Mr. President, I rise today to introduce bipartisan legislation with Senators Lugar, Lincoln, Murray, Kerry, Cantwell, Kohl, Lautenberg, Boxer and Corzine. This legislation, entitled the ``Start…
Mr. President, I rise today to introduce bipartisan legislation with Senators Lugar, Lincoln, Murray, Kerry, Cantwell, Kohl, Lautenberg, Boxer and Corzine. This legislation, entitled the ``Start Healthy, Stay Healthy Act of 2005,'' would significantly reduce the number of uninsured pregnant women and newborns by expanding coverage to pregnant women through Medicaid and the Children's Health Insurance Program, or CHIP, and to newborns through the first full year of life.
Today is World Health Day 2005 and the message this year is ``Make Every Mother and Child Count''. I can think of no better way to honor our Nation's mothers and children than to increase their access to health care services and improve their overall health.
According to a recent report by Save the Children entitled ``The State of the World's Mothers,'' the United States fares no better than 11th in the world. Why is this? According to the report, ``The United States earned its 11th place rank this year based on several factors: One of the key indicators used to calculate the well-being for mothers is lifetime risk of maternal mortality. . . . Canada, Australia, and all the Western and Northern European countries in the study performed better than the United States in this indicator.''
The study adds, ``Similarly, the United States did not do as well as the top 10 countries with regard to infant mortality rates.''
In fact, the United States ranks 21st in maternal mortality and 28th in infant mortality, the worst among developed nations. We should and must do
better by our Nation's mothers and infants.
There has been long-standing policy in this country linking programs for pregnant women to programs for infants, including Medicaid, WIC, and the Maternal and Child Health Block Grant. Yet the CHIP program, unfortunately, fails to provide coverage to pregnant women beyond the age of 18. As a result, it is more likely that newborns eligible for CHIP are not covered from the moment of birth, and therefore, often miss having comprehensive prenatal care and care during those first critical months of life until their CHIP application is processed.
By expanding coverage to pregnant women through CHIP, the ``Start Healthy, Stay Healthy Act'' recognizes the importance of prenatal care to the health and development of a child. As Dr. Alan Waxman of the University of New Mexico School of Medicine has written, ``Prenatal care is an important factor in the prevention of birth defects and the prevention of prematurity, the most common causes of infant death and disability. Babies born to women with no prenatal care or late prenatal care are nearly twice as likely to [be] low birthweight or very low birthweight as infants born to women who received early prenatal care.''
Unfortunately, according to the Centers for Disease Control and Prevention, New Mexico ranked worst in the nation in the percentage of mothers receiving late or no prenatal care in 2003. The result is often quite costly--both in terms of the health of the mother and newborn but also in terms of the long-term expenses for society since the result can be chronic, lifelong health problems.
In fact, according to the Agency for Healthcare Research and Quality, ``four of the top 10 most expensive conditions in the hospital are related to care of infants with complications (respiratory distress, prematurity, heart defects, and lack of oxygen).'' In addition to reduced infant mortality and morbidity, the provision to expand coverage to pregnant women is cost effective.
The ``Start Healthy, Stay Healthy Act'' also eliminates the unintended federal policy through CHIP that covers pregnant women only through the age of 18 and cuts off that coverage once the women turn 19 years of age. Certainly, everybody can agree that the government should not be telling women that they are more likely to receive prenatal care coverage only if they become pregnant as a teenager.
This bipartisan legislation has been supported in the past by: the March of Dimes, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the What to Expect Foundation, the American Academy of Family Physicians, the American Academy of Pediatric Dentistry, the American Academy of Child and Adolescent Psychiatry, the National Association of Community Health Centers, the American Hospital Association, the National Association of Children's Hospitals, the Federation of American Health Systems, the National Association of Public Hospitals and Health Systems, Premier, Catholic Health Association, Catholic Charities USA, Family Voices, the Association of Maternal and Child Health Programs, the National Health Law Program, the National Association of Social Workers, Every Child By Two, the United Cerebral Palsy Associations, the Society for Maternal- Fetal Medicine, and Families USA.
This legislation is a reintroduction of a bill that was introduced in 2001 and 2003. Throughout 2001, the Administration made numerous statements in support of the passage of this type of legislation, but unfortunately, reversed course in October 2002 after publishing a regulation allowing states to redefine a ``child'' as an ``unborn child'' only and to provide prenatal care, but not postnatal care through CHIP in that manner. In a letter to Senator Nickles dated October 8, 2002, Secretary Thompson argued, ``I believe the regulation is a more effective and comprehensive solution to this issue.''
While a number of senators strongly disagreed with Secretary Thompson's assertion and sent him letters to that effect on October 10, 2002, and on October 23, 2002, we felt it was important to get the testimony of our nation's medical experts on the health and well-being of both pregnant women and newborns. We called for a hearing in the Senate Health, Education, Labor and Pensions Committee on October 24, 2002. Witnesses included representatives from the March of Dimes, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the What to Expect Foundation. They were asked to compare the regulation to the legislation and I will let their testimony speak for itself.
Dr. Nancy Green testified on behalf of the March of Dimes Birth Defects Foundation. She said:
We support giving states the flexibility they need to cover
income-eligible pregnant women age 19 and older, and to
automatically enroll infants born to SCHIP-eligible mothers.
By establishing a uniform eligibility threshold for coverage
for pregnant women and infants, states will be able to
improve maternal health, eliminate waiting periods for
infants and streamline administration of publicly supported
health programs. Currently, according to the Department of
Health and Human Services' Centers for Medicare and Medicaid
Services and the National Governors' Association, 36 states
and the District of Columbia have income eligibility
thresholds that are more restrictive for women than for their
newborns. Encouraging states to eliminate this disparity by
allowing them to establish a uniform eligibility threshold
for pregnant women and their infants should be a national
policy priority.
Dr. Green adds:
Specifically, we are deeply concerned that final regulation
fails to provide to the mother the standard scope of
maternity care services recommended by the American College
of Obstetricians and Gynecologists (ACOG) and the American
Academy of Pediatrics (AAP). Of particular concern, the
regulation explicitly states that postpartum care is not
covered and, therefore, federal reimbursement will not be
available for these services. In addition, because of the
contentious collateral issues raised by this regulation
groups like the March of Dimes will find it even more
difficult to work in the states to generate support for
legislation to extend coverage to uninsured pregnant women.
Dr. Laura Riley testified on behalf of ACOG. In her testimony, she stated:
ACOG is very concerned that mothers will not have access to
postpartum services under the regulation. The rule clearly
states that ``. . . care after delivery, such as postpartum
services could not be covered as part of the Title XXI State
Plan . . . because they are not services for an eligible
child.
On the importance of postpartum care, Dr. Riley adds:
When new mothers develop postpartum complications, quick
access to their physicians is absolutely critical. Postpartum
care is especially important for women who have preexisting
medical conditions, and for those whose medical conditions
were induced by their pregnancies, such as gestational
diabetes or hypertension, and for whom it is necessary to
ensure that their conditions are stabilized and treated.
As a result, Dr. Riley concludes:
Limiting coverage to the fetus instead of the mother omits
a critical component of postpartum care that physicians
regard as essential for the health of the mother and the
child. Covering the fetus as opposed to the mother also
raises questions of whether certain services will be
available during pregnancy and labor if the condition is one
that directly affects the woman. The best way to address this
coverage issue is to pass S. 724, supported by Senators
Bond, Bingaman and Lincoln and many others, and which
provides a full range of medical services during and after
pregnancy directly to the pregnant woman.
Dr. Richard Bucciarelli testified on behalf of the American Academy of Pediatrics. He said:
Recently, the Administration published a final rule
expanding SCHIP to cover unborn children. The Academy is
concerned that, as written, this regulation falls dangerously
short of the clinical standards of care outlined in our
guidelines, which describe the importance of covering all
stages of a birth--pregnancy, delivery, and postpartum care.
It is important to note that the regulation subtracts the time that an ``unborn child'' is covered from the period of continuously eligibility after birth. Consequently, children would be denied insurance coverage at very critical points during the first full year of life. As such, Dr. Bucciarelli expressed support for the legislation over the regulation because it, in his words:
. . . takes an important step to decrease the number of
uninsured children by providing 12 months of continuous
eligibility for those children born . . . This legislation
ensures that children born to women enrolled in Medicaid or
SCHIP are immediately enrolled in the program for which they
are eligible. Additionally, this provision prevents newborns
eligible for SCHIP from being subject to enrollment waiting
periods, ensuring that infants receive appropriate health
care in their first year of life.
And finally, Lisa Bernstein testified as Executive Director of The What to Expect Foundation, which takes its name from the bestselling What to Expect pregnancy and parenting series that has helped over 20 million families from pregnancy through their child's toddler years. Ms. Bernstein also supported the legislation as a far superior option over the regulation and make this simple but eloquent point:
. . . only a healthy parent can provide a healthy future for a healthy child.
The testimony of these experts speaks for itself and I urge my colleagues to pass this legislation as soon as possible.
I ask unanimous consent that the text of this bill be printed in the Record.
