Providing for consideration of the Senate amendment to the bill (H.R. 2) to amend title XXI of the Social Security Act to extend and improve the Childrens's Health Insurance Program, and for other purposes.

Madam Speaker, I rise today in strong opposition to this completely closed rule and to the ill-conceived underlying legislation.

Madam Speaker, the gentleman from Colorado, who has extended me the time, well understands, as a freshman, that we have a good number of new Members to this body and who will be making a decision and voting for very important public policy decisions. It's my hope today that I will be able to gather together an argument, not to rebut the gentleman, but to show him and many of his other new colleagues, my new colleagues, why the statement ``cost effective and common sense'' does not apply to the SCHIP bill that the gentleman brings forth today.

Madam Speaker, 2 weeks ago I questioned my Democrat colleagues about their claim to be the most honest, open and transparent House in history when they tout that that is what the leadership of this body is attempting to accomplish. Once again, I will question that claim, because we're provided with a product and a process that is none of the above.

I know that the gentleman on the Rules Committee had a chance, just last night, to hear a debate in the Rules Committee about this SCHIP bill. And I believe that that hearing would produce enough evidence to suggest that this bill is neither cost effective nor common sense. Since the beginning of the 111th Congress, my colleagues on the other side of the aisle have had no regard--no regard--for regular order and continue to cram legislation through this body without Republican input.

When I came to the floor last month to oppose the previous version of this legislation, I explained my opposition on the way that it had been brought to the floor without a single legislative markup. So unfortunately, the new Members of this body, unless they serve on the Rules Committee, have not heard the real facts of the case.

The real facts of the case, unfortunately, have not changed. In fact, neither Republican leadership nor Republican members on the Energy and Commerce Committee have had any opportunity to participate in crafting this 280-plus pages piece of legislation. I will repeat that. Republican members or Republican leadership have had no chance to craft any part of this 280-page legislative bill.

On January 12 of this year, my Republican colleagues and myself sent to President Obama and Speaker Pelosi, which I would like included in the Record, a letter outlining what Republicans would like to see the majority party, the Democrats, consider before expanding the current SCHIP program. We still, as of this morning, have received no answer, no answer, to a forthright and open letter. In responding to this, we are simply asking today on the floor of the House of Representatives for the opportunity not only to be heard but also to make sure that the newest Members of this body have a chance to know the facts of the case. And in reauthorizing this program, the first priority should be, should be, to make sure that our Nation's poorest uninsured children are covered. The intent of the program is that. And we must first fulfill that goal.

Currently, at least two-thirds of the children who do not have health insurance are already eligible for Federal help through either SCHIP or Medicaid. The second priority is to ensure that SCHIP does not replace or significantly impact those who already have private health insurance and replace it with a government-run program. Speaking of common sense, why would you take someone who has private health insurance and move them to a government-run program?

Madam Speaker, if this legislation passes, we know that there are 2.4 million children who will be moved from private insurance to SCHIP, a program that reimburses physicians 30 to 50 percent less than private health insurance. As a matter of fact, last night in the Rules Committee, there was in the debate that took place an acknowledgment from the Democrat side lead who said, yes, he did understand. They're even having problems getting physicians who will accept the patients because of the reduction in the reimbursement. Common sense would tell you that alone is not cost effective nor common sense.

More to my point about the newest Members of this body understanding the facts of the case because regular order did not take place, how would we expect them to know what they were going to vote on? Congress should be encouraging superior health care for our Nation's children, not undermining it. That is common sense.

Furthermore, a citizenship verification standard is critical to ensuring that only U.S. citizens and certain legal immigrants are allowed to access taxpayer-funded benefits, not illegal immigrants. The underlying legislation takes out from the law and offers no safeguards to ensure a check that it will be for American children before illegal immigrants. Once again, cost effective, and once again, common sense for the new Members of this body.

The Democrats' proposed $32.8 billion expansion of a program that has yet to accomplish its original intent is typical of my friends on the other side. My friends, the Democrats, continue to push their government-run health care agenda, ``universal coverage'' as they call it, even though this legislation moves 2.4 million children currently on private health coverage to an inferior public program with less access. Common sense says you should not be doing that.

So, then, with physicians scaling back on Medicaid and SCHIP due to the extremely low government reimbursement rate, why would we want to subject 4 million more children to this type of care? Once again, the standard of common sense. I don't know that this bill passes that hurdle. Madam Speaker, it seems likely that my Democratic colleagues are putting their agenda first, not our children's health care.

In the days where Congress is faced with a second $350 billion financial services bailout and a proposed $1.2 trillion stimulus package, is the Federal Government in any financial shape to be financing health care costs for children who are already receiving priority health insurance? Once again, the test of common sense and cost effectiveness would fail this legislation.

The current legislation before us recklessly increases entitlement spending by at least $73.3 billion over the next 10 years. That is increasing it due to the new entitlements. That is neither cost effective nor common sense. This expansion will allow SCHIP to grow at an annual rate of 23.7 percent over the next 5 years. Once again, not cost effective and not common sense. Based on the Treasury Department's financial report, the government has $56 trillion in unfunded liabilities, the majority of which are in the Federal Government's health care program. Why not do something that would be for the Nation's poorest children rather than

trying to push 2.4 million more children, unless you have a political agenda rather than a public policy agenda?

Each year that Congress fails to act on a solution, the long-term problem grows by $2 to $3 trillion. Do my friends on the other side of the aisle not see the writing on the wall? Where is common sense?

Madam Speaker, last week, a bipartisan group of Members voted against the Democratic Party's $1.2 trillion stimulus package. Not only was the Democrat plan full of wasteful government spending that would not stimulate the economy, but my friends on the other side of the aisle shut out Republicans from the process much as they are doing today.

The American people are hurting. And the economy is struggling. Americans know that we cannot borrow and spend our way back to a growing economy. Republicans have a plan for fast-acting tax relief that will release the resources and creativity of the American people to create 6.2 million new jobs. Madam Speaker, I ask my Democrat colleagues, if the American people had the choice between fast-acting tax relief and slow, wasteful government spending, which would they choose? Trust me. A number of Democrats and every single Republican knew the answer on this floor. It is common sense to vote ``no.''

This so-called ``stimulus bill'' includes $524 billion in spending provisions, $3 billion in prevention and wellness, including $400 million for STD prevention, sexually transmitted disease prevention, and $600 million to buy new cars for government workers. That will make sure we don't have to ask for reform out of the Big Three auto makers. We will just buy them at the current rate. The bill includes $150 million for building repairs for the Smithsonian, $1 billion for follow-up on the 2010 Census that does not even begin until April 1, 2010, $1 billion for Amtrak which has not turned a profit in 40 years, $400 million for global-warming research, and another $2.2 billion for carbon-capture demonstration projects. The list goes on and on and on.

The American people deserve to know how their hard-earned tax dollars will stimulate the economy, not government spending where Washington gets fatter, but those with good explanations so that the American people have confidence, not only in Congress, but in their own individual Member of Congress who casts that vote.

If expanding SCHIP to families making $80,000 a year isn't enough, as this bill does, last week my Democrat colleagues voted in favor of making Wall Street millionaires and billionaires, like the former Lehman Brothers CEO, who was reported to have earned nearly half a billion dollars in compensation, eligible for public health subsidies. Approximately $100 billion of our friends', the Democrats', $1.2 trillion stimulus is the bailout for the failing Medicaid program. One such bailout provision is section 3003, which expands Medicaid eligibility to all individuals currently receiving unemployment benefits, regardless of their personal income or financial assets.

Boy, once again that standard of common sense and cost effectiveness that my good friend from Colorado talked about is simply not there.

Madam Speaker, why are our friends, the Democrats, trying to force American taxpayers to pay for free health coverage for the very same executives who helped create the financial crisis in the stimulus package able to get this help?

Adding another trillion dollars to the Federal deficit and swelling the number of persons dependent on subsidized, government-run health care is hazardous to the health of the American economy and an unfair burden to place on our grandchildren.

The American people want more than just welfare. They want freedom. They want jobs. They want a real stimulus package and a real SCHIP bill. That's what this Congress is failing to provide. The American people want more innovation, more efficiency, more accountability, and they want cost effectiveness and common sense. Evidently, this body is in short supply of each of those items under this leadership.

The American people hate waste in government, but our friends, the Democrats, who are the majority party, are spending like never before, delaying even the thought of addressing the underlying programs of the already burdensome Medicaid and SCHIP programs. My friends on the other side of the aisle seem to be playing with money that does not even exist. We are printing it at this time. The printing presses are alive and working 24 hours a day, just simply first to meet the $700 billion bailout, and then to prepare for the $1.3 trillion stimulus package that is prepared for the President's signature soon.

So what's next? A $32.8 billion expansion of SCHIP, and finally, the massive omnibus which is expected this week or next.

We should be demanding more accountability. We should be demanding cost effectiveness, and we should be demanding common sense. That's what the American people want, Madam Speaker.

Madam Speaker, we need a fast-acting tax relief bill that will stimulate the economy and create jobs. We cannot borrow and spend our way out of this crisis. We need to secure the original intent of the current government programs before expanding additional programs.

I came to Congress to protect the American taxpayer, which is why I encourage my colleagues to oppose this rule and the underlying legislation.

Washington, DC,

January 12, 2009.

President-elect Barack Obama,

Presidential Transition Office,

Washington, DC.

Hon. Nancy Pelosi,

Speaker, Capitol,

Washington, DC.

Dear President-elect Obama and Speaker Pelosi: Thank you

for expressing your desire to work with us to address the

needs of the American people. We recognize that reauthorizing

the State Children's Health Insurance Program (SCHIP) is an

early legislative priority, and we hope that you will

consider this legislation to be one of the first

opportunities for bipartisan cooperation.

During the last Congress, significant efforts were made in

an attempt to address concerns raised by House Republicans

about how the underlying bills would impact uninsured

children. Despite the progress that was made, there are still

a few outstanding issues that we hope you agree should be

addressed when we work to reauthorize the program this year:

Serving Eligible Low-income Children First

SCHIP is intended to serve those that are neediest first.

As low-income families continue to face more economic

insecurity, providing access to affordable health care

coverage, regardless of any job change or displacement,

should be our first priority. The legislation should demand

success from the states in enrolling poor and low-income

children below 200 percent of the federal poverty level,

especially those who are currently eligible for Medicaid and/

or SCHIP, but are not yet enrolled. Demanding success from

the states could be as simple as requiring that states meet a

threshold of enrollment before further expansions. Nearly all

the states have demonstrated over the past year to the

Centers for Medicare and Medicaid Services that meeting this

standard is indeed possible.

Furthermore, in the current economic environment, several

states have indicated that they will be experiencing

shortfalls that could impact their ability to provide

Medicaid benefits and services. Asking states to expand their

SCHIP program before they are able to finance their existing

Medicaid program would be a mistake. Expanding SCHIP to

higher income families will only exacerbate the real access

to care problem in the Medicaid program.

Citizenship Status

We believe that only U.S. citizens and certain legal

residents should be permitted to benefit from a program like

SCHIP. We also think it is fair to say that both parties

believe that our immigration system is broken. That is why it

is so important that the legislation include stronger

provisions to prevent fraud by including citizenship

verification standards to ensure that only eligible U.S.

citizens and certain legal residents are enrolled in the

program.

Protecting Private Insurance Options

We agree that those with private coverage should not be

forced into a government-run plan. SCHIP legislation should

focus expansion efforts on children who are currently

uninsured instead of moving children who have private health

insurance options into government-run health insurance.

Moving a child from private health insurance to government-

run health insurance should not be part of your stated goal

of providing SCHIP for 10 million children, a number we

assume to be targeted towards low-income uninsured children.

Stable Funding Source

In order to guarantee access to the program and long term

stability, SCHIP should

be funded through a stable funding source, not budget

gimmicks. Further, the legislation should not include

extraneous provisions unrelated to SCHIP that limit patient

choice or prohibit access to quality medical care. Our

nation's Governors need a stable SCHIP program so they may

properly budget. Every American faces the crushing burden of

a declining economy. This should not be a time Congress

raises taxes, especially on the poorest Americans, to finance

program expansions as part of the SCHIP reauthorization bill.

We believe these to be critical elements to improve this

vital program that if fully incorporated would dramatically

increase bipartisan support for the legislation. Thank you

for the consideration of this request. We look forward

hearing from you and working with you towards a bipartisan

agreement.

Sincerely,

Robert B. Aderholt, Steve Austria, Michele Bachmann,

Spencer Bachus, J. Gresham Barrett, Roscoe G. Bartlett,

Joe Barton, Judy Biggert, Gus M. Bilirakis, Rob Bishop,

Marsha Blackburn, Roy Blunt, John A. Boehner, Mary Bono

Mack, John Boozman, Charles W. Boustany, Jr., Kevin

Brady, Paul C. Broun, Henry E. Brown, Jr., Ginny Brown-

Waite, Michael C. Burgess, Dan Burton, Steve Buyer, Ken

Calvert, Dave Camp, Eric Cantor, John R. Carter, Bill

Cassidy, Jason Chaffetz, Howard Coble,

Mike Coffman, Tom Cole, K. Michael Conaway, Ander

Crenshaw, John Abney Culberson, Geoff Davis, Nathan

Deal, David Dreier, Mary Fallin, Jeff Flake, John

Fleming, J. Randy Forbes, Jeff Fortenberry, Virginia

Foxx, Trent Franks, Rodney P. Frelinghuysen, Phil

Gingrey, Louie Gohmert, Bob Goodlatte, Kay Granger, Sam

Graves, Ralph M. Hall, Doc Hastings, Dean Heller, Jeb

Hensarling, Wally Herger, Peter Hoekstra, Duncan

Hunter, Bob Inglis, Darrell E. Issa,

Lynn Jenkins, Sam Johnson, Walter B. Jones, Jim Jordan,

Steve King, Jack Kingston, Mark Steven Kirk, John

Kline, Doug Lamborn, Christopher John Lee, Jerry Lewis,

Blaine Luetkemeyer, Cynthia M. Lummis, Daniel E.

Lungren, Donald A. Manzullo, Kevin McCarthy, Thaddeus

G. McCotter, Patrick T. McHenry, John M. McHugh, Cathy

McMorris Rodgers, Jeff Miller, Sue Wilkins Myrick,

Devin Nunes, Pete Olson, Erik Paulsen, Mike Pence,

Joseph R. Pitts, Todd Russell Platts, Ted Poe, Bill

Posey.

Tom Price, Adam H. Putnam, George Radanovich, Harold

Rogers, Mike Rogers (MI), Thomas J. Rooney, Peter J.

Roskam, Paul Ryan, Steve Scalise, Jean Schmidt, Aaron

Schock, F. James Sensenbrenner, Jr., Pete Sessions,

John B. Shadegg, John Shimkus, Bill Shuster, Michael K.

Simpson, Adrian Smith, Lamar Smith, Cliff Stearns, John

Sullivan, Lee Terry, Glenn Thompson, Patrick J. Tiberi,

Fred Upton, Greg Walden, Zach Wamp, Lynn A.

Westmoreland, Ed Whitfield, Joe Wilson, Robert J.

Wittman.

Madam Speaker, I reserve the balance of my time.

Madam Speaker, I would like to yield 1\1/2\ minutes to the gentleman from Lewisville, Texas, Dr. Burgess.

I give the gentleman 30 additional seconds.

Madam Speaker, at this time I would like to yield 1\1/ 2\ minutes to the gentleman from Marietta, Georgia, Dr. Gingrey.

I yield the gentleman 15 additional seconds.

Madam Speaker, at this time, I would like to yield 2\1/ 2\ minutes to the gentleman from San Dimas, California, the ranking member of the committee, Mr. Dreier.

(Mr. DREIER asked and was given permission to revise and extend his remarks.)

Madam Speaker, at this time, I would like to yield 2 minutes to the gentleman from Lafayette, Louisiana (Mr. Boustany).

I yield the gentleman an additional 15 seconds.

Madam Speaker, because there were no hearings held on this subject, many, many Republicans are coming down to the floor today to give their feedback and thoughts on this issue. Our next speaker is one of the most thoughtful and caring Members of Congress.

I would like to yield 1\1/2\ minutes to the gentlewoman from Fort Worth, Texas (Ms. Granger).

Madam Speaker, if I could please inquire as to the time remaining on both sides.

Madam Speaker, due to the time inequity at this point, I would like to reserve my time.

Madam Speaker, we have had a series of Members who have come to the floor--Republican Members--who have talked, I believe, very adequately about the frailties of this bill. The frailties of this bill are obvious. The gentleman representing the Democratic majority has indicated that there were two tests laid forth--cost-effectiveness and common sense. I believe that the feedback from the Members of Congress on the Republican side have enunciated and have talked about several things that are important.

First of all, no hearings were held. Second of all, no Republican or bipartisan feedback was allowed in this bill. Thirdly, it is a huge expansion that will place this great Nation in terrible financial circumstances for the future. It expands a program that was working well for poor children. Lastly, it will move 2.4 million children from a private-run insurance program to a government-run insurance program. We think that is a failure. We believe the two tests have not passed.

In closing, I want to say that I oppose this closed rule. With the current program not expiring until March 31 of this year, we have seen enough Members question the underlying legislation, and it deserves to be debated, I believe, openly and, I believe, in the committees of jurisdiction before we take a vote to pass on such a large expansion of a government program.

This legislation spends billions of dollars to substitute superior, private health care coverage with an inferior government-run program. It enables illegal aliens to fraudulently enroll in Medicaid and SCHIP. The majority party knows that, and so does every Member of this body. The legislation increases the number of adults on SCHIP, allowing even more resources to be taken away from low-income, uninsured children who need it the most and what this legislation should be about.

Madam Speaker, this legislation moves us closer and closer and closer to not only financial insanity but also to a government-run health care program and further away from access to quality health care, which is what this should be about. It should be about quality health care for poor children. That is not what we are doing here today.

I encourage all of my colleagues to vote ``no'' on the rule and ``no'' on the underlying piece of legislation because, today, unlike before today, each of my colleagues has had a chance to hear the facts of the case. The facts of the case are compelling. The test that was established by our Democrat majority colleagues about cost- effectiveness and commonsense simply does not hold water. For these reasons on these issues, I believe that the Republicans have stated the case of why we should not only vote ``no'' but why this is a bad deal not just for the taxpayers but for the children it was intended to help.

I yield back the balance of my time.

Madam Speaker, by direction of the Committee on Rules, I call up House Resolution 107 and ask for its immediate consideration.

Madam Speaker, for the purposes of debate only, I yield the customary 30 minutes to the gentleman from Texas and my colleague on the Rules Committee, Mr. Sessions. All time yielded during consideration of the rule is for debate only.

General Leave

I ask unanimous consent that all Members may have 5 legislative days within which to revise and extend their remarks and insert extraneous material into the Record.

Madam Speaker, I yield myself such time as I may consume.

Madam Speaker, House Resolution 107 provides for consideration of the Senate amendment to H.R. 2, the Children's Health Insurance Program Reauthorization Act of 2009.

I rise in support of House Resolution 107, the Children's Health Insurance Program Reauthorization Act. I again wish to thank Speaker Pelosi who has been an unrelenting champion on this important issue. I also want to thank Chairman Rangel and Chairman Dingell for sponsoring bills that were vetoed in the 110th Congress, and Chairman Waxman and all of my colleagues for their leadership on this issue in this Congress, and I want to recognize everyone's efforts to bring this bill to where it is today.

Although I began my House service only a few weeks ago, I have received hundreds of letters from constituents who have serious concerns about health care cost and coverage. Too common is the story of hardworking, low-income moms and dads forced to choose between buying groceries and visiting their family doctor. I have heard from those who have either lost their health care coverage or feared that they will lose it because they simply can't afford it.

I have heard from parents who are denied necessary health care by their insurers, and as a result, their children are suffering too. I have heard from caregivers who have been laid off losing not only their health coverage, but that of their children's as well. This is a serious problem that we can no longer afford to ignore.

No longer can we lay the blame at the front door of the White House. With the change in administration, we can ensure that this legislation passes the House today and reaches the President's desk as soon as possible. With our approval, President Obama has indicated he will sign this bill into law today and change the lives of millions of children and families. Delay is simply not an option.

A large majority of Americans of all political persuasions support this important bill. It's a fiscally responsible way to not only extend the number of children in our Nation who will receive health care, but to improve the quality of that care. This bill relieves the burden of taxpayers who currently subsidize millions of costly and inefficient uninsured emergency room visits. By encouraging preventative care for children who lack insurance today, we can actually reduce costs from the system and provide healthier outcomes for young people.

This bill is just common sense, given the Nation's skyrocketing health care costs, coupled with our current economic challenges. It is an investment where the return is a generation of healthy, happy and productive Americans. This legislation will provide health care coverage for more than 11 million children nationally.

Tomorrow morning, 170,000 children in my home State of Colorado wake up without health insurance. That is 170,000 too many. This bill will change that terrible statistic for the better by

giving States the vital tools needed to reach out to uninsured children who are eligible for SCHIP and Medicaid, but not yet enrolled. This is not only critical to Colorado, but to all our States and territories.

Madam Speaker, the epidemic of the uninsured is not just a consequence of our struggling economy, it is a component of it. Under a new administration, with the political will of this new Congress, we have the power to set this particular wrong right. A healthy economy is supported by healthy people. Providing health care insurance for millions of uninsured Americans is an important beginning to keeping our people and our economy healthy. But it is just a beginning.

Protecting the health of our Nation's young children is of paramount importance to society and the security of our Nation. A recent military study reveals that one-third of American teenagers are incapable of passing a basic physical test. This legislation will help give every child a chance at a healthy start.

With rising unemployment, a battered economy and more layoffs coming every day, the plight of the uninsured is likely to only get worse. Next month, Madam Speaker, SCHIP will expire. Our failure today would add millions of children to the rolls of the uninsured. To me, my constituents, and hopefully to my colleagues, as well, this is unacceptable. Today we have an opportunity to protect millions of children across the Nation who don't have a voice and to safeguard their future.

I urge you to vote for this legislation.

I reserve the balance of my time.

Madam Speaker, as you know, children do not control what family they are born into. And an important part of the meritocracy that makes our country great is that every child should have the opportunity to succeed. Establishing healthy habits and a healthy life early in life, regardless of the parent's station, is an important part of making sure that a child has the opportunity to climb to whatever station they are capable of.

Madam Speaker, I would like to yield 2 minutes to the gentlewoman from Connecticut (Ms. DeLauro).

Madam Speaker, a brief history on the SCHIP legislation and why this is so critical for us to pass here today. This rule before the House would permit the House to concur in the Senate amendment because this legislation has been considered repeatedly and thoroughly in the House in this Congress and the last.

In July of 2007 the House considered H.R. 3162 to reauthorize and amend

SCHIP and the bill passed. In September 2007 the House considered H.R. 976 to reauthorize and amend SCHIP. The bill passed. The Senate also passed the bill and it was presented to President Bush and received a veto. In October of 2007 the House again tried to reauthorize SCHIP. 3963 was the House bill. Passed the House, passed the Senate. The President again vetoed the bill and the House was unable to override the veto.

Ultimately, legislation to merely extend SCHIP as it was enacted into law will expire next month. Children's lives are at stake. That's what's so critical about passing this bill today.

When people lack health care insurance they often don't seek preventative care and are forced to use emergency rooms as their primary care provider. Not only does this cost more, this also provides for worse health outcomes, and conditions that could have been dealt with less expensively and more successfully in the onset are instead deferred, and incur more expense and worse health outcomes.

By passing this bill today, we can ensure that hundreds of thousands of poor children across our country receive adequate health care and are able to succeed and grow in school and be able to succeed in their lives.

Madam Speaker, I would like to reserve the balance of my time.

Madam Speaker, I am proud to back a plan to help improve the health and chance for success of 11 million children. It also reduces the more costly nature of emergency room use, and moves us closer to providing every child in our Nation with affordable, high quality health care.

This bill also extends health care coverage to 4.1 million additional low-income children who are currently uninsured.

A healthy child is better prepared for learning and success. Studies show that early childhood health is indicative and can, in fact, impact the learning processes, the special education needs of the child and indeed, even the IQ of the child as the child matriculates through education. By making sure that children have health care coverage, we can, in fact, prevent a lot of gaps within our education system from arising before they arise, and ensure that children, regardless of their background, have the opportunity to succeed in our country. This is the change that America needs.

Providing health care coverage for children and indeed, all Americans, is one of the reasons that I ran for Congress. Providing health care to 4 million more children will be a clear demonstration that change has come to Washington.

This is legislation that President Bush vetoed twice in the 110th Congress. Today we have the opportunity to send this bill to a new President who has committed to sign it this very afternoon and begin implementing it immediately to help cover 4.1 million additional children in our Nation.

Madam Speaker, I reserve the balance of my time.

Madam Speaker, with regard to the delivery of the services, most SCHIP and Medicaid beneficiaries receive service delivery through private doctors and through private management care plans, not through government doctors. So, when we are talking about how the service is delivered, we are talking about an important aspect of what insurance and what coverage allows. Yes, separately, we certainly hope that we will be able to address universal coverage, in rural areas in particular, as an important component of health care in this country.

With regard to income limits, this bill does provide that if a State covers children in families of three with income over $52,800, which is 300 percent of the poverty rate, then the States get the regular Medicaid match rate. There are, in fact, income provisions in here as well. There is also section 605 of the bill, which prevents payments to individuals not lawfully residing in the United States. So I believe that the issues that have been raised by my colleagues are addressed in the bill.

It does, of course, matter what the bill says. The bill says very clearly that individuals not lawfully residing in the United States will not receive payments, and it also is very clear with regard to the income level. So I think that this bill has been clear.

As I have mentioned, this bill has been voted on a number of times in Congress. The main difference now is we are sending it to a President who has indicated that he is, in fact, willing to sign it and, indeed, is willing to do so on this very afternoon.

Madam Speaker, I reserve the balance of my time.

Madam Speaker, I would also like to discuss that SCHIP provides quality dental care, alleviating the most common childhood disease--tooth decay.

I cannot help but remember a story that was told to me when I was visiting a free dental clinic in Boulder, Colorado that provides services to those who are uninsured. This story is about a young girl who was in the third grade. Due to the lack of dental care and poor dental hygiene practices at home, her teeth had actually rotted out. This is when she was a young girl. She had received no care for that as well. As a result, she was very, very shy, and was constantly in pain. Her diet suffered. She suffered malnutrition because of the condition of her teeth. Fortunately, the community there was able to help her, but there are hundreds of thousands of young people across the country who suffer from no or from poor quality dental care, which has vast ramifications as well.

In addition, this bill gives the option of providing pregnant women critical prenatal care. When we talk about the impact on reducing the need for special education and for increasing one's IQ, these things start in the prenatal stage, and they continue through early childhood. I think that that is a very important aspect in terms of giving States that option as well as covering 4.1 million additional low-income children who currently lack insurance.

Madam Speaker, I reserve the balance of my time.

Madam Speaker, another story from Colorado is about someone who I know firsthand, a student at one of the schools that I was involved in running.

Like many of the students I worked with, this student lacked health care insurance. She was diagnosed with diabetes, and she was not diagnosed early. She had severe symptoms, weakness, et cetera, but because of economic barriers to seeking health care and because of her lack of insurance, she did not seek any form of preventative treatment. When she then went in, she went into the emergency room, and she needed emergency dialysis immediately. So a condition that could have been dealt with through a combination of diet and insulin instead became an acute condition which had to be dealt with at a much greater cost and with a much worse health outcome for the individual.

These are the stories that are taking place across our great Nation. By passing this bill today, we can make a dent in making sure that people have access to preventative care and to health care throughout their childhoods.

Madam Speaker, I reserve the balance of my time.

Madam Speaker, I am the last speaker for this

side. I would like to reserve my time until the gentleman has closed for his side and has yielded back his time.

Madam Speaker, SCHIP currently provides for coverage of 7 million children. This bill before us today would also allow for extending the coverage to 4.1 million uninsured children, every single one of them who is currently eligible for but not enrolled in SCHIP and Medicaid.

Polls have shown that more than 8 percent of the American people support this bipartisan legislation, including large majorities of both major political parties. This is not only popular, Madam Speaker; this is the right thing to do for American families.

I urge a ``yes'' vote on the previous question and on the rule.

I yield back the balance of my time, and I move the previous question on the resolution.

The previous question was ordered.

Let me thank the chairman of the full Energy and Commerce Committee, Mr. Waxman. Let me thank the manager, Dr. McDermott, and the chairman of the Full Committee on Ways and Means.

This is a miraculous accomplishment. The children of America are shouting today. It's important to know that there are 8.9 million uninsured children in America. Overall, 11.3 percent of children in the United States are uninsured. That is unacceptable, and it is not befitting of this great Nation.

In Texas we have close to 1.5 million children that are uninsured. Today we say to them that they are a priority, and that their health care and their preventative health care is crucial; that it is not a waste of money. When 74 percent of uninsured children eligible for CHIP, for Medicaid are not enrolled, this is not a waste of money.

I am gratified that pregnant women will have access. I am gratified that they will also have access for certain adults that meet certain criteria; and I am delighted that we still have an opportunity to protect certain hospitals owned by physicians that will continue to serve children that are uninsured as well.

This is a great bill. We should vote on it enthusiastically and continue to work again to enroll more children for this great medical service.

Madam Speaker, I rise today in strong support for the Senate Amendment to H.R. 2--``The Children's Health Insurance Program Reauthorization Act''. We stand today, closer to helping 4 million children without health insurance. No longer will these children be forced to live with fear of getting sick. Today is a great day. Today we are able to bring 4 million children in to the fold. Finally, we can tell those 4 million children that are begging for help that Yes We Can!

nationally and in texas

There are an estimated 8.9 million uninsured children in America. Overall, about 11.3 percent of children in the United States are uninsured, but the percentage of uninsured children in each state varies widely. Based on a 3-year average, there were an estimated 20.9% of uninsured children (under 19 years of age) in the State of Texas representing 1,454,000 of the State's children.

According to the Institute of Medicine, uninsured people are less likely to use preventive services and receive regular care. They are also more likely to delay care resulting in poorer health and outcomes. Texas has the highest uninsured rates of all 50 States and the District of Columbia (2005-2007). Almost one-quarter (24.4%) of Texans are uninsured compared to 15.3% of the general U.S. population.

Recent studies estimate that for every 1 percent increase in U.S. unemployment, 1.1 million Americans lose health insurance and more than a million enroll in Medicaid and CHIP. While Texas' 6 percent December unemployment rate remains better than the national average of 7.2 percent, the State rate is up from just 4.2 percent in December 2007. Widespread job losses continue, and leading economists predict that absent dramatic government action, the national unemployment rate could reach 10 percent by 2010. Many states, including Texas, already experience much higher Medicaid enrollment than projected due to job loss and lower incomes, and will be unable to support the higher demand without this relief.

how does chip help texas families?

According to 2004 U.S. Census data, Texas has the highest rate of uninsured children in the country with 21.6% of children in Texas lacking health insurance coverage.

Nearly 90% of uninsured children in Texas have at least one working parent. The high cost of health insurance means that it is unaffordable for many Texas families. According to the Milliman Medical Index, the annual cost of health insurance for a family of four is $13,382.

Although many Texans have employer sponsored health care insurance, many cannot get affordable coverage for dependents through an employer.

National data shows that virtually all the net reduction in SCHIP enrollment has been among children in families with incomes below 150% FPL. I want to share with you just some of the scary health statistics that are affecting children:

74% of uninsured children eligible for SCHIP or Medicaid but not enrolled.

11% of uninsured children in families not eligible for Medicaid or SCHIP with incomes below.

15% of uninsured children in families with incomes over 300 percent of the federal poverty-level who are ineligible for Medicaid and SCHIP.

90% of uninsured children that come from families where at least one parent works.

50% of two-parent families of uninsured children in which both parents work.

3.4 million uninsured children who are white, non-Hispanic.

1.6 million uninsured children who are African American.

3.3 million uninsured children who are Hispanic.

670,000 uninsured children of other racial and ethnic backgrounds.

physician-owned hospitals

I am very pleased to see that this new version does not include the restrictions on physician owned hospitals. Along with many of my colleagues, I have been very concerned that we had with the prohibition on physician-owned hospitals. Which is why I worked with my colleagues to ensure that this language was not included.

In my district of Houston, Texas the population has grown close to 4.5 million people and there are only approximately 16,000 beds available in the city. Physician-owned hospitals like St. Joseph Medical Center in my district provide essential emergency, maternity, and psychiatric care for their patients. They delivered over 6,000 babies in 2008, of which 3,700 were insured by Medicaid. Currently they provide $14M in uninsured care in the Houston Market. A Houston Institution for 120 years, St. Joseph Medical Center is also a major provider of psychiatric beds as it currently operates 102 of the 800 licensed beds in Houston.

In 2006, St. Joseph Medical Center, downtown Houston's first and only teaching hospital was on the verge of closing its doors. When I learned that they were going to shut down this hospital and turn it into high- end condominiums, I personally worked with the hospital board, community leaders, and local government to ensure this did not take place.

Eventually, after I was assured that it would be responsibly managed and it's doors would remain open, I was able to help a hospital corporation, which, in partnership with physicians, purchased the hospital and has made it the premier hospital in the region to keep open St. Joseph's doors including its qualified emergency room responsive to a heavily populated downtown Houston. This formerly troubled medical center is now in the process of reopening Houston Heights Hospital, the fourth oldest acute care hospital in Houston.

robin from texas--her story

Her daughter has a developmental disorder, known as autism. She was not certain of the extent or the prognosis diagnosis of her disorder due to her lack of funds being a single mother, and lack of quality health insurance. She is one of the many uninsured in Texas.

She scraped together money to take her daughter to the doctor when she gets sick and does not pay her electricity bill so she can pay for 30 minutes of private speech therapy a week to complement what the school system provides.

She cannot qualify for SSI or Medicaid, they say she makes just over the maximum allowable income. She had trouble qualifying for CHIP in the past as well. Sadly once this mother has paid for daycare, speech therapy, clothing, car insurance, food, shelter , transportation, the rising cost of gasoline etc., she can barely afford to pay her monthly bills let alone quality insurance on her salary.

Robin wants the American dream for her and her daughter, but she is unable to obtain it. She is stuck in an old apartment building, with an even older car, and inadequate health coverage for her sweet 7 year old daughter. God help us, Robin and the many like her and her daughter deserve better.

the economic affect on healthcare

The economy has now lost 1.2 million jobs since the beginning of the year, with nearly half of those losses occurring in the last three months alone, pointing to acceleration in the pace of erosion in labor markets. It is more important than ever in this economy that children's healthcare is not sacrificed.

Madam Speaker, my faith is renewed in the process that is so often maligned in the media. Thoughtful and deliberate negotiations were taken to advance this legislation--and through your leadership we have succeeding in bringing this to the floor for passage.

I look forward to a day when every child is covered and can play on football fields and jungle gyms without their parents fearing a bankrupting injury to their child. This legislation is piece of mind to 4 million families and I will joyfully cast my vote for passage of this important legislation.

Madam Speaker, pursuant to House Resolution 107, I call up from the Speaker's table the bill (H.R. 2) to amend title XXI of the Social Security Act to extend and improve the Children's Health Insurance Program, and for other purposes, with the Senate amendment thereto, and I have a motion at the desk.

Madam Speaker, I yield myself 1\1/2\ minutes.

I rise in strong support of H.R. 2, as amended by the Senate. This is the same bill, by and large, that we passed in the House by an overwhelming bipartisan majority a few weeks ago.

The opportunity before us today is to make basic health insurance available to 11 million low-income children who would otherwise have no insurance.

We know that without health insurance many children go without the health care they need to grow, to learn, to compete, and to contribute.

The bill before us will extend the current program for 4\1/2\ years, ensuring that States will be able to maintain coverage for the 7 million kids now enrolled and to extend coverage to an additional 4.1 million uninsured low-income children.

The bill is fully paid for. It will cost $33 billion over the next 5 years, fully offset by a 62-cent per pack increase in the cigarette tax.

The Senate made a few minor changes, adding a new option for CHIP to provide dental care for privately insured children and creating a new commission to evaluate provider payments and access in CHIP and Medicaid.

The Senate did not retain the House provision closing a loophole in Medicare that allows physicians to refer patients to hospitals where they have ownership interest. We will continue to work on that matter.

While this bill is short of our ultimate goal of health reform, it is a down payment, and it is an essential start. We need to pass this bill. We need to do so now.

I urge my colleagues to vote for this bill and send it to the President for his signature.

I reserve the balance of my time.

Madam Speaker, I still continue to reserve our time.

Madam Speaker, I'm pleased at this time to yield 3 minutes to the gentleman from Washington State (Mr. McDermott).

Madam Speaker, I am pleased at this time to yield 1 minute to the distinguished majority leader of the House of Representatives, the gentleman from Maryland (Mr. Hoyer).

Madam Speaker, I yield to the chairman of the Health Subcommittee and the author of the SCHIP bill in the House, Mr. Pallone from the State of New Jersey, 1 minute with an option for more.

Madam Speaker, I yield 1 minute to a member of the Energy and Commerce Committee and a member as well of the Health Subcommittee, the gentlewoman from Illinois (Ms. Schakowsky).

Madam Speaker, I yield 1 minute to the gentlelady from California (Ms. Eshoo).

Madam Speaker, I yield 1 minute to the Speaker of the House, without whom we would not have this legislation before us today, who has been tireless in pushing forward the agenda to make sure that no child in this country goes without health insurance, the gentlewoman from California (Ms. Pelosi).

I yield 1 minute to a member of the Health Subcommittee and the full Energy and Commerce Committee who played a role in this legislation, the gentlelady from Wisconsin (Ms. Baldwin).

Madam Speaker, I yield 1 minute to the vice chairman of the Energy and Commerce Committee and a longtime member of the Health Subcommittee, the gentlelady from Colorado (Ms. DeGette).

Madam Speaker, I am pleased to yield to the gentleman from Washington State, a member of the Energy and Commerce Committee, Mr. Inslee, for 1 minute.

(Mr. INSLEE asked and was given permission to revise and extend his remarks.)

Madam Speaker, I am pleased to yield to the gentleman from North Carolina (Mr. Butterfield), a very important and distinguished member of the Energy and Commerce Committee, 1 minute.

Madam Speaker, at this time it is my great honor to yield to speak on this legislation to the gentleman from Michigan (Mr. Dingell), who has been the author of this bill for child health insurance in the last Congress. Unfortunately, the bill was vetoed by President Bush. But we all have to recognize his strong commitment and leadership on this issue, and so I want to yield to him 1 minute to be able to speak in favor of the legislation.

(Mr. DINGELL asked and was given permission to revise and extend his remarks.)

Madam Speaker, I wish to yield the balance of our time to the gentlelady from Colorado (Ms. Markey).

(Ms. MARKEY of Colorado asked and was given permission to revise and extend her remarks.)

Madam Speaker, we wish to reserve our time to close the debate.

Madam Speaker, Members of the House of Representatives, this bill is going to pass by an overwhelming bipartisan majority, as it passed in the last Congress as well, at least twice. But the difference is, this bill will be signed tonight by the President of the United States.

President Bush vetoed this children's health bill twice. And it is interesting to review the arguments he gave for rejecting the legislation. First of all, he said, there's no problem for children getting health care when they need it. They can always go to an emergency

room of a hospital. Of course, the care in an emergency room of a hospital is the most expensive care, and it often means that the child has gotten sicker than otherwise would be the case and is forced to go to that emergency room as the only option.

And the second reason he gave for vetoing the bill is, to me, one of the most astounding. He said, why should taxpayers subsidize parents for their children's health insurance if the parents could afford to buy a private health insurance plan for their own children? Well, many parents just can't afford it or will not have that as an opportunity because of a pre-existing medical condition. But think of that argument.

Suppose the President of the United States said, we ought not to have public schools for children whose parents could afford to send them to private schools. I find that a remarkable argument for him to have made.

We, in this country, should value the opportunity for every child to succeed to the fullest extent of his or her ability, and that means education for all children and health care when those children need it.

We will see the President of the United States sign this bill tonight because election results make a difference. And we will have a President who will sign this bill into law, along with a bipartisan majority in the House and the Senate. And that will be a happy day for America's children.

Madam Speaker, I rise today in strong support of H.R. 2, the Children's Health Insurance Program (CHIP) Reauthorization Act. Our nation must show true compassion for the most vulnerable among us, and CHIP helps millions of low-income children receive healthcare.

The last time we had a floor debate on H.R. 2, there were references made by those in opposition to the bill to a program in my state called Keiki Care. It was suggested by those individuals that the Keiki Care program was cancelled due to perceived crowd-out, where parents drop their children's private insurance in order to enroll into a free government program.

That claim was entirely false, and I join Congressman Abercrombie in correcting the misstatements made by the opposition. The Keiki Care program did not have an issue with crowd-out. It was intentionally designed so that those who wish to enroll in the program must be continuously uninsured for six months. There was also no spike in program enrollment that even suggests that parents were indeed dropping their private insurance to join. I would like to insert into the Record a fact sheet on Keiki Care published by the group Hawaii Covering Kids.

In Hawaiian, ``keiki'' means ``child'' or taken literally ``little one.'' H.R. 2 is a bill that provides for the health and well-being of the keiki most in need of our help. I urge my colleagues to join me in voting in support of H.R. 2 today.

Keiki Care

Goal

All children and youths living in Hawai`i are enrolled in

health insurance.

Children's Health

Compelling national health care statistics drive Hawai`i

Covering Kids' goal:

Children who are uninsured are twice as likely not to

receive any medical care;

Only 45% of uninsured children had one or more well-child

visits in the past year compared with more than 70% of

insured children;

More than one in three uninsured children do not have a

personal physician; and

Uninsured children are less likely to receive proper

medical care for common childhood illnesses such as sore

throats, earaches, and asthma.

Background Information

Approximately five percent of Hawai`i's children and youths

are uninsured statewide which means over 16,000 kids do not

have health insurance. Hawai`i Covering Kids sponsored

meetings in October 2006 and January 2007 to determine the

``gap groups'' and possible solutions. We concluded these

children and youths are most likely uninsured:

Eligible for QUEST or Medicaid Fee-for-Service in

households between 251-300% FPL but parents cannot afford

monthly premium payments;

In families with incomes above 300% FPL and parents cannot

afford private health insurance;

Have temporary visas (V, H, K, etc.);

Undocumented immigrants; and

Student dependents (F2 visa) whose parents cannot afford

university health insurance plans.

2007 Initiative

The Hawai`i State Legislature introduced HB1008, now Act

236, to help uninsured children and youths in the gap groups.

It included paying QUEST and Medicaid Fee-for-Service monthly

premiums for children between 251-300% FPL and establishing a

free Keiki Care plan for children ages 31 days to 19 years

old who are ineligible for public health insurance. The Keiki

Care plan is modeled after the low-cost HMSA Children's Plan

with limited benefits and some out-of-pocket expenses. It

requires the child live in Hawai`i and be continuously

uninsured for six months. Exceptions to the six-month

uninsured provision include: (1) children who ``income

out'' of QUEST or Medicaid Fee-for-Service, (2) children

enrolled in a managed care children's plan on the

effective date (one-time only exemption), (3) newborns

uninsured since birth, and (4) children in families

affected by Aloha Airline's bankruptcy.

Timeline

3 May 2007--HB1008 HD2 SD2 CD1 Passed by the Legislature;

30 June 2007--Signed by the Governor as Act 236;

1 March 2008--Enrollment Commenced;

1 April 2008--Keiki Care Effective Date.

Enrollment

1 April 2008--1,827;

1 November 2008--2,021.

Crowd-Out

Hawai`i has never experienced problems with parents

dropping their children's private health insurance to enroll

them in public-financed programs. Keiki Care specifically

discourages this tactic (called ``crowd-out'') through an

eligibility requirement that each child must be uninsured

continuously for six months, limited benefit package, and

some out-of-pocket expenses. The

fact enrollment in November 2008 isn't significantly greater

than when Keiki Care began illustrates crowd-out prevention

is working.

Outreach

Hawai`i Covering Kids has conducted intensive outreach

through broadcast emails to state and community partners,

mailouts to statewide outreach workers, web site information,

211 hotline referrals, and natural points of contact

including community health centers, hospitals, public health

nurses, Head Start, WIC, and schools.

Economic Impact

The modest investment in Keiki Care pays off in several

significant ways. It supports healthier children, confident

parents, and reliable payments to health care providers while

preserving precious charity care and limited uninsured funds

for those who are uninsurable. Keiki Care empowers parents by

connecting their children to a pediatrician and regular

preventive health care. Should a sudden illness or injury

occur, the children are also insured for emergency care which

averts personal and institutional financial crises. In fact,

as the number of insured kids has increased in Hawai`i,

hospital emergency department data for 2000-2006 show that

visits by uninsured children and youths have declined from

5.25% to 3.79%.