Madam Speaker, I want to thank the gentleman from Florida as we begin a new year and a new Congress with an opportunity to work not only with the gentleman, but also my colleagues from the Rules Committee, and you, Madam Speaker, during…
Madam Speaker, I want to thank the gentleman from Florida as we begin a new year and a new Congress with an opportunity to work not only with the gentleman, but also my colleagues from the Rules Committee, and you, Madam Speaker, during this new Congress. And I thank the gentleman for yielding me the time that he has done.
Madam Speaker, I rise today in strong opposition to this rule and to the ill-conceived underlying legislation. I think the premise that I have heard my friends on the other side of the aisle talk about today of making sure that we just expand this program to meet every single need of every single child is not what this program was designed for, and a $35 billion expansion of the program will help bankrupt this country and the States that try and provide the services also.
I do not support this bill or the way it has been brought to the floor either. My Democrat colleagues on the other side of the aisle who promised to be the most open and honest ethical Congress have once again given Republicans absolutely no say in the process, and they are completely disregarding President-elect Obama's promises to work together to solve the problems of this country.
Today, House Democrats have once again chosen to force their own legislation through a biased rule that we are here debating on the floor of the House right now. This bill has been brought to the floor today without one committee hearing or markup. The current SCHIP program expires on March 31, and so I would ask my colleagues, why aren't we having hearings? Why aren't we having input from House Members? Why aren't we consulting Republicans in this process? In fact, Republicans only received the text yesterday morning. And today's rule once again limits the Republican opportunities for any chance of reform or ideas, confirming the Democrats' plans to govern this House without any input from Republicans.
Democrats over the past few years have demonized me and my Republican colleagues for not expanding the current State Children's Health Insurance Program to unprecedented levels, and they continue to cry out that Republicans are anti-children. I would like to remind them that it was a Republican Congress that initiated this program over a decade ago. It was begun to make sure that children that had no health coverage could gain that coverage.
However, my colleagues and I recognized the need for SCHIP, and we see that we need to help low-income, uninsured children whose families earn too much to qualify for Medicaid but not enough to buy private coverage. For that reason SCHIP was created and today covers about 6.7 million children in our country.
However, today we find that the Democrats' proposed $35 billion expansion of a program that has not yet accomplished its original intent is now being taken to unprecedented levels by my friends on the other side of the aisle. My Democrat friends want to continue to push their government-run health care agenda even though this legislation moves some 2.4 million children who are currently on private health insurance to an inferior public program with less access.
I'll repeat that. The numbers that my friends have been talking about of expanding this to children across this country, 2.4 million of them already have private insurance.
That's a mistake. It's a mistake. So now what we're looking at is that Medicaid programs facing extreme shortfalls and physicians who are scaling back on Medicaid and SCHIP patients due to extremely low reimbursement rates will now take on these additional children.
Why would we want to subject 4 to 6 million more children to this kind of care? Madam Speaker, it seems like my Democrat colleagues are putting their agenda first, not our American children.
This legislation turns an innovative idea on its head by increasing government spending exponentially, leaving taxpayers to foot the bill when their budget gimmicks fail to create the necessary ability to fund properly these programs. This bill has no income limits for eligibility. None. And it allows coverage for families making up to $83,000 a year and has no annual authorization limit and allows States to decide who qualifies, leaving adults and illegal immigrants to compete against low-income American children.
Madam Speaker, it should be important that we should meet the current goals of the program and expectations before we expand that program. For that reason some of my Republican colleagues and I sent a letter to our new President-elect, President Obama, and Speaker Pelosi outlining what we think Republicans would like our Democrat colleagues to understand and consider before expanding the current SCHIP program. I would like to include this as part of our deliberations today.
Congress of the United States,
Washington, DC, January 12, 2009.
President-elect Barack Obama,
Presidential Transition Office,
Washington, DC.
Hon. Nancy Pelosi,
Speaker, U.S. 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 Aderholt, Steve Austria, Michele Bachmann, Spencer
Bachus, Gresham Barrett, Roscoe Bartlett, Joe Barton,
Judy Biggert, Gus Bilirakis, Rob Bishop, Marsha
Blackburn, Roy Blunt, John Boehner, Mary Bono Mack,
John Boozman, Charles Boustany, Kevin Brady, Paul
Broun, Henry Brown, Ginny Brown-Waite, Michael Burgess,
Dan Burton, Steve Buyer, Ken Calvert, Dave Camp, Eric
Cantor, John Carter, Bill Cassidy, Jason Chaffetz,
Howard Coble, Mike Coffman, Tom Cole, Michael Conaway,
Ander Crenshaw, John Culberson, Geoff Davis, Nathan
Deal, David Dreier, Mary Fallin, Jeff Flake, John
Fleming, Randy Forbes, Jeff Fortenberry, Virginia Foxx,
Trent Franks, Rodney Frelinghuysen, Phil Gingrey, Louie
Gohmert, Bob Goodlatte, Kay Granger, Sam Graves, Ralph
Hall, Doc Hastings, Dean Heller, Jeb Hensarling, Wally
Herger, Peter Hoekstra, Duncan Hunter, Bob Inglis,
Darrell Issa, Lynn Jenkins, Sam Johnson, Walter Jones,
Jim Jordan, Steve King, Jack Kingston, Mark Kirk, John
Kline
Doug Lamborn, Christopher Lee, Jerry Lewis, Blaine
Luetkemeyer, Cynthia Lummis, Daniel Lungren, Don
Manzullo, Kevin McCarthy, Thaddeus McCotter, Patrick
McHenry, John McHugh, Cathy McMorris Rodgers, Jeff
Miller, Sue Myrick, Devin Nunes, Pete Olson, Erik
Paulsen, Mike Pence, Joe Pitts, Todd Platts, Ted Poe,
Bill Posey, Tom Price, Adam Putnam, George Radanovich,
Hal Rogers, Mike Rogers, Thomas Rooney, Peter Roskam,
Paul Ryan, Steve Scalise, Jean Schmidt, Aaron Schock,
James Sensenbrenner, Pete Sessions, John Shadegg, John
Shimkus, Bill Shuster, Michael Simpson, Adrian Smith,
Lamar Smith, Cliff Stearns, John Sullivan, Lee Terry,
Glenn Thompson, Patrick Tiberi, Fred Upton, Greg
Walden, Zach Wamp, Lynn Westmoreland, Ed Whitfield, Joe
Wilson, Robert Wittman
The first priority should be to make our Nation's poorest, uninsured children covered. This is the intent of the program, and we should fulfill that program and that goal. Currently, at least two-thirds of children who do not have health insurance are already eligible for Federal help through either SCHIP or Medicaid. We should enroll these children first before expanding to higher income brackets.
The second priority is to ensure that SCHIP does not replace or significantly impact those who already have private health insurance with a government-run program. Last year Hawaii created a new government-financed program to fill the gap between private and public insurance in an effort to provide universal coverage for children. But State officials soon found that families were dropping private coverage to enroll their children in the government plan. The Governor of Hawaii terminated the plan when she realized Hawaii could not and should not subsidize the cost for children already receiving private health insurance.
Madam Speaker, should this legislation pass, we know that 2.4 million more children will be ``crowded out'' from their private insurance plan and moved to SCHIP. In days where Congress is faced with a second $350 billion bailout plan and a possible $1.3 trillion stimulus package, is the Federal Government in any financial shape to be financing health care costs for children who are already receiving private health insurance?
Lastly, a citizenship verification standard is critical to ensuring that only U.S. citizens and certain legal immigrants are allowed to access the taxpayer-funded benefits, not illegal immigrants. The underlying legislation offers no safeguards to ensure American children come before illegal immigrants.
Republicans understand how important and personal health care decisions are for individuals and families. We believe in freedom of choice, and allowing patients and doctors to make health care decisions, not government bureaucrats, is the direction we should go. Allowing for a tax credit or tax deduction for the purchase of health care insurance would give an individual or a family the choice of an affordable health care plan that fits their needs.
Said another way, a family and their children should be able to choose their own doctor and go to that doctor day in and day out, not simply to have to shop to find what is then available through a government-run program. This would bring the ownership and control back to the individual and the family.
Madam Speaker, additionally, if we allow individuals to purchase health insurance across State lines and let businesses and associations band together to purchase insurance, we guarantee choice, portability, and flexibility for families and employees. Rather than limiting choice like my Democrat colleagues, Republicans strive for quality, affordable health care for every single American.
Madam Speaker, another fatal flaw with this huge government expansion is how our Democrat colleagues are going to pay for this plan. The proposed budget uses gimmicks to comply with PAYGO rules, masking the true cost of the expansion. Democrats will increase taxes on cigarette packs by 61 cents to $1 and included taxes on cigars of up to $3 to come up with the majority of the $35 billion expansion. The problem is that this tobacco tax disproportionately burdens low-income Americans because the majority of smokers are young adults and individuals and families making less than 300 percent of the Federal poverty level. To produce the revenues that Congress needs to fund the $35 billion SCHIP expansion would require a tax for 22.4 million new smokers by 2017 or 80 percent of the beneficiaries would lose coverage in 5 years. That means that we are going to tax these users and rely on that stream of revenue that will be diminishing very quickly. That is not a responsible way to fund the program.
Eliminating physician ownership and health care practices is another way that the Democrats plan to pay for expansion. The current state of our community hospitals is in disarray. Community hospitals are overcrowded and understaffed. Physician-owned hospitals run more efficiently, have higher patient satisfaction and higher quality outcomes than their community counterparts. Yet my friends on the other side of the aisle want to eliminate that option for individuals. So while dumping children in a government-run health care plan, they also want to limit health care choices for everyone by eliminating physician-owned facilities.
Rather than limiting choices, Congress should be in the business of creating more avenues and opportunities for individuals and families to find affordable insurance for their choices that provides them and leads them to quality care. This legislation does the opposite.
I encourage my colleagues to oppose this rule and the underlying legislation.
Madam Speaker, I reserve the balance of my time.
Madam Speaker, at this time I would like to yield 2 minutes to the ranking member of the Rules Committee, the gentleman from San Dimas, California (Mr. Dreier).
(Mr. DREIER asked and was given permission to revise and extend his remarks.)
Madam Speaker, you know, it's pretty incredible. A number of speakers that we've had here today sat through the hearing yesterday and understood that this bill is not going to become law anytime soon. Yet we are down on the floor of the House of Representatives touting how this will be the first bill that our new President, President Barack Obama, will sign; and yet, testimony in the Rules Committee yesterday, a full admittance that we don't know whether this is all going to make it or not. It will be interesting to see.
Madam Speaker, at this time I would like to yield 2 minutes to the gentlewoman from Energy and Commerce, Mrs. Blackburn.
Madam Speaker, at this time I would like to yield 3 minutes to the gentleman from the Energy and Commerce Committee, Dr. Gingrey.
Madam Speaker, at this time I would like to yield 1\1/ 2\ minutes to the gentlewoman from Illinois (Mrs. Biggert).
Madam Speaker, at this time I would like to yield 1\1/ 2\ minutes to the distinguished gentleman from Miami, Florida (Mr. Lincoln Diaz-Balart).
Madam Speaker, we believe we are in agreement with the gentleman from Florida (Mr. Hastings) that we will allow their side to catch up at this time.
We continue to reserve.
Madam Speaker, I yield 1 minute to the gentleman from Lewisville, Texas (Mr. Burgess).
Madam Speaker, at this time I would like to yield 2 minutes to the gentleman from Lincoln, Nebraska (Mr. Fortenberry).
Madam Speaker, at this time I would like to yield 2 minutes to the gentleman from Louisiana (Mr. Scalise).
Madam Speaker, the gentleman, the majority leader, indicated he had not had an opportunity to see the Congressional Budget Office report to the gentleman Mr. Waxman, dated January 13. I would like to insert this into the transcript of today's debate.
Congressional Budget Office Cost Estimate
H.R. 2--Children's Health Insurance Program Reauthorization
Act of 2009
Summary: The legislation would authorize the Children's
Health Insurance Program (CHIP) through fiscal year 2013 and
increase federal funding for the program above current
levels. The bill would provide performance bonus payments to
states for enrollment costs resulting from specified
enrollment and retention efforts. H.R. 2 would establish a
child enrollment contingency fund to cover state CHIP
expenditures beyond the amount allotted in statute for the
2009-2013 reauthorization period. The bill also would add an
additional state option to use CHIP funding to provide a
premium assistance subsidy for children enrolled in a
qualified health insurance plan, provide additional funding
for outreach grants, and improve access to dental benefits
and mental health parity in CHIP plans.
H.R. 2 includes other provisions related to the Medicaid
program and CHIP. These provisions include ones that would
allow states the authority to waive the restriction on
providing Medicaid and CHIP coverage to certain legal
immigrants before five years of
residency, provide an alternative citizenship verification
process for states when determining Medicaid eligibility, and
provide grants for increased outreach and enrollment
activities. Finally, the bill would increase the federal
excise tax on tobacco products.
The effects on direct spending and revenues over the 2009-
2013 and 2009-2018 periods are relevant for enforcing pay-as-
you-go rules under the current budget resolution. CBO
estimates that enacting H.R. 2 would increase direct spending
by approximately $32.3 billion over the 2009-2013 period, and
by $65.4 billion over the 2009-2018 period. In addition, the
Joint Committee on Taxation (JCT) estimates that certain
provisions of the bill would increase federal revenues by
$31.3 billion over the 2009-2013 period and $64.7 billion
over the 2009-2018 period. Accounting for those effects and
other revenue effects stemming from provisions in H.R. 2, CBO
estimates that enacting the legislation would reduce deficits
by $1.1 billion over the 2009-2013 period and by $1.7 billion
over the 2009-2018 period.
CBO has reviewed the nontax provisions of the bill (Title I
through Title VI, excluding section 311(a)) and determined
that they contain no intergovernmental mandates as defined in
the Unfunded Mandates Reform Act (UMRA). CBO has determined
that those provisions contain private-sector mandates on
group health plans and issuers of group health insurance. In
aggregate, the costs of the mandates on private entities in
the nontax provisions of the bill would not exceed the annual
threshold established by UMRA for private-sector mandates
($139 million in 2009, adjusted annually for inflation).
Estimated cost to the Federal Government: CBO's estimate of
the impact of H.R. 2 on direct spending and revenues is shown
in the following table. The costs of this legislation fall
within budget function 550 (health).
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year in billions of dollars--
Madam Speaker, we reserve our time.
Madam Speaker, we continue to reserve our time.
Madam Speaker, we will continue to reserve our time.
Madam Speaker, we will continue to reserve our time.
I thank the gentleman. I have no further speakers and would yield myself the balance of my time to close.
Madam Speaker, I will be asking for a recorded vote on 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 I think we deserve an open and honest debate in the committees of jurisdiction before we take a vote on such a large expansion--$35 billion more of government programs.
This legislation spends billions of dollars to substitute private health insurance with government-run coverage. It enables illegal aliens to fraudulently enroll in Medicaid and in SCHIP. The bill creates the most regressive tax increase in American history, using funding gained from taxing the poor to pay for expanding SCHIP eligibility to higher income families. This legislation increases the number of adults on SCHIP, allowing even more resources to be taken away from the low-income, uninsured children who need it the most.
Madam Speaker, this legislation moves us closer and closer to a government-run program and further and further away to access for quality health care of our choice.
I encourage all of my colleagues to vote ``no'' on the rule and to vote ``no'' on the underlying legislation. We should ensure that SCHIP meets its original intent and that it covers the poorest children first.
We have been very clear about saying that the Republicans in this body have asked for the opportunity to have regular order to discuss this issue in committee and have asked for the opportunity to have Republicans and Democrats present their ideas and hear them accepted for amendments before the Rules Committee. We object to the way that this Rules Committee has handled this issue.
I yield back the balance of my time.
Madam Speaker, I demand a recorded vote.