Guaranteed Access to Medicaid for Newborns Act of 2007

Mr. President, I am pleased today to introduce the Guaranteed Access to Medicaid for Newborns Act. This bill corrects a problem that has arisen during the implementation of the Deficit Reduction Act, DRA, of 2005. Through this act, we will guarantee that children born in America who are eligible for Medicaid can seamlessly get Medicaid coverage.

For the last two decades, Medicaid recipients have been required to be a U.S. citizen or qualified alien who has been in the country for at least 5 years. In a July 2005 report, the HHS Office of Inspector General found that 47 States allowed individuals to ``self attest'' their citizenship status to qualify for Medicaid benefits. In short, the State simply asked a Medicaid applicant if they were a citizen. The applicant need only respond, ``Yes, I am an American.'' No documents necessary. And of those 47 States, 27 did no followup verification such as checking with the Social Security Administration. In response to this report, the DRA included a House-led provision that I supported to require States to more carefully document the citizenship of Medicaid recipients and applicants.

Implementation of this provision, as is often the case with legislation, has not been without its challenges. The interim final rule that was issued by CMS effective July 6, 2006, did make many improvements so that the new statute could be implemented consistent with legislative intent. I think, on the whole, CMS did a good job. However, there was one specific provision in the interim final rule that I do not think is consistent with congressional intent: the provision that makes it more difficult for children born to undocumented mothers to gain Medicaid eligibility.

In section 1903(v) of the Social Security Act, the Medicaid statute makes available payment to States for treatment of an alien who is not otherwise eligible for Medicaid in the case of an emergency medical condition. A woman who is undocumented or not

otherwise eligible for Medicaid is covered under Medicaid for labor and delivery. Nothing in the DRA changed that nor was anything in the DRA intended to change that.

Under section 1902(e)(4) of the Social Security Act, a child born to a woman receiving Medicaid at the time of the child's birth is deemed onto Medicaid for a year. States had been interpreting that to mean the child of a woman who was undocumented could be deemed onto Medicaid for a year since the mother, under 1903(v), was eligible for Medicaid at the time of the child's birth. The interim final rule now specifically prevents a State from deeming the child of an undocumented mother onto the State Medicaid program without properly documenting the child's citizenship first.

In this case, I believe CMS has gone too far. A child born in the United States of America is a citizen. Before the DRA, children born to mothers on Medicaid were deemed onto Medicaid, and I think that is absolutely in the best interest of that newborn child. The DRA did not change two fundamental facts: First, the mother, regardless of documentation status, was eligible for Medicaid at the time of the child's birth and, second, the child is a citizen. In my mind, there is no reason then to have any new documentation requirement for the child.

The legislation I am introducing today reinstitutes the pre-DRA policy with one notable exception. Under the old rule, a State could issue a temporary Medicaid identification number to the mother which served as the identification number for the child for up to a year. I don't think that it's necessary or appropriate for a State to provide a child Medicaid benefits by issuing the mother a Medicaid card. This especially problematic in cases where the mother may not be in the country legally nor eligible for Medicaid after delivery. My legislation changes the old policy by requiring the State to issue an identification number to the child of the undocumented mother. This does not in any way change the States' responsibility to provide the mother benefits when she comes to the emergency room in labor.

The legislation makes one further change to the statute to benefit newborns. Under the interim final rule, all children born to mothers on Medicaid are required to document their citizenship within 1 year of birth. I do not think that is necessary. Medicaid paid for the birth of an American citizen. It is simple common sense that the child is a citizen and requiring any further documentation is redundant and counter-intuitive.

I want to be clear that I support the requirement that a State more fully document the citizenship of applicants for Medicaid. Given what the Congressional Budget Office has told us would be the cost of making undocumented aliens eligible for public programs, the Deficit Reduction Act addressed a real concern by requiring documentation. I want the new statutory provision to go forward to ensure that the people getting the benefits are actually eligible for the benefits. However, CMS and the States should recognize what is to me, common sense: A child born in the United States whose birth was paid for by Medicaid is a citizen under current law. No further documentation necessary.

Mr. President, I am pleased today to introduce the Guaranteed Access to Medicaid for Newborns Act. This bill corrects a problem that has arisen during the implementation of the Deficit Reduction Act, DRA, of 2005. Through this act, we will guarantee that children born in America who are eligible for Medicaid can seamlessly get Medicaid coverage.

For the last two decades, Medicaid recipients have been required to be a U.S. citizen or qualified alien who has been in the country for at least 5 years. In a July 2005 report, the HHS Office of Inspector General found that 47 States allowed individuals to ``self attest'' their citizenship status to qualify for Medicaid benefits. In short, the State simply asked a Medicaid applicant if they were a citizen. The applicant need only respond, ``Yes, I am an American.'' No documents necessary. And of those 47 States, 27 did no followup verification such as checking with the Social Security Administration. In response to this report, the DRA included a House-led provision that I supported to require States to more carefully document the citizenship of Medicaid recipients and applicants.

Implementation of this provision, as is often the case with legislation, has not been without its challenges. The interim final rule that was issued by CMS effective July 6, 2006, did make many improvements so that the new statute could be implemented consistent with legislative intent. I think, on the whole, CMS did a good job. However, there was one specific provision in the interim final rule that I do not think is consistent with congressional intent: the provision that makes it more difficult for children born to undocumented mothers to gain Medicaid eligibility.

In section 1903(v) of the Social Security Act, the Medicaid statute makes available payment to States for treatment of an alien who is not otherwise eligible for Medicaid in the case of an emergency medical condition. A woman who is undocumented or not

otherwise eligible for Medicaid is covered under Medicaid for labor and delivery. Nothing in the DRA changed that nor was anything in the DRA intended to change that.

Under section 1902(e)(4) of the Social Security Act, a child born to a woman receiving Medicaid at the time of the child's birth is deemed onto Medicaid for a year. States had been interpreting that to mean the child of a woman who was undocumented could be deemed onto Medicaid for a year since the mother, under 1903(v), was eligible for Medicaid at the time of the child's birth. The interim final rule now specifically prevents a State from deeming the child of an undocumented mother onto the State Medicaid program without properly documenting the child's citizenship first.

In this case, I believe CMS has gone too far. A child born in the United States of America is a citizen. Before the DRA, children born to mothers on Medicaid were deemed onto Medicaid, and I think that is absolutely in the best interest of that newborn child. The DRA did not change two fundamental facts: First, the mother, regardless of documentation status, was eligible for Medicaid at the time of the child's birth and, second, the child is a citizen. In my mind, there is no reason then to have any new documentation requirement for the child.

The legislation I am introducing today reinstitutes the pre-DRA policy with one notable exception. Under the old rule, a State could issue a temporary Medicaid identification number to the mother which served as the identification number for the child for up to a year. I don't think that it's necessary or appropriate for a State to provide a child Medicaid benefits by issuing the mother a Medicaid card. This especially problematic in cases where the mother may not be in the country legally nor eligible for Medicaid after delivery. My legislation changes the old policy by requiring the State to issue an identification number to the child of the undocumented mother. This does not in any way change the States' responsibility to provide the mother benefits when she comes to the emergency room in labor.

The legislation makes one further change to the statute to benefit newborns. Under the interim final rule, all children born to mothers on Medicaid are required to document their citizenship within 1 year of birth. I do not think that is necessary. Medicaid paid for the birth of an American citizen. It is simple common sense that the child is a citizen and requiring any further documentation is redundant and counter-intuitive.

I want to be clear that I support the requirement that a State more fully document the citizenship of applicants for Medicaid. Given what the Congressional Budget Office has told us would be the cost of making undocumented aliens eligible for public programs, the Deficit Reduction Act addressed a real concern by requiring documentation. I want the new statutory provision to go forward to ensure that the people getting the benefits are actually eligible for the benefits. However, CMS and the States should recognize what is to me, common sense: A child born in the United States whose birth was paid for by Medicaid is a citizen under current law. No further documentation necessary.

Mr. President, today I come to the floor to discuss an important piece of legislation that I am introducing to address a major public health need.

I am pleased to be joined by Senators Hagel, Brownback, and Baucus.

Today, I am introducing the Veterinary Public Health Workforce Expansion Act, to address the growing shortage of veterinarians in the public health sector.

Over the past decade, the world has faced a significant increase of newly emerging infectious disease outbreaks, including West Nile virus; Severe Acute Respiratory Syndrome, SARS; monkeypox; and avian influenza.

In addition to their ability to cause severe illness, and even death, these diseases share another important characteristic: they are all transmitted from animals to man.

Veterinary medicine is an integral and indispensable component of our Nation's public health system.

Veterinarians protect human health by preventing and controlling infectious diseases, ensuring the safety and security of the Nation's food supply, promoting healthy environments, and providing health care for animals.

Veterinarians are essential for early detection and response to unusual disease events that could be linked to newly emerging infectious diseases, or other biothreat agents of concern.

In fact, it was a veterinarian who first diagnosed West Nile virus in the United States and a veterinarian who first notified health authonties of the introduction of monkeypox to the United States.

A veterinarian's prompt diagnosis and reporting of screwworm infestation prevent this disease from becoming reestablished in the United States, thus saving hundreds of millions of dollars in expensive eradication programs.

There is a need to build national capacity in research and training in the prevention, surveillance, diagnosis, and control of newly emerging and reemerging infectious diseases.

Veterinarians are uniquely qualified to address these high-priority public health issues because of their extensive professional training in basic biomedical sciences, population medicine, and broad, multi- species, comparative medical approach to disease prevention and control.

There is a shortage of veterinarians working in public health practice. As used in the preceding sentence, the term ``public health practice'' includes bioterrorism and emergency preparedness, environmental health, food safety and food security, regulatory medicine, diagnostic laboratory medicine, and biomedical research.

The Bureau of Labor Statistics expects there to be 28,000 job openings in the veterinary medical profession by 2012 due to growth and net replacements, a turnover of nearly 38 percent.

The Nation's veterinary medical colleges do not have the capacity to satisfy the current and future demand for veterinarians and veterinary expertise that is vital to maintain public health preparedness.

Veterinary colleges also provide a broad, multi-species, comparative medical approach to disease prevention and control, which is fundamental to understanding the transmission and life cycle of infectious disease agents, especially those that are shared with animals.

Veterinarians have special expertise in preventing and controlling these types of diseases, but there is a critical shortage of veterinarians working in public health practice, and the Nation's veterinary medical colleges do not have enough capacity to meet the demand.

In order to meet the critical shortages of veterinarians today I am introducing the Veterinary Public Health Workforce Expansion Act, which will allow veterinary medical colleges to expand their training programs for veterinary public health professionals.

The Veterinary Public Health Workforce Expansion Act will create a new competitive grant program for capital improvements to allow veterinary medical colleges to expand their training programs for public health professionals.

There are critical shortages of veterinarians across the United States, and the Nation's veterinary medical colleges do not have enough capacity to meet the demand.

The Veterinary Public Health Workforce Expansion Act will build infrastructure, research laboratories, and classroom space to provide training for veterinary students in public health, food safety, infectious diseases, global health, and environmental quality.

Mr. President, back in Georgia, we have a saying. When people are treating the symptoms and never treating the cause, we say they are avoiding the 800-pound gorilla in the living room. I wish to talk for a minute about a 6-pound gorilla that is in the United States Capitol. It is called the U.S. Tax Code.

Printed in the 8-point font type, the U.S. Tax Code weighs 6 pounds, but the

burden is equal to that or more of an 800-pound gorilla on the backs of American business and American families. To that end, I am joined by Senators Vitter, Chambliss, Allard, Graham, and others in the introduction of Tax Code simplification legislation to finally address the 800-pound gorilla in the living room and the 6-pound gorilla on the back of every American.

This bill simply calls on the Congress to establish a tax review commission which will be required to report back to the Congress on July 4, 2010. Its job will be to analyze all options for revenue for the United States. Consumption taxes or sales taxes, flat taxes, income taxes, productivity taxes, whatever it might be, wipe the slate clean and say: If we could do it all over again, what would be the best way to finance this great country of ours.

Second, once they have made those determinations, they make the recommendations back to the Congress. Then it is the Congress's responsibility to either adopt the commission's recommendations, much as we do with BRAC, or to reject them and affirmatively ratify the Tax Code of 1986, amended thousands of times, now weighing 6 pounds on the back of every single American.

All of us have different ideas over what is the right way to do things. All of us know the United States of America needs revenue to operate. All of us know that. But since 1986 and the major rewrite of the Tax Code, every year all we have done is decorate it like a Christmas tree, amend it here, lower it there, raise it somewhere else--until it has become an absolute burden.

We all know--I know the Presiding Officer deals with it in his State, as I do--the tremendous upheaval over the alternative minimum tax which passed in the 1960s to address the 169 taxpayers who made over a million dollars who did not pay any taxes. Today, the AMT affects everybody, including a family of four making $50,000 a year, if they own their own home, deduct interest, and itemize their deductions. That is just wrong.

So rather than take individual Senators--I respect every one of us in the Chamber, including, obviously, myself--take our ideas and try to volley them back and forth, why not get a distinguished commission of learned people to sit down for a protracted period of time, analyze what is right for this country, and make recommendations to us?

We solved the political disability in terms of reforming the military when we passed BRAC. Why not take the greatest disability on the American people--and that is the Tax Code--and approach it the same way: have thoughtful people who are knowledgeable and understand the Tax Code as it is make the recommendations on what might make it better? It may be a sales tax or a consumption tax. It may be a flat income tax. It may be a series of fees or other revenue streams. It may be a combination.

But what we need most importantly is simplicity, fairness, equity, and I would submit one other thing--participation by all Americans. Everybody has a stake in this country, and everybody should contribute something. I think if we open up the Tax Code to scrutiny, we give this group 3 solid years to look and make their determination, we get the recommendation back by July 4, and then we debate it in this Congress, then, by the end of 2010, we have two choices: We ratify what we have today, which is the 600-pound gorilla on the back of every American citizen, or we look to a vision for the future and adopt a fair and a simpler and a more equitable tax system for every citizen of the United States of America.

I urge my colleagues to join us on this legislation, help bring about and make it a reality, and, for the first time since 1986, address the cause and not the symptom of the cumbersome nature of the American Tax Code.

Mr. President, today, I introduce the EPSCoR Research and Competitive Act of 2007, and I am proud to have the bipartisan support of my colleagues, Senators Snowe, Reed, Hagel, Baucus, Roberts, and Cochran.

The Experimental Program to Stimulate Competitive Research, EPSCoR, is part of the National Science Foundation and is intended to assist smaller States competing for research grants that historically have not received as much funding from the NSF as larger States. Twenty-six States, representing 20 percent of our Nation's population and 25 percent of our doctoral and research institutions are currently eligible for the EPSCoR program yet receive only 10 percent of the total NSF research funding. EPSCoR funding provides valuable research opportunities in States with unique scientific features. States such as West Virginia, Alaska, Hawaii, Montana and New Mexico all stand to gain from EPSCoR funding, and our country will gain from the scientists and innovations made in our States.

EPSCoR has the additional bonus of having a proven track record. Over 50 percent of researchers supported by EPSCoR funds have successfully competed for non-EPSCoR funding. EPSCoR is also helping drive the economy in active States by providing cutting edge job opportunities. Seventy-five percent of new technology companies started by university research are based in the States where the original research was done.

In order for our Nation to remain competitive in the global marketplace, EPSCoR will play an important role in promoting science nationwide. This legislation provides some specifics to meet that goal. First off, this bill proposes that the Research Infrastructure Improvements Grant increase to $75 million beginning in fiscal year 2009 and remain at that level through 2012. Secondly, it seeks 20 percent of the EPSCoR budget for the cofunding program, an innovative initiative to help encourage each of the NSF directorates to collaborate and fund meritorious projects from the EPSCoR States. Thirdly, it encourages the NSF Director to develop creative ways to ensure that the EPSCoR States are part of the new major initiatives of the foundation, including cyberinfrastructure and major research instrumentation.

The citizens of West Virginia have benefited tremendously as a result of this program. Competitive Federal research has increased 68 percent in West Virginia since 2001. In 2005 alone, research created more than $147 million in economic activity and supported 4,432 jobs. Much like other States involved, EPSCoR has been a tremendous boon to our flagship higher institutions with West Virginia University and Marshall University having worked together through this program to come up with innovate solutions like never before. To help ensure that EPSCoR States remain competitive, this legislation suggests that EPSCoR grow proportionately with the foundation. To achieve our competitiveness goals and to increase the numbers of engineers and scientists, every State needs to play a role. It is encouraging to note that the administration's budget request for this year seeks a $7 million increase in EPSCoR.

Ensuring the economic well-being of all our States is an essential part of keeping our entire Nation competitive and EPSCoR is an important step in that direction. EPSCoR States are the home for 25 percent of the doctoral and research universities, and our States train nearly 20 percent of our science and engineering graduate students. This legislation will help encourage and promote competitiveness.