for fiscal year 2010 will exceed the sum of--
       ``(A) the amount of the State's allotments for each of 
     fiscal years 2008 and 2009 that will not be expended by the 
     end of fiscal year 2009;
       ``(B) the amount, if any, that is to be redistributed to 
     the State during fiscal year 2010 in accordance with 
     subsection (f); and
       ``(C) the amount of the State's allotment for fiscal year 
     2010.
       ``(3) Allotments.--In addition to the allotments provided 
     under subsections (b) and (c), subject to paragraph (4), of 
     the amount available for the additional allotments under 
     paragraph (1) for fiscal year 2010, the Secretary shall 
     allot--
       ``(A) to each shortfall State described in paragraph (2) 
     not described in subparagraph (B) such amount as the 
     Secretary determines will eliminate the estimated shortfall 
     described in such paragraph for the State; and
       ``(B) to each commonwealth or territory described in 
     subsection (c)(3), an amount equal to the percentage 
     specified in subsection (c)(2) for the commonwealth or 
     territory multiplied by 1.05 percent of the sum of the 
     amounts determined for each shortfall State under 
     subparagraph (A).
       ``(4) Proration rule.--If the amounts available for 
     additional allotments under paragraph (1) are less than the 
     total of the amounts determined under subparagraphs (A) and 
     (B) of paragraph (3), the amounts computed under such 
     subparagraphs shall be reduced proportionally.
       ``(5) Retrospective adjustment.--The Secretary may adjust 
     the estimates and determinations made to carry out this 
     subsection as necessary on the basis of the amounts reported 
     by States not later than November 30, 2010, on CMS Form 64 or 
     CMS Form 21, as the case may be, and as approved by the 
     Secretary.
       ``(6) Availability; no redistribution of unexpended 
     additional allotments.--Notwithstanding subsections (e) and 
     (f), amounts allotted to a State pursuant to this subsection 
     for fiscal year 2010, subject to paragraph (5), shall only 
     remain available for expenditure by the State through 
     September 30, 2010. Any amounts of such allotments that 
     remain unexpended as of such date shall not be subject to 
     redistribution under subsection (f).
       ``(n) Application to Fiscal Years 2011, 2012, 2013, 2014, 
     or 2015.--
       ``(1) In general.--Subject to paragraph (2), subsection (m) 
     shall apply to each of fiscal years 2011, 2012, 2013, 2014, 
     or 2015 in the same manner such subsection applies to fiscal 
     year 2010.
       ``(2) Application.--In applying subsection (m) under 
     paragraph (1) with respect to--
       ``(A) fiscal year 2011--
       ``(i) each reference to a year or date in such subsection 
     shall be deemed a reference to the following year or to one 
     year after such date, respectively; and
       ``(ii) the reference to `$4,000,000,000' in paragraph (1) 
     of such subsection shall be deemed a reference to 
     `$5,000,000,000';
       ``(B) fiscal year 2012--
       ``(i) each reference to a year or date in such subsection 
     shall be deemed a reference to the second following year or 
     to two years after such date, respectively; and
       ``(ii) the reference to `$4,000,000,000' in paragraph (1) 
     of such subsection shall be deemed a reference to 
     `$6,000,000,000';
       ``(C) fiscal year 2013--
       ``(i) each reference to a year or date in such subsection 
     shall be deemed a reference to the third following year or to 
     three years after such date, respectively; and
       ``(ii) the reference to `$4,000,000,000' in paragraph (1) 
     of such subsection shall be deemed a reference to 
     `$6,000,000,000';
       ``(D) fiscal year 2014--
       ``(i) each reference to a year or date in such subsection 
     shall be deemed a reference to the fourth following year or 
     to four years after such date, respectively; and
       ``(ii) the reference to `$4,000,000,000' in paragraph (1) 
     of such subsection shall be deemed a reference to 
     `$7,000,000,000'; and
       ``(E) fiscal year 2015--
       ``(i) each reference to a year or date in such subsection 
     shall be deemed a reference to the fifth following year or to 
     five years after such date, respectively; and
       ``(ii) the reference to `$4,000,000,000' in paragraph (1) 
     of such subsection shall be deemed a reference to 
     `$7,000,000,000'.''.

     SEC. 3. OPTION FOR QUALIFYING STATES TO RECEIVE THE ENHANCED 
                   PORTION OF THE SCHIP MATCHING RATE FOR MEDICAID 
                   COVERAGE OF CERTAIN CHILDREN.

       Section 2105(g) of the Social Security Act (42 U.S.C. 
     1397ee(g)) is amended--
       (1) in paragraph (1)(A), by inserting ``subject to 
     paragraph (4),'' after ``Notwithstanding any other provision 
     of law,''; and

[[Page 754]]

       (2) by adding at the end the following new paragraph:
       ``(4) Option for certain allotments.--
       ``(A) Payment of enhanced portion of matching rate for 
     certain expenditures.--In the case of expenditures described 
     in subparagraph (B), a qualifying State (as defined in 
     paragraph (2)) may elect to be paid from the State's 
     allotment made under section 2104 for any fiscal year 
     (beginning with fiscal year 2009) (insofar as the allotment 
     is available to the State under subsection (e) of such 
     section) an amount each quarter equal to the additional 
     amount that would have been paid to the State under title XIX 
     with respect to such expenditures if the enhanced FMAP (as 
     determined under subsection (b)) had been substituted for the 
     Federal medical assistance percentage (as defined in section 
     1905(b)).
       ``(B) Expenditures described.--For purposes of subparagraph 
     (A), the expenditures described in this subparagraph are 
     expenditures made after the date of the enactment of this 
     paragraph and during the period in which funds are available 
     to the qualifying State for use under subparagraph (A), for 
     the provision of medical assistance to individuals residing 
     in the State who are eligible for medical assistance under 
     the State plan under title XIX or under a waiver of such plan 
     and who have not attained age 19, and whose family income 
     equals or exceeds 133 percent of the poverty line but does 
     not exceed the Medicaid applicable income level.''.

     SEC. 4. REQUIRING OUTREACH AND COVERAGE BEFORE EXPANSION OF 
                   ELIGIBILITY.

       (a) State Plan Required to Specify How It Will Achieve 
     Health Benefits Coverage for 90 Percent of Low-Income 
     Children.--
       (1) In general.--Section 2102(a) of the Social Security Act 
     (42 U.S.C. 1397bb(a)) is amended--
       (A) in paragraph (6), by striking ``and'' at the end;
       (B) in paragraph (7), by striking the period at the end and 
     inserting ``; and''; and
       (C) by adding at the end the following new paragraph:
       ``(8) how the State for each fiscal year (beginning with 
     fiscal year 2010) will achieve, through eligibility and 
     benefits provided for under the plan and otherwise, a rate of 
     health benefits coverage (whether private or public) for low-
     income children in the State that is at least 90 percent.''.
       (2) Effective date.--The amendments made by paragraph (1) 
     shall apply to State child health plans for fiscal years 
     beginning with fiscal year 2010.
       (b) Limitation on Program Expansions Until Lowest Income 
     Eligible Individuals Enrolled.--Section 2105(c) (42 U.S.C. 
     1397dd(c)) is amended by adding at the end the following new 
     paragraph:
       ``(8) Limitation on increased coverage of higher income 
     children.--For child health assistance furnished in a fiscal 
     year beginning with fiscal year 2010:
       ``(A) Special rules for payment for children with family 
     income above 200 percent of poverty line.--In the case of 
     child health assistance for a targeted low-income child in a 
     family the income of which exceeds 200 percent (but does not 
     exceed 300 percent) of the poverty line applicable to a 
     family of the size involved no payment shall be made under 
     this section for such assistance unless the State 
     demonstrates to the satisfaction of the Secretary (in 
     accordance with any methodology established by the Secretary) 
     that the State has met the 90 percent retrospective coverage 
     test specified in subparagraph (B) for the previous fiscal 
     year.
       ``(B) 90 percent coverage test.--The 90 percent 
     retrospective coverage test specified in this subparagraph 
     is, for a State for a fiscal year, that on average for any 3-
     consecutive month period during the fiscal year, at least 90 
     percent of low-income children residing in the State have 
     health benefits coverage (whether private or public).
       ``(C) Grandfather.--Subparagraphs (A) and (B) shall not 
     apply to the provision of child health assistance--
       ``(i) to a targeted low-income child who is enrolled for 
     child health assistance under this title as of September 30, 
     2009;
       ``(ii) to a pregnant woman who is enrolled for assistance 
     under this title as of September 30, 2009, through the 
     completion of the post-partum period following completion of 
     her pregnancy; and
       ``(iii) for items and services furnished before October 1, 
     2009, to an individual who is not a targeted low-income child 
     and who is enrolled for assistance under this title as of 
     September 30, 2009.
       ``(D) Promulgation of methodology.--Not later than July 1, 
     2009, the Secretary shall issue regulations that establish a 
     methodology by which States meet the requirements of 
     subparagraph (A).
       ``(E) Determination of income based on gross family income 
     without disregards or exclusions.--
       ``(i) In general.--For purposes of this paragraph, the 
     family income shall be determined under subparagraph (A) (and 
     under subparagraph (B) for purposes of determining who is a 
     low-income child, as defined in section 2110(c)(4)) based on 
     gross family income.
       ``(ii) Gross family income defined.--

       ``(I) In general.--Subject to subclause (II), in this 
     subparagraph, the term `gross family income' means, with 
     respect to an individual, gross income (as defined by the 
     Secretary in regulations) for the members of the individual's 
     family. For purposes of the previous sentence, in defining 
     `gross income' the Secretary shall, to the maximum extent 
     practicable, include income from whatever source, other than 
     amounts deducted under section 62(a)(1) of the Internal 
     Revenue Code of 1986.
       ``(II) Income disregards authorized.--A State may provide, 
     through a State plan amendment and with the approval of the 
     Secretary, for the disregard from gross family income of one 
     or more amounts so long as the total amount of such 
     disregards for a family does not exceed $250 per month, or 
     $3,000 per year.''.

     SEC. 5. SCHIP GROSS INCOME ELIGIBILITY CEILING.

       (a) Application of SCHIP Eligibility Ceiling.--
       (1) In general.--Section 2110 of the Social Security Act 
     (42 U.S.C. 1397jj) is amended--
       (A) in subsection (b)(1)--
       (i) by striking ``and'' at the end of subparagraph (B);
       (ii) by striking the period at the end of subparagraph (C) 
     and inserting ``; and''; and
       (iii) by adding at the end the following new subparagraph:
       ``(D) whose gross family income (as defined in subsection 
     (c)(9)) does not exceed 300 percent of the poverty line.''; 
     and
       (B) in subsection (c), by adding at the end the following 
     new paragraph:
       ``(9) Gross family income.--
       ``(A) In general.--Subject to subparagraph (B), the term 
     `gross family income' means, with respect to an individual, 
     gross income (as defined by the Secretary in regulations) for 
     the members of the individual's family. For purposes of the 
     previous sentence, in defining `gross income' the Secretary 
     shall, to the maximum extent practicable, include income from 
     whatever source, other than amounts deducted under section 
     62(a)(1) of the Internal Revenue Code of 1986.
       ``(B) Income disregards authorized.--A State may provide, 
     through a State plan amendment and with the approval of the 
     Secretary, for the disregard from gross family income of one 
     or more amounts so long as the total amount of such 
     disregards for a family does not exceed $250 per month, or 
     $3,000 per year.''.
       (2) Denial of federal matching payments for state schip 
     expenditures for individuals with gross family income above 
     300 percent of the poverty line.--Section 2105(c) of the 
     Social Security Act (42 U.S.C. 1397ee(c)), as amended by 
     section 4(b), is amended by adding at the end the following 
     new paragraph:
       ``(9) Denial of payments for expenditures for child health 
     assistance for individuals whose gross family income exceeds 
     300 percent of the poverty line.--No payment may be made 
     under this section, for any expenditures for providing child 
     health assistance or health benefits coverage under a State 
     child health plan under this title, including under a waiver 
     under section 1115, with respect to an individual whose gross 
     family income (as defined in section 2110(c)(9)) exceeds 300 
     percent of the poverty line.''.
       (b) Effective Date; Transition.--
       (1) In general.--Subject to paragraph (2), the amendments 
     made by this section shall apply to payments made for items 
     and services furnished on or after the first day of the first 
     calendar quarter beginning more than 90 days after the date 
     of the enactment of this Act.
       (2) Transition.--The amendments made by--
       (A) subsection (a)(1) shall not apply to an individual who 
     was receiving, or was determined eligible to receive, child 
     health assistance or health benefits coverage under a State 
     child health plan under title XXI of the Social Security Act, 
     including under a waiver under section 1115 of such Act, as 
     of the day before the date of the enactment of this Act, 
     until such date as the individual is determined ineligible 
     using income standards or methodologies in place as of the 
     day before the date of the enactment of this Act; and
       (B) subsection (a)(2) shall not apply to payment for items 
     and services furnished to an individual described in clause 
     (i);

     SEC. 6. TIME FOR PAYMENT OF CORPORATE ESTIMATED TAXES.

       (a) 5-Year Period.--The percentage under subparagraph (C) 
     of section 401(1) of the Tax Increase Prevention and 
     Reconciliation Act of 2005 in effect on the date of the 
     enactment of this Act is increased by 19 percentage points.
       (b) 10-Year Period.--Notwithstanding section 6655 of the 
     Internal Revenue Code of 1986--
       (1) the amount of any required installment of corporate 
     estimated tax which is otherwise due in July, August, or 
     September of 2018 shall be 130 percent of such amount, and
       (2) the amount of the next required installment after the 
     installment referred to in paragraph (1) shall be 
     appropriately reduced to reflect the amount of the increase 
     by reason of paragraph (1).

  Mr. WAXMAN (during the reading). Madam Speaker, I ask unanimous 
consent that the motion to recommit be

[[Page 755]]

considered read, and I also withdraw my point of order.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  The SPEAKER pro tempore. Reservation of the point of order is 
withdrawn.
  The gentleman from Georgia is recognized for 5 minutes in support of 
his motion.
  Mr. DEAL of Georgia. Madam Speaker, the Republican motion to recommit 
replaces what I consider to be a deeply flawed bill that has been 
offered and also has improvements to the SCHIP proposal that we are 
considering.
  Unlike H.R. 2, the Republican motion to recommit fully funds SCHIP 
program for the next 7 years, not 4\1/2\ years as the underlying bill 
would do, and thereby ensures that needy families and those with low 
incomes will be covered and eligible under SCHIP through fiscal year 
2015. According to the Congressional Budget Office, the motion to 
recommit will not cause a single SCHIP enrolled child to lose his or 
her health care coverage.
  Unlike the bill that is under consideration, H.R. 2, the motion to 
recommit puts poor children first by holding States accountable for not 
finding and enrolling their low-income, uninsured children. Each year, 
States would be required to report to the Secretary of HHS how they 
intend to ensure that at least 90 percent of their children with family 
incomes under $40,000 per year have quality health care coverage in 
either a public or private health care plan. States would also be 
required to demonstrate that they have met this 90 percent coverage 
target before they are able to shift their enrollment activities to 
higher income families.
  Unlike H.R. 2, the motion to recommit maintains the requirement in 
current law that States verify the identity and citizenship status of 
Medicaid and SCHIP applicants and prevents illegal aliens and other 
unqualified individuals from fraudulently gaining access to these 
taxpayer-funded programs.
  Unlike H.R. 2, the Republican motion to recommit preserves limited 
SCHIP dollars for low-income, uninsured children by preventing States 
from abusing the income-disregard loophole that is in the current law 
and would be continued under the underlying bill.
  Unlike H.R. 2, the Republican motion to recommit Federal funds will 
be reserved for families with incomes under 300 percent of the Federal 
poverty level, which is currently $63,600 for a family of four.
  This motion to recommit is compliant with the majority's PAYGO rules 
by asking corporations with assets in excess of $1 billion to shift 
some estimated tax payments due in fiscal year 2009 to fiscal year 
2018.
  The majority has repeatedly used this short-term shifting of funding 
to meet the 5-year PAYGO requirements, and we're using it today to 
comply with the majority's PAYGO requirements without raising taxes.
  Fully paid for without increasing taxes on the American people is 
what this motion to recommit would provide. And unlike the underlying 
bill, H.R. 2, the Republican recommit motion will actually allow 
President-elect Obama to keep his promise to the American people of not 
increasing their taxes.
  We believe that these fundamental changes from the underlying bill 
not only improve it, but extend the life of it for a full 7-year period 
and is altogether appropriate, and does not include increasing taxes on 
the American people.
  We believe in the SCHIP program. We think that it should be properly 
applied in States and applied primarily to those who are low-income, 
poor families first rather than going up the economic scale of 
eligibility.
  For these reasons, I would urge this body to adopt the motion to 
recommit and to pass a bill for a 7-year period that fully funds and 
assures States and families that their children will be covered.
  Madam Speaker, I yield back the balance of my time.
  Mr. PALLONE. Madam Speaker, I rise in opposition to the motion to 
recommit.
  The SPEAKER pro tempore. The gentleman from New Jersey is recognized 
for 5 minutes.
  Mr. PALLONE. Madam Speaker, it wasn't enough that President Bush 
vetoed two children's health bills that would have made great advances 
in children's health. Now my Republican colleagues are trying to 
undermine the coverage gains that would be made in this bill.
  This proposal being put forward by my Republican colleagues isn't a 
way to put poor kids first. It's a way to stop States from moving 
forward to help additional uninsured children.
  The CHIP bill already puts poor kids first by targeting enrollment 
bonuses only to the poorest kids, those in Medicaid. Eight in ten newly 
insured children under CHIP have incomes below current eligibility 
levels. The Republican proposal is simply a way to stop States from 
moving forward.
  Unfortunately, the reality of today is that these moderate income 
families who would be excluded under this motion are struggling to make 
ends meet, too. Health costs have been rising much faster than income 
over the past decade. A family at 300 percent of poverty, for example, 
earning $52,800 a year--these so-called rich folks, according to 
Republicans--now spend an average of 19 percent of their income on 
premiums for employer-sponsored coverage if they even have access to 
it. Ten years ago, that same family was only spending 11 percent of 
income on premiums for their employer plan.
  The CHIP bill moves us forward. It's the largest investment in 
children's health since the original CHIP law was passed in '97. And 
this Congress will do more for children, and it's an excellent step 
forward.
  Now I want to mention that research shows that no means tested 
program reaches 90 percent of the individuals or families eligible for 
it. Moreover, there is not reliable State-by-State data to even measure 
participation rates accurately among the States.
  While the Bush administration initially attempted to establish 
measures like Mr. Deal is talking about, leading independent academic 
and research institutions discredited the Bush administration's target 
rate, such as CBO and the Urban Institute, and the Bush administration 
has moved away from its initial administrative directive of enforcing 
such limits on States the way this motion would do.
  So again, the point is we need to move forward. This is simply a ruse 
essentially to gut the bill for those moderate-income families that 
would benefit for it.
  I would urge my colleagues to oppose this motion to recommit. Let's 
move the bill as originally proposed. It will do great things for 
America's children.
  Madam Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. Without objection, the previous question is 
ordered on the motion to recommit.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to recommit.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.
  Mr. DEAL of Georgia. Madam Speaker, I object to the vote on the 
ground that a quorum is not present and make the point of order that a 
quorum is not present.
  The SPEAKER pro tempore. Evidently a quorum is not present.
  The Sergeant at Arms will notify absent Members.
  Pursuant to clause 9 of rule XX, the Chair will reduce to 5 minutes 
the minimum time for any electronic vote on the question of passage.
  The vote was taken by electronic device, and there were--yeas 179, 
nays 247, not voting 7, as follows:

                             [Roll No. 15]

                               YEAS--179

     Aderholt
     Akin
     Alexander
     Austria
     Bachmann
     Bachus
     Barrett (SC)
     Bartlett
     Barton (TX)
     Biggert
     Bilbray
     Bilirakis
     Bishop (UT)
     Blackburn
     Blunt
     Boehner
     Bonner
     Bono Mack
     Boozman
     Boustany
     Brady (TX)
     Bright
     Broun (GA)
     Brown (SC)
     Brown-Waite, Ginny
     Burgess
     Burton (IN)
     Buyer
     Calvert
     Camp
     Campbell
     Cantor
     Cao
     Capito
     Carter
     Cassidy
     Castle
     Chaffetz

[[Page 756]]


     Coble
     Coffman (CO)
     Cole
     Conaway
     Crenshaw
     Culberson
     Davis (KY)
     Deal (GA)
     Dent
     Diaz-Balart, L.
     Diaz-Balart, M.
     Dreier
     Duncan
     Ehlers
     Emerson
     Fallin
     Flake
     Fleming
     Forbes
     Fortenberry
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gallegly
     Garrett (NJ)
     Gerlach
     Gingrey (GA)
     Gohmert
     Goodlatte
     Granger
     Graves
     Guthrie
     Hall (TX)
     Harper
     Hastings (WA)
     Heller
     Hensarling
     Herger
     Hoekstra
     Hunter
     Inglis
     Issa
     Jenkins
     Johnson (IL)
     Johnson, Sam
     Jones
     Jordan (OH)
     King (IA)
     King (NY)
     Kingston
     Kirk
     Kline (MN)
     Lamborn
     Lance
     Latham
     LaTourette
     Latta
     Lee (NY)
     Lewis (CA)
     Linder
     Lucas
     Luetkemeyer
     Lummis
     Lungren, Daniel E.
     Mack
     Manzullo
     Marchant
     Marshall
     McCarthy (CA)
     McCaul
     McClintock
     McCotter
     McHenry
     McHugh
     McIntyre
     McKeon
     McMorris Rodgers
     Mica
     Miller (FL)
     Miller (MI)
     Miller, Gary
     Minnick
     Moran (KS)
     Murphy, Tim
     Myrick
     Neugebauer
     Nunes
     Olson
     Paul
     Paulsen
     Pence
     Petri
     Pitts
     Platts
     Poe (TX)
     Posey
     Price (GA)
     Putnam
     Radanovich
     Rehberg
     Reichert
     Roe (TN)
     Rogers (AL)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Rooney
     Ros-Lehtinen
     Roskam
     Royce
     Ryan (WI)
     Scalise
     Schmidt
     Schock
     Sensenbrenner
     Sessions
     Shadegg
     Shimkus
     Shuster
     Simpson
     Smith (NE)
     Smith (TX)
     Souder
     Stearns
     Taylor
     Terry
     Thompson (PA)
     Thornberry
     Tiahrt
     Tiberi
     Turner
     Upton
     Walden
     Wamp
     Westmoreland
     Whitfield
     Wilson (SC)
     Wittman
     Wolf
     Young (AK)
     Young (FL)

                               NAYS--247

     Abercrombie
     Ackerman
     Adler (NJ)
     Altmire
     Andrews
     Arcuri
     Baca
     Baird
     Baldwin
     Barrow
     Bean
     Becerra
     Berkley
     Berman
     Berry
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Boccieri
     Boren
     Boswell
     Boyd
     Brady (PA)
     Braley (IA)
     Brown, Corrine
     Buchanan
     Butterfield
     Capps
     Capuano
     Cardoza
     Carnahan
     Carney
     Carson (IN)
     Castor (FL)
     Chandler
     Childers
     Clarke
     Clay
     Cleaver
     Clyburn
     Cohen
     Connolly (VA)
     Cooper
     Costa
     Costello
     Courtney
     Crowley
     Cuellar
     Cummings
     Dahlkemper
     Davis (AL)
     Davis (CA)
     Davis (IL)
     Davis (TN)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Dicks
     Dingell
     Doggett
     Donnelly (IN)
     Doyle
     Driehaus
     Edwards (MD)
     Edwards (TX)
     Ellison
     Ellsworth
     Engel
     Eshoo
     Etheridge
     Farr
     Fattah
     Filner
     Foster
     Frank (MA)
     Fudge
     Giffords
     Gillibrand
     Gonzalez
     Gordon (TN)
     Grayson
     Green, Al
     Green, Gene
     Griffith
     Grijalva
     Gutierrez
     Hall (NY)
     Halvorson
     Hare
     Harman
     Hastings (FL)
     Heinrich
     Higgins
     Hill
     Himes
     Hinchey
     Hinojosa
     Hirono
     Hodes
     Holden
     Holt
     Honda
     Hoyer
     Inslee
     Israel
     Jackson (IL)
     Jackson-Lee (TX)
     Johnson (GA)
     Johnson, E. B.
     Kagen
     Kanjorski
     Kaptur
     Kennedy
     Kildee
     Kilpatrick (MI)
     Kilroy
     Kind
     Kirkpatrick (AZ)
     Kissell
     Klein (FL)
     Kosmas
     Kratovil
     Kucinich
     Langevin
     Larsen (WA)
     Larson (CT)
     Lee (CA)
     Levin
     Lewis (GA)
     Lipinski
     LoBiondo
     Loebsack
     Lofgren, Zoe
     Lowey
     Lujan
     Lynch
     Maffei
     Maloney
     Markey (CO)
     Markey (MA)
     Massa
     Matheson
     Matsui
     McCarthy (NY)
     McCollum
     McDermott
     McGovern
     McMahon
     McNerney
     Meek (FL)
     Meeks (NY)
     Melancon
     Michaud
     Miller (NC)
     Miller, George
     Mitchell
     Mollohan
     Moore (KS)
     Moore (WI)
     Moran (VA)
     Murphy (CT)
     Murphy, Patrick
     Murtha
     Nadler (NY)
     Napolitano
     Neal (MA)
     Nye
     Oberstar
     Obey
     Olver
     Ortiz
     Pallone
     Pascrell
     Pastor (AZ)
     Payne
     Perlmutter
     Perriello
     Peters
     Peterson
     Pingree (ME)
     Polis (CO)
     Pomeroy
     Price (NC)
     Rahall
     Rangel
     Reyes
     Richardson
     Rodriguez
     Ross
     Rothman (NJ)
     Roybal-Allard
     Ruppersberger
     Rush
     Ryan (OH)
     Salazar
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Schakowsky
     Schauer
     Schiff
     Schrader
     Schwartz
     Scott (GA)
     Scott (VA)
     Serrano
     Sestak
     Shea-Porter
     Shuler
     Sires
     Skelton
     Slaughter
     Smith (NJ)
     Smith (WA)
     Space
     Speier
     Spratt
     Stark
     Stupak
     Sutton
     Tanner
     Tauscher
     Teague
     Thompson (CA)
     Thompson (MS)
     Tierney
     Titus
     Tonko
     Towns
     Tsongas
     Van Hollen
     Velazquez
     Visclosky
     Walz
     Wasserman Schultz
     Waters
     Watson
     Watt
     Waxman
     Weiner
     Welch
     Wexler
     Wilson (OH)
     Woolsey
     Wu
     Yarmuth

                             NOT VOTING--7

     Boucher
     Conyers
     Herseth Sandlin
     Sherman
     Snyder
     Solis (CA)
     Sullivan

                              {time}  1435

  Mr. HALL of New York, Ms. FUDGE, Ms. LORETTA SANCHEZ of California, 
Messrs. CARNEY, SIRES, FARR, Ms. SPEIER, and Mr. RAHALL changed their 
vote from ``yea'' to ``nay.''
  Messrs. ROSKAM, NUNES, CANTOR, LaTOURETTE, ROGERS of Kentucky, and 
GERLACH changed their vote from ``nay'' to ``yea.''
  So the motion to recommit was rejected.
  The result of the vote was announced as above recorded.
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.


                             Recorded Vote

  Mr. CARDOZA. Madam Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The SPEAKER pro tempore. This is a 5-minute vote.
  The vote was taken by electronic device, and there were--ayes 289, 
noes 139, not voting 6, as follows:

                             [Roll No. 16]

                               AYES--289

     Abercrombie
     Ackerman
     Adler (NJ)
     Altmire
     Andrews
     Arcuri
     Austria
     Baca
     Baird
     Baldwin
     Barrow
     Bean
     Becerra
     Berkley
     Berman
     Berry
     Bishop (GA)
     Bishop (NY)
     Blumenauer
     Boccieri
     Bono Mack
     Boren
     Boswell
     Boyd
     Brady (PA)
     Braley (IA)
     Brown, Corrine
     Buchanan
     Butterfield
     Cao
     Capito
     Capps
     Capuano
     Cardoza
     Carnahan
     Carney
     Carson (IN)
     Castle
     Castor (FL)
     Chandler
     Childers
     Clarke
     Clay
     Cleaver
     Clyburn
     Cohen
     Connolly (VA)
     Conyers
     Cooper
     Costa
     Costello
     Courtney
     Crowley
     Cuellar
     Cummings
     Dahlkemper
     Davis (AL)
     Davis (CA)
     Davis (IL)
     Davis (TN)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Dent
     Diaz-Balart, L.
     Diaz-Balart, M.
     Dicks
     Dingell
     Doggett
     Donnelly (IN)
     Doyle
     Driehaus
     Edwards (MD)
     Edwards (TX)
     Ehlers
     Ellison
     Ellsworth
     Emerson
     Engel
     Eshoo
     Etheridge
     Farr
     Fattah
     Filner
     Foster
     Frank (MA)
     Frelinghuysen
     Fudge
     Gerlach
     Giffords
     Gillibrand
     Gonzalez
     Gordon (TN)
     Grayson
     Green, Al
     Green, Gene
     Griffith
     Grijalva
     Gutierrez
     Hall (NY)
     Halvorson
     Hare
     Harman
     Hastings (FL)
     Heinrich
     Herseth Sandlin
     Higgins
     Hill
     Himes
     Hinchey
     Hinojosa
     Hirono
     Hodes
     Holden
     Holt
     Honda
     Hoyer
     Inslee
     Israel
     Jackson (IL)
     Jackson-Lee (TX)
     Johnson (GA)
     Johnson, E. B.
     Kagen
     Kanjorski
     Kaptur
     Kennedy
     Kildee
     Kilpatrick (MI)
     Kilroy
     Kind
     King (NY)
     Kirk
     Kirkpatrick (AZ)
     Kissell
     Klein (FL)
     Kosmas
     Kratovil
     Kucinich
     Lance
     Langevin
     Larsen (WA)
     Larson (CT)
     LaTourette
     Lee (CA)
     Lee (NY)
     Levin
     Lewis (GA)
     Lipinski
     LoBiondo
     Loebsack
     Lofgren, Zoe
     Lowey
     Lujan
     Lynch
     Maffei
     Maloney
     Markey (CO)
     Markey (MA)
     Massa
     Matheson
     Matsui
     McCarthy (NY)
     McCollum
     McCotter
     McDermott
     McGovern
     McHugh
     McIntyre
     McMahon
     McNerney
     Meek (FL)
     Melancon
     Michaud
     Miller (MI)
     Miller (NC)
     Miller, George
     Minnick
     Mitchell
     Mollohan
     Moore (KS)
     Moore (WI)
     Moran (KS)
     Moran (VA)
     Murphy (CT)
     Murphy, Patrick
     Murphy, Tim
     Murtha
     Nadler (NY)
     Napolitano
     Neal (MA)
     Nye
     Oberstar
     Obey
     Olver
     Ortiz
     Pallone
     Pascrell
     Pastor (AZ)
     Paulsen
     Payne
     Pelosi
     Perlmutter
     Perriello
     Peters
     Peterson
     Petri
     Pingree (ME)
     Platts
     Polis (CO)
     Pomeroy
     Price (NC)
     Rahall
     Rangel
     Rehberg
     Reichert
     Reyes
     Richardson
     Rodriguez
     Rogers (AL)
     Ros-Lehtinen
     Ross
     Rothman (NJ)
     Roybal-Allard
     Ruppersberger
     Rush
     Ryan (OH)
     Salazar
     Sanchez, Linda T.
     Sanchez, Loretta
     Sarbanes
     Schakowsky
     Schauer
     Schiff
     Schrader
     Schwartz
     Scott (GA)
     Scott (VA)
     Serrano
     Sestak
     Shea-Porter
     Shuler
     Simpson
     Sires
     Skelton
     Slaughter
     Smith (NJ)
     Smith (WA)
     Space
     Speier
     Spratt
     Stark
     Stupak
     Sutton
     Tanner
     Tauscher
     Taylor
     Teague
     Thompson (CA)
     Thompson (MS)
     Thompson (PA)
     Tiberi
     Tierney
     Titus
     Tonko
     Towns
     Tsongas
     Turner
     Upton
     Van Hollen
     Velazquez
     Visclosky
     Walz
     Wasserman Schultz
     Waters
     Watson
     Watt
     Waxman
     Weiner
     Welch
     Wexler
     Wilson (OH)
     Wolf
     Woolsey
     Wu
     Yarmuth
     Young (AK)
     Young (FL)

                               NOES--139

     Aderholt
     Akin
     Alexander
     Bachmann
     Bachus
     Barrett (SC)
     Bartlett
     Barton (TX)
     Biggert
     Bilbray
     Bilirakis
     Bishop (UT)
     Blackburn
     Blunt
     Boehner
     Bonner
     Boozman
     Boustany

[[Page 757]]


     Brady (TX)
     Bright
     Broun (GA)
     Brown (SC)
     Brown-Waite, Ginny
     Burgess
     Burton (IN)
     Buyer
     Calvert
     Camp
     Campbell
     Cantor
     Carter
     Cassidy
     Chaffetz
     Coble
     Coffman (CO)
     Cole
     Conaway
     Crenshaw
     Culberson
     Davis (KY)
     Deal (GA)
     Dreier
     Duncan
     Fallin
     Flake
     Fleming
     Forbes
     Fortenberry
     Foxx
     Franks (AZ)
     Gallegly
     Garrett (NJ)
     Gingrey (GA)
     Gohmert
     Goodlatte
     Granger
     Graves
     Guthrie
     Hall (TX)
     Harper
     Hastings (WA)
     Heller
     Hensarling
     Herger
     Hoekstra
     Hunter
     Inglis
     Issa
     Jenkins
     Johnson (IL)
     Johnson, Sam
     Jones
     Jordan (OH)
     King (IA)
     Kingston
     Kline (MN)
     Lamborn
     Latham
     Latta
     Lewis (CA)
     Linder
     Lucas
     Luetkemeyer
     Lummis
     Lungren, Daniel E.
     Mack
     Manzullo
     Marchant
     Marshall
     McCarthy (CA)
     McCaul
     McClintock
     McHenry
     McKeon
     McMorris Rodgers
     Mica
     Miller (FL)
     Miller, Gary
     Myrick
     Neugebauer
     Nunes
     Olson
     Paul
     Pence
     Pitts
     Poe (TX)
     Posey
     Price (GA)
     Putnam
     Radanovich
     Roe (TN)
     Rogers (KY)
     Rogers (MI)
     Rohrabacher
     Rooney
     Roskam
     Royce
     Ryan (WI)
     Scalise
     Schmidt
     Schock
     Sensenbrenner
     Sessions
     Shadegg
     Shimkus
     Shuster
     Smith (NE)
     Smith (TX)
     Souder
     Stearns
     Terry
     Thornberry
     Tiahrt
     Walden
     Wamp
     Westmoreland
     Whitfield
     Wilson (SC)
     Wittman

                             NOT VOTING--6

     Boucher
     Meeks (NY)
     Sherman
     Snyder
     Solis (CA)
     Sullivan


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore (during the vote). There are 2 minutes 
remaining on this vote.

                              {time}  1445

  So the bill was passed.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.
   Stated for:
  Mr. MEEKS of New York. Madam Speaker, on Rollcall No. 16, I was 
avoidably delayed and just missed the vote. Had I been present, I would 
have voted ``aye.''

                          ____________________