Medicaid Emergency Psychiatric Care Act of 2007

Mr. President, I rise today to speak about members of the American family whom we all care about, and I think all of us do in this chamber and across America, but for whom we do not do nearly enough to support, and those members of the American family are pregnant women.

I remember, as so many others do in the life of the family the times my wife Terese learned that she was pregnant, and even through I, of course, cannot ever experience it directly, I knew and I know now through her and my sisters' experience that that moment is indelible, and it is unforgettable in the life of a woman, in the life of a family, the moment she finds out that she is pregnant.

For many women this is a moment, of course, of great joy. It is the moment where they learn they are pregnant and they appreciate the miracle of pregnancy. And perhaps it has been long awaited or in the case of a particular woman and her family, perhaps it is something of a surprise. But for many women, for many families, it is a welcome surprise.

Many of these women do not need help beyond what their families can provide them and what others may receive in terms of adequate support from our existing framework of support within this country, so they do not feel they have any great burden at that moment.

But there is another circumstance other pregnant women may face. And for those pregnant women, and for one, in particular, if we can imagine who that person is in the life, in our own lives, people we have known, for that woman the moment of discovery that she is pregnant unfortunately is not a moment of joy. For her it is a moment of terror or panic or even shame in some circumstances. She may be in a doctor's office or a clinic or she may be at home. But for her that moment begins a crisis, a real crisis in her life, in which she feels overwhelmingly and perhaps almost unbearably alone, all alone. She could be wealthy, middle income, or poor. Most likely, in our country, unfortunately, she would be poor. But whatever her income, that woman at that moment in that circumstance feels very simply all alone.

A pregnant woman may have an abusive spouse or boyfriend, for example, that person who is tormenting her at that moment, and that will continue.

At that moment for her, she is all alone with no help at all. Another pregnant woman may believe she cannot support or care for a new baby at this point in her life. She too is all alone. Another woman might believe her financial situation is so precarious that she cannot care for or raise a child. She may also feel alone and even helpless.

We know the staggering numbers in America today: 48 percent of all pregnancies are unintended; excluding cases of after miscarriages, 54 percent of those unintended pregnancies end in abortion.

The response: ``cannot afford a baby,'' is the second most frequently cited reason why women choose to have an abortion. And 73 percent of women having abortions citing this reason: ``cannot afford a baby,'' cite this reason as a contributing factor in their decision.

So a woman who is facing the challenges of an unplanned pregnancy, that may be a crisis for her, does not need, does not need a lecture from a politician and does not need a clinical reminder that she just has a simple choice to make. The choice is never simple, never, and this woman needs support and love and understanding. She needs to be embraced in a time of crisis in her life, not sent on her way to deal with this question on her own.

She needs our help and she needs us to walk with her, not only through the 9 months of her pregnancy, but also for the early months and years of her child's life. We in the Congress, both House and Senate, both parties, need to address this issue in a comprehensive way that meets those needs that woman has in her life.

Some Members in this body for years, and up to the current day, have initiated good efforts. We should applaud those efforts and support them. In some cases there is support for them. But I believe neither political party is doing enough for pregnant women in America today-- neither party.

While there is tremendous disagreement about how best to do this, there is one significant area of common ground. Despite all we hear in Washington, there is, on these questions, one area of common ground, one thing we all agree upon, and that is, we all want to reduce the number of abortions.

We all want to help as many pregnant women, as many families as we can. Many women who have had abortions do so very reluctantly. While choice is a term that is widely used in this debate, many women who face unplanned pregnancies do not feel, do not feel they have a genuine choice. And that is why for so many reasons I am introducing new legislation, the Pregnant Women Support Act. With this bill it is my fervent hope that a new dialog, a kind of common ground, will emerge on how we can reduce abortion by offering pregnant women real choices and real help.

Let me outline a couple of provisions of the bill. This bill will, first of all, assist pregnant and parenting teens to finish high school and prepare for college or vocational training. Next, it will help pregnant college students stay in school, offering them counseling as well as assistance with continuing their education, parenting support classes, and also childcare assistance.

Third, it will provide counseling and shelter to pregnant women in abusive relationships who may be fearful of continuing a pregnancy in a crisis situation. It will establish a national toll-free hotline and a public awareness campaign to offer women support and knowledge about options and resources available to them when they face an unplanned pregnancy.

It will give women free sonogram examinations by providing grants for the purchase of ultrasound equipment. It will provide parents with information about genetic disability testing, including support for parents who receive a diagnosis of Downs syndrome. It will ensure that pregnant women receive prenatal and postnatal care by eliminating pregnancy as a preexisting condition in the individual health care market, and also eliminating waiting periods for women with prior coverage.

It will establish a nurse home visitation program for pregnant and first-time mothers as an eligible benefit under Medicaid and the State Children's Health Insurance Program, what we refer to here as SCHIP. We know it means Children's Health Insurance.

One example of this home visitation program is the nurse-family partnership, an evidence-based program and national model in which nurses mentor young first-time and primarily low-income mothers, establishing a supportive relationship with both mother and child. Studies have shown this program to be both cost effective and hugely successful in terms of life outcomes for both mothers and their children. This legislation will increase funding for the Women, Infants and Children Program, known as the WIC Program, providing nutrition assistance, counseling and education, obesity prevention, breastfeeding support, prenatal and pediatric health care referrals, immunization screening and referral, and a host of other services for mothers and their children.

Next, it will expand nutritional support for low-income parents by increasing the income eligibility levels for food stamps. It will increase funding for the childcare and development block grant program, which is the primary source of Federal funding for childcare assistance for low-income parents.

Finally, it will provide support for adoption as an alternative to abortion and make the adoption tax credit permanent. I introduced this bill with the deepest conviction that we can indeed find common ground. I believe we can transform this debate by focusing upon the issues that unite us and not the issues that divide us.

As most people know who cover the Senate and understand what happens here and where candidates stand, most people know this already, but I am a pro-life Democrat, and I believe life begins at conception and ends when we draw our last breath.

I also believe the role of Government is to protect, enrich, and value life for everyone, at every moment, from beginning to end. I believe we as a nation

have to do more to support women and their children when they are most vulnerable, during pregnancy and early childhood.

I also strongly support, and have for years, family planning programs, because they avoid sometimes those dark moments when a woman, often alone, faces a pregnancy she feels she cannot handle. I also support family planning programs precisely because they reduce the number of abortions.

But that is not the issue I address today. Today, with this bill, I am focused on the woman who is pregnant, and I am asking myself, and I think Congress and the administration, as any Congress and any administration has to ask themselves this fundamental question: For that woman who is facing that crisis in her life, we have to ask ourselves, as a Congress and as a society: What more can we do? What more can we do to help her? That is the question we must continually ask. I think if we ask that question today, the answer, unfortunately, is: Not enough.

We are not doing enough. I believe there is more common ground in America than we might realize on these questions, if only we focus on how we can truly help and support that woman who wishes to carry her pregnancy to term and how we can give her and her child what they need to begin healthy and productive lives together.

For the past 34 years, unfortunately, the issue of abortion has been used mostly as a way to divide people, even as the number of abortions remains and still remains unacceptably high. We have to find a better way.

I believe this legislation, the Pregnant Women Support Act, is a part of that better way. I believe we must look toward real solutions to the issue of abortion by targeting the underlying factors that often lead women to make the decision to have an abortion. This is precisely what this act, the Pregnant Women Support Act, will do.

I really believe when it comes to this issue of helping a pregnant woman, we need to consider what our obligations are. I think we can state it very simply: We need to walk in solidarity with her, in her pregnancy, especially when it is an unplanned pregnancy, and we need to support her and give her all the help we can at this time in her life.

That is exactly what this bill does for women who may find themselves in a position where they are facing one of the most difficult situations in their life. The woman who has no one to turn to for advice, for counsel, or for support, we have got to be there for her at that moment and for a long time thereafter.

I truly believe there are few things more terrifying than the prospect of supporting another human being when you have no support of your own. Unfortunately, far too many women face that decision, face that crisis.

So I believe reducing the number of abortions should not be a partisan issue. It should not pit Republicans against Democrats. So what do I seek? I seek common ground, and I ask my colleagues on both sides of the aisle to join me in seeking real solutions that will unite us in providing life with dignity, before--before--and after the birth of a child, for a pregnant woman, for her family, and for her child. Surely, we must all agree that no woman should ever have to face the crisis of an unplanned pregnancy all alone.

Mr. President, I rise today to introduce the Keep Americans Warm Act, which provides an additional $1 billion in emergency home heating aid under the highly successful Low Income Home Energy Assistance Program, otherwise known as LIHEAP. Most importantly, this $1 billion in emergency home heating assistance would be in addition to the overall fiscal year 2008 appropriations for LIHEAP.

I am delighted this bill enjoys widespread bipartisan support from across the political spectrum. As a matter of fact, this legislation is being cosponsored by 23 of my colleagues--16 Democrats, 6 Republicans, and 1 Independent.

I would like to recognize all of the cosponsors this morning: both Senators from Minnesota, Mr. Coleman and Ms. Klobuchar; Senator Obama; both Senators from Maine, Ms. Snowe and Ms. Collins; both Senators from Massachusetts, Mr. Kerry and Mr. Kennedy; Senator Brown; Senator Lugar; the senior Senator from the great State of Vermont, Senator Leahy; Senator Smith; Senator Bingaman, the chairman of the Energy and Natural Resources Committee; Senator Sununu; both Senators from New York, Mr. Schumer and Mrs. Clinton; Senator Casey; Senator Mikulski; Senator Menendez; Senator Stabenow; Senator Lieberman; Senator Cantwell; Senator Biden; and Senator Boxer.

Mr. President, the reason this legislation is being cosponsored by so many of my colleagues is simple: Skyrocketing home heating prices in New England, the Northeast, and the Mideast, are already stretching household budgets beyond the breaking point.

In the wealthiest country on the face of the Earth, not one family should go cold this winter. That is not what America is supposed to be about. Not one senior citizen should have to choose between heating their homes or paying for their prescription drugs.

I am afraid if we do not act, and act aggressively, that is what is going to happen all across this country. While the official start of winter is still about 3 weeks away, home heating prices in Vermont and in other parts of the country are already going through the roof.

According to the Central Vermont Community Action Council, many Vermont families have been paying an incredible $3.47 a gallon for heating oil and as much as $3.71 a gallon for kerosene this year. Nationwide, heating oil prices are already up 90 cents from last year, or more than double from where they were 4 years ago. Further, the price of kerosene has also increased by 50 cents a gallon from last year.

These rapidly rising energy prices right now are bad enough; but the overall projections of what people will pay for energy over the course of this winter is frightening.

The National Energy Assistance Directors Association has projected that the typical household using heating oil will pay $2,157 to heat their homes this winter--a 47-percent increase from what they paid last year. Those using propane will pay $1,765 this winter, or 30 percent more than what they paid 2 years ago.

Before we got back into session this week, the debate over LIHEAP was between an 11.6-percent increase from last year, as included in the fiscal year 2008 Labor-HHS conference report, and the President's budget proposal of a 21-percent cut--cut--from last year.

While the level of funding for LIHEAP included in the Labor-HHS conference report is a good starting point, even if this level eventually becomes law, it would still be 31 percent below the $3.2 billion provided in fiscal year 2006.

Making matters worse, the President vetoed the Labor-HHS conference report, insisting on a $379 million cut to LIHEAP, among other things.

We hear a lot of talk in Washington about family values. Well, to my mind, a family value is that we do not let our fellow Americans go cold when the cost of home heating oil is exploding.

I thank all my colleagues. This legislation has brought forth widespread bipartisan support from Senators all across this country. Let us be aggressive and pass this legislation so that in this great country nobody goes cold this winter. Thank you.

Mr. President, today I rise to introduce the Medicaid Emergency Psychiatric Care Act of 2007. Original cosponsors this bill include two of my colleagues on the Finance Committee, Senators Conrad and Lincoln, as well as Senator Collins. Our legislation will improve access to mental health treatment and remove an unfunded mandate on our nonpublic mental health treatment centers by allowing freestanding psychiatric hospitals to receive appropriate reimbursement for emergency treatment.

According to the CDC, visits to hospital emergency rooms rose 20 percent in the past 10 years. This situation is exacerbated by a shortage of short-term inpatient psychiatric care facilities leaving psychiatric patients with a serious mental illness with nowhere to go. In fact, in 2003, there were 3.7 million visits to hospital emergency department for mental disorders. If treatment remains unavailable, patients could become homeless or be housed as criminal offenders.

The Emergency Medical and Labor Treatment Act, EMTALA, requires all hospitals, including psychiatric hospitals, to stabilize patients who come in with an emergency medical condition. However, an outdated Medicaid provision called the Institution for Mental Diseases, IMD, exclusion does not allow Medicaid reimbursement to nonpublic psychiatric hospitals for stabilizing care delivered to Medicaid patients between the ages of 21-64. This policy isolates adults with mental illnesses from all other Medicaid-eligible populations and contradicts the principles of equal treatment and insurance parity for treatment of mental illnesses.

When the IMD exclusion was created, individuals who were afflicted with mental health conditions often were institutionalized for an extended time. Today, hospitalization for common mental health concerns such as mild depression does not generally occur, thus removing the potential for abuse of the system. This exclusion burdens these facilities with an unfunded mandate and has caused severe financial burdens to psychiatric facilities--often amounting to millions of dollars a year. The IMD exclusion does not take into consideration the vast advancements that have transformed mental health services available today, and actually restricts access to critical mental health services for those who, by today's standards, are in the greatest need.

Emergency department overcrowding is a growing and severe problem in the United States, and dedicated physicians and nurses who work in emergency rooms are reaching a breaking point where they may not have the resources or surge capacity to respond effectively. Patients often face a long wait in the emergency room, sometimes for days, because there is no bed or other appropriate setting available. Tens of thousands of dollars every day are being spent inefficiently on extended treatment in emergency rooms that is not the most appropriate or clinically effective care. Passage of this bill will help relieve overcrowding in emergency departments and allow hospitals to provide the appropriate care these patients deserve.

Mr. President, today I rise to introduce the Medicaid Emergency Psychiatric Care Act of 2007. Original cosponsors this bill include two of my colleagues on the Finance Committee, Senators Conrad and Lincoln, as well as Senator Collins. Our legislation will improve access to mental health treatment and remove an unfunded mandate on our nonpublic mental health treatment centers by allowing freestanding psychiatric hospitals to receive appropriate reimbursement for emergency treatment.

According to the CDC, visits to hospital emergency rooms rose 20 percent in the past 10 years. This situation is exacerbated by a shortage of short-term inpatient psychiatric care facilities leaving psychiatric patients with a serious mental illness with nowhere to go. In fact, in 2003, there were 3.7 million visits to hospital emergency department for mental disorders. If treatment remains unavailable, patients could become homeless or be housed as criminal offenders.

The Emergency Medical and Labor Treatment Act, EMTALA, requires all hospitals, including psychiatric hospitals, to stabilize patients who come in with an emergency medical condition. However, an outdated Medicaid provision called the Institution for Mental Diseases, IMD, exclusion does not allow Medicaid reimbursement to nonpublic psychiatric hospitals for stabilizing care delivered to Medicaid patients between the ages of 21-64. This policy isolates adults with mental illnesses from all other Medicaid-eligible populations and contradicts the principles of equal treatment and insurance parity for treatment of mental illnesses.

When the IMD exclusion was created, individuals who were afflicted with mental health conditions often were institutionalized for an extended time. Today, hospitalization for common mental health concerns such as mild depression does not generally occur, thus removing the potential for abuse of the system. This exclusion burdens these facilities with an unfunded mandate and has caused severe financial burdens to psychiatric facilities--often amounting to millions of dollars a year. The IMD exclusion does not take into consideration the vast advancements that have transformed mental health services available today, and actually restricts access to critical mental health services for those who, by today's standards, are in the greatest need.

Emergency department overcrowding is a growing and severe problem in the United States, and dedicated physicians and nurses who work in emergency rooms are reaching a breaking point where they may not have the resources or surge capacity to respond effectively. Patients often face a long wait in the emergency room, sometimes for days, because there is no bed or other appropriate setting available. Tens of thousands of dollars every day are being spent inefficiently on extended treatment in emergency rooms that is not the most appropriate or clinically effective care. Passage of this bill will help relieve overcrowding in emergency departments and allow hospitals to provide the appropriate care these patients deserve.