a lack of attention or an for mation to stand between these children and the health care that they need and of quote back in new york city early september two thousand and four three months later the president's reelected had a mandate it seems to me the president was very clear in his convictions me repeat his words because i think they are important he said he would quote lead an aggressive effort to enroll millions of poor children in government health insurance programs and to quote mr president mr president boy this is your friend chuck grassley helping you keep the promise that you made in new york city and helping you keep your mandate that you had as a result of the last election but somewhere the priorities of this administration the congressional budget office reports that the proposal for s chip included in the president's fiscal year two thousand and eight budget would result in the loss of coverage not an increase of coverage as the administration had been advocating for in the year two thousand and four and that loss of coverage would add up to one in four tenths million children and pregnant women the secretary of health and human services mike leavitt has also supported expanding as general secretary leavitt is a president's cabinet member for health care when secretary leavitt was governor you've got he favor expanding s chip during a public media availability and asked if following a meeting with the president here is what he he now secretary leavitt then governor had to say about that meeting and i quote there was a discussion on children's health care a lot of celebration among governors and the president on the successes that we have had in implementing the children's health insurance program over the course of the last couple of years it's been a very successful partnership and we discussed i assume that we means the president and the governors discussed ways in which that could be expanded and t and that's michael leavitt and also there was a governor glendening at that time representing the democratic governors holding a roundtable with the president now however secretary leavitt wrote the finance committee to say that the president would veto the finance committee's s chip bill but even in that l program that has made a significant difference in the health of lower income children through ten years of experience and bipartisan support the states children's health insurance program serves as a valuable safety net for children and families who don't have the means to purchase affordable health care we are committed to its continuation and a quote i appreciate the support in the past expanding as  from both the president and from secretary leavitt now however some around here say that we shouldn't update the s chip program regards to what the president said in the past in new york city regardless of what secretary leavitt said these people are basically saying the program is fine as it is right now they want a simple continuation of the current program and current funding and i'll soon say what's wrong with that but the current program doesn't work and the current levels of funding won't do the job that everybody says they want to do either under current law the current program is authorized to spend twenty five billion dollars over the next five years that's if this program were not sunsetting and just continuing on as is that's what we call a baseline amount but the congressional budget office says that the one twenty five billion dollars may's baseline amount won't fully fund the program o's says that without more funding eight hundred thousand kids would lose coverage and now to the chagrin of many republican senators and even some democrats senators the administration in the last six years in fact in one case of wisconsin in the last three months has allowed adults to get covered under a program for children and that's not what we intended when the children's health insurance program asked chip is for kids not for adults and there's no letter a in the acronym s chip a simple extension of current law however means that adults that everybody's complaining about being on the program are only jailed or would stay on the program and a simple extension would also mean more adults would be add and of course the reason for that is that states will continue in the future asked for waivers and b those waivers granted they would be free to get approval for more childless adults and parents to be on the program that wasn't intended for anything but children covering adults during scarce resources away from what we consider a priority children's coverage first now we may end up having to pass a short term extension of the current law for a few months before workers fanny's on this reauthorization i hope not but that's a possibility this is something that we have to live with while congress finishes work on the final version of the reauthorization if that happens and so be it but hopefully we can avoid a long term extension of current law the s chip formula funding in current law doesn't work either it actually gives less money to states that gets kids covered so you know that doesn't make sense an extension a current law won't fix a formula the current formula also penalizes small rural states that's because on insured kids aren't counted accurately in small rural states that has resulted in funding shortfalls in those states an extension of current law means that this in akron funding formula would could a new that means more shortfalls for the states another problem with current law is that there isn't enough funding so under the straight extension of current law there's going to be additional state charge fall we dealt with that earlier this year i think fourteen fifteen sixteen states a short fall the current the congressional budget office says that those short tours halls would cause eight hundred thousand kids to lose coverage when congress has faced the shortfalls in the past what have we done we just handed out more money to the states congress did that on three separate occasions so all that would keep those eight hundred thousand kids from losing coverage but this wouldn't fix any of the other problems with the legislation in fact the problems that everybody's complaining about it would perpetuate those problems it means the funding coverage of adults number one and number two is a fundamentally flawed formula that our legislation takes care of so that's why an extension of current law won't work more adults will start to think think of all the senators who have been complaining to me because there's no  asked it wasn't meant to cover adults just leave things go as they are more adult we've got a broken funding formula we've got states some states coming up short so you got appropriate more money and most importantly you've got eight hundred thousand kids losing coverage so what other options are there well there's the president's proposal and i'm not here to bad the president's proposal or any of my colleagues on this side of the aisle that are working on proposals and i'm not going to obviously bad mouth anything senator wyden is doing in the same respect on the democratic side of the aisle these policies are good but i am going to tell the president now's not the time the president's plan is in these budget what many have overlooked is the president's planned assumes a massive redistribution of about four billion dollars and has kept funds that states have in reserve so the president assumes that states will willing relinquish all of those s chip reserves and it assumes the secretary will redistribute those funds to states that currently have s chip shortfalls as someone who was worried about the state as chip shortfalls before worrying about s chip shortfalls was cool i'll tell you that dog won't hunt it's robbing peter to pay paul there's no way a proposal that sucks four billion dollars out of state coffers will ever fly around this united states senate and that's not all under the president's plan one in four chance million children pregnant women would be cut off of the program between now and the year two thousand and twelve one in four chance million would lose coverage to emphasize so that the end result of the president's plan that's the end of the that's the end result rob peter to pay paul one in four chance million children losing coverage and then we're going to hear about a more comprehensive plan and this is the one i was referring to when i referred to senator wyden and when i was referring to the president having a proposal and some and well meaning people on my site a comprehensive proposal and mostly most of the news is is from either senator wyden or from these republican colleagues of mine a well meaning approach a proposal to use the tax code to cover many millions of uninsured children adults through private health insurance again i say i don't disagree with that policy but not now is not the time for i and i said during the finance committee consideration of those bail that i would have liked a debate about asked chip to have focused on the larger effort to address americans who are uninsured i think we're missing an opportunity by only focusing this debate on asked to pre authorization too many americans don't have health insurance and we need to address rising health care costs and i think that approach will help that as well i agree that we should be doing more and i want to see congress consider proposals to reform the tax treatment and health care to increase coverage for tens of millions of the forty six million people that don't have insurance today but in terms of this bill and the whole issue of s chip reauthorization that is not realistic i continue to be disappointed by the fact that there isn't bipartisan support for tax reform alternative to the s chip bail even though it won't happen with this bail we still need to work for a broader package to address the more fundamental problems of rising health costs and also the uninsured until then asked chip i see it as a stopgap major five years in duration five years to do something bigger the thirty five billion dollars that we're investing in children's health coverage over the next five years is a drop in the bucket now people that's when i say thirty five billion dollars is a drop in the bucket somebody will say you've been in washington too long but let me explain that that's one quarter of one percent of the fourteen trillion dollars that will be spent on health care in this entire united states public and private expenditures between now and the end of this authorization two thousand and twelve economists generally agree that if a condition cannot persist then it won't proceed as the current spending on health care cannot persist members on both sides of the aisle have worked on proposals to address the broader issues of the uninsured and health reform overall i've already research referred to senator wyden as a leader among democrats on this he has senator bennett of utah as a republican working with them they've been championing a more comprehensive approach to cover the uninsured many republican senators want to make changes in the tax code to help cover cans of millions of americans of all ages instead of a few million kids that we do in this legislation i'm came forward to a fruitful debate on this issue of health reform and the uninsured through the senate finance committee but not until we complete action on this bail s chip must be passed turning back to the finance committee bill meaning the ash gippi bill before us i am really rather surprised at the overheated rhetoric that has emerged from both sides of the aisle it's really been pretty unbelievable on one side i hear there's nothing less than fifty billion dollars to do their job assets numbers not reached children are risk  dying on the other side i hear maintaining coverage for kids currently on this program and covering about half the kids eligible for medicaid or asked chip represents a slippery slope that leads us to the government takeover of the entire health care system both sides need to call time out to cool down stop the hysteria and take a look at what we've actually got before the it's our model for how a safety net should work is not an open ended entitle the finance committee bill maintains the block grant it does not create an entitlement but i wan warn you mr president other members of the senate you're going to hear this too much and you're going hear me wake them up that this is not on the entitlement i think they know it but you know the game that's played around here these tools included allowing a waiting list adding reasonable cost share and limiting enrollment of finance will maintain the flexibility the flexibility that was in that nine hundred ninety seven act is maintain in the bill before the senate in one thousand nine hundred seven as chip gave states the flexibility to address geographical differences in health care costs states determine eligibility for benefits and tailor the benefits to the states needs the finance bill affirms the state's role of managing this program s chip is also a humble program when compared to medicaid medicaid is the bigger and more expansive entitlement program medicaid is a program for low income individuals pregnant women and families the bill before us today represents a modest update modest update of the s chip program created by the one nine hundred ninety seven  what does the bill before the senate actually accomplish the bill before the senate expands the program and fixes problems with current law first of all by extending the program that would otherwise expire september thirtieth doing away with the sunset or extending the sunset five years number two eliminating shortfalls that plague the program number three eliminating enhancements for coverage of parents and childless adults and other words saving money so you spend more on kids and for preserving the original s chip nation coverage of low income children the bill before the senate continues and focuses coverage on low income children by doing the following one provides additional resources targeted towards covering low income children two it expands coverage for the six and six tenths million children currently enrolled in as and i want to emphasize ninety one percent of these families have incomes below two hundred percent of poverty number three it covers an additional two and seven times mil million children already eligible for medicaid or as chip under current law and for it provides coverage for an additional six hundred thousand uninsured low income children the finance committee bill provides targeted incentives to precisely and more importantly efficiently cover the lowest income children it does is by doing two things one providing precisely targeted incentives that use an incentive fund to encourage enrollment of the lowest income children in other words go after those with the most need and to by encouraging states to increase outreach and in ro committee bipartisan bail also removes childless adults and limits payments for parents it eliminates coverage under s chip for childless adults within two years those are the people that are already on the program  enhancement for parents covered under asked if prohibits new state waivers to expand coverage for parents now again i want to emphasize this point it doesn't way was state waivers you get back to every complaint i hear about this bill you don't hear complaints about covering kids under two hundred percent of poverty from republicans or democrats but you hear an awful lot from both republicans and democrats about covering adults because there's no a letter a in the acronym s chip and and those adults are covered because the law allows a waiver so this bill does away with waivers so you don't get the adults on the program the way that they have gotten there in the past next that reduces spending on adults by hundred one tenth billion dollars finally the finance committee bails spans less than the fifty billion authorize in the budget now once again let me emphasize there's people around here that says five billion dollars additional what we're spending now is enough and you've got people that says only twenty only fifty billion dollars more than what we're spending is representing along with seventeen other members of the finance committee seventeen before this bill was voted out were fifteen billion dollars under what a lot of people in this body would like to spend and i think for some people continuing as chip was static enrollment would cost fourteen billion over five years over the baseline anyway at thirty five billion dollars the billion dollars less than what was included in our budget this additional funding goes towards coverage of lowest income children this bill doesn't include everything on everybody's  i worked hard for responsible bipartisan agreement because i want to see this bill passed and i think we've done a good job but i also want to make one more point very clear my support for this legislation the end will be bent upon the outcome on for debate in conference i'm not going be able to support a bill that changes significantly for what we have here in this proposal i appreciate very much the leadership of chairman baucus provided i thank him senator rockefeller what they did to reach a his commitment to the ideals and fundamentals of the program is steadfast and the program is better for it mr president i also have to say that i'm disappointed by the way that the democratic leadership is handling the process of bringing this bill up for consideration the floor it does not bode well for the outcome of the bail in the senate process the process matters as much as policy and this process has not been managed in a bipartisan or responsible manner however the finance committee s chip bill is still one that i can support it's a compromise it's based upon reality this bill is for kids so i will end with an analogy from a child's bedtime story this  doing this for senator reins of because he had to do something else i want to call up amendment number twenty five thirty eight before you call it out let me check with something here once again the senator from oregon is recognized as president since the senator from iowa has been taught thing about the efforts of senator bennett and i am how it relates to the children's health program i want to just take a few minutes and discuss that relationship first i think that senator baucus and senator rockefeller and senator grassley and senator hatch through the hours and hours of effort they put in to make the children's health proposal ready for floor action have done a great service and done a great service first and foremost to the country's kids seems to me that every single member of the senate can say today that we cannot afford in a country as good and strong and richer as ours to have so many kids go to bed at night without decent health care and as a result of the bipartisan work of four members of the united states senate two democrats and two republicans we have laid the foundation to take steps immediately to help youngsters who are falling between the cracks and i have long felt that the challenge with respect to health care today is twofold first you act immediately to help those who are the most vulnerable in our society that is in fact what four members of the senate finance committee have helped the senate to promote today second we ought to be taking steps on a broader basis to fix health care in our country we're spending enough money on health care today not spending at the right places we're spending enough money today on american health care to be able to go out and hire a doctor for every seven families in the united states that doctor would do nothing except take care of seven families pay the doctor two hundred thousand dollars a year and my guess is the distinguished president the senate would probably have physician in the state of delaware come to him and say where do the where do you go to get your seven families because they all like to be physicians again so we're spending enough money on health care today we're not spending it in the right places and we need at a time when our population is growing so rapidly when costs are skyrocketing out of control we need to fix american health care but in order to get to the broader health reform efforts an effort that is bipartisan senator bennett joining me in the first bipartisan health reform bill in thirteen years to get to the broader health reform effort you've got to take steps to meet the needs of youngsters today the senate has already said that on multiple occasions we said it first by passing the children's health program and now through the reauthorization efforts we say kids will come first and we also set it in fact through the budget resolution where there was an effort to look at the relationship between broader health reform and care for kids and the senate again said children will come first so i'm very hopeful that through this process the senate is just beginning i believe that consider a consideration of the children's health program is essentially the opening bell of round one in the fight to fix health care and if we can tackle the issue of children's health in a bipartisan the way the senate finance committee has done it ought it be possible even in this session of congress to move on to broader health reform i'm very hopeful that the administration will join in this bipartisan effort we've all read about discussions of the come out the just possible veto message i'm very hopeful that the administer gration will join discussions here in the senate join discussions in the other body and help us to move quickly on the issue of children's health if we do that it ought to be possible as the distinguished senator from iowa has indicated to move on to something the administration feel strongly about where i happen to think by and large they're correct the federal tax rules as it relates to health care are a now essential ie they reward inefficiency they disproportionally favor the most affluent if you're a high flyer in our country you can go out and get every manner of deluxe kind of health service right off on your taxes and if you're a hard working woman in delaware or oregon or around the country and your company doesn't have a health plan you get virtually nothing like come to the floor today to say what democratic economists have said what republican economists have said what the administration officials  there ought to be an effort to fix the tax code as it relates to health care but to get at that issue and i and senator bennett and others want to and we want to get at it in this session of the congress you're going to first have to meet the needs of children i was asked today what the implications of the children's health program are for bipartisanship i think that if this body can pick up on the bipartisan work of the senate finance committee there are extraordinary opportunities for broader health reform in discussion of congress i don't think the country wants to w three or four or five more years to fix american health care i've heard the discussion about how there's a presidential campaign coming up and let's just wait another two three four years to talk about a more comprehensive effort to fix american health care i don't think any of us got sent here to tell businesses that are trying to compete in tough global markets to tell those who can afford the skyrocketing premiums well we're really not going to work on health care abroad or health care reform for another three or four years i think they want to hear how we're going to deal in a bipartisan way with the premier domestic issue of our time centers baucus and grassley and hatch and rockefeller have given us an initial dose of bipartisanship an initial dose of bipartisanship in the area that the country cares about and cares about strongly and that's meeting the needs of our children but in the spirit that that senate finance committee course cat has worked i and senator bennett and others would like to pick up on that kind of bipartisan thing and move aggressively to looking at the health care system as a whole and taking steps to transform it madam president i will say i'm struck again by how every single day it seems to me opportunities for bipartisanship on health care about and i was very pleased that the nominee to head c m s the agency that deals with medicare and and medicaid reacted very positively to our ideas on health care prevention the fact of the matter is in this country we really don't have health care at all we've got  care we wait till somebody flat on their back in a hospital medicare program shows this clearly by paying those bills under parte of medicare part b of medicare on the other hand the outpatient  medicare pay virtually nothing for prevention virtually nothing to keep people well well we've known about the value of prevention madam president for quite some time the distinguished senator from iowa senator harkin has been talking about the value of health care prevention for years and year what i and senator bennett have proposed is for the first time the first time under federal law medicare would be given the legal authority to go out and lower premiums for fifteen years reduce their blood pressure and reduce their cholesterol take the kind of preventive steps that everyone understands make sense helped to prolong individual good health and also save money for the medicare program and we were very pleased that the nominee to head the agency that deals with medicare and medicaid was supportive of those changes and indicated that he wanted to work if confirmed in a bipartisan way so the fact of the matter is madam president there are great opportunities for bipartisanship on health care in this congress if we can get past this first step this initial effort at addressing american health care the senate has indicated through the initial authorization of the children's health program and through the budget resolution that this is the program it once to begin the debate on health care on in the discussions in the finance committee i followed very closely all of the different i'll turn this it was a big bipartisan left to get a seventeen to four vote in the senate finance committee a lot of colleagues wanted to spend more a lot of colleagues thought that the program ought to be available to us there are groups of citizen sons felt there was much of a role for government at all and even the existing children's health program was too expensive but the committee came together on a seventeen to four basis i'd say the distinguished senator from iowa has has returned and i simply want to say that i think if we can pass this legislation with the kind of bipartisan support that was initially demonstrated in the senate finance committee i think it is very possible that this senate spite of all the popular with them to the contrary  achieve broader health care reform in this session of congress i've seen one poll after another madam president that indicates that health care is the premier domestic issue of our time that it is the most important issue for our citizens in many poll by something like two to one margin so i think that in addressing this issue today of health care for children the senate can lay a bipartisan foundation for broader reform i think senator bennett and i have provided some direction for the senate to go from here but we would be the first to acknowledge that there are many senators with ideas on these issues and many of them are good i've already indicated that i think the administration's got a valid point with respect to these tax rules on health care the disting finance committee is is back here and i have listened to one economist after another testify before the finance committee democrats and republicans talking about how the tax code on health care makes no sense largely comes out of the forty so you've got senators of both political parties who would like to on broader health care reform but first we've got a pass this legislation i hope will pass it with a with sounding bipartisan the senator from iowa mr grassley for mr ensign proposes and then that number twenty five thirty eight two and then the number twenty five thirty at the appropriate place insert the following and since the reading thus far constitutes a reading of the a man without amendment to the s chip bill this is the same amendment i offered during the finance committee's consider aeration of this legislation i've heard a lot of talk about how the  chip back on low income children so much talk in fact that you would hardly know that the baucus bill allows certain states to provide families making up to seventy our eighty thousand dollars a year in income with government run health care let's start from the beginning the way the s chip and medicaid program work is that states get federal matching dollars to help fund their programs the eps s chip mat from the federal government is higher than the state's medicaid match this means that for my state the federal government's match for medicaid is about seventy percent while the state pays for the remaining thirty percent far as  the federal matching is eighty percent while the state matt makes up the remaining twenty percent as chip was intended to help states provide medicare shares may health care coverage to children and families whose income were below two hundred percent of the federal poverty line these families were likely working but making too much money to call to qualify for medicaid and couldn't afford private health insurance i'd like to note that two hundred percent of the federal poverty level is about forty one thousand dollars a year in income for a family of four the baucus bill allows states to expand their s chip programs and receive the higher s chip matching rate for families with incomes up to three hundred percent of the poverty level are almost sixty two thousand for a family of four personally i think that in and of itself is too high especially when the national media median income in this country was about forty six thousand dollars a year in two thousand and five and the baucus bill states that choose to go above the three hundred percent of poverty would receive their medicare matching rate for those families with three ma chip the bill provides an exemption for states that have already gone above are currently trying to go above three hundred percent of poverty coverage new jersey already provides coverage for families up to three hundred fifty percent of poverty new york is working to get approval to extend coverage up to four hundred percent of poverty i want to make sure that everyone understands four hundred percent of poverty is eighty two thousand six hundred dollars a year for a family of four three hundred fifty percent of poverty is seventy two thousand thousand two hundred and seventy five dollars per year are we really going to be providing government health care for families making seventy to eighty thousand dollars a year my amendment is fairly simple it strikes the exemption has given to just new york and new jersey so they have to play by the same rules as every other state of these two states want to provide health care coverage to families above three hundred percent of poverty level they can do so they just cannot get a higher s chip matching rate they would get their medicaid it would take these savings and provide additional money to outreach and then rollman grants some people will try to say that it is more expensive to live in these two states then it is in other states and that is probably true in certain areas however s chip is a federal program and all states should play by the same rules also these two states can still cover these higher income families if they choose they just have to get the lower medicaid matching rate to do so if the york and new jersey feel so strongly about letting families making seventy or eighty thousand a year have government health care then the state should be willing to pay a little more for their own tax revenue this last time i checked money doesn't grow on trees around here or at least  very rarely does the baucus bill is requiring people in other states like kentucky new mexico florida and maine to pay more so new york and new jersey can cover families at these higher income levels to me that is grossly unfair some people may also try to argue that new york is only thinking about going to two hundred four hundred percent of the poverty level and they would have to get a waiver or plan approval by the department of health and human services for this increase ok so then when why give them this special protection in the baucus bill why create special rules for new york when they haven't even gotten approval yet to me it's outrageous that a program designed for lower income kids is being expanded to include families at the three hundred fifty percent or four hundred percent of the poverty level that's too high and it's unfair to ask people in other states to pay for these types of expenses so with my amendment you have two options more money for outreach and enrollment efforts and requiring all states to play by the same rules all are covering kids and families that most of us probably don't consider low income those making up to seventy two thousand are eighty two thousand a year for a family of four thank you and i reserve the balance of my time and i ask for the a it is appropriate is there sufficient second to support the effort that we have on the floor to address a national healthcare imperative that is providing health insurance to ten million young people in our country today you know for me madam president when i come to this united states senate every day and speak on behalf of the millions of people in my state of colorado around the country i think about the biggest issues that we are faced with the biggest challenges of our time those that are the imperatives if you will  dawn of the century in the twenty first century and they are three in my mind the first is the questions that we face in terms of foreign affairs and how we protect america and homeland security and we'll have other occasions where we will be dealing with that fundamental issue of protecting america and making sure that our homeland is secure and we took some significant steps in that direction last week with the largest they should implementing the nine eleven recommendations as well as the passage of the homeland security appropriations legislation the second issue which for me is an imperative is how we move forward and embrace a clean energy economy for the twenty first century and that with the committees that have reported legislation including our energy committee that adopted the legislation in a bipartisan way here on this floor few weeks ago we've taken a significant step forward with that national and international imperative and the third issue which i think is an imperative the twenty first century is how we take a health care which is in crisis the health care system which is broken the health care system which is not working for the people of america today and how we fix it and today is an opportunity for us this week is an opportunity for us in the u s senate to take a first very major step towards making sure that we're moving towards addressing the complex issue of health care and providing health care insurance to the ten million children of america who without this program would wake up after september without the health insurance to provide them with an opportunity to live a healthy american life so this legislation is very important for us to move through this body i want to say also at the outset that we would not be here today today in the framework that gives it the great possibility of receiving an overwhelming bipartisan vote as we move this legislation out of the united states senate madam president and we think about all the measures we know that our health care system is in crisis some of those measures include the fact that we have forty seven million americans without health insurance today nine million of those americans are kids in my state of twenty percent of our population that's one in five seven hundred eighty thousand people seven hundred eighty thousand people in colorado lack any health insurance at all one hundred eighty thousand of those people in my they are the children of colorado these are middle class citizens madam president they're middle class citizens who are getting squeezed by the ballooning cost of health care two thirds of americans and seventy seventy percent of coloradoans without health insurance are now working full time these are people who are working full time and they're the ones today who do not have health insurance they play by the rules but no matter how hard they work they still find it extremely difficult and in many cases impossible to afford health insurance and ma president for those who can afford health insurance the picture for them is also very grim health insurance premiums for family coverage every resident by over seventy percent since two thousand and employer sponsored family coverage plan now costs nearly ten thousand dollars a year this is a huge chunk of a working families income our health care set system is indeed in dire need of major change we must start today with those who are most vulnerable our children and see to it that they have the health care coverage that they deserve covering our kids providing them with preventive care with doctors and nurses that will ensure that they grow up healthy and strong that is an american imperative this week as we move forward with this legislation i hope that we give the kid kids of america an opportunity that they deserve to live up to their potential as a president reason we focus our first reforms of the health care system on our children is simple every american child deserves the opportunities that come from a healthy start in life the fact that nine million of our kids have no coverage in america is simply unacceptable the fact that a hundred eighty thousand people young people in colorado in mice they have no health insurance is an unacceptable it is a massive liability not just for the health of our children but for their education and for our future economic security the impacts of a lack of health coverage are clear uninsured children are six times more likely to have unmet medical needs uninsured sure children are two and a half times more likely to have unmet dental needs one third of all uninsured children go without any medical care for the entire year uninsured children are less likely to do well in school due to absences because of health problems uninsured children are more likely to seek care from hospital emergency rooms which are often the provider of last resort the most costly venue for health care and the least equipped to provide the type of preventive and comprehensive health care that our children need as sobering as the statistics are the stories of families and health care providers are even more compelling under the leadership of senator baucus and his suggestion i traveled around my state to listen to people about what they thought about the children's health insurance program i traveled to greeley for morgan fort collins steamboat silverthorne grand junction durango alamosa public colorado springs and denver and with my staff we met with health care providers in those communities that talked about the need for the reauthorization of the children's health plan i heard many tales about delayed health care which would cause children's health worsen one school nurse told me of a boy who injured his leg during a school school football game because his family could not afford to take him to a doctor they applied to his leg and prayed and prayed that it would get better and fortunately the boy's leg which is fractured group progressively worse swelling to two times its normal size th school nurse told me of the pain and the anguish of the child and the pain and anguish and toured by him and his parents because they could not afford a doctor's visit i heard countless other stories of colds that turned into the monia of ear aches that develop into ear infections and other illnesses a grew worse because parents could not afford to seek medical care for their kids these families eventually had to take their kids to the emergency room for treatment again the most expensive expensive venue or cure for millions of children and their families or hospitals clinics and health care providers who can no longer shoulder the burden of uncompensated care the time has c here in washington d c for this congress for this us senate to take action and to provide health insurance to the children of america mr president i'm very proud of the work of the finance committee i'm proud to be a member of that committee and i'm proud that we've taken the initiative to provide coverage to ten million uninsured children that's ten million children in america it is a huge step towards providing coverage for it for every uninsured child in america unfortunately the president today seems to have a different perspective he has already issued a veto threat and i believe that on this issue he is wrong for the sake of our children we must  reauthorize the children's health insurance program and we asked the president for his help to get it done the children's health insurance program has become a critical resource to us in colorado and throughout the nation in how we provide health care to children whether why would go uninsured madam president this is a moral obligation of our nation to these young people of america i hope the president changes mind and embraces this proposal which will help ten million children in our country live the american dream speak however you introduce about one amendment that i hope to offer to the legislation that's an amendment relating to the nurse family partnership it is a an amendment which embraces a home visitation program a nurse or a social worker or a volunteer can come to a home and provide prenatal care it is a program which has been in place for a long time in our country by mammon is straightforward it would create a one hundred million dollar grant program to fund cost effective form visitation programs that would also require a study of the cost effectiveness of adding phone visitation programs to coverage under chip for my experience with these programs in colorado i know that they work well the statistics and the evidence demonstrate the success of this program the nurse family partnership program has been shown to do the following then shown to reduce child abuse and neglect by forty eight percent it's been shown to reduce child arrest by fifty one percent it's been shown to reduce arrests of the mother by sixty one percent has been shown to reduce criminal convictions for the mother by seventy two percent and it's been shown to increase the presence of a father in a household by forty two percent and this is to six go on with the success of this program i know that there are other very worthwhile amendments that my colleagues may be bringing forth or that were discussed in the enough an asse committee i do hope that as we move forward with this legislation they will have an opportunity to consider this amendment to the legislation that is now before us finally madam president i want to once again thank baucus and ranking member grassley for their leadership on what is one of america's imperative and that is how we address the issue of health care and take the first post important step which is to provide health insurance coverage to the young people of timing i'm not sure when you went when you said limiting time i'm not sure what you meant by that if you get a sense of the timing well i have i have a list of centers i wish to speak i have a times next to the saturdays when they're going to speak i have time allocated how much time they think they're going to speak and that's getting squeezed and so i'm asking all senators forthwith to  i think be able to basically speak at the times of the day that they really are hope to speak but i'm asking them to speak maybe fewer minutes so that all senators can speak at the times that they've been allot and if morgan and president i assure the manager of the village i'll be as brief as i can on the big issue all of us who are parents madam president you know that the health of a child is critically important to ensuring they have the opportunity to reach their full potential yet today in america there are approximately six million children who are eligible for either medicaid or s chip who are going without health care nevertheless in oregon alone there are approximately sixty thousand kids eligible for assistance that aren't getting the help that they need therefore the debate before says about whether we as a country will invest in our young people by providing access to health coverage or whether we will leave these children without the essential urge my colleagues to support the bill that the finance committee is now produced which sees this whole promise of shift one step closer to fulfillment this bill will allow states to cover an additional three point three million children and in oregon this would allow an additional one hundred thousand children to receive health care coverage when thinking about our responsibility to children i often like to quote one of our nation's health care leaders former surgeon program fulfills the government's responsibility to take care of our nation's children it also lives up to the expectations of the american public we the people who want tongass to pass this bill and extend health care coverage to america's underprivileged children this bill also is a testament to a bipartisan legacy of the finance committee it contains less money and benefits and some desire well more than others well more than others have indicated they will support yet when you look at the actual policy i believe you will find that it deserves the full support of the senate my colleagues and the american public should know that this bill is not as some have claimed an expansion and it is not the federalization of health care in fact it simply takes a step a reasonable step towards achieving the original objective the original vision for s chip it will provide adequate funding and make some program matic enhanced meant to help an additional three point three million currently eligible children to enroll in the program i want to emphasize madam president these are currently eligible children this just makes the program available to them this package that many of us have work to craft also does not create a new government run health care system in fact forty eight states including my state of oregon utilize private health insurers to deliver the s chip benefit package like medicare part d it is a highly successful melding of government and private sector care i also believe it important to note that s chip is an efficient and cost effective healthcare program it's overhead ranges from about five percent compared to the commercial market which is over ten percent perhaps most importantly this bill returns the focus of the state children's health insurance program to children many on both sides of the political aisle were amazed and disappointed to learn that the administration has allowed states to extend coverage under s chip to adults this proposal puts the brakes on that practice and says another is  act another bill the administration no longer will be able to extend waivers to states to cover any adult further by the end of two thousand and nine those states that currently cover childless adults will be required to move those people into medicaid and any parent currently covered will be moved into a separate block grant starting in two thousand and ten this represents a bipartisan agreement for those of us who have battled over the years to insure mental health parity i'm pleased to report that the committee accepted an amendment from me and senator kerry that this bill now delivers a victory to those who advocate for mental health parity  require states to that offer access to mental health care to provide coverage that is on par with coverage for physical illnesses as a parent whose child battled a mental illness i know how important it is for our young people to have timely access to mental health care treatments each year in the united states thirty thousand people die by suicide that's more deaths than by drunk driving and homicides combined yet with proper treatment these deaths are preventable our nation and our government simply cannot continue to ignore this problem that's why this small victory and as chip was included so that we will now begin to reverse these federal discrimination as a relates to mental health care i believe that by ensuring equity among mental mental and physical illnesses this bill takes the first step towards eliminating the discrimination against persons with mental illnesses that has existed in our federal and state health care programs for generations it is an important first step and fulfills the promise of s chip for all children including those children with a mental illness for those of you who believe s chip will erode health care coverage through employers do not believe that this bill takes a significant step toward offering access to privately delivered options and help small businesses gain access to affordable health care coverage for all of their employees i authored a provision that allows states to create employer purchasing pool under the premium assisted assistance section of  my provision will allow small businesses with less than two hundred fifty employees to buy health insurance coverage to a state sponsored employer purchasing pool employers that that participate will have access to a choice of privately delivered quality health insurance products for all of their employees and will receive reimbursement for those employees or their children who are eligible for s chip it is a win win arrangement that i hope will lead to more extensive coverage among employees and small and medium sized businesses finally this package rightly utilizes the sixty one cent increase in the tobacco products excise tax which i proposed during the senate's budget debate to pay for the cost of reauthorizing s chip increasing the cost of tobacco products not only puts real dollars on the table to pay for  over time it will lower the cost of tobacco related illnesses for all federal state health care programs will deter young people from smoking why is this important by state of oregon was the first in the nation in hundred seven to begin tracking the number of deaths that were related to the use of tobacco two thousand and five the most recent year for which data are available there were a total of nearly seven thousand deaths in oregon due to tobacco this means that tobacco contributed to twenty two percent of all deaths in the state of oregon in fact from one nine hundred ninety six to two thousand and five tobacco use has consistently contributed to more than one fifth of all oregon deaths ranging from twenty one percent to twenty three percent of the total deaths per year officials in my state explain to me that to determine the death rate in this state they often look at it in terms of the number of deaths per one hundred thousand oregonians in two thousand and five the death rate includes the death rate due to tobacco was about thirteen times the rate of deaths from the following causes alcohol induced deaths drug induced das motor vehicle accidents and deaths from an infection or parasitic disease what's more the state estimates that an additional eight hundred s were attributable to secondhand smoking in two thousand and five that means in one year seven thousand seven hundred twenty one oregonians needlessly died because of the use of tobacco so for those of you question the rate the raising the rate of the federal tobacco excised rate i say look at these numbers look at the seven thousand deaths from tobacco in the state of oregon in two thousand and five alone and understand that this federal rate increase could dramatically lower the death rate from tobacco that is why this bill rightly includes a sixty one cent increase in the excise tax in closing chairman baucus and ranking member grassley they have a long working tradition of tackling challenging issues and developing bipartisan solutions the development of the children's health improvement program reauthorized reauthorization act of two thousand and seven is no different many hurdles were encountered and many are yet to come but if the senate can follow the example set by chairman baucus and ranking member grassley i'm confident we will see as jeffrey authorized by the end of september therefore adam president i urge my colleagues to support this bill and i thank you for the time i yield the floor to thank chairman baucus for his leadership and for for the way he's conducted the debate on this bill i want to make a couple of points that probably haven't been made yet some of them have in different ways but the first thing i want to say is this bill overall provides what a lot of americans expect us to provide an ability this it lowers the rates of uninsured children in america just like the the original children's health insurance bill did some ten years ago now it strengthens the program by increasing and targeting funding for our children and it also gives states the tools they need to do the outreach required to get our children enrolled in to do that in a way that spends money wisely one of the things that i think has been missed in this debate is this is really about all of america this isn't simply about one state or one community and one of the one of  the one of the population sectors that have been ignored i think often in this discussion by by some people have talked about this are rural children and you can see this chart on my right what children's health insurance program means to rural rural children rural children are far less likely to have access to impose lawyer based health care plans because most of them aren't most of these families who have had to struggle are not getting jobs that offer affordable health insurance and that that number is gone far too high in terms of the number of rural families that have lost their jobs or seeking jobs with health insurance and secondly rural children are difficult to roll in children's health insurance even when they're clearly eligible outreach and roman efforts are critically important to those communities that's why the features of this bill that deal with outreach television advertising and other kinds of very ties is critically important the second point about children who live in rural communities across america and i have to say in pennsylvania we have literally millions of pennsylvania's live and in communities that are defined demographically as rural rural children are more likely to be poor nearly half of rural children live in low income families at or below two hundred percent of the poverty level so we're talking about a doubling of the number  just little more than forty thousand dollars of family income secondly rural children increasingly rely upon children's health insurance in this program and in rural america more than one third of all children one third of all rural children upon the children's health insurance program or medicaid another point on benefits if we can go to the next chart there's been a lot of talk about what this program means and how much it costs and it's interesting to debate that but let's get back to the point of what this program means for families immunizations routine checkups prescription drugs dental care maternity care mental health benefits down the list you can see what this means to the life of the family and to the health the nation and i think it bears repeating how important those benefits are next chart we want to focus on an example from pennsylvania there's been a lot of talk on the floor ready some of that inaccurate talk so let's get back to the facts this is what what the children's health insurance income levels means in pennsylvania but we're talking about here for forty one thousand three hundred dollars of income and below under two hundred percent of the f t l federal poverty level  free for those families and the average premium is of course zero but the net category forty one thousand three hundred sixty one thousand nine hundred fifty above two hundred percent of poverty up to three hundred here is provided but a a low cost albeit but a cost nonetheless the and they pay a premium arranging for premiums finally the higher income groups and some people in a very misleading in sixty one thousand nine fifty one above that higher income level care is provided at cost and the average premium is one hundred fifty dollars so i think we should stop the talk about misleading people that wealthier families making eighty thousand and others are going to discuss this later but we've already heard a lot of misleading and i hope it's not deliberate but it's been misleading rhetoric on this floor already about those families just for the record not only are there no family no families eighty thousand dollars in the children's health insurance program there are only about three thousand kids enrolled in the children's health insurance program today out of six point six million that have a family income of three hundred percent of poverty or more so let's let's speak with with the truth and let's be at here ourselves to the facts instead of what we've heard already misleading statements on this floor about these income levels one more point minority children in america we've heard a lot about what this means and whether it's working we have lots of proof already the minority children have already been helped since the inception of this program ten years ago the percentage of uninsured hispanic children has decreased by nearly one third for african american children by almost one half so don't tell us that this isn't working and some people on the other side have made that point this is working for rural kids is working for minority children all across the country not to mention what i've seen in pennsylvania one more one more chart and with this will be our last chart i think seventy eight percent we've heard a lot about what this means for the broad spectrum of america here's the fact again seventy eight percent of the kids covered by the children's health insurance program are from working families working families and i think that's an important point to make when we talk about who is helped by this program now if we want to go the way that the president has taken us and cut off kids from children's health insurance one point four million kids a loser coverage under the president's plan here's what happens when a child doesn't get dental care we've heard this story from a couple of months ago it bears repeating over and over and over again twelve year old de'monte driver price prince george's county here in maryland died because he didn't have coverage for a routine eighty dollars dental procedure for his infected tooth without that simple treatment the infection spread to de'monte driver's brain and killed him so let's let's put aside some of the ms ology about what we've heard from some people not everyone but some people in this chamber about what this means if that child got an eighty dollar dental procedure he might be alive today but of course we hear political rhetoric and here to back up the president i think it's important to remember why we're here i have two more points to make to keep within my time john junior distinguished ph d work for president bush worked to lead his faith based initiatives in the early part of his administration he wrote an op ed in the philadelphia inquirer a few days ago i won't of course read it i'd ask unanimous consent to be entered in the record at this time but i do want to highlight what he said some of what he said he talked about the president and what's been happening with this debate on children's health insurance he made this point on the second to last paragraph treating health insurance for needy children as a political bargaining chip and he's referring to the president's other health care ideas would be wrong and he talks about the fact that mitch daniels who worked in a republican administration is a governor now and governor of indiana and also is a great supporter of this program and mr dooley concludes this way he says for compassion sake the president should compromise on s chip and a this to move forward so i have to say that some of what we heard in the last couple of days have been misleading but in the end it's about this and i'll conclude with this this is about whether we're going to be fair to families across america now whether the u s senate is like a programmer doesn't like it this is about whether or not we're going to be fair to families and every parent knows anyone has had the experience of being a parent when their child is born that parent whoever they are falls in love again my wife and i have four daughters and we know that feeling and so many others here do as well and as a parent you always want to love your child and protect them and want to child is injured  get sick the first and instinct of any parent but especially a mother is to hug that child to dry her tears and to soothe her pain immediately not months later not days later but immediately and of course if it's more serious you want to get her to a doctor or hospital but for millions of parents that's why this bill is so important to get done for millions of parents that hug that they give their son or daughter that warm embrace and the comfort that a hug can bring to a child that will often be all that they have at the end of the road because their son or daughter has no health insurance like the millions of children we've talked about in the last couple of days so if that child cries in the dark of night from pain or if she endures the slow ache of disease or sickness her mother cannot bring the full measure of her life to that child in essence the mother is rendered powerless because of that and just think of what that does to a mother and to a family so when we have debates on this floor about this bill none of it matters none of the debate in the last couple of days will have mattered if it doesn't result in a total commitment to the children of america and unfortunately the president gets his way on this we will have failed that basic test about a folk amendment to our children i conclude with one line when my father served as a governor of pennsylvania is one of the first states to have a children's health insurance program he knew the benefits of it and his test for every public official in every difficult fight was very simple it's a very tough test what did you do when you had the power this senate has the power this week to tell the president that he's wrong about children's health insurance but more importantly to tell america that we've made a full commitment to the children of america  if we pass that test we will have done our job if this body does not it will have failed that test that when we have the power to positively impact millions of children that we exercise that power on behalf of that known as s chip nine hundred ninety seven a republican led congress has s chip to help states provide health coverage to low income children current law defines a targeted low income child as one who is under the age of nineteen years uninsured and who would not have been eligible for medicaid in one thousand nine hundred said that states may set the upper income eligibility level at two hundred percent of the federal poverty level or fifty percentage points above a state's medicare medicaid income level that a chairman that's not what's happening today in my state of colorado we had a health care conference or summit meeting early on the year very popular well attended by representatives of health providers all over the state of colorado and they had this to say to say we think that the ass to program is too accessible and we think that it ought to provide care to needy children those who are uninsured and they further stated that there needs to be equity among the various states and the money that they get for astrid well today anywhere between twelve and fifteen states have income threshold above two hundred thousand the federal poverty level member two hundred percent the federal poverty level or fifty percent above the state's medicare which was provided for in their original legislations we have twelve or fifteen states that are figured out how to get around that provision states such as california maryland massachusetts new york new jersey pennsylvania and vermont use encumber disregards to expand their income threshold beyond the  intent s chip program that as of july two thousand and six just a year ago new jersey topped the list at three hundred fifty percent of the federal poverty level at seventy two thousand two hundred seventy five dollars for a family of four i'm told in fiscal year two thousand and five nearly half of all children in the united states were covered by medicaid or s chip s chip was never intended to cover all seventy seven million children in the united states it was never intended to make all children regardless of income dependent on government for access to health insurance april  york passed this budget which expanded s chip to four hundred percent of the or eighty two thousand six hundred for a family of four by disregarding specific types of incomes states candy no or earnings between two hundred percent of federal poverty level and their upper limit as if that income didn't even exist at the state should not be disregarding large portions of income to avoid s chip eligibility levels rather than returning s chip to its true intent the pending legislation makes a deliberate choice to drive eligibility levels by m m it brings the language back to the original intent of this chip my memo would require that a family's gross income be used to determine eligibility for s chip and that the secretary of health and human services would determine new regulations for eligibility for s chip bya stablish is referred to as gross income and having that defined as a certain level states would still have the opportunity to cover any child who is determined to be ineligible for asked chip based on the changes made by this amendment they would remain eligible for the program but the state would be reimbursed according to the federal medical assistance percentage rate rather than the enhanced that ickle federal medical assistance percentage rate so i asked that of my  children supporting this attorney tourney is a step toward renewing our commitment to america's most vulnerable population and that's our children i  withhold so i could just address a couple questions to him on his amendment under your amendment would say that the states have to take in consideration the gross income of the family not including certain so called income disregards now that's the way we talk in washington but to the average man or woman what we're talking about here are we saying that even though they may have other sources of income i don't know what that level income so that they can get under this whatever it is three hundred percent of poverty or four hundred percent of poverty is the newest application i understand from new york do you have any and i just manager from mr chip is mississippi forest question and here's here's what my memory does it's directs the secretary of health and human services to stablish rules and regulations to set a uniform gross income among the states and he has ninety days once the bill becomes law to do that this will give the states further opportunity to put their input to the secretary gives him some flexibility to listen what their concerns are but says then the states all have to operate in the same rules now some states for example when they looked at total gross income have not included benefit income benefits from other programs some states have and so this amounted to a considerable amount of discrepancy particularly in high income states where the benefits are running much higher so we see some states that are getting a much higher rate of benefit through s chip than perhaps a more responsible states like your state of mississippi in my state of colorado for example and so this is a  really important program i think to bring some integrity amendment to bring some integrity to the program well i think they put a senator for that explanation and for his amendment because it's clear that through these waivers or through move the various states without question their motives have been able to develop a system which is very unequal on monga states i found for instance that the reimbursement rate to the states by the states as required by the states for medicaid for instance president senator from new jersey madam president i rise in strong strong opposition to first the bunning amendment which is one i particularly want to talk about  because it is a direct attack on children in new jersey and i didn't think i'd come to the senate and see such a re fine focus on the children of any one state but that's what the bunning amendment does i'm sure i could draft amendments that would hone in on the interest of any given state but i don't think that's where we want to go as  congress as a senate i don't think that's particularly good public policy as so right now i'm feeling let me start off with i thought this was one country one country a lot of things that i have voted for in the senate in my fifteen years in the congress and the other body before i came here that clearly did not specifically benefit my state  crops disaster to acid i can't get an e twenty five company jersey to a whole host of things for farmers and the list goes on and on i looked at it always looked at as one country and there are some times that in the allocation of resources there are certain needs that get taken care of in one part of the country whereas in other parts there are different needs these amendments are an attack directly upon that notion that this is one country i also think it's very easy to talk about income but never talk about costs as if living in one part of the country automatically means that those costs are the same in another part of the country whether or not we recognize that in a variety of laws in which we give differentials to a whole host of different elements from federal employees to differentials from military to a whole host of people based upon where they're stationed because we recognize that in fact there are different costs in living in this country so it's interesting to talk about income but not talk about cost you know what i am for let's let's make sure we have no member of the senate three hundred fifty percent let's make sure that any one of those that sure that everybody here makes in excess of three hundred  fifty percent of the federal poverty level let's eliminate health care for all those that you alternately get by virtue of the taxpayers dollars do you deserve health care more than children who happen to fall into that category these are the children of working families they're not full or as in not working because if they were they'd get medicaid but they also are the children of those individuals who are working and work at some of the toughest jobs and yet make an income that doesn't allow them to purchase health insurance and their job doesn't seem to offer health insurance this is a great universe of americans who are trying to cover under the children's health insurance program and i agree what is the goal the goal is to cover children children who don't have coverage otherwise well this is exactly what we seek to do now you know in new jersey we do cover one hundred twenty six thousand children and yes we cover children up to three hundred fifty percent of the federal poverty level that means there's there's three thousand new jersey children who happen to fall in this category that  children what they do to you what they do to you you know the difference is maybe if i lived in kentucky i could afford to get health care based upon the incomes but first of all we've heard a lot of numbers bandied around here that has some of them a clearly not true three hundred fifty percent of the federal poverty level is sixty thousand ninety five dollars for a family of three so it's not eighty two thousand dollars as some suggest of starters in fact there's no child in this country no child in this country covered up to that dollar amounts in the entire country that's a scare tactic and it's shameful we need to cover children up to three hundred fifty percent because new jersey families face higher living costs and they get less of their return on the federal dollars so again we can have a policy doesn't take all of that into account but let me lay it out for you at the top of the new jersey's current eligibility level you know family might make somewhere around this one hundred twenty eight well when you dock housing costs in new jersey when you deduct food costs when you deduct transportation to get to work and i think a byproduct is that we want to in our values make sure that we value the welfare of these children we're talking about in their health care we also want to value work one of the things these parents are doing is they're working now they could not be working and be on welfare and then  medicaid who want to value work as well they're working so they've got to get to work have child care costs and here's what the department of insurance in new jersey says is the cost monthly monthly for family care in new jersey for family health insurance two thousand sixty five dollars now this doesn't have utility costs this doesn't have clothing this doesn't have any emergency expenses for the family it has this is no buffer no bottom what's the consequence of that for this family they were trying to have health insurance they'd be in the red each month by twelve hundred dollars which means that they simply won't have health insurance they simply won't have health insurance and these kids would have health insurance now that's the goal of the program to provide health insurance for children who aren't so poor that they would get it under medicaid but in fact  are in a set of circumstances where because of their parents work and not getting insurance at work they find themselves in that category for which there is no coverage and no money to be covered by virtue of their fa so you know it simply doesn't do it it simply doesn't do it so it's basic math that's why the jersey unrolls children up to three hundred fifty percent of federal poverty level because if you live in new jersey with that income without this coverage children wouldn't have health insurance purchasing a private plan no matter the tax incentives and i've heard of some of the tax incentives that is being offered as some suggest it's about five thousand dollars tax credit great well that's two and a half months of health care coverage in new jersey what do we do for the rest of the time we roll the dice we're supposed to hope that for the other ten months they don't get sick they don't get preventive care that's what our public policy is all about that's what our values are as a senate as a country i don't think so now the fact of the matter is i urge my colleagues to think about this because in new jersey you know you need to have forty three thousand and sixty dollars to purchase the same goods from kentucky for thirty two thousand six hundred sixty nine dollars just about eleven thousand dollars more to do the same thing as if you're living in kentucky now the reality is that's why one size fits all doesn't work and i've heard many times on the debate here states no bass let's have flexibility well this is a perfect example of how that flexibility is giving us the wherewithal to cover children now i must say i want to warn my colleagues that supporting the bunning amendment is about dumping children off of the child health insurance program and it's the beginning of a surfer the slope so now we begin and eradicate those who are three hundred fifty percent we take them off so then somebody comes up with an amendment let's do three hundred percent let's eliminate that and let's bring someone else who brings two hundred seventy five percent and then list goes on and on and before you know it instead of having a program that covers more children in our country we have less children covered in our country less children covered in our country i believe that in fact what we want to do is quite a difference and that's why i respect what the senate finance committee did on a bipartisan basis they looked at all of the issues all of the costs they look at the goal of achieving ensuring more children in our country heaping those who are on the six point six million adding another three point two three point four million trying to reach the goal of ensuring all of our kids and doing within the fiscal context that are allowed to happen that's what that's what this is about that's what this is supposed to be about so i hope my colleagues don't belong on the slippery slope  begins to cut back and cut back and cut back the takes children all of health care coverage because it's set a precedent that i think none of us want to do at the end of the day not only on children's health but on other issues that may be critical to our states i think that this is about a set of values in the senate what are our values we care so much about children our future yet our values speak to if we pass this amendment is to cut children off of health care even though clearly there's a far greater cost to living in a state like new jersey than it is to living i say in kentucky now there's a lot of things that go on in the senate on different issues that clearly there is an appeal because of the nature of the unique challenges that state faces well we face a unique challenge and we want to make sure that our children who are already on and by the way these are children who already have who will lose coverage as a result of the bunning amendment i'm simply baffled i thought that we were about family values here i thought we were about protecting children i thought we about increasing the opportunity for children to ultimately be covered and i thought we were about enhancing the quality of life and protecting life well obviously it's the lives of children who we're talking about here we put at risk by knocking off their coverage so i find it embarrassing that some in washington some in the very senate who have about the best health care coverage in the world can come and offer amendments that they could not live  they could not live under if in fact they had to but member of the senate doesn't make more than three hundred fifty percent of federal poverty level do you not deserve to have the government subsidizing your health care you should be out then let's have the amendment to make that happen to before you take three thousand kids off of child health insurance program just incredible in my mind so i urge my colleagues when the time comes and i and i hope that there will be a time frame when that amendment does to be pursued because i will be vigorous in pursuing it on the floor that we don't head down the slope of pitting one part of our nation against another creating the realities of the difficulties of living in one part of our nation versus the other pitting children in one part of the nation versus the other pitting the very essence of preserving children and their health against some simple formula number that ultimately members of this body could live under themselves i think is good enough for us good enough for these children and i would not want to see about that ultimately undermines the ability of thousands of children who presently get health care under this program to be eliminated that would be as a senator from mississippi for allowing me to to speak first i appreciate his courtesy i want to also congratulate the senator from new jersey for his outstanding statement  sentiments which i fully share and that i'm president going to be briefed as i travel across the country during these past several months there are few issues that show a greater disconnect between what the american people want and the way washington works than health care every single year people put it at the very top of the list of their concerns every year more people lose their insurance or watch their premiums skyrocket or open up medical bills that they just can't pay and yet whenever the issue actually comes up in washington they watch health care debates play out that are filled with half truths and scare tactics the insurance companies run ads telling folks they'll lose their doctor or wait forever if universal health care  they watch the industry spend billions on lobbyists who's on to influence block much needed reform and at the end of the day nothing gets done and we move on to fight about something else to most americans we seem completely disconnected from the reality that they're living every single day especially when we have a president who has actually said and i quote i mean people have access to health care in america after all you just go to an emergency room unquote that's what passed as for universal health care in the greatest wealthiest country on earth overcrowded understaffed emergency rooms that raise everyone's premiums and cost taxpayers more money it's shameful and what's even more shameful is that nine million of the americans were forced to wait in emergency rooms when they get sick we have no health insurance at all our children children children who did not choose where they were born or how much money their parents and children whose development depends on the care and nourishment they receive in those early years children who any parent anywhere should want to protect at any cost we can shave the truth and pretend there are only one million uninsured like the president says we can make excuses for this neglect we can start getting an ideological argument about whether we're slipping into socialism or we can just ignore the problem altogether but as long as there are nine million children in the united states of america with no health insurance it is a betrayal of our ideals that we hold as americans not who we are in today's our chance to prove it we  know that s chip works because the best chip six million children who would otherwise be uninsured have health care today because of s chip millions of children are protected when their parents lose their health care because of s chip individual states like my home state of illinois are building on its success to expand health coverage even further because the best chip millions of children with asthma dramatic injuries and mental health conditions are able to see a doctor and get the treatment they need even though the uninsured rate among low income children fell by more than one third in the years after s chip was enacted the trend reversed two years ago and since then we've seen growing numbers of uninsured  that's why i'm always puzzled when we start getting in these debates that are ideologically driven about whether or not government should provide coverage if the marketplace was covering coverage for these children then it wouldn't be necessary but they would uninsured reason they're uninsured is because their parents can't afford coverage the uninsured children are twice as likely as uninsured children as in short children to miss out on much needed medical care including doctor's visits and checkups one quarter of uninsured children don't get any medical care at all and those who do get lower quality care even with the same illness and conditions whether it's an ear infection or appendicitis studies have found that uninsured children get different treatment and often suffer more as a result one study even found that uninsured children who are admitted to a hospital with injuries are twice as likely to die as children who are admitted with health insurance put this problem in the larger context we know that when a child gets sick and can't get treated or receives inadequate treatment he misses more days of school and when he misses more days of school he begins to do worse relative to his peers and that can have long term consequences on his chances in life that's not something that i'd want for either of my two young daughters or for any american child and this body should not want it for any child either so let's get serious and solve this problem make sure that the six million children who are now covered through the program continue to be covered and let's extend coverage to an additional three point two million uninsured children we also know that the question of children's health care is tied to the larger question universal care in this country because we know that when we cover parents we also cover children and that's something we've seen in illinois when i was a state senator i was able to help extend health care coverage to an additional hundred  fifty thousand parents and their children so for serious about covering every child at some point we're going to have to cover every parent as well the american people have been waiting for us to act on health care for far too long and starting by covering more children should not be a difficult issue to agree on i urge every senator to vote for this bill and if the president actually decides to use his veto which he has all sparingly use to deny health insurance to america's children that is a fight that we should have i urge my colleagues to stand and fight that veto every which way we can there's not a single person here with their child was sick and they couldn't afford health insurance would be begging the government to give them some help we won't be having these arguments let's show some empathy for the families that are out there many of whom are working every single day sometimes working two jobs and still don't have health insurance let's make sure that they have what every parent wants which is some assurance that if their child gets ill they're going to have the kind of care that they deserve that's remind the american people who we are and why they sent us here in the first place thank you madam president agreed that the would go further than i've been following his place let me just say on this the bill we have here again it's very easy to get up and talk about children and the need to help children that affect us all i'm a pair i'm a grandparent there's nothing size me more in the world i'm going to see my four little grandchildren and i i can't stand the thought of children anywhere regardless of income level not getting the kind of health care that they need that's why i voted for  health care and so i thought we've done a good thing but the problem here is we're exploding the problem in terms of costs tags increases or cuts in the house they're not they're not done at the back of dags increase they're cutting medicare advantage which affects people at the other end of the age schedule older people that need medicare advantage to get health in rural areas and states like my state  so there is a balance here we agree on a reasonable increase to make sure we continue to cover children that wouldn't be covered otherwise but also what is ultimate goal is for all children big covered by mother washington washington bureaucracy health care why should any family have to worry regardless of income or a state have to worry illness connected to a family of dentist dental hygienists and dental technicians but the question is how much can the government pay for and why can't we keep some limits why do we want to force people the private insurance we're going to have children now covered by private insurance going all and going over to our medicaid and why are we trying to force everybody owned s chip now this chart with these twenty seven percent was covered by medicaid one percent was covered by the children's health insurance program and seventy two percent other programs including private insurance two thousand and five it had grown to thirty seven percent covered by medicaid eight percent by the chip program and fifty five percent other with this bill the underlying bill going in place is the way it is now will jump seventy one percent of all children will be covered by medicaid and s chip and only twenty percent other you see the steady march toward average every child in covered by this particular program this the problem with this bill can be described with a b c not only have you had the steady march and higher income level children being covered adults have been uncovered some other adults that maybe need some extra consideration too so it's not only hard higher income children it's adults and more adults and even more adults so the first problem is adults a gentleman you're talking billions here the underlying program is twenty five billion the finance committee would add thirty five minimum of thirty five alone top of that and in out years it just expands tremendously to think in the year two thousand and twelve the number is is maybe thirty seven billion in that single year but remember too if we passed the finance committee bill that sixty billion twenty five plus thirty five it will be sixty billion the house is going to pass a bill that what eighty ninety one hundred billion paid for by taking money away from medicare beneficiaries and we go to conference if we go to conference of what will happen a little bit of what always happens you split the difference w sixty there nonny oh well ok how about seventy five seventy five billion has to be paid for is going to be paid for by cutting benefits for elderly and or raising taxes for all kinds of people we can fix this that gets back to the a b c to the core mission children that are low income families we need to get back to that we have some good amendments pending we should pass the bunning amendment which would eliminate the high income eligibility above three hundred percent aldred amendment which would stop the income disregards which drives the income level up steadily and i understand that senator gregg will have one that would just  adult coverage we can fix this and we could get together on a bill that would be part bipartisan they would help the children that really do need it the ones that we started out to help before we got the right idea will just cover every to great interest about the senator from mississippi talking about the cost of this program and the paying of this program does the senate to agree with me that every member of the united states  senate has a health insurance program that is funded and financed seventy two percent by the federal taxpayer as a senator agree with me we do have a program that has input from the the t is seventy two percent of every member in here program health insurance program every member republican and democrat is paid for by the american taxpayer number one secondly what  respond i got a solution well let's cut that well but we're not in the title of that the senate want to show up for that amendment fine but i don't hear i hear him talking about cutting out children but i don't hear him talking about them a second lead with the senate not agree with me th members of the united states senate have access to bethesda naval hospital and walter reed hospital and virtually for free care at those at places where the children of america do not have with the senate not agree with me that we're treating members of m an advocate of cutting children i advocate covering the children of the now covered and making sure we cover the children that we committed what i'm opposed to is the ever increasing level income level and number of children and adults what about adults that are being covered by this program if we're going to have a if it's going to be a chip adults children insurance health program that's one thing but i would like to keep the focus on covering the children that really you know everything we're doing and ourselves with might as well do that to ed be fine with me but and if and if we could control the growth of this program i'd be more than glad to help pay for the standard you know for one more question i is talking about covering we have nine million children that will not take covered all of our children are covered of we have a hundred sixty thousand dollars of in found and every one of our children are covered why is the senate a so concerned about trying to cover the remaining children who are not covered in this in this country where coverage under this program four million more but why by a lot of our children are covered we have a hundred sixty thousand dollars i'd listen to the senator wanting to they're not covered at all by this but i would be glad to control that to anything the senator wants to do to the senate i suspect it richly deserves it but another thing what i'm saying is one state is only covering  children up to two hundred percent other states now have three fifty or even one of them now warning four hundred percent of poverty but children and adults all i'm saying is stick with the program we intended left don't furnace and adjust to washington bear cra that's what this is all about this is about moving us toward a system that we couldn't get any other way where the government will pay for and control everything in terms of health and coverage in america and i know i don't lead america they want to i worry about my children my grandchildren in this respect what kind of burden we put on their back and terms of what they'll have to pay for in the future does nobody ever think about that anymore every program is growing exponentially everyone president today i rise to speak about health care for children we're talking about the s chip program and and i come with great interest because the s of s chip stands for state and that the c stands for children for the last five years i spent time in the wyoming legislature on the labor health and social services committee where we both worked closely on the issue of children's health and specifically work closely with s chip i've been a fan and a supporter of children's health and specifically of s chip in wyoming madam president as chip has been a very successful program in wyoming right now there are over five thousand young people who are in this program five thousand six hundred and forty two and our count in july we call the program kid care and that's because kids can be born with club feet kids can fall of the playground kids can have problems with measles or mumps nationwide this very successful program has covered over six million children it is a good program some folks confuse s chip with medicaid they're very different medicaid is designed for people below the poverty level s chip is for people above the poverty level but in that income range up to two hundred percent of the federal poverty level for us that's an income of about forty thousand dollars a year for a family of four in wyoming if you talk to anyone in the legislature both parties they will tell you that this program has been cost effective it is not an entitlement it's done through a combined partnership with blue cross blue shield a public private partnership it covers the people in wyoming who are intended to be covered many government programs do not work well or produce results yet s chip very successfully achieved what it set out to do about ten years ago when the program began we have significantly reduced the number of uninsured children in america it has worked that's why i want to be clear madam president from the outset as we go into this debate i am one hundred percent committed to reauthorizing this very important safety net program for kids i strongly support of the program as a state senator i will continue to do so in my capacity as a united states senator five thousand six hundred forty two wyoming children depend on s chip right now to stay healthy now madam president there are additional young people in our state who are eligible for s chip but who are not yet enrolled so i want to do more in terms of outreach working for ways to enroll working on the outreach and enrollment efforts to find these people to target these low income children and get them enrolled in the program i want to support and enhance public private collaboration's to make sure we're doing the most cost effective efficient and quality health care possible for these young people but mostly i want to make sure that this senate and this congress produces a reasonable commonsense piece of legislation that we can send to the president and that he will sign i have concerns with the bill that's in front of us this bill this piece of legislation reported out of the finance committee takes a successful spending program and uses it out of it as a vehicle to create a new entitlement the bill that i look yet today covers high income people covers people who already have insurance and covers adults to be madam president this bill should be all about children well let's look at those three concerns high income people this bill allows families at four hundred percent of the poverty level to be covered in new york state that's an income of eighty two thousand six hundred dollars a year in new jersey three hundred fifty percent of the poverty level and income over seventy two thousand dollars a year at home in wyoming we play by the rules it's two hundred percent of the poverty level that's what we need that's what works are there kids in new york and new jersey that need to be covered of course there are kids everywhere that need to be covered but why the different rules for different states and why so many high income people as part of the program so that's number one number two people who already have health insurance when you start to cover children  families above that two hundred percent of the poverty level many of those children are in families where they already have insurance children and families between two hundred and three hundred percent of the federal poverty level seventy seven percent of them have private health insurance when you go above that above the three hundred percent level between three hundred and four hundred percent of the federal poverty level eighty nine percent of those children are in families where they have private health insurance when you do the math and look at the numbers of people in those categories will be financially compelled to take their children off of the private usually employer sponsored health care plans and put them on the taxpayer supported the congressional budget office looked at this and they think with this plan two point one million people will move from private coverage to government dependency if this legislation is an act of better president this is supposed to be a program to help children children who don't have health insurance seems like some in this body may be trying to use this plan to nationalize health insurance the third thing that i see as a matter with this problem with this plan is that in some places it covers adults not just children it covers the parents of children nowhere nowhere in the word s chips is there an a for adults this the c stands for children madame president this country does need to have a serious debate on health care and it should not be on the backs of these children covered under s chip in the future we need to debate health care in america how we pay for health care how we encourage people to better care for themselves to take more responsibility for their own health what incentives we can have for people to stay well how insurance is used in this nation should be deductible for all instead of just in businesses and not and by individuals should there be tax credits is there a way we can set up small business health plans to help people with insurance who need insurance i find that people are very thoughtful when it comes to how they spend their own money so often in the medical world very few people spend the same kind of time making those financial decisions as they do when they're spending money out of their own pocket when it's a third party payer who is making who is doing the spending in the future we need to have a debate a discussion about how we handle medical errors in this country number one how to prevent them from ever happening and number two how to deal with the fact that when they occur we want to make sure that people are taken care of quickly and that anything that goes to them goes more to the injured party than it does to the system and we need to find ways to define to lower the significant cost in america of defensive medicine madam president these are all very serious issues they all deserve a serious national debate and that day will come but the bill today madam president wrongly attempts to massively expand a successful program under excessive spending for many people who do not need it and it avoids a debate we need to have on health care in america floor mr mr president not a president senator from massachusetts i believe that i have fifteen minutes and i correct senator is not limited ago and i stand to be corrected i say that there is not a single member of the united states senate that doesn't take affectively the federal employees an insurance program and in our situation the federal government pay pays for seventy two percent of it we have one member and i admire and i've just learned of his name or not to mention it here i'll ask whether i can include it as part of the record but rather than embarrass him but it's a noble act on his part has said that till we get universal coverage he wasn't going to take this but the idea that all americans would understand now is what we are standing for and i come in the senate again from montana and the senator from iowa and the others send my friend senator hatch who we worked with years ago and as senator rockefeller on this program is a rather simple and fundamental concept and that is this that every child in america ought to have a healthy start we are about here in the united states senate we are about expressing priorities and those of us on this side of the aisle and a group on the other side a small group of the other side courageous group on the other side have stated that same concept that every child in america should have a healthy start number one and number two that every parent in america should be very relieved to be anxiety about wearing whether they have sufficient resources to be able to make sure that their child is going to receive decent quality health care those are revolutionary thoughts and those are surprising concepts is that right evidently they are friends on the other side of the aisle get all worked up about that those two concepts that all children in this country should have a healthy start and that mothers and fathers but mothers and fathers should be relieved from  anxiety that they with their child has an earache or their child has a sore throat or their child has a headache they have to wonder whether their child is a hundred and fifty or a hundred seventy five dollars sick because that is what it's cost to take them to the emergency room so they wait overnight they let the child get a little sick they have a sleepless night they worry they hope and they pray that their child gets better well we in this body say that america can do better i live listen to my friend and he is my friend from mississippi talking about the cost of this program sixty continued conflict in iraq where we're losing the blood of our young men and women this is the issue let's not complicate it let's not make it difficult let's not make it unreasonable and that is what this is about sure which is listen to the arguments over they someone's going to have to pay for it yes it's going to be those that are going to be smoking what is the result of increasing the tobacco tax what is the direct result tobacco cigarettes when used as advertised increased death in america among folks among children every day twenty eight hundred children become addicted every year five hundred thousand people die because of the use of tobacco so what happens when we raise the tax of sixty percent sixty one cents on cigarettes you know what happens children stop smoking all they do yes they do we says so who says so just look at the history of what has happened when we have increased increase the tax on cigarettes so mr president i commend those on the finance committee for finding a revenue measure that will make sure that will ensure not that all children i gotta stop and end smoking but that this will be a major disincentive for young people just smoke on the other hand it gives children a healthy start and relieve the anxiety for parents and then the thirty third really it make sure that discovery has a children from smoking so mr president this is a measure that speaks for action it speaks for justice it speaks for fairness it speaks for our values but i for one who strongly believe in the concept of comprehensive health care and we'll have that debate at another place and another time mr president  when i i know that my children were covered but they're grown now as others have been here but i know when they needed health care i know that they were able to receive it and i remember very clearly that when my child was lost it's like a cancer  families in that chamber that were absolutely driven into poverty because they couldn't afford the same kind of health care that we had and there is a statement in a comment that we here in the united states senate find children to be a priority find their parents to be a priority find to be in the interests of children to increase the tobacco tax this legislation makes a great deal of sense and i again commend the present i have a proposal i'm going to make shortly but i want to begin my comments by thanking our colleague from massachusetts once again for giving heart to an argument that sometimes get lost in statistics and numbers here is all of us know  every one of us one way or another have watched it their fellow members here or others that we know our staffs are constituents who have gone through the dreaded situation of watching a child in need of health care and knowing how fortunate are to be members of congress here where we receive a tremendous amount of support for health care services here here and the fact that we are living in a day and age in the twenty first century when so many of our children in this society with growing numbers without any kind of health care coverage at all is it shameful to put it mildly and i commend the distinguished senator from montana the chair of the finance committee and once again the senate massachusetts for his tremendous support of that of this effort million americans have been able to take advantage of that lot here which is made a difference in the lives of many people it's related to the subject matter yet a little bit off center here the other day senator dole and others donna shalala reported to the president o commission on the care of america's returning war wounded warriors urging congress to extend family medical leave for up to six months for a family member of a service member who was severely injured in combat and we believe this is a worthwhile propos and one that i've offered in drafted i'm deeply grateful to senator dole a former colleague of ours who quoted here is that over the course of our investigation the commission found that congress should draft legislation to allow up to six months leave for family members of troops ain't combat injured injuries and for twenty years he points out that we had off of the legislation here to extend a family medical leave to families in this country and so that a present i would hope that at the appropriate time here then i'm in on this matter would be considered fact unanimously adopted a bias here maybe an argument on germane is but i can't think of a more appropriate step for us to take here than to allow these veterans coming back who are recovering from their  devon family member with them during that period of recovery here i'll submit the villain ask a consideration madam president for this that is amendment but i want to lay out for my colleagues the value of this amendment a valuable it's been to so many people and present we've authored legislation to extend family medical leave to become paid leave i will be offering that at this juncture here but certainly a leave program unpaid leave that would go to veterans for a period of six months so that family members could be with them during this period of recuperation is something i think all of us recognize the value of the reason obviously is is obvious here in our survey thirty three percent of active duty twenty two percent of reserve opponents and thirty seven percent of retired separated service members report that family members are close friends relocated for extended periods of time to be with them while they're in the hospital here twenty one percent of active duty fifty percent of reserve component and twenty four percent of retired separated service members say friends or family gave up a job to be with them or their caregiver it seems to be they shouldn't have to give up a job in order to be with a recuperating veteran coming back from iraq or afghanistan and so i can't think of anything more important we could do as we wrap up here this week to go on a august break here then to incorporate as part of this legislation a proposal that would provide for the servicemen and women the opportunity to have a family member with them during their period of recovery and so madam president the appropriate time last contact us in this amendment to the desk if i may and at the appropriate time under consultation with the chairman of the ranking member bring up this amendment for their for their president senate from kentucky and president i would like to talk about the state children's health insurance program also known as s chip few weeks ago the finance committee passed the baucus bill to reauthorize this program i did not support the bill and committee and will not be supporting it on the floor today i'd like to take a few minutes to explain my concerns with the baucus bill i'd also like to talk about the i will be supporting this week have helped craft over the past couple of months the kids first that this bill is a good piece of legislation that reauthorizes this important program in a fiscally sound way and keeps the focus on the program on what it was originally on on low income children i have significant concerns with the budget gimmicks used the eschewed provisions and the tax increases in the baucus bill the budget gimmicks used to fund bill are irresponsible jeopardises coverage under the program and basic guarantees another tax increase five years from now under the bill ept s chip spending in two thousand and twelve reaches sixteen billion dollars however the very next year spending drops to three point five billion dollars while this strategy helps the drafters hide an additional forty billion in spending does any member of the senate really think that s chip spending in two thousand and thirteen will be three point five billion dollars that's below the current spending level of five billion dollars a year does any member really think kick millions of kids off this program in two thousand and thirteen to accommodate this lowered spending of course the answer is no that means congress will have to come can amount of money to pay for the increased spending which will likely mean reaching into the wallets of hard working americans again i also believe that s chip should be a program for low income children when congress created the program in one thousand nine hundred seven it was intended for children without health insurance who lived in families making less than two hundred percent of the federal poverty limit for two thousand and seven two hundred percent of poverty is about forty one thousand dollars in income for a family of four not many people realize adults are now covered under arrest chip most people rightly think this is a program only for children that is the state children's health insurance program that's its name over the years the department of health and human services has approved expansions to the program to allow states to cover these adults these expansions should not have been approved in the first place and it is congress's responsibility in the r authorization to rein in these abuses while the baucus bill at least ends coverage for childless adults currently on s chip it still allows other adults specifically parents to stay on the program in certain states and any state that currently covers parents can keep adding new parents in their program the kids first act that i am supporting responsibly reauthorizes the the program and keeps the focus on low income children this bill reauthorizes the program for five years at a cost of about thirty nine billion dollars this would be a significant but responsible increase over spending in the first ten years of the program the bill would require states that want to cover children and pregnant women above two hundred percent of the poverty level are forty one thousand for a family of four to pay more for their state coffers  than they do now the bill also take steps to limit the number of adults on the u s to program while we wouldn't require states to remove any adults currently on the program from their roles we would reimburse states as a lower amount for the children children less adults and parents they currently have on their programs also states couldn't add any new childless adults our parents to their s chip roles if they want to cover these individuals then they need to do it under their medicaid programs the kids first act also stops the department and help and human services from approving anymore waivers are demonstration projects for states that want to cover parents are childless adults the kids first act is a good proposal that i hope will get full consideration on the senate floor it keeps s chip focused on low income children curtails starts state's ability to add new parents our child most adults to the program and make sense from a fiscal standpoint unfortunately the baucus bill falls short on these key points also the tobacco tax in the baucus bill is fundamentally unfair to my state and the surrounding states and i want to show you the chart one that i have here showing the fifty states and illustrates the real problem it is competent it is compiled from data drawn from c d c database on tobacco consumption and projects projections by family usa concerning as chip spending you will see that there are big winners in this program and the big winners are in dark green you can see texas in california and arizona new mexico new york california two point five six four billion dollars new york one point six eight four billion and it shows kentucky tennessee south carolina north carolina virginia indiana missouri iowa wisconsin and particularly florida it shows those states as dad net losers seven hundred and three million dollars in florida six hundred and two million dollars in kentucky five hundred and seventeen million dollars in indiana five hundred thirty six in north carolina five hundred seventy six in so on it also says states that are neutral or a good in idaho idaho nebraska and some other states there's a kind of in the middle west virginia georgia alabama mississippi air and on so on so you can see from the charts that we pick big winners and big losers some neutral and some low are losers not big like the ones in dark brown or in red it's very very important that you realize that that is a completely unfair reason and method of funding the problem with the tax is that the money comes from low income smokers in my state and all of the red states on this chart and it is going to pay for and makes traffic an expansion of web skip in california new york texas and the states depicted in green the bill will also without any doubt add an enormous boost to black market tobacco smuggling and counterfeiting the plan would be a tremendous gift to argue nice crime and the black market kingpins who will profit handsomely from it in future years there is plenty of past evidence of this in two thousand and two for example new york city increase the tobacco tax from eight cents per pack to a dollar fifty per bag the city revenue estimate or zz predicted an additional one hundred seven million in revenue you know what they really got you know what they really got brought in forty three million dollars what is more the tax increase on cigarettes cost this the state over six hundred million in tax revenue due to lower sales at convenience stores throughout new york state and in a condom is found that most of the reduction was due to smuggling cross border sales internet sales and sales on indian reservations even supporters of this filling knowledge that the higher tax will have an impact on demand it will reduce legal consumption of cigarettes it is not likely to reduce code total consumption as the as the supporters of this bill say it will because it will also increase smuggling but legal consumption is what matters to us because that is the only part that is taxed the revenue estimates provided by the joint committee on taxation show this revenue is projected to decline by seven hundred million per year by the last year of the estimating window that's right i understand this now revenue is expected to go down over time as the number of legal sales of tobacco products declined whatever the other problems th tobacco tax is a poor foundation for s chip we are matching a declining source of revenue with a growing federal problem this does not make any fiscal sense at any time if we were honest we would truly want to fully fund estep spending with a tobacco tax federal government would have to encourage people to smoke that's what this next chart shows additional smokers the federal government would need an additional two hundred twenty two million four hundred thousand smokers by the year two thousand and seventeen of course i told support such an effort but this highlights the budget gap as you can see from two thousand and ten all the way up to two thousand and seventeen the revenue for this program is going to have to come from more tax increases down the road and we all say we oppose rigorous regressive taxes but what we are considering today impact on low income taxpayers will be compound and it will hit low income kentucky and kentucky tobacco farmers and every citizen in the commonwealth of kentucky although there has been a dramatic decrease in the amount of tobacco farmers in my state due to the tobacco buyout taxes continued to pay play an important role in kentucky's agriculture landscape tobacco barns and small plots of tobacco still dot the kentucky landscape castree speak seats for tobacco are projected to contribute between three hundred and three hundred and fifty million dollars to kentucky these economy this year an increase in the excise tax on tobacco will drive down the demand for consumption this will result in less tobacco being purchased from kentucky tobacco farmers by manufacturers both cigarette and non cigarette it will likely force the specialty growers in my state kentucky derby leith and kentucky wisconsin leave completely out of business they are small family farms in rural kentucky that rely on these revenues for their crops the money they get from the tobacco pays for mortgages put their kids through school and allows them to keep farming the c b l has estimated that the s proposal result in a five to six percent cent reduction in demand for tobacco during its first year in existence this will likely cause a five point four million dollars reduction in payments to rural farmers in my state under the master settlement agreement that we signed a few years ago some people will say there's nothing wrong with all of this because it will force some people to quit smoking and we're using the money to help poor children but who's getting credit for this supposedly act of charity this plan would take money from one group of poor people and give it to another i urge my colleagues to oppose the baucus s chip bill and support the kids first  understand the what we've agreed to i have two and a half minutes to speak on my m m and i'll be some in two and a half i plan on spending about a minute or a minute i have to talk about my name and then i'll heels and then i'd like to have opportunity to wrap it up at the end if i might so that the very important memon what do we think what we see happening now is that there's a discrepancy between the county elation of gross income between the very state and because of the way the various states are calculating their gross income some states are getting more benefit under arrest chip than other states the state of colorado for example is not one of those states there are some fifteen twelve or fifteen states that have made some adjustments in the way the figures gross income tha entitles them to more federal dollars as far as s chip is concerned so what my amendment does it says that if it's adopted it will direct the secretary of health and human services to put in regulations the definition of gross income and this is going to have a ninety day period in order to establish this value and this will allow the states an opportunity to come and g their input as to where they think the calculation from gross income is concerned and then when that rule and regulation isn't enacted then all the states are going to be acting under the same rules so that they'll all be figuring their gross income in the same way so i think this is a this is an important amendment i think we're talking about equity of benefits to the various states i think it's extremely important that we make sure that they're operating under the same rules right now we have some of the states that disregarded the original intent s chip and as a result of that they are receiving considerably more benefit as far as as chip is concerned and so the other states so my hope is that my language will be adopted and then we can move forward with this program it's been working we just have to create some equity among the states and i yield the floor and senator from montana has two minutes and fifty seconds is present i don't want to belabor the issue but that picking here i'll use all my time as president the hallmark of the chip program the children's health insurance program is a block grant not entitlement first and second it gives states flexibility states design drone program this is a state children's health insurance program different states are different different states have different needs different states have different cost of living that every states are different and it many states find themselves in a situation where as if the law our plight strictly and a flexibility many people who earn just a little too much find they cannot get health insurance and they quit their jobs the goal here is to get people to work people want to sure people have health insurance people need health insurance but if in many states people are just above the level here can't find health insurance and therefore quit their jobs so they can be on jobs and health insurance programs i think the states should have the right to make some adjustments to keep people working so they get health insurance now if this amendment passes a one size fits all we should not have one size that fits all we need flexibility and there are very definite federal limits on how much states can make an adjustment that is not include certain not income good here we cannot and we cannot take away health insurance coverage for kids and thirty states and i do think the goal here is for people to work we want people to work we should not  policies which this member effect would be to say ok people sorry you're not going to we're going to you're not can't work you can't work so that you can go if you can qualify for joe's health insurance with the real effect to be in many states i think sarah's realizes is probably not right thing to do would oppose the memories best mr president so there is another matter of fairness among the states any child who is determine to be eligible for ships should remain eligible for the fro graham but the members join me in voting for this particular  mr by mr bennett mr biden mr bingham and mr bond mrs boxer mr brown mr brownback mr bunning mrs clinton mr coburn mr cochran mr coleman ms collins mr conrad mr cork mr johnson mr kennedy mr kerry mr lieberman mrs lincoln mr lott mr lugar mr martinez mr mccain mrs mrs murray mr nelson of florida mr nelson of nebraska mr rockefeller mr salazar mr sanders mr schumer mr sessions mr white house mr wyden mr cochran and mr cochran  are there any senators in the chamber who have not voted or who wish to change their vote and if not this vote the amendment was not agreed to on a vote of thirty seven to fifty nine write the senators take their conversations up here the senator from montana under the previous order the senator from north dakota is to be recognized followed by the senator from north carolina mr president i ask your consent that following those two senators i seek recognition order senators will take their conversations off of the floor the senators and staffs please take your conversations off the floor so that we could hear the senator from montana senate please come to order senator grassley the chairman and ranking member of the finance committee for bringing to the floor the senate the piece of legislation called children's health insurance is a very important bill that will add several million more children to the health insurance rolls provide important health insurance for kids who otherwise would not have it and all of us i believe in this chamber would believe that children with respect to their health should not that the health of children i should say should not be the function of how much money their parents might have in their pocketbook or in their checkbook a sick child needs help and needs health care and this legislation moves in that direction and i am pleased to support it i think my colleagues for the work they have done on it  i do want to offer a member at this point in and i want to talk a bit about a very important issue that also relates to health care my amendment deals with the indian health care improvement act it is true that we will now improve the lives of three million children with the underlying bill i fully support that compliment my colleagues for doing that it is also true there are at least two million american indians in this country living on indian reservations that are seeing health rationing virtually every day in their lives it is nearly unbelievable that that condition continues to exist we have a trust responsibility for those people the american indians are a group of people in our midst two with whom we made trade easily made agreements we have trust responsibilities for indian health care and we have not nearly met those responsibilities i would observe that we have a responsibility for the health care of those who are incarcerated in federal prisons and guess what we spend twice as much per person on health care for federal prisoners as we do in meeting our health care responsibility for american indians on a per capita basis mr president let me president let me describe now if i might this issue that i believe is an urgent national need the issue of health care for american indians we have a trust responsibility for that health care we have a piece of legislation that exists in the law called the indian health care improvement act but it needs to be reauthorized it has not been reauthorized for fifteen years it's been expired for seven years we need to do this year after year after year this congress postpones it we passed legislation out of the committee it doesn't get to the floor doesn't get done so let me show my colleagues a picture of a young fourteen year old girl this precious child her name is little and her relatives gave me permission to use her picture davis's bed davis committed suicide and i want to tell you the story about any of us because i went and talked to the school officials the tribal officials the mental health officials and those who were in the extended family this fourteen year old girl took her own life it probably should not have been a surprise to anyone because for ninety days this got a girl lay in bed in a fetal position missed school seriously something was very very wrong this school girl had a sister that two years previous had committed suicide this little girl had a father who took his own life this little girl had another parent who was a very serious drug abuser and she laid in bed ninety days before she took her life now mr president one might ask the question why does this fourteen year old girl just fall through the cracks she thinks she's in a situation that's hopeless and she's helpless and she takes her own life as just another name but this little girl had a full life in front of you know something on that indian reservation were able to little band live there was a mental health treatment facilities that were nearly adequate for someone to take this young lady this young girl mr president the senate is not in order for the senate please come to order so that we can hear the senator from north  dakota senators and the senator from north dakota may continue president one might ask and certainly should ask why is it in this country that mental health treatment isn't available to young child like this why is the person responsible for trying to give this young lady some help couldn't even have a car no transportation if you could find a mental health person available to treat this person there's no transportation to get the person there why is that for ninety days this young lady lay in bed and nobody from the school nobody from the area said all right there must be a big big problem here let's find out what's going on fact is this is one precious child that took her life we've had clusters of teen suicides and indian reservations which present the senate is not in order the senate is not in order i and i will ask our senators to take their conversations off of the floor and into the cloak room some of north dakota may proceed mr president this is but one aspect of the indian health care improvement act but it is not just mental health it is virtually every aspect of indian health we are told that about sixty percent of indian healthcare needs are met that means forty percent of the health care needs are unmet there is full scale health care rationing and indian reservations rationing of health care if we were to debate that on the floor of the senate people would be a pall you can't ration health care and yet that's what's happening with the trust responsibility and yet health care is being rationed with respect to native americans american indians diet higher rates with respect to tuberculosis six times the national average alcoholism five times the national average diabetes one hundred eighty percent higher than the national average in alaska native communities in alaska have fewer than ninety doctors for every one hundred thousand alaskan natives that compares to two hundred twenty nine doctors for every one hundred thousand americans heart disease diabetes blood pressure stroke you name it and there are much much higher rates that are affecting our native americans cervical cancer for american indians and alaska natives as nearly four times higher th cervical cancer for other women in this country i mentioned before the federal prisoners for whom we have a responsibility for health care get twice as much per person spent on their health care needs than do american indians for whom we have a trust responsibility stated another way we spend twice as much per person on federal prisoners to make sure that we're dealing with their health needs than we do with respect to american indians and we have a trust responsibility in law to deal with american indian health issues mr president i want to show a photograph to describe about health care rationing this is a photograph of our del hale baker she has also allowed me to use her photographs are the hill baker was having a heart attack and as she was having a heart attack she was taken from the indian reservation by ambulance to a hospital where they offloaded her from the ambulance onto a gurney to take her in the hospital this woman at the emergency room interest in france having a heart attack it was noticed that there was a piece of paper taped to her thigh and so the hospital due to flea looked at that piece of paper and the piece of paper that was taped for her thigh said that the indian health service contract health care is not an entitlement program meaning there are no funds to pay for this service because not it is not a life or limb medical condition let me say that again someone's having a heart attack when they're brought to the hospital they've got a big piece of paper taped to their leg and it says the hospital by the way if you admit this person you're on your own because our contract health care money is gone in fact this is the piece of paper that was taped to the leg of an indian patient coming into a hospital having a hard to say what would anybody in this chamber think if this were taped to the leg of their spouse or their son or their daughter they're having a heart attack but we say you know what i don't have any money for you you admit this person you're on your own contract health care called health care rationing travel chairman tell me that the refrain on their reservation is don't get sick after june because if you get second after june there's no money in contract health care and by the way you can get a little help still but it has to be life or limb you must be threatened with the loss of a limb or the last year life if not tough luck president we would be outraged outraged every single one of us if this were our relatives but it wasn't it was our del valle baker she survived but there are plenty who don't beard stale had a serious problem with her legs the bones in her knee were rubbing against each other cartilage was worn away she was in great pain in great discomfort the normal treatment for perhaps someone in this chamber or perhaps for a relative of someone in this chamber would be to get a knee replacement but light of bear's tail wasn't given the option of getting a knee replacement despite the great pain it was not determined to be priority one life or limb she was going to lose her limb she was going to lose her life she does live with the pain so because it wasn't priority one life or limb this woman whose bones were rubbing together in a knee and in unbelievable pain was told there's no health care available for you mr president we have hearings to talk about all of these issues and a doctor comes to our hearing and says you know i had a patient come to me with a very serious problem with a knee it was a ligament problem very serious very painful and that patient went to the indian health service and then health service said wrap that knee in cabbage leaves for four days and you'll be ok it's really pretty unbelievable what's happening and yet we can't get a bill on the floor of the united states senate to deal with in health care it's just unbelievable we've a responsibility to pass this legislation i passed it out of the indian affairs committee now we need to move it to the house and the senate so that we say to these people who are needing health care the first americans native american so we say to them that this country under stands its obligation to this country understand just trust responsibility and we're going to do what we need to do to pass the legislation it is almost unbelievable to me that with all of the priorities that we discuss that we can somehow find this a priority in my state we have some wonderful indian tribes the three affiliated tribes is a is a wonderful tribe it's the men then they have dotted the record if you get sick on that reservation in twin buttes north dakota just as an example your nearest health facility is a small little old building with a couple tie any examination rooms and if you're lucky enough to get sick on one of the right days when a nurse is there and one of the few days when a doctor might be there you might ok but this is a one million acre reservation it is a big big big place we have testimony from law enforcement the other day on that reservation and the first you would expect to be able to get someone to come to deal with a law enforcement call no matter how serious would be about an hour and a quarter to an hour and a half so call somebody with a crime in commission perhaps an hour and a quarter later if you're lucky you're go get someone from law enforcement to show up and you might you might understand them that if you if you need a prescription or if you have a health care emergency you might understand the dilemma that they face on reservations  a mother who has a favorite child that needs met a buyout of a diabetic that needs insulin in circumstances like that we must we must we must find ways to meet these healthcare needs there are some who say and i agree with them that that we we need substantial change my colleague from oklahoma is on the floor and he's talked about than the the prospect of saying all right let's let's have dramatic change and i'm perfectly willing to work on dramatic changes say that if we have trust responsibility for someone for health care less about them show up at a hospital someplace with us pay the bill so they can go to the providers that have the capability and we will pay for the responsibility to do that the problem with that is we can't get a bill like that through the senate i mean i've offered time and time again on the floor of the ny state senate to add funding the last time i added one billion dollars went down on a partisan vote unfortunately you can't get money added on the floor of the senate to meet the responsibility that we are to meet with respect to indian health care now we have worked in a bipartisan way on this legislation in indian affairs committee and as i indicated the vice chairman of the committee senator murkowski from alaska is a co sponsor as well and the indian health care improvement act is a piece of legislation that i think and it answers it begins to answer at least in advance the interests of providing health care to american indians and meeting our trust responsibility to do that we would authorize additional tools to deal with this issue of teen suicide on indian reservations i began by talking about eva schoolin but i could have talked about many many others and i've had several hearings on this subject the bill also includes new  to address the lack of health care services we want to begin trying to find a different construct of convenient care for american indians on reservations it includes several medicaid provisions that are in the jurisdiction of the finance committee and the finance committee is i understand going to be holding a markup we'll talk with the chairman and the ranking member about that but my point today is very simple i understand that the need to provide additional health care opportunities for three million american children is very very important it is no more important than providing the health care that we promised we would provide the two million american indians who live on reservations for whom we have trust responsibilities we've broken far too many promises to american indians we've done it for over far too many decades and it's time for this congress and this country to keep its word and meet its promise it doesn't it is not going to break the bank to do that but we don't have a choice urge all of my colleagues go to the indian reservations and see for yourself see a dentist practicing in an old trailer house for five thousand patients a population of five thousand operating out of no trailer i will see that and then ask yourself is this the kind of health care that we promised are we delivering what we promised and the answer is a  no i understand that in this chamber there are priorities and with respect to the priorities that all of us have we all have different things that we're passionate about in our lives and we have now on the floor of the senate a health care bill that health care bill that health care bill is important the reason i offer this amendment is when we talk about health care i think we have a responsibility to address this subject as  well and i will look at if we can either tonight or tomorrow get a commitment on dates to mark up and bring to the floor of the senate the opportunity to address the indian health care improvement act which is seven years overdue and fifteen years since it was it was last done if we can get that commitment that that's that would be fine with me because then i'll know that we're going to get this done through the senate that's the goal mr president i'm going to visit  with senator baucus that me also make a point senator baucus has been a very strong supporter of indian issues and i've been happy and pleased to work with him this this legislation the indian health care improvement act was sent to the indian affairs committee we have moved this out of the committee i think we've we've written it in a way that substantially improves the indian health care and now it it waits just as it waited last year waited the year before in the year before that in the year before that ever every single year the same thing and i'm just flat out tired of it and i'm not going to let it happen this time one way or another this needs to get done by the senate because the senate is the responsibility to do and it's not met its responsibility for too many years this year i insisted do so fact is kids are dying elders are dying because the health care doesn't exist that we have previously promised and we have a responsibility to do something about if if i can get a commitment that we can get from the finance committee a markup and and i know the center wants to do that if i can then get a commitment from senator reid to bring this to the floor i don't intend to interrupt the  children's health insurance bill but if i can't get that commitment i fully intend to interrupt this bill as long as i can interrupt it because it's that important so to my colleague from montana let me say thank you for allowing me to  at least at this moment offer this amendment and let me ask my colleague if i can if i can get some some hope that the two of us working with others can move together to get this through the united states senate in a reasonable time and i went going to in the ask the same of the majority leader who i know also is very supportive of indian issues very much wants to get this done so that meal if i might to my colleague from montana president senator from montana as president  this bill enacted this year i very much share the conviction stand with what we've got to find a way to get this done this year is an outrage i told outrage united states of america to let these conditions continue and frankly this legislation is o and with that first of all let me say thank you if we can get a markup in the senate finance committee on september twelfth that moves us to the floor of the senate and i'm going to talk to senator reid who i know is a strong supporter of indian issues and feels very strongly about this if i can get a commitment i know he wants to provide that commitment to get to the floor of the senate then i will seek to withdraw the amendment from this bill but i but i do want to visit and perhaps in the morning on the floor with senator reid on that subject to make just two more points and then i know my colleague from north carolina wishes to seek recognition but this chart shows the expenditures per capita relative to other failed federal health expenditure benchmarks this deals with indians versus all others well medicare is an expenditure per capita the veteran's administration medicaid federal prisoners the federal employees health benefits and here's indian health service it's unbelievable to me just unbelievable and if we don't fix the system you know in many ways all of this is intertwined social services health care law enforcement was a young girl named emira and camera was a young three year old american indian girl who was put in a foster home but the person that was handling the social services cases was handling one hundred fifty cases so didn't bother to check the home this little girl was going to be put into and it wasn't long before a drunken party that little girl had her nose broken her arm broken and her hair pulled out at the roots it will scar that little girl for life i met her i met her granddad talked to the social worker i fixed that social worker problem by getting additional workers in this that's not going to happen again but the fact is that should never happen these issues should not happen we don't have the resources to do what's necessary to do what needs to be done and nowhere is that more true than in health care and health care is not a luxury when there's a sick kid someplace or a sick elder when somebody has a problem and we have a responsibility to find a way to help and if for those who might listen this is a well that's our responsibility oh yes it is we signed treaties we made promises and we broke them every chance we got maybe in the year two thousand and seven we could begin keeping a promise or t these are promises we have a responsibility to keep it's our trust responsibility there's a lot to do in health care but there's nothing more important than meeting our obligation to provide health care for native americans because we made that agreement with them and we need to keep that agreement this president of the floor the senator from north carolina i think the president arrives to speak on the s chip bill mr president i have an amendment to the s chip bill but i don't intend to call it up at this mr president i think it's a sight to say that health care is probably one of the most important things that this body can debate and i think that you have to look at  overall health care system today to understand why it's so important it's because we have the best health care delivery system in the world bar none we've seen other countries tried to develop a system that fit within a budget framework that over time as the dollars got tight it constricted the level of care delivered it created waiting lines for individuals who had certain health conditions but the united states has always been considered the innovative health care delivery system of the world it was excessive goal for most regardless of region region and i think it's safe to say that for a long period of time it was very affordable but that's all changed the u s system still provides a level of security if in fact you're insured if you're not insured i'm not sure that the sense of security just knowing that there's a hospital or doctors necessarily provides you with a tremendous amount of security and with every day that continues on the level of choice that exist within the united states health care system begins to get less and less most of us have been here for the debates of the creation of h m o s and p p o s and all the products that employers insure individuals desperately tried to create to address this rising cost of health care while maintaining some degree of bennett that for the end of it you'll enforce family but over time we've continued to see changes to those products to where there's very little difference between the products now except for what we call them and clearly that has eliminated many of the choices what's happened in the united states system over a very slow period of time maybe the last two decades over fifty percent of the american people are now on a government health care plan it's no longer private sector really rive where we're here with this big question mark about why market conditions don't affect the cost of health care or the cost of premiums or that they don't create choice and in fact over half of the american people are now in the government run system one that mirrors more what others in the country have tried only to find out that unless you have an unlimited pool of money they don't work well what's government systems eventually create they create a system that has less doctors less nurses less hospitals which means less care for those in the country i know the ranking member represents a state that is considered the rule north carolina state that considered the rule and as you have a contraction of doctors if you have a contraction a specialist if you have less nurses in the pool it means there's not enough to go around all the facilities there are many regional areas of my state today where we can't find o b g y n to deliver babies now sure i can look at a pregnant woman and say within a thirty or forty five mile radius you will be able to get delivery care but try to explain that to a mother when her water breaks and she goes into labor that the person it's going to deliver that baby is forty five miles away that in fact that individual who is probably the one who needs the prenatal care more than that than anybody else because the prenatal care is now forty five miles away because that's where her o b g y n is that we're going to not going to get the level of prenatal care in rural america what's the government controlling more of health care produced less choices fewer providers and less services and especially those limited amount of services that are prevented if now let me state from the beginning this i am for reauthorizing the s chip bill i will support the substitute that senator mcconnell will offer which provides thirty eight point nine billion dollars over five years an increase increase of thirteen point nine billion and i also was here in the house on the energy and commerce committee in one thousand nine hundred seven when we enacted the first s chip bill  forty billion dollar federal commitment over ten years to those individuals those children at two hundred percent of poverty or less  many states expanded that asked schip program to cover parents of s chip kids and childless adults protects the original s chip program by making sure that low income children are the focus of our efforts and i will say north carolina has one of the best s chip programs in the united states i'm pleased will give north carolina the additional funds that it needs to continue serving low income children but mr president i'm sadly here today to tell you i'm not for expanding the roles of the the finance committee bill adds more than thirty billion dollars to the current s chip base budget twenty five billion to roughly cover three point three million additional children scored what the state and federal government spending was per child and let me put that up for everybody thirty nine hundred thirty dollars per child yet today the average private health care plan in the private sector my question is if we're going to spend thirty nine hundred dollars for children in a government plan but we can insure them fully in the private sector today for eleven hundred thirty dollars where is the choice as a colleague of ours in the house you say beam me up scotty something's wrong here this seems like a no brainer this is this is not an investment that one can make on the part of american taxpayers and feel good today in one thousand nine hundred seven we spent forty billion dollars is an honorable goal and the quite frankly the program has been very reauthorization plan though would spend sixty billion dollars over the next five years now people talk about budget gimmicks i'm not here to talk about that i think they're here i think it hides millions of dollars that i think are extra spending that maybe they're going to ensure there's re point three and thirty nine thirty nine hundred dollars is incorrect or maybe there are more people that are going to be covered and many of them outside of the ranks of low income children but there's no question that the baucus grassley bill expands s chip so much that i feel children who need it the most will get lost in a new larger government run program as a matter of fact if s chip works as well as i think it does why would we change and i think some would tell us that we're we're not here change in the chip program but i would only point to section six zero six of the grassley baucus bill where they remove the word state from the name of as gypsy s chip is the state children's health insurance program it was always designed as being an enhanced share for the states in the state run the program now it's chips going to be called the children insurance program sounds like a what a big one size fits all government program to make the solution to our health care crisis is not to put every child in america in a government program today one out of two children in america are in a government program they're either enrolled in medicaid arrest h the baucus plan puts more children in the government health care and a recent c b s analysis concluded that for every one additional children covered under arrest you  estimated two hundred fifty thousand to five hundred thousand will be switched from private insurance to the new public s chip coverage and let me say that again see  three point three million kids which means one point six five now you could be switched from private insurance the of taxpayers why in the world would we create an avenue for people to go off their families plan and come on a government plan where we're committed as c b o t said to spend thirty nine hundred dollars roughly per child now before people think that we're all insane they know i am now what should we be discussing i believe we should be discussing how do we reform health care system and i don't think i would find much opposition except on how we do that because this president there are forty five million uninsured americans today and if they're sitting at home listening to this debate about covering three million low income children are or where they are every day or on the income scale for the person that's sitting home that's an adult today they're saying what about me what about the fact that i don't have insurance you know if they have no job and they have no income we know they're on medicaid if they have a job and they don't qualify financially for medicaid then where do they go well there forty five million of them out there so where that are in this class some are kids and some are dolts and every time they access health care and they can't pay for it on on an incredibly predictable thing happens the cost which unrecovered is shifted to everybody else in the system in north carolina there one point three million uninsured seventeen percent of the north carolina population is uninsured and sixteen percent of the american population is uninsured yet our debate is limited to three million or three point three million children it's not about how we insure america it's not about the rising cost of health care it's not about the fact that health care premiums have in fact doubled in the country since the year two thousand if compared with the growth of the growth of inflation since two thousand and eighteen percent and the growth of wages at twenty percent then health insurance premiums for family coverage have increased seventy three percent over the last five years health care co rising three times the rate of inflation and with no corresponding rise in quality now there's the red flag we've seen a seventy three percent increase in the premium and if you could turn to something tangible in the system to say that the qualities gotten that much better then one could maybe rationalize this increase but the fact is that there's been no corresponding rise the quality is a matter of fact today mr president there's not health care plans that are focused primarily on wellness and prevention i remember when we tried to get mammographies and p covered in medicare and we tried to get an array of preventative health care and it was the hardest thing that i've ever worked on in health care to try to get added to a system i guess it's because t with and why would we do anything preventative yet if we look at the research that goes on every day and that we pay for we find the earlier we can detect cancer there earlier we can to direct that b d s the more we can monitor disease management the better the outcome is but more importantly from a taxpayer standpoint the less it costs the system well we know that happens in the government system we don't implement wellness and prevention like we should if we did would require i medicaid but we have an opportunity as we talk about redesigning the american health care system we have an opportunity to build wellness and prevention is the mainstay piece of this broken system today we have a system that only triggers when you get sick it doesn't trigger when you want to stay well it triggers when you get sick but if you look at companies that have said there's no way i'll ever be competitive if in fact the health care system doesn't change in america that i've made a decision that they're going to go outside of the the insurance products that are available today and they're going to do things that are creative out of the box and they've self insured their insurance and they've gone out and partnered with somebody to to administer their plan what do you find whether it's dell computers who has now about four years of experience about disease management how to brings the overall cost of their health care for their employees not just corporately but for their individual cost of their employees down all the way to safeway who has a model that i know every member on the hills probably been briefed on what safe ways do and given people control of their care but more importantly stressing to them that prevention and wellness is something that they'll actually receive an incentive on people without access to employer sponsored coverage of should severely disadvantage in the current system and i know that both of the senators that are in charge of the tax committee probably would agree that we've got inequities ninety one percent of workers in large firms have health insurance sixty six percent of workers in small firms ten employees or less have health insurance twenty nine percent of the uninsured work in small business the percentage of employers offering coverage has dropped eight percent since the year two thousand global economy that's what's happened since two thousand there's a global economy where it doesn't matter where you manufacture all that matters is where your customers and most u s businesses have changed from a model that it was predominantly for domestic consumption to a model today where sixty or seventy percent of their business is internationally and thirty or forty percent of it is domestically in the united states we ought to look at some of the decisions they've made and wonder geez why didn't we have this challenge before this point with those employers looking at their business model and saying how can i continue to pay the health care cost that rises in double digit ways each year with inflation and remain competitive with my global the marketplace they sell and do which is global and health care cost is the number one issue that makes money competitive in the absence of us reforming the system and creating a way for them to provide health care not that six double digit inflation every year but begins a downward pressure on the cost of health care i will assure you they have two choices they eliminate the benefit or they leave the country and both of them are devastating to the united states well if we don't reform health care what happens health care becomes an affordable for people u s businesses become uncompetitive government will have its normal reaction down the reimbursement that we pay through medicare and medicaid and the effects of that is that private insurance sees that as an opportunity to ratchet down the provider reimbursements doctors and nurses get paid last more people go on government health care doctors and nurses will become government employees hospitals will become government property insurance companies will become pay paper pushers we must all agree that the outcomes got to be better for by the way taxes will rise to i'm not sure whether it's individual or corporate but let me assure you though some believe that health care is free somebody pays for look at the systems around the world where the government's in control of their health care and yeah the beneficiaries may think that it's free but one of the problems one of the reasons they're ratcheting back the scope of coverage they've got is the fact that is the government runs out of money can't find ways to raise revenue they have choice they can tax individuals they can tax corporations or they can reduce benefits well when you look at the prevailing tax right that they've got now you understand why their only choice is to cut benefits and the likelihood is that would be faced with the same thing as socialized medicine is just corner and i think times actually running out this present current tax structure for health care benefits exist for employer focused plans lawyers get a tax deduction for the amount of the health care benefit provided for their employees but the deduction unfortunately doesn't exist for individuals who shop in the marketplace we spend fifty percent more of our g d p sixteen percent on health care than the next three spenders germany japan in france but we aren't any healthier stime we begin to focus on house our system becomes more efficient healthier and more fordable  mr president one out of every four dollars in health care spent in this country does nothing to help patients it's actually  wasted on defensive medicine unnecessary paperwork and outright fraud and when you put individuals in charge of their health care not just constructing it or negotiating it but responsible for whether the system is a fish an ineffective you'd be amazed at how you rang out that twenty five percent that one out of four the source of the problem is runaway health care costs which is caused by a lack of choice and a lack of government control now let me assure you that in sweden today heart patients wait twenty five weeks  england today heritage said that cancer patients sometimes wait a year between their diagnosis and their chemotherapy treatment canada supreme court justice beverly mclaughlin  it best in two thousand and five ruling when i quote access to a waiting list is not access to health care we have a roadmap as to where we're going and we have an opportunity to change t today what happens if the united states senate if the congress unites united states becomes the visionary body that it needs to be and the reform body that it has to be if in fact you want to protect the system in this country americans have to have three things they have to have choice after of ownership they have to have control they have to have the ability to construct their insurance policies to meet their health care needs to be portable just like a four hundred one k when you give an individual ownership of a four hundred one k they're no longer strapped to an employer about their pension or retirement they have the ability to take that money with them to the next job well i would tell you we've reached the point now that health care should be the same thing it should be ownership and we should have the ability to take that health care from employer to pull to employer where we're not locked in and for the first time americans would have the freedom to make decisions about their future and about the future of their families this present innovation works we all know what a year ago forty six inch plasma t v cost much is eleven thousand dollars but today you can buy the same t v for health care don't pull yourself between one thousand nine hundred ninety two thousand for the cost of lasik surgery which is used to it which is set by the market forces and outs and outside the current system went down twenty percent while health care expenditures per person increased by more than forty five percent lasik surgery is this new surgery that individuals have on their eyes if they have a certain condition they can have lasix and throw their glasses away  controversial thing innovation brought it through f d a approved at the cost was very high to begin with and as more people have sought like it's lasik surgery the prices come down and down and down and down and down i'm sure that dr coburn will talk more about it as we go through this debate duke university set up a program to manage congestive heart failure half of it's typically have a five year life expectancy in a cost and cost a total of twenty two point five billion dollars for congestive heart failure annually in the united states do develop a program that integrated the care to develop best practice models for congestive heart patients the approach resulted in better patient outcomes increased patient compliance with their doctor's recommendations and most importantly a thirty two percent drop in the cost per patient of treating congestive heart failure innovation allows incredible things to happen but only when we have a marketplace that rewards innovation mispresent i said when i stood up i had an amendment that i didn't intend to call up and i'm not going to call it up that amendment is the every american insured health act i want to just briefly talk about it hopefully this accomplishes everything that i've spent the last twenty minutes talking about it provides the resources for every american not on a government plan to access the coverage they need and say that again it provides the resources for all the uninsured in america to negotiate the coverage they need in the private marketplace number two it eliminates cost shifting eliminate that bill that we get through our premium cost or through the cost of a service delivered that we can figure out who used it but somebody didn't pay because they weren't insured and it got shifted to everybody  eliminate that by ensuring by providing the resources for every american to negotiate coverage we estimate mr president maybe two hundred billion dollars a three million children are going to be can we afford what it's going to cost us to insure everybody who's uninsured in america well here's what we do we address the tax inequity and through that we treat those who get insurance provided by an employer the same way we do individuals and then we turn around every american who's not on a government plan and we do this we give them a refundable advanced  flat tax credit and for an individual twenty one hundred sixty dollars a year and if it's a family we give them fifty four hundred dollars a year now if in fact you had tax consequences from this new equality in treating individuals and an employer plans the same the likelihood is that if your health benefit from your employer doesn't exceed fifteen thousand dollars from the employer on a family plan than fifty four hundred dollars is more than enough to cover the tax consequences if in fact you're an individual that's uninsured and you get a refundable tax credit on an annual basis of twenty one hundred sixty dollars then you can go out negotiate in the private sector for health care coverage that on average today is between fifteen and seventeen hundred dollars nationally for an individual plan and about forty five to forty six hundred dollars for a family plan and you can insure yourself as an individual or you can insure yourself as a family and you can do that all within the confines of the refundable tax credit that we've allowed now people have question whether there's a little bit of a shift in wealth yeah there is we're taken people who have rich health care plans more health care than they need health care plans that are priced because there's no out of pocket cost there's a lot that we know we need to do from a standpoint of making sure that americans have skin in the game every time they go in a doctor's office for the facts of utilization and we're shifting it down to where we give people a refundable tax credit that are barely over the medicaid qualifications and we're going to give them a slip and that's plan twenty one hundred sixty dollars for an individual fifty four hundred dollars for family annually refundable tax credit that's only good for health care when they sign up with an insurer the money will go directly from the s government to the insure and if there's money left over it would automatically transfer over into a health savings account for that individual to use for other health care benefits be it co payments deductibles whatever their plan was structured and they're allowed the opportunity to design a plan that meets their age their income their health condition we give states incentives to make sure that in every marketplace there is an affordable plan and  it's absolutely crucial that you begin to have insurance reform at the same time you're creating a marketplace that's that's driven by individuals our goals are to give americans the resources the right in the purchase and the right to purchase health care in a private marketplace to in the tax discrimination to encourage individuals to take control to eliminate the current shop call shift so that every american health care begins to come down because of this new benefit and ensure the accessibility and affordability of high quality health care by the way mr president this plan that i just described that did this for the first time insured everybody who's uninsured provided annually a twenty one sixty refundable tax flat tax credit and fifty four hundred dollars for a family i still didn't tell you how much it cost i'm like the guy on t v for the i'm from mercial that waits till the end of spring on you just how great of a bargain it is this is budget neutral it doesn't cost the american taxpayer one dollar and that doesn't take into account that there may be two hundred billion dollars where the cost shifting going on in the system we get no story for the fact that we could potentially drive two hundred billion dollars a call out of the health care of everybody else in the system by making sure that everybody's insured we get absolutely no credit for being able to put together plans that promote prevent and wellness that begin to drive down utilization that began to make americans healthier that began to create data for so we know exactly what the right reimbursements are for doctors and nurses  hospitals and community health centers we pull that out of the sky today and they bitch and they complain and i should because there is no relation to that and reality this by creating a real marketplace real competition from the insure all the way through to the service delivered will begin to build the database of information we need to know what reimbursement the marketplace says are fair to the people that provide then they can make a decision i believe will sign that every doctor every nurse every hospital every community health center will receive this in a warm way because now they believe that this is a system that will evaluate what they deliver and what cost they're reimbursed for  mr president i'm sure that the chairman of the committee and the ranking member would have preferred to have this solely focused on s chip tonight i know  but i think it's also rational do understand that when you're talking about expanding the roles of government insurance coverage to three point three million kids that somebody ought to stand up and say what about the other forty five million americans and if in fact numbers than that there's value to the reform for the entire system then why would we put the three point three million kids in a in a program vo already told us would cost thirty nine hundred thirty dollars per child that we can buy in the private marketplace for eleven hundred thirty dollars worth of coverage today why don't we integrate  to the last system which is reform our health care system let's bring equity to the tax side let's provide every american that's uninsured the resources they need to go out and negotiate their coverage whether they're individuals or whether their families less the health care delivery system the confidence of knowing that we're willing to create a market this is not an unusual thing for us we did it with part d medicare and the chairman of the committee was very instrumental in it passage and today one year after the in akron a part the medicare we created transparency we created competition on what was one of the most price sensitive areas prescription drugs what is the net result in premiums reduce twenty eight percent the first year drugs reduced thirty three percent in first year because we created competition we created transparency we made people show their prices and we made sure that there was more than one plan there were multiple plans that people could choose from the net result of that is exactly what we're trying to mirror here but we're trying to do it in a way that treats health care in its entirety and you can't do that without prevention and wellness being the main pieces of it i want to thank the chairman for the fact that he listened i appreciate that and i plan to be the floor probably several times this week i'll try to do it when it doesn't interrupt the s chip but i think this is an important time to begin to educate our members to begin to educate america about the need for health care reform and how health care reform can their tester is their objection without objection so order senator from missouri thank you mr president you know i don't know that anybody could argue that the children's health insurance program has has been a success of course it's been a success and frankly successes have not come easily in the in the area of health care availability in this country over the last decade and so we've got to protect it we've got to make sure it continues and we need to make sure that we expand it to as many children as possible i think this strong piece of bipartisanship that we are debating today in fact does those things and you know the interesting thing is i i think back to a debate in this chamber that occurred in november of two thousand and three and november of two thousand and three there was a piece of legislation concerning prescription drugs now children's health insurance prescription drugs these are both noble and good causes the united states senate to try to lower the cost of prescription drugs to try to provide more insurance for children what are the differences between the two debates it's really interesting to look because that's when that ugly head of politics begins to rear and people begin to see that sometimes unfortunately in this building it is about politics instead of about public policy both goals of public policy prescription drug lower cost children's health insurance everyone has to be for those goals but how you get there and what complaints you have on the way is where politics come in medicare part d was a four hundred billion dollars program interestingly enough it was passed in november of zero three as we were approaching presidential elections and a cycle of elections interestingly enough the president was running for reelection not a whisper of a veto threat was heard even though it was four hundred billion dollars that had no way to be paid for there was no cigarette tax and medicare part d and it was guaranteeing a profit to the pharmaceutical industry in fact they went so far to make sure you could negotiate for lower prices a bold saying i think for a country where free market is supposed to be something we relish negotiating for lower prices well that's pretty all american but oh no we made sure there was no negotiation for lower prices on of the government in medicare part d and there was no mechanism to pay for it but yet i hear senators today speaking out against this bill with rights ascendant nation saying well the the the tobacco taxes in here isn't going to be enough the vast majority of the republican party voted for medicare part d even though and i will i'll note that the senator that's going to follow me on the floor was one of the brave souls voted no and i'm willing to bet is because he was trying to be responsible as it related to the budget knowing his history and knowing how he speaks about budget responsibility on this floor but most of his colleagues didn't agree with it and certainly the present united states didn't not only did  sign the bill he signed it with relish any campaigned on it even though the way the program was going to be implemented was not going to get home for seniors for years in advance and i think we can all be proud that there is some savings with medicare part d but we got  beyond that the government paid a price for it just like we're going to pay a price for enhancing and protecting the children's health insurance program in this country other than medicare part d we really haven't looked at a pinky finger in the area of health care during this ministration and most americans are now scared they're scared about getting care for their children they're scared about getting care for their parents they're scared about whether or not they're going to be able afford health care knowing any minute their employer may drop coverage and the expansion of this program has more to do with the on availability of health care from an employer than it has to do with some effort on the part of the government to ensure every person this is a public private effort that has been a success it is a block grant not an entitlement it allows the state flexibility is everything a government program should be getting at a very important need there are so many reasons to be for this bill and i will not take the time tonight to go into the mall because all of my colleagues will over that they have today i listened for a couple of hours mr president when i was sitting at the diet and i'm sure that this will go on tomorrow with many people talking about the things that are important i want to mention one part of this bill that i think is very important that hasn't been talked about enough and that's mental health parity we have spent a lot of time talking about our children being at risk for drugs and alcohol we have talked a lot about how we've got to teach them the dangers of drugs and alcohol truth be known one of the biggest failures in our health care system right now in this country is a complete on availability of mental health services for children right now in america if you have health insurance and you know people and you are educated it is difficult to find a middle health professional that specializes in children if you are a poor working family and your child has got involved with drugs or alcohol and you want to get the middle health assistance treatment program forget about it it is