Children's Health Insurance Program Reauthorization Act Of 2009

Floor Speech

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Ms. MURKOWSKI. Madam President, I am speaking on the floor about this very important issue of how we provide for the best coverage, the maximum coverage, for the rising number of Americans without health insurance because we all recognize this is a problem. According to the most recent data, 47 million Americans today are not receiving proper medical care, so CHIP comes in--the Children's Health Insurance Program.

This program has been an exceptionally important means of providing the most vulnerable of our population--our children--with health care. And we all know that when our children are sick, it is not just the child who is impacted, it is the whole family--it is the parent who misses time from work to care for their child because they don't want to take their child to school for fear that the bug will spread. So the social and economic impact of a sick child goes well beyond the need for cough syrups and bandaids, and the impact in my State of Alaska is felt even greater within our Native communities.

I think it is fair to say SCHIP has always been a bipartisan bill. Since its inception back in 1977, with the then Republican-controlled Senate, working with Democrats in Congress and a Democratic administration, we were able to ensure that the poorest of our children have access to health insurance. Since then, we have seen continued success with this program, with Republicans, Democrats, and Independents alike rejoicing in a health care bill that has broad bipartisan support and that has been able to effectively cover our poorest children.

I supported both of the CHIP bills that passed in 2007. It expanded the SCHIP eligibility to 300 percent of the Federal poverty level--the FPL--which is $66,600 for a family of four. But I will tell you I think the bill we have in front of us is not even close to what we passed in 2007. And quite frankly, I am not sure why a bill that enjoyed such broad bipartisan support was gutted and filled with provisions which, as we have seen on the floor today and yesterday, have been pretty controversial. I am perplexed that the decision has been made to go in a different direction than the direction we took when we overwhelmingly passed this legislation before.

There are some provisions, particularly with regard to ensuring that our lowest income children are covered first, that have made this bill difficult for some to support, even for some of those Senators who spearheaded the SCHIP bills in the past. So I would like to offer an amendment that I believe will improve this bill in a significant way and will reassure many of us who are concerned about how we ensure that the lowest income children will be covered.

I am offering an amendment to the CHIP bill that has been cosponsored by Senator Specter, Senator Johanns, and Senator Collins. Senator Specter, Senator Collins and myself were all on the previous SCHIP bills. Senator Johanns, of course, is new to the Senate but a former Governor.

Let me describe it quickly, briefly, because this is a pretty simple amendment. You might say it sounds pretty similar to what we had before us in the past, and you would be correct. The amendment includes three basic principles that I believe are essential to the continued success of the CHIP program.

First of all, it says we need to know and we need to have published information on how States are addressing the best practices for insuring low-income children--those children from families who are earning less than 200 percent of the Federal poverty level.

So let's figure it out. We want to know, we need to publish it, we need to accumulate the data, as to what States are doing to make sure they are covering the poorest children. When we know what it is that other States are doing to be successful, let's share that with other States so they, too, can use similar types of approaches to make sure we are not losing any of these children through the cracks; that we are not overlooking them. Let's share these best practices.

The second piece of this amendment says we also need to know and have published information on what factors are attributing to kids over 200 percent of FPL that are enrolling in their State CHIP. Of course, this goes back to the crowdout issue that has been discussed a great deal on the floor this afternoon. What is it? What are the factors? Let's know and understand what it is that would be causing those families who may have private insurance--what is causing the push then to enroll in their State's CHIP. Again, let's try to understand better what is going on.

I can't imagine there is anything controversial with either the first or second part of this amendment.

The third part of the amendment says that if a State wants to exceed 300 percent of the Federal poverty level for CHIP, they will have the flexibility in working with the Secretary of Health and Human Services to ensure that the State first demonstrates an enrollment of at least 80 percent of the children below 200 percent of FPL. So we are saying: OK, if you want to go above 300 percent, you are certainly able to do so, but please first demonstrate to us that you have covered 80 percent of your children who are below 200 percent of the Federal poverty level.

Now, we had some target language out here earlier, and there was actually target language in both CHIP I and CHIP II. This standard, if you will, of 80 percent, is a much less rigorous and, quite honestly, a much more obtainable standard. If you look through the list of States, there are various FPLs for each State and then what their percentages are in terms of how many of their children they are enrolling. I think, if you look to the State of Michigan, you are at 200 percent of FPL. In your State, you are doing actually very well in terms of enrolling your children. You are about 90 percent. So you are in pretty good shape.

So for purposes of what I am laying out here, the State of Michigan is absolutely unaffected. You can move forward. You don't have any concern because you have done the job of insuring at least 80 percent. In fact, you have gone to 90 percent.

So this is a target we are setting that I believe is reasonable and achievable and workable. So what we are asking, again, is if you are going to exceed 300 percent of FPL--if Michigan wanted to go above 300 percent, you could because you have demonstrated that you have covered at least 80 percent of your children below the 200-percent Federal poverty level. If you haven't, then no Federal payment match will be made for those individuals over 300 percent FPL, unless and until the Secretary establishes that the State is in compliance with these regulations in an amount of time not to exceed 12 months. Again, if you are a State that has already established you have covered that target rate of 80 percent of your kids, you could go above the 300 percent level.

My amendment is pretty straightforward. It allows the Secretary to ensure that what we have is a built-in safeguard--a safeguard measure--for at least 80 percent of the poorest of our children to be enrolled in SCHIP or a Medicaid expansion program before children from higher income families--those earning above 300 percent--are enrolled. This amendment provides flexibility to the States in working with the Secretary of Health and Human Services to ensure that we are protecting our poorest kids by insuring them before we expand to higher income populations.

I submit this is a very reasonable provision. Part of the components of this amendment we have seen in CHIP I and CHIP II, which a broad bipartisan group of Senators voted to back. I think it is reasonable, I think it would be a good improvement to this bill, and I think it would help to allay some of the concerns that we are not working first to address the enrollment of at least 80 percent of our more needy children.

With that, I would certainly encourage my colleagues to look carefully at my amendment, I ask for their support, and I yield the floor.

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Ms. MURKOWSKI. Mr. President, I ask that all Members listen for 1 minute. I would like to think I have earned the reputation of being a relatively reasonable Senator in my approach. What I have before you today is a pretty reasonable amendment.

What I am proposing in this amendment we have before us is if a State wants to exceed the 300 percent FPL for CHIP, if they want to go above that level, what my amendment says is, we are going to give the flexibility for the States to be working with the Secretary to ensure that before they do that, if they can ensure that 80 percent of the children within their State are covered, those children below 200 percent of the Federal poverty level, if 80 percent of those are covered, then you have the flexibility to go above that 300 percent.

What we are allowing for is to guarantee, if you will, that we are covering those children we set out to do when we passed SCHIP in the first place. So, 80 percent, look at your State's level. Just about all States can meet this. We want to provide a level of flexibility, but we want to ensure that the children from the neediest families are going to be taken care of first. I ask for my colleagues' support.

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