August 03, 2007

REAUTHORIZATION OF THE CHILDREN'S HEALTH INSURANCE PROGRAM

Mr. CARDIN.  Mr. President, this is an important week in the United States Senate.  It is a week in which we have a chance to make a fundamental difference in the lives of America's children by reauthorizing the Children's Health Insurance Program. The  bipartisan bill we are considering will extend to more than 3 million children comprehensive, affordable, health care coverage, and it will provide  continued coverage to the approximately 6.6 million children in the program today.

 

We know that there is a health care crisis in this country.   The United States spends far more per capita than any other nation on health care services, yet our health status lags in many areas.  This is primarily because we have a fragmented, inefficient health care system that shifts costs, and because there are so many Americans who don't have comprehensive coverage.

 

With more than 46 million Americans uninsured, it is no longer a matter of whether we take action to achieve universal health insurance, but how.    On Monday, I introduced the Universal Health Coverage Act of 2007, a bill that requires all Americans to have health insurance.  It is a universal mandate that builds upon our current system of employer-based insurance.  It provides for a choice of state-developed and approved low cost plans for those who cannot afford health insurance coverage in the private market  yet do not qualify for programs such as Medicare, Medicaid, and CHIP.    I believe that universal health care is an attainable goal, yet one that requires us to fully fund and support existing programs that are proven successes. 

 

One such program is CHIP, the Children's Health Insurance Program, which is now before the Senate.

 

This is a program that has provided millions of American children with the care they need to grow into healthy adults.  This week, we can make great strides by reauthorizing CHIP and covering millions more uninsured children now.

 

We know that most uninsured Americans are members of working families.     It is the CHIP program, first established ten years ago, that provides the children of these families with access to health insurance.

 

Numerous studies show that the SCHIP program improves the health of the children who are enrolled.  

 

When previously uninsured children are enrolled in SCHIP, they are far more likely to receive regular primary medical and dental care, and they are less likely to visit the emergency room for services that could be rendered in a physician's office.

 

They are more likely to receive necessary immunizations and other preventive services they need to stay healthy, and to get the prescription drugs they need to get well.

 

But the best evidence of the program's success doesn't rest in studies or surveys, but in the families themselves. 

 

Earlier this year, the Bedford family, from my home town of Baltimore Maryland, traveled to Capitol Hill to tell their story. 

 

Craig and Kim Lee Bedford and their five children testified before Chairman Baucus and the members of the Senate Finance Committee about the importance of SCHIP in their lives.

 

Their words said it best. Mrs. Bedford said, "Perhaps the greatest impact MCHIP [the Maryland Children's Health Insurance Program] has had on our family medically is that we no longer have to make impossible health choices based on a financial perspective. We no longer have to decide whether a child is 'really sick enough' to warrant a doctor's visit.

"We no longer have to decide whether a child 'really needs' a certain medication prescribed by his pediatrician."   

 

Mr. Bedford said, "The face of CHIP is families such as ours, families that work hard and play by the rules, trying to live the American dream."  Mr. President, that is what this bill is about-giving those families the chance to live the American dream.

 

At the close of last year, the 109 th Congress enacted legislation that addressed the funding shortfall facing 17 states, including Maryland.  Without that legislation, Maryland would have been forced to either freeze enrollment or reduce eligibility for SCHIP.   

This year, we expect that more than a dozen states will exhaust all of their SCHIP funds and will have a shortfall totaling nearly $800 million dollars.  We must reauthorize CHIP at levels to make certain that children do not lose coverage because of shortfalls in federal funds.

SCHIP is not perfect.  There are still approximately 9 million uninsured children in America.  Two-thirds of them, or about six million, are eligible for SCHIP or Medicaid, but aren't enrolled. This bill makes progress by extending coverage to more than 3.3 million of them.   

 

And the states are making progress--simplifying their enrollment procedures, expanding outreach efforts, and using joint applications for Medicaid and CHIP so that families can enroll together. This bill also helps them do that.

 

In its FY08 Budget proposal, the Bush Administration proposed to  reduce the current federal SCHIP matching rate for low-income children in families of three with incomes of just $34,000 or more. 

 

It does this by "emphasizing" health insurance coverage for children with incomes below 200 percent of the poverty line.    

 

But the Bush budget language doesn't say that this would affect one-third of all state SCHIP programs, which now cover children above that level.  Children in 17 states, including Maryland, which covers children in families that earn up to 300 percent of the poverty level, would be harmed.   

 

Also, a number of states are considering making further progress towards covering uninsured children, but the Bush proposal moves in the opposite direction and discourages those states from expanding their rolls.   By reducing the matching rate, the Administration's proposal significantly shifts SCHIP costs onto states, requiring them to either increase their own level of funding for SCHIP or reduce their programs.  As a result, many children would lose their SCHIP coverage.    

 

   In Senate Budget Committee, under Chairman Conrad's leadership, we reported out a budget resolution that contained a $50 billion reserve fund for CHIP. 

   Our resolution rejected the inadequate funding proposed by the Bush budget and provided for funding to cover state shortfalls, maintain coverage for currently-enrolled children and expand coverage to unenrolled children.

 

The Senate Finance Committee reached a bipartisan compromise and produced the bill that we are considering today. 

 

By a margin of 17-4, they agreed to a $35 billion bill that will provide coverage for an additional 3 million two hundred thousand uninsured children. 

 

Mr. President, this is an important bill for Maryland families.  Since CHIP was created in 1997, the program has been a proven success in Maryland. 

 

Our state created the Maryland Children's Health program (MCHP), which took effect on July 1, 1998.  It covers children in families with incomes up to 200 percent of the federal poverty level.   

Three years later, in 2001, Maryland created MCHP Premium, an expansion program.  For a modest monthly premium, families with incomes of between 200 and 300 percent of poverty can enroll in coverage.  The premiums are on a per family basis, regardless of the number of children enrolled. Families with incomes between 200% and 250% of poverty pay $44 a month for coverage.  Families with incomes above 250%  but below 300% of poverty  pay $55 a month. 

 

Our programs have been a success.  Average enrollment grew from 38,000 children in the first year to 101,000 today.   

 

But our state has been facing shortfalls.  Because SCHIP is a capped program, not an entitlement program, there are annual allotments that each state receives for its enrollees. 

These allotments are based on a federal funding formula established back when the program was created in 1997, but they do not meet all of Maryland's MCHP needs. 

 

Because there are some states who don't use their entire allotment, Congress has allowed the redistribution of that excess funding to states like Maryland that need it. 

 

For the past five years, Maryland has been able to receive federal funding redistributions to enroll children from low income families. 

 

The bill before us today is going to provide significant new resources for Maryland and other shortfall states.  Under the bipartisan CHIP bill, Maryland will receive an allotment based on its projected spending; it will receive access to a contingency fund if there is a shortfall, and additional funds based on gains in enrollment.    The allotment for Maryland would increase from $67 million in FY07 to an estimated $188.9 million in F08. 

This would allow us to extend coverage to as many as 42,000 children who are now uninsured, over the next five years.

 

There are also new incentive bonus funds that will provide Maryland with targeted assistance in enrolling uninsured children already eligible for coverage. 

 

This bill also retains the flexibility that Maryland needs to meet the health care needs of its children.  We have a high cost of living in our state.  This legislation recognizes the difficulties that many families have in securing affordable health care coverage, and it continues to give Maryland an enhanced CHIP match to cover families with incomes up to 300% of the federal poverty level. 

If Maryland chooses to expand CHIP for families with incomes above 300% of poverty, our state will receive the regular Medicaid matching rate of 50% rather than the enhanced CHIP rate of 65% to cover children in those families.

 

This bill will also help our state identify and enroll children who are already eligible, but uninsured. 

Right now, it's estimated that 7 of every ten uninsured children are eligible for some type of coverage.  This bill sets aside $100 million in outreach funding to help target unenrolled children and get them the comprehensive coverage they need.

 

This bill also includes $45 million to improve the quality of care that our children receive, including a demonstration project aimed at combating obesity. 

 

Mr. President, in the broader debate over this bill, there are two very important issues that I want to mention-mental and dental.  This bill takes an enormous step toward eliminating the stigma of mental health treatment, by establishing mental health parity in the CHIP program.   It is the right thing to do and will give so many of America's low-income children access to the mental health services they need.

 

Equally important is the issue of dental coverage. Mr. Speaker, a few moments ago I mentioned the Bedford family of Baltimore.  Now I want to talk briefly about another Maryland family-the Drivers.     Alyce Driver and her children fell in and out of the health insurance safety net-they were at times eligible for Medicaid.  But because they had no fixed address, bureaucratic snafus caused them to lose their coverage periodically.  Even when the Driver family had coverage, it was difficult to find health providers who would treat patients with public health insurance plans.  One of Mrs. Driver's sons, DaShawn, had six rotten teeth, and Alyce Driver spent a great deal of time trying to find dental care for him. 

 

Another son, Deamonte, had cavities and complained of a headache, but his problems didn't seem as severe as his brother's.  

 

Now, sadly, we know that they were.  We now all know Deamonte Driver's story.  A dedicated community social worker tried to help the family, but it took more than 20 calls just to find a dentist. 

 

His headaches grew more acute and finally, during an evaluation at Children's Hospital here in Washington, it was discovered that they were caused by an abscessed tooth.   The infection from that tooth spread to his brain.  After emergency brain surgery in January 2007, he began to have seizures, and then he needed a second operation.

 

Even though he received further treatment and therapy and appeared to be recovering, medical intervention had come too late.

 

Deamonte passed away on Sunday, February 25.  What a tragedy, Mr. President.    This 12 year-old boy died for want of an $80 tooth extraction, and his total health care expenses by the end amounted to more than $250,000.    

 

Deamonte lived only about six miles from this Capitol, and it is a sad indictment of this nation that we have not yet guaranteed that   all our children have access to the health care they need.

 

Our former surgeon general, C. Everett Koop, once said that "There is no health without oral health."  The sad story of the Driver family has brought Dr. Koop's  lesson home in a painful way. 

 

Our medical researchers have discovered the important linkage between plaque and heart disease; that chewing stimulates brain cell growth; and that gum disease can signal diabetes, liver ailments and hormone imbalances.  

 

They have learned the vital connection between oral research and advanced treatments like gene therapy, which can help patients with chronic renal failure.

 

But without real support for government insurance programs such as SCHIP and Medicaid, all this textbook knowledge will do nothing to help our children.

Here are some basic facts:

 

·         Dental decay is the most common chronic childhood disease among children in the United States.  It affects one in five children aged 2-4, half of those aged 6-8 and nearly three- fifths of 15 year olds.

 

·         Tooth decay is five times more common than asthma among school age children. Children living in poverty suffer twice as much tooth decay as middle and upper income children

 

·         Nearly 40 percent of black children have untreated tooth decay in their permanent teeth;

 

·         More than 10 percent of the nation's rural population have never visited a dentist,

 

·         An estimated 25 million people live in areas that lack adequate dental care services.

 

It is our responsibility to change that.   I want to express my gratitude to my colleague form New Mexico, Senator Jeff Bingaman for his leadership.

 

There is no one in the Senate who has done more to highlight the need for access to oral health care in America.  

 

I also want to thank my colleagues from Maine, Senators Snowe and Collins, for speaking out about this issue so eloquently.  And I want to thank Chairman Baucus and Senator Grassley for including in this legislation $200 million in grants for improved access to dental services.  This is an important step, and I hope that we will be able to improve upon that level.

 

The choices we make here on the floor of the Senate reflect our priorities.  It's time to listen to the voices across our nation.  They tell us that nothing could be more important to our nation than giving children the opportunity to thrive and grow into healthy, productive citizens.  This bipartisan CHIP reauthorization bill will help us give them that opportunity. 

 

This is a bill that will help us improve both the quality and the scope of health care that our children receive.  I urge my colleagues to support it, and to close this week with a resounding, overwhelming vote for the health of America's children.