Madam President, I ask unanimous consent that the order for the quorum call be rescinded. Madam President, the amendment before us is the amendment offered by the Senator from Kentucky, Mr. McConnell. It is a substitute amendment to the…
Madam President, I ask unanimous consent that the order for the quorum call be rescinded.
Madam President, the amendment before us is the amendment offered by the Senator from Kentucky, Mr. McConnell. It is a substitute amendment to the bill before us. The bill before us is an expansion of the Children's Health Insurance Program. It is very similar to the two bills that were taken up by Congress in 2007. Both were vetoed by President Bush. Both bodies had more than a majority. Both bodies passed the program. But the House did not get enough votes to override the President's veto.
The point is this is a very popular expansion of children's health insurance. The fact is we would add approximately 4 million more low- income, uninsured children who currently do not have health insurance.
Today about 6.7 million low-income kids have health insurance. Clearly, in this very difficult time of recession, parents are losing their jobs, their incomes are not what they once were. They have a hard time getting health insurance for their kids.
We took the same bill--actually, there were two bills last year, but they are very close--and mixed and matched a little bit, essentially the same bills that passed in 2007 which President Bush vetoed, and we are bringing up that same bill today, with one exception, and that is including perfectly legal alien citizens. They are not citizens but perfectly legal kids in America. Not illegals but legals.
The other side is opposing this bill because they do not want to include perfectly legal kids in the program. I think that is a big mistake because these children are here legally. Their parents pay taxes. If you are an 18-year-old, you could be drafted if we had a draft. These parents are in line to be full citizens after several years. They have green cards, but they will be full citizens. The perfectly legal folks in America receive food stamps. They are eligible for lots of things. They are in public school. It seems to me, therefore, they should be entitled to get health insurance, just like every other kid.
What this comes down to is either you are for low-income, uninsured kids getting health insurance or you are not. It is pretty simple. It is pretty basic. I believe, and I think most people on this side of the aisle believe, therefore, the bill should pass and the substitute offered by the Senator from Kentucky, which does not include these children, should not be adopted.
The other difference is the bill before us will add about 4 million more children who are currently uninsured to the Children's Health Insurance Program. The amendment before us does not add that many. It adds about 2 million. Again, the point is, you are for kids or you are not for kids. I think the answer to that is pretty clear. We do want to add 4 million more low-income, uninsured kids to the Children's Health Insurance Program.
We are going to hear from the other side: Gee, the underlying bill crowds out private coverage; that is, some parents will say: Gee, if the addition passes, I can no longer insure my child with a private health insurance plan but, rather, go off private health insurance and go into the public program.
The point is, that is a national phenomenon that occurs in a lot of ways and in a lot of places. It occurs in Medicaid. For example, some person might be on private health insurance but Medicaid might be better. And if you compare the two bills; that is, the underlying bill and the substitute being offered, essentially they are the same in that about two-thirds of the additional children covered under the underlying bill will go on the public program and about one-third will come out from private coverage in the same proportion that occurs in the substitute amendment--lower numbers but the same proportion.
It just seems to me that the main underlying point is we want low- income, uninsured kids to have health insurance. That is what we want here. In the next several months and in the next year, probably, we will be doing health insurance reform, and then we can make sure private health insurance is bolstered so people who are not insured--46 million, 47 million people in America uninsured--will be able to get insurance either through the public program or private coverage.
It is a bit difficult to explain here, but the main point is if every American has to have health insurance and the low-income people have to have subsidies to get health insurance, that is something the Congress should do. But at this point here today, let's reject the substitute amendment. Why? Because, as I said, a lot of kids who are here, perfectly legally, won't get health insurance, and that is not right. It also doesn't go nearly as far as it should because there are so many kids who don't have health insurance here today but who should get it.
I ask unanimous consent that at 10:55 a.m. the Senate resume consideration of the Grassley amendment, No. 41, and proceed to a vote on the amendment with no intervening action or debate; further, that no amendment be in order to the Grassley amendment prior to the vote; that upon disposition of the Grassley amendment, the Senate resume consideration of the McConnell amendment under the previous order.
Madam President, I also want to inform my colleagues that vote at 10:55 is expected to be a voice vote.
How long does the Senator wish to speak?
I yield 5 minutes to the Senator from Arizona.
Madam President, the real question is, do we want more low-income uninsured children to have health insurance? That is the basic question. I am sure the answer to that question is yes. Most Americans, certainly parents of low-income kids and low-income parents, wish to have their children covered.
Next question: How do we do it? The Children's Health Insurance Program is immensely popular. It was enacted, I think, in 1997. It was set up as a block grant program. States had the option whether they wanted to participate. And immediately, in a very short period of time, all States decided, yes, they wanted to participate in the Children's Health Insurance Program, because it so helps their kids get health insurance.
Now, many people have private health insurance. That is good. The question is, what about lower income people, not Medicaid levels, but working poor who have private health insurance. What should they do? And this legislation gives people the option, gives States the option that a person can continue his private health insurance. If he or she wants to, a person currently on private health insurance who has a couple three kids and who qualifies for the Children's Health Insurance Program, because the parents are working poor, has the option to keep the private health insurance or to put the children in the Children's Health Insurance Program.
Now, this question always arises, that is, when there is a public program, a health program, there is always going to be a question for those who have private coverage, should they stay in their private plan or should they move to the public plan?
About one-third of the new children who have health insurance under the underlying bill will come from the private sector; two-thirds have no insurance whatsoever. The real answer to the dilemma is to make sure that the people in our country have good private health insurance at premiums they can afford, benefits that make sense. The Children's Health Insurance Program has good benefits. So, clearly, a mother whose income is quite low, not quite as low as Medicaid levels, but quite low, will probably want her child to enroll in the Children's Health Insurance Program.
We have to bolster private health insurance in this country. There are 47 million Americans who do not have health insurance. That is unconscionable. About 25 million Americans are underinsured; they have got health insurance, but it is not very good.
So the answer to this question is, how do we insure more kids but in a
way that private health insurance is also a viable option for low- income families. How do you do that?
We are going to take up health care reform this year in this Congress. It is so important. It should be a result where all Americans have health insurance. It also means we have to figure out ways to get the cost down, because health insurance is so costly, and health care is so costly.
Unfortunately, today, insurance in the individual markets is very expensive. The benefits are not that great and the copays are pretty high. It is not a good choice for low-income people. That is the individual market, even small group markets in many cases. So the goal here of national health insurance reform, through all kinds of mechanisms, of health care delivery, and pay for performance, et cetera, is to make sure that private health insurance is a viable option for all Americans, more of an option than it is today.
That means insurance reform, eliminating preexisting conditions as a means to deny coverage. The fancy term ``guarantee issues'' means that when someone applies for health insurance, that health insurance provides there is no discrimination on the basis of health care or age or whatnot.
That is the goal we are all striving for. And, fortunately, it is a goal that almost all of our colleagues agree with. I very much hope--it is imperative that this year, this Congress move aggressively for national health insurance reform, because that will then tend to eliminate this question of crowdout.
But, more importantly, as we worry about crowdout, I do not think it is that much of a worry, frankly. We should keep our eye on the ball which is how do we get more low-income kids insured. That is what the underlying bill does.
Madam President, I suggest the absence of a quorum and ask unanimous consent that the time of the quorum be charged to both sides.
Madam President, I move to reconsider the vote.
Madam President, while we are waiting for the vote, which occurs in a few minutes, I will make a couple of points here.
I will yield.
Madam President, very briefly in response to the Senator from Kentucky, the underlying legislation adds 4 million more children to the Children's Health Insurance Program for a total of about 10 million. I think that is a good goal. On the other hand, the substitute amendment offered by the Senator from Kentucky does not go near that far. It is about 2 million fewer children. I think we want to add more kids to the Children's Health Insurance Program.
Second, he claims his substitute focuses more on low-income kids first. I might say that the underlying bill, the bill offered by myself and others, focuses on low-income first. How does it do so? There is a bonus to States to seek out low-incomes first.
Second, the bill phases out coverage of childless adults. That has been an issue; that is, should adults, who are not children, be covered under the Children's Health Insurance Program? That is an issue because this is a block grant program, and States have the option to cover whom they want to. Some States have covered adults. Actually only one or two have. And we are saying, no, no more of that. So we are phasing out the ability of any State to cover an adult who does not have children.
Parents or pregnant women and kids are another issue. But childless adults are being phased out. So we are focusing more on low-income kids first. I might say too that there is a lower match rate for those States at their own option that want to go to a higher level. Some States want to go to a higher level. That is their choice under the Children's Health Insurance Program, because it is a State option. That is a choice those States can take.
But if they do so, the match is a lower rate than it otherwise might be.
Again, I am trying to make sure that low-income kids are helped first.
And, finally, under the underlying legislation, 91 percent of children covered are at a level of 200 percent of poverty or lower; 91 percent, 200 percent or lower. So this legislation clearly is focused on the working poor.
Mr. President, I ask unanimous consent the vote in relation to the Martinez amendment, No. 65, occur at 12:10 p.m. today, and the additional time be divided and controlled by Senators Boxer and Martinez or their designees, with the remaining provisions of the previous order in effect.
Mr. President, despite the previous unanimous consent agreement, I ask consent the Senator from California be allowed to speak for 1 minute prior to the vote.
I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Madam President, I ask unanimous consent that the next speakers be the following Senators: Senator Murray for 10 minutes, Senator Cornyn for 5 minutes, and Senator Roberts for 20 minutes.
Madam President, I ask unanimous consent that the Senate debate concurrently the Cornyn amendment No. 67 and the Roberts amendment No. 75.
If I might continue, Madam President.
That the time until 2:15 p.m. be equally divided between the chairman and ranking member, or their designees; further, that at 2:15 p.m., the Senate proceed to a vote in relation to the Cornyn amendment No. 67; following disposition of the Cornyn amendment, the Senate proceed to a vote in relation to the Roberts amendment No. 75; further, that no amendments be in order to the Cornyn and Roberts amendments prior to the votes; that there be 2 minutes for debate equally divided prior to the second vote; and that the second vote be limited to 10 minutes.
Mr. President, first, I might remind all my colleagues 69 Senators voted for the underlying bill, essentially, when it was last before the Senate in 2007, and that bill did not include the amendments the Senators on the floor are now suggesting; that is, 69 Senators voted for the bill without these two limiting amendments that are being suggested on the floor.
The Children's Health Insurance Program is clearly helping lower income families. In 2007, 91 percent of children enrolled in CHIP were in families living at or below 200 percent of poverty. It is helping those people. The bill also, I might say, with respect to this so- called issue of crowdout, provides States with bonus payments-- additional money--to cover more uninsured low-income kids in Medicaid, and those are the kids from the lowest income families. This bill targets low-income people.
Also, there are other outreach initiatives designed to encourage States to find low-income kids who are eligible but not enrolled.
Now, I must say, it is true in some States kids are eligible in families earning more than twice the poverty level. These two amendments would reduce Federal funding to these States. I think that is not a good idea. We should resist efforts to kick kids off the Children's Health Insurance Program. That is what those amendments would do.
One of the hallmarks of the Children's Health Insurance Program is giving States flexibility in designing their own programs. Remember, this is a block grant program.
States have the option to participate. States decide if they want to participate. I must also say this bill before us takes the more limited version of the two bills that were voted on by very large margins in this body last year with respect to the 300 percent of poverty.
What I am getting at is this. If the States want to go above 300 percent of poverty, they get the lower match rate. The lower Medicaid rate. They do not get the higher Children's Health Insurance Program match rate. It is a discouragement to those States that, at their own option, decide they want to go above 300 percent of poverty.
Do not forget the poverty rate is a national figure. It is not the poverty rate of one State versus another State. It is a national figure. Some States are healthier States. Some incomes are higher than they are in other States. So it makes sense some States, at their own option, might decide they want to cover children above the national Federal poverty level. But if they do so, the bill provides a lower match rate. I must also say, this bill gives States a reduced Federal match rate along the lines I have indicated.
Let me add to that and make one more point. It is a difficulty with the Roberts amendment because it caps the Federal match at families with $65,000 or median State income. What is the problem?
First, the amendment uses a flat dollar amount and does not index it for inflation. Obviously, over time, that means the Federal funds would have to be fewer and fewer for families because inflation would cut into the families' ability to participate, as inflation eats away at the value of the dollar.
Second, using median State income is an additional problem because the program is directed at helping families who make just a little more than Medicaid levels but not enough to afford private insurance.
The Federal poverty level for a family of four is just a little more than $21,000. In many States, the median State income is less than twice the Federal poverty level--less than twice, less than 200 percent of the Federal poverty level. Thus, the Roberts amendment would constrain Children's Health Insurance Program funding severely in those States compared with other States.
For example, in Mississippi, the median household income is $35,900. That is 170 percent of the Federal poverty level--not 200 percent; it is 170 percent. That means we would have to cap the match rates in Mississippi at lower than 200 percent of poverty; that is, at the 170 percent level.
In 10 States, the median household income is less than 200 percent of poverty. Those States include New Mexico, Montana, Tennessee, Oklahoma, Alabama, West Virginia, Kentucky, Louisiana, Arkansas, and Mississippi.
So the effect of the Roberts amendment would be to further constrain States to take kids off CHIP--those kids who are in families at less than 200 percent of poverty. I do not think that is what we want to do, but that is the effect of the Roberts amendment.
The policy on low-income kids in the bill is the same policy that was in this first Children's Health Insurance bill. The Senate passed that bill with 69 votes, including Senator Roberts, I might say, and Senator Hatch. They both voted for the underlying bill and without these amendments that have been on the floor. True, that bill was vetoed by President Bush, and the House was unable to override the veto. But 69 Senators voted for these policies that are in this bill, without the amendments that have been suggested on the floor.
I thank the Chair.
Mr. President, this is very simple. The real question is, Do we want to kick kids off of the Children's Health Insurance Program--kids who are currently qualified, and qualified because that was a State decision, that was the State option. Most States made that decision for those kids to be included. The Federal poverty level is a national figure, so we cannot apply the Federal poverty level fairly to New York or Mississippi or other States because it
is not relevant because the income levels of States are different. It is not fair to take kids, in my judgment, off SCHIP. There are also provisions in the States that eliminate childless adults, We do not allow waivers. There was a waiver by President Bush that allowed New Jersey to have that higher level.
The bottom line is let's keep the program. It is good. Sixty-nine Senators voted for the underlying bill last time.
We did it for the right reasons. Let's do it again.
Mr. President, I move to table the Cornyn amendment and ask for the yeas and nays.
Mr. President, there are at least 10 States with median incomes at such a level that the effect of this amendment would take kids off the rolls, even when the parents' incomes are lower than 200 percent of poverty. That is because in those States, the median family income is lower than what is prescribed in this amendment. I can list the States. It makes no sense for kids of families who are at lower than 200 percent of poverty to be taken off the Children's Health Insurance Program. That is the effect of this amendment.
In addition, the amendment denies States the opportunity to set the levels they want. Some States are much more wealthy than other States. It is also an optional program. We also cut the reimbursement rate. That is the match rate for States that are wealthier States.
The main point I want to say is, already 91 percent of the kids are in families under 200 percent of poverty. The effect of this amendment would take the kids lower than 200 percent of poverty in 10 States off the rolls, and that is not the right thing to do.
I ask for the yeas and nays.
Mr. President, I compliment the Senator from North Carolina. She is doing what a good Senator should do. First, she is defending the interests of her State. She is here representing the State of North Carolina, and she is doing an excellent job, pointing out some of the problems this bill contains for constituents in her State of North Carolina. But she also is looking at the larger picture, too, and the status of low-income children. It is a classic case that many of us face in the Senate. It is balancing interests and what is most important. It is not an easy decision. But I highly compliment the Senator from North Carolina for such articulation in expressing the views of constituents in her State and the interests of her State but also recognizing it is probably not right to deprive 10 million uninsured, lower income children of health insurance. So I compliment the Senator.
Mr. President, I suggest the absence of a quorum.
Mr. President, yes, that would be fine.
Madam President, the Children's Health Insurance Program Reauthorization Act of 2009 will extend the Children's Health Insurance Program to cover more than 4 million additional children whose parents work but cannot afford insurance on their own.
These low-income working families make too much to qualify for Medicaid, but they cannot afford private insurance. Ninety-one percent of the children covered by the State Children's Health Insurance Program live in families making less than twice the poverty level.
Let me repeat that. Ninety-one percent of the children covered by this program live in families making less than twice the poverty level. That is not very much. These are the working poor. Ninety-one percent of the kids covered by this program live in families who are working poor. Let's not make perfect the enemy of good. Ninety-one percent is pretty good. It is not 100 percent. It is 91 percent. That is pretty good.
I know some of my colleagues are concerned that this bill will cause individuals to drop their private coverage in order to join the Children's Health Insurance Program. Around here that is called crowdout; that is, leaving private health insurance coverage to move over to the Children's Health Insurance Program.
The fact is that any attempt to reduce the number of uninsured will inevitably result in some level of substitution of existing coverage. It just happens. The Medicaid Program--not many, but some families who may have had private insurance, as expensive as it is, decided Medicaid is a little bit better, and they chose Medicaid. As with every public program, it happens.
The next question is, what do we do to minimize too much of it? What is the right policy? Where do we draw the line?
Clearly, we want kids to have health insurance. We want it done in an efficient way, a way that makes sense that is good public policy but not do it in a way that disrupts the private health insurance market. But there is going to be some reduction in private coverage when kids leave the private health insurance market to go to CHIP.
Why would a family want to do that? I can think of several. One is the private coverage is not very good. The premiums are very high. The benefits are pretty low. It is not good. It costs a lot, particularly when we are talking about low-income families. It may not cost quite as much, it may not be quite as much of a burden on someone making $45,000, but it is going to be a big burden on somebody making $20,000 $30,000, $40,000, $50,000. They have to pay the food bills, make the mortgage payments. They have a car payment. You name it. It is expensive to also pay for private health insurance on top of all that.
I can very much understand some people--we are talking about low- income families now--think it makes more sense to maybe try not to pay those health insurance premiums but, rather, go on the Children's Health Insurance Program.
Let's remember, SCHIP is optional. It is up to the States. States can set the levels they want. That is their
privilege. That is their option. This is not an entitlement program. Some people think this is an entitlement program. It is not. It is a block grant program. What does that mean? That means every several years, Congress reauthorizes the program, allocates a certain amount of dollars, and distributes them through a formula to the States, and it ends after a certain period of time. This is a 4\1/2\-year authorization. If you want to participate in this program, you have to set up your own match rates. Uncle Sam will give you more than half of it, but you have to come up with your own match rates. If they want to set income eligibility levels a little higher because they are a State with higher income than other States, that is their privilege, that is what they should do, that is the State's option. It makes sense to me that we should formulate policy to try to draw a line that is fair-- fair to States, fair to kids.
This legislation also recognizes the problem--if it is a problem--of kids leaving private coverage to go to the Children's Health Insurance Program. What do we do? A couple things. One, we make bonus payments to States that focus more on low-income kids. If you have a program in your State and you show you are putting out an extra effort to help low-income kids, you get a bonus. That is very good because that means with lower income people, there is less likely going to be this so- called crowdout.
We also give premium assistance. What is that? We tell States, you can take some of your money and help people pay their private health insurance premiums so they stay on private insurance instead of moving over to the Children's Health Insurance Program. So this bill recognizes the issue that some say is extremely important, namely, we give States the option to provide dollars for premium assistance, that is dollars to families to help them pay their health insurance premiums. That is only fair.
This is complicated. We are a big country. We have different States with different income levels. And we are a Federal system. We have Uncle Sam and we have States. It is very complicated. It is our job to try to find a way to put it all together in a way that is fair and makes sense.
The bottom line is what is fair and makes sense is give a little priority to the kids. Let's find some way to help low-income kids in the country, as we are still trying to be sensitive to concerns of States and concerns of the private health insurance industry.
I believe it makes eminent sense for us to not adopt the amendment offered by the good Senator from Arizona. What does that do? That amendment basically tells States to try to affirmatively find ways to restrict coverage which will have the effect of kids not getting off private health insurance. Do all the things you can to prevent kids from getting off private health insurance. That tilts the balance way too far. It tilts away from the kids. The goal here is kids. We want kids to get the best health insurance possible.
What this comes down to is the need for health reform in this country. We need to reform our health system. When we do, when we address the 46 million, 47 million Americans who do not have health insurance and find ways to make health insurance work for people, then this so-called issue will not be such because people will have the ability to go to the Children's Health Insurance Program or private health insurance that works.
Our legislation, if we pass it, will include health reform so the individual market makes sense, so there is no discrimination in the individual market, so the insurance company cannot discriminate on the basis of health, history, age, and other bases which health insurance companies now utilize to drive up premium costs for people trying to buy into the individual market. That was a guaranteed issue. That is the goal we are striving for, and the insurance companies know that makes sense.
I have talked with many of their CEOs. They want to move down that road. They know it is right. Even though it will change their business model, a model from cherry-picking to one of guaranteed issue, they will have more volume, they will make it up because everybody will have health insurance. They will sell more health insurance policies and give subsidies to people who cannot afford health insurance. That is part of the plan. We are not quite there yet. We have a ways to go. Then this will not be the issue that is raised today, and even today I think it is a bit of a red herring. I don't think that is what is going on here. What is going on here is some people do not want--I hate to put it this way--do not want to use Government funds to give low-income kids health insurance. That is basically what is going on here. I do not want to overstate that point, but I think it is obvious.
Bottom line, I think the amendment should be defeated. Sixty-nine Senators have already voted for this legislation, which did not include this amendment. Sixty-nine Senators in 2007 voted for this very same Children's Health Insurance Program which did not include this amendment. If they could vote for it and it did not include this amendment, I would think those who are here could vote for it again.
I yield the floor.
Madam President, there is not a time agreement, so I don't have to yield, but as a courtesy, as chairman, I yield for the Senator from New Mexico.
Madam President, first, I strongly commend and applaud the Senator from Virginia. He is doing what all good Senators do. He is representing his State. He is quite concerned about the 61-cents-per- pack tobacco tax to be levied, additional tax to be levied on cigarettes. Certainly his State has a big interest, as do several other State. I commend the Senator for what he is doing.
However, I must point out that this same provision passed this body twice before. It passed the House of Representatives twice before--both bodies--with large margins. It is, I think, understood by those who support the Children's Health Insurance Program that this is the proper way to pay for that program.
The alternative method of financing which the Senator recommends is one which I think many Members of this body, including myself, believe should be addressed. Those editorials to which the Senator referred have more than a grain of truth in them. Carried interest is something that must be dealt with and I think it will be dealt with in the context of tax reform later this year or next year. But clearly we will have tax legislation this year. We have to have tax legislation this year because of the expiration of certain very important provisions.
Add it all together, I commend the Senator but say to the Senator I do not think this is the proper time and place to bring up a very important issue, namely carried interest. But there soon will be a time that we will take up that very important issue. The Senator has my assurance that I look at it extremely seriously. I have spoken about this publicly, by the way, as have many others. But like a lot of issues, there is a time and place for everything and this is not the proper time and place but soon it will be. I commend the Senator.
Madam President, I want to correct the Record. Not long ago I misspoke. I said a moment ago the substance of the Kyl amendment was not in the two previous children's health insurance measures that passed this body.
I was incorrect. The substance of the Kyl amendment was in the two bills to which I was referring. Why was the substance of the Kyl amendment in those two bills? Very simply because they were a response to the directive of President Bush on August 17. What was that, the August 17 directive? It basically was a directive by the President to States to develop policies to make it very difficult for people to leave private health insurance to move into the Children's Health Insurance Program.
That was Draconian. Frankly, it was so Draconian that we in the Congress adopted the substance of the Kyl amendment to moderate that directive because the directive was so Draconian. Well, times have changed. We have a new President now; there is not going to be an August 17 directive. It certainly will not be enforced. So there is no need for the so-called section 116 provision to which the Kyl amendment is referring.
So even though I misspoke; it was in those bills, I still firmly believe because of the new election, a new President, the August 17 directive will not be enforced, that we do not need that moderating language in the prior bill.
Accordingly, I will still vote for the underlying legislation.
I yield the floor, and I suggest the absence of a quorum.
Mr. President, the amendment of the good Senator from Ohio would do two things. It would allow five hospitals to receive geographic reclassifications for the purpose of receiving higher Medicare reimbursements; and, second, it would provide a prospective payment service exemption to a cancer facility, which would make the hospital eligible for extra Medicare reimbursement.
While I am sympathetic with the problems the Senator alludes to with respect to, as I understand it, six facilities in his State of Ohio, the fact is, these are so-called rifle shots. This is going to affect the reclassification of five hospitals and change the reimbursement system for one other.
I would like to help out, but I must tell my good friend from Ohio, there are over 50 other requests from other Senators for reclassifications in their home States. If we accept this, Katy bar the door. I can tell the Senator from Ohio, I am thinking of one Senator right now who talks to me constantly--constantly--about the reclassification of hospitals in his home State, and there are many others.
The classification issue in this country is nuts. It is how we pay hospitals based upon--GPCI is the common phrase of what it is called in other formulas for hospitals. And it does not make a lot of sense. It is disparate. It is confusing. It is a mixture. It is not a fair way to reimburse hospitals. So we will be taking this up in health care reform legislation later on this year. And we have to. That is the proper time and place to deal with it.
The same is also true for reclassification of cancer hospitals. That, too, must be taken up. This Congress, frankly, is not competent to decide which hospitals receive which reimbursements. There are so many hospitals in this country that it is getting to the point where we are, as Members of the Senate, asked to decide what the proper reimbursement rate should be for individual hospitals. That is just hospitals. Think of all the other individual, separate medical reimbursement questions we are asked to make. We are not competent as Senators to make that decision.
It is too complicated, and it is getting worse every year--worse every year--because Senators and House Members, appropriately representing their States and their congressional districts, come to the committees of jurisdiction and say: Do this for our State, do this for me, and so forth, as they appropriately should. But this has been going on for year after year after year after year, and it is getting more and more and more complicated. It is out of hand, and it is just one reason why our health care system in this country is in such disarray.
We do not have a health care system in this country. It is a conglomeration, it is kind of a hodgepodge of individual providers, patients, different groups, medical equipment manufacturers--kind of a free market atmosphere--just asking for help for themselves, and they come to Congress saying: Do this for me because I am not being treated fairly.
So I say to my good friend from Ohio, there is a proper time and place to do this to address geographic reclassifications. However, this is not the time. Once we start going down this road on this bill, it is Katy bar the door. That is another reason we shouldn't go down this road because we didn't pass this children's health insurance legislation pronto, right away, with the House, and get it to the President's desk. The President very much wants us to get this legislation passed very quickly.
I say to my good friend from Ohio if we start going down this road and adopting amendments to reclassify hospitals in one State, virtually every other Senator is going to come up here and say, What about my State? You have to do it for me too. Then it is going to open up doors even more.
I urge us all to refrain from going down that road right now. Let's not allow any of these--there are no rifleshots at this bill. None. These are rifleshots. There are none in this bill, with the exception of a couple hospitals in Tennessee that were included in the last children's health insurance bill 3 years ago. It was a commitment I made to those two Senators from that State that they would be in this bill too. That is the only commitment I have made. A deal is a deal. I told them back then we would do it for various reasons, but other than that, there are no rifleshots in this bill and I think it would be wrong to include more and go down this road of reclassification.
I urge the Senator to either withdraw his amendment or I will urge Senators not to vote for it.
Absolutely. I make that commitment to the Senator, because he makes a good point. There are a lot of hospitals in similar situations.
Mr. President, I ask unanimous consent that at 5:30 p.m., the Senate resume consideration of the Kyl amendment No. 46; that the Senate then proceed to a vote in relation to the Kyl amendment, with no intervening action or debate; that upon disposition of the Kyl amendment, the Senate proceed to a vote in relation to the Murkowski amendment No. 77; that there be no amendments in order to the Kyl or Murkowski amendments prior to the votes; and that there be 2 minutes of debate equally divided between the two votes.
I amend that to say the balance of the time between now and 5:30 to be equally divided and then 2 minutes for the Murkowski amendment.
Mr. President, I oppose the Kyl amendment. Senator Kyl has mentioned that the provision which includes the substance of his amendment was in the prior two bills, in the 2007 bills, and he is correct. The Senator is correct. I voted for those, as did many other Senators. However, the circumstances were different back then. That was in response to what is called President Bush's August 17 directive. That August 17 directive, in my judgment, was a Draconian effort by States to essentially, in effect, not let children leave private health insurance for the Children's Health Insurance Program. So Congress, as a response to that directive, enacted this section we are talking about here, section 116. However, that directive was never put in place. We have a new President who is certainly not going to issue a similar directive, which makes the legislation we put in earlier--legislation to moderate the August 17 directive--not necessary.
So that is why I think it makes sense to vote for the bill, but not put this unnecessary language back in. It is unnecessary because the August 17 directive is no longer operable.
Let me also say a few words about the Murkowski amendment, which is the second amendment we will be voting on. The Murkowski amendment would take Federal funding away for kids above 300 percent of the Federal poverty level if the State cannot prove that at least 80 percent of the kids below 200 percent of poverty are covered. States cannot be held accountable for things beyond their control.
This amendment would make States responsible for things such as the private insurance market, the percent of employers offering health coverage, and the overall economy--matters which are beyond the control of States. These factors and others contribute to the level of uninsured kids. States should be encouraged to cover as many low-income kids as possible, not penalized for doing so. This amendment draws an arbitrary line between 200 percent and 300 percent of poverty. I don't think that makes sense.
The Children's Health Insurance Program was started as a joint partnership between States and the Federal Government--a joint partnership. We want to continue this partnership, not limit State flexibility, as was the intent of the original CHIP legislation. That is the hallmark of the Children's Health Insurance Program.
The Murkowski amendment might sound reasonable, but the truth is that it jeopardizes health care for kids. Setting arbitrary targets for States to meet is unfair, it is inappropriate, in a program designed to help kids--not discourage kids but to help kids--and to get them to the doctor visits and the medicines they need.
I urge Members to vote against both the Kyl amendment, which will be the next vote, and the Murkowski amendment, which will be the subsequent vote.
On the contrary, just the opposite. I do not support it. I did not support it.
Mr. President, I ask unanimous consent that an additional 15 minutes equally divided be allocated on this amendment.
Mr. President, without prolonging this debate, very simply this comes down to whether you support the policy of President Bush's so-called August 17 directive.
The amendment in question is kind of a watered-down version of that August 17 directive. That directive basically discouraged States from providing children's health insurance availability to kids of moderate income. That is what the August 17 directive did. It discouraged States from, at their own discretion, a State option, providing children's health insurance coverage for kids who are above 200 percent poverty and a little higher, which has a tendency to mean those families would not have private health insurance but would have insurance under CHIP.
It is simple: If you are for discouraging kids going to the CHIP, middle-income people--actually, lower than middle income--vote for the Kyl amendment because that basically is a watered-down version of the August 17 directive. If you are for the August 17 directive, you are probably for the amendment. If you are not for the August 17 directive, you are not for the Kyl amendment.
I oppose the amendment. I think most are opposed to it. We should not vote for it. I don't mean to disparage the Senator, but it is a watered-down version of the August 17 directive.
Mr. President, very simply, what is wrong with this amendment? What is wrong is we don't know the consequences, what it will do to States. It may have consequences we have not anticipated. Therefore, I think it is not proper.
Second, without belaboring the point, the provision we discussed here was placed in legislation to counteract the August 17 directive. The August 17 directive is now going to be withdrawn; therefore, there is no need for this amendment. That is another reason this amendment is not needed. The August 17 directive is going to be withdrawn totally. That legislation was put in place to moderate the August 17 directive. If there is no August 17 directive, there is no need to moderate; therefore, we don't need the amendment.
I ask unanimous consent--unless the Senator wants to say something-- that a quorum call be placed until a quarter of the hour.
Mr. President, the answer to this is to deal with it in health care reform. Nobody knows the degree to which this is an issue. There is a lot of talk about this issue, especially from the other side. We don't know for sure what the dynamics are that cause or do not cause. We don't know what the consequences are. We don't know how much this really is a problem, frankly. That is why we should have health care reform legislation.
This country does not have a health care system really, just a hodgepodge of different people doing different things. Clearly, we want a solution that is a combination of private insurance as well as public insurance, a uniquely American solution that is a combination of public insurance and private insurance.
There is a very strong role for private health insurance in this country. In fact, the private health insurance industry wants health care reform. When they start to insure 46 million, 47 million Americans who do not have health insurance, it is an opportunity for them. They also want to engage us in insurance reform. They will have to change their business model, but they do agree the time has come to guarantee issue. That is a fancy word saying anybody who applies for health insurance is guaranteed to get it, and there is no discrimination on preexisting conditions, no discrimination based on medical history, no discrimination based on age.
There is a lot we need to do in this country to get meaningful health care reform so everybody has health insurance, all Americans have health insurance, and also so costs are brought down.
I remind my colleagues, we pay twice as much per capita on health care in this country than the next most expensive country. If we keep going down the road we have been going down--that is, not addressing comprehensively health care in this country--then that trend will continue to get worse and worse. That is a cost not just to families and individuals who pay so much more, but it is also a cost to our companies that have to pay so much more for health care than companies in other countries. Third, it is a big cost to our State and Federal budgets. Their budgets are so high because health care costs in this country are so high.
Although this is more than an interesting question, we really do not know the answer to it. We are addressing it by this amendment in a piecemeal way. That is what is the whole problem with what we have been doing for the last 15, 23 years in this country.
I do not mean to be critical of the Senator from Arizona and disparage what he is doing. If we come back with different Senators and different amendments to address another health care issue, it is like a big balloon: push it here and it pops up someplace else. We don't look at it comprehensively. I think the proper place to look, the place to draw the line between public coverage and private coverage is in the context of national health care reform.
I am ready to vote.
They want us to wait 2 minutes, Mr. President. I suggest the absence of a quorum to be equally divided.
Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.
Mr. President, I ask for the yeas and nays on the Kyl amendment.
Mr. President, I move to reconsider the vote.
Madam President, this is frankly a cleverly designed amendment which has dire consequences. Essentially it takes away Federal funding under the Children's Health Insurance Program where States cover children above 300 percent of poverty where the State cannot prove at least 80 percent of all the children in the State are below 200 percent of poverty, as covered either under the CHIP program or privately.
The problem is this: States cannot control their economies. Let's say there is a recession. Let's say there is high unemployment. Let's say people lose their private health insurance coverage. States cannot control that. They cannot control what the total coverage in their State will be, public and private.
If a State cannot guarantee that 80 percent, it cannot control it, then that State loses its Federal funds. So I think that even though it sounds pretty good on the surface, the trouble is States cannot control the dynamics that are going to determine whether the States get those Federal dollars.
Therefore, I urge that the amendment not be adopted.
I ask for the yeas and nays.
Madam President, reserving the right to object, let me get a sense of the lay of the land here. Let me see what this amendment is first.
Madam President, I have no objection.
Madam President, reserving the right to object, I would like to see the amendment.
Madam President, might I ask if the Senator from Oklahoma could right now begin talking about his amendment while we have a chance to look at it, and then we could bring it up as soon as we have a chance to look at it. It saves some time.
I am just saying speak on the amendment. Then we will make a decision to move it after we have had a chance to look at it.
Madam President, I listened carefully to the Senator from Oklahoma, and I might say he has some interesting thoughts and interesting ideas. Let me think about them and maybe there is something we can do about them, and I thank the Senator.
Madam Chairman, I yield the floor.