Madam President, I ask unanimous consent to set aside the pending amendment and call up amendment No. 75. Madam President, I ask unanimous consent that the reading of the amendment be dispensed with. Madam President, first, I ask unanimous…
Madam President, I ask unanimous consent to set aside the pending amendment and call up amendment No. 75.
Madam President, I ask unanimous consent that the reading of the amendment be dispensed with.
Madam President, first, I ask unanimous consent to add Senator Collins as a cosponsor of this amendment, which is already cosponsored by Senator Hatch.
Madam President, I rise today to offer an amendment to refocus this bill and to more accurately reflect our priorities in regard to low-income children. After all, that is what this bill is supposed to be all about.
The SCHIP program was established in title XXI of the Social Security Act. We had one goal, and that goal was to cover targeted low-income children. A targeted low-income child is defined as one who is under the age of 19 with no health insurance, whose family makes too much money to qualify them for Medicaid but not enough to be able to afford to buy them health insurance.
The statute is very clear about who SCHIP is intended to cover. Low- income children should be our priority. That is the intent of the program. That is what the authors of the program had in mind when it was first passed in 1997.
In Kansas, we take this priority very seriously. Our SCHIP is called HealthWave, and it covers children under the age of 19 whose families' incomes are up to 200 percent of the Federal poverty line. That is about $44,000 per year for a family of four. In 2007, we were able to cover nearly 40,000 children through HealthWave, but an estimated 32,000 low-income kids still remain uninsured. So my colleagues can imagine my surprise and frustration when I learned that some States were not following the intent of SCHIP. This was under the previous administration. That administration had granted, I think, something like 14 waivers to States that violated, in my mind, the intent of this program. So instead of prioritizing low-income children, they were, instead, exploiting loopholes and waivers granted by the previous administration to cover high-income kids and even adults--adults being covered by a program intended for low-income children. It shows us what can happen to a program.
In the 2007 SCHIP reauthorization bill, which I and other Republicans supported--and, I might add, at no small political cost--we worked hard to close some of those loopholes and to refocus our priorities toward low-income kids. Now, this new bill, H.R. 2, cancels all of our good work.
I wish to ask my colleagues a question about H.R. 2: Do you know, and do the folks back home whom you represent know, that this bill allows youngsters from families with incomes of $128,000 in some States to be eligible for SCHIP--$128,000? If that is low-income children--I don't know what the allegory is. I will think of it. I will come back to it.
So consider this: Under H.R. 2, the State of New York will be allowed to cover children from families with incomes up to 400 percent of the Federal poverty line. Now, start right there.
That is $88,200 for a family of four. In other States, 200 percent, maybe 250 percent; in New York, 400 percent. When I asked the Senator from New York how on Earth I could go back to Kansas taxpayers and say why are you paying taxes--or why am I paying taxes, on the part of the constituent for SCHIP for low-income kids, and yet you are providing it to a State where they are having the income level at 88,200? The answer I got back is that when you are poor in New York you are poorer than you are in Kansas. My response to that is, they might want to move.
In addition, a State can use something called--now get this. This is bureaucratic talk. This is--I don't know what kind of talk this is. It is gobbledygook. A State can use something called an income disregard. So we can use this income disregard which the expert panel at our Finance Committee markup admitted could exclude as much as $40,000 of additional income.
So in New York, a family of four making $128,000 per year could be eligible to receive SCHIP. In the last SCHIP bill, we closed this loophole. We put a hard cap on income at 300 percent of poverty, still higher than some of us like, to target those low-income kids. It is a lot easier to raise that level, find those kids, and add them to the rolls than go after the low-income kids and give them the insurance the program was intended to do. We came up with a compromise I thought was worth the extra coverage for Kansas youngsters.
In addition, we disallowed the practice of block income disregards. The current bill reverses that policy. How can I explain this to my Kansas families making $40,000 a year? What does this say about our priorities? We just considered an $825 billion economic stimulus bill in the Finance Committee late last night, 9:30, with amendment after amendment after amendment after amendment after amendment. It pretty well wore us out. All were defeated except one by a party-line vote.
Now we are talking about an additional $33 billion to provide health insurance to kids in families with incomes close to $130,000. I repeat, with incomes close to $130,000. That does not make any sense.
I have one more question for my colleagues, Mr. President. Are they aware that H.R. 2 could result in bonus payments being made to States for expanding their Medicaid Programs to cover kids from families making over $128,000 a year? Let me explain how this works.
In order to increase the enrollment of the lowest income kids into Medicaid, which is a good cause, we establish a bonus payment program for States that go out and identify and enroll these young people. However, some States, using their existing Medicaid flexibility, have added a new layer of Medicaid eligibility on top of their maximum SCHIP income eligibility level. They mixed the two. This Medicaid group is made up entirely of people with incomes that are above the maximum SCHIP income levels, which we have seen under H.R. 2 could be over $128,000.
We call this phenomenon in some circles the Medicaid-SCHIP sandwich. It is an extra sandwich. It is frosting on the cake, and the cake is $128,000. It will unintentionally result in States being eligible for bonus payments for expanding their Medicaid enrollments to cover very high income kids. It would be a nice thing to do if we could afford it, but we cannot.
Obviously, this is a gross abuse of congressional intent. Increasing the coverage of low-income children is and should be our priority with these bonus payments. No more sandwiches to add on to SCHIP. Even so, I still believe SCHIP is a program that is worth keeping and putting the SCHIP program back where it belongs--on low-income children.
SCHIP is not supposed to be the Adult Health Insurance Program. It is not the Rich Kid's Free Health Care Program. It is not the Pathway to Government-Run Health Care for All Program. This program is supposed to be targeting, again, low-income children. So let's make sure we take care of them first. Let's get our priorities right.
The amendment I am offering will close some of the loopholes I described in H.R. 2 that corrupt the intent of this program and skew our priorities.
Let me say something I do not have in my prepared remarks, and it refers to a good conversation I had with the former leader of the Senate, Senator Tom Daschle, who is now the designee to be Secretary of Health and Human Services. That is a job I would not want, and I told him that when he came to the office and we had a nice chat.
He asked me: Pat, what could we do, like the President wants to do, to reach out across the aisle, pass something bipartisan where everybody could agree that we could do it, do it quickly, and say: There, we have done something, instead of the back-and-forth politics like last night when we had, what, 40 amendments--I don't know, 30, 40, 50 amendments, straight party-line votes. This is not the road we want to take.
I said: Tom, why don't we take SCHIP that was passed in the last Congress. It was vetoed by President Bush, but we had large majorities. It could be passed again, same bill.
That did not happen. SCHIP popped out of the woodwork. The SCHIP horse came out of the chute, and it was a different rodeo. Underneath that saddle were four burrs. In the SCHIP program, there is a crowdout provision in regard to private insurance. That is the problem we have today. There is the problem of inserting immigration into this bill, which is a very passionate issue. We should not do that either. There are other things wrong with the bill.
This is not the bill we intended, we passed, everybody voted--not everybody voted for it; some on our side, everybody over there--and we passed it. It was the same thing in the House. We could have done it again, the same bill, but the bill is changed. And, I might add, I don't like the way it was done. This is not the way this place is supposed to run. This is not the way the Senate is supposed to run. We should have regular order. We should have committee jurisdiction. We should have hearings. We could have passed that other SCHIP bill we passed in the last session of Congress. It did not happen.
All of a sudden we had a new bill. I went to our ranking member, the distinguished Senator from Iowa, Mr. Grassley. I said: What happened?
I went to the distinguished chairman of the committee, the Senator from Montana, and I asked Senator Baucus: Max, I don't understand this. We usually meet as Republicans; we meet as Democrats. We get together and the Finance Committee is usually bipartisan and then we come up with something and figure out if we cannot do a bipartisan bill, we should not do it.
This is a brandnew ball game. This is not what the President said yesterday when he met with Republicans and said: I want to work with you. This is not what the President said when he said: I am going to reach out; I need your suggestions. This is a cramdown. This is a thing where we had SCHIP, and then, boom, here we are. We have SCHIP, a different bill. I cannot now vote for it. I voted for the last one, but I am not going to vote for this one because of the problems it has.
This is not the way to do business. I feel very badly I advised Tom Daschle who, obviously, advised the transition team who may have advised the President to start off with SCHIP. Now we have SCHIP and it is not SCHIP; it is sandwich plus and plus and plus, most especially for New York and New Jersey. I have been picking on New York. I might as well pick on New Jersey.
The amendment I am offering will close some of the loopholes of H.R. 2 that corrupt the intent of the program and skew priorities. My amendment strikes section 114 of H.R. 2 and replaces it with language that prevents any State from receiving Federal SCHIP funds to cover kids, young people, children, not adults, from families with incomes which are the lower of $65,000 or the State median income for a family of four.
Why do I do that? Because I want to target the program to the low- income kids. You raise all of these caps and all of these income disregards--income disregards; I love those two words, ``income disregards.'' Does that make any sense? That is not an oxymoron; it is something that does not make any sense. Income disregard. We are going to disregard this income--your house, your car, I don't know, maybe your dog. It would have to be a pure-bred dog.
At any rate, this is ridiculous. You raise it and you spend money on those folks, if you can find them. They are sure going to come to the waterhole. But you need not do that and fine the low-income kids who desperately need it. They desperately need it in Kansas and desperately need it in every State. Again, we cover families with incomes which are the lower of $65,000 the State median income for a family of four.
In addition, my amendment addresses the Medicaid-SCHIP sandwich-- SCHIP funding for bonus payments for higher income Medicaid kids.
To be sure, even if this amendment is accepted, a lot of my concerns with this bill will remain, although this would be a giant step forward.
I am also concerned--this is another one of the burrs under the saddle of the SCHIP horse that came out from the chute looking entirely different from the old SCHIP horse which was about to finish first in the race. I am very concerned about the removal of the crowdout provision that had been included in both SCHIP 1 and 2 of last year.
What am I talking about? My concerns are confirmed by the CBO's estimate that over 2 million out of the 6 million new children who will be covered by SCHIP or Medicaid under this new bill already have insurance in the private market. So here we have 6 million youngsters, 2 million of whom are already covered by private insurance. That is the very definition of crowdout, and it needs to be addressed.
What is going to happen to the insurance company that covers these kids? Of course, we are trying to find the low-income kids. But we find out that 2 million--actually it is more than that--are covered by insurance. Do you think that insurance company is going to cover them? Of course not. They are going to get the free Federal program. And what does that do to the insurance company that is covering them now? It means they will probably say: I think we are not going to go into that business anymore. That could leave a lot of other people without insurance. So it is crowding out private insurance, and that needs to be addressed.
I am also upset that this debate over children's health insurance has largely been hijacked by an amendment which inserted one of the most passionate and divisive issues of the past decade into the bill. I am obviously talking about immigration. That has been debated on the floor before. That is the immigration issue. I am very disappointed it was injected into this debate.
Finally, I reiterate my discouragement with the partisan character of this new bill. I think I have indicated that. It is an insult to myself and to my Republican colleagues who worked so very hard to convince our own caucus in the Senate--very difficult--and over in the House to reach across the aisle to work on a bipartisan basis on an issue of huge importance to the children and families of this country. All of that time in good faith. Again, the horse came out of the chute. Wrong horse. Wasted now. It is unfortunate and sets a very negative tone for future health care reform discussions in the 111th Congress.
I said when we started the debate on this bill, and I appealed to the chairman who is a very fair man, a great chairman who works closely with Senator Grassley--either one, it doesn't make a difference who is chairman; we work in a bipartisan way--this tears at the fabric and the comity of the Finance Committee, the very committee that is in charge of the economic stimulus that affects every American. If we are going to do this, simply ram it down our throats, burrs under the saddle and everything, or fish hooks or whatever you want to call it, that is a very bad precedent.
Now, all that being said, I hope my colleagues will support my amendment. I hope we can recapture some of that bipartisan spirit that accompanied the previous SCHIP bill just in the last session. And I hope we can again--that we can again, Madam President--place our priority on covering low-income children.
I yield the floor.
Madam President, it appears to me that a quorum is not present. I suggest the absence of a quorum.
Mr. President, will the distinguished Senator from Arizona yield for a question?
Mr. President, I would ask the distinguished Senator from Arizona, it is my understanding section 116, the anticrowdout section from the previous bill--meaning SCHIP II which passed both the House and the Senate by big majorities last year, and was recommended by some of us as the first bill that should come up this year so we could demonstrate bipartisan support, thinking, of course, the anticrowdout legislation would be in it. It is my understanding that section 116 was left out of the SCHIP bill that we are considering today.
Section 116 required that all States submit a State plan amendment detailing how each State will implement best practices to limit crowdout--the very problem the Senator has been talking about. It also required the Government Accountability Office to issue a report describing the best practices by States in addressing the issue of SCHIP crowdout. Finally, it required the Secretary of HHS to ensure that States which include higher income populations in their SCHIP program to cover a target rate of low-income children, or these States would not receive any Federal payment. This is the very thing we are talking about here whereby under H.R. 2, two States are allowed to expand eligibility up to 400 percent of poverty--that is $88,200--and then you allow income disregards on top of that--that is a marvelous term: ``income disregard''--which allow you to subtract $10,000 for your car; $10,000 for your house; $10,000 for your food, clothing, whatever; up to $40,000 on top of $88,200--how on Earth am I going to explain to a Kansas taxpayer, an Arizona taxpayer, any taxpayer that you are giving a program intended for low-income kids to children of people earning $128,000?
At any rate: Section 116 required that states that included these higher income populations in their SCHIP programs cover a target rate of low-income children, or these States would not receive any Federal payment for such higher income children. That was section 116. What happened to that?
Mr. President, will the distinguished Senator from Arizona yield for another question?
Mr. President, my amendment is very simple, I say to all those milling about. My amendment strikes section 114 of H.R. 2 and replaces it with language that prevents any State from receiving Federal SCHIP funds to cover kids from families with incomes which are the lower of $65,000 or the State median income for a family of four.
It also addresses the Medicaid-SCHIP sandwich by preventing States from receiving SCHIP funding or bonus payments for any higher income Medicaid kids.
We now have States that can cover kids with family incomes up to $128,000. I do not think that is right.
Let me tell the chairman he is absolutely wrong if he says median income is too low. It is median family income, as determined by the Secretary, look at page 2 of my amendment. But how on Earth can we explain to people that we are giving money to a $128,000 income family of four when this is supposed to be for low-income kids? You are ruining SCHIP.
Mr. President, I ask whether the distinguished Senator from Arizona will respond to a question?
I am trying to figure out the practical effect of this. You have already described the fact that this is exactly the same legislation, the same language in the legislation that was passed by this body and the House last year--CHIP I, CHIP II--and then it was deleted. They were talking about crowding out, and that is what happens when public subsidies encourage people to give up their private insurance.
So I am sitting here trying to figure this out. The CBO analysis says that 400,000 children will be covered in higher income families, but another 400,000 children will drop their existing private coverage as a result.
I think you had another figure that you just said.
So the SCHIP legislation ensures one new child for the cost of two. That doesn't seem like a very good deal.
But here is what I want to get to. Is this correct, in the view of the Senator from Arizona. You are an insurance company--BlueCross BlueShield in Kansas, for that matter, Arizona, or John Deere from Iowa--I know they provide this kind of insurance for low-income families. What happens to them when SCHIP expands and crowds them out? And another thing, I'm assuming that providers get less in terms of reimbursement from SCHIP than they do from private insurance. So if I am a provider--and this story has been told in Medicaid, it has been told in Medicare, and now it is going to be told in SCHIP--and I get paid less, some providers are going to say: Adios. I am sorry, I am not going to see you.
Basically, we had that with Medicare Part D and pharmacists, where they were only reimbursed up to 70 percent, and some of them say: I am not going to do this anymore.
Now we are doing it with SCHIP because we are crowding out the private insurance companies. If you are a private insurance company, if you are John Deere of Iowa, and all of a sudden somebody comes along and takes away this number of youngsters from the coverage, how are you going to exist?
I thank the Senator.