Children's Health Insurance Program Reauthorization Act of 2009--Continued

Floor Speech

CHILDREN'S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT OF 2009--Continued -- (Senate - January 27, 2009)

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Mr. WHITEHOUSE. Mr. President, I see my colleague and friend from Virginia, Senator Webb, who is prepared to speak, and we will recognize him in just a moment.

I would note there would have been, by our estimates, 3.3 million children who would have been covered had the bill passed in 2007. That would have been one very good way to reduce the number of children in this country who are not protected by health insurance.

Mr. BURR. Mr. President, will the Senator yield for a question?

Mr. WHITEHOUSE. Of course.

Mr. BURR. Would any of those 3.3 million children have been in 100 percent to 200 percent of poverty?

Mr. WHITEHOUSE. As I understand it, the bill contained both funds and programs for outreach that would have supported the States in their initiatives to find the children who, because their parents were moving or for one reason or another, were eligible but had not entered into these State programs. So I think the answer to that question would be yes.

Mr. BURR. Let me suggest to the Senator--and I will not ask him to yield much longer--there was the same expansion of eligibility in last year's bill, so the likelihood is any increase in enrollment would have been spread across not just the 100 percent to 200 percent of poverty, but all the way up to the 400 percent of poverty.

Mr. WHITEHOUSE. I think the increase in enrollment would have spread wherever the program went. There are very few areas, as the Senator knows, where the eligibility level is 400 percent of poverty. In the vast majority of the country, in my State, for instance, it is well below that. It is a program that supports working families, that supports low-income working families, that makes sure their children get health care.

But for a number of reasons, probably the most prominent of which is people moving from location to location and not being registered with the local program, there are outreach requirements. I would be happy to work with the Senator on improving those outreach requirements in any way he wishes. But I think to hold the entire bill and his support--I think in this case we are estimating it will now reach 4.1 million children--hostage because of not having gotten the outreach better is a strategic mistake.

If your goal is to insure more children, then you should go about it by insuring more children. If the outreach is a problem, then we can happily make that better. But for outreach to be criticized, when it was President Bush who vetoed that bill, I am not sure how the distinguished Senator from North Carolina voted on that--

Mr. BURR. Mr. President, I would be happy to disclose to my colleague that I voted against the bill, for the same reasons that without changes I will oppose it this year because the eligibility requirement is being expanded.

As I said, and I thought fairly clearly, when you expand eligibility, you take the pressure off of making sure the enrollees come from the most at risk. It is my hope we can modify this bill. I am not embarrassed to be on the Senate floor and talk about the aspects of this legislation that I am unhappy with. But certainly I can count, and I know the majority can move this bill at any point they feel comfortable, and I am sure they will.

At the end of the day, it is my hope we will cover as many of the originally targeted children in that 100 percent to 200 percent of poverty as possible.

Mr. WHITEHOUSE. I understand the Senator from Virginia wishes to speak. I will simply respond before I yield the floor to Senator Webb that I have had quite a number of years of experience with our Children's Health Program in Rhode Island, back to the years when I came in with Governor Sundlun in a bad economic crisis in Rhode Island--probably the largest percentage deficit in the State budget of any State ever recorded. Even in that very gloomy fiscal environment, Governor Sundlun insisted we build a statewide universal health care program that protected children.

SCHIP is very much in line with that. The people who have been working on that for these many years in Rhode Island--and I suspect it is the case in many other States--feel a real passion for trying to make sure children get health care, that they get the health care to which they are entitled.

So I am not sure the notion that by just putting more pressure on them, by just refusing to add any other children until they have done this, is really a productive or fair way to go about reaching the children who have not been reached. What the bill does is provide outreach funds and empower these people who care so deeply about this issue to actually get out there and work harder to find them, have the additional resources to find people. From my work in law enforcement, my work with schools, my work on health care, there are a lot of people who live apartment to apartment, very hand to mouth, and it is a very significant challenge to keep up with them. The resources to do that, I submit, would be the best way to solve that problem, not holding one set of children hostage to providing health care for another set of children.

With that, Mr. President, I yield the floor for the distinguished Senator from Virginia.

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Mr. WHITEHOUSE. Mr. President, this week we have the chance in the Senate to provide health insurance to 4.1 million children in this country who now don't have it, to cover 11 million children total. All we have to do is the right thing and pass H.R. 2, the Children's Health Insurance Program.

I know the distinguished Presiding Officer from Nebraska and the distinguished Senator from Virginia, who has just spoken so eloquently, have shared the experience I have had in my home State of Rhode Island, and that is to travel around and hear personal stories from people whose lives and whose health have collided with our broken, dysfunctional health care system. Too often, families in this country can't afford to pay for the care they need. As our economic troubles worsen, that problem only grows more acute. Too often, they can't even get in to see a doctor. Too often, when they do receive care, it falls short in quality, in efficiency, in effectiveness, and in timeliness.

The crisis in our health care system affects all of us, but it is greatest and it is most tragic when it affects our children. That is why Congress created the Children's Health Insurance Program which for years has given millions of uninsured, hard-working American families access to health care for their kids.

The program has not only expanded health care coverage for children, it has encouraged States to be flexible, innovative, and responsive in meeting their families' health care needs. We come from 50 different States with 50 different sets of history, demographics, and economics, and as a result, the States come up with different programs. That is something to celebrate, not to bemoan. The program has safeguarded the vulnerable, it has united families, and it has invested in the future of our Nation. It is a special program of all the things that we do here.

The Children's Health Insurance Program means that children are more likely to receive medical care for common conditions such as asthma or ear infections. It means that children end up with higher school attendance rates, and that children have higher academic achievement. It means that children have more contacts with medical professionals. It means that children receive more preventive care. It means that children go to the emergency room when it is an emergency, and when it is not, they have someplace else to go that allows them and their families to stay out of those expensive urgent care settings. So as we have done for the past 2 years, this week we are working to pass legislation to ensure that every eligible uninsured child in America can get regular checkups when they are well and can get medicine when they are sick.

Not long ago, former President Bush denied children needed health care coverage by vetoing this legislation. But the American voters have spoken and we are in a new era in this country--a new era for peace of mind, for security, and for dignity for American children and for their families. With a new Congress and a new President committed to health care for all American families, I could not be more hopeful as we discuss this bill today.

I am especially proud to serve with my senior Senator, Jack Reed of Rhode Island, and to support him in this fight. I have been in the Senate for 2 years now. Before I even got here, Jack Reed was one of the most prominent, most ardent, and most determined fighters for our Nation's children. Frankly, it is in significant part due to his relentless work that we have come this far.

I am proud also to represent a State that has one of the lowest rates of uninsured adults and children in the Nation. It was not easy. Rhode Island worked hard over the past 15 years to achieve this success. It began with the RIte Care Program in 1993. In 2001, the creation of the Children's Health Insurance Program allowed Rhode Island to further reduce uninsurance rates in the State. I am proud to be on the team of former Governor Bruce Sundlun who turned 89 a few days ago. When he was Governor, he created the original RIte Care Program. His vision and determination to do this, in a time of grave economic straits for Rhode Island, has yielded immense rewards. Now, as health care costs skyrocket and the number of people in this country who lack health insurance approaches the staggering number of 50 million--50 million Americans, and so many of them children--we in Congress have an obligation to strengthen initiatives like RIte Care through which States have made health care more accessible.

Today, 4.1 million uninsured children are waiting for us to pass this bill; 4.1 million children who might not see a doctor this winter when they get the flu because their parents can't afford to pay out of pocket for the visit; 4.1 million children who might delay needed vaccinations or other preventive care because their parents have to buy food instead; 4.1 million children who might not get an inhaler or insulin or--heaven forbid--chemotherapy because in this economic downturn, the money just isn't there.

Who could say no to uninsured, vulnerable children? Should we not at least be able to agree on that? Why would anyone say no? We plan to raise taxes on cigarettes, a tax that the American Cancer Society says could prevent nearly 1 million deaths and keep nearly 2 million children from starting to smoke; a tax with health savings that could ultimately decrease government costs for government health care programs; a tax that the Congressional Budget Office confirms will fully offset this bill so as not to add to our deficit. I don't think that would be a good reason to deny vulnerable children the safety and security of health insurance.

During the course of this discussion, some Members have tried to make this debate about illegal immigration. It is not. We should not permit the very difficult issue of illegal immigration to affect this bill to deny millions of children the health care they badly need. That would be a grave mistake. That would be a wrong.

Let me be very clear: Only children who are legally in the United States are eligible to receive coverage under Medicaid or the Children's Health Insurance Program. They must document their immigration status. Medicaid agencies use information provided by the Bureau of Citizenship and Immigration Services to confirm the status of legal immigrants applying for benefits.

Further, this bill does not even require States to cover legal immigrant children. It simply provides and supports that option.

Legal immigrants pay taxes, they serve in our Armed Forces, and just like the rest of us, they play by the rules. They are our future citizens, and insuring their children makes sense. This was the law until 1996 when sweeping restrictions affecting legal immigrants were made. Since 1996, we have become wiser, and many of those restrictions have been reversed on a bipartisan basis by Congress. The provision in this legislation covering legal immigrants is fully consistent with that trend back to 1996 levels.

This Nation is slowly emerging from a dark time when our ideals and our virtues were too often hidden in the shadows, when we let our fear overcome our principles and our better judgment, when we lost sight of our priorities and left millions of people in the cold and millions of children uninsured. That time can end now.

This bill is a chance to show these millions of Americans that we have heard them and that we stand ready to help. We know how tough it is for working families in this economy. If there is one worry, one burden we can take off those parents' shoulders so they can be sure their children have the health insurance every American deserves, we should stand ready to help. This country should once again own its duty to protect those who cannot protect themselves and to restore dignity and hope where it has diminished.

I close by applauding Chairman Baucus and the Finance Committee for bringing this vitally important and long overdue legislation to the floor.

I urge all of my colleagues--it would be wonderful if we could do this together--to allow these 11 million children to be covered by health insurance, to have access to the health care they need, to grow up healthy and strong and ready to seize the boundless opportunities that are at the heart of the American dream.

I think we will find in the months and in the years ahead that there will be things we cannot do to help families. I know everybody in this Chamber wants to do everything they can, and we want to work as hard as we can, but the economic situation is dire, and we are not going to be able to do everything we would like. But this is something we can do. This is something we can do for American families and for their children, and I hope very much we will do it.

I yield the floor. I suggest the absence of a quorum.

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Mr. WHITEHOUSE. Madam President, I see the very distinguished Senator from Arkansas in the Chamber to take over managing this bill.

Before I leave the floor, I want to make two points. I have been here while a great deal of discussion has taken place about 5.4 million children who are eligible for children's health care but who, through lack of effort, it is claimed, the State programs are not finding. The purpose of the argument has been to argue if we could make the States find these kids, they would be the ones for whom the program was truly designed, and that the 4.1 million additional children we are going to help with this legislation are sort of a distraction from that figure.

I have not been able to source that 5.4 million number to anything. I would note on a population basis, my State of Rhode Island is one three-hundredth of the country. So if there are 5.4 million kids out there, in that circumstance, Rhode Island should have, by my math, 18,000 of them. We only have 12,000 kids in the CHIP-funded portion of what we call the RIte Care Program.

From my own experience, the likelihood of there being 18,000 eligible children in our small State who cannot be found makes no logical sense at all, which gives me significant pause about the validity of this 5.4 million number upon which so much of our colleagues' argument stands.

The other point I would make is there are many States that could reach more eligible children, but the funding is not there for them. Rhode Island is one such State. When other States return funds, we get access to that pool, and we can expand our coverage.

So, in fact, by supporting this legislation, you will enable the State programs to reach whatever that group of kids is, whether it is 5.4 million or 540,000. I do not know what the number is. Madam President, 5.4 million sounds very unlikely. But even setting that question aside, the fact that we would vote against this piece of legislation in order to help those 5.4 million kids makes no sense whatsoever because this legislation contains both the funding and the outreach tools to allow the State programs to reach those very kids.

So that argument, at least from this Senator's perspective, appears to hold no water whatsoever, or at least requires substantially better justification and support before it should be counted on, at least in my view, by any Senator as a reason to oppose this piece of legislation.

With that observation, I yield the floor and suggest the absence of a quorum.

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