[Congressional Record (Bound Edition), Volume 161 (2015), Part 3]
[Senate]
[Pages 4138-4140]
[From the U.S. Government Publishing Office, www.gpo.gov]




           THE BUDGET AND CHILDREN'S HEALTH INSURANCE PROGRAM

  Mr. CASEY. Mr. President, I rise to talk tonight about one issue: the 
issue of children. But I wish to speak about that one issue in two 
separate contexts: One is the budget we are debating now and will 
continue to vote on all week and the second is with regard to the 
Children's Health Insurance Program.
  Let me start with the premise that I believe those of us who were 
elected to both Houses of the Congress and in both parties are charged 
with a basic responsibility to our children. It doesn't matter where we 
live or what State we represent or what district, in the case of the 
House, I believe we are charged with that responsibility.
  A long time ago, Hubert Humphrey, who served in this Chamber for many 
years and was well known across the country, set forth a moral test for 
government. He talked about the moral test being how government treats 
those in the dawn of life, those in the shadow of life, and those in 
the twilight of life. Of course, in speaking of the dawn of life, we 
are talking about children. That test is still appropriate and we 
should try our best to adhere to it in terms of public policy, 
especially when it comes to the budget.
  The budget, of course, is a reflection of who we are as a country and 
what our values are. It is in a sense a mirror into which we look or 
should be looking to see who we are. And if we are not setting forth 
policy and being strong advocates for our children, we may as well not 
be here. So I think there is a test that each one of us must face when 
it comes to what we are doing on behalf of children.
  I also believe in a very real sense that the programs, the 
strategies, the expenditures we make on behalf of children are in fact 
an investment--an investment in the long-term economy of the United 
States. This isn't just the

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right thing to do; it is also the best thing we could do for a growing 
economy and for our fiscal situation years from now. If kids are 
healthier, they will get better jobs. If they learn more when they are 
younger, they are going to earn more when they are older. That is not 
just a rhyme, it is true, and all the studies show it. So I believe 
this budget debate is a time to reflect upon what will happen to our 
children. I have real concerns about the budget as it relates to 
children.
  Again, these are in our society the folks who are powerless and in 
many cases voiceless. They are not voting, they don't have a lobbyist, 
they don't have a high-paid strategist or voice for their needs. 
Because they are powerless and because they are in a sense voiceless, 
it is up to us to speak on their behalf--and we speak with our votes, 
we speak with our work.
  So what is the proposal in this budget? Let me work through some of 
the numbers.
  According to one of the leading advocacy organizations in the United 
States, First Focus, discretionary investments make up nearly one-third 
of all Federal investments that go to children. So what we do on the 
discretionary part of the budget--which, by definition, because it is 
discretionary, we have decisions to make about it year after year. 
Because of that, we have to be very careful when it comes to these 
decisions--whether it is the budget resolution, whether it is the 
authorization process, or whether it is in fact the appropriations 
process. This funding, this so-called discretionary, nonmandatory--if I 
can call it that--part of the budget includes programs such as Head 
Start, childcare assistance, housing support, special education, to 
name a few examples that have a direct and substantial impact upon our 
children.
  The Republican budget we are debating this week cuts $236 billion 
over 10 years in the nondefense discretionary part of the budget. 
Nondefense discretionary is a long way of saying the part of the budget 
that we vote on and we will have votes on that relate to the 
appropriations. So $236 billion over 10 years is the cut. That cut, I 
would argue, falls disproportionately in a substantial way upon 
children.
  What do these cuts mean for children and for families? Of course, we 
cannot separate one from the other. We will look at Head Start, and 
35,000 children will be cut from Head Start--some 1,250 fewer children 
in a State like Pennsylvania, just by example for one State. What are 
we going to gain? How better off would the country be with 35,000 fewer 
kids in Head Start? I don't think we are going to be better off. I 
think we are worse off if we do that. It makes no sense. This is a 
program that has been in existence for 50 years. It has helped a lot of 
children succeed.
  The State director from my office in Pennsylvania, who just left our 
staff recently and served with distinction, Ed Williams, was a Head 
Start kid. I meet people all the time in our State who are leading very 
successful lives in the private sector or public sector. Ed is just one 
example of having had the benefit of Head Start to get a head start in 
life because of disadvantages that certain children face.
  How about students with disabilities, a $347 million cut to funding 
for students with disabilities, which means a little more than $12 
million less for Pennsylvania children with disabilities.
  How about housing, 133,000 nationwide fewer housing vouchers. In 
Pennsylvania, that adds up to 620 families who, if they had those 
vouchers, would be able to afford decent and safe housing. What are we 
getting for fewer families who have access to housing vouchers? Again, 
it is not an experimental program. It is a program that we know works, 
a program that has been in existence for a long time to help folks.
  We know when we invest early in a child's life, we see a great return 
on investment. All the studies show this. It is irrefutable: If you 
spend a buck, you get a lot more than a buck back. By some estimates, 
the bang for the buck is in the double figures. In one study on early 
learning, we get $17 back for the $1 spent.
  I mentioned before that if we make investments in children in terms 
of their early learning, they will in fact learn more now and earn more 
later. That is what we should be focused on when it comes to our 
children, when it comes to their ability to succeed in school and, of 
course, when it comes to their ability to get a good job and be part of 
a growing economy.
  The budget proposal makes deep cuts in many other investments to 
protect our most vulnerable children, including the Supplemental 
Nutrition Assistance Program, the so-called SNAP program that we used 
to call food stamps. That, of course, provides nutrition aid. If we 
were doing the right thing as a nation--and we are not there yet, even 
though we have made some progress on some fronts--we would make sure 
children have enough to eat. That would be one pillar of our protection 
for children. We are not there yet, but the SNAP program helps 
substantially on that. We would make sure they have early learning 
opportunities. I talked about that and will talk about it more. We 
would make sure they have access to health care. That is why we have 
Medicaid for poor children, that is why we have the Children's Health 
Insurance Program for others, and that is why so many private sector 
companies provide health care that, of course, covers children of their 
employees. But if we are doing at least those three things--early 
learning, food security or food and nutrition, as well as health care--
we are going to be doing what is right for our children.
  I would argue we have to examine this budget and apply a kids' test--
not a special interest test, not a lobbyist test, not a who-is-powerful 
test, not a test about who has the most to gain from this budget, but 
who might have to most to lose, and one of those groups, I would argue, 
is our children.
  When it comes to the SNAP program, according to Feeding America--
another great advocacy group--nearly half of all SNAP participants are 
children. And according to another organization we rely upon for 
analysis, the Center on Budget and Policy Priorities, investments in 
SNAP lifted 2.1 million children out of poverty in 2013.
  So why would we cut a program like that, that would 
disproportionately and adversely impact our children? What do we gain 
from that as a country? What do we gain when fewer and fewer children 
are helped with a nutrition program that will make sure they have 
enough to eat?
  In addition to SNAP, the Republican budget would roll back 
significant progress we have made for children who qualify for the 
child tax credit or the earned-income tax credit. If the improvements 
to these credits are allowed to lapse, the Center on Budget and Policy 
Priorities estimates that 1 million children will fall back into 
poverty. I think people in both parties would argue that these two--and 
maybe especially the earned-income tax credit--are one of the best, 
some would argue the best--the best--poverty reduction strategies we 
have ever had in place in our policy.
  I think if the earned-income tax credit is keeping children out of 
poverty, we should make sure it remains in place and remains a tax 
strategy that can help prevent 1 million children from falling back 
into poverty.
  We should also be using the Tax Code to help working families rise 
into the middle class, those families who may not be there yet but can 
rise into the middle class. But instead, the Republican budget does 
nothing to prevent tax increases, averaging $1,100 for 12 million 
families and students paying for college, and $9,000 for 16 million 
working families with children. That makes no sense for those families 
or for those children.
  As many as 486,000 Pennsylvania families could benefit from the 
earned-income tax credit, the child tax credit and the opportunity tax 
credit of 2015--all good ideas, all impacted adversely by the budget.
  Finally, I will conclude with Medicaid. Medicaid for some people is 
some program far away that they don't think affects their lives. A lot 
of families--lower income families, middle-class families, even--
benefit from the long-term care part of Medicaid. A lot

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of families may not know that Medicaid is the reason that their mother, 
father, or loved one could be in a nursing home.
  What does it mean for kids? Medicaid for so many children, millions 
of them, is the only health care they have. The good news is that it is 
very good health care for a lot of children. They get access to early 
periodic screening and diagnostic testing. So they get the screening 
and the testing they need so we can provide the kind of health care 
that child needs, but we cannot provide unless we do that screening for 
those children. It provides quality health care for millions of 
children in the country. We should remember that when people make 
proposals around here to slash Medicaid, some by hundreds of billions 
of dollars over the next decade, that it is a direct hit--a direct hit 
on children.
  Based on calculations from the White House, the Republican budget 
proposal would block-grant Medicaid funding to Pennsylvania by more 
than $41 billion over 10 years. I don't know how the Commonwealth of 
Pennsylvania or any State is going is to be better off when Medicaid is 
block-granted, sent back to the States, hoping--just hoping--that maybe 
the States can pick up the cost. That makes no sense. Our State is 
going to be worse off if we lose $40 billion, or even a number lower 
than that, over the next 10 years on Medicaid.
  By one estimate last fall, 47 percent of children who live in rural 
areas are the beneficiaries of either Medicaid or the Children's Health 
Insurance Program. So when those folks talk about cutting Medicaid or 
not doing what I hope we can do--which is to extend the Children's 
Health Insurance Program for the next 4 years, not only 2--they should 
remember that 47 percent of rural children benefit from those programs.
  When it comes to Medicaid, children may only make up 20 percent of 
the cost of Medicaid, but half of the enrollees in Medicaid are 
children. So they might only be 20 percent of the cost, but they are 
half of the enrollees.
  We know that Medicaid was created 50 years ago. The government put 
forth a promise, which is somewhat of the test I started with about 
children in the dawn of their life. The promise was to ensure that the 
most vulnerable members of society had access to health care, a pretty 
simple promise and pretty easy to understand our obligation when we 
recite that promise.
  So whether it is our kids, whether it is older Americans who need to 
get nursing home care, or whether it is Americans and many of them 
children with disabilities, Medicaid ensures that access to health 
care. Medicaid is the promise we must keep to folks who need nursing 
home care, to children who are poor and may not have health insurance 
without Medicaid, and of course to individuals with disabilities. So we 
have a long way to go to prove that we are keeping that promise.
  Mr. President, I will conclude with some thoughts about the 
Children's Health Insurance Program. We all know this is not only a 
bipartisan program but a very successful program. From 1997, when it 
was enacted, to the year 2012, the uninsured rate for children fell by 
half--from 14 percent to 7 percent--across the country, a remarkable 
achievement. It means we are not there yet because we still have 7 
percent who are uninsured, but that is a substantial step forward and a 
substantial measure of progress for the country.
  This program, the Children's Health Insurance Program, along with 
Medicaid, is helping to reduce disparity in health coverage affecting 
low-income children across the country. Without legislative action to 
extend funding beyond September 30 of this year, over 10 million 
children across America are at risk of losing their comprehensive, 
affordable--I will say that again, comprehensive and affordable quality 
care, including, by one estimate, 270,000 children in Pennsylvania. 
About 2 million of the children currently enrolled in CHIP would likely 
end up uninsured while the others would face higher premiums and higher 
out-of-pocket costs. We should do the right thing and make sure we have 
funding in place for 4 years for the Children's Health Insurance 
Program, not just 2 years.
  Unfortunately, what we are hearing from the proposal sent to us from 
the House is that the 4-year commitment is only 2 years. So we have a 
lot of work to do. I believe the right thing to do on CHIP is to enact 
what Senate Democrats have proposed--a 4-year so-called clean extension 
of the Children's Health Insurance Program as soon as possible, and 
that is S. 522. That would be the right thing to do.
  We can give speeches and talk a lot about how we all support kids, 
and it is nice to say that and it is nice to vote once in a while for 
programs and strategies that help kids, but I believe the test is a lot 
tougher than that. The test will come on this budget vote--a test on 
whether we support children. If we are cutting Medicaid by hundreds of 
billions of dollars over the next 10 years, if we are cutting the SNAP 
program by tens of billions of dollars or more, maybe even higher than 
that over the next 10 years, and if we are not doing the right thing on 
children's health insurance--and I could go down a longer list--then we 
are not doing what we need to do for children. They don't have 
lobbyists, they don't give campaign contributions, they don't have 
power, and they may be voiceless, but we have an obligation in both 
parties and in both Houses to be their voice. But I am afraid we are 
headed down a road with a budget that harms children substantially, and 
I hope that over the next couple of days we will make the right 
decisions for our children.
  With that, I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. Will the Senator withhold his request?
  Mr. CASEY. I will.

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