H216 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

no one in this body knows that there is 

a significant number of children who 

are uninsured and that this measure, 

once offered in 1997, did begin the process that today we wish to continue and 

that still does not complete the task 

that most of us feel is necessary in 

order to insure all of the children in 

this country. 

Madam Speaker, this is a good rule 

for a critically important bill. Although this bill cannot repair all of the 

flaws that are intrinsic in America’s 

health care system, it undoubtedly 

serves as a strong and honorable prelude to facilitating comprehensive 

health care reform. 

Mahatma Gandhi, among many 

things, said that you can learn about a 

country’s condition by looking at its 

most weak and vulnerable people. The 

alarming rate of uninsured and poverty-stricken children in this country 

tells us that the richest country on 

Earth is in poor condition. 

I urge my colleagues to vote in favor 

of this rule so that we may support a 

bill that will give millions of children 

the basic right to health so that they 

can become leaders and productive citizens. 

I urge a ‘‘yes’’ vote on the previous 

question and on the rule. 

I yield back the balance of my time, 

and I move the previous question on 

the resolution. 

The previous question was ordered. 

The SPEAKER pro tempore. The 

question is on the resolution. 

The question was taken; and the 

Speaker pro tempore announced that 

the ayes appeared to have it. 

RECORDED VOTE

Mr. SESSIONS. Madam Speaker, I 

demand a recorded vote. 

A recorded vote was ordered. 

The vote was taken by electronic device, and there were—ayes 244, noes 178, 

not voting 11, as follows: 

[Roll No. 14] 

AYES—244 

Abercrombie 

Ackerman 

Adler (NJ) 

Altmire 

Andrews 

Arcuri 

Baca 

Baird 

Baldwin 

Barrow 

Bean 

Becerra 

Berkley 

Berman 

Berry 

Bishop (GA) 

Bishop (NY) 

Blumenauer 

Boccieri 

Boren 

Boswell 

Boyd 

Brady (PA) 

Braley (IA) 

Bright 

Brown, Corrine 

Butterfield 

Capps 

Capuano 

Cardoza 

Carnahan 

Carney 

Carson (IN) 

Castor (FL) 

Chandler 

Childers 

Clarke 

Clay 

Cleaver 

Clyburn 

Cohen 

Connolly (VA) 

Conyers 

Cooper 

Costa 

Costello 

Courtney 

Crowley 

Cuellar 

Cummings 

Dahlkemper 

Davis (AL) 

Davis (CA) 

Davis (IL) 

Davis (TN) 

DeFazio 

DeGette 

Delahunt 

DeLauro 

Dicks 

Dingell 

Doggett 

Donnelly (IN) 

Doyle 

Driehaus 

Edwards (MD) 

Edwards (TX) 

Ellison 

Ellsworth 

Engel 

Eshoo 

Etheridge 

Farr 

Fattah 

Filner 

Foster 

Frank (MA) 

Fudge 

Giffords 

Gillibrand 

Gonzalez 

Gordon (TN) 

Grayson 

Green, Al 

Green, Gene 

Griffith 

Grijalva 

Gutierrez 

Hall (NY) 

Halvorson 

Hare 

Harman 

Hastings (FL) 

Heinrich 

Higgins 

Himes 

Hinchey 

Hinojosa 

Hirono 

Hodes 

Holden 

Holt 

Honda 

Hoyer 

Inslee 

Israel 

Jackson (IL) 

Jackson-Lee 

(TX) 

Johnson (GA) 

Johnson, E. B. 

Kagen 

Kanjorski 

Kaptur 

Kennedy 

Kildee 

Kilpatrick (MI) 

Kilroy 

Kind 

Kirkpatrick (AZ) 

Kissell 

Klein (FL) 

Kosmas 

Kratovil 

Kucinich 

Langevin 

Larsen (WA) 

Larson (CT) 

Lee (CA) 

Levin 

Lewis (GA) 

Lipinski 

Loebsack 

Lofgren, Zoe 

Lowey 

Luja ́n 

Lynch 

Maffei 

Markey (CO) 

Markey (MA) 

Marshall 

Massa 

Matheson 

Matsui 

McCarthy (NY) 

McCollum 

McDermott 

McGovern 

McIntyre 

McMahon 

McNerney 

Meek (FL) 

Meeks (NY) 

Melancon 

Michaud 

Miller (NC) 

Miller, George 

Mitchell 

Mollohan 

Moore (KS) 

Moore (WI) 

Moran (VA) 

Murphy (CT) 

Murphy, Patrick 

Murtha 

Nadler (NY) 

Napolitano 

Neal (MA) 

Nye 

Oberstar 

Obey 

Olver 

Ortiz 

Pallone 

Pascrell 

Pastor (AZ) 

Payne 

Perlmutter 

Perriello 

Peters 

Peterson 

Pingree (ME) 

Polis (CO) 

Pomeroy 

Price (NC) 

Rahall 

Rangel 

Reyes 

Richardson 

Rodriguez 

Ross 

Rothman (NJ) 

Roybal-Allard 

Ruppersberger 

Rush 

Ryan (OH) 

Salazar 

Sa ́nchez, Linda 

T. 

Sanchez, Loretta 

Sarbanes 

Schakowsky 

Schauer 

Schiff 

Schrader 

Schwartz 

Scott (GA) 

Scott (VA) 

Serrano 

Sestak 

Shea-Porter 

Sires 

Skelton 

Slaughter 

Smith (WA) 

Space 

Speier 

Spratt 

Stark 

Stupak 

Sutton 

Tanner 

Tauscher 

Taylor 

Teague 

Thompson (CA) 

Thompson (MS) 

Tierney 

Titus 

Tonko 

Towns 

Tsongas 

Van Hollen 

Vela ́ zquez 

Walz 

Wasserman 

Schultz 

Watson 

Watt 

Waxman 

Weiner 

Welch 

Wexler 

Wilson (OH) 

Woolsey 

Wu 

Yarmuth 

NOES—178 

Aderholt 

Akin 

Alexander 

Austria 

Bachmann 

Bachus 

Barrett (SC) 

Bartlett 

Barton (TX) 

Biggert 

Bilbray 

Bilirakis 

Bishop (UT) 

Blackburn 

Blunt 

Bonner 

Bono Mack 

Boozman 

Boustany 

Brady (TX) 

Broun (GA) 

Brown (SC) 

Brown-Waite, 

Ginny 

Buchanan 

Burgess 

Burton (IN) 

Buyer 

Calvert 

Camp 

Campbell 

Cantor 

Cao 

Capito 

Carter 

Cassidy 

Castle 

Chaffetz 

Coble 

Coffman (CO) 

Cole 

Conaway 

Crenshaw 

Culberson 

Davis (KY) 

Deal (GA) 

Dent 

Diaz-Balart, L. 

Diaz-Balart, M. 

Dreier 

Duncan 

Ehlers 

Emerson 

Fallin 

Flake 

Fleming 

Forbes 

Fortenberry 

Foxx 

Franks (AZ) 

Frelinghuysen 

Gallegly 

Garrett (NJ) 

Gerlach 

Gingrey (GA) 

Gohmert 

Goodlatte 

Granger 

Graves 

Guthrie 

Hall (TX) 

Harper 

Hastings (WA) 

Heller 

Hensarling 

Herger 

Hill 

Hoekstra 

Hunter 

Inglis 

Issa 

Jenkins 

Johnson (IL) 

Johnson, Sam 

Jones 

Jordan (OH) 

King (IA) 

King (NY) 

Kingston 

Kirk 

Kline (MN) 

Lamborn 

Lance 

Latham 

LaTourette 

Latta 

Lee (NY) 

Lewis (CA) 

Linder 

LoBiondo 

Lucas 

Luetkemeyer 

Lummis 

Lungren, Daniel 

E. 

Mack 

Manzullo 

Marchant 

McCarthy (CA) 

McCaul 

McClintock 

McCotter 

McHenry 

McHugh 

McKeon 

McMorris 

Rodgers 

Mica 

Miller (FL) 

Miller (MI) 

Miller, Gary 

Minnick 

Moran (KS) 

Murphy, Tim 

Myrick 

Neugebauer 

Nunes 

Olson 

Paul 

Paulsen 

Pence 

Petri 

Pitts 

Platts 

Poe (TX) 

Posey 

Price (GA) 

Putnam 

Radanovich 

Rehberg 

Reichert 

Roe (TN) 

Rogers (AL) 

Rogers (KY) 

Rogers (MI) 

Rohrabacher 

Rooney 

Ros-Lehtinen 

Roskam 

Royce 

Ryan (WI) 

Scalise 

Schmidt 

Schock 

Sensenbrenner 

Sessions 

Shadegg 

Shimkus 

Shuler 

Shuster 

Simpson 

Smith (NE) 

Smith (NJ) 

Smith (TX) 

Souder 

Stearns 

Terry 

Thompson (PA) 

Thornberry 

Tiahrt 

Tiberi 

Turner 

Upton 

Walden 

Wamp 

Westmoreland 

Whitfield 

Wilson (SC) 

Wittman 

Wolf 

Young (AK) 

NOT VOTING—11 

Boehner 

Boucher 

Herseth Sandlin 

Maloney 

Sherman 

Snyder 

Solis (CA) 

Sullivan 

Visclosky 

Waters 

Young (FL) 

b 1225 

Messrs. GINGREY of Georgia, BURTON of Indiana and REICHERT 

changed their vote from ‘‘aye’’ to ‘‘no.’’ 

So the resolution was agreed to. 

The result of the vote was announced 

as above recorded. 

A motion to reconsider was laid on 

the table. 

f 

ELECTING A MINORITY MEMBER 

TO A STANDING COMMITTEE 

Mr. SESSIONS. Madam Speaker, by 

the direction of the House Republican 

Conference, I send to the desk a privileged resolution and ask for its immediate consideration. 

The Clerk read the resolution, as follows: 

H. RES. 59 

Resolved, That the following Member is, 

and is hereby, elected to the following standing committee of the House of Representatives: 

COMMITTEE ON RULES—Ms. Foxx. 

The resolution was agreed to. 

A motion to reconsider was laid on 

the table. 

f 

CHILDREN’S HEALTH INSURANCE 

PROGRAM REAUTHORIZATION 

ACT OF 2009 

Mr. PALLONE. Madam Speaker, pursuant to House Resolution 52, I call up 

the bill (H.R. 2) to amend title XXI of 

the Social Security Act to extend and 

improve the Children’s Health Insurance Program, and for other purposes, 

and ask for its immediate consideration in the House. 

The Clerk read the title of the bill. 

The text of the bill is as follows: 

H.R. 2 

Be it enacted by the Senate and House of Representatives of the United States of America in 

Congress assembled, 

SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT; REFERENCES; 

TABLE OF CONTENTS. 

(a) SHORT TITLE.—This Act may be cited as 

the ‘‘Children’s Health Insurance Program 

Reauthorization Act of 2009’’. 

(b) AMENDMENTS TO SOCIAL SECURITY

ACT.—Except as otherwise specifically provided, whenever in this Act an amendment is 

expressed in terms of an amendment to or repeal of a section or other provision, the reference shall be considered to be made to that 

section or other provision of the Social Security Act. 

(c) REFERENCES TO CHIP; MEDICAID; SECRETARY.—In this Act: 


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January 14, 2009 CONGRESSIONAL RECORD — HOUSE H217 

(1) CHIP.—The term ‘‘CHIP’’ means the 

State Children’s Health Insurance Program 

established under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.). 

(2) MEDICAID.—The term ‘‘Medicaid’’ means 

the program for medical assistance established under title XIX of the Social Security 

Act (42 U.S.C. 1396 et seq.). 

(3) SECRETARY.—The term ‘‘Secretary’’ 

means the Secretary of Health and Human 

Services. 

(d) TABLE OF CONTENTS.—The table of contents of this Act is as follows: 

Sec. 1. Short title; amendments to Social 

Security Act; references; table 

of contents. 

Sec. 2. Purpose. 

Sec. 3. General effective date; exception for 

State legislation; contingent effective date; reliance on law. 

TITLE I—FINANCING 

Subtitle A—Funding 

Sec. 101. Extension of CHIP. 

Sec. 102. Allotments for States and territories for fiscal years 2009 

through 2013. 

Sec. 103. Child Enrollment Contingency 

Fund. 

Sec. 104. CHIP performance bonus payment 

to offset additional enrollment 

costs resulting from enrollment 

and retention efforts. 

Sec. 105. Two-year initial availability of 

CHIP allotments. 

Sec. 106. Redistribution of unused allotments. 

Sec. 107. Option for qualifying States to receive the enhanced portion of 

the CHIP matching rate for 

Medicaid coverage of certain 

children. 

Sec. 108. One-time appropriation. 

Sec. 109. Improving funding for the territories under CHIP and Medicaid. 

Subtitle B—Focus on Low-Income Children 

and Pregnant Women 

Sec. 111. State option to cover low-income 

pregnant women under CHIP 

through a State plan amendment. 

Sec. 112. Phase-out of coverage for nonpregnant childless adults under 

CHIP; conditions for coverage 

of parents. 

Sec. 113. Elimination of counting Medicaid 

child presumptive eligibility 

costs against title XXI allotment. 

Sec. 114. Limitation on matching rate for 

States that propose to cover 

children with effective family 

income that exceeds 300 percent 

of the poverty line. 

Sec. 115. State authority under Medicaid. 

TITLE II—OUTREACH AND ENROLLMENT 

Subtitle A—Outreach and Enrollment 

Activities 

Sec. 201. Grants and enhanced administrative funding for outreach and 

enrollment. 

Sec. 202. Increased outreach and enrollment 

of Indians. 

Sec. 203. State option to rely on findings 

from an Express Lane agency to 

conduct simplified eligibility 

determinations. 

Subtitle B—Reducing Barriers to Enrollment 

Sec. 211. Verification of declaration of citizenship or nationality for purposes of eligibility for Medicaid 

and CHIP. 

Sec. 212. Reducing administrative barriers 

to enrollment. 

Sec. 213. Model of Interstate coordinated enrollment and coverage process. 

Sec. 214. Permitting States to ensure coverage without a 5-year delay of 

certain children and pregnant 

women under the Medicaid program and CHIP. 

TITLE III—REDUCING BARRIERS TO 

PROVIDING PREMIUM ASSISTANCE 

Subtitle A—Additional State Option for 

Providing Premium Assistance 

Sec. 301. Additional State option for providing premium assistance. 

Sec. 302. Outreach, education, and enrollment assistance. 

Subtitle B—Coordinating Premium 

Assistance With Private Coverage 

Sec. 311. Special enrollment period under 

group health plans in case of 

termination of Medicaid or 

CHIP coverage or eligibility for 

assistance in purchase of employment-based coverage; coordination of coverage. 

TITLE IV—STRENGTHENING QUALITY OF 

CARE AND HEALTH OUTCOMES 

Sec. 401. Child health quality improvement 

activities for children enrolled 

in Medicaid or CHIP. 

Sec. 402. Improved availability of public information regarding enrollment 

of children in CHIP and Medicaid. 

Sec. 403. Application of certain managed 

care quality safeguards to 

CHIP. 

TITLE V—IMPROVING ACCESS TO 

BENEFITS 

Sec. 501. Dental benefits. 

Sec. 502. Mental health parity in CHIP 

plans. 

Sec. 503. Application of prospective payment 

system for services provided by 

Federally-qualified health centers and rural health clinics. 

Sec. 504. Premium grace period. 

Sec. 505. Clarification of coverage of services 

provided through school-based 

health centers. 

TITLE VI—PROGRAM INTEGRITY AND 

OTHER MISCELLANEOUS PROVISIONS 

Subtitle A—Program Integrity and Data 

Collection 

Sec. 601. Payment error rate measurement 

(‘‘PERM’’). 

Sec. 602. Improving data collection. 

Sec. 603. Updated Federal evaluation of 

CHIP. 

Sec. 604. Access to records for IG and GAO 

audits and evaluations. 

Sec. 605. No Federal funding for illegal 

aliens. 

Subtitle B—Miscellaneous Health Provisions 

Sec. 611. Deficit Reduction Act technical 

corrections. 

Sec. 612. References to title XXI. 

Sec. 613. Prohibiting initiation of new 

health opportunity account 

demonstration programs. 

Sec. 614. Adjustment in computation of Medicaid FMAP to disregard an extraordinary employer pension 

contribution. 

Sec. 615. Clarification treatment of regional 

medical center. 

Sec. 616. Extension of Medicaid DSH allotments for Tennessee and Hawaii. 

Subtitle C—Other Provisions 

Sec. 621. Outreach regarding health insurance options available to children. 

Sec. 622. Sense of the Senate regarding access to affordable and meaningful health insurance coverage. 

Sec. 623. Limitation on Medicare exception 

to the prohibition on certain 

physician referrals for hospitals. 

TITLE VII—REVENUE PROVISIONS 

Sec. 701. Increase in excise tax rate on tobacco products. 

Sec. 702. Administrative improvements. 

Sec. 703. Treasury study concerning magnitude of tobacco smuggling in 

the United States. 

Sec. 704. Time for payment of corporate estimated taxes. 

SEC. 2. PURPOSE. 

It is the purpose of this Act to provide dependable and stable funding for children’s 

health insurance under titles XXI and XIX of 

the Social Security Act in order to enroll all 

six million uninsured children who are eligible, but not enrolled, for coverage today 

through such titles. 

SEC. 3. GENERAL EFFECTIVE DATE; EXCEPTION 

FOR STATE LEGISLATION; CONTINGENT EFFECTIVE DATE; RELIANCE 

ON LAW. 

(a) GENERAL EFFECTIVE DATE.—Unless otherwise provided in this Act, subject to subsections (b) through (d), this Act (and the 

amendments made by this Act) shall take effect on April 1, 2009, and shall apply to child 

health assistance and medical assistance 

provided on or after that date. 

(b) EXCEPTION FOR STATE LEGISLATION.—In 

the case of a State plan under title XIX or 

State child health plan under XXI of the Social Security Act, which the Secretary of 

Health and Human Services determines requires State legislation in order for the respective plan to meet one or more additional 

requirements imposed by amendments made 

by this Act, the respective plan shall not be 

regarded as failing to comply with the requirements of such title solely on the basis 

of its failure to meet such an additional requirement before the first day of the first 

calendar quarter beginning after the close of 

the first regular session of the State legislature that begins after the date of enactment 

of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year 

legislative session, each year of the session 

shall be considered to be a separate regular 

session of the State legislature. 

(c) COORDINATION OF CHIP FUNDING FOR

FISCAL YEAR 2009.—Notwithstanding any 

other provision of law, insofar as funds have 

been appropriated under section 2104(a)(11), 

2104(k), or 2104(l) of the Social Security Act, 

as amended by section 201 of Public Law 110– 

173, to provide allotments to States under 

CHIP for fiscal year 2009— 

(1) any amounts that are so appropriated 

that are not so allotted and obligated before 

April 1, 2009, are rescinded; and 

(2) any amount provided for CHIP allotments to a State under this Act (and the 

amendments made by this Act) for such fiscal year shall be reduced by the amount of 

such appropriations so allotted and obligated 

before such date. 

(d) RELIANCE ON LAW.—With respect to 

amendments made by this Act (other than 

title VII) that become effective as of a date— 

(1) such amendments are effective as of 

such date whether or not regulations implementing such amendments have been issued; 

and 

(2) Federal financial participation for medical assistance or child health assistance furnished under title XIX or XXI, respectively, 

of the Social Security Act on or after such 

date by a State in good faith reliance on 

such amendments before the date of promulgation of final regulations, if any, to carry 

out such amendments (or before the date of 

guidance, if any, regarding the implementation of such amendments) shall not be denied 


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H218 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

on the basis of the State’s failure to comply 

with such regulations or guidance. 

TITLE I—FINANCING 

Subtitle A—Funding 

SEC. 101. EXTENSION OF CHIP. 

Section 2104(a) (42 U.S.C. 1397dd(a)) is 

amended— 

(1) in paragraph (10), by striking ‘‘and’’ at 

the end; 

(2) by amending paragraph (11), by striking 

‘‘each of fiscal years 2008 and 2009’’ and inserting ‘‘fiscal year 2008’’; and 

(3) by adding at the end the following new 

paragraphs: 

‘‘(12) for fiscal year 2009, $10,562,000,000; 

‘‘(13) for fiscal year 2010, $12,520,000,000; 

‘‘(14) for fiscal year 2011, $13,459,000,000; 

‘‘(15) for fiscal year 2012, $14,982,000,000; and 

‘‘(16) for fiscal year 2013, for purposes of 

making 2 semi-annual allotments— 

‘‘(A) $3,000,000,000 for the period beginning 

on October 1, 2012, and ending on March 31, 

2013, and 

‘‘(B) $3,000,000,000 for the period beginning 

on April 1, 2013, and ending on September 30, 

2013.’’. 

SEC. 102. ALLOTMENTS FOR STATES AND TERRITORIES FOR FISCAL YEARS 2009 

THROUGH 2013. 

Section 2104 (42 U.S.C. 1397dd) is amended— 

(1) in subsection (b)(1), by striking ‘‘subsection (d)’’ and inserting ‘‘subsections (d) 

and (m)’’; 

(2) in subsection (c)(1), by striking ‘‘subsection (d)’’ and inserting ‘‘subsections (d) 

and (m)(4)’’; and 

(3) by adding at the end the following new 

subsection: 

‘‘(m) ALLOTMENTS FOR FISCAL YEARS 2009 

THROUGH 2013.— 

‘‘(1) FOR FISCAL YEAR 2009.— 

‘‘(A) FOR THE 50 STATES AND THE DISTRICT

OF COLUMBIA.—Subject to the succeeding provisions of this paragraph and paragraph (4), 

the Secretary shall allot for fiscal year 2009 

from the amount made available under subsection (a)(12), to each of the 50 States and 

the District of Columbia 110 percent of the 

highest of the following amounts for such 

State or District: 

‘‘(i) The total Federal payments to the 

State under this title for fiscal year 2008, 

multiplied by the allotment increase factor 

determined under paragraph (5) for fiscal 

year 2009. 

‘‘(ii) The amount allotted to the State for 

fiscal year 2008 under subsection (b), multiplied by the allotment increase factor determined under paragraph (5) for fiscal year 

2009. 

‘‘(iii) The projected total Federal payments to the State under this title for fiscal 

year 2009, as determined on the basis of the 

February 2009 projections certified by the 

State to the Secretary by not later than 

March 31, 2009. 

‘‘(B) FOR THE COMMONWEALTHS AND TERRITORIES.—Subject to the succeeding provisions of this paragraph and paragraph (4), 

the Secretary shall allot for fiscal year 2009 

from the amount made available under subsection (a)(12) to each of the commonwealths 

and territories described in subsection (c)(3) 

an amount equal to the highest amount of 

Federal payments to the commonwealth or 

territory under this title for any fiscal year 

occurring during the period of fiscal years 

1999 through 2008, multiplied by the allotment increase factor determined under paragraph (5) for fiscal year 2009, except that subparagraph (B) thereof shall be applied by 

substituting ‘the United States’ for ‘the 

State’. 

‘‘(C) ADJUSTMENT FOR QUALIFYING

STATES.—In the case of a qualifying State described in paragraph (2) of section 2105(g), 

the Secretary shall permit the State to submit a revised projection described in subparagraph (A)(iii) in order to take into account changes in such projections attributable to the application of paragraph (4) of 

such section. 

‘‘(2) FOR FISCAL YEARS 2010 THROUGH 2012.— 

‘‘(A) IN GENERAL.—Subject to paragraphs 

(4) and (6), from the amount made available 

under paragraphs (13) through (15) of subsection (a) for each of fiscal years 2010 

through 2012, respectively, the Secretary 

shall compute a State allotment for each 

State (including the District of Columbia 

and each commonwealth and territory) for 

each such fiscal year as follows: 

‘‘(i) GROWTH FACTOR UPDATE FOR FISCAL

YEAR 2010.—For fiscal year 2010, the allotment 

of the State is equal to the sum of— 

‘‘(I) the amount of the State allotment 

under paragraph (1) for fiscal year 2009; and 

‘‘(II) the amount of any payments made to 

the State under subsection (k), (l), or (n) for 

fiscal year 2009, 

multiplied by the allotment increase factor 

under paragraph (5) for fiscal year 2010. 

‘‘(ii) REBASING IN FISCAL YEAR 2011.—For fiscal year 2011, the allotment of the State is 

equal to the Federal payments to the State 

that are attributable to (and countable towards) the total amount of allotments available under this section to the State in fiscal 

year 2010 (including payments made to the 

State under subsection (n) for fiscal year 2010 

as well as amounts redistributed to the State 

in fiscal year 2010), multiplied by the allotment increase factor under paragraph (5) for 

fiscal year 2011. 

‘‘(iii) GROWTH FACTOR UPDATE FOR FISCAL

YEAR 2012.—For fiscal year 2012, the allotment 

of the State is equal to the sum of— 

‘‘(I) the amount of the State allotment 

under clause (ii) for fiscal year 2011; and 

‘‘(II) the amount of any payments made to 

the State under subsection (n) for fiscal year 

2011, 

multiplied by the allotment increase factor 

under paragraph (5) for fiscal year 2012. 

‘‘(3) FOR FISCAL YEAR 2013.— 

‘‘(A) FIRST HALF.—Subject to paragraphs 

(4) and (6), from the amount made available 

under subparagraph (A) of paragraph (16) of 

subsection (a) for the semi-annual period described in such paragraph, increased by the 

amount of the appropriation for such period 

under section 108 of the Children’s Health Insurance Program Reauthorization Act of 

2009, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth 

and territory) for such semi-annual period in 

an amount equal to the first half ratio (described in subparagraph (D)) of the amount 

described in subparagraph (C). 

‘‘(B) SECOND HALF.—Subject to paragraphs 

(4) and (6), from the amount made available 

under subparagraph (B) of paragraph (16) of 

subsection (a) for the semi-annual period described in such paragraph, the Secretary 

shall compute a State allotment for each 

State (including the District of Columbia 

and each commonwealth and territory) for 

such semi-annual period in an amount equal 

to the amount made available under such 

subparagraph, multiplied by the ratio of— 

‘‘(i) the amount of the allotment to such 

State under subparagraph (A); to 

‘‘(ii) the total of the amount of all of the 

allotments made available under such subparagraph. 

‘‘(C) FULL YEAR AMOUNT BASED ON REBASED

AMOUNT.—The amount described in this subparagraph for a State is equal to the Federal 

payments to the State that are attributable 

to (and countable towards) the total amount 

of allotments available under this section to 

the State in fiscal year 2012 (including payments made to the State under subsection 

(n) for fiscal year 2012 as well as amounts redistributed to the State in fiscal year 2012), 

multiplied by the allotment increase factor 

under paragraph (5) for fiscal year 2013. 

‘‘(D) FIRST HALF RATIO.—The first half 

ratio described in this subparagraph is the 

ratio of— 

‘‘(i) the sum of— 

‘‘(I) the amount made available under subsection (a)(16)(A); and 

‘‘(II) the amount of the appropriation for 

such period under section 108 of the Children’s Health Insurance Program Reauthorization Act of 2009; to 

‘‘(ii) the sum of the— 

‘‘(I) amount described in clause (i); and 

‘‘(II) the amount made available under subsection (a)(16)(B). 

‘‘(4) PRORATION RULE.—If, after the application of this subsection without regard to this 

paragraph, the sum of the allotments determined under paragraph (1), (2), or (3) for a 

fiscal year (or, in the case of fiscal year 2013, 

for a semi-annual period in such fiscal year) 

exceeds the amount available under subsection (a) for such fiscal year or period, the 

Secretary shall reduce each allotment for 

any State under such paragraph for such fiscal year or period on a proportional basis. 

‘‘(5) ALLOTMENT INCREASE FACTOR.—The allotment increase factor under this paragraph 

for a fiscal year is equal to the product of 

the following: 

‘‘(A) PER CAPITA HEALTH CARE GROWTH FACTOR.—1 plus the percentage increase in the 

projected per capita amount of National 

Health Expenditures from the calendar year 

in which the previous fiscal year ends to the 

calendar year in which the fiscal year involved ends, as most recently published by 

the Secretary before the beginning of the fiscal year. 

‘‘(B) CHILD POPULATION GROWTH FACTOR.—1 

plus the percentage increase (if any) in the 

population of children in the State from July 

1 in the previous fiscal year to July 1 in the 

fiscal year involved, as determined by the 

Secretary based on the most recent published estimates of the Bureau of the Census 

before the beginning of the fiscal year involved, plus 1 percentage point. 

‘‘(6) INCREASE IN ALLOTMENT TO ACCOUNT

FOR APPROVED PROGRAM EXPANSIONS.—In the 

case of one of the 50 States or the District of 

Columbia that— 

‘‘(A) has submitted to the Secretary, and 

has approved by the Secretary, a State plan 

amendment or waiver request relating to an 

expansion of eligibility for children or benefits under this title that becomes effective 

for a fiscal year (beginning with fiscal year 

2010 and ending with fiscal year 2013); and 

‘‘(B) has submitted to the Secretary, before 

the August 31 preceding the beginning of the 

fiscal year, a request for an expansion allotment adjustment under this paragraph for 

such fiscal year that specifies— 

‘‘(i) the additional expenditures that are 

attributable to the eligibility or benefit expansion provided under the amendment or 

waiver described in subparagraph (A), as certified by the State and submitted to the Secretary by not later than August 31 preceding 

the beginning of the fiscal year; and 

‘‘(ii) the extent to which such additional 

expenditures are projected to exceed the allotment of the State or District for the year, 

subject to paragraph (4), the amount of the 

allotment of the State or District under this 

subsection for such fiscal year shall be increased by the excess amount described in 

subparagraph (B)(i). A State or District may 

only obtain an increase under this paragraph 

for an allotment for fiscal year 2010 or fiscal 

year 2012. 

‘‘(7) AVAILABILITY OF AMOUNTS FOR SEMI-ANNUAL PERIODS IN FISCAL YEAR 2013.—Each 

semi-annual allotment made under paragraph (3) for a period in fiscal year 2013 shall 


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January 14, 2009 CONGRESSIONAL RECORD — HOUSE H219 

remain available for expenditure under this 

title for periods after the end of such fiscal 

year in the same manner as if the allotment 

had been made available for the entire fiscal 

year.’’. 

SEC. 103. CHILD ENROLLMENT CONTINGENCY 

FUND. 

Section 2104 (42 U.S.C. 1397dd), as amended 

by section 102, is amended by adding at the 

end the following new subsection: 

‘‘(n) CHILD ENROLLMENT CONTINGENCY

FUND.— 

‘‘(1) ESTABLISHMENT.—There is hereby established in the Treasury of the United 

States a fund which shall be known as the 

‘Child Enrollment Contingency Fund’ (in 

this subsection referred to as the ‘Fund’). 

Amounts in the Fund shall be available without further appropriations for payments 

under this subsection. 

‘‘(2) DEPOSITS INTO FUND.— 

‘‘(A) INITIAL AND SUBSEQUENT APPROPRIATIONS.—Subject to subparagraphs (B) and 

(D), out of any money in the Treasury of the 

United States not otherwise appropriated, 

there are appropriated to the Fund— 

‘‘(i) for fiscal year 2009, an amount equal to 

20 percent of the amount made available 

under paragraph (12) of subsection (a) for the 

fiscal year; and 

‘‘(ii) for each of fiscal years 2010 through 

2012 (and for each of the semi-annual allotment periods for fiscal year 2013), such sums 

as are necessary for making payments to eligible States for such fiscal year or period, 

but not in excess of the aggregate cap described in subparagraph (B). 

‘‘(B) AGGREGATE CAP.—The total amount 

available for payment from the Fund for 

each of fiscal years 2010 through 2012 (and for 

each of the semi-annual allotment periods 

for fiscal year 2013), taking into account deposits made under subparagraph (C), shall 

not exceed 20 percent of the amount made 

available under subsection (a) for the fiscal 

year or period. 

‘‘(C) INVESTMENT OF FUND.—The Secretary 

of the Treasury shall invest, in interest bearing securities of the United States, such currently available portions of the Fund as are 

not immediately required for payments from 

the Fund. The income derived from these investments constitutes a part of the Fund. 

‘‘(D) AVAILABILITY OF EXCESS FUNDS FOR

PERFORMANCE BONUSES.—Any amounts in excess of the aggregate cap described in subparagraph (B) for a fiscal year or period shall 

be made available for purposes of carrying 

out section 2105(a)(3) for any succeeding fiscal year and the Secretary of the Treasury 

shall reduce the amount in the Fund by the 

amount so made available. 

‘‘(3) CHILD ENROLLMENT CONTINGENCY FUND

PAYMENTS.— 

‘‘(A) IN GENERAL.—If a State’s expenditures 

under this title in fiscal year 2009, fiscal year 

2010, fiscal year 2011, fiscal year 2012, or a 

semi-annual allotment period for fiscal year 

2013, exceed the total amount of allotments 

available under this section to the State in 

the fiscal year or period (determined without 

regard to any redistribution it receives 

under subsection (f) that is available for expenditure during such fiscal year or period, 

but including any carryover from a previous 

fiscal year) and if the average monthly 

unduplicated number of children enrolled 

under the State plan under this title (including children receiving health care coverage 

through funds under this title pursuant to a 

waiver under section 1115) during such fiscal 

year or period exceeds its target average 

number of such enrollees (as determined 

under subparagraph (B)) for that fiscal year 

or period, subject to subparagraph (D), the 

Secretary shall pay to the State from the 

Fund an amount equal to the product of— 

‘‘(i) the amount by which such average 

monthly caseload exceeds such target number of enrollees; and 

‘‘(ii) the projected per capita expenditures 

under the State child health plan (as determined under subparagraph (C) for the fiscal 

year), multiplied by the enhanced FMAP (as 

defined in section 2105(b)) for the State and 

fiscal year involved (or in which the period 

occurs). 

‘‘(B) TARGET AVERAGE NUMBER OF CHILD ENROLLEES.—In this paragraph, the target average number of child enrollees for a State— 

‘‘(i) for fiscal year 2009 is equal to the 

monthly average unduplicated number of 

children enrolled in the State child health 

plan under this title (including such children 

receiving health care coverage through funds 

under this title pursuant to a waiver under 

section 1115) during fiscal year 2008 increased 

by the population growth for children in that 

State for the year ending on June 30, 2007 (as 

estimated by the Bureau of the Census) plus 

1 percentage point; or 

‘‘(ii) for a subsequent fiscal year (or semiannual period occurring in a fiscal year) is 

equal to the target average number of child 

enrollees for the State for the previous fiscal 

year increased by the child population 

growth factor described in subsection 

(m)(5)(B) for the State for the prior fiscal 

year. 

‘‘(C) PROJECTED PER CAPITA EXPENDITURES.—For purposes of subparagraph (A)(ii), 

the projected per capita expenditures under a 

State child health plan— 

‘‘(i) for fiscal year 2009 is equal to the average per capita expenditures (including both 

State and Federal financial participation) 

under such plan for the targeted low-income 

children counted in the average monthly 

caseload for purposes of this paragraph during fiscal year 2008, increased by the annual 

percentage increase in the projected per capita amount of National Health Expenditures 

(as estimated by the Secretary) for 2009; or 

‘‘(ii) for a subsequent fiscal year (or semiannual period occurring in a fiscal year) is 

equal to the projected per capita expenditures under such plan for the previous fiscal 

year (as determined under clause (i) or this 

clause) increased by the annual percentage 

increase in the projected per capita amount 

of National Health Expenditures (as estimated by the Secretary) for the year in 

which such subsequent fiscal year ends. 

‘‘(D) PRORATION RULE.—If the amounts 

available for payment from the Fund for a 

fiscal year or period are less than the total 

amount of payments determined under subparagraph (A) for the fiscal year or period, 

the amount to be paid under such subparagraph to each eligible State shall be reduced 

proportionally. 

‘‘(E) TIMELY PAYMENT; RECONCILIATION.— 

Payment under this paragraph for a fiscal 

year or period shall be made before the end 

of the fiscal year or period based upon the 

most recent data for expenditures and enrollment and the provisions of subsection (e) of 

section 2105 shall apply to payments under 

this subsection in the same manner as they 

apply to payments under such section. 

‘‘(F) CONTINUED REPORTING.—For purposes 

of this paragraph and subsection (f), the 

State shall submit to the Secretary the 

State’s projected Federal expenditures, even 

if the amount of such expenditures exceeds 

the total amount of allotments available to 

the State in such fiscal year or period. 

‘‘(G) APPLICATION TO COMMONWEALTHS AND

TERRITORIES.—No payment shall be made 

under this paragraph to a commonwealth or 

territory described in subsection (c)(3) until 

such time as the Secretary determines that 

there are in effect methods, satisfactory to 

the Secretary, for the collection and reporting of reliable data regarding the enrollment 

of children described in subparagraphs (A) 

and (B) in order to accurately determine the 

commonwealth’s or territory’s eligibility 

for, and amount of payment, under this paragraph.’’. 

SEC. 104. CHIP PERFORMANCE BONUS PAYMENT 

TO OFFSET ADDITIONAL ENROLLMENT COSTS RESULTING FROM ENROLLMENT AND RETENTION EFFORTS. 

Section 2105(a) (42 U.S.C. 1397ee(a)) is 

amended by adding at the end the following 

new paragraphs: 

‘‘(3) PERFORMANCE BONUS PAYMENT TO OFFSET ADDITIONAL MEDICAID AND CHIP CHILD ENROLLMENT COSTS RESULTING FROM ENROLLMENT AND RETENTION EFFORTS.— 

‘‘(A) IN GENERAL.—In addition to the payments made under paragraph (1), for each fiscal year (beginning with fiscal year 2009 and 

ending with fiscal year 2013), the Secretary 

shall pay from amounts made available 

under subparagraph (E), to each State that 

meets the condition under paragraph (4) for 

the fiscal year, an amount equal to the 

amount described in subparagraph (B) for the 

State and fiscal year. The payment under 

this paragraph shall be made, to a State for 

a fiscal year, as a single payment not later 

than the last day of the first calendar quarter of the following fiscal year. 

‘‘(B) AMOUNT FOR ABOVE BASELINE MEDICAID

CHILD ENROLLMENT COSTS.—Subject to subparagraph (E), the amount described in this 

subparagraph for a State for a fiscal year is 

equal to the sum of the following amounts: 

‘‘(i) FIRST TIER ABOVE BASELINE MEDICAID

ENROLLEES.—An amount equal to the number 

of first tier above baseline child enrollees (as 

determined under subparagraph (C)(i)) under 

title XIX for the State and fiscal year, multiplied by 15 percent of the projected per capita State Medicaid expenditures (as determined under subparagraph (D)) for the State 

and fiscal year under title XIX. 

‘‘(ii) SECOND TIER ABOVE BASELINE MEDICAID

ENROLLEES.—An amount equal to the number 

of second tier above baseline child enrollees 

(as determined under subparagraph (C)(ii)) 

under title XIX for the State and fiscal year, 

multiplied by 62.5 percent of the projected 

per capita State Medicaid expenditures (as 

determined under subparagraph (D)) for the 

State and fiscal year under title XIX. 

‘‘(C) NUMBER OF FIRST AND SECOND TIER

ABOVE BASELINE CHILD ENROLLEES; BASELINE

NUMBER OF CHILD ENROLLEES.—For purposes 

of this paragraph: 

‘‘(i) FIRST TIER ABOVE BASELINE CHILD ENROLLEES.—The number of first tier above 

baseline child enrollees for a State for a fiscal year under title XIX is equal to the number (if any, as determined by the Secretary) 

by which— 

‘‘(I) the monthly average unduplicated 

number of qualifying children (as defined in 

subparagraph (F)) enrolled during the fiscal 

year under the State plan under title XIX, 

respectively; exceeds 

‘‘(II) the baseline number of enrollees described in clause (iii) for the State and fiscal 

year under title XIX, respectively; 

but not to exceed 10 percent of the baseline 

number of enrollees described in subclause 

(II). 

‘‘(ii) SECOND TIER ABOVE BASELINE CHILD ENROLLEES.—The number of second tier above 

baseline child enrollees for a State for a fiscal year under title XIX is equal to the number (if any, as determined by the Secretary) 

by which— 

‘‘(I) the monthly average unduplicated 

number of qualifying children (as defined in 

subparagraph (F)) enrolled during the fiscal 

year under title XIX as described in clause 

(i)(I); exceeds 

‘‘(II) the sum of the baseline number of 

child enrollees described in clause (iii) for 


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H220 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

the State and fiscal year under title XIX, as 

described in clause (i)(II), and the maximum 

number of first tier above baseline child enrollees for the State and fiscal year under 

title XIX, as determined under clause (i). 

‘‘(iii) BASELINE NUMBER OF CHILD ENROLLEES.—Subject to subparagraph (H), the baseline number of child enrollees for a State 

under title XIX— 

‘‘(I) for fiscal year 2009 is equal to the 

monthly average unduplicated number of 

qualifying children enrolled in the State 

plan under title XIX during fiscal year 2007 

increased by the population growth for children in that State from 2007 to 2008 (as estimated by the Bureau of the Census) plus 4 

percentage points, and further increased by 

the population growth for children in that 

State from 2008 to 2009 (as estimated by the 

Bureau of the Census) plus 4 percentage 

points; 

‘‘(II) for each of fiscal years 2010, 2011, and 

2012, is equal to the baseline number of child 

enrollees for the State for the previous fiscal 

year under title XIX, increased by the population growth for children in that State from 

the calendar year in which the respective fiscal year begins to the succeeding calendar 

year (as estimated by the Bureau of the Census) plus 3.5 percentage points; 

‘‘(III) for each of fiscal years 2013, 2014, and 

2015, is equal to the baseline number of child 

enrollees for the State for the previous fiscal 

year under title XIX, increased by the population growth for children in that State from 

the calendar year in which the respective fiscal year begins to the succeeding calendar 

year (as estimated by the Bureau of the Census) plus 3 percentage points; and 

‘‘(IV) for a subsequent fiscal year is equal 

to the baseline number of child enrollees for 

the State for the previous fiscal year under 

title XIX, increased by the population 

growth for children in that State from the 

calendar year in which the fiscal year involved begins to the succeeding calendar 

year (as estimated by the Bureau of the Census) plus 2 percentage points. 

‘‘(D) PROJECTED PER CAPITA STATE MEDICAID

EXPENDITURES.—For purposes of subparagraph (B), the projected per capita State 

Medicaid expenditures for a State and fiscal 

year under title XIX is equal to the average 

per capita expenditures (including both 

State and Federal financial participation) 

for children under the State plan under such 

title, including under waivers but not including such children eligible for assistance by 

virtue of the receipt of benefits under title 

XVI, for the most recent fiscal year for 

which actual data are available (as determined by the Secretary), increased (for each 

subsequent fiscal year up to and including 

the fiscal year involved) by the annual percentage increase in per capita amount of National Health Expenditures (as estimated by 

the Secretary) for the calendar year in which 

the respective subsequent fiscal year ends 

and multiplied by a State matching percentage equal to 100 percent minus the Federal 

medical assistance percentage (as defined in 

section 1905(b)) for the fiscal year involved. 

‘‘(E) AMOUNTS AVAILABLE FOR PAYMENTS.— 

‘‘(i) INITIAL APPROPRIATION.—Out of any 

money in the Treasury not otherwise appropriated, there are appropriated $3,225,000,000 

for fiscal year 2009 for making payments 

under this paragraph, to be available until 

expended. 

‘‘(ii) TRANSFERS.—Notwithstanding any 

other provision of this title, the following 

amounts shall also be available, without fiscal year limitation, for making payments 

under this paragraph: 

‘‘(I) UNOBLIGATED NATIONAL ALLOTMENT.— 

‘‘(aa) FISCAL YEARS 2009 THROUGH 2012.—As of 

December 31 of fiscal year 2009, and as of December 31 of each succeeding fiscal year 

through fiscal year 2012, the portion, if any, 

of the amount appropriated under subsection 

(a) for such fiscal year that is unobligated 

for allotment to a State under subsection 

(m) for such fiscal year or set aside under 

subsection (a)(3) or (b)(2) of section 2111 for 

such fiscal year. 

‘‘(bb) FIRST HALF OF FISCAL YEAR 2013.—As 

of December 31 of fiscal year 2013, the portion, if any, of the sum of the amounts appropriated under subsection (a)(16)(A) and 

under section 108 of the Children’s Health Insurance Reauthorization Act of 2009 for the 

period beginning on October 1, 2012, and ending on March 31, 2013, that is unobligated for 

allotment to a State under subsection (m) 

for such fiscal year or set aside under subsection (b)(2) of section 2111 for such fiscal 

year. 

‘‘(cc) SECOND HALF OF FISCAL YEAR 2013.—As 

of June 30 of fiscal year 2013, the portion, if 

any, of the amount appropriated under subsection (a)(16)(B) for the period beginning on 

April 1, 2013, and ending on September 30, 

2013, that is unobligated for allotment to a 

State under subsection (m) for such fiscal 

year or set aside under subsection (b)(2) of 

section 2111 for such fiscal year. 

‘‘(II) UNEXPENDED ALLOTMENTS NOT USED

FOR REDISTRIBUTION.—As of November 15 of 

each of fiscal years 2010 through 2013, the 

total amount of allotments made to States 

under section 2104 for the second preceding 

fiscal year (third preceding fiscal year in the 

case of the fiscal year 2006, 2007, and 2008 allotments) that is not expended or redistributed under section 2104(f) during the period 

in which such allotments are available for 

obligation. 

‘‘(III) EXCESS CHILD ENROLLMENT CONTINGENCY FUNDS.—As of October 1 of each of fiscal years 2010 through 2013, any amount in 

excess of the aggregate cap applicable to the 

Child Enrollment Contingency Fund for the 

fiscal year under section 2104(n). 

‘‘(IV) UNEXPENDED TRANSITIONAL COVERAGE

BLOCK GRANT FOR NONPREGNANT CHILDLESS

ADULTS.—As of October 1, 2011, any amounts 

set aside under section 2111(a)(3) that are not 

expended by September 30, 2011. 

‘‘(iii) PROPORTIONAL REDUCTION.—If the 

sum of the amounts otherwise payable under 

this paragraph for a fiscal year exceeds the 

amount available for the fiscal year under 

this subparagraph, the amount to be paid 

under this paragraph to each State shall be 

reduced proportionally. 

‘‘(F) QUALIFYING CHILDREN DEFINED.—For 

purposes of this subsection, the term ‘qualifying children’ means children who meet the 

eligibility criteria (including income, categorical eligibility, age, and immigration 

status criteria) in effect as of July 1, 2008, for 

enrollment under title XIX, taking into account criteria applied as of such date under 

title XIX pursuant to a waiver under section 

1115. Such term does not include any children for whom the State has made an election to provide medical assistance under section 1903(v)(4). 

‘‘(G) APPLICATION TO COMMONWEALTHS AND

TERRITORIES.—The provisions of subparagraph (G) of section 2104(n)(3) shall apply 

with respect to payment under this paragraph in the same manner as such provisions 

apply to payment under such section. 

‘‘(H) APPLICATION TO STATES THAT IMPLEMENT A MEDICAID EXPANSION FOR CHILDREN

AFTER FISCAL YEAR 2008.—In the case of a 

State that provides coverage under section 

115 of the Children’s Health Insurance Program Reauthorization Act of 2009 for any fiscal year after fiscal year 2008— 

‘‘(i) any child enrolled in the State plan 

under title XIX through the application of 

such an election shall be disregarded from 

the determination for the State of the 

monthly average unduplicated number of 

qualifying children enrolled in such plan 

during the first 3 fiscal years in which such 

an election is in effect; and 

‘‘(ii) in determining the baseline number of 

child enrollees for the State for any fiscal 

year subsequent to such first 3 fiscal years, 

the baseline number of child enrollees for 

the State under title XIX for the third of 

such fiscal years shall be the monthly average unduplicated number of qualifying children enrolled in the State plan under title 

XIX for such third fiscal year. 

‘‘(4) ENROLLMENT AND RETENTION PROVISIONS FOR CHILDREN.—For purposes of paragraph (3)(A), a State meets the condition of 

this paragraph for a fiscal year if it is implementing at least 4 of the following enrollment and retention provisions (treating each 

subparagraph as a separate enrollment and 

retention provision) throughout the entire 

fiscal year: 

‘‘(A) CONTINUOUS ELIGIBILITY.—The State 

has elected the option of continuous eligibility for a full 12 months for all children described in section 1902(e)(12) under title XIX 

under 19 years of age, as well as applying 

such policy under its State child health plan 

under this title. 

‘‘(B) LIBERALIZATION OF ASSET REQUIREMENTS.—The State meets the requirement 

specified in either of the following clauses: 

‘‘(i) ELIMINATION OF ASSET TEST.—The 

State does not apply any asset or resource 

test for eligibility for children under title 

XIX or this title. 

‘‘(ii) ADMINISTRATIVE VERIFICATION OF ASSETS.—The State— 

‘‘(I) permits a parent or caretaker relative 

who is applying on behalf of a child for medical assistance under title XIX or child 

health assistance under this title to declare 

and certify by signature under penalty of 

perjury information relating to family assets 

for purposes of determining and redetermining financial eligibility; and 

‘‘(II) takes steps to verify assets through 

means other than by requiring documentation from parents and applicants except in 

individual cases of discrepancies or where 

otherwise justified. 

‘‘(C) ELIMINATION OF IN-PERSON INTERVIEW

REQUIREMENT.—The State does not require an 

application of a child for medical assistance 

under title XIX (or for child health assistance under this title), including an application for renewal of such assistance, to be 

made in person nor does the State require a 

face-to-face interview, unless there are discrepancies or individual circumstances justifying an in-person application or face-to-face 

interview. 

‘‘(D) USE OF JOINT APPLICATION FOR MEDICAID AND CHIP.—The application form and 

supplemental forms (if any) and information 

verification process is the same for purposes 

of establishing and renewing eligibility for 

children for medical assistance under title 

XIX and child health assistance under this 

title. 

‘‘(E) AUTOMATIC RENEWAL (USE OF ADMINISTRATIVE RENEWAL).— 

‘‘(i) IN GENERAL.—The State provides, in 

the case of renewal of a child’s eligibility for 

medical assistance under title XIX or child 

health assistance under this title, a preprinted form completed by the State based 

on the information available to the State 

and notice to the parent or caretaker relative of the child that eligibility of the child 

will be renewed and continued based on such 

information unless the State is provided 

other information. Nothing in this clause 

shall be construed as preventing a State 

from verifying, through electronic and other 

means, the information so provided. 

‘‘(ii) SATISFACTION THROUGH DEMONSTRATED

USE OF EX PARTE PROCESS.—A State shall be 

treated as satisfying the requirement of 


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January 14, 2009 CONGRESSIONAL RECORD — HOUSE H221 

clause (i) if renewal of eligibility of children 

under title XIX or this title is determined 

without any requirement for an in-person 

interview, unless sufficient information is 

not in the State’s possession and cannot be 

acquired from other sources (including other 

State agencies) without the participation of 

the applicant or the applicant’s parent or 

caretaker relative. 

‘‘(F) PRESUMPTIVE ELIGIBILITY FOR CHILDREN.—The State is implementing section 

1920A under title XIX as well as, pursuant to 

section 2107(e)(1), under this title. 

‘‘(G) EXPRESS LANE.—The State is implementing the option described in section 

1902(e)(13) under title XIX as well as, pursuant to section 2107(e)(1), under this title.’’. 

SEC. 105. TWO-YEAR INITIAL AVAILABILITY OF 

CHIP ALLOTMENTS. 

Section 2104(e) (42 U.S.C. 1397dd(e)) is 

amended to read as follows: 

‘‘(e) AVAILABILITY OF AMOUNTS ALLOTTED.— 

‘‘(1) IN GENERAL.—Except as provided in 

paragraph (2), amounts allotted to a State 

pursuant to this section— 

‘‘(A) for each of fiscal years 1998 through 

2008, shall remain available for expenditure 

by the State through the end of the second 

succeeding fiscal year; and 

‘‘(B) for fiscal year 2009 and each fiscal 

year thereafter, shall remain available for 

expenditure by the State through the end of 

the succeeding fiscal year. 

‘‘(2) AVAILABILITY OF AMOUNTS REDISTRIBUTED.—Amounts redistributed to a State 

under subsection (f) shall be available for expenditure by the State through the end of 

the fiscal year in which they are redistributed.’’. 

SEC. 106. REDISTRIBUTION OF UNUSED ALLOTMENTS. 

(a) BEGINNING WITH FISCAL YEAR 2007.— 

(1) IN GENERAL.—Section 2104(f) (42 U.S.C. 

1397dd(f)) is amended— 

(A) by striking ‘‘The Secretary’’ and inserting the following: 

‘‘(1) IN GENERAL.—The Secretary’’; 

(B) by striking ‘‘States that have fully expended the amount of their allotments under 

this section.’’ and inserting ‘‘States that the 

Secretary determines with respect to the fiscal year for which unused allotments are 

available for redistribution under this subsection, are shortfall States described in 

paragraph (2) for such fiscal year, but not to 

exceed the amount of the shortfall described 

in paragraph (2)(A) for each such State (as 

may be adjusted under paragraph (2)(C)).’’; 

and 

(C) by adding at the end the following new 

paragraph: 

‘‘(2) SHORTFALL STATES DESCRIBED.— 

‘‘(A) IN GENERAL.—For purposes of paragraph (1), with respect to a fiscal year, a 

shortfall State described in this subparagraph is a State with a State child health 

plan approved under this title for which the 

Secretary estimates on the basis of the most 

recent data available to the Secretary, that 

the projected expenditures under such plan 

for the State for the fiscal year will exceed 

the sum of— 

‘‘(i) the amount of the State’s allotments 

for any preceding fiscal years that remains 

available for expenditure and that will not 

be expended by the end of the immediately 

preceding fiscal year; 

‘‘(ii) the amount (if any) of the child enrollment contingency fund payment under 

subsection (n); and 

‘‘(iii) the amount of the State’s allotment 

for the fiscal year. 

‘‘(B) PRORATION RULE.—If the amounts 

available for redistribution under paragraph 

(1) for a fiscal year are less than the total 

amounts of the estimated shortfalls determined for the year under subparagraph (A), 

the amount to be redistributed under such 

paragraph for each shortfall State shall be 

reduced proportionally. 

‘‘(C) RETROSPECTIVE ADJUSTMENT.—The 

Secretary may adjust the estimates and determinations made under paragraph (1) and 

this paragraph with respect to a fiscal year 

as necessary on the basis of the amounts reported by States not later than November 30 

of the succeeding fiscal year, as approved by 

the Secretary.’’. 

(2) EFFECTIVE DATE.—The amendments 

made by paragraph (1) shall apply to redistribution of allotments made for fiscal year 

2007 and subsequent fiscal years. 

(b) REDISTRIBUTION OF UNUSED ALLOTMENTS

FOR FISCAL YEAR 2006.—Section 2104(k) (42 

U.S.C. 1397dd(k)) is amended— 

(1) in the subsection heading, by striking 

‘‘THE FIRST 2 QUARTERS OF’’; 

(2) in paragraph (1), by striking ‘‘the first 

2 quarters of’’; and 

(3) in paragraph (6)— 

(A) by striking ‘‘the first 2 quarters of’’; 

and 

(B) by striking ‘‘March 31’’ and inserting 

‘‘September 30’’. 

SEC. 107. OPTION FOR QUALIFYING STATES TO 

RECEIVE THE ENHANCED PORTION 

OF THE CHIP MATCHING RATE FOR 

MEDICAID COVERAGE OF CERTAIN 

CHILDREN. 

(a) IN GENERAL.—Section 2105(g) (42 U.S.C. 

1397ee(g)) is amended— 

(1) in paragraph (1)(A), as amended by section 201(b)(1) of Public Law 110–173— 

(A) by inserting ‘‘subject to paragraph (4),’’ 

after ‘‘Notwithstanding any other provision 

of law,’’; and 

(B) by striking ‘‘2008, or 2009’’ and inserting 

‘‘or 2008’’; and 

(2) by adding at the end the following new 

paragraph: 

‘‘(4) OPTION FOR ALLOTMENTS FOR FISCAL

YEARS 2009 THROUGH 2013.— 

‘‘(A) PAYMENT OF ENHANCED PORTION OF

MATCHING RATE FOR CERTAIN EXPENDITURES.— 

In the case of expenditures described in subparagraph (B), a qualifying State (as defined 

in paragraph (2)) may elect to be paid from 

the State’s allotment made under section 

2104 for any of fiscal years 2009 through 2013 

(insofar as the allotment is available to the 

State under subsections (e) and (m) of such 

section) an amount each quarter equal to the 

additional amount that would have been paid 

to the State under title XIX with respect to 

such expenditures if the enhanced FMAP (as 

determined under subsection (b)) had been 

substituted for the Federal medical assistance percentage (as defined in section 

1905(b)). 

‘‘(B) EXPENDITURES DESCRIBED.—For purposes of subparagraph (A), the expenditures 

described in this subparagraph are expenditures made after the date of the enactment 

of this paragraph and during the period in 

which funds are available to the qualifying 

State for use under subparagraph (A), for the 

provision of medical assistance to individuals residing in the State who are eligible for 

medical assistance under the State plan 

under title XIX or under a waiver of such 

plan and who have not attained age 19 (or, if 

a State has so elected under the State plan 

under title XIX, age 20 or 21), and whose family income equals or exceeds 133 percent of 

the poverty line but does not exceed the 

Medicaid applicable income level.’’. 

(b) REPEAL OF LIMITATION ON AVAILABILITY

OF FISCAL YEAR 2009 ALLOTMENTS.—Paragraph (2) of section 201(b) of the Medicare, 

Medicaid, and SCHIP Extension Act of 2007 

(Public Law 110–173) is repealed. 

SEC. 108. ONE-TIME APPROPRIATION. 

There is appropriated to the Secretary, out 

of any money in the Treasury not otherwise 

appropriated, $11,406,000,000 to accompany 

the allotment made for the period beginning 

on October 1, 2012, and ending on March 31, 

2013, under section 2104(a)(16)(A) of the Social 

Security Act (42 U.S.C. 1397dd(a)(16)(A)) (as 

added by section 101), to remain available 

until expended. Such amount shall be used to 

provide allotments to States under paragraph (3) of section 2104(m) of the Social Security Act (42 U.S.C. 1397dd(i)), as added by 

section 102, for the first 6 months of fiscal 

year 2013 in the same manner as allotments 

are provided under subsection (a)(16)(A) of 

such section 2104 and subject to the same 

terms and conditions as apply to the allotments provided from such subsection 

(a)(16)(A). 

SEC. 109. IMPROVING FUNDING FOR THE TERRITORIES UNDER CHIP AND MEDICAID. 

(a) REMOVAL OF FEDERAL MATCHING PAYMENTS FOR DATA REPORTING SYSTEMS FROM

THE OVERALL LIMIT ON PAYMENTS TO TERRITORIES UNDER TITLE XIX.—Section 1108(g) (42 

U.S.C. 1308(g)) is amended by adding at the 

end the following new paragraph: 

‘‘(4) EXCLUSION OF CERTAIN EXPENDITURES

FROM PAYMENT LIMITS.—With respect to fiscal years beginning with fiscal year 2009, if 

Puerto Rico, the Virgin Islands, Guam, the 

Northern Mariana Islands, or American 

Samoa qualify for a payment under subparagraph (A)(i), (B), or (F) of section 1903(a)(3) 

for a calendar quarter of such fiscal year, the 

payment shall not be taken into account in 

applying subsection (f) (as increased in accordance with paragraphs (1), (2), and (3) of 

this subsection) to such commonwealth or 

territory for such fiscal year.’’. 

(b) GAO STUDY AND REPORT.—Not later 

than September 30, 2010, the Comptroller 

General of the United States shall submit a 

report to the Committee on Finance of the 

Senate and the Committee on Energy and 

Commerce of the House of Representatives 

regarding Federal funding under Medicaid 

and CHIP for Puerto Rico, the United States 

Virgin Islands, Guam, American Samoa, and 

the Northern Mariana Islands. The report 

shall include the following: 

(1) An analysis of all relevant factors with 

respect to— 

(A) eligible Medicaid and CHIP populations 

in such commonwealths and territories; 

(B) historical and projected spending needs 

of such commonwealths and territories and 

the ability of capped funding streams to respond to those spending needs; 

(C) the extent to which Federal poverty 

guidelines are used by such commonwealths 

and territories to determine Medicaid and 

CHIP eligibility; and 

(D) the extent to which such commonwealths and territories participate in data 

collection and reporting related to Medicaid 

and CHIP, including an analysis of territory 

participation in the Current Population Survey versus the American Community Survey. 

(2) Recommendations regarding methods 

for the collection and reporting of reliable 

data regarding the enrollment under Medicaid and CHIP of children in such commonwealths and territories. 

(3) Recommendations for improving Federal funding under Medicaid and CHIP for 

such commonwealths and territories. 

Subtitle B—Focus on Low-Income Children 

and Pregnant Women 

SEC. 111. STATE OPTION TO COVER LOW-INCOME 

PREGNANT WOMEN UNDER CHIP 

THROUGH A STATE PLAN AMENDMENT. 

(a) IN GENERAL.—Title XXI (42 U.S.C. 

1397aa et seq.), as amended by section 112(a), 

is amended by adding at the end the following new section: 


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H222 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

‘‘SEC. 2112. OPTIONAL COVERAGE OF TARGETED 

LOW-INCOME PREGNANT WOMEN 

THROUGH A STATE PLAN AMENDMENT. 

‘‘(a) IN GENERAL.—Subject to the succeeding provisions of this section, a State 

may elect through an amendment to its 

State child health plan under section 2102 to 

provide pregnancy-related assistance under 

such plan for targeted low-income pregnant 

women. 

‘‘(b) CONDITIONS.—A State may only elect 

the option under subsection (a) if the following conditions are satisfied: 

‘‘(1) MINIMUM INCOME ELIGIBILITY LEVELS

FOR PREGNANT WOMEN AND CHILDREN.—The 

State has established an income eligibility 

level— 

‘‘(A) for pregnant women under subsection 

(a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) 

of section 1902 that is at least 185 percent (or 

such higher percent as the State has in effect 

with regard to pregnant women under this 

title) of the poverty line applicable to a family of the size involved, but in no case lower 

than the percent in effect under any such 

subsection as of July 1, 2008; and 

‘‘(B) for children under 19 years of age 

under this title (or title XIX) that is at least 

200 percent of the poverty line applicable to 

a family of the size involved. 

‘‘(2) NO CHIP INCOME ELIGIBILITY LEVEL FOR

PREGNANT WOMEN LOWER THAN THE STATE’S

MEDICAID LEVEL.—The State does not apply 

an effective income level for pregnant 

women under the State plan amendment 

that is lower than the effective income level 

(expressed as a percent of the poverty line 

and considering applicable income disregards) specified under subsection 

(a)(10)(A)(i)(III), (a)(10)(A)(i)(IV), or (l)(1)(A) 

of section 1902, on the date of enactment of 

this paragraph to be eligible for medical assistance as a pregnant woman. 

‘‘(3) NO COVERAGE FOR HIGHER INCOME PREGNANT WOMEN WITHOUT COVERING LOWER INCOME PREGNANT WOMEN.—The State does not 

provide coverage for pregnant women with 

higher family income without covering pregnant women with a lower family income. 

‘‘(4) APPLICATION OF REQUIREMENTS FOR

COVERAGE OF TARGETED LOW-INCOME CHILDREN.—The State provides pregnancy-related 

assistance for targeted low-income pregnant 

women in the same manner, and subject to 

the same requirements, as the State provides 

child health assistance for targeted low-income children under the State child health 

plan, and in addition to providing child 

health assistance for such women. 

‘‘(5) NO PREEXISTING CONDITION EXCLUSION

OR WAITING PERIOD.—The State does not 

apply any exclusion of benefits for pregnancy-related assistance based on any preexisting condition or any waiting period (including any waiting period imposed to carry 

out section 2102(b)(3)(C)) for receipt of such 

assistance. 

‘‘(6) APPLICATION OF COST-SHARING PROTECTION.—The State provides pregnancy-related 

assistance to a targeted low-income woman 

consistent with the cost-sharing protections 

under section 2103(e) and applies the limitation on total annual aggregate cost sharing 

imposed under paragraph (3)(B) of such section to the family of such a woman. 

‘‘(7) NO WAITING LIST FOR CHILDREN.—The 

State does not impose, with respect to the 

enrollment under the State child health plan 

of targeted low-income children during the 

quarter, any enrollment cap or other numerical limitation on enrollment, any waiting 

list, any procedures designed to delay the 

consideration of applications for enrollment, 

or similar limitation with respect to enrollment. 

‘‘(c) OPTION TO PROVIDE PRESUMPTIVE ELIGIBILITY.—A State that elects the option 

under subsection (a) and satisfies the conditions described in subsection (b) may elect to 

apply section 1920 (relating to presumptive 

eligibility for pregnant women) to the State 

child health plan in the same manner as such 

section applies to the State plan under title 

XIX. 

‘‘(d) DEFINITIONS.—For purposes of this section: 

‘‘(1) PREGNANCY-RELATED ASSISTANCE.—The 

term ‘pregnancy-related assistance’ has the 

meaning given the term ‘child health assistance’ in section 2110(a) with respect to an individual during the period described in paragraph (2)(A). 

‘‘(2) TARGETED LOW-INCOME PREGNANT

WOMAN.—The term ‘targeted low-income 

pregnant woman’ means an individual— 

‘‘(A) during pregnancy and through the end 

of the month in which the 60-day period (beginning on the last day of her pregnancy) 

ends; 

‘‘(B) whose family income exceeds 185 percent (or, if higher, the percent applied under 

subsection (b)(1)(A)) of the poverty line applicable to a family of the size involved, but 

does not exceed the income eligibility level 

established under the State child health plan 

under this title for a targeted low-income 

child; and 

‘‘(C) who satisfies the requirements of 

paragraphs (1)(A), (1)(C), (2), and (3) of section 2110(b) in the same manner as a child 

applying for child health assistance would 

have to satisfy such requirements. 

‘‘(e) AUTOMATIC ENROLLMENT FOR CHILDREN

BORN TO WOMEN RECEIVING PREGNANCY-RELATED ASSISTANCE.—If a child is born to a 

targeted low-income pregnant woman who 

was receiving pregnancy-related assistance 

under this section on the date of the child’s 

birth, the child shall be deemed to have applied for child health assistance under the 

State child health plan and to have been 

found eligible for such assistance under such 

plan or to have applied for medical assistance under title XIX and to have been found 

eligible for such assistance under such title, 

as appropriate, on the date of such birth and 

to remain eligible for such assistance until 

the child attains 1 year of age. During the 

period in which a child is deemed under the 

preceding sentence to be eligible for child 

health or medical assistance, the child 

health or medical assistance eligibility identification number of the mother shall also 

serve as the identification number of the 

child, and all claims shall be submitted and 

paid under such number (unless the State 

issues a separate identification number for 

the child before such period expires). 

‘‘(f) STATES PROVIDING ASSISTANCE

THROUGH OTHER OPTIONS.— 

‘‘(1) CONTINUATION OF OTHER OPTIONS FOR

PROVIDING ASSISTANCE.—The option to provide assistance in accordance with the preceding subsections of this section shall not 

limit any other option for a State to provide— 

‘‘(A) child health assistance through the 

application of sections 457.10, 457.350(b)(2), 

457.622(c)(5), and 457.626(a)(3) of title 42, Code 

of Federal Regulations (as in effect after the 

final rule adopted by the Secretary and set 

forth at 67 Fed. Reg. 61956–61974 (October 2, 

2002)), or 

‘‘(B) pregnancy-related services through 

the application of any waiver authority (as 

in effect on June 1, 2008). 

‘‘(2) CLARIFICATION OF AUTHORITY TO PROVIDE POSTPARTUM SERVICES.—Any State that 

provides child health assistance under any 

authority described in paragraph (1) may 

continue to provide such assistance, as well 

as postpartum services, through the end of 

the month in which the 60-day period (beginning on the last day of the pregnancy) ends, 

in the same manner as such assistance and 

postpartum services would be provided if 

provided under the State plan under title 

XIX, but only if the mother would otherwise 

satisfy the eligibility requirements that 

apply under the State child health plan 

(other than with respect to age) during such 

period. 

‘‘(3) NO INFERENCE.—Nothing in this subsection shall be construed— 

‘‘(A) to infer congressional intent regarding the legality or illegality of the content 

of the sections specified in paragraph (1)(A); 

or 

‘‘(B) to modify the authority to provide 

pregnancy-related services under a waiver 

specified in paragraph (1)(B).’’. 

(b) ADDITIONAL CONFORMING AMENDMENTS.— 

(1) NO COST SHARING FOR PREGNANCY-RELATED BENEFITS.—Section 2103(e)(2) (42 U.S.C. 

1397cc(e)(2)) is amended— 

(A) in the heading, by inserting ‘‘or pregnancy-related assistance’’ after ‘‘preventive 

services’’; and 

(B) by inserting before the period at the 

end the following: ‘‘or for pregnancy-related 

assistance’’. 

(2) NO WAITING PERIOD.—Section 

2102(b)(1)(B) (42 U.S.C. 1397bb(b)(1)(B)) is 

amended— 

(A) in clause (i), by striking ‘‘, and’’ at the 

end and inserting a semicolon; 

(B) in clause (ii), by striking the period at 

the end and inserting ‘‘; and’’; and 

(C) by adding at the end the following new 

clause: 

‘‘(iii) may not apply a waiting period (including a waiting period to carry out paragraph (3)(C)) in the case of a targeted low-income pregnant woman provided pregnancyrelated assistance under section 2112.’’. 

SEC. 112. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS ADULTS 

UNDER CHIP; CONDITIONS FOR COVERAGE OF PARENTS. 

(a) PHASE-OUT RULES.— 

(1) IN GENERAL.—Title XXI (42 U.S.C. 1397aa 

et seq.) is amended by adding at the end the 

following new section: 

‘‘SEC. 2111. PHASE-OUT OF COVERAGE FOR NONPREGNANT CHILDLESS ADULTS; 

CONDITIONS FOR COVERAGE OF 

PARENTS. 

‘‘(a) TERMINATION OF COVERAGE FOR NONPREGNANT CHILDLESS ADULTS.— 

‘‘(1) NO NEW CHIP WAIVERS; AUTOMATIC EXTENSIONS AT STATE OPTION THROUGH FISCAL

YEAR 2010.—Notwithstanding section 1115 or 

any other provision of this title, except as 

provided in this subsection— 

‘‘(A) the Secretary shall not on or after the 

date of the enactment of the Children’s 

Health Insurance Program Reauthorization 

Act of 2009, approve or renew a waiver, experimental, pilot, or demonstration project that 

would allow funds made available under this 

title to be used to provide child health assistance or other health benefits coverage to 

a nonpregnant childless adult; and 

‘‘(B) notwithstanding the terms and conditions of an applicable existing waiver, the 

provisions of paragraphs (2) and (3) shall 

apply for purposes of any period beginning 

on or after October 1, 2010, in determining 

the period to which the waiver applies, the 

individuals eligible to be covered by the 

waiver, and the amount of the Federal payment under this title. 

‘‘(2) TERMINATION OF CHIP COVERAGE UNDER

APPLICABLE EXISTING WAIVERS AT THE END OF

FISCAL YEAR 2010.— 

‘‘(A) IN GENERAL.—No funds shall be available under this title for child health assistance or other health benefits coverage that 

is provided to a nonpregnant childless adult 

under an applicable existing waiver after 

September 30, 2010. 

‘‘(B) EXTENSION UPON STATE REQUEST.—If 

an applicable existing waiver described in 


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January 14, 2009 CONGRESSIONAL RECORD — HOUSE H223 

subparagraph (A) would otherwise expire before October 1, 2010, and the State requests 

an extension of such waiver, the Secretary 

shall grant such an extension, but only 

through September 30, 2011. 

‘‘(C) APPLICATION OF ENHANCED FMAP.—The 

enhanced FMAP determined under section 

2105(b) shall apply to expenditures under an 

applicable existing waiver for the provision 

of child health assistance or other health 

benefits coverage to a nonpregnant childless 

adult during fiscal year 2010. 

‘‘(3) OPTIONAL 1-YEAR TRANSITIONAL COVERAGE BLOCK GRANT FUNDED FROM STATE ALLOTMENT.—Subject to paragraph (4)(B), each 

State for which coverage under an applicable 

existing waiver is terminated under paragraph (2)(A) may elect to provide nonpregnant childless adults who were provided 

child health assistance or health benefits 

coverage under the applicable existing waiver at any time during fiscal year 2010 with 

such assistance or coverage during fiscal 

year 2011, as if the authority to provide such 

assistance or coverage under an applicable 

existing waiver was extended through that 

fiscal year, but subject to the following 

terms and conditions: 

‘‘(A) BLOCK GRANT SET ASIDE FROM STATE

ALLOTMENT.—The Secretary shall set aside 

for the State an amount equal to the Federal 

share of the State’s projected expenditures 

under the applicable existing waiver for providing child health assistance or health benefits coverage to all nonpregnant childless 

adults under such waiver for fiscal year 2010 

(as certified by the State and submitted to 

the Secretary by not later than August 31, 

2010, and without regard to whether any such 

individual lost coverage during fiscal year 

2010 and was later provided child health assistance or other health benefits coverage 

under the waiver in that fiscal year), increased by the annual adjustment for fiscal 

year 2011 determined under section 

2104(m)(5)(A). The Secretary may adjust the 

amount set aside under the preceding sentence, as necessary, on the basis of the expenditure data for fiscal year 2010 reported 

by States on CMS Form 64 or CMS Form 21 

not later than November 30, 2010, but in no 

case shall the Secretary adjust such amount 

after December 31, 2010. 

‘‘(B) NO COVERAGE FOR NONPREGNANT CHILDLESS ADULTS WHO WERE NOT COVERED DURING

FISCAL YEAR 2010.— 

‘‘(i) FMAP APPLIED TO EXPENDITURES.—The 

Secretary shall pay the State for each quarter of fiscal year 2011, from the amount set 

aside under subparagraph (A), an amount 

equal to the Federal medical assistance percentage (as determined under section 1905(b) 

without regard to clause (4) of such section) 

of expenditures in the quarter for providing 

child health assistance or other health benefits coverage to a nonpregnant childless 

adult but only if such adult was enrolled in 

the State program under this title during fiscal year 2010 (without regard to whether the 

individual lost coverage during fiscal year 

2010 and was reenrolled in that fiscal year or 

in fiscal year 2011). 

‘‘(ii) FEDERAL PAYMENTS LIMITED TO

AMOUNT OF BLOCK GRANT SET-ASIDE.—No payments shall be made to a State for expenditures described in this subparagraph after 

the total amount set aside under subparagraph (A) for fiscal year 2011 has been paid to 

the State. 

‘‘(4) STATE OPTION TO APPLY FOR MEDICAID

WAIVER TO CONTINUE COVERAGE FOR NONPREGNANT CHILDLESS ADULTS.— 

‘‘(A) IN GENERAL.—Each State for which 

coverage under an applicable existing waiver 

is terminated under paragraph (2)(A) may 

submit, not later than June 30, 2011, an application to the Secretary for a waiver under 

section 1115 of the State plan under title XIX 

to provide medical assistance to a nonpregnant childless adult whose coverage is so terminated (in this subsection referred to as a 

‘Medicaid nonpregnant childless adults waiver’). 

‘‘(B) DEADLINE FOR APPROVAL.—The Secretary shall make a decision to approve or 

deny an application for a Medicaid nonpregnant childless adults waiver submitted under 

subparagraph (A) within 90 days of the date 

of the submission of the application. If no decision has been made by the Secretary as of 

September 30, 2011, on the application of a 

State for a Medicaid nonpregnant childless 

adults waiver that was submitted to the Secretary by June 30, 2011, the application shall 

be deemed approved. 

‘‘(C) STANDARD FOR BUDGET NEUTRALITY.— 

The budget neutrality requirement applicable with respect to expenditures for medical 

assistance under a Medicaid nonpregnant 

childless adults waiver shall— 

‘‘(i) in the case of fiscal year 2012, allow expenditures for medical assistance under title 

XIX for all such adults to not exceed the 

total amount of payments made to the State 

under paragraph (3)(B) for fiscal year 2011, 

increased by the percentage increase (if any) 

in the projected nominal per capita amount 

of National Health Expenditures for calendar 

year 2012 over 2011, as most recently published by the Secretary; and 

‘‘(ii) in the case of any succeeding fiscal 

year, allow such expenditures to not exceed 

the amount in effect under this subparagraph for the preceding fiscal year, increased 

by the percentage increase (if any) in the 

projected nominal per capita amount of National Health Expenditures for the calendar 

year that begins during the fiscal year involved over the preceding calendar year, as 

most recently published by the Secretary. 

‘‘(b) RULES AND CONDITIONS FOR COVERAGE

OF PARENTS OF TARGETED LOW-INCOME CHILDREN.— 

‘‘(1) TWO-YEAR TRANSITION PERIOD; AUTOMATIC EXTENSION AT STATE OPTION THROUGH

FISCAL YEAR 2011.— 

‘‘(A) NO NEW CHIP WAIVERS.—Notwithstanding section 1115 or any other provision 

of this title, except as provided in this subsection— 

‘‘(i) the Secretary shall not on or after the 

date of the enactment of the Children’s 

Health Insurance Program Reauthorization 

Act of 2009 approve or renew a waiver, experimental, pilot, or demonstration project that 

would allow funds made available under this 

title to be used to provide child health assistance or other health benefits coverage to 

a parent of a targeted low-income child; and 

‘‘(ii) notwithstanding the terms and conditions of an applicable existing waiver, the 

provisions of paragraphs (2) and (3) shall 

apply for purposes of any fiscal year beginning on or after October 1, 2011, in determining the period to which the waiver applies, the individuals eligible to be covered 

by the waiver, and the amount of the Federal 

payment under this title. 

‘‘(B) EXTENSION UPON STATE REQUEST.—If 

an applicable existing waiver described in 

subparagraph (A) would otherwise expire before October 1, 2011, and the State requests 

an extension of such waiver, the Secretary 

shall grant such an extension, but only, subject to paragraph (2)(A), through September 

30, 2011. 

‘‘(C) APPLICATION OF ENHANCED FMAP.—The 

enhanced FMAP determined under section 

2105(b) shall apply to expenditures under an 

applicable existing waiver for the provision 

of child health assistance or other health 

benefits coverage to a parent of a targeted 

low-income child during the third and fourth 

quarters of fiscal year 2009 and during fiscal 

years 2010 and 2011. 

‘‘(2) RULES FOR FISCAL YEARS 2012 THROUGH

2013.— 

‘‘(A) PAYMENTS FOR COVERAGE LIMITED TO

BLOCK GRANT FUNDED FROM STATE ALLOTMENT.—Any State that provides child health 

assistance or health benefits coverage under 

an applicable existing waiver for a parent of 

a targeted low-income child may elect to 

continue to provide such assistance or coverage through fiscal year 2012 or 2013, subject 

to the same terms and conditions that applied under the applicable existing waiver, 

unless otherwise modified in subparagraph 

(B). 

‘‘(B) TERMS AND CONDITIONS.— 

‘‘(i) BLOCK GRANT SET ASIDE FROM STATE ALLOTMENT.—If the State makes an election 

under subparagraph (A), the Secretary shall 

set aside for the State for each such fiscal 

year an amount equal to the Federal share of 

110 percent of the State’s projected expenditures under the applicable existing waiver 

for providing child health assistance or 

health benefits coverage to all parents of 

targeted low-income children enrolled under 

such waiver for the fiscal year (as certified 

by the State and submitted to the Secretary 

by not later than August 31 of the preceding 

fiscal year). In the case of fiscal year 2013, 

the set aside for any State shall be computed 

separately for each period described in subparagraphs (A) and (B) of section 2104(a)(16) 

and any reduction in the allotment for either 

such period under section 2104(m)(4) shall be 

allocated on a pro rata basis to such set 

aside. 

‘‘(ii) PAYMENTS FROM BLOCK GRANT.—The 

Secretary shall pay the State from the 

amount set aside under clause (i) for the fiscal year, an amount for each quarter of such 

fiscal year equal to the applicable percentage determined under clause (iii) or (iv) for 

expenditures in the quarter for providing 

child health assistance or other health benefits coverage to a parent of a targeted lowincome child. 

‘‘(iii) ENHANCED FMAP ONLY IN FISCAL YEAR

2012 FOR STATES WITH SIGNIFICANT CHILD OUTREACH OR THAT ACHIEVE CHILD COVERAGE

BENCHMARKS; FMAP FOR ANY OTHER STATES.— 

For purposes of clause (ii), the applicable 

percentage for any quarter of fiscal year 2012 

is equal to— 

‘‘(I) the enhanced FMAP determined under 

section 2105(b) in the case of a State that 

meets the outreach or coverage benchmarks 

described in any of subparagraph (A), (B), or 

(C) of paragraph (3) for fiscal year 2011; or 

‘‘(II) the Federal medical assistance percentage (as determined under section 1905(b) 

without regard to clause (4) of such section) 

in the case of any other State. 

‘‘(iv) AMOUNT OF FEDERAL MATCHING PAYMENT IN 2013.—For purposes of clause (ii), the 

applicable percentage for any quarter of fiscal year 2013 is equal to— 

‘‘(I) the REMAP percentage if— 

‘‘(aa) the applicable percentage for the 

State under clause (iii) was the enhanced 

FMAP for fiscal year 2012; and 

‘‘(bb) the State met either of the coverage 

benchmarks described in subparagraph (B) or 

(C) of paragraph (3) for 2012; or 

‘‘(II) the Federal medical assistance percentage (as so determined) in the case of any 

State to which subclause (I) does not apply. 

For purposes of subclause (I), the REMAP 

percentage is the percentage which is the 

sum of such Federal medical assistance percentage and a number of percentage points 

equal to one-half of the difference between 

such Federal medical assistance percentage 

and such enhanced FMAP. 

‘‘(v) NO FEDERAL PAYMENTS OTHER THAN

FROM BLOCK GRANT SET ASIDE.—No payments 

shall be made to a State for expenditures described in clause (ii) after the total amount 


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H224 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

set aside under clause (i) for a fiscal year has 

been paid to the State. 

‘‘(vi) NO INCREASE IN INCOME ELIGIBILITY

LEVEL FOR PARENTS.—No payments shall be 

made to a State from the amount set aside 

under clause (i) for a fiscal year for expenditures for providing child health assistance or 

health benefits coverage to a parent of a targeted low-income child whose family income 

exceeds the income eligibility level applied 

under the applicable existing waiver to parents of targeted low-income children on the 

date of enactment of the Children’s Health 

Insurance Program Reauthorization Act of 

2009. 

‘‘(3) OUTREACH OR COVERAGE BENCHMARKS.— 

For purposes of paragraph (2), the outreach 

or coverage benchmarks described in this 

paragraph are as follows: 

‘‘(A) SIGNIFICANT CHILD OUTREACH CAMPAIGN.—The State— 

‘‘(i) was awarded a grant under section 2113 

for fiscal year 2011; 

‘‘(ii) implemented 1 or more of the enrollment and retention provisions described in 

section 2105(a)(4) for such fiscal year; or 

‘‘(iii) has submitted a specific plan for outreach for such fiscal year. 

‘‘(B) HIGH-PERFORMING STATE.—The State, 

on the basis of the most timely and accurate 

published estimates of the Bureau of the 

Census, ranks in the lowest 1⁄3 of States in 

terms of the State’s percentage of low-income children without health insurance. 

‘‘(C) STATE INCREASING ENROLLMENT OF

LOW-INCOME CHILDREN.—The State qualified 

for a performance bonus payment under section 2105(a)(3)(B) for the most recent fiscal 

year applicable under such section. 

‘‘(4) RULES OF CONSTRUCTION.—Nothing in 

this subsection shall be construed as prohibiting a State from submitting an application 

to the Secretary for a waiver under section 

1115 of the State plan under title XIX to provide medical assistance to a parent of a targeted low-income child that was provided 

child health assistance or health benefits 

coverage under an applicable existing waiver. 

‘‘(c) APPLICABLE EXISTING WAIVER.—For 

purposes of this section— 

‘‘(1) IN GENERAL.—The term ‘applicable existing waiver’ means a waiver, experimental, 

pilot, or demonstration project under section 

1115, grandfathered under section 6102(c)(3) of 

the Deficit Reduction Act of 2005, or otherwise conducted under authority that— 

‘‘(A) would allow funds made available 

under this title to be used to provide child 

health assistance or other health benefits 

coverage to— 

‘‘(i) a parent of a targeted low-income 

child; 

‘‘(ii) a nonpregnant childless adult; or 

‘‘(iii) individuals described in both clauses 

(i) and (ii); and 

‘‘(B) was in effect during fiscal year 2009. 

‘‘(2) DEFINITIONS.— 

‘‘(A) PARENT.—The term ‘parent’ includes a 

caretaker relative (as such term is used in 

carrying out section 1931) and a legal guardian. 

‘‘(B) NONPREGNANT CHILDLESS ADULT.—The 

term ‘nonpregnant childless adult’ has the 

meaning given such term by section 2107(f).’’. 

(2) CONFORMING AMENDMENTS.— 

(A) Section 2107(f) (42 U.S.C. 1397gg(f)) is 

amended— 

(i) by striking ‘‘, the Secretary’’ and inserting ‘‘: 

‘‘(1) The Secretary’’; 

(ii) in the first sentence, by inserting ‘‘or a 

parent (as defined in section 2111(c)(2)(A)), 

who is not pregnant, of a targeted low-income child’’ before the period; 

(iii) by striking the second sentence; and 

(iv) by adding at the end the following new 

paragraph: 

‘‘(2) The Secretary may not approve, extend, renew, or amend a waiver, experimental, pilot, or demonstration project with 

respect to a State after the date of enactment of the Children’s Health Insurance Program Reauthorization Act of 2009 that would 

waive or modify the requirements of section 

2111.’’. 

(B) Section 6102(c) of the Deficit Reduction 

Act of 2005 (Public Law 109–171; 120 Stat. 131) 

is amended by striking ‘‘Nothing’’ and inserting ‘‘Subject to section 2111 of the Social 

Security Act, as added by section 112 of the 

Children’s Health Insurance Program Reauthorization Act of 2009, nothing’’. 

(b) GAO STUDY AND REPORT.— 

(1) IN GENERAL.—The Comptroller General 

of the United States shall conduct a study of 

whether— 

(A) the coverage of a parent, a caretaker 

relative (as such term is used in carrying out 

section 1931), or a legal guardian of a targeted low-income child under a State health 

plan under title XXI of the Social Security 

Act increases the enrollment of, or the quality of care for, children, and 

(B) such parents, relatives, and legal 

guardians who enroll in such a plan are more 

likely to enroll their children in such a plan 

or in a State plan under title XIX of such 

Act. 

(2) REPORT.—Not later than 2 years after 

the date of the enactment of this Act, the 

Comptroller General shall report the results 

of the study to the Committee on Finance of 

the Senate and the Committee on Energy 

and Commerce of the House of Representatives, including recommendations (if any) for 

changes in legislation. 

SEC. 113. ELIMINATION OF COUNTING MEDICAID 

CHILD PRESUMPTIVE ELIGIBILITY 

COSTS AGAINST TITLE XXI ALLOTMENT. 

(a) IN GENERAL.—Section 2105(a)(1) (42 

U.S.C. 1397ee(a)(1)) is amended— 

(1) in the matter preceding subparagraph 

(A), by striking ‘‘(or, in the case of expenditures described in subparagraph (B), the Federal medical assistance percentage (as defined in the first sentence of section 

1905(b)))’’; and 

(2) by striking subparagraph (B) and inserting the following new subparagraph: 

‘‘(B) [reserved]’’. 

(b) AMENDMENTS TO MEDICAID.— 

(1) ELIGIBILITY OF A NEWBORN.—Section 

1902(e)(4) (42 U.S.C. 1396a(e)(4)) is amended in 

the first sentence by striking ‘‘so long as the 

child is a member of the woman’s household 

and the woman remains (or would remain if 

pregnant) eligible for such assistance’’. 

(2) APPLICATION OF QUALIFIED ENTITIES TO

PRESUMPTIVE ELIGIBILITY FOR PREGNANT

WOMEN UNDER MEDICAID.—Section 1920(b) (42 

U.S.C. 1396r–1(b)) is amended by adding after 

paragraph (2) the following flush sentence: 

‘‘The term ‘qualified provider’ also includes 

a qualified entity, as defined in section 

1920A(b)(3).’’. 

SEC. 114. LIMITATION ON MATCHING RATE FOR 

STATES THAT PROPOSE TO COVER 

CHILDREN WITH EFFECTIVE FAMILY 

INCOME THAT EXCEEDS 300 PERCENT OF THE POVERTY LINE. 

(a) FMAP APPLIED TO EXPENDITURES.—Section 2105(c) (42 U.S.C. 1397ee(c)) is amended 

by adding at the end the following new paragraph: 

‘‘(8) LIMITATION ON MATCHING RATE FOR EXPENDITURES FOR CHILD HEALTH ASSISTANCE

PROVIDED TO CHILDREN WHOSE EFFECTIVE FAMILY INCOME EXCEEDS 300 PERCENT OF THE POVERTY LINE.— 

‘‘(A) FMAP APPLIED TO EXPENDITURES.—Except as provided in subparagraph (B), for fiscal years beginning with fiscal year 2009, the 

Federal medical assistance percentage (as 

determined under section 1905(b) without regard to clause (4) of such section) shall be 

substituted for the enhanced FMAP under 

subsection (a)(1) with respect to any expenditures for providing child health assistance or 

health benefits coverage for a targeted lowincome child whose effective family income 

would exceed 300 percent of the poverty line 

but for the application of a general exclusion 

of a block of income that is not determined 

by type of expense or type of income. 

‘‘(B) EXCEPTION.—Subparagraph (A) shall 

not apply to any State that, on the date of 

enactment of the Children’s Health Insurance Program Reauthorization Act of 2009, 

has an approved State plan amendment or 

waiver to provide, or has enacted a State law 

to submit a State plan amendment to provide, expenditures described in such subparagraph under the State child health plan.’’. 

(b) RULE OF CONSTRUCTION.—Nothing in the 

amendments made by this section shall be 

construed as— 

(1) changing any income eligibility level 

for children under title XXI of the Social Security Act; or 

(2) changing the flexibility provided States 

under such title to establish the income eligibility level for targeted low-income children under a State child health plan and the 

methodologies used by the State to determine income or assets under such plan. 

SEC. 115. STATE AUTHORITY UNDER MEDICAID. 

Notwithstanding any other provision of 

law, including the fourth sentence of subsection (b) of section 1905 of the Social Security Act (42 U.S.C. 1396d) or subsection (u) of 

such section, at State option, the Secretary 

shall provide the State with the Federal 

medical assistance percentage determined 

for the State for Medicaid with respect to expenditures described in section 1905(u)(2)(A) 

of such Act or otherwise made to provide 

medical assistance under Medicaid to a child 

who could be covered by the State under 

CHIP. 

TITLE II—OUTREACH AND ENROLLMENT 

Subtitle A—Outreach and Enrollment 

Activities 

SEC. 201. GRANTS AND ENHANCED ADMINISTRATIVE FUNDING FOR OUTREACH AND 

ENROLLMENT. 

(a) GRANTS.—Title XXI (42 U.S.C. 1397aa et 

seq.), as amended by section 111, is amended 

by adding at the end the following: 

‘‘SEC. 2113. GRANTS TO IMPROVE OUTREACH AND 

ENROLLMENT. 

‘‘(a) OUTREACH AND ENROLLMENT GRANTS; 

NATIONAL CAMPAIGN.— 

‘‘(1) IN GENERAL.—From the amounts appropriated under subsection (g), subject to 

paragraph (2), the Secretary shall award 

grants to eligible entities during the period 

of fiscal years 2009 through 2013 to conduct 

outreach and enrollment efforts that are designed to increase the enrollment and participation of eligible children under this title 

and title XIX. 

‘‘(2) TEN PERCENT SET ASIDE FOR NATIONAL

ENROLLMENT CAMPAIGN.—An amount equal to 

10 percent of such amounts shall be used by 

the Secretary for expenditures during such 

period to carry out a national enrollment 

campaign in accordance with subsection (h). 

‘‘(b) PRIORITY FOR AWARD OF GRANTS.— 

‘‘(1) IN GENERAL.—In awarding grants under 

subsection (a), the Secretary shall give priority to eligible entities that— 

‘‘(A) propose to target geographic areas 

with high rates of— 

‘‘(i) eligible but unenrolled children, including such children who reside in rural 

areas; or 

‘‘(ii) racial and ethnic minorities and 

health disparity populations, including those 

proposals that address cultural and linguistic barriers to enrollment; and 


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‘‘(B) submit the most demonstrable evidence required under paragraphs (1) and (2) 

of subsection (c). 

‘‘(2) TEN PERCENT SET ASIDE FOR OUTREACH

TO INDIAN CHILDREN.—An amount equal to 10 

percent of the funds appropriated under subsection (g) shall be used by the Secretary to 

award grants to Indian Health Service providers and urban Indian organizations receiving funds under title V of the Indian Health 

Care Improvement Act (25 U.S.C. 1651 et seq.) 

for outreach to, and enrollment of, children 

who are Indians. 

‘‘(c) APPLICATION.—An eligible entity that 

desires to receive a grant under subsection 

(a) shall submit an application to the Secretary in such form and manner, and containing such information, as the Secretary 

may decide. Such application shall include— 

‘‘(1) evidence demonstrating that the entity includes members who have access to, and 

credibility with, ethnic or low-income populations in the communities in which activities funded under the grant are to be conducted; 

‘‘(2) evidence demonstrating that the entity has the ability to address barriers to enrollment, such as lack of awareness of eligibility, stigma concerns and punitive fears associated with receipt of benefits, and other 

cultural barriers to applying for and receiving child health assistance or medical assistance; 

‘‘(3) specific quality or outcomes performance measures to evaluate the effectiveness 

of activities funded by a grant awarded 

under this section; and 

‘‘(4) an assurance that the eligible entity 

shall— 

‘‘(A) conduct an assessment of the effectiveness of such activities against the performance measures; 

‘‘(B) cooperate with the collection and reporting of enrollment data and other information in order for the Secretary to conduct 

such assessments; and 

‘‘(C) in the case of an eligible entity that is 

not the State, provide the State with enrollment data and other information as necessary for the State to make necessary projections of eligible children and pregnant 

women. 

‘‘(d) DISSEMINATION OF ENROLLMENT DATA

AND INFORMATION DETERMINED FROM EFFECTIVENESS ASSESSMENTS; ANNUAL REPORT.— 

The Secretary shall— 

‘‘(1) make publicly available the enrollment data and information collected and reported in accordance with subsection 

(c)(4)(B); and 

‘‘(2) submit an annual report to Congress 

on the outreach and enrollment activities 

conducted with funds appropriated under 

this section. 

‘‘(e) MAINTENANCE OF EFFORT FOR STATES

AWARDED GRANTS; NO STATE MATCH REQUIRED.—In the case of a State that is awarded a grant under this section— 

‘‘(1) the State share of funds expended for 

outreach and enrollment activities under the 

State child health plan shall not be less than 

the State share of such funds expended in the 

fiscal year preceding the first fiscal year for 

which the grant is awarded; and 

‘‘(2) no State matching funds shall be required for the State to receive a grant under 

this section. 

‘‘(f) DEFINITIONS.—In this section: 

‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible 

entity’ means any of the following: 

‘‘(A) A State with an approved child health 

plan under this title. 

‘‘(B) A local government. 

‘‘(C) An Indian tribe or tribal consortium, 

a tribal organization, an urban Indian organization receiving funds under title V of the 

Indian Health Care Improvement Act (25 

U.S.C. 1651 et seq.), or an Indian Health Service provider. 

‘‘(D) A Federal health safety net organization. 

‘‘(E) A national, State, local, or community-based public or nonprofit private organization, including organizations that use 

community health workers or communitybased doula programs. 

‘‘(F) A faith-based organization or consortia, to the extent that a grant awarded to 

such an entity is consistent with the requirements of section 1955 of the Public Health 

Service Act (42 U.S.C. 300x–65) relating to a 

grant award to nongovernmental entities. 

‘‘(G) An elementary or secondary school. 

‘‘(2) FEDERAL HEALTH SAFETY NET ORGANIZATION.—The term ‘Federal health safety net 

organization’ means— 

‘‘(A) a Federally-qualified health center (as 

defined in section 1905(l)(2)(B)); 

‘‘(B) a hospital defined as a disproportionate share hospital for purposes of section 

1923; 

‘‘(C) a covered entity described in section 

340B(a)(4) of the Public Health Service Act 

(42 U.S.C. 256b(a)(4)); and 

‘‘(D) any other entity or consortium that 

serves children under a federally funded program, including the special supplemental nutrition program for women, infants, and children (WIC) established under section 17 of 

the Child Nutrition Act of 1966 (42 U.S.C. 

1786), the Head Start and Early Head Start 

programs under the Head Start Act (42 

U.S.C. 9801 et seq.), the school lunch program 

established under the Richard B. Russell National School Lunch Act, and an elementary 

or secondary school. 

‘‘(3) INDIANS; INDIAN TRIBE; TRIBAL ORGANIZATION; URBAN INDIAN ORGANIZATION.—The 

terms ‘Indian’, ‘Indian tribe’, ‘tribal organization’, and ‘urban Indian organization’ have 

the meanings given such terms in section 4 

of the Indian Health Care Improvement Act 

(25 U.S.C. 1603). 

‘‘(4) COMMUNITY HEALTH WORKER.—The 

term ‘community health worker’ means an 

individual who promotes health or nutrition 

within the community in which the individual resides— 

‘‘(A) by serving as a liaison between communities and health care agencies; 

‘‘(B) by providing guidance and social assistance to community residents; 

‘‘(C) by enhancing community residents’ 

ability to effectively communicate with 

health care providers; 

‘‘(D) by providing culturally and linguistically appropriate health or nutrition education; 

‘‘(E) by advocating for individual and community health or nutrition needs; and 

‘‘(F) by providing referral and followup 

services. 

‘‘(g) APPROPRIATION.—There is appropriated, out of any money in the Treasury 

not otherwise appropriated, $100,000,000 for 

the period of fiscal years 2009 through 2013, 

for the purpose of awarding grants under this 

section. Amounts appropriated and paid 

under the authority of this section shall be 

in addition to amounts appropriated under 

section 2104 and paid to States in accordance 

with section 2105, including with respect to 

expenditures for outreach activities in accordance with subsections (a)(1)(D)(iii) and 

(c)(2)(C) of that section. 

‘‘(h) NATIONAL ENROLLMENT CAMPAIGN.— 

From the amounts made available under subsection (a)(2), the Secretary shall develop 

and implement a national enrollment campaign to improve the enrollment of underserved child populations in the programs established under this title and title XIX. Such 

campaign may include— 

‘‘(1) the establishment of partnerships with 

the Secretary of Education and the Secretary of Agriculture to develop national 

campaigns to link the eligibility and enrollment systems for the assistance programs 

each Secretary administers that often serve 

the same children; 

‘‘(2) the integration of information about 

the programs established under this title and 

title XIX in public health awareness campaigns administered by the Secretary; 

‘‘(3) increased financial and technical support for enrollment hotlines maintained by 

the Secretary to ensure that all States participate in such hotlines; 

‘‘(4) the establishment of joint public 

awareness outreach initiatives with the Secretary of Education and the Secretary of 

Labor regarding the importance of health insurance to building strong communities and 

the economy; 

‘‘(5) the development of special outreach 

materials for Native Americans or for individuals with limited English proficiency; and 

‘‘(6) such other outreach initiatives as the 

Secretary determines would increase public 

awareness of the programs under this title 

and title XIX. 

‘‘(i) GRANTS FOR OUTREACH AND ENROLLMENT OF NATIVE AMERICAN BENEFICIARIES.— 

‘‘(1) IN GENERAL.—To overcome language 

and cultural barriers to program access by 

Native Americans, the Secretary shall establish grant programs to conduct outreach and 

enrollment efforts to increase the enrollment and participation of eligible individuals in programs of the Social Security Act 

(42 U.S.C. 1397aa et seq.) and other Federal 

health and social service programs. 

‘‘(2) USE OF TRIBAL BENEFITS-COUNSELORS

MODEL.—The grant program under this subsection shall incorporate expansion and stabilization of the tribal benefits-counselors 

model developed in the State of Washington 

to overcome language and cultural barriers 

to Federal programs. 

‘‘(3) RECIPIENTS.—In order to qualify for a 

grant under this subsection, an applicant 

shall be a national, nonprofit organization 

with successful and verifiable experience in 

assisting Native Americans access Federal 

programs. 

‘‘(4) REPORT.—At the end of the period of 

funding provided under subsection (f), the 

Secretary shall submit to Congress a report 

on the grants made under this subsection, including the efficacy of outreach efforts and 

the cost effectiveness of projects funded by 

such grants in improving access to Federal 

programs by Native Americans.’’. 

(b) ENHANCED ADMINISTRATIVE FUNDING FOR

TRANSLATION OR INTERPRETATION SERVICES

UNDER CHIP AND MEDICAID.— 

(1) CHIP.—Section 2105(a)(1) (42 U.S.C. 

1397ee(a)(1)), as amended by section 113, is 

amended— 

(A) in the matter preceding subparagraph 

(A), by inserting ‘‘(or, in the case of expenditures described in subparagraph (D)(iv), the 

higher of 75 percent or the sum of the enhanced FMAP plus 5 percentage points)’’ 

after ‘‘enhanced FMAP’’; and 

(B) in subparagraph (D)— 

(i) in clause (iii), by striking ‘‘and’’ at the 

end; 

(ii) by redesignating clause (iv) as clause 

(v); and 

(iii) by inserting after clause (iii) the following new clause: 

‘‘(iv) for translation or interpretation services in connection with the enrollment of, retention of, and use of services under this 

title by, individuals for whom English is not 

their primary language (as found necessary 

by the Secretary for the proper and efficient 

administration of the State plan); and’’. 

(2) MEDICAID.— 

(A) USE OF MEDICAID FUNDS.—Section 

1903(a)(2) (42 U.S.C. 1396b(a)(2)) is amended by 


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adding at the end the following new subparagraph: 

‘‘(E) an amount equal to 75 percent of so 

much of the sums expended during such 

quarter (as found necessary by the Secretary 

for the proper and efficient administration of 

the State plan) as are attributable to translation or interpretation services in connection with the enrollment of, retention of, 

and use of services under this title by, children of families for whom English is not the 

primary language; plus’’. 

(B) USE OF COMMUNITY HEALTH WORKERS

FOR OUTREACH ACTIVITIES.— 

(i) IN GENERAL.—Section 2102(c)(1) of such 

Act (42 U.S.C. 1397bb(c)(1)) is amended by inserting ‘‘(through community health workers and others)’’ after ‘‘Outreach’’. 

(ii) IN FEDERAL EVALUATION.—Section 

2108(c)(3)(B) of such Act (42 U.S.C. 

1397hh(c)(3)(B)) is amended by inserting 

‘‘(such as through community health workers and others)’’ after ‘‘including practices’’. 

SEC. 202. INCREASED OUTREACH AND ENROLLMENT OF INDIANS. 

(a) IN GENERAL.—Section 1139 (42 U.S.C. 

1320b–9) is amended to read as follows: 

‘‘SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE FOR INDIANS 

UNDER TITLES XIX AND XXI. 

‘‘(a) AGREEMENTS WITH STATES FOR MEDICAID AND CHIP OUTREACH ON OR NEAR RESERVATIONS TO INCREASE THE ENROLLMENT OF

INDIANS IN THOSE PROGRAMS.— 

‘‘(1) IN GENERAL.—In order to improve the 

access of Indians residing on or near a reservation to obtain benefits under the Medicaid and State children’s health insurance 

programs established under titles XIX and 

XXI, the Secretary shall encourage the State 

to take steps to provide for enrollment on or 

near the reservation. Such steps may include 

outreach efforts such as the outstationing of 

eligibility workers, entering into agreements 

with the Indian Health Service, Indian 

Tribes, Tribal Organizations, and Urban Indian Organizations to provide outreach, education regarding eligibility and benefits, enrollment, and translation services when such 

services are appropriate. 

‘‘(2) CONSTRUCTION.—Nothing in paragraph 

(1) shall be construed as affecting arrangements entered into between States and the 

Indian Health Service, Indian Tribes, Tribal 

Organizations, or Urban Indian Organizations for such Service, Tribes, or Organizations to conduct administrative activities 

under such titles. 

‘‘(b) REQUIREMENT TO FACILITATE COOPERATION.—The Secretary, acting through the 

Centers for Medicare & Medicaid Services, 

shall take such steps as are necessary to facilitate cooperation with, and agreements 

between, States and the Indian Health Service, Indian Tribes, Tribal Organizations, or 

Urban Indian Organizations with respect to 

the provision of health care items and services to Indians under the programs established under title XIX or XXI. 

‘‘(c) DEFINITION OF INDIAN; INDIAN TRIBE; 

INDIAN HEALTH PROGRAM; TRIBAL ORGANIZATION; URBAN INDIAN ORGANIZATION.—In this 

section, the terms ‘Indian’, ‘Indian Tribe’, 

‘Indian Health Program’, ‘Tribal Organization’, and ‘Urban Indian Organization’ have 

the meanings given those terms in section 4 

of the Indian Health Care Improvement 

Act.’’. 

(b) NONAPPLICATION OF 10 PERCENT LIMIT ON

OUTREACH AND CERTAIN OTHER EXPENDITURES.—Section 2105(c)(2) (42 U.S.C. 

1397ee(c)(2)) is amended by adding at the end 

the following: 

‘‘(C) NONAPPLICATION TO CERTAIN EXPENDITURES.—The limitation under subparagraph 

(A) shall not apply with respect to the following expenditures: 

‘‘(i) EXPENDITURES TO INCREASE OUTREACH

TO, AND THE ENROLLMENT OF, INDIAN CHILDREN

UNDER THIS TITLE AND TITLE xix.—Expenditures for outreach activities to families of 

Indian children likely to be eligible for child 

health assistance under the plan or medical 

assistance under the State plan under title 

XIX (or under a waiver of such plan), to inform such families of the availability of, and 

to assist them in enrolling their children in, 

such plans, including such activities conducted under grants, contracts, or agreements entered into under section 1139(a).’’. 

SEC. 203. STATE OPTION TO RELY ON FINDINGS 

FROM AN EXPRESS LANE AGENCY 

TO CONDUCT SIMPLIFIED ELIGIBILITY DETERMINATIONS. 

(a) APPLICATION UNDER MEDICAID AND CHIP 

PROGRAMS.— 

(1) MEDICAID.—Section 1902(e) (42 U.S.C. 

1396a(e)) is amended by adding at the end the 

following: 

‘‘(13) EXPRESS LANE OPTION.— 

‘‘(A) IN GENERAL.— 

‘‘(i) OPTION TO USE A FINDING FROM AN EXPRESS LANE AGENCY.—At the option of the 

State, the State plan may provide that in determining eligibility under this title for a 

child (as defined in subparagraph (G)), the 

State may rely on a finding made within a 

reasonable period (as determined by the 

State) from an Express Lane agency (as defined in subparagraph (F)) when it determines whether a child satisfies one or more 

components of eligibility for medical assistance under this title. The State may rely on 

a finding from an Express Lane agency notwithstanding any differences in budget unit, 

disregard, deeming or other methodology, if 

the following requirements are met: 

‘‘(I) PROHIBITION ON DETERMINING CHILDREN

INELIGIBLE FOR COVERAGE.—If a finding from 

an Express Lane agency would result in a determination that a child does not satisfy an 

eligibility requirement for medical assistance under this title and for child health assistance under title XXI, the State shall determine eligibility for assistance using its 

regular procedures. 

‘‘(II) NOTICE REQUIREMENT.—For any child 

who is found eligible for medical assistance 

under the State plan under this title or child 

health assistance under title XXI and who is 

subject to premiums based on an Express 

Lane agency’s finding of such child’s income 

level, the State shall provide notice that the 

child may qualify for lower premium payments if evaluated by the State using its 

regular policies and of the procedures for requesting such an evaluation. 

‘‘(III) COMPLIANCE WITH SCREEN AND ENROLL

REQUIREMENT.—The State shall satisfy the 

requirements under subparagraphs (A) and 

(B) of section 2102(b)(3) (relating to screen 

and enroll) before enrolling a child in child 

health assistance under title XXI. At its option, the State may fulfill such requirements 

in accordance with either option provided 

under subparagraph (C) of this paragraph. 

‘‘(IV) VERIFICATION OF CITIZENSHIP, NATIONALITY STATUS, OR QUALIFIED ALIEN STATUS.— 

The State shall satisfy the requirements of 

sections 1137(d) and 1902(a)(46)(B) for 

verifications of citizenship, nationality status, or qualified alien status. 

‘‘(V) CODING.—The State meets the requirements of subparagraph (E). 

‘‘(ii) OPTION TO APPLY TO RENEWALS AND REDETERMINATIONS.—The State may apply the 

provisions of this paragraph when conducting initial determinations of eligibility, 

redeterminations of eligibility, or both, as 

described in the State plan. 

‘‘(B) RULES OF CONSTRUCTION.—Nothing in 

this paragraph shall be construed— 

‘‘(i) to relieve a State of the obligation to 

determine components of eligibility that are 

not the subject of an Express Lane agency’s 

finding, as described in subparagraph (A); 

‘‘(ii) to limit or prohibit a State from taking any actions otherwise permitted under 

this title or title XXI in determining eligibility for or enrolling children into medical 

assistance under this title or child health assistance under title XXI; or 

‘‘(iii) to modify the limitations in section 

1902(a)(5) concerning the agencies that may 

make a determination of eligibility for medical assistance under this title. 

‘‘(C) OPTIONS FOR SATISFYING THE SCREEN

AND ENROLL REQUIREMENT.— 

‘‘(i) IN GENERAL.—With respect to a child 

whose eligibility for medical assistance 

under this title or for child health assistance 

under title XXI has been evaluated by a 

State agency using an income finding from 

an Express Lane agency, a State may carry 

out its duties under subparagraphs (A) and 

(B) of section 2102(b)(3) (relating to screen 

and enroll) in accordance with either clause 

(ii) or clause (iii). 

‘‘(ii) ESTABLISHING A SCREENING THRESHOLD.— 

‘‘(I) IN GENERAL.—Under this clause, the 

State establishes a screening threshold set 

as a percentage of the Federal poverty level 

that exceeds the highest income threshold 

applicable under this title to the child by a 

minimum of 30 percentage points or, at State 

option, a higher number of percentage points 

that reflects the value (as determined by the 

State and described in the State plan) of any 

differences between income methodologies 

used by the program administered by the Express Lane agency and the methodologies 

used by the State in determining eligibility 

for medical assistance under this title. 

‘‘(II) CHILDREN WITH INCOME NOT ABOVE

THRESHOLD.—If the income of a child does 

not exceed the screening threshold, the child 

is deemed to satisfy the income eligibility 

criteria for medical assistance under this 

title regardless of whether such child would 

otherwise satisfy such criteria. 

‘‘(III) CHILDREN WITH INCOME ABOVE THRESHOLD.—If the income of a child exceeds the 

screening threshold, the child shall be considered to have an income above the Medicaid applicable income level described in 

section 2110(b)(4) and to satisfy the requirement under section 2110(b)(1)(C) (relating to 

the requirement that CHIP matching funds 

be used only for children not eligible for 

Medicaid). If such a child is enrolled in child 

health assistance under title XXI, the State 

shall provide the parent, guardian, or custodial relative with the following: 

‘‘(aa) Notice that the child may be eligible 

to receive medical assistance under the 

State plan under this title if evaluated for 

such assistance under the State’s regular 

procedures and notice of the process through 

which a parent, guardian, or custodial relative can request that the State evaluate the 

child’s eligibility for medical assistance 

under this title using such regular procedures. 

‘‘(bb) A description of differences between 

the medical assistance provided under this 

title and child health assistance under title 

XXI, including differences in cost-sharing requirements and covered benefits. 

‘‘(iii) TEMPORARY ENROLLMENT IN CHIP

PENDING SCREEN AND ENROLL.— 

‘‘(I) IN GENERAL.—Under this clause, a 

State enrolls a child in child health assistance under title XXI for a temporary period 

if the child appears eligible for such assistance based on an income finding by an Express Lane agency. 

‘‘(II) DETERMINATION OF ELIGIBILITY.—During such temporary enrollment period, the 

State shall determine the child’s eligibility 

for child health assistance under title XXI or 

for medical assistance under this title in accordance with this clause. 


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‘‘(III) PROMPT FOLLOW UP.—In making such 

a determination, the State shall take prompt 

action to determine whether the child should 

be enrolled in medical assistance under this 

title or child health assistance under title 

XXI pursuant to subparagraphs (A) and (B) of 

section 2102(b)(3) (relating to screen and enroll). 

‘‘(IV) REQUIREMENT FOR SIMPLIFIED DETERMINATION.—In making such a determination, 

the State shall use procedures that, to the 

maximum feasible extent, reduce the burden 

imposed on the individual of such determination. Such procedures may not require the 

child’s parent, guardian, or custodial relative to provide or verify information that 

already has been provided to the State agency by an Express Lane agency or another 

source of information unless the State agency has reason to believe the information is 

erroneous. 

‘‘(V) AVAILABILITY OF CHIP MATCHING FUNDS

DURING TEMPORARY ENROLLMENT PERIOD.— 

Medical assistance for items and services 

that are provided to a child enrolled in title 

XXI during a temporary enrollment period 

under this clause shall be treated as child 

health assistance under such title. 

‘‘(D) OPTION FOR AUTOMATIC ENROLLMENT.— 

‘‘(i) IN GENERAL.—The State may initiate 

and determine eligibility for medical assistance under the State Medicaid plan or for 

child health assistance under the State CHIP 

plan without a program application from, or 

on behalf of, the child based on data obtained 

from sources other than the child (or the 

child’s family), but a child can only be automatically enrolled in the State Medicaid 

plan or the State CHIP plan if the child or 

the family affirmatively consents to being 

enrolled through affirmation and signature 

on an Express Lane agency application, if 

the requirement of clause (ii) is met. 

‘‘(ii) INFORMATION REQUIREMENT.—The requirement of this clause is that the State informs the parent, guardian, or custodial relative of the child of the services that will be 

covered, appropriate methods for using such 

services, premium or other cost sharing 

charges (if any) that apply, medical support 

obligations (under section 1912(a)) created by 

enrollment (if applicable), and the actions 

the parent, guardian, or relative must take 

to maintain enrollment and renew coverage. 

‘‘(E) CODING; APPLICATION TO ENROLLMENT

ERROR RATES.— 

‘‘(i) IN GENERAL.—For purposes of subparagraph (A)(iv), the requirement of this subparagraph for a State is that the State 

agrees to— 

‘‘(I) assign such codes as the Secretary 

shall require to the children who are enrolled 

in the State Medicaid plan or the State CHIP 

plan through reliance on a finding made by 

an Express Lane agency for the duration of 

the State’s election under this paragraph; 

‘‘(II) annually provide the Secretary with a 

statistically valid sample (that is approved 

by Secretary) of the children enrolled in 

such plans through reliance on such a finding by conducting a full Medicaid eligibility 

review of the children identified for such 

sample for purposes of determining an eligibility error rate (as described in clause (iv)) 

with respect to the enrollment of such children (and shall not include such children in 

any data or samples used for purposes of 

complying with a Medicaid Eligibility Quality Control (MEQC) review or a payment 

error rate measurement (PERM) requirement); 

‘‘(III) submit the error rate determined 

under subclause (II) to the Secretary; 

‘‘(IV) if such error rate exceeds 3 percent 

for either of the first 2 fiscal years in which 

the State elects to apply this paragraph, 

demonstrate to the satisfaction of the Secretary the specific corrective actions implemented by the State to improve upon such 

error rate; and 

‘‘(V) if such error rate exceeds 3 percent for 

any fiscal year in which the State elects to 

apply this paragraph, a reduction in the 

amount otherwise payable to the State 

under section 1903(a) for quarters for that fiscal year, equal to the total amount of erroneous excess payments determined for the 

fiscal year only with respect to the children 

included in the sample for the fiscal year 

that are in excess of a 3 percent error rate 

with respect to such children. 

‘‘(ii) NO PUNITIVE ACTION BASED ON ERROR

RATE.—The Secretary shall not apply the 

error rate derived from the sample under 

clause (i) to the entire population of children 

enrolled in the State Medicaid plan or the 

State CHIP plan through reliance on a finding made by an Express Lane agency, or to 

the population of children enrolled in such 

plans on the basis of the State’s regular procedures for determining eligibility, or penalize the State on the basis of such error rate 

in any manner other than the reduction of 

payments provided for under clause (i)(V). 

‘‘(iii) RULE OF CONSTRUCTION.—Nothing in 

this paragraph shall be construed as relieving a State that elects to apply this paragraph from being subject to a penalty under 

section 1903(u), for payments made under the 

State Medicaid plan with respect to ineligible individuals and families that are determined to exceed the error rate permitted 

under that section (as determined without 

regard to the error rate determined under 

clause (i)(II)). 

‘‘(iv) ERROR RATE DEFINED.—In this subparagraph, the term ‘error rate’ means the 

rate of erroneous excess payments for medical assistance (as defined in section 

1903(u)(1)(D)) for the period involved, except 

that such payments shall be limited to individuals for which eligibility determinations 

are made under this paragraph and except 

that in applying this paragraph under title 

XXI, there shall be substituted for references 

to provisions of this title corresponding provisions within title XXI. 

‘‘(F) EXPRESS LANE AGENCY.— 

‘‘(i) IN GENERAL.—In this paragraph, the 

term ‘Express Lane agency’ means a public 

agency that— 

‘‘(I) is determined by the State Medicaid 

agency or the State CHIP agency (as applicable) to be capable of making the determinations of one or more eligibility requirements 

described in subparagraph (A)(i); 

‘‘(II) is identified in the State Medicaid 

plan or the State CHIP plan; and 

‘‘(III) notifies the child’s family— 

‘‘(aa) of the information which shall be disclosed in accordance with this paragraph; 

‘‘(bb) that the information disclosed will be 

used solely for purposes of determining eligibility for medical assistance under the State 

Medicaid plan or for child health assistance 

under the State CHIP plan; and 

‘‘(cc) that the family may elect to not have 

the information disclosed for such purposes; 

and 

‘‘(IV) enters into, or is subject to, an interagency agreement to limit the disclosure 

and use of the information disclosed. 

‘‘(ii) INCLUSION OF SPECIFIC PUBLIC AGENCIES.—Such term includes the following: 

‘‘(I) A public agency that determines eligibility for assistance under any of the following: 

‘‘(aa) The temporary assistance for needy 

families program funded under part A of title 

IV. 

‘‘(bb) A State program funded under part D 

of title IV. 

‘‘(cc) The State Medicaid plan. 

‘‘(dd) The State CHIP plan. 

‘‘(ee) The Food and Nutrition Act of 2008 (7 

U.S.C. 2011 et seq.). 

‘‘(ff) The Head Start Act (42 U.S.C. 9801 et 

seq.). 

‘‘(gg) The Richard B. Russell National 

School Lunch Act (42 U.S.C. 1751 et seq.). 

‘‘(hh) The Child Nutrition Act of 1966 (42 

U.S.C. 1771 et seq.). 

‘‘(ii) The Child Care and Development 

Block Grant Act of 1990 (42 U.S.C. 9858 et 

seq.). 

‘‘(jj) The Stewart B. McKinney Homeless 

Assistance Act (42 U.S.C. 11301 et seq.). 

‘‘(kk) The United States Housing Act of 

1937 (42 U.S.C. 1437 et seq.). 

‘‘(ll) The Native American Housing Assistance and Self-Determination Act of 1996 (25 

U.S.C. 4101 et seq.). 

‘‘(II) A State-specified governmental agency that has fiscal liability or legal responsibility for the accuracy of the eligibility determination findings relied on by the State. 

‘‘(III) A public agency that is subject to an 

interagency agreement limiting the disclosure and use of the information disclosed for 

purposes of determining eligibility under the 

State Medicaid plan or the State CHIP plan. 

‘‘(iii) EXCLUSIONS.—Such term does not include an agency that determines eligibility 

for a program established under the Social 

Services Block Grant established under title 

XX or a private, for-profit organization. 

‘‘(iv) RULES OF CONSTRUCTION.—Nothing in 

this paragraph shall be construed as— 

‘‘(I) exempting a State Medicaid agency 

from complying with the requirements of 

section 1902(a)(4) relating to merit-based personnel standards for employees of the State 

Medicaid agency and safeguards against conflicts of interest); or 

‘‘(II) authorizing a State Medicaid agency 

that elects to use Express Lane agencies 

under this subparagraph to use the Express 

Lane option to avoid complying with such 

requirements for purposes of making eligibility determinations under the State Medicaid plan. 

‘‘(v) ADDITIONAL DEFINITIONS.—In this paragraph: 

‘‘(I) STATE.—The term ‘State’ means 1 of 

the 50 States or the District of Columbia. 

‘‘(II) STATE CHIP AGENCY.—The term ‘State 

CHIP agency’ means the State agency responsible for administering the State CHIP 

plan. 

‘‘(III) STATE CHIP PLAN.—The term ‘State 

CHIP plan’ means the State child health 

plan established under title XXI and includes 

any waiver of such plan. 

‘‘(IV) STATE MEDICAID AGENCY.—The term 

‘State Medicaid agency’ means the State 

agency responsible for administering the 

State Medicaid plan. 

‘‘(V) STATE MEDICAID PLAN.—The term 

‘State Medicaid plan’ means the State plan 

established under title XIX and includes any 

waiver of such plan. 

‘‘(G) CHILD DEFINED.—For purposes of this 

paragraph, the term ‘child’ means an individual under 19 years of age, or, at the option 

of a State, such higher age, not to exceed 21 

years of age, as the State may elect. 

‘‘(H) APPLICATION.—This paragraph shall 

not apply to with respect to eligibility determinations made after September 30, 2013.’’. 

(2) CHIP.—Section 2107(e)(1) (42 U.S.C. 

1397gg(e)(1)) is amended by redesignating 

subparagraphs (B), (C), and (D) as subparagraphs (C), (D), and (E), respectively, and by 

inserting after subparagraph (A) the following new subparagraph: 

‘‘(B) Section 1902(e)(13) (relating to the 

State option to rely on findings from an Express Lane agency to help evaluate a child’s 

eligibility for medical assistance).’’. 

(b) EVALUATION AND REPORT.— 

(1) EVALUATION.—The Secretary shall conduct, by grant, contract, or interagency 

agreement, a comprehensive, independent 

evaluation of the option provided under the 


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H228 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

amendments made by subsection (a). Such 

evaluation shall include an analysis of the 

effectiveness of the option, and shall include— 

(A) obtaining a statistically valid sample 

of the children who were enrolled in the 

State Medicaid plan or the State CHIP plan 

through reliance on a finding made by an Express Lane agency and determining the percentage of children who were erroneously enrolled in such plans; 

(B) determining whether enrolling children 

in such plans through reliance on a finding 

made by an Express Lane agency improves 

the ability of a State to identify and enroll 

low-income, uninsured children who are eligible but not enrolled in such plans; 

(C) evaluating the administrative costs or 

savings related to identifying and enrolling 

children in such plans through reliance on 

such findings, and the extent to which such 

costs differ from the costs that the State 

otherwise would have incurred to identify 

and enroll low-income, uninsured children 

who are eligible but not enrolled in such 

plans; and 

(D) any recommendations for legislative or 

administrative changes that would improve 

the effectiveness of enrolling children in 

such plans through reliance on such findings. 

(2) REPORT TO CONGRESS.—Not later than 

September 30, 2012, the Secretary shall submit a report to Congress on the results of the 

evaluation under paragraph (1). 

(3) FUNDING.— 

(A) IN GENERAL.—Out of any funds in the 

Treasury not otherwise appropriated, there 

is appropriated to the Secretary to carry out 

the evaluation under this subsection 

$5,000,000 for the period of fiscal years 2009 

through 2012. 

(B) BUDGET AUTHORITY.—Subparagraph (A) 

constitutes budget authority in advance of 

appropriations Act and represents the obligation of the Federal Government to provide 

for the payment of such amount to conduct 

the evaluation under this subsection. 

(c) ELECTRONIC TRANSMISSION OF INFORMATION.—Section 1902 (42 U.S.C. 1396a) is 

amended by adding at the end the following 

new subsection: 

‘‘(dd) ELECTRONIC TRANSMISSION OF INFORMATION.—If the State agency determining 

eligibility for medical assistance under this 

title or child health assistance under title 

XXI verifies an element of eligibility based 

on information from an Express Lane Agency (as defined in subsection (e)(13)(F)), or 

from another public agency, then the applicant’s signature under penalty of perjury 

shall not be required as to such element. Any 

signature requirement for an application for 

medical assistance may be satisfied through 

an electronic signature, as defined in section 

1710(1) of the Government Paperwork Elimination Act (44 U.S.C. 3504 note). The requirements of subparagraphs (A) and (B) of section 1137(d)(2) may be met through evidence 

in digital or electronic form.’’. 

(d) AUTHORIZATION OF INFORMATION DISCLOSURE.— 

(1) IN GENERAL.—Title XIX is amended by 

adding at the end the following new section: 

‘‘SEC. 1942. AUTHORIZATION TO RECEIVE RELEVANT INFORMATION. 

‘‘(a) IN GENERAL.—Notwithstanding any 

other provision of law, a Federal or State 

agency or private entity in possession of the 

sources of data directly relevant to eligibility determinations under this title (including eligibility files maintained by Express Lane agencies described in section 

1902(e)(13)(F), information described in paragraph (2) or (3) of section 1137(a), vital 

records information about births in any 

State, and information described in sections 

453(i) and 1902(a)(25)(I)) is authorized to convey such data or information to the State 

agency administering the State plan under 

this title, to the extent such conveyance 

meets the requirements of subsection (b). 

‘‘(b) REQUIREMENTS FOR CONVEYANCE.— 

Data or information may be conveyed pursuant to subsection (a) only if the following requirements are met: 

‘‘(1) The individual whose circumstances 

are described in the data or information (or 

such individual’s parent, guardian, caretaker 

relative, or authorized representative) has 

either provided advance consent to disclosure or has not objected to disclosure after 

receiving advance notice of disclosure and a 

reasonable opportunity to object. 

‘‘(2) Such data or information are used 

solely for the purposes of— 

‘‘(A) identifying individuals who are eligible or potentially eligible for medical assistance under this title and enrolling or attempting to enroll such individuals in the 

State plan; and 

‘‘(B) verifying the eligibility of individuals 

for medical assistance under the State plan. 

‘‘(3) An interagency or other agreement, 

consistent with standards developed by the 

Secretary— 

‘‘(A) prevents the unauthorized use, disclosure, or modification of such data and otherwise meets applicable Federal requirements 

safeguarding privacy and data security; and 

‘‘(B) requires the State agency administering the State plan to use the data and 

information obtained under this section to 

seek to enroll individuals in the plan. 

‘‘(c) PENALTIES FOR IMPROPER DISCLOSURE.— 

‘‘(1) CIVIL MONEY PENALTY.—A private entity described in the subsection (a) that publishes, discloses, or makes known in any 

manner, or to any extent not authorized by 

Federal law, any information obtained under 

this section is subject to a civil money penalty in an amount equal to $10,000 for each 

such unauthorized publication or disclosure. 

The provisions of section 1128A (other than 

subsections (a) and (b) and the second sentence of subsection (f)) shall apply to a civil 

money penalty under this paragraph in the 

same manner as such provisions apply to a 

penalty or proceeding under section 1128A(a). 

‘‘(2) CRIMINAL PENALTY.—A private entity 

described in the subsection (a) that willfully 

publishes, discloses, or makes known in any 

manner, or to any extent not authorized by 

Federal law, any information obtained under 

this section shall be fined not more than 

$10,000 or imprisoned not more than 1 year, 

or both, for each such unauthorized publication or disclosure. 

‘‘(d) RULE OF CONSTRUCTION.—The limitations and requirements that apply to disclosure pursuant to this section shall not be 

construed to prohibit the conveyance or disclosure of data or information otherwise permitted under Federal law (without regard to 

this section).’’. 

(2) CONFORMING AMENDMENT TO TITLE XXI.— 

Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)), as 

amended by subsection (a)(2), is amended by 

adding at the end the following new subparagraph: 

‘‘(F) Section 1942 (relating to authorization 

to receive data directly relevant to eligibility determinations).’’. 

(3) CONFORMING AMENDMENT TO PROVIDE ACCESS TO DATA ABOUT ENROLLMENT IN INSURANCE FOR PURPOSES OF EVALUATING APPLICATIONS AND FOR CHIP.—Section 1902(a)(25)(I)(i) 

(42 U.S.C. 1396a(a)(25)(I)(i)) is amended— 

(A) by inserting ‘‘(and, at State option, individuals who apply or whose eligibility for 

medical assistance is being evaluated in accordance with section 1902(e)(13)(D))’’ after 

‘‘with respect to individuals who are eligible’’; and 

(B) by inserting ‘‘under this title (and, at 

State option, child health assistance under 

title XXI)’’ after ‘‘the State plan’’. 

(e) AUTHORIZATION FOR STATES ELECTING

EXPRESS LANE OPTION TO RECEIVE CERTAIN

DATA DIRECTLY RELEVANT TO DETERMINING

ELIGIBILITY AND CORRECT AMOUNT OF ASSISTANCE.—The Secretary shall enter into such 

agreements as are necessary to permit a 

State that elects the Express Lane option 

under section 1902(e)(13) of the Social Security Act to receive data directly relevant to 

eligibility determinations and determining 

the correct amount of benefits under a State 

child health plan under CHIP or a State plan 

under Medicaid from the following: 

(1) The National Directory of New Hires established under section 453(i) of the Social 

Security Act (42 U.S.C. 653(i)). 

(2) Data regarding enrollment in insurance 

that may help to facilitate outreach and enrollment under the State Medicaid plan, the 

State CHIP plan, and such other programs as 

the Secretary may specify. 

(f) EFFECTIVE DATE.—The amendments 

made by this section are effective on the 

date of the enactment of this Act. 

Subtitle B—Reducing Barriers to Enrollment 

SEC. 211. VERIFICATION OF DECLARATION OF 

CITIZENSHIP OR NATIONALITY FOR 

PURPOSES OF ELIGIBILITY FOR 

MEDICAID AND CHIP. 

(a) ALTERNATIVE STATE PROCESS FOR

VERIFICATION OF DECLARATION OF CITIZENSHIP

OR NATIONALITY FOR PURPOSES OF ELIGIBILITY

FOR MEDICAID.— 

(1) ALTERNATIVE TO DOCUMENTATION REQUIREMENT.— 

(A) IN GENERAL.—Section 1902 (42 U.S.C. 

1396a), as amended by section 203(c), is 

amended— 

(i) in subsection (a)(46)— 

(I) by inserting ‘‘(A)’’ after ‘‘(46)’’; 

(II) by adding ‘‘and’’ after the semicolon; 

and 

(III) by adding at the end the following new 

subparagraph: 

‘‘(B) provide, with respect to an individual 

declaring to be a citizen or national of the 

United States for purposes of establishing 

eligibility under this title, that the State 

shall satisfy the requirements of— 

‘‘(i) section 1903(x); or 

‘‘(ii) subsection (ee);’’; and 

(ii) by adding at the end the following new 

subsection: 

‘‘(ee)(1) For purposes of subsection 

(a)(46)(B)(ii), the requirements of this subsection with respect to an individual declaring to be a citizen or national of the United 

States for purposes of establishing eligibility 

under this title, are, in lieu of requiring the 

individual to present satisfactory documentary evidence of citizenship or nationality 

under section 1903(x) (if the individual is not 

described in paragraph (2) of that section), as 

follows: 

‘‘(A) The State submits the name and social security number of the individual to the 

Commissioner of Social Security as part of 

the program established under paragraph (2). 

‘‘(B) If the State receives notice from the 

Commissioner of Social Security that the 

name or social security number, or the declaration of citizenship or nationality, of the 

individual is inconsistent with information 

in the records maintained by the Commissioner— 

‘‘(i) the State makes a reasonable effort to 

identify and address the causes of such inconsistency, including through typographical or other clerical errors, by contacting the individual to confirm the accuracy of the name or social security number 

submitted or declaration of citizenship or 

nationality and by taking such additional 

actions as the Secretary, through regulation 


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or other guidance, or the State may identify, 

and continues to provide the individual with 

medical assistance while making such effort; 

and 

‘‘(ii) in the case such inconsistency is not 

resolved under clause (i), the State— 

‘‘(I) notifies the individual of such fact; 

‘‘(II) provides the individual with a period 

of 90 days from the date on which the notice 

required under subclause (I) is received by 

the individual to either present satisfactory 

documentary evidence of citizenship or nationality (as defined in section 1903(x)(3)) or 

resolve the inconsistency with the Commissioner of Social Security (and continues to 

provide the individual with medical assistance during such 90-day period); and 

‘‘(III) disenrolls the individual from the 

State plan under this title within 30 days 

after the end of such 90-day period if no such 

documentary evidence is presented or if such 

inconsistency is not resolved. 

‘‘(2)(A) Each State electing to satisfy the 

requirements of this subsection for purposes 

of section 1902(a)(46)(B) shall establish a program under which the State submits at least 

monthly to the Commissioner of Social Security for comparison of the name and social 

security number, of each individual newly 

enrolled in the State plan under this title 

that month who is not described in section 

1903(x)(2) and who declares to be a United 

States citizen or national, with information 

in records maintained by the Commissioner. 

‘‘(B) In establishing the State program 

under this paragraph, the State may enter 

into an agreement with the Commissioner of 

Social Security— 

‘‘(i) to provide, through an on-line system 

or otherwise, for the electronic submission 

of, and response to, the information submitted under subparagraph (A) for an individual enrolled in the State plan under this 

title who declares to be citizen or national 

on at least a monthly basis; or 

‘‘(ii) to provide for a determination of the 

consistency of the information submitted 

with the information maintained in the 

records of the Commissioner through such 

other method as agreed to by the State and 

the Commissioner and approved by the Secretary, provided that such method is no 

more burdensome for individuals to comply 

with than any burdens that may apply under 

a method described in clause (i). 

‘‘(C) The program established under this 

paragraph shall provide that, in the case of 

any individual who is required to submit a 

social security number to the State under 

subparagraph (A) and who is unable to provide the State with such number, shall be 

provided with at least the reasonable opportunity to present satisfactory documentary 

evidence of citizenship or nationality (as defined in section 1903(x)(3)) as is provided 

under clauses (i) and (ii) of section 

1137(d)(4)(A) to an individual for the submittal to the State of evidence indicating a 

satisfactory immigration status. 

‘‘(3)(A) The State agency implementing the 

plan approved under this title shall, at such 

times and in such form as the Secretary may 

specify, provide information on the percentage each month that the inconsistent submissions bears to the total submissions made 

for comparison for such month. For purposes 

of this subparagraph, a name, social security 

number, or declaration of citizenship or nationality of an individual shall be treated as 

inconsistent and included in the determination of such percentage only if— 

‘‘(i) the information submitted by the individual is not consistent with information in 

records maintained by the Commissioner of 

Social Security; 

‘‘(ii) the inconsistency is not resolved by 

the State; 

‘‘(iii) the individual was provided with a 

reasonable period of time to resolve the inconsistency with the Commissioner of Social 

Security or provide satisfactory documentation of citizenship status and did not successfully resolve such inconsistency; and 

‘‘(iv) payment has been made for an item 

or service furnished to the individual under 

this title. 

‘‘(B) If, for any fiscal year, the average 

monthly percentage determined under subparagraph (A) is greater than 3 percent— 

‘‘(i) the State shall develop and adopt a 

corrective plan to review its procedures for 

verifying the identities of individuals seeking to enroll in the State plan under this 

title and to identify and implement changes 

in such procedures to improve their accuracy; and 

‘‘(ii) pay to the Secretary an amount equal 

to the amount which bears the same ratio to 

the total payments under the State plan for 

the fiscal year for providing medical assistance to individuals who provided inconsistent information as the number of individuals with inconsistent information in excess 

of 3 percent of such total submitted bears to 

the total number of individuals with inconsistent information. 

‘‘(C) The Secretary may waive, in certain 

limited cases, all or part of the payment 

under subparagraph (B)(ii) if the State is unable to reach the allowable error rate despite 

a good faith effort by such State. 

‘‘(D) Subparagraphs (A) and (B) shall not 

apply to a State for a fiscal year if there is 

an agreement described in paragraph (2)(B) 

in effect as of the close of the fiscal year 

that provides for the submission on a realtime basis of the information described in 

such paragraph. 

‘‘(4) Nothing in this subsection shall affect 

the rights of any individual under this title 

to appeal any disenrollment from a State 

plan.’’. 

(B) COSTS OF IMPLEMENTING AND MAINTAINING SYSTEM.—Section 1903(a)(3) (42 U.S.C. 

1396b(a)(3)) is amended— 

(i) by striking ‘‘plus’’ at the end of subparagraph (E) and inserting ‘‘and’’, and 

(ii) by adding at the end the following new 

subparagraph: 

‘‘(F)(i) 90 percent of the sums expended 

during the quarter as are attributable to the 

design, development, or installation of such 

mechanized verification and information retrieval systems as the Secretary determines 

are necessary to implement section 1902(ee) 

(including a system described in paragraph 

(2)(B) thereof), and 

‘‘(ii) 75 percent of the sums expended during the quarter as are attributable to the operation of systems to which clause (i) applies, plus’’. 

(2) LIMITATION ON WAIVER AUTHORITY.—Notwithstanding any provision of section 1115 of 

the Social Security Act (42 U.S.C. 1315), or 

any other provision of law, the Secretary 

may not waive the requirements of section 

1902(a)(46)(B) of such Act (42 U.S.C. 

1396a(a)(46)(B)) with respect to a State. 

(3) CONFORMING AMENDMENTS.—Section 1903 

(42 U.S.C. 1396b) is amended— 

(A) in subsection (i)(22), by striking ‘‘subsection (x)’’ and inserting ‘‘section 

1902(a)(46)(B)’’; and 

(B) in subsection (x)(1), by striking ‘‘subsection (i)(22)’’ and inserting ‘‘section 

1902(a)(46)(B)(i)’’. 

(4) APPROPRIATION.—Out of any money in 

the Treasury of the United States not otherwise appropriated, there are appropriated to 

the Commissioner of Social Security 

$5,000,000 to remain available until expended 

to carry out the Commissioner’s responsibilities under section 1902(ee) of the Social Security Act, as added by subsection (a). 

(b) CLARIFICATION OF REQUIREMENTS RELATING TO PRESENTATION OF SATISFACTORY DOCUMENTARY EVIDENCE OF CITIZENSHIP OR NATIONALITY.— 

(1) ACCEPTANCE OF DOCUMENTARY EVIDENCE

ISSUED BY A FEDERALLY RECOGNIZED INDIAN

TRIBE.—Section 1903(x)(3)(B) (42 U.S.C. 

1396b(x)(3)(B)) is amended— 

(A) by redesignating clause (v) as clause 

(vi); and 

(B) by inserting after clause (iv), the following new clause: 

‘‘(v)(I) Except as provided in subclause (II), 

a document issued by a federally recognized 

Indian tribe evidencing membership or enrollment in, or affiliation with, such tribe 

(such as a tribal enrollment card or certificate of degree of Indian blood). 

‘‘(II) With respect to those federally recognized Indian tribes located within States 

having an international border whose membership includes individuals who are not citizens of the United States, the Secretary 

shall, after consulting with such tribes, issue 

regulations authorizing the presentation of 

such other forms of documentation (including tribal documentation, if appropriate) 

that the Secretary determines to be satisfactory documentary evidence of citizenship or 

nationality for purposes of satisfying the requirement of this subsection.’’. 

(2) REQUIREMENT TO PROVIDE REASONABLE

OPPORTUNITY TO PRESENT SATISFACTORY DOCUMENTARY EVIDENCE.—Section 1903(x) (42 

U.S.C. 1396b(x)) is amended by adding at the 

end the following new paragraph: 

‘‘(4) In the case of an individual declaring 

to be a citizen or national of the United 

States with respect to whom a State requires 

the presentation of satisfactory documentary evidence of citizenship or nationality 

under section 1902(a)(46)(B)(i), the individual 

shall be provided at least the reasonable opportunity to present satisfactory documentary evidence of citizenship or nationality 

under this subsection as is provided under 

clauses (i) and (ii) of section 1137(d)(4)(A) to 

an individual for the submittal to the State 

of evidence indicating a satisfactory immigration status.’’. 

(3) CHILDREN BORN IN THE UNITED STATES TO

MOTHERS ELIGIBLE FOR MEDICAID.— 

(A) CLARIFICATION OF RULES.—Section 

1903(x) (42 U.S.C. 1396b(x)), as amended by 

paragraph (2), is amended— 

(i) in paragraph (2)— 

(I) in subparagraph (C), by striking ‘‘or’’ at 

the end; 

(II) by redesignating subparagraph (D) as 

subparagraph (E); and 

(III) by inserting after subparagraph (C) 

the following new subparagraph: 

‘‘(D) pursuant to the application of section 

1902(e)(4) (and, in the case of an individual 

who is eligible for medical assistance on 

such basis, the individual shall be deemed to 

have provided satisfactory documentary evidence of citizenship or nationality and shall 

not be required to provide further documentary evidence on any date that occurs during 

or after the period in which the individual is 

eligible for medical assistance on such 

basis); or’’; and 

(ii) by adding at the end the following new 

paragraph: 

‘‘(5) Nothing in subparagraph (A) or (B) of 

section 1902(a)(46), the preceding paragraphs 

of this subsection, or the Deficit Reduction 

Act of 2005, including section 6036 of such 

Act, shall be construed as changing the requirement of section 1902(e)(4) that a child 

born in the United States to an alien mother 

for whom medical assistance for the delivery 

of such child is available as treatment of an 

emergency medical condition pursuant to 

subsection (v) shall be deemed eligible for 

medical assistance during the first year of 

such child’s life.’’. 

(B) STATE REQUIREMENT TO ISSUE SEPARATE

IDENTIFICATION NUMBER.—Section 1902(e)(4) 

(42 U.S.C. 1396a(e)(4)) is amended by adding 


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H230 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

at the end the following new sentence: ‘‘Notwithstanding the preceding sentence, in the 

case of a child who is born in the United 

States to an alien mother for whom medical 

assistance for the delivery of the child is 

made available pursuant to section 1903(v), 

the State immediately shall issue a separate 

identification number for the child upon notification by the facility at which such delivery occurred of the child’s birth.’’. 

(4) TECHNICAL AMENDMENTS.—Section 

1903(x)(2) (42 U.S.C. 1396b(x)) is amended— 

(A) in subparagraph (B)— 

(i) by realigning the left margin of the 

matter preceding clause (i) 2 ems to the left; 

and 

(ii) by realigning the left margins of 

clauses (i) and (ii), respectively, 2 ems to the 

left; and 

(B) in subparagraph (C)— 

(i) by realigning the left margin of the 

matter preceding clause (i) 2 ems to the left; 

and 

(ii) by realigning the left margins of 

clauses (i) and (ii), respectively, 2 ems to the 

left. 

(c) APPLICATION OF DOCUMENTATION SYSTEM

TO CHIP.— 

(1) IN GENERAL.—Section 2105(c) (42 U.S.C. 

1397ee(c)), as amended by section 114(a), is 

amended by adding at the end the following 

new paragraph: 

‘‘(9) CITIZENSHIP DOCUMENTATION REQUIREMENTS.— 

‘‘(A) IN GENERAL.—No payment may be 

made under this section with respect to an 

individual who has, or is, declared to be a 

citizen or national of the United States for 

purposes of establishing eligibility under 

this title unless the State meets the requirements of section 1902(a)(46)(B) with respect 

to the individual. 

‘‘(B) ENHANCED PAYMENTS.—Notwithstanding subsection (b), the enhanced FMAP 

with respect to payments under subsection 

(a) for expenditures described in clause (i) or 

(ii) of section 1903(a)(3)(F) necessary to comply with subparagraph (A) shall in no event 

be less than 90 percent and 75 percent, respectively.’’. 

(2) NONAPPLICATION OF ADMINISTRATIVE EXPENDITURES CAP.—Section 2105(c)(2)(C) (42 

U.S.C. 1397ee(c)(2)(C)), as amended by section 

202(b), is amended by adding at the end the 

following: 

‘‘(ii) EXPENDITURES TO COMPLY WITH CITIZENSHIP OR NATIONALITY VERIFICATION REQUIREMENTS.—Expenditures necessary for the 

State to comply with paragraph (9)(A).’’. 

(d) EFFECTIVE DATE.— 

(1) IN GENERAL.— 

(A) IN GENERAL.—Except as provided in 

subparagraph (B), the amendments made by 

this section shall take effect on October 1, 

2009. 

(B) TECHNICAL AMENDMENTS.—The amendments made by— 

(i) paragraphs (1), (2), and (3) of subsection 

(b) shall take effect as if included in the enactment of section 6036 of the Deficit Reduction Act of 2005 (Public Law 109–171; 120 Stat. 

80); and 

(ii) paragraph (4) of subsection (b) shall 

take effect as if included in the enactment of 

section 405 of division B of the Tax Relief 

and Health Care Act of 2006 (Public Law 109– 

432; 120 Stat. 2996). 

(2) RESTORATION OF ELIGIBILITY.—In the 

case of an individual who, during the period 

that began on July 1, 2006, and ends on October 1, 2009, was determined to be ineligible 

for medical assistance under a State Medicaid plan, including any waiver of such plan, 

solely as a result of the application of subsections (i)(22) and (x) of section 1903 of the 

Social Security Act (as in effect during such 

period), but who would have been determined 

eligible for such assistance if such subsections, as amended by subsection (b), had 

applied to the individual, a State may deem 

the individual to be eligible for such assistance as of the date that the individual was 

determined to be ineligible for such medical 

assistance on such basis. 

(3) SPECIAL TRANSITION RULE FOR INDIANS.— 

During the period that begins on July 1, 2006, 

and ends on the effective date of final regulations issued under subclause (II) of section 

1903(x)(3)(B)(v) of the Social Security Act (42 

U.S.C. 1396b(x)(3)(B)(v)) (as added by subsection (b)(1)(B)), an individual who is a 

member of a federally-recognized Indian 

tribe described in subclause (II) of that section who presents a document described in 

subclause (I) of such section that is issued by 

such Indian tribe, shall be deemed to have 

presented satisfactory evidence of citizenship or nationality for purposes of satisfying 

the requirement of subsection (x) of section 

1903 of such Act. 

SEC. 212. REDUCING ADMINISTRATIVE BARRIERS 

TO ENROLLMENT. 

Section 2102(b) (42 U.S.C. 1397bb(b)) is 

amended— 

(1) by redesignating paragraph (4) as paragraph (5); and 

(2) by inserting after paragraph (3) the following new paragraph: 

‘‘(4) REDUCTION OF ADMINISTRATIVE BARRIERS TO ENROLLMENT.— 

‘‘(A) IN GENERAL.—Subject to subparagraph 

(B), the plan shall include a description of 

the procedures used to reduce administrative 

barriers to the enrollment of children and 

pregnant women who are eligible for medical 

assistance under title XIX or for child health 

assistance or health benefits coverage under 

this title. Such procedures shall be established and revised as often as the State determines appropriate to take into account 

the most recent information available to the 

State identifying such barriers. 

‘‘(B) DEEMED COMPLIANCE IF JOINT APPLICATION AND RENEWAL PROCESS THAT PERMITS APPLICATION OTHER THAN IN PERSON.—A State 

shall be deemed to comply with subparagraph (A) if the State’s application and renewal forms and supplemental forms (if any) 

and information verification process is the 

same for purposes of establishing and renewing eligibility for children and pregnant 

women for medical assistance under title 

XIX and child health assistance under this 

title, and such process does not require an 

application to be made in person or a faceto-face interview.’’. 

SEC. 213. MODEL OF INTERSTATE COORDINATED 

ENROLLMENT AND COVERAGE 

PROCESS. 

(a) IN GENERAL.—In order to assure continuity of coverage of low-income children 

under the Medicaid program and the State 

Children’s Health Insurance Program (CHIP), 

not later than 18 months after the date of 

the enactment of this Act, the Secretary of 

Health and Human Services, in consultation 

with State Medicaid and CHIP directors and 

organizations representing program beneficiaries, shall develop a model process for 

the coordination of the enrollment, retention, and coverage under such programs of 

children who, because of migration of families, emergency evacuations, natural or 

other disasters, public health emergencies, 

educational needs, or otherwise, frequently 

change their State of residency or otherwise 

are temporarily located outside of the State 

of their residency. 

(b) REPORT TO CONGRESS.—After development of such model process, the Secretary of 

Health and Human Services shall submit to 

Congress a report describing additional steps 

or authority needed to make further improvements to coordinate the enrollment, retention, and coverage under CHIP and Medicaid of children described in subsection (a). 

SEC. 214. PERMITTING STATES TO ENSURE COVERAGE WITHOUT A 5-YEAR DELAY 

OF CERTAIN CHILDREN AND PREGNANT WOMEN UNDER THE MEDICAID PROGRAM AND CHIP. 

(a) PURPOSE.—In order to promote the 

health of needy children and pregnant 

women residing lawfully in the United 

States, States should be permitted to waive 

certain restrictions which result in a 5-year 

delay for coverage of necessary health services for such children and women under the 

Medicaid program and CHIP. 

(b) MEDICAID PROGRAM.—Section 1903(v) of 

the Social Security Act (42 U.S.C. 1396b(v)) is 

amended— 

(1) in paragraph (1), by striking ‘‘paragraph 

(2)’’ and inserting ‘‘paragraphs (2) and (4)’’; 

and 

(2) by adding at the end the following new 

paragraph: 

‘‘(4)(A) A State may elect (in a plan 

amendment under this title) to provide, notwithstanding sections 401(a), 402(b), 403, and 

421 of Public Law 104–193, medical assistance 

under a State plan under this title to children and pregnant women who are lawfully 

residing in the United States (including battered individuals described in section 431(c) 

of such Act) and are otherwise eligible for 

such assistance. 

‘‘(B) Such election may be made only with 

respect to either or both of the following categories of individuals: 

‘‘(i) Children. 

‘‘(ii) Pregnant women. 

‘‘(C) In this paragraph: 

‘‘(i) The term ‘pregnant women’ means 

women during pregnancy (and during the 60- 

day period beginning on the last day of the 

pregnancy). 

‘‘(ii) The term ‘children’ means individuals 

under age 19 (or such higher age as the State 

has elected under section 1902(l)(1)(D)), including optional targeted low-income children described in section 1905(u)(2)(B).’’. 

(c) CHIP.—Section 2107(e)(1) of such Act (42 

U.S.C. 1397gg(e)(1)), as amended by section 

203(a)(2) and 203(d)(2), is amended by redesignating subparagraphs (E) and (F) as subparagraphs (F) and (G), respectively and by inserting after subparagraph (D) the following 

new subparagraph: 

‘‘(E) Paragraph (4) of section 1903(v), insofar as it relates to the category of children 

or pregnant women (as such terms are defined in such paragraph), but only if the 

State has elected to apply such paragraph 

with respect to such category of children or 

pregnant women under title XIX and only if, 

in the case of pregnant women, the State has 

elected the option under section 2111 to provide assistance for pregnant women under 

this title.’’. 

(d) CONFORMING AMENDMENT.—Section 

423(d)(1) of Public Law 104–193 is amended by 

inserting before the period the following: 

‘‘and medical or child health assistance furnished under section 1903(v)(4) or 

2107(e)(1)(E), respectively, of the Social Security Act’’. 

(e) EFFECTIVE DATE.—The amendments 

made by this section take effect on the date 

of the enactment of this Act. 

TITLE III—REDUCING BARRIERS TO 

PROVIDING PREMIUM ASSISTANCE 

Subtitle A—Additional State Option for 

Providing Premium Assistance 

SEC. 301. ADDITIONAL STATE OPTION FOR PROVIDING PREMIUM ASSISTANCE. 

(a) CHIP.— 

(1) IN GENERAL.—Section 2105(c) (42 U.S.C. 

1397ee(c)), as amended by sections 114(a) and 

211(c), is amended by adding at the end the 

following: 

‘‘(10) STATE OPTION TO OFFER PREMIUM ASSISTANCE.— 


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‘‘(A) IN GENERAL.—A State may elect to 

offer a premium assistance subsidy (as defined in subparagraph (C)) for qualified employer-sponsored coverage (as defined in subparagraph (B)) to all targeted low-income 

children who are eligible for child health assistance under the plan and have access to 

such coverage in accordance with the requirements of this paragraph. No subsidy 

shall be provided to a targeted low-income 

child under this paragraph unless the child 

(or the child’s parent) voluntarily elects to 

receive such a subsidy. A State may not require such an election as a condition of receipt of child health assistance. 

‘‘(B) QUALIFIED EMPLOYER-SPONSORED COVERAGE.— 

‘‘(i) IN GENERAL.—Subject to clause (ii), in 

this paragraph, the term ‘qualified employer-sponsored coverage’ means a group 

health plan or health insurance coverage offered through an employer— 

‘‘(I) that qualifies as creditable coverage as 

a group health plan under section 2701(c)(1) 

of the Public Health Service Act; 

‘‘(II) for which the employer contribution 

toward any premium for such coverage is at 

least 40 percent; and 

‘‘(III) that is offered to all individuals in a 

manner that would be considered a nondiscriminatory eligibility classification for 

purposes of paragraph (3)(A)(ii) of section 

105(h) of the Internal Revenue Code of 1986 

(but determined without regard to clause (i) 

of subparagraph (B) of such paragraph). 

‘‘(ii) EXCEPTION.—Such term does not include coverage consisting of— 

‘‘(I) benefits provided under a health flexible spending arrangement (as defined in section 106(c)(2) of the Internal Revenue Code of 

1986); or 

‘‘(II) a high deductible health plan (as defined in section 223(c)(2) of such Code), without regard to whether the plan is purchased 

in conjunction with a health savings account 

(as defined under section 223(d) of such Code). 

‘‘(C) PREMIUM ASSISTANCE SUBSIDY.— 

‘‘(i) IN GENERAL.—In this paragraph, the 

term ‘premium assistance subsidy’ means, 

with respect to a targeted low-income child, 

the amount equal to the difference between 

the employee contribution required for enrollment only of the employee under qualified employer-sponsored coverage and the 

employee contribution required for enrollment of the employee and the child in such 

coverage, less any applicable premium costsharing applied under the State child health 

plan (subject to the limitations imposed 

under section 2103(e), including the requirement to count the total amount of the employee contribution required for enrollment 

of the employee and the child in such coverage toward the annual aggregate cost-sharing limit applied under paragraph (3)(B) of 

such section). 

‘‘(ii) STATE PAYMENT OPTION.—A State may 

provide a premium assistance subsidy either 

as reimbursement to an employee for out-ofpocket expenditures or, subject to clause 

(iii), directly to the employee’s employer. 

‘‘(iii) EMPLOYER OPT-OUT.—An employer 

may notify a State that it elects to opt-out 

of being directly paid a premium assistance 

subsidy on behalf of an employee. In the 

event of such a notification, an employer 

shall withhold the total amount of the employee contribution required for enrollment 

of the employee and the child in the qualified employer-sponsored coverage and the 

State shall pay the premium assistance subsidy directly to the employee. 

‘‘(iv) TREATMENT AS CHILD HEALTH ASSISTANCE.—Expenditures for the provision of premium assistance subsidies shall be considered child health assistance described in 

paragraph (1)(C) of subsection (a) for purposes of making payments under that subsection. 

‘‘(D) APPLICATION OF SECONDARY PAYOR

RULES.—The State shall be a secondary 

payor for any items or services provided 

under the qualified employer-sponsored coverage for which the State provides child 

health assistance under the State child 

health plan. 

‘‘(E) REQUIREMENT TO PROVIDE SUPPLEMENTAL COVERAGE FOR BENEFITS AND COSTSHARING PROTECTION PROVIDED UNDER THE

STATE CHILD HEALTH PLAN.— 

‘‘(i) IN GENERAL.—Notwithstanding section 

2110(b)(1)(C), the State shall provide for each 

targeted low-income child enrolled in qualified employer-sponsored coverage, supplemental coverage consisting of— 

‘‘(I) items or services that are not covered, 

or are only partially covered, under the 

qualified employer-sponsored coverage; and 

‘‘(II) cost-sharing protection consistent 

with section 2103(e). 

‘‘(ii) RECORD KEEPING REQUIREMENTS.—For 

purposes of carrying out clause (i), a State 

may elect to directly pay out-of-pocket expenditures for cost-sharing imposed under 

the qualified employer-sponsored coverage 

and collect or not collect all or any portion 

of such expenditures from the parent of the 

child. 

‘‘(F) APPLICATION OF WAITING PERIOD IMPOSED UNDER THE STATE.—Any waiting period 

imposed under the State child health plan 

prior to the provision of child health assistance to a targeted low-income child under 

the State plan shall apply to the same extent 

to the provision of a premium assistance 

subsidy for the child under this paragraph. 

‘‘(G) OPT-OUT PERMITTED FOR ANY MONTH.— 

A State shall establish a process for permitting the parent of a targeted low-income 

child receiving a premium assistance subsidy 

to disenroll the child from the qualified employer-sponsored coverage and enroll the 

child in, and receive child health assistance 

under, the State child health plan, effective 

on the first day of any month for which the 

child is eligible for such assistance and in a 

manner that ensures continuity of coverage 

for the child. 

‘‘(H) APPLICATION TO PARENTS.—If a State 

provides child health assistance or health 

benefits coverage to parents of a targeted 

low-income child in accordance with section 

2111(b), the State may elect to offer a premium assistance subsidy to a parent of a targeted low-income child who is eligible for 

such a subsidy under this paragraph in the 

same manner as the State offers such a subsidy for the enrollment of the child in qualified employer-sponsored coverage, except 

that— 

‘‘(i) the amount of the premium assistance 

subsidy shall be increased to take into account the cost of the enrollment of the parent in the qualified employer-sponsored coverage or, at the option of the State if the 

State determines it cost-effective, the cost 

of the enrollment of the child’s family in 

such coverage; and 

‘‘(ii) any reference in this paragraph to a 

child is deemed to include a reference to the 

parent or, if applicable under clause (i), the 

family of the child. 

‘‘(I) ADDITIONAL STATE OPTION FOR PROVIDING PREMIUM ASSISTANCE.— 

‘‘(i) IN GENERAL.—A State may establish an 

employer-family premium assistance purchasing pool for employers with less than 250 

employees who have at least 1 employee who 

is a pregnant woman eligible for assistance 

under the State child health plan (including 

through the application of an option described in section 2112(f)) or a member of a 

family with at least 1 targeted low-income 

child and to provide a premium assistance 

subsidy under this paragraph for enrollment 

in coverage made available through such 

pool. 

‘‘(ii) ACCESS TO CHOICE OF COVERAGE.—A 

State that elects the option under clause (i) 

shall identify and offer access to not less 

than 2 private health plans that are health 

benefits coverage that is equivalent to the 

benefits coverage in a benchmark benefit 

package described in section 2103(b) or 

benchmark-equivalent coverage that meets 

the requirements of section 2103(a)(2) for employees described in clause (i). 

‘‘(iii) CLARIFICATION OF PAYMENT FOR ADMINISTRATIVE EXPENDITURES.—Nothing in 

this subparagraph shall be construed as permitting payment under this section for administrative expenditures attributable to 

the establishment or operation of such pool, 

except to the extent that such payment 

would otherwise be permitted under this 

title. 

‘‘(J) NO EFFECT ON PREMIUM ASSISTANCE

WAIVER PROGRAMS.—Nothing in this paragraph shall be construed as limiting the authority of a State to offer premium assistance under section 1906 or 1906A, a waiver described in paragraph (2)(B) or (3), a waiver 

approved under section 1115, or other authority in effect prior to the date of enactment of 

the Children’s Health Insurance Program Reauthorization Act of 2009. 

‘‘(K) NOTICE OF AVAILABILITY.—If a State 

elects to provide premium assistance subsidies in accordance with this paragraph, the 

State shall— 

‘‘(i) include on any application or enrollment form for child health assistance a notice of the availability of premium assistance subsidies for the enrollment of targeted 

low-income children in qualified employersponsored coverage; 

‘‘(ii) provide, as part of the application and 

enrollment process under the State child 

health plan, information describing the 

availability of such subsidies and how to 

elect to obtain such a subsidy; and 

‘‘(iii) establish such other procedures as 

the State determines necessary to ensure 

that parents are fully informed of the 

choices for receiving child health assistance 

under the State child health plan or through 

the receipt of premium assistance subsidies. 

‘‘(L) APPLICATION TO QUALIFIED EMPLOYERSPONSORED BENCHMARK COVERAGE.—If a group 

health plan or health insurance coverage offered through an employer is certified by an 

actuary as health benefits coverage that is 

equivalent to the benefits coverage in a 

benchmark benefit package described in section 2103(b) or benchmark-equivalent coverage that meets the requirements of section 

2103(a)(2), the State may provide premium 

assistance subsidies for enrollment of targeted low-income children in such group 

health plan or health insurance coverage in 

the same manner as such subsidies are provided under this paragraph for enrollment in 

qualified employer-sponsored coverage, but 

without regard to the requirement to provide 

supplemental coverage for benefits and costsharing protection provided under the State 

child health plan under subparagraph (E). 

‘‘(M) SATISFACTION OF COST-EFFECTIVENESS

TEST.—Premium assistance subsidies for 

qualified employer-sponsored coverage offered under this paragraph shall be deemed 

to meet the requirement of subparagraph (A) 

of paragraph (3).’’. 

(2) DETERMINATION OF COST-EFFECTIVENESS

FOR PREMIUM ASSISTANCE OR PURCHASE OF

FAMILY COVERAGE.— 

(A) IN GENERAL.—Section 2105(c)(3)(A) (42 

U.S.C. 1397ee(c)(3)(A)) is amended by striking 

‘‘relative to’’ and all that follows through 

the comma and inserting ‘‘relative to 

‘‘(i) the amount of expenditures under the 

State child health plan, including administrative expenditures, that the State would 


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H232 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

have made to provide comparable coverage 

of the targeted low-income child involved or 

the family involved (as applicable); or 

‘‘(ii) the aggregate amount of expenditures 

that the State would have made under the 

State child health plan, including administrative expenditures, for providing coverage 

under such plan for all such children or families.’’. 

(B) NONAPPLICATION TO PREVIOUSLY APPROVED COVERAGE.—The amendment made by 

subparagraph (A) shall not apply to coverage 

the purchase of which has been approved by 

the Secretary under section 2105(c)(3) of the 

Social Security Act prior to the date of enactment of this Act. 

(b) MEDICAID.—Title XIX is amended by inserting after section 1906 the following new 

section: 

‘‘PREMIUM ASSISTANCE OPTION FOR CHILDREN

‘‘SEC. 1906A. (a) IN GENERAL.—A State may 

elect to offer a premium assistance subsidy 

(as defined in subsection (c)) for qualified 

employer-sponsored coverage (as defined in 

subsection (b)) to all individuals under age 19 

who are entitled to medical assistance under 

this title (and to the parent of such an individual) who have access to such coverage if 

the State meets the requirements of this section. 

‘‘(b) QUALIFIED EMPLOYER-SPONSORED COVERAGE.— 

‘‘(1) IN GENERAL.—Subject to paragraph 

(2)), in this paragraph, the term ‘qualified 

employer-sponsored coverage’ means a group 

health plan or health insurance coverage offered through an employer— 

‘‘(A) that qualifies as creditable coverage 

as a group health plan under section 

2701(c)(1) of the Public Health Service Act; 

‘‘(B) for which the employer contribution 

toward any premium for such coverage is at 

least 40 percent; and 

‘‘(C) that is offered to all individuals in a 

manner that would be considered a nondiscriminatory eligibility classification for 

purposes of paragraph (3)(A)(ii) of section 

105(h) of the Internal Revenue Code of 1986 

(but determined without regard to clause (i) 

of subparagraph (B) of such paragraph). 

‘‘(2) EXCEPTION.—Such term does not include coverage consisting of— 

‘‘(A) benefits provided under a health flexible spending arrangement (as defined in section 106(c)(2) of the Internal Revenue Code of 

1986); or 

‘‘(B) a high deductible health plan (as defined in section 223(c)(2) of such Code), without regard to whether the plan is purchased 

in conjunction with a health savings account 

(as defined under section 223(d) of such Code). 

‘‘(3) TREATMENT AS THIRD PARTY LIABILITY.—The State shall treat the coverage provided under qualified employer-sponsored 

coverage as a third party liability under section 1902(a)(25). 

‘‘(c) PREMIUM ASSISTANCE SUBSIDY.—In this 

section, the term ‘premium assistance subsidy’ means the amount of the employee contribution for enrollment in the qualified employer-sponsored coverage by the individual 

under age 19 or by the individual’s family. 

Premium assistance subsidies under this section shall be considered, for purposes of section 1903(a), to be a payment for medical assistance. 

‘‘(d) VOLUNTARY PARTICIPATION.— 

‘‘(1) EMPLOYERS.—Participation by an employer in a premium assistance subsidy offered by a State under this section shall be 

voluntary. An employer may notify a State 

that it elects to opt-out of being directly 

paid a premium assistance subsidy on behalf 

of an employee. 

‘‘(2) BENEFICIARIES.—No subsidy shall be 

provided to an individual under age 19 under 

this section unless the individual (or the individual’s parent) voluntarily elects to receive such a subsidy. A State may not require such an election as a condition of receipt of medical assistance. State may not 

require, as a condition of an individual under 

age 19 (or the individual’s parent) being or 

remaining eligible for medical assistance 

under this title, apply for enrollment in 

qualified employer-sponsored coverage under 

this section. 

‘‘(3) OPT-OUT PERMITTED FOR ANY MONTH.— 

A State shall establish a process for permitting the parent of an individual under age 19 

receiving a premium assistance subsidy to 

disenroll the individual from the qualified 

employer-sponsored coverage. 

‘‘(e) REQUIREMENT TO PAY PREMIUMS AND

COST-SHARING AND PROVIDE SUPPLEMENTAL

COVERAGE.—In the case of the participation 

of an individual under age 19 (or the individual’s parent) in a premium assistance subsidy under this section for qualified employer-sponsored coverage, the State shall 

provide for payment of all enrollee premiums 

for enrollment in such coverage and all 

deductibles, coinsurance, and other costsharing obligations for items and services 

otherwise covered under the State plan 

under this title (exceeding the amount otherwise permitted under section 1916 or, if applicable, section 1916A). The fact that an individual under age 19 (or a parent) elects to enroll in qualified employer-sponsored coverage under this section shall not change the 

individual’s (or parent’s) eligibility for medical assistance under the State plan, except 

insofar as section 1902(a)(25) provides that 

payments for such assistance shall first be 

made under such coverage.’’. 

(c) GAO STUDY AND REPORT.—Not later 

than January 1, 2010, the Comptroller General of the United States shall study cost 

and coverage issues relating to any State 

premium assistance programs for which Federal matching payments are made under 

title XIX or XXI of the Social Security Act, 

including under waiver authority, and shall 

submit a report to the Committee on Finance of the Senate and the Committee on 

Energy and Commerce of the House of Representatives on the results of such study. 

SEC. 302. OUTREACH, EDUCATION, AND ENROLLMENT ASSISTANCE. 

(a) REQUIREMENT TO INCLUDE DESCRIPTION

OF OUTREACH, EDUCATION, AND ENROLLMENT

EFFORTS RELATED TO PREMIUM ASSISTANCE

SUBSIDIES IN STATE CHILD HEALTH PLAN.— 

Section 2102(c) (42 U.S.C. 1397bb(c)) is amended by adding at the end the following new 

paragraph: 

‘‘(3) PREMIUM ASSISTANCE SUBSIDIES.—In 

the case of a State that provides for premium assistance subsidies under the State 

child health plan in accordance with paragraph (2)(B), (3), or (10) of section 2105(c), or 

a waiver approved under section 1115, outreach, education, and enrollment assistance 

for families of children likely to be eligible 

for such subsidies, to inform such families of 

the availability of, and to assist them in enrolling their children in, such subsidies, and 

for employers likely to provide coverage 

that is eligible for such subsidies, including 

the specific, significant resources the State 

intends to apply to educate employers about 

the availability of premium assistance subsidies under the State child health plan.’’. 

(b) NONAPPLICATION OF 10 PERCENT LIMIT ON

OUTREACH AND CERTAIN OTHER EXPENDITURES.—Section 2105(c)(2)(C) (42 U.S.C. 

1397ee(c)(2)(C)), as amended by section 

211(c)(2), is amended by adding at the end the 

following new clause: 

‘‘(iii) EXPENDITURES FOR OUTREACH TO INCREASE THE ENROLLMENT OF CHILDREN UNDER

THIS TITLE AND TITLE xix THROUGH PREMIUM

ASSISTANCE SUBSIDIES.—Expenditures for outreach activities to families of children likely 

to be eligible for premium assistance subsidies in accordance with paragraph (2)(B), 

(3), or (10), or a waiver approved under section 1115, to inform such families of the 

availability of, and to assist them in enrolling their children in, such subsidies, and to 

employers likely to provide qualified employer-sponsored coverage (as defined in subparagraph (B) of such paragraph), but not to 

exceed an amount equal to 1.25 percent of the 

maximum amount permitted to be expended 

under subparagraph (A) for items described 

in subsection (a)(1)(D).’’. 

Subtitle B—Coordinating Premium 

Assistance With Private Coverage 

SEC. 311. SPECIAL ENROLLMENT PERIOD UNDER 

GROUP HEALTH PLANS IN CASE OF 

TERMINATION OF MEDICAID OR 

CHIP COVERAGE OR ELIGIBILITY 

FOR ASSISTANCE IN PURCHASE OF 

EMPLOYMENT-BASED COVERAGE; 

COORDINATION OF COVERAGE. 

(a) AMENDMENTS TO INTERNAL REVENUE

CODE OF 1986.—Section 9801(f) of the Internal 

Revenue Code of 1986 (relating to special enrollment periods) is amended by adding at 

the end the following new paragraph: 

‘‘(3) SPECIAL RULES RELATING TO MEDICAID

AND CHIP.— 

‘‘(A) IN GENERAL.—A group health plan 

shall permit an employee who is eligible, but 

not enrolled, for coverage under the terms of 

the plan (or a dependent of such an employee 

if the dependent is eligible, but not enrolled, 

for coverage under such terms) to enroll for 

coverage under the terms of the plan if either of the following conditions is met: 

‘‘(i) TERMINATION OF MEDICAID OR CHIP COVERAGE.—The employee or dependent is covered under a Medicaid plan under title XIX 

of the Social Security Act or under a State 

child health plan under title XXI of such Act 

and coverage of the employee or dependent 

under such a plan is terminated as a result of 

loss of eligibility for such coverage and the 

employee requests coverage under the group 

health plan not later than 60 days after the 

date of termination of such coverage. 

‘‘(ii) ELIGIBILITY FOR EMPLOYMENT ASSISTANCE UNDER MEDICAID OR CHIP.—The employee or dependent becomes eligible for assistance, with respect to coverage under the 

group health plan under such Medicaid plan 

or State child health plan (including under 

any waiver or demonstration project conducted under or in relation to such a plan), 

if the employee requests coverage under the 

group health plan not later than 60 days 

after the date the employee or dependent is 

determined to be eligible for such assistance. 

‘‘(B) EMPLOYEE OUTREACH AND DISCLOSURE.— 

‘‘(i) OUTREACH TO EMPLOYEES REGARDING

AVAILABILITY OF MEDICAID AND CHIP COVERAGE.— 

‘‘(I) IN GENERAL.—Each employer that 

maintains a group health plan in a State 

that provides medical assistance under a 

State Medicaid plan under title XIX of the 

Social Security Act, or child health assistance under a State child health plan under 

title XXI of such Act, in the form of premium assistance for the purchase of coverage under a group health plan, shall provide to each employee a written notice informing the employee of potential opportunities then currently available in the State 

in which the employee resides for premium 

assistance under such plans for health coverage of the employee or the employee’s dependents. For purposes of compliance with 

this clause, the employer may use any Statespecific model notice developed in accordance with section 701(f)(3)(B)(i)(II) of the Employee Retirement Income Security Act of 

1974 (29 U.S.C. 1181(f)(3)(B)(i)(II)). 


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‘‘(II) OPTION TO PROVIDE CONCURRENT WITH

PROVISION OF PLAN MATERIALS TO EMPLOYEE.—An employer may provide the 

model notice applicable to the State in 

which an employee resides concurrent with 

the furnishing of materials notifying the employee of health plan eligibility, concurrent 

with materials provided to the employee in 

connection with an open season or election 

process conducted under the plan, or concurrent with the furnishing of the summary 

plan description as provided in section 104(b) 

of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1024). 

‘‘(ii) DISCLOSURE ABOUT GROUP HEALTH PLAN

BENEFITS TO STATES FOR MEDICAID AND CHIP

ELIGIBLE INDIVIDUALS.—In the case of a participant or beneficiary of a group health plan 

who is covered under a Medicaid plan of a 

State under title XIX of the Social Security 

Act or under a State child health plan under 

title XXI of such Act, the plan administrator 

of the group health plan shall disclose to the 

State, upon request, information about the 

benefits available under the group health 

plan in sufficient specificity, as determined 

under regulations of the Secretary of Health 

and Human Services in consultation with the 

Secretary that require use of the model coverage coordination disclosure form developed 

under section 311(b)(1)(C) of the Children’s 

Health Insurance Program Reauthorization 

Act of 2009, so as to permit the State to 

make a determination (under paragraph 

(2)(B), (3), or (10) of section 2105(c) of the Social Security Act or otherwise) concerning 

the cost-effectiveness of the State providing 

medical or child health assistance through 

premium assistance for the purchase of coverage under such group health plan and in 

order for the State to provide supplemental 

benefits required under paragraph (10)(E) of 

such section or other authority.’’. 

(b) CONFORMING AMENDMENTS.— 

(1) AMENDMENTS TO EMPLOYEE RETIREMENT

INCOME SECURITY ACT.— 

(A) IN GENERAL.—Section 701(f) of the Employee Retirement Income Security Act of 

1974 (29 U.S.C. 1181(f)) is amended by adding 

at the end the following new paragraph: 

‘‘(3) SPECIAL RULES FOR APPLICATION IN

CASE OF MEDICAID AND CHIP.— 

‘‘(A) IN GENERAL.—A group health plan, 

and a health insurance issuer offering group 

health insurance coverage in connection 

with a group health plan, shall permit an 

employee who is eligible, but not enrolled, 

for coverage under the terms of the plan (or 

a dependent of such an employee if the dependent is eligible, but not enrolled, for coverage under such terms) to enroll for coverage under the terms of the plan if either of 

the following conditions is met: 

‘‘(i) TERMINATION OF MEDICAID OR CHIP COVERAGE.—The employee or dependent is covered under a Medicaid plan under title XIX 

of the Social Security Act or under a State 

child health plan under title XXI of such Act 

and coverage of the employee or dependent 

under such a plan is terminated as a result of 

loss of eligibility for such coverage and the 

employee requests coverage under the group 

health plan (or health insurance coverage) 

not later than 60 days after the date of termination of such coverage. 

‘‘(ii) ELIGIBILITY FOR EMPLOYMENT ASSISTANCE UNDER MEDICAID OR CHIP.—The employee or dependent becomes eligible for assistance, with respect to coverage under the 

group health plan or health insurance coverage, under such Medicaid plan or State 

child health plan (including under any waiver or demonstration project conducted under 

or in relation to such a plan), if the employee requests coverage under the group 

health plan or health insurance coverage not 

later than 60 days after the date the employee or dependent is determined to be eligible for such assistance. 

‘‘(B) COORDINATION WITH MEDICAID AND

CHIP.— 

‘‘(i) OUTREACH TO EMPLOYEES REGARDING

AVAILABILITY OF MEDICAID AND CHIP COVERAGE.— 

‘‘(I) IN GENERAL.—Each employer that 

maintains a group health plan in a State 

that provides medical assistance under a 

State Medicaid plan under title XIX of the 

Social Security Act, or child health assistance under a State child health plan under 

title XXI of such Act, in the form of premium assistance for the purchase of coverage under a group health plan, shall provide to each employee a written notice informing the employee of potential opportunities then currently available in the State 

in which the employee resides for premium 

assistance under such plans for health coverage of the employee or the employee’s dependents. 

‘‘(II) MODEL NOTICE.—Not later than 1 year 

after the date of enactment of the Children’s 

Health Insurance Program Reauthorization 

Act of 2009, the Secretary and the Secretary 

of Health and Human Services, in consultation with Directors of State Medicaid agencies under title XIX of the Social Security 

Act and Directors of State CHIP agencies 

under title XXI of such Act, shall jointly develop national and State-specific model notices for purposes of subparagraph (A). The 

Secretary shall provide employers with such 

model notices so as to enable employers to 

timely comply with the requirements of subparagraph (A). Such model notices shall include information regarding how an employee may contact the State in which the 

employee resides for additional information 

regarding potential opportunities for such 

premium assistance, including how to apply 

for such assistance. 

‘‘(III) OPTION TO PROVIDE CONCURRENT WITH

PROVISION OF PLAN MATERIALS TO EMPLOYEE.—An employer may provide the 

model notice applicable to the State in 

which an employee resides concurrent with 

the furnishing of materials notifying the employee of health plan eligibility, concurrent 

with materials provided to the employee in 

connection with an open season or election 

process conducted under the plan, or concurrent with the furnishing of the summary 

plan description as provided in section 104(b). 

‘‘(ii) DISCLOSURE ABOUT GROUP HEALTH PLAN

BENEFITS TO STATES FOR MEDICAID AND CHIP

ELIGIBLE INDIVIDUALS.—In the case of a participant or beneficiary of a group health plan 

who is covered under a Medicaid plan of a 

State under title XIX of the Social Security 

Act or under a State child health plan under 

title XXI of such Act, the plan administrator 

of the group health plan shall disclose to the 

State, upon request, information about the 

benefits available under the group health 

plan in sufficient specificity, as determined 

under regulations of the Secretary of Health 

and Human Services in consultation with the 

Secretary that require use of the model coverage coordination disclosure form developed 

under section 311(b)(1)(C) of the Children’s 

Health Insurance Program Reauthorization 

Act of 2009, so as to permit the State to 

make a determination (under paragraph 

(2)(B), (3), or (10) of section 2105(c) of the Social Security Act or otherwise) concerning 

the cost-effectiveness of the State providing 

medical or child health assistance through 

premium assistance for the purchase of coverage under such group health plan and in 

order for the State to provide supplemental 

benefits required under paragraph (10)(E) of 

such section or other authority.’’. 

(B) CONFORMING AMENDMENT.—Section 

102(b) of the Employee Retirement Income 

Security Act of 1974 (29 U.S.C. 1022(b)) is 

amended— 

(i) by striking ‘‘and the remedies’’ and inserting ‘‘, the remedies’’; and 

(ii) by inserting before the period the following: ‘‘, and if the employer so elects for 

purposes of complying with section 

701(f)(3)(B)(i), the model notice applicable to 

the State in which the participants and 

beneficiaries reside’’. 

(C) WORKING GROUP TO DEVELOP MODEL COVERAGE COORDINATION DISCLOSURE FORM.— 

(i) MEDICAID, CHIP, AND EMPLOYER-SPONSORED COVERAGE COORDINATION WORKING

GROUP.— 

(I) IN GENERAL.—Not later than 60 days 

after the date of enactment of this Act, the 

Secretary of Health and Human Services and 

the Secretary of Labor shall jointly establish 

a Medicaid, CHIP, and Employer-Sponsored 

Coverage Coordination Working Group (in 

this subparagraph referred to as the ‘‘Working Group’’). The purpose of the Working 

Group shall be to develop the model coverage 

coordination disclosure form described in 

subclause (II) and to identify the impediments to the effective coordination of coverage available to families that include employees of employers that maintain group 

health plans and members who are eligible 

for medical assistance under title XIX of the 

Social Security Act or child health assistance or other health benefits coverage under 

title XXI of such Act. 

(II) MODEL COVERAGE COORDINATION DISCLOSURE FORM DESCRIBED.—The model form described in this subclause is a form for plan 

administrators of group health plans to complete for purposes of permitting a State to 

determine the availability and cost-effectiveness of the coverage available under such 

plans to employees who have family members who are eligible for premium assistance 

offered under a State plan under title XIX or 

XXI of such Act and to allow for coordination of coverage for enrollees of such plans. 

Such form shall provide the following information in addition to such other information 

as the Working Group determines appropriate: 

(aa) A determination of whether the employee is eligible for coverage under the 

group health plan. 

(bb) The name and contract information of 

the plan administrator of the group health 

plan. 

(cc) The benefits offered under the plan. 

(dd) The premiums and cost-sharing required under the plan. 

(ee) Any other information relevant to coverage under the plan. 

(ii) MEMBERSHIP.—The Working Group 

shall consist of not more than 30 members 

and shall be composed of representatives of— 

(I) the Department of Labor; 

(II) the Department of Health and Human 

Services; 

(III) State directors of the Medicaid program under title XIX of the Social Security 

Act; 

(IV) State directors of the State Children’s 

Health Insurance Program under title XXI of 

the Social Security Act; 

(V) employers, including owners of small 

businesses and their trade or industry representatives and certified human resource 

and payroll professionals; 

(VI) plan administrators and plan sponsors 

of group health plans (as defined in section 

607(1) of the Employee Retirement Income 

Security Act of 1974); 

(VII) health insurance issuers; and 

(VIII) children and other beneficiaries of 

medical assistance under title XIX of the Social Security Act or child health assistance 

or other health benefits coverage under title 

XXI of such Act. 


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H234 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

(iii) COMPENSATION.—The members of the 

Working Group shall serve without compensation. 

(iv) ADMINISTRATIVE SUPPORT.—The Department of Health and Human Services and 

the Department of Labor shall jointly provide appropriate administrative support to 

the Working Group, including technical assistance. The Working Group may use the 

services and facilities of either such Department, with or without reimbursement, as 

jointly determined by such Departments. 

(v) REPORT.— 

(I) REPORT BY WORKING GROUP TO THE SECRETARIES.—Not later than 18 months after 

the date of the enactment of this Act, the 

Working Group shall submit to the Secretary of Labor and the Secretary of Health 

and Human Services the model form described in clause (i)(II) along with a report 

containing recommendations for appropriate 

measures to address the impediments to the 

effective coordination of coverage between 

group health plans and the State plans under 

titles XIX and XXI of the Social Security 

Act. 

(II) REPORT BY SECRETARIES TO THE CONGRESS.—Not later than 2 months after receipt of the report pursuant to subclause (I), 

the Secretaries shall jointly submit a report 

to each House of the Congress regarding the 

recommendations contained in the report 

under such subclause. 

(vi) TERMINATION.—The Working Group 

shall terminate 30 days after the date of the 

issuance of its report under clause (v). 

(D) EFFECTIVE DATES.—The Secretary of 

Labor and the Secretary of Health and 

Human Services shall develop the initial 

model notices under section 701(f)(3)(B)(i)(II) 

of the Employee Retirement Income Security Act of 1974, and the Secretary of Labor 

shall provide such notices to employers, not 

later than the date that is 1 year after the 

date of enactment of this Act, and each employer shall provide the initial annual notices to such employer’s employees beginning with the first plan year that begins 

after the date on which such initial model 

notices are first issued. The model coverage 

coordination disclosure form developed 

under subparagraph (C) shall apply with respect to requests made by States beginning 

with the first plan year that begins after the 

date on which such model coverage coordination disclosure form is first issued. 

(E) ENFORCEMENT.—Section 502 of the Employee Retirement Income Security Act of 

1974 (29 U.S.C. 1132) is amended— 

(i) in subsection (a)(6), by striking ‘‘or (8)’’ 

and inserting ‘‘(8), or (9)’’; and 

(ii) in subsection (c), by redesignating 

paragraph (9) as paragraph (10), and by inserting after paragraph (8) the following: 

‘‘(9)(A) The Secretary may assess a civil 

penalty against any employer of up to $100 a 

day from the date of the employer’s failure 

to meet the notice requirement of section 

701(f)(3)(B)(i)(I). For purposes of this subparagraph, each violation with respect to 

any single employee shall be treated as a 

separate violation. 

‘‘(B) The Secretary may assess a civil penalty against any plan administrator of up to 

$100 a day from the date of the plan administrator’s failure to timely provide to any 

State the information required to be disclosed under section 701(f)(3)(B)(ii). For purposes of this subparagraph, each violation 

with respect to any single participant or 

beneficiary shall be treated as a separate 

violation.’’. 

(2) AMENDMENTS TO PUBLIC HEALTH SERVICE

ACT.—Section 2701(f) of the Public Health 

Service Act (42 U.S.C. 300gg(f)) is amended by 

adding at the end the following new paragraph: 

‘‘(3) SPECIAL RULES FOR APPLICATION IN

CASE OF MEDICAID AND CHIP.— 

‘‘(A) IN GENERAL.—A group health plan, 

and a health insurance issuer offering group 

health insurance coverage in connection 

with a group health plan, shall permit an 

employee who is eligible, but not enrolled, 

for coverage under the terms of the plan (or 

a dependent of such an employee if the dependent is eligible, but not enrolled, for coverage under such terms) to enroll for coverage under the terms of the plan if either of 

the following conditions is met: 

‘‘(i) TERMINATION OF MEDICAID OR CHIP COVERAGE.—The employee or dependent is covered under a Medicaid plan under title XIX 

of the Social Security Act or under a State 

child health plan under title XXI of such Act 

and coverage of the employee or dependent 

under such a plan is terminated as a result of 

loss of eligibility for such coverage and the 

employee requests coverage under the group 

health plan (or health insurance coverage) 

not later than 60 days after the date of termination of such coverage. 

‘‘(ii) ELIGIBILITY FOR EMPLOYMENT ASSISTANCE UNDER MEDICAID OR CHIP.—The employee or dependent becomes eligible for assistance, with respect to coverage under the 

group health plan or health insurance coverage, under such Medicaid plan or State 

child health plan (including under any waiver or demonstration project conducted under 

or in relation to such a plan), if the employee requests coverage under the group 

health plan or health insurance coverage not 

later than 60 days after the date the employee or dependent is determined to be eligible for such assistance. 

‘‘(B) COORDINATION WITH MEDICAID AND

CHIP.— 

‘‘(i) OUTREACH TO EMPLOYEES REGARDING

AVAILABILITY OF MEDICAID AND CHIP COVERAGE.— 

‘‘(I) IN GENERAL.—Each employer that 

maintains a group health plan in a State 

that provides medical assistance under a 

State Medicaid plan under title XIX of the 

Social Security Act, or child health assistance under a State child health plan under 

title XXI of such Act, in the form of premium assistance for the purchase of coverage under a group health plan, shall provide to each employee a written notice informing the employee of potential opportunities then currently available in the State 

in which the employee resides for premium 

assistance under such plans for health coverage of the employee or the employee’s dependents. For purposes of compliance with 

this subclause, the employer may use any 

State-specific model notice developed in accordance with section 701(f)(3)(B)(i)(II) of the 

Employee Retirement Income Security Act 

of 1974 (29 U.S.C. 1181(f)(3)(B)(i)(II)). 

‘‘(II) OPTION TO PROVIDE CONCURRENT WITH

PROVISION OF PLAN MATERIALS TO EMPLOYEE.—An employer may provide the 

model notice applicable to the State in 

which an employee resides concurrent with 

the furnishing of materials notifying the employee of health plan eligibility, concurrent 

with materials provided to the employee in 

connection with an open season or election 

process conducted under the plan, or concurrent with the furnishing of the summary 

plan description as provided in section 104(b) 

of the Employee Retirement Income Security Act of 1974. 

‘‘(ii) DISCLOSURE ABOUT GROUP HEALTH PLAN

BENEFITS TO STATES FOR MEDICAID AND CHIP

ELIGIBLE INDIVIDUALS.—In the case of an enrollee in a group health plan who is covered 

under a Medicaid plan of a State under title 

XIX of the Social Security Act or under a 

State child health plan under title XXI of 

such Act, the plan administrator of the 

group health plan shall disclose to the State, 

upon request, information about the benefits 

available under the group health plan in sufficient specificity, as determined under regulations of the Secretary of Health and 

Human Services in consultation with the 

Secretary that require use of the model coverage coordination disclosure form developed 

under section 311(b)(1)(C) of the Children’s 

Health Insurance Reauthorization Act of 

2009, so as to permit the State to make a determination (under paragraph (2)(B), (3), or 

(10) of section 2105(c) of the Social Security 

Act or otherwise) concerning the cost-effectiveness of the State providing medical or 

child health assistance through premium assistance for the purchase of coverage under 

such group health plan and in order for the 

State to provide supplemental benefits required under paragraph (10)(E) of such section or other authority.’’. 

TITLE IV—STRENGTHENING QUALITY OF 

CARE AND HEALTH OUTCOMES 

SEC. 401. CHILD HEALTH QUALITY IMPROVEMENT ACTIVITIES FOR CHILDREN 

ENROLLED IN MEDICAID OR CHIP. 

(a) DEVELOPMENT OF CHILD HEALTH QUALITY MEASURES FOR CHILDREN ENROLLED IN

MEDICAID OR CHIP.—Title XI (42 U.S.C. 1301 et 

seq.) is amended by inserting after section 

1139 the following new section: 

‘‘SEC. 1139A. CHILD HEALTH QUALITY MEASURES. 

‘‘(a) DEVELOPMENT OF AN INITIAL CORE SET

OF HEALTH CARE QUALITY MEASURES FOR

CHILDREN ENROLLED IN MEDICAID OR CHIP.— 

‘‘(1) IN GENERAL.—Not later than January 

1, 2010, the Secretary shall identify and publish for general comment an initial, recommended core set of child health quality 

measures for use by State programs administered under titles XIX and XXI, health insurance issuers and managed care entities that 

enter into contracts with such programs, and 

providers of items and services under such 

programs. 

‘‘(2) IDENTIFICATION OF INITIAL CORE MEASURES.—In consultation with the individuals 

and entities described in subsection (b)(3), 

the Secretary shall identify existing quality 

of care measures for children that are in use 

under public and privately sponsored health 

care coverage arrangements, or that are part 

of reporting systems that measure both the 

presence and duration of health insurance 

coverage over time. 

‘‘(3) RECOMMENDATIONS AND DISSEMINATION.—Based on such existing and identified 

measures, the Secretary shall publish an initial core set of child health quality measures 

that includes (but is not limited to) the following: 

‘‘(A) The duration of children’s health insurance coverage over a 12-month time period. 

‘‘(B) The availability and effectiveness of a 

full range of— 

‘‘(i) preventive services, treatments, and 

services for acute conditions, including services to promote healthy birth, prevent and 

treat premature birth, and detect the presence or risk of physical or mental conditions 

that could adversely affect growth and development; and 

‘‘(ii) treatments to correct or ameliorate 

the effects of physical and mental conditions, including chronic conditions, in infants, young children, school-age children, 

and adolescents. 

‘‘(C) The availability of care in a range of 

ambulatory and inpatient health care settings in which such care is furnished. 

‘‘(D) The types of measures that, taken together, can be used to estimate the overall 

national quality of health care for children, 

including children with special needs, and to 

perform comparative analyses of pediatric 

health care quality and racial, ethnic, and 

socioeconomic disparities in child health and 

health care for children. 


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January 14, 2009 CONGRESSIONAL RECORD — HOUSE H235 

‘‘(4) ENCOURAGE VOLUNTARY AND STANDARDIZED REPORTING.—Not later than 2 years after 

the date of enactment of the Children’s 

Health Insurance Program Reauthorization 

Act of 2009, the Secretary, in consultation 

with States, shall develop a standardized format for reporting information and procedures and approaches that encourage States 

to use the initial core measurement set to 

voluntarily report information regarding the 

quality of pediatric health care under titles 

XIX and XXI. 

‘‘(5) ADOPTION OF BEST PRACTICES IN IMPLEMENTING QUALITY PROGRAMS.—The Secretary 

shall disseminate information to States regarding best practices among States with respect to measuring and reporting on the 

quality of health care for children, and shall 

facilitate the adoption of such best practices. In developing best practices approaches, the Secretary shall give particular 

attention to State measurement techniques 

that ensure the timeliness and accuracy of 

provider reporting, encourage provider reporting compliance, encourage successful 

quality improvement strategies, and improve efficiency in data collection using 

health information technology. 

‘‘(6) REPORTS TO CONGRESS.—Not later than 

January 1, 2011, and every 3 years thereafter, 

the Secretary shall report to Congress on— 

‘‘(A) the status of the Secretary’s efforts to 

improve— 

‘‘(i) quality related to the duration and 

stability of health insurance coverage for 

children under titles XIX and XXI; 

‘‘(ii) the quality of children’s health care 

under such titles, including preventive 

health services, health care for acute conditions, chronic health care, and health services to ameliorate the effects of physical and 

mental conditions and to aid in growth and 

development of infants, young children, 

school-age children, and adolescents with 

special health care needs; and 

‘‘(iii) the quality of children’s health care 

under such titles across the domains of quality, including clinical quality, health care 

safety, family experience with health care, 

health care in the most integrated setting, 

and elimination of racial, ethnic, and socioeconomic disparities in health and health 

care; 

‘‘(B) the status of voluntary reporting by 

States under titles XIX and XXI, utilizing 

the initial core quality measurement set; 

and 

‘‘(C) any recommendations for legislative 

changes needed to improve the quality of 

care provided to children under titles XIX 

and XXI, including recommendations for 

quality reporting by States. 

‘‘(7) TECHNICAL ASSISTANCE.—The Secretary 

shall provide technical assistance to States 

to assist them in adopting and utilizing core 

child health quality measures in administering the State plans under titles XIX and 

XXI. 

‘‘(8) DEFINITION OF CORE SET.—In this section, the term ‘core set’ means a group of 

valid, reliable, and evidence-based quality 

measures that, taken together— 

‘‘(A) provide information regarding the 

quality of health coverage and health care 

for children; 

‘‘(B) address the needs of children throughout the developmental age span; and 

‘‘(C) allow purchasers, families, and health 

care providers to understand the quality of 

care in relation to the preventive needs of 

children, treatments aimed at managing and 

resolving acute conditions, and diagnostic 

and treatment services whose purpose is to 

correct or ameliorate physical, mental, or 

developmental conditions that could, if untreated or poorly treated, become chronic. 

‘‘(b) ADVANCING AND IMPROVING PEDIATRIC

QUALITY MEASURES.— 

‘‘(1) ESTABLISHMENT OF PEDIATRIC QUALITY

MEASURES PROGRAM.—Not later than January 

1, 2011, the Secretary shall establish a pediatric quality measures program to— 

‘‘(A) improve and strengthen the initial 

core child health care quality measures established by the Secretary under subsection 

(a); 

‘‘(B) expand on existing pediatric quality 

measures used by public and private health 

care purchasers and advance the development of such new and emerging quality 

measures; and 

‘‘(C) increase the portfolio of evidencebased, consensus pediatric quality measures 

available to public and private purchasers of 

children’s health care services, providers, 

and consumers. 

‘‘(2) EVIDENCE-BASED MEASURES.—The 

measures developed under the pediatric quality measures program shall, at a minimum, 

be— 

‘‘(A) evidence-based and, where appropriate, risk adjusted; 

‘‘(B) designed to identify and eliminate racial and ethnic disparities in child health 

and the provision of health care; 

‘‘(C) designed to ensure that the data required for such measures is collected and reported in a standard format that permits 

comparison of quality and data at a State, 

plan, and provider level; 

‘‘(D) periodically updated; and 

‘‘(E) responsive to the child health needs, 

services, and domains of health care quality 

described in clauses (i), (ii), and (iii) of subsection (a)(6)(A). 

‘‘(3) PROCESS FOR PEDIATRIC QUALITY MEASURES PROGRAM.—In identifying gaps in existing pediatric quality measures and establishing priorities for development and advancement of such measures, the Secretary 

shall consult with— 

‘‘(A) States; 

‘‘(B) pediatricians, children’s hospitals, 

and other primary and specialized pediatric 

health care professionals (including members 

of the allied health professions) who specialize in the care and treatment of children, 

particularly children with special physical, 

mental, and developmental health care 

needs; 

‘‘(C) dental professionals, including pediatric dental professionals; 

‘‘(D) health care providers that furnish primary health care to children and families 

who live in urban and rural medically underserved communities or who are members of 

distinct population sub-groups at heightened 

risk for poor health outcomes; 

‘‘(E) national organizations representing 

children, including children with disabilities 

and children with chronic conditions; 

‘‘(F) national organizations representing 

consumers and purchasers of children’s 

health care; 

‘‘(G) national organizations and individuals with expertise in pediatric health quality measurement; and 

‘‘(H) voluntary consensus standards setting 

organizations and other organizations involved in the advancement of evidence-based 

measures of health care. 

‘‘(4) DEVELOPING, VALIDATING, AND TESTING

A PORTFOLIO OF PEDIATRIC QUALITY MEASURES.—As part of the program to advance pediatric quality measures, the Secretary 

shall— 

‘‘(A) award grants and contracts for the development, testing, and validation of new, 

emerging, and innovative evidence-based 

measures for children’s health care services 

across the domains of quality described in 

clauses (i), (ii), and (iii) of subsection 

(a)(6)(A); and 

‘‘(B) award grants and contracts for— 

‘‘(i) the development of consensus on evidence-based measures for children’s health 

care services; 

‘‘(ii) the dissemination of such measures to 

public and private purchasers of health care 

for children; and 

‘‘(iii) the updating of such measures as necessary. 

‘‘(5) REVISING, STRENGTHENING, AND IMPROVING INITIAL CORE MEASURES.—Beginning no 

later than January 1, 2013, and annually 

thereafter, the Secretary shall publish recommended changes to the core measures described in subsection (a) that shall reflect 

the testing, validation, and consensus process for the development of pediatric quality 

measures described in subsection paragraphs 

(1) through (4). 

‘‘(6) DEFINITION OF PEDIATRIC QUALITY

MEASURE.—In this subsection, the term ‘pediatric quality measure’ means a measurement 

of clinical care that is capable of being examined through the collection and analysis 

of relevant information, that is developed in 

order to assess 1 or more aspects of pediatric 

health care quality in various institutional 

and ambulatory health care settings, including the structure of the clinical care system, 

the process of care, the outcome of care, or 

patient experiences in care. 

‘‘(7) CONSTRUCTION.—Nothing in this section shall be construed as supporting the restriction of coverage, under title XIX or XXI 

or otherwise, to only those services that are 

evidence-based. 

‘‘(c) ANNUAL STATE REPORTS REGARDING

STATE-SPECIFIC QUALITY OF CARE MEASURES

APPLIED UNDER MEDICAID OR CHIP.— 

‘‘(1) ANNUAL STATE REPORTS.—Each State 

with a State plan approved under title XIX 

or a State child health plan approved under 

title XXI shall annually report to the Secretary on the— 

‘‘(A) State-specific child health quality 

measures applied by the States under such 

plans, including measures described in subparagraphs (A) and (B) of subsection (a)(6); 

and 

‘‘(B) State-specific information on the 

quality of health care furnished to children 

under such plans, including information collected through external quality reviews of 

managed care organizations under section 

1932 of the Social Security Act (42 U.S.C. 

1396u–4) and benchmark plans under sections 

1937 and 2103 of such Act (42 U.S.C. 1396u–7, 

1397cc). 

‘‘(2) PUBLICATION.—Not later than September 30, 2010, and annually thereafter, the 

Secretary shall collect, analyze, and make 

publicly available the information reported 

by States under paragraph (1). 

‘‘(d) DEMONSTRATION PROJECTS FOR IMPROVING THE QUALITY OF CHILDREN’S HEALTH CARE

AND THE USE OF HEALTH INFORMATION TECHNOLOGY.— 

‘‘(1) IN GENERAL.—During the period of fiscal years 2009 through 2013, the Secretary 

shall award not more than 10 grants to 

States and child health providers to conduct 

demonstration projects to evaluate promising ideas for improving the quality of children’s health care provided under title XIX 

or XXI, including projects to— 

‘‘(A) experiment with, and evaluate the use 

of, new measures of the quality of children’s 

health care under such titles (including testing the validity and suitability for reporting 

of such measures); 

‘‘(B) promote the use of health information 

technology in care delivery for children 

under such titles; 

‘‘(C) evaluate provider-based models which 

improve the delivery of children’s health 

care services under such titles, including 

care management for children with chronic 


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H236 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

conditions and the use of evidence-based approaches to improve the effectiveness, safety, and efficiency of health care services for 

children; or 

‘‘(D) demonstrate the impact of the model 

electronic health record format for children 

developed and disseminated under subsection 

(f) on improving pediatric health, including 

the effects of chronic childhood health conditions, and pediatric health care quality as 

well as reducing health care costs. 

‘‘(2) REQUIREMENTS.—In awarding grants 

under this subsection, the Secretary shall 

ensure that— 

‘‘(A) only 1 demonstration project funded 

under a grant awarded under this subsection 

shall be conducted in a State; and 

‘‘(B) demonstration projects funded under 

grants awarded under this subsection shall 

be conducted evenly between States with 

large urban areas and States with large rural 

areas. 

‘‘(3) AUTHORITY FOR MULTISTATE

PROJECTS.—A demonstration project conducted with a grant awarded under this subsection may be conducted on a multistate 

basis, as needed. 

‘‘(4) FUNDING.—$20,000,000 of the amount appropriated under subsection (i) for a fiscal 

year shall be used to carry out this subsection. 

‘‘(e) CHILDHOOD OBESITY DEMONSTRATION

PROJECT.— 

‘‘(1) AUTHORITY TO CONDUCT DEMONSTRATION.—The Secretary, in consultation with 

the Administrator of the Centers for Medicare & Medicaid Services, shall conduct a 

demonstration project to develop a comprehensive and systematic model for reducing childhood obesity by awarding grants to 

eligible entities to carry out such project. 

Such model shall— 

‘‘(A) identify, through self-assessment, behavioral risk factors for obesity among children; 

‘‘(B) identify, through self-assessment, 

needed clinical preventive and screening benefits among those children identified as target individuals on the basis of such risk factors; 

‘‘(C) provide ongoing support to such target individuals and their families to reduce 

risk factors and promote the appropriate use 

of preventive and screening benefits; and 

‘‘(D) be designed to improve health outcomes, satisfaction, quality of life, and appropriate use of items and services for which 

medical assistance is available under title 

XIX or child health assistance is available 

under title XXI among such target individuals. 

‘‘(2) ELIGIBILITY ENTITIES.—For purposes of 

this subsection, an eligible entity is any of 

the following: 

‘‘(A) A city, county, or Indian tribe. 

‘‘(B) A local or tribal educational agency. 

‘‘(C) An accredited university, college, or 

community college. 

‘‘(D) A Federally-qualified health center. 

‘‘(E) A local health department. 

‘‘(F) A health care provider. 

‘‘(G) A community-based organization. 

‘‘(H) Any other entity determined appropriate by the Secretary, including a consortia or partnership of entities described in 

any of subparagraphs (A) through (G). 

‘‘(3) USE OF FUNDS.—An eligible entity 

awarded a grant under this subsection shall 

use the funds made available under the grant 

to— 

‘‘(A) carry out community-based activities 

related to reducing childhood obesity, including by— 

‘‘(i) forming partnerships with entities, including schools and other facilities providing 

recreational services, to establish programs 

for after school and weekend community activities that are designed to reduce childhood obesity; 

‘‘(ii) forming partnerships with daycare facilities to establish programs that promote 

healthy eating behaviors and physical activity; and 

‘‘(iii) developing and evaluating community educational activities targeting good 

nutrition and promoting healthy eating behaviors; 

‘‘(B) carry out age-appropriate schoolbased activities that are designed to reduce 

childhood obesity, including by— 

‘‘(i) developing and testing educational 

curricula and intervention programs designed to promote healthy eating behaviors 

and habits in youth, which may include— 

‘‘(I) after hours physical activity programs; and 

‘‘(II) science-based interventions with multiple components to prevent eating disorders 

including nutritional content, understanding 

and responding to hunger and satiety, positive body image development, positive selfesteem development, and learning life skills 

(such as stress management, communication 

skills, problemsolving and decisionmaking 

skills), as well as consideration of cultural 

and developmental issues, and the role of 

family, school, and community; 

‘‘(ii) providing education and training to 

educational professionals regarding how to 

promote a healthy lifestyle and a healthy 

school environment for children; 

‘‘(iii) planning and implementing a healthy 

lifestyle curriculum or program with an emphasis on healthy eating behaviors and physical activity; and 

‘‘(iv) planning and implementing healthy 

lifestyle classes or programs for parents or 

guardians, with an emphasis on healthy eating behaviors and physical activity for children; 

‘‘(C) carry out educational, counseling, 

promotional, and training activities through 

the local health care delivery systems including by— 

‘‘(i) promoting healthy eating behaviors 

and physical activity services to treat or 

prevent eating disorders, being overweight, 

and obesity; 

‘‘(ii) providing patient education and counseling to increase physical activity and promote healthy eating behaviors; 

‘‘(iii) training health professionals on how 

to identify and treat obese and overweight 

individuals which may include nutrition and 

physical activity counseling; and 

‘‘(iv) providing community education by a 

health professional on good nutrition and 

physical activity to develop a better understanding of the relationship between diet, 

physical activity, and eating disorders, obesity, or being overweight; and 

‘‘(D) provide, through qualified health professionals, training and supervision for community health workers to— 

‘‘(i) educate families regarding the relationship between nutrition, eating habits, 

physical activity, and obesity; 

‘‘(ii) educate families about effective strategies to improve nutrition, establish healthy 

eating patterns, and establish appropriate 

levels of physical activity; and 

‘‘(iii) educate and guide parents regarding 

the ability to model and communicate positive health behaviors. 

‘‘(4) PRIORITY.—In awarding grants under 

paragraph (1), the Secretary shall give priority to awarding grants to eligible entities— 

‘‘(A) that demonstrate that they have previously applied successfully for funds to 

carry out activities that seek to promote individual and community health and to prevent the incidence of chronic disease and 

that can cite published and peer-reviewed research demonstrating that the activities 

that the entities propose to carry out with 

funds made available under the grant are effective; 

‘‘(B) that will carry out programs or activities that seek to accomplish a goal or 

goals set by the State in the Healthy People 

2010 plan of the State; 

‘‘(C) that provide non-Federal contributions, either in cash or in-kind, to the costs 

of funding activities under the grants; 

‘‘(D) that develop comprehensive plans 

that include a strategy for extending program activities developed under grants in 

the years following the fiscal years for which 

they receive grants under this subsection; 

‘‘(E) located in communities that are medically underserved, as determined by the Secretary; 

‘‘(F) located in areas in which the average 

poverty rate is at least 150 percent or higher 

of the average poverty rate in the State involved, as determined by the Secretary; and 

‘‘(G) that submit plans that exhibit multisectoral, cooperative conduct that includes 

the involvement of a broad range of stakeholders, including— 

‘‘(i) community-based organizations; 

‘‘(ii) local governments; 

‘‘(iii) local educational agencies; 

‘‘(iv) the private sector; 

‘‘(v) State or local departments of health; 

‘‘(vi) accredited colleges, universities, and 

community colleges; 

‘‘(vii) health care providers; 

‘‘(viii) State and local departments of 

transportation and city planning; and 

‘‘(ix) other entities determined appropriate 

by the Secretary. 

‘‘(5) PROGRAM DESIGN.— 

‘‘(A) INITIAL DESIGN.—Not later than 1 year 

after the date of enactment of the Children’s 

Health Insurance Program Reauthorization 

Act of 2009, the Secretary shall design the 

demonstration project. The demonstration 

should draw upon promising, innovative 

models and incentives to reduce behavioral 

risk factors. The Administrator of the Centers for Medicare & Medicaid Services shall 

consult with the Director of the Centers for 

Disease Control and Prevention, the Director 

of the Office of Minority Health, the heads of 

other agencies in the Department of Health 

and Human Services, and such professional 

organizations, as the Secretary determines 

to be appropriate, on the design, conduct, 

and evaluation of the demonstration. 

‘‘(B) NUMBER AND PROJECT AREAS.—Not 

later than 2 years after the date of enactment of the Children’s Health Insurance Program Reauthorization Act of 2009, the Secretary shall award 1 grant that is specifically designed to determine whether programs similar to programs to be conducted 

by other grantees under this subsection 

should be implemented with respect to the 

general population of children who are eligible for child health assistance under State 

child health plans under title XXI in order to 

reduce the incidence of childhood obesity 

among such population. 

‘‘(6) REPORT TO CONGRESS.—Not later than 3 

years after the date the Secretary implements the demonstration project under this 

subsection, the Secretary shall submit to 

Congress a report that describes the project, 

evaluates the effectiveness and cost effectiveness of the project, evaluates the beneficiary satisfaction under the project, and includes any such other information as the 

Secretary determines to be appropriate. 

‘‘(7) DEFINITIONS.—In this subsection: 

‘‘(A) FEDERALLY-QUALIFIED HEALTH CENTER.—The term ‘Federally-qualified health 

center’ has the meaning given that term in 

section 1905(l)(2)(B). 

‘‘(B) INDIAN TRIBE.—The term ‘Indian tribe’ 

has the meaning given that term in section 


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January 14, 2009 CONGRESSIONAL RECORD — HOUSE H237 

4 of the Indian Health Care Improvement Act 

(25 U.S.C. 1603). 

‘‘(C) SELF-ASSESSMENT.—The term ‘self-assessment’ means a form that— 

‘‘(i) includes questions regarding— 

‘‘(I) behavioral risk factors; 

‘‘(II) needed preventive and screening services; and 

‘‘(III) target individuals’ preferences for receiving follow-up information; 

‘‘(ii) is assessed using such computer generated assessment programs; and 

‘‘(iii) allows for the provision of such ongoing support to the individual as the Secretary determines appropriate. 

‘‘(D) ONGOING SUPPORT.—The term ‘ongoing 

support’ means— 

‘‘(i) to provide any target individual with 

information, feedback, health coaching, and 

recommendations regarding— 

‘‘(I) the results of a self-assessment given 

to the individual; 

‘‘(II) behavior modification based on the 

self-assessment; and 

‘‘(III) any need for clinical preventive and 

screening services or treatment including 

medical nutrition therapy; 

‘‘(ii) to provide any target individual with 

referrals to community resources and programs available to assist the target individual in reducing health risks; and 

‘‘(iii) to provide the information described 

in clause (i) to a health care provider, if designated by the target individual to receive 

such information. 

‘‘(8) AUTHORIZATION OF APPROPRIATIONS.— 

There is authorized to be appropriated to 

carry out this subsection, $25,000,000 for the 

period of fiscal years 2009 through 2013. 

‘‘(f) DEVELOPMENT OF MODEL ELECTRONIC

HEALTH RECORD FORMAT FOR CHILDREN ENROLLED IN MEDICAID OR CHIP.— 

‘‘(1) IN GENERAL.—Not later than January 

1, 2010, the Secretary shall establish a program to encourage the development and dissemination of a model electronic health 

record format for children enrolled in the 

State plan under title XIX or the State child 

health plan under title XXI that is— 

‘‘(A) subject to State laws, accessible to 

parents, caregivers, and other consumers for 

the sole purpose of demonstrating compliance with school or leisure activity requirements, such as appropriate immunizations or 

physicals; 

‘‘(B) designed to allow interoperable exchanges that conform with Federal and 

State privacy and security requirements; 

‘‘(C) structured in a manner that permits 

parents and caregivers to view and understand the extent to which the care their children receive is clinically appropriate and of 

high quality; and 

‘‘(D) capable of being incorporated into, 

and otherwise compatible with, other standards developed for electronic health records. 

‘‘(2) FUNDING.—$5,000,000 of the amount appropriated under subsection (i) for a fiscal 

year shall be used to carry out this subsection. 

‘‘(g) STUDY OF PEDIATRIC HEALTH AND

HEALTH CARE QUALITY MEASURES.— 

‘‘(1) IN GENERAL.—Not later than July 1, 

2010, the Institute of Medicine shall study 

and report to Congress on the extent and 

quality of efforts to measure child health 

status and the quality of health care for children across the age span and in relation to 

preventive care, treatments for acute conditions, and treatments aimed at ameliorating 

or correcting physical, mental, and developmental conditions in children. In conducting 

such study and preparing such report, the Institute of Medicine shall— 

‘‘(A) consider all of the major national population-based reporting systems sponsored 

by the Federal Government that are currently in place, including reporting requirements under Federal grant programs and national population surveys and estimates conducted directly by the Federal Government; 

‘‘(B) identify the information regarding 

child health and health care quality that 

each system is designed to capture and generate, the study and reporting periods covered by each system, and the extent to which 

the information so generated is made widely 

available through publication; 

‘‘(C) identify gaps in knowledge related to 

children’s health status, health disparities 

among subgroups of children, the effects of 

social conditions on children’s health status 

and use and effectiveness of health care, and 

the relationship between child health status 

and family income, family stability and 

preservation, and children’s school readiness 

and educational achievement and attainment; and 

‘‘(D) make recommendations regarding improving and strengthening the timeliness, 

quality, and public transparency and accessibility of information about child health and 

health care quality. 

‘‘(2) FUNDING.—Up to $1,000,000 of the 

amount appropriated under subsection (i) for 

a fiscal year shall be used to carry out this 

subsection. 

‘‘(h) RULE OF CONSTRUCTION.—Notwithstanding any other provision in this section, 

no evidence based quality measure developed, published, or used as a basis of measurement or reporting under this section may 

be used to establish an irrebuttable presumption regarding either the medical necessity 

of care or the maximum permissible coverage for any individual child who is eligible 

for and receiving medical assistance under 

title XIX or child health assistance under 

title XXI. 

‘‘(i) APPROPRIATION.—Out of any funds in 

the Treasury not otherwise appropriated, 

there is appropriated for each of fiscal years 

2009 through 2013, $45,000,000 for the purpose 

of carrying out this section (other than subsection (e)). Funds appropriated under this 

subsection shall remain available until expended.’’. 

(b) INCREASED MATCHING RATE FOR COLLECTING AND REPORTING ON CHILD HEALTH

MEASURES.—Section 1903(a)(3)(A) (42 U.S.C. 

1396b(a)(3)(A)), is amended— 

(1) by striking ‘‘and’’ at the end of clause 

(i); and 

(2) by adding at the end the following new 

clause: 

‘‘(iii) an amount equal to the Federal medical assistance percentage (as defined in section 1905(b)) of so much of the sums expended 

during such quarter (as found necessary by 

the Secretary for the proper and efficient administration of the State plan) as are attributable to such developments or modifications of systems of the type described in 

clause (i) as are necessary for the efficient 

collection and reporting on child health 

measures; and’’. 

SEC. 402. IMPROVED AVAILABILITY OF PUBLIC 

INFORMATION REGARDING ENROLLMENT OF CHILDREN IN CHIP AND 

MEDICAID. 

(a) INCLUSION OF PROCESS AND ACCESS

MEASURES IN ANNUAL STATE REPORTS.—Section 2108 (42 U.S.C. 1397hh) is amended— 

(1) in subsection (a), in the matter preceding paragraph (1), by striking ‘‘The 

State’’ and inserting ‘‘Subject to subsection 

(e), the State’’; and 

(2) by adding at the end the following new 

subsection: 

‘‘(e) INFORMATION REQUIRED FOR INCLUSION

IN STATE ANNUAL REPORT.—The State shall 

include the following information in the annual report required under subsection (a): 

‘‘(1) Eligibility criteria, enrollment, and 

retention data (including data with respect 

to continuity of coverage or duration of benefits). 

‘‘(2) Data regarding the extent to which 

the State uses process measures with respect 

to determining the eligibility of children 

under the State child health plan, including 

measures such as 12-month continuous eligibility, self-declaration of income for applications or renewals, or presumptive eligibility. 

‘‘(3) Data regarding denials of eligibility 

and redeterminations of eligibility. 

‘‘(4) Data regarding access to primary and 

specialty services, access to networks of 

care, and care coordination provided under 

the State child health plan, using quality 

care and consumer satisfaction measures included in the Consumer Assessment of 

Healthcare Providers and Systems (CAHPS) 

survey. 

‘‘(5) If the State provides child health assistance in the form of premium assistance 

for the purchase of coverage under a group 

health plan, data regarding the provision of 

such assistance, including the extent to 

which employer-sponsored health insurance 

coverage is available for children eligible for 

child health assistance under the State child 

health plan, the range of the monthly 

amount of such assistance provided on behalf 

of a child or family, the number of children 

or families provided such assistance on a 

monthly basis, the income of the children or 

families provided such assistance, the benefits and cost-sharing protection provided 

under the State child health plan to supplement the coverage purchased with such premium assistance, the effective strategies the 

State engages in to reduce any administrative barriers to the provision of such assistance, and, the effects, if any, of the provision 

of such assistance on preventing the coverage provided under the State child health 

plan from substituting for coverage provided 

under employer-sponsored health insurance 

offered in the State. 

‘‘(6) To the extent applicable, a description 

of any State activities that are designed to 

reduce the number of uncovered children in 

the State, including through a State health 

insurance connector program or support for 

innovative private health coverage initiatives.’’. 

(b) STANDARDIZED REPORTING FORMAT.— 

(1) IN GENERAL.—Not later than 1 year after 

the date of enactment of this Act, the Secretary shall specify a standardized format 

for States to use for reporting the information required under section 2108(e) of the Social Security Act, as added by subsection 

(a)(2). 

(2) TRANSITION PERIOD FOR STATES.—Each 

State that is required to submit a report 

under subsection (a) of section 2108 of the Social Security Act that includes the information required under subsection (e) of such 

section may use up to 3 reporting periods to 

transition to the reporting of such information in accordance with the standardized format specified by the Secretary under paragraph (1). 

(c) ADDITIONAL FUNDING FOR THE SECRETARY TO IMPROVE TIMELINESS OF DATA REPORTING AND ANALYSIS FOR PURPOSES OF DETERMINING ENROLLMENT INCREASES UNDER

MEDICAID AND CHIP.— 

(1) APPROPRIATION.—There is appropriated, 

out of any money in the Treasury not otherwise appropriated, $5,000,000 to the Secretary 

for fiscal year 2009 for the purpose of improving the timeliness of the data reported and 

analyzed from the Medicaid Statistical Information System (MSIS) for purposes of 

providing more timely data on enrollment 

and eligibility of children under Medicaid 

and CHIP and to provide guidance to States 

with respect to any new reporting requirements related to such improvements. 

Amounts appropriated under this paragraph 

shall remain available until expended. 


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H238 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

(2) REQUIREMENTS.—The improvements 

made by the Secretary under paragraph (1) 

shall be designed and implemented (including with respect to any necessary guidance 

for States to report such information in a 

complete and expeditious manner) so that, 

beginning no later than October 1, 2009, data 

regarding the enrollment of low-income children (as defined in section 2110(c)(4) of the 

Social Security Act (42 U.S.C. 1397jj(c)(4)) of 

a State enrolled in the State plan under 

Medicaid or the State child health plan 

under CHIP with respect to a fiscal year 

shall be collected and analyzed by the Secretary within 6 months of submission. 

(d) GAO STUDY AND REPORT ON ACCESS TO

PRIMARY AND SPECIALITY SERVICES.— 

(1) IN GENERAL.—The Comptroller General 

of the United States shall conduct a study of 

children’s access to primary and specialty 

services under Medicaid and CHIP, including— 

(A) the extent to which providers are willing to treat children eligible for such programs; 

(B) information on such children’s access 

to networks of care; 

(C) geographic availability of primary and 

specialty services under such programs; 

(D) the extent to which care coordination 

is provided for children’s care under Medicaid and CHIP; and 

(E) as appropriate, information on the degree of availability of services for children 

under such programs. 

(2) REPORT.—Not later than 2 years after 

the date of enactment of this Act, the Comptroller General shall submit a report to the 

Committee on Finance of the Senate and the 

Committee on Energy and Commerce of the 

House of Representatives on the study conducted under paragraph (1) that includes recommendations for such Federal and State 

legislative and administrative changes as 

the Comptroller General determines are necessary to address any barriers to access to 

children’s care under Medicaid and CHIP 

that may exist. 

SEC. 403. APPLICATION OF CERTAIN MANAGED 

CARE QUALITY SAFEGUARDS TO 

CHIP. 

(a) IN GENERAL.—Section 2103(f) of Social 

Security Act (42 U.S.C. 1397bb(f)) is amended 

by adding at the end the following new paragraph: 

‘‘(3) COMPLIANCE WITH MANAGED CARE REQUIREMENTS.—The State child health plan 

shall provide for the application of subsections (a)(4), (a)(5), (b), (c), (d), and (e) of 

section 1932 (relating to requirements for 

managed care) to coverage, State agencies, 

enrollment brokers, managed care entities, 

and managed care organizations under this 

title in the same manner as such subsections 

apply to coverage and such entities and organizations under title XIX.’’. 

(b) EFFECTIVE DATE.—The amendment 

made by subsection (a) shall apply to contract years for health plans beginning on or 

after July 1, 2009. 

TITLE V—IMPROVING ACCESS TO 

BENEFITS 

SEC. 501. DENTAL BENEFITS. 

(a) COVERAGE.— 

(1) IN GENERAL.—Section 2103 (42 U.S.C. 

1397cc) is amended— 

(A) in subsection (a)— 

(i) in the matter before paragraph (1), by 

striking ‘‘subsection (c)(5)’’ and inserting 

‘‘paragraphs (5) and (7) of subsection (c)’’; 

and 

(ii) in paragraph (1), by inserting ‘‘at 

least’’ after ‘‘that is’’; and 

(B) in subsection (c)— 

(i) by redesignating paragraph (5) as paragraph (7); and 

(ii) by inserting after paragraph (4), the 

following: 

‘‘(5) DENTAL BENEFITS.— 

‘‘(A) IN GENERAL.—The child health assistance provided to a targeted low-income child 

shall include coverage of dental services necessary to prevent disease and promote oral 

health, restore oral structures to health and 

function, and treat emergency conditions. 

‘‘(B) PERMITTING USE OF DENTAL BENCHMARK PLANS BY CERTAIN STATES.—A State 

may elect to meet the requirement of subparagraph (A) through dental coverage that 

is equivalent to a benchmark dental benefit 

package described in subparagraph (C). 

‘‘(C) BENCHMARK DENTAL BENEFIT PACKAGES.—The benchmark dental benefit packages are as follows: 

‘‘(i) FEHBP CHILDREN’S DENTAL COVERAGE.—A dental benefits plan under chapter 

89A of title 5, United States Code, that has 

been selected most frequently by employees 

seeking dependent coverage, among such 

plans that provide such dependent coverage, 

in either of the previous 2 plan years. 

‘‘(ii) STATE EMPLOYEE DEPENDENT DENTAL

COVERAGE.—A dental benefits plan that is offered and generally available to State employees in the State involved and that has 

been selected most frequently by employees 

seeking dependent coverage, among such 

plans that provide such dependent coverage, 

in either of the previous 2 plan years. 

‘‘(iii) COVERAGE OFFERED THROUGH COMMERCIAL DENTAL PLAN.—A dental benefits plan 

that has the largest insured commercial, 

non-medicaid enrollment of dependent covered lives of such plans that is offered in the 

State involved.’’. 

(2) ASSURING ACCESS TO CARE.—Section 

2102(a)(7)(B) (42 U.S.C. 1397bb(c)(2)) is amended by inserting ‘‘and services described in 

section 2103(c)(5)’’ after ‘‘emergency services’’. 

(3) EFFECTIVE DATE.—The amendments 

made by paragraph (1) shall apply to coverage of items and services furnished on or 

after October 1, 2009. 

(b) DENTAL EDUCATION FOR PARENTS OF

NEWBORNS.—The Secretary shall develop and 

implement, through entities that fund or 

provide perinatal care services to targeted 

low-income children under a State child 

health plan under title XXI of the Social Security Act, a program to deliver oral health 

educational materials that inform new parents about risks for, and prevention of, early 

childhood caries and the need for a dental 

visit within their newborn’s first year of life. 

(c) PROVISION OF DENTAL SERVICES

THROUGH FQHCS.— 

(1) MEDICAID.—Section 1902(a) (42 U.S.C. 

1396a(a)) is amended— 

(A) by striking ‘‘and’’ at the end of paragraph (70); 

(B) by striking the period at the end of 

paragraph (71) and inserting ‘‘; and’’; and 

(C) by inserting after paragraph (71) the 

following new paragraph: 

‘‘(72) provide that the State will not prevent a Federally-qualified health center 

from entering into contractual relationships 

with private practice dental providers in the 

provision of Federally-qualified health center services.’’. 

(2) CHIP.—Section 2107(e)(1) (42 U.S.C. 

1397g(e)(1)), as amended by subsections (a)(2) 

and (d)(2) of section 203, is amended by inserting after subparagraph (B) the following 

new subparagraph (and redesignating the 

succeeding subparagraphs accordingly): 

‘‘(C) Section 1902(a)(72) (relating to limiting FQHC contracting for provision of dental services).’’. 

(3) EFFECTIVE DATE.—The amendments 

made by this subsection shall take effect on 

January 1, 2009. 

(d) REPORTING INFORMATION ON DENTAL

HEALTH.— 

(1) MEDICAID.—Section 1902(a)(43)(D)(iii) (42 

U.S.C. 1396a(a)(43)(D)(iii)) is amended by inserting ‘‘and other information relating to 

the provision of dental services to such children described in section 2108(e)’’ after ‘‘receiving dental services,’’. 

(2) CHIP.—Section 2108 (42 U.S.C. 1397hh) is 

amended by adding at the end the following 

new subsection: 

‘‘(e) INFORMATION ON DENTAL CARE FOR

CHILDREN.— 

‘‘(1) IN GENERAL.—Each annual report 

under subsection (a) shall include the following information with respect to care and 

services described in section 1905(r)(3) provided to targeted low-income children enrolled in the State child health plan under 

this title at any time during the year involved: 

‘‘(A) The number of enrolled children by 

age grouping used for reporting purposes 

under section 1902(a)(43). 

‘‘(B) For children within each such age 

grouping, information of the type contained 

in questions 12(a)–(c) of CMS Form 416 (that 

consists of the number of enrolled targeted 

low income children who receive any, preventive, or restorative dental care under the 

State plan). 

‘‘(C) For the age grouping that includes 

children 8 years of age, the number of such 

children who have received a protective sealant on at least one permanent molar tooth. 

‘‘(2) INCLUSION OF INFORMATION ON ENROLLEES IN MANAGED CARE PLANS.—The information under paragraph (1) shall include information on children who are enrolled in managed care plans and other private health 

plans and contracts with such plans under 

this title shall provide for the reporting of 

such information by such plans to the 

State.’’. 

(3) EFFECTIVE DATE.—The amendments 

made by this subsection shall be effective for 

annual reports submitted for years beginning 

after date of enactment. 

(e) IMPROVED ACCESSIBILITY OF DENTAL

PROVIDER INFORMATION TO ENROLLEES UNDER

MEDICAID AND CHIP.—The Secretary shall— 

(1) work with States, pediatric dentists, 

and other dental providers (including providers that are, or are affiliated with, a 

school of dentistry) to include, not later 

than 6 months after the date of the enactment of this Act, on the Insure Kids Now 

website (http://www.insurekidsnow.gov/) and 

hotline (1–877–KIDS–NOW) (or on any successor websites or hotlines) a current and accurate list of all such dentists and providers 

within each State that provide dental services to children enrolled in the State plan (or 

waiver) under Medicaid or the State child 

health plan (or waiver) under CHIP, and 

shall ensure that such list is updated at least 

quarterly; and 

(2) work with States to include, not later 

than 6 months after the date of the enactment of this Act, a description of the dental 

services provided under each State plan (or 

waiver) under Medicaid and each State child 

health plan (or waiver) under CHIP on such 

Insure Kids Now website, and shall ensure 

that such list is updated at least annually. 

(f) INCLUSION OF STATUS OF EFFORTS TO IMPROVE DENTAL CARE IN REPORTS ON THE

QUALITY OF CHILDREN’S HEALTH CARE UNDER

MEDICAID AND CHIP.—Section 1139A(a), as 

added by section 401(a), is amended— 

(1) in paragraph (3)(B)(ii), by inserting 

‘‘and, with respect to dental care, conditions 

requiring the restoration of teeth, relief of 

pain and infection, and maintenance of dental health’’ after ‘‘chronic conditions’’; and 

(2) in paragraph (6)(A)(ii), by inserting 

‘‘dental care,’’ after ‘‘preventive health services,’’. 

(g) GAO STUDY AND REPORT.— 


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January 14, 2009 CONGRESSIONAL RECORD — HOUSE H239 

(1) STUDY.—The Comptroller General of the 

United States shall provide for a study that 

examines— 

(A) access to dental services by children in 

underserved areas; 

(B) children’s access to oral health care, 

including preventive and restorative services, under Medicaid and CHIP, including— 

(i) the extent to which dental providers are 

willing to treat children eligible for such 

programs; 

(ii) information on such children’s access 

to networks of care, including such networks 

that serve special needs children; and 

(iii) geographic availability of oral health 

care, including preventive and restorative 

services, under such programs; and 

(C) the feasibility and appropriateness of 

using qualified mid-level dental health providers, in coordination with dentists, to improve access for children to oral health services and public health overall. 

(2) REPORT.—Not later than 18 months year 

after the date of the enactment of this Act, 

the Comptroller General shall submit to 

Congress a report on the study conducted 

under paragraph (1). The report shall include 

recommendations for such Federal and State 

legislative and administrative changes as 

the Comptroller General determines are necessary to address any barriers to access to 

oral health care, including preventive and restorative services, under Medicaid and CHIP 

that may exist. 

SEC. 502. MENTAL HEALTH PARITY IN CHIP 

PLANS. 

(a) ASSURANCE OF PARITY.—Section 2103(c) 

(42 U.S.C. 1397cc(c)), as amended by section 

501(a)(1)(B), is amended by inserting after 

paragraph (5), the following: 

‘‘(6) MENTAL HEALTH SERVICES PARITY.— 

‘‘(A) IN GENERAL.—In the case of a State 

child health plan that provides both medical 

and surgical benefits and mental health or 

substance use disorder benefits, such plan 

shall ensure that the financial requirements 

and treatment limitations applicable to such 

mental health or substance use disorder benefits comply with the requirements of section 2705(a) of the Public Health Service Act 

in the same manner as such requirements 

apply to a group health plan. 

‘‘(B) DEEMED COMPLIANCE.—To the extent 

that a State child health plan includes coverage with respect to an individual described 

in section 1905(a)(4)(B) and covered under the 

State plan under section 1902(a)(10)(A) of the 

services described in section 1905(a)(4)(B) (relating to early and periodic screening, diagnostic, and treatment services defined in section 1905(r)) and provided in accordance with 

section 1902(a)(43), such plan shall be deemed 

to satisfy the requirements of subparagraph 

(A).’’. 

(b) CONFORMING AMENDMENTS.—Section 

2103 (42 U.S.C. 1397cc) is amended— 

(1) in subsection (a), as amended by section 

501(a)(1)(A)(i), in the matter preceding paragraph (1), by inserting ‘‘, (6),’’ after ‘‘(5)’’; 

and 

(2) in subsection (c)(2), by striking subparagraph (B) and redesignating subparagraphs 

(C) and (D) as subparagraphs (B) and (C), respectively. 

SEC. 503. APPLICATION OF PROSPECTIVE PAYMENT SYSTEM FOR SERVICES PROVIDED BY FEDERALLY-QUALIFIED 

HEALTH CENTERS AND RURAL 

HEALTH CLINICS. 

(a) APPLICATION OF PROSPECTIVE PAYMENT

SYSTEM.— 

(1) IN GENERAL.—Section 2107(e)(1) (42 

U.S.C. 1397gg(e)(1)), as amended by section 

501(c)(2) is amended by inserting after subparagraph (C) the following new subparagraph (and redesignating the succeeding subparagraphs accordingly): 

‘‘(D) Section 1902(bb) (relating to payment 

for services provided by Federally-qualified 

health centers and rural health clinics).’’. 

(2) EFFECTIVE DATE.—The amendment 

made by paragraph (1) shall apply to services 

provided on or after October 1, 2009. 

(b) TRANSITION GRANTS.— 

(1) APPROPRIATION.—Out of any funds in 

the Treasury not otherwise appropriated, 

there is appropriated to the Secretary for fiscal year 2009, $5,000,000, to remain available 

until expended, for the purpose of awarding 

grants to States with State child health 

plans under CHIP that are operated separately from the State Medicaid plan under 

title XIX of the Social Security Act (including any waiver of such plan), or in combination with the State Medicaid plan, for expenditures related to transitioning to compliance with the requirement of section 

2107(e)(1)(D) of the Social Security Act (as 

added by subsection (a)) to apply the prospective payment system established under 

section 1902(bb) of the such Act (42 U.S.C. 

1396a(bb)) to services provided by Federallyqualified health centers and rural health 

clinics. 

(2) MONITORING AND REPORT.—The Secretary shall monitor the impact of the application of such prospective payment system 

on the States described in paragraph (1) and, 

not later than October 1, 2011, shall report to 

Congress on any effect on access to benefits, 

provider payment rates, or scope of benefits 

offered by such States as a result of the application of such payment system. 

SEC. 504. PREMIUM GRACE PERIOD. 

(a) IN GENERAL.—Section 2103(e)(3) (42 

U.S.C. 1397cc(e)(3)) is amended by adding at 

the end the following new subparagraph: 

‘‘(C) PREMIUM GRACE PERIOD.—The State 

child health plan— 

‘‘(i) shall afford individuals enrolled under 

the plan a grace period of at least 30 days 

from the beginning of a new coverage period 

to make premium payments before the individual’s coverage under the plan may be terminated; and 

‘‘(ii) shall provide to such an individual, 

not later than 7 days after the first day of 

such grace period, notice— 

‘‘(I) that failure to make a premium payment within the grace period will result in 

termination of coverage under the State 

child health plan; and 

‘‘(II) of the individual’s right to challenge 

the proposed termination pursuant to the applicable Federal regulations. 

For purposes of clause (i), the term ‘new coverage period’ means the month immediately 

following the last month for which the premium has been paid.’’. 

(b) EFFECTIVE DATE.—The amendment 

made by subsection (a) shall apply to new 

coverage periods beginning on or after the 

date of the enactment of this Act. 

SEC. 505. CLARIFICATION OF COVERAGE OF 

SERVICES PROVIDED THROUGH 

SCHOOL-BASED HEALTH CENTERS. 

Section 2103(c) (42 U.S.C. 1397cc(c)), as 

amended by section 501(a)(1)(B), is amended 

by adding at the end the following new paragraph: 

‘‘(8) AVAILABILITY OF COVERAGE FOR ITEMS

AND SERVICES FURNISHED THROUGH SCHOOLBASED HEALTH CENTERS.—Nothing in this 

title shall be construed as limiting a State’s 

ability to provide child health assistance for 

covered items and services that are furnished 

through school-based health centers.’’. 

TITLE VI—PROGRAM INTEGRITY AND 

OTHER MISCELLANEOUS PROVISIONS 

Subtitle A—Program Integrity and Data 

Collection 

SEC. 601. PAYMENT ERROR RATE MEASUREMENT 

(‘‘PERM’’). 

(a) EXPENDITURES RELATED TO COMPLIANCE

WITH REQUIREMENTS.— 

(1) ENHANCED PAYMENTS.—Section 2105(c) 

(42 U.S.C. 1397ee(c)), as amended by section 

301(a), is amended by adding at the end the 

following new paragraph: 

‘‘(11) ENHANCED PAYMENTS.—Notwithstanding subsection (b), the enhanced FMAP 

with respect to payments under subsection 

(a) for expenditures related to the administration of the payment error rate measurement (PERM) requirements applicable to the 

State child health plan in accordance with 

the Improper Payments Information Act of 

2002 and parts 431 and 457 of title 42, Code of 

Federal Regulations (or any related or successor guidance or regulations) shall in no 

event be less than 90 percent.’’. 

(2) EXCLUSION OF FROM CAP ON ADMINISTRATIVE EXPENDITURES.—Section 2105(c)(2)(C) (42 

U.S.C. 1397ee(c)(2)C)), as amended by section 

302(b)), is amended by adding at the end the 

following: 

‘‘(iv) PAYMENT ERROR RATE MEASUREMENT

(PERM) EXPENDITURES.—Expenditures related 

to the administration of the payment error 

rate measurement (PERM) requirements applicable to the State child health plan in accordance with the Improper Payments Information Act of 2002 and parts 431 and 457 of 

title 42, Code of Federal Regulations (or any 

related or successor guidance or regulations).’’. 

(b) FINAL RULE REQUIRED TO BE IN EFFECT

FOR ALL STATES.—Notwithstanding parts 431 

and 457 of title 42, Code of Federal Regulations (as in effect on the date of enactment 

of this Act), the Secretary shall not calculate or publish any national or State-specific error rate based on the application of 

the payment error rate measurement (in this 

section referred to as ‘‘PERM’’) requirements to CHIP until after the date that is 6 

months after the date on which a new final 

rule (in this section referred to as the ‘‘new 

final rule’’) promulgated after the date of the 

enactment of this Act and implementing 

such requirements in accordance with the requirements of subsection (c) is in effect for 

all States. Any calculation of a national 

error rate or a State specific error rate after 

such new final rule in effect for all States 

may only be inclusive of errors, as defined in 

such new final rule or in guidance issued 

within a reasonable time frame after the effective date for such new final rule that includes detailed guidance for the specific 

methodology for error determinations. 

(c) REQUIREMENTS FOR NEW FINAL RULE.— 

For purposes of subsection (b), the requirements of this subsection are that the new 

final rule implementing the PERM requirements shall— 

(1) include— 

(A) clearly defined criteria for errors for 

both States and providers; 

(B) a clearly defined process for appealing 

error determinations by— 

(i) review contractors; or 

(ii) the agency and personnel described in 

section 431.974(a)(2) of title 42, Code of Federal Regulations, as in effect on September 1, 

2007, responsible for the development, direction, implementation, and evaluation of eligibility reviews and associated activities; 

and 

(C) clearly defined responsibilities and 

deadlines for States in implementing any 

corrective action plans; and 

(2) provide that the payment error rate determined for a State shall not take into account payment errors resulting from the 

State’s verification of an applicant’s selfdeclaration or self-certification of eligibility 

for, and the correct amount of, medical assistance or child health assistance, if the 

State process for verifying an applicant’s 

self-declaration or self-certification satisfies 

the requirements for such process applicable 


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under regulations promulgated by the Secretary or otherwise approved by the Secretary. 

(d) OPTION FOR APPLICATION OF DATA FOR

STATES IN FIRST APPLICATION CYCLE UNDER

THE INTERIM FINAL RULE.—After the new 

final rule implementing the PERM requirements in accordance with the requirements 

of subsection (c) is in effect for all States, a 

State for which the PERM requirements 

were first in effect under an interim final 

rule for fiscal year 2007 or under a final rule 

for fiscal year 2008 may elect to accept any 

payment error rate determined in whole or 

in part for the State on the basis of data for 

that fiscal year or may elect to not have any 

payment error rate determined on the basis 

of such data and, instead, shall be treated as 

if fiscal year 2010 or fiscal year 2011 were the 

first fiscal year for which the PERM requirements apply to the State. 

(e) HARMONIZATION OF MEQC AND PERM.— 

(1) REDUCTION OF REDUNDANCIES.—The Secretary shall review the Medicaid Eligibility 

Quality Control (in this subsection referred 

to as the ‘‘MEQC’’) requirements with the 

PERM requirements and coordinate consistent implementation of both sets of requirements, while reducing redundancies. 

(2) STATE OPTION TO APPLY PERM DATA.—A 

State may elect, for purposes of determining 

the erroneous excess payments for medical 

assistance ratio applicable to the State for a 

fiscal year under section 1903(u) of the Social 

Security Act (42 U.S.C. 1396b(u)) to substitute data resulting from the application of 

the PERM requirements to the State after 

the new final rule implementing such requirements is in effect for all States for data 

obtained from the application of the MEQC 

requirements to the State with respect to a 

fiscal year. 

(3) STATE OPTION TO APPLY MEQC DATA.—For 

purposes of satisfying the requirements of 

subpart Q of part 431 of title 42, Code of Federal Regulations, relating to Medicaid eligibility reviews, a State may elect to substitute data obtained through MEQC reviews 

conducted in accordance with section 1903(u) 

of the Social Security Act (42 U.S.C. 1396b(u)) 

for data required for purposes of PERM requirements, but only if the State MEQC reviews are based on a broad, representative 

sample of Medicaid applicants or enrollees in 

the States. 

(f) IDENTIFICATION OF IMPROVED STATE-SPECIFIC SAMPLE SIZES.—The Secretary shall establish State-specific sample sizes for application of the PERM requirements with respect to State child health plans for fiscal 

years beginning with fiscal year 2009, on the 

basis of such information as the Secretary 

determines appropriate. In establishing such 

sample sizes, the Secretary shall, to the 

greatest extent practicable— 

(1) minimize the administrative cost burden on States under Medicaid and CHIP; and 

(2) maintain State flexibility to manage 

such programs. 

SEC. 602. IMPROVING DATA COLLECTION. 

(a) INCREASED APPROPRIATION.—Section 

2109(b)(2) (42 U.S.C. 1397ii(b)(2)) is amended 

by striking ‘‘$10,000,000 for fiscal year 2000’’ 

and inserting ‘‘$20,000,000 for fiscal year 

2009’’. 

(b) USE OF ADDITIONAL FUNDS.—Section 

2109(b) (42 U.S.C. 1397ii(b)), as amended by 

subsection (a), is amended— 

(1) by redesignating paragraph (2) as paragraph (4); and 

(2) by inserting after paragraph (1), the following new paragraphs: 

‘‘(2) ADDITIONAL REQUIREMENTS.—In addition to making the adjustments required to 

produce the data described in paragraph (1), 

with respect to data collection occurring for 

fiscal years beginning with fiscal year 2009, 

in appropriate consultation with the Secretary of Health and Human Services, the 

Secretary of Commerce shall do the following: 

‘‘(A) Make appropriate adjustments to the 

Current Population Survey to develop more 

accurate State-specific estimates of the 

number of children enrolled in health coverage under title XIX or this title. 

‘‘(B) Make appropriate adjustments to the 

Current Population Survey to improve the 

survey estimates used to determine the child 

population growth factor under section 

2104(m)(5)(B) and any other data necessary 

for carrying out this title. 

‘‘(C) Include health insurance survey information in the American Community Survey 

related to children. 

‘‘(D) Assess whether American Community 

Survey estimates, once such survey data are 

first available, produce more reliable estimates than the Current Population Survey 

with respect to the purposes described in 

subparagraph (B). 

‘‘(E) On the basis of the assessment required under subparagraph (D), recommend 

to the Secretary of Health and Human Services whether American Community Survey 

estimates should be used in lieu of, or in 

some combination with, Current Population 

Survey estimates for the purposes described 

in subparagraph (B). 

‘‘(F) Continue making the adjustments described in the last sentence of paragraph (1) 

with respect to expansion of the sample size 

used in State sampling units, the number of 

sampling units in a State, and using an appropriate verification element. 

‘‘(3) AUTHORITY FOR THE SECRETARY OF

HEALTH AND HUMAN SERVICES TO TRANSITION

TO THE USE OF ALL, OR SOME COMBINATION OF, 

ACS ESTIMATES UPON RECOMMENDATION OF THE

SECRETARY OF COMMERCE.—If, on the basis of 

the assessment required under paragraph 

(2)(D), the Secretary of Commerce recommends to the Secretary of Health and 

Human Services that American Community 

Survey estimates should be used in lieu of, 

or in some combination with, Current Population Survey estimates for the purposes described in paragraph (2)(B), the Secretary of 

Health and Human Services, in consultation 

with the States, may provide for a period 

during which the Secretary may transition 

from carrying out such purposes through the 

use of Current Population Survey estimates 

to the use of American Community Survey 

estimates (in lieu of, or in combination with 

the Current Population Survey estimates, as 

recommended), provided that any such transition is implemented in a manner that is designed to avoid adverse impacts upon States 

with approved State child health plans under 

this title.’’. 

SEC. 603. UPDATED FEDERAL EVALUATION OF 

CHIP. 

Section 2108(c) (42 U.S.C. 1397hh(c)) is 

amended by striking paragraph (5) and inserting the following: 

‘‘(5) SUBSEQUENT EVALUATION USING UPDATED INFORMATION.— 

‘‘(A) IN GENERAL.—The Secretary, directly 

or through contracts or interagency agreements, shall conduct an independent subsequent evaluation of 10 States with approved 

child health plans. 

‘‘(B) SELECTION OF STATES AND MATTERS INCLUDED.—Paragraphs (2) and (3) shall apply 

to such subsequent evaluation in the same 

manner as such provisions apply to the evaluation conducted under paragraph (1). 

‘‘(C) SUBMISSION TO CONGRESS.—Not later 

than December 31, 2011, the Secretary shall 

submit to Congress the results of the evaluation conducted under this paragraph. 

‘‘(D) FUNDING.—Out of any money in the 

Treasury of the United States not otherwise 

appropriated, there are appropriated 

$10,000,000 for fiscal year 2010 for the purpose 

of conducting the evaluation authorized 

under this paragraph. Amounts appropriated 

under this subparagraph shall remain available for expenditure through fiscal year 

2012.’’. 

SEC. 604. ACCESS TO RECORDS FOR IG AND GAO 

AUDITS AND EVALUATIONS. 

Section 2108(d) (42 U.S.C. 1397hh(d)) is 

amended to read as follows: 

‘‘(d) ACCESS TO RECORDS FOR IG AND GAO 

AUDITS AND EVALUATIONS.—For the purpose 

of evaluating and auditing the program established under this title, or title XIX, the 

Secretary, the Office of Inspector General, 

and the Comptroller General shall have access to any books, accounts, records, correspondence, and other documents that are 

related to the expenditure of Federal funds 

under this title and that are in the possession, custody, or control of States receiving 

Federal funds under this title or political 

subdivisions thereof, or any grantee or contractor of such States or political subdivisions.’’. 

SEC. 605. NO FEDERAL FUNDING FOR ILLEGAL 

ALIENS. 

Nothing in this Act allows Federal payment for individuals who are not lawfully residing in the United States. Titles XI, XIX, 

and XXI of the Social Security Act provide 

for the disallowance of Federal financial participation for erroneous expenditures under 

Medicaid and under CHIP, respectively. 

Subtitle B—Miscellaneous Health Provisions 

SEC. 611. DEFICIT REDUCTION ACT TECHNICAL 

CORRECTIONS. 

(a) CLARIFICATION OF REQUIREMENT TO PROVIDE EPSDT SERVICES FOR ALL CHILDREN IN

BENCHMARK BENEFIT PACKAGES UNDER MEDICAID.—Section 1937(a)(1) (42 U.S.C. 1396u– 

7(a)(1)), as inserted by section 6044(a) of the 

Deficit Reduction Act of 2005 (Public Law 

109–171, 120 Stat. 88), is amended— 

(1) in subparagraph (A)— 

(A) in the matter before clause (i)— 

(i) by striking ‘‘Notwithstanding any other 

provision of this title’’ and inserting ‘‘Notwithstanding section 1902(a)(1) (relating to 

statewideness), section 1902(a)(10)(B) (relating to comparability) and any other provision of this title which would be directly 

contrary to the authority under this section 

and subject to subsection (E)’’; and 

(ii) by striking ‘‘enrollment in coverage 

that provides’’ and inserting ‘‘coverage 

that’’; 

(B) in clause (i), by inserting ‘‘provides’’ 

after ‘‘(i)’’; and 

(C) by striking clause (ii) and inserting the 

following: 

‘‘(ii) for any individual described in section 

1905(a)(4)(B) who is eligible under the State 

plan in accordance with paragraphs (10) and 

(17) of section 1902(a), consists of the items 

and services described in section 1905(a)(4)(B) 

(relating to early and periodic screening, diagnostic, and treatment services defined in 

section 1905(r)) and provided in accordance 

with the requirements of section 

1902(a)(43).’’; 

(2) in subparagraph (C)— 

(A) in the heading, by striking ‘‘wraparound’’ and inserting ‘‘additional’’; and 

(B) by striking ‘‘wrap-around or’’; and 

(3) by adding at the end the following new 

subparagraph: 

‘‘(E) RULE OF CONSTRUCTION.—Nothing in 

this paragraph shall be construed as— 

‘‘(i) requiring a State to offer all or any of 

the items and services required by subparagraph (A)(ii) through an issuer of benchmark 

coverage described in subsection (b)(1) or 

benchmark equivalent coverage described in 

subsection (b)(2); 

‘‘(ii) preventing a State from offering all or 

any of the items and services required by 


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subparagraph (A)(ii) through an issuer of 

benchmark coverage described in subsection 

(b)(1) or benchmark equivalent coverage described in subsection (b)(2); or 

‘‘(iii) affecting a child’s entitlement to 

care and services described in subsections 

(a)(4)(B) and (r) of section 1905 and provided 

in accordance with section 1902(a)(43) whether provided through benchmark coverage, 

benchmark equivalent coverage, or otherwise.’’. 

(b) CORRECTION OF REFERENCE TO CHILDREN

IN FOSTER CARE RECEIVING CHILD WELFARE

SERVICES.—Section 1937(a)(2)(B)(viii) (42 

U.S.C. 1396u–7(a)(2)(B)(viii)), as inserted by 

section 6044(a) of the Deficit Reduction Act 

of 2005, is amended by striking ‘‘aid or assistance is made available under part B of title 

IV to children in foster care and individuals’’ 

and inserting ‘‘child welfare services are 

made available under part B of title IV on 

the basis of being a child in foster care or’’. 

(c) TRANSPARENCY.—Section 1937 (42 U.S.C. 

1396u–7), as inserted by section 6044(a) of the 

Deficit Reduction Act of 2005, is amended by 

adding at the end the following: 

‘‘(c) PUBLICATION OF PROVISIONS AFFECTED.—With respect to a State plan 

amendment to provide benchmark benefits 

in accordance with subsections (a) and (b) 

that is approved by the Secretary, the Secretary shall publish on the Internet website 

of the Centers for Medicare & Medicaid Services, a list of the provisions of this title that 

the Secretary has determined do not apply in 

order to enable the State to carry out the 

plan amendment and the reason for each 

such determination on the date such approval is made, and shall publish such list in 

the Federal Register and not later than 30 

days after such date of approval.’’. 

(d) EFFECTIVE DATE.—The amendments 

made by subsections (a), (b), and (c) of this 

section shall take effect as if included in the 

amendment made by section 6044(a) of the 

Deficit Reduction Act of 2005. 

SEC. 612. REFERENCES TO TITLE XXI. 

Section 704 of the Medicare, Medicaid, and 

SCHIP Balanced Budget Refinement Act of 

1999, as enacted into law by division B of 

Public Law 106–113 (113 Stat. 1501A–402) is repealed. 

SEC. 613. PROHIBITING INITIATION OF NEW 

HEALTH OPPORTUNITY ACCOUNT 

DEMONSTRATION PROGRAMS. 

After the date of the enactment of this 

Act, the Secretary of Health and Human 

Services may not approve any new demonstration programs under section 1938 of 

the Social Security Act (42 U.S.C. 1396u–8). 

SEC. 614. ADJUSTMENT IN COMPUTATION OF 

MEDICAID FMAP TO DISREGARD AN 

EXTRAORDINARY EMPLOYER PENSION CONTRIBUTION. 

(a) IN GENERAL.—Only for purposes of computing the FMAP (as defined in subsection 

(e)) for a State for a fiscal year (beginning 

with fiscal year 2006) and applying the FMAP 

under title XIX of the Social Security Act, 

any significantly disproportionate employer 

pension or insurance fund contribution described in subsection (b) shall be disregarded 

in computing the per capita income of such 

State, but shall not be disregarded in computing the per capita income for the continental United States (and Alaska) and Hawaii. 

(b) SIGNIFICANTLY DISPROPORTIONATE EMPLOYER PENSION AND INSURANCE FUND CONTRIBUTION.— 

(1) IN GENERAL.—For purposes of this section, a significantly disproportionate employer pension and insurance fund contribution described in this subsection with respect 

to a State is any identifiable employer contribution towards pension or other employee 

insurance funds that is estimated to accrue 

to residents of such State for a calendar year 

(beginning with calendar year 2003) if the increase in the amount so estimated exceeds 25 

percent of the total increase in personal income in that State for the year involved. 

(2) DATA TO BE USED.—For estimating and 

adjustment a FMAP already calculated as of 

the date of the enactment of this Act for a 

State with a significantly disproportionate 

employer pension and insurance fund contribution, the Secretary shall use the personal income data set originally used in calculating such FMAP. 

(3) SPECIAL ADJUSTMENT FOR NEGATIVE

GROWTH.—If in any calendar year the total 

personal income growth in a State is negative, an employer pension and insurance fund 

contribution for the purposes of calculating 

the State’s FMAP for a calendar year shall 

not exceed 125 percent of the amount of such 

contribution for the previous calendar year 

for the State. 

(c) HOLD HARMLESS.—No State shall have 

its FMAP for a fiscal year reduced as a result of the application of this section. 

(d) REPORT.—Not later than May 15, 2009, 

the Secretary shall submit to the Congress a 

report on the problems presented by the current treatment of pension and insurance 

fund contributions in the use of Bureau of 

Economic Affairs calculations for the FMAP 

and for Medicaid and on possible alternative 

methodologies to mitigate such problems. 

(e) FMAP DEFINED.—For purposes of this 

section, the term ‘‘FMAP’’ means the Federal medical assistance percentage, as defined in section 1905(b) of the Social Security 

Act (42 U.S.C. 1396(d)). 

SEC. 615. CLARIFICATION TREATMENT OF REGIONAL MEDICAL CENTER. 

(a) IN GENERAL.—Nothing in section 1903(w) 

of the Social Security Act (42 U.S.C. 

1396b(w)) shall be construed by the Secretary 

of Health and Human Services as prohibiting 

a State’s use of funds as the non-Federal 

share of expenditures under title XIX of such 

Act where such funds are transferred from or 

certified by a publicly-owned regional medical center located in another State and described in subsection (b), so long as the Secretary determines that such use of funds is 

proper and in the interest of the program 

under title XIX. 

(b) CENTER DESCRIBED.—A center described 

in this subsection is a publicly-owned regional medical center that— 

(1) provides level 1 trauma and burn care 

services; 

(2) provides level 3 neonatal care services; 

(3) is obligated to serve all patients, regardless of ability to pay; 

(4) is located within a Standard Metropolitan Statistical Area (SMSA) that includes at 

least 3 States; 

(5) provides services as a tertiary care provider for patients residing within a 125-mile 

radius; and 

(6) meets the criteria for a disproportionate share hospital under section 1923 of 

such Act (42 U.S.C. 1396r–4) in at least one 

State other than the State in which the center is located. 

SEC. 616. EXTENSION OF MEDICAID DSH ALLOTMENTS FOR TENNESSEE AND HAWAII. 

Section 1923(f)(6) (42 U.S.C. 1396r–4(f)(6)), as 

amended by section 202 of the Medicare Improvements for Patients and Providers Act 

of 2008 (Public Law 110–275) is amended— 

(1) in the paragraph heading, by striking 

‘‘2009 AND THE FIRST CALENDAR QUARTER OF

FISCAL YEAR 2010’’ and inserting ‘‘2011 AND THE

FIRST CALENDAR QUARTER OF FISCAL YEAR

2012’’; 

(2) in subparagraph (A)— 

(A) in clause (i)— 

(i) in the second sentence— 

(I) by striking ‘‘and 2009’’ and inserting ‘‘, 

2009, 2010, and 2011’’; and 

(II) by striking ‘‘such portion of’’; and 

(ii) in the third sentence, by striking ‘‘2010 

for the period ending on December 31, 2009’’ 

and inserting ‘‘2012 for the period ending on 

December 31, 2011’’; 

(B) in clause (ii), by striking ‘‘or for a period in fiscal year 2010’’ and inserting ‘‘2010, 

2011, or for period in fiscal year 2012’’; and 

(C) in clause (iv)— 

(i) in the clause heading, by striking ‘‘2009

AND THE FIRST CALENDAR QUARTER OF FISCAL

YEAR 2010’’ and inserting ‘‘2011 AND THE FIRST

CALENDAR QUARTER OF FISCAL YEAR 2012’’; and 

(ii) in each of subclauses (I) and (II), by 

striking ‘‘ or for a period in fiscal year 2010’’ 

and inserting ‘‘2010, 2011, or for a period in 

fiscal year 2012’’; and 

(3) in subparagraph (B)— 

(A) in clause (i)— 

(i) in the first sentence, by striking ‘‘2009’’ 

and inserting ‘‘2011’’; and 

(ii) in the second sentence, by striking 

‘‘2010 for the period ending on December 31, 

2009’’ and inserting ‘‘2012 for the period ending on December 31, 2011’’. 

Subtitle C—Other Provisions 

SEC. 621. OUTREACH REGARDING HEALTH INSURANCE OPTIONS AVAILABLE TO 

CHILDREN. 

(a) DEFINITIONS.—In this section— 

(1) the terms ‘‘Administration’’ and ‘‘Administrator’’ means the Small Business Administration and the Administrator thereof, 

respectively; 

(2) the term ‘‘certified development company’’ means a development company participating in the program under title V of 

the Small Business Investment Act of 1958 

(15 U.S.C. 695 et seq.); 

(3) the term ‘‘Medicaid program’’ means 

the program established under title XIX of 

the Social Security Act (42 U.S.C. 1396 et 

seq.); 

(4) the term ‘‘Service Corps of Retired Executives’’ means the Service Corps of Retired 

Executives authorized by section 8(b)(1) of 

the Small Business Act (15 U.S.C. 637(b)(1)); 

(5) the term ‘‘small business concern’’ has 

the meaning given that term in section 3 of 

the Small Business Act (15 U.S.C. 632); 

(6) the term ‘‘small business development 

center’’ means a small business development 

center described in section 21 of the Small 

Business Act (15 U.S.C. 648); 

(7) the term ‘‘State’’ has the meaning 

given that term for purposes of title XXI of 

the Social Security Act (42 U.S.C. 1397aa et 

seq.); 

(8) the term ‘‘State Children’s Health Insurance Program’’ means the State Children’s Health Insurance Program established 

under title XXI of the Social Security Act 

(42 U.S.C. 1397aa et seq.); 

(9) the term ‘‘task force’’ means the task 

force established under subsection (b)(1); and 

(10) the term ‘‘women’s business center’’ 

means a women’s business center described 

in section 29 of the Small Business Act (15 

U.S.C. 656). 

(b) ESTABLISHMENT OF TASK FORCE.— 

(1) ESTABLISHMENT.—There is established a 

task force to conduct a nationwide campaign 

of education and outreach for small business 

concerns regarding the availability of coverage for children through private insurance 

options, the Medicaid program, and the 

State Children’s Health Insurance Program. 

(2) MEMBERSHIP.—The task force shall consist of the Administrator, the Secretary of 

Health and Human Services, the Secretary of 

Labor, and the Secretary of the Treasury. 

(3) RESPONSIBILITIES.—The campaign conducted under this subsection shall include— 

(A) efforts to educate the owners of small 

business concerns about the value of health 

coverage for children; 

(B) information regarding options available to the owners and employees of small 


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business concerns to make insurance more 

affordable, including Federal and State tax 

deductions and credits for health care-related expenses and health insurance expenses 

and Federal tax exclusion for health insurance options available under employer-sponsored cafeteria plans under section 125 of the 

Internal Revenue Code of 1986; 

(C) efforts to educate the owners of small 

business concerns about assistance available 

through public programs; and 

(D) efforts to educate the owners and employees of small business concerns regarding 

the availability of the hotline operated as 

part of the Insure Kids Now program of the 

Department of Health and Human Services. 

(4) IMPLEMENTATION.—In carrying out this 

subsection, the task force may— 

(A) use any business partner of the Administration, including— 

(i) a small business development center; 

(ii) a certified development company; 

(iii) a women’s business center; and 

(iv) the Service Corps of Retired Executives; 

(B) enter into— 

(i) a memorandum of understanding with a 

chamber of commerce; and 

(ii) a partnership with any appropriate 

small business concern or health advocacy 

group; and 

(C) designate outreach programs at regional offices of the Department of Health 

and Human Services to work with district offices of the Administration. 

(5) WEBSITE.—The Administrator shall ensure that links to information on the eligibility and enrollment requirements for the 

Medicaid program and State Children’s 

Health Insurance Program of each State are 

prominently displayed on the website of the 

Administration. 

(6) REPORT.— 

(A) IN GENERAL.—Not later than 2 years 

after the date of enactment of this Act, and 

every 2 years thereafter, the Administrator 

shall submit to the Committee on Small 

Business and Entrepreneurship of the Senate 

and the Committee on Small Business of the 

House of Representatives a report on the status of the nationwide campaign conducted 

under paragraph (1). 

(B) CONTENTS.—Each report submitted 

under subparagraph (A) shall include a status update on all efforts made to educate 

owners and employees of small business concerns on options for providing health insurance for children through public and private 

alternatives. 

SEC. 622. SENSE OF THE SENATE REGARDING ACCESS TO AFFORDABLE AND MEANINGFUL HEALTH INSURANCE COVERAGE. 

(a) FINDINGS.—The Senate finds the following: 

(1) There are approximately 45 million 

Americans currently without health insurance. 

(2) More than half of uninsured workers are 

employed by businesses with less than 25 employees or are self-employed. 

(3) Health insurance premiums continue to 

rise at more than twice the rate of inflation 

for all consumer goods. 

(4) Individuals in the small group and individual health insurance markets usually pay 

more for similar coverage than those in the 

large group market. 

(5) The rapid growth in health insurance 

costs over the last few years has forced many 

employers, particularly small employers, to 

increase deductibles and co-pays or to drop 

coverage completely. 

(b) SENSE OF THE SENATE.—The Senate— 

(1) recognizes the necessity to improve affordability and access to health insurance 

for all Americans; 

(2) acknowledges the value of building 

upon the existing private health insurance 

market; and 

(3) affirms its intent to enact legislation 

this year that, with appropriate protection 

for consumers, improves access to affordable 

and meaningful health insurance coverage 

for employees of small businesses and individuals by— 

(A) facilitating pooling mechanisms, including pooling across State lines, and 

(B) providing assistance to small businesses and individuals, including financial 

assistance and tax incentives, for the purchase of private insurance coverage. 

SEC. 623. LIMITATION ON MEDICARE EXCEPTION 

TO THE PROHIBITION ON CERTAIN 

PHYSICIAN REFERRALS FOR HOSPITALS. 

(a) IN GENERAL.—Section 1877 (42 U.S.C. 

1395nn) is amended— 

(1) in subsection (d)(2)— 

(A) in subparagraph (A), by striking ‘‘and’’ 

at the end; 

(B) in subparagraph (B), by striking the period at the end and inserting ‘‘; and’’; and 

(C) by adding at the end the following new 

subparagraph: 

‘‘(C) in the case where the entity is a hospital, the hospital meets the requirements of 

paragraph (3)(D).’’; 

(2) in subsection (d)(3)— 

(A) in subparagraph (B), by striking ‘‘and’’ 

at the end; 

(B) in subparagraph (C), by striking the period at the end and inserting ‘‘; and’’; and 

(C) by adding at the end the following new 

subparagraph: 

‘‘(D) the hospital meets the requirements 

described in subsection (i)(1).’’; and 

(3) by adding at the end the following new 

subsection: 

‘‘(i) REQUIREMENTS FOR HOSPITALS TO

QUALIFY FOR RURAL PROVIDER AND HOSPITAL

EXCEPTION TO OWNERSHIP OR INVESTMENT

PROHIBITION.— 

‘‘(1) REQUIREMENTS DESCRIBED.—For purposes of subsection (d)(3)(D), the requirements described in this paragraph for a hospital are as follows: 

‘‘(A) PROVIDER AGREEMENT.—The hospital 

had— 

‘‘(i) physician ownership or investment on 

January 1, 2009; and 

‘‘(ii) a provider agreement under section 

1866 in effect on such date. 

‘‘(B) PROHIBITION ON PHYSICIAN OWNERSHIP

OR INVESTMENT.—The percentage of the total 

value of the ownership or investment interests held in the hospital, or in an entity 

whose assets include the hospital, by physician owners or investors in the aggregate 

does not exceed such percentage as of the 

date of enactment of this subsection. 

‘‘(C) PROHIBITION ON EXPANSION OF FACILITY

CAPACITY.—Except as provided in paragraph 

(3), the number of operating rooms, procedure rooms, and beds of the hospital at any 

time on or after the date of the enactment of 

this subsection are no greater than the number of operating rooms, procedure rooms, and 

beds as of such date. 

‘‘(D) PREVENTING CONFLICTS OF INTEREST.— 

‘‘(i) The hospital submits to the Secretary 

an annual report containing a detailed description of— 

‘‘(I) the identity of each physician owner 

and physician investor and any other owners 

or investors of the hospital; and 

‘‘(II) the nature and extent of all ownership 

and investment interests in the hospital. 

‘‘(ii) The hospital has procedures in place 

to require that any referring physician 

owner or investor discloses to the patient 

being referred, by a time that permits the 

patient to make a meaningful decision regarding the receipt of care, as determined by 

the Secretary— 

‘‘(I) the ownership or investment interest, 

as applicable, of such referring physician in 

the hospital; and 

‘‘(II) if applicable, any such ownership or 

investment interest of the treating physician. 

‘‘(iii) The hospital does not condition any 

physician ownership or investment interests 

either directly or indirectly on the physician 

owner or investor making or influencing referrals to the hospital or otherwise generating business for the hospital. 

‘‘(iv) The hospital discloses the fact that 

the hospital is partially owned by physicians— 

‘‘(I) on any public website for the hospital; 

and 

‘‘(II) in any public advertising for the hospital. 

‘‘(E) ENSURING BONA FIDE OWNERSHIP AND

INVESTMENT.— 

‘‘(i) Any ownership or investment interests 

that the hospital offers to a physician owner 

or investor are not offered on more favorable 

terms than the terms offered to a person who 

is not a physician owner or investor. 

‘‘(ii) The hospital (or any investors in the 

hospital) does not directly or indirectly provide loans or financing for any physician 

owner or investor in the hospital. 

‘‘(iii) The hospital (or any investors in the 

hospital) does not directly or indirectly 

guarantee a loan, make a payment toward a 

loan, or otherwise subsidize a loan, for any 

individual physician owner or investor or 

group of physician owners or investors that 

is related to acquiring any ownership or investment interest in the hospital. 

‘‘(iv) Ownership or investment returns are 

distributed to each owner or investor in the 

hospital in an amount that is directly proportional to the ownership or investment interest of such owner or investor in the hospital. 

‘‘(v) Physician owners and investors do not 

receive, directly or indirectly, any guaranteed receipt of or right to purchase other 

business interests related to the hospital, including the purchase or lease of any property 

under the control of other owners or investors in the hospital or located near the premises of the hospital. 

‘‘(vi) The hospital does not offer a physician owner or investor the opportunity to 

purchase or lease any property under the 

control of the hospital or any other owner or 

investor in the hospital on more favorable 

terms than the terms offered to an individual who is not a physician owner or investor. 

‘‘(F) PATIENT SAFETY.—The hospital has 

the capacity to— 

‘‘(i) provide assessment and initial treatment for patients; and 

‘‘(ii) refer and transfer patients to hospitals with the capability to treat the needs 

of the patient involved. 

‘‘(G) LIMITATION ON APPLICATION TO CERTAIN

CONVERTED FACILITIES.—The hospital was not 

converted from an ambulatory surgical center to a hospital on or after the date of enactment of this subsection. 

‘‘(2) PUBLICATION OF INFORMATION REPORTED.—The Secretary shall publish, and 

update on an annual basis, the information 

submitted by hospitals under paragraph 

(1)(D)(i) on the public Internet website of the 

Centers for Medicare & Medicaid Services. 

‘‘(3) EXCEPTION TO PROHIBITION ON EXPANSION OF FACILITY CAPACITY.— 

‘‘(A) PROCESS.— 

‘‘(i) ESTABLISHMENT.—The Secretary shall 

establish and implement a process under 

which an applicable hospital (as defined in 

subparagraph (E)) may apply for an exception from the requirement under paragraph 

(1)(C). 


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January 14, 2009 CONGRESSIONAL RECORD — HOUSE H243 

‘‘(ii) OPPORTUNITY FOR COMMUNITY INPUT.— 

The process under clause (i) shall provide individuals and entities in the community in 

which the applicable hospital applying for an 

exception is located with the opportunity to 

provide input with respect to the application. 

‘‘(iii) TIMING FOR IMPLEMENTATION.—The 

Secretary shall implement the process under 

clause (i) on July 1, 2010. 

‘‘(iv) REGULATIONS.—Not later than June 1, 

2010, the Secretary shall promulgate regulations to carry out the process under clause 

(i). 

‘‘(B) FREQUENCY.—The process described in 

subparagraph (A) shall permit an applicable 

hospital to apply for an exception up to once 

every 2 years. 

‘‘(C) PERMITTED INCREASE.— 

‘‘(i) IN GENERAL.—Subject to clause (ii) and 

subparagraph (D), an applicable hospital 

granted an exception under the process described in subparagraph (A) may increase the 

number of operating rooms, procedure 

rooms, and beds of the applicable hospital 

above the baseline number of operating 

rooms, procedure rooms, and beds of the applicable hospital (or, if the applicable hospital has been granted a previous exception 

under this paragraph, above the number of 

operating rooms, procedure rooms, and beds 

of the hospital after the application of the 

most recent increase under such an exception). 

‘‘(ii) 100 PERCENT INCREASE LIMITATION.— 

The Secretary shall not permit an increase 

in the number of operating rooms, procedure 

rooms, and beds of an applicable hospital 

under clause (i) to the extent such increase 

would result in the number of operating 

rooms, procedure rooms, and beds of the applicable hospital exceeding 200 percent of the 

baseline number of operating rooms, procedure rooms, and beds of the applicable hospital. 

‘‘(iii) BASELINE NUMBER OF OPERATING

ROOMS, PROCEDURE ROOMS, AND BEDS.—In this 

paragraph, the term ‘baseline number of operating rooms, procedure rooms, and beds’ 

means the number of operating rooms, procedure rooms, and beds of the applicable hospital as of the date of enactment of this subsection. 

‘‘(D) INCREASE LIMITED TO FACILITIES ON

THE MAIN CAMPUS OF THE HOSPITAL.—Any increase in the number of operating rooms, 

procedure rooms, and beds of an applicable 

hospital pursuant to this paragraph may 

only occur in facilities on the main campus 

of the applicable hospital. 

‘‘(E) APPLICABLE HOSPITAL.—In this paragraph, the term ‘applicable hospital’ means a 

hospital— 

‘‘(i) that is located in a county in which 

the percentage increase in the population 

during the most recent 5-year period (as of 

the date of the application under subparagraph (A)) is at least 150 percent of the percentage increase in the population growth of 

the State in which the hospital is located 

during that period, as estimated by Bureau 

of the Census and available to the Secretary; 

‘‘(ii) whose annual percent of total inpatient admissions that represent inpatient admissions under the program under title XIX 

is equal to or greater than the average percent with respect to such admissions for all 

hospitals located in the county in which the 

hospital is located; 

‘‘(iii) that does not discriminate against 

beneficiaries of Federal health care programs and does not permit physicians practicing at the hospital to discriminate against 

such beneficiaries; 

‘‘(iv) that is located in a State in which the 

average bed capacity in the State is less 

than the national average bed capacity; and 

‘‘(v) that has an average bed occupancy 

rate that is greater than the average bed occupancy rate in the State in which the hospital is located. 

‘‘(F) PROCEDURE ROOMS.—In this subsection, the term ‘procedure rooms’ includes 

rooms in which catheterizations, 

angiographies, angiograms, and endoscopies 

are performed, except such term shall not include emergency rooms or departments (exclusive of rooms in which catheterizations, 

angiographies, angiograms, and endoscopies 

are performed). 

‘‘(G) PUBLICATION OF FINAL DECISIONS.—Not 

later than 60 days after receiving a complete 

application under this paragraph, the Secretary shall publish in the Federal Register 

the final decision with respect to such application. 

‘‘(H) LIMITATION ON REVIEW.—There shall be 

no administrative or judicial review under 

section 1869, section 1878, or otherwise of the 

process under this paragraph (including the 

establishment of such process). 

‘‘(4) COLLECTION OF OWNERSHIP AND INVESTMENT INFORMATION.—For purposes of subparagraphs (A)(i) and (B) of paragraph (1), 

the Secretary shall collect physician ownership and investment information for each 

hospital. 

‘‘(5) PHYSICIAN OWNER OR INVESTOR DEFINED.—For purposes of this subsection, the 

term ‘physician owner or investor’ means a 

physician (or an immediate family member 

of such physician) with a direct or an indirect ownership or investment interest in the 

hospital. 

‘‘(6) PATIENT SAFETY REQUIREMENT.—In the 

case of a hospital to which the requirements 

of paragraph (1) apply, insofar as the hospital described in this subsection admits a 

patient and does not have any physician 

available on the premises to provide services 

during all hours in which the hospital is providing services to such patient, before admitting the patient— 

‘‘(A) the hospital shall disclose such fact to 

a patient; and 

‘‘(B) following such disclosure, the hospital 

shall receive from the patient a signed acknowledgment that the patient understands 

such fact. 

‘‘(7) CLARIFICATION.—Nothing in this subsection shall be construed as preventing the 

Secretary from revoking a hospital’s provider agreement if not in compliance with 

regulations implementing section 1866.’’. 

(b) ENFORCEMENT.— 

(1) ENSURING COMPLIANCE.—The Secretary 

of Health and Human Services shall establish 

policies and procedures to ensure compliance 

with the requirements described in subsections (i)(1) and (i)(7) of section 1877 of the 

Social Security Act, as added by subsection 

(a)(3), beginning on the date such requirements first apply. Such policies and procedures may include unannounced site reviews 

of hospitals. 

(2) AUDITS.—Beginning not later than July 

1, 2011, the Secretary of Health and Human 

Services shall conduct audits to determine if 

hospitals violate the requirements referred 

to in paragraph (1). 

TITLE VII—REVENUE PROVISIONS 

SEC. 701. INCREASE IN EXCISE TAX RATE ON TOBACCO PRODUCTS. 

(a) CIGARS.— 

(1) SMALL CIGARS.—Paragraph (1) of section 

5701(a) of the Internal Revenue Code of 1986 

is amended to read as follows: 

‘‘(1) SMALL CIGARS.—On cigars, weighing 

not more than 3 pounds per thousand, the 

amount determined in accordance with the 

following table: 

‘‘Cigars Removed During Calendar Year— 

Tax Rate 

Per 

Thousand— 

2009 or 2010 ................................... $12.50

2011 or 2012 ................................... $25.00

2013 or 2014 ................................... $37.50

2015 or thereafter ......................... $50.00.’’. 

(2) LARGE CIGARS.—Paragraph (2) of section 

5701(a) of such Code is amended— 

(A) by striking ‘‘20.719 percent (18.063 percent on cigars removed during 2000 or 2001)’’ 

and inserting ‘‘52.4 percent’’, and 

(B) by striking ‘‘$48.75 per thousand ($42.50 

per thousand on cigars removed during 2000 

or 2001)’’ and inserting ‘‘40 cents per cigar’’. 

(b) CIGARETTES.—Section 5701(b) of such 

Code is amended— 

(1) by striking ‘‘$19.50 per thousand ($17 per 

thousand on cigarettes removed during 2000 

or 2001)’’ in paragraph (1) and inserting 

‘‘$50.00 per thousand’’, and 

(2) by striking ‘‘$40.95 per thousand ($35.70 

per thousand on cigarettes removed during 

2000 or 2001)’’ in paragraph (2) and inserting 

‘‘$105.00 per thousand’’. 

(c) CIGARETTE PAPERS.—Section 5701(c) of 

such Code is amended by striking ‘‘1.22 cents 

(1.06 cents on cigarette papers removed during 2000 or 2001)’’ and inserting ‘‘3.13 cents’’. 

(d) CIGARETTE TUBES.—Section 5701(d) of 

such Code is amended by striking ‘‘2.44 cents 

(2.13 cents on cigarette tubes removed during 

2000 or 2001)’’ and inserting ‘‘6.26 cents’’. 

(e) SMOKELESS TOBACCO.—Section 5701(e) of 

such Code is amended— 

(1) by striking ‘‘58.5 cents (51 cents on snuff 

removed during 2000 or 2001)’’ in paragraph 

(1) and inserting ‘‘$1.50’’, and 

(2) by striking ‘‘19.5 cents (17 cents on 

chewing tobacco removed during 2000 or 

2001)’’ in paragraph (2) and inserting ‘‘50 

cents’’. 

(f) PIPE TOBACCO.—Section 5701(f) of such 

Code is amended by striking ‘‘$1.0969 cents 

(95.67 cents on pipe tobacco removed during 

2000 or 2001)’’ and inserting ‘‘$2.8126’’. 


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H244 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

(g) ROLL-YOUR-OWN TOBACCO.—Section 

5701(g) of such Code is amended by striking 

‘‘$1.0969 cents (95.67 cents on roll-your-own 

tobacco removed during 2000 or 2001)’’ and inserting ‘‘$24.62’’. 

(h) FLOOR STOCKS TAXES.— 

(1) IMPOSITION OF TAX.—On tobacco products (other than cigars described in section 

5701(a)(2) of the Internal Revenue Code of 

1986) and cigarette papers and tubes manufactured in or imported into the United 

States which are removed before any tax increase date and held on such date for sale by 

any person, there is hereby imposed a tax in 

an amount equal to the excess of— 

(A) the tax which would be imposed under 

section 5701 of such Code on the article if the 

article had been removed on such date, over 

(B) the prior tax (if any) imposed under 

section 5701 of such Code on such article. 

(2) CREDIT AGAINST TAX.—Each person shall 

be allowed as a credit against the taxes imposed by paragraph (1) an amount equal to 

$500. Such credit shall not exceed the 

amount of taxes imposed by paragraph (1) on 

such date, for which such person is liable. 

(3) LIABILITY FOR TAX AND METHOD OF PAYMENT.— 

(A) LIABILITY FOR TAX.—A person holding 

tobacco products, cigarette papers, or cigarette tubes on any tax increase date, to 

which any tax imposed by paragraph (1) applies shall be liable for such tax. 

(B) METHOD OF PAYMENT.—The tax imposed 

by paragraph (1) shall be paid in such manner as the Secretary shall prescribe by regulations. 

(C) TIME FOR PAYMENT.— 

(i) IN GENERAL.—The tax imposed by paragraph (1) shall be paid on or before August 1, 

2009. 

(ii) SPECIAL RULE FOR SMALL CIGARS.—In 

the case of small cigars, the tax imposed by 

paragraph (1) on or after January 1, 2011, 

shall be paid on or before April 1 following 

any tax increase date. 

(4) ARTICLES IN FOREIGN TRADE ZONES.— 

Notwithstanding the Act of June 18, 1934 

(commonly known as the Foreign Trade 

Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.) 

or any other provision of law, any article 

which is located in a foreign trade zone on 

any tax increase date shall be subject to the 

tax imposed by paragraph (1) if— 

(A) internal revenue taxes have been determined, or customs duties liquidated, with respect to such article before such date pursuant to a request made under the 1st proviso 

of section 3(a) of such Act, or 

(B) such article is held on such date under 

the supervision of an officer of the United 

States Customs and Border Protection of the 

Department of Homeland Security pursuant 

to the 2d proviso of such section 3(a). 

(5) DEFINITIONS.—For purposes of this subsection— 

(A) IN GENERAL.—Any term used in this 

subsection which is also used in section 5702 

of the Internal Revenue Code of 1986 shall 

have the same meaning as such term has in 

such section. 

(B) TAX INCREASE DATE.—The term ‘‘tax increase date’’ means April 1, 2009, January 1, 

2011, January 1, 2013, and January 1, 2015. 

(C) SECRETARY.—The term ‘‘Secretary’’ 

means the Secretary of the Treasury or the 

Secretary’s delegate. 

(6) CONTROLLED GROUPS.—Rules similar to 

the rules of section 5061(e)(3) of such Code 

shall apply for purposes of this subsection. 

(7) OTHER LAWS APPLICABLE.—All provisions of law, including penalties, applicable 

with respect to the taxes imposed by section 

5701 of such Code shall, insofar as applicable 

and not inconsistent with the provisions of 

this subsection, apply to the floor stocks 

taxes imposed by paragraph (1), to the same 

extent as if such taxes were imposed by such 

section 5701. The Secretary may treat any 

person who bore the ultimate burden of the 

tax imposed by paragraph (1) as the person 

to whom a credit or refund under such provisions may be allowed or made. 

(i) EFFECTIVE DATE.—The amendments 

made by this section shall apply to articles 

removed (as defined in section 5702(j) of the 

Internal Revenue Code of 1986) after March 

31, 2009. 

SEC. 702. ADMINISTRATIVE IMPROVEMENTS. 

(a) PERMIT, INVENTORIES, REPORTS, AND

RECORDS REQUIREMENTS FOR MANUFACTURERS

AND IMPORTERS OF PROCESSED TOBACCO.— 

(1) PERMIT.— 

(A) APPLICATION.—Section 5712 of the Internal Revenue Code of 1986 is amended by 

inserting ‘‘or processed tobacco’’ after ‘‘tobacco products’’. 

(B) ISSUANCE.—Section 5713(a) of such Code 

is amended by inserting ‘‘or processed tobacco’’ after ‘‘tobacco products’’. 

(2) INVENTORIES, REPORTS, AND PACKAGES.— 

(A) INVENTORIES.—Section 5721 of such 

Code is amended by inserting ‘‘, processed tobacco,’’ after ‘‘tobacco products’’. 

(B) REPORTS.—Section 5722 of such Code is 

amended by inserting ‘‘, processed tobacco,’’ 

after ‘‘tobacco products’’. 

(C) PACKAGES, MARKS, LABELS, AND NOTICES.—Section 5723 of such Code is amended 

by inserting ‘‘, processed tobacco,’’ after ‘‘tobacco products’’ each place it appears. 

(3) RECORDS.—Section 5741 of such Code is 

amended by inserting ‘‘, processed tobacco,’’ 

after ‘‘tobacco products’’. 

(4) MANUFACTURER OF PROCESSED TOBACCO.—Section 5702 of such Code is amended 

by adding at the end the following new subsection: 

‘‘(p) MANUFACTURER OF PROCESSED TOBACCO.— 

‘‘(1) IN GENERAL.—The term ‘manufacturer 

of processed tobacco’ means any person who 

processes any tobacco other than tobacco 

products. 

‘‘(2) PROCESSED TOBACCO.—The processing 

of tobacco shall not include the farming or 

growing of tobacco or the handling of tobacco solely for sale, shipment, or delivery 

to a manufacturer of tobacco products or 

processed tobacco.’’. 

(5) CONFORMING AMENDMENT.—Sections 

5702(j), 5702(k), and 5704(h) of such Code is 

amended by inserting ‘‘, or any processed tobacco,’’ after ‘‘nontaxpaid tobacco products 

or cigarette papers or tubes’’. 

(6) EFFECTIVE DATE.—The amendments 

made by this subsection shall take effect on 

April 1, 2009. 

(b) BASIS FOR DENIAL, SUSPENSION, OR REVOCATION OF PERMITS.— 

(1) DENIAL.—Paragraph (3) of section 5712 

of such Code is amended to read as follows: 

‘‘(3) such person (including, in the case of 

a corporation, any officer, director, or principal stockholder and, in the case of a partnership, a partner)— 

‘‘(A) is, by reason of his business experience, financial standing, or trade connections or by reason of previous or current 

legal proceedings involving a felony violation of any other provision of Federal criminal law relating to tobacco products, processed tobacco, cigarette paper, or cigarette 

tubes, not likely to maintain operations in 

compliance with this chapter, 

‘‘(B) has been convicted of a felony violation of any provision of Federal or State 

criminal law relating to tobacco products, 

processed tobacco, cigarette paper, or cigarette tubes, or 

‘‘(C) has failed to disclose any material information required or made any material 

false statement in the application therefor.’’. 

(2) SUSPENSION OR REVOCATION.—Subsection 

(b) of section 5713 of such Code is amended to 

read as follows: 

‘‘(b) SUSPENSION OR REVOCATION.— 

‘‘(1) SHOW CAUSE HEARING.—If the Secretary 

has reason to believe that any person holding a permit— 

‘‘(A) has not in good faith complied with 

this chapter, or with any other provision of 

this title involving intent to defraud, 

‘‘(B) has violated the conditions of such 

permit, 

‘‘(C) has failed to disclose any material information required or made any material 

false statement in the application for such 

permit, 

‘‘(D) has failed to maintain his premises in 

such manner as to protect the revenue, 

‘‘(E) is, by reason of previous or current 

legal proceedings involving a felony violation of any other provision of Federal criminal law relating to tobacco products, processed tobacco, cigarette paper, or cigarette 

tubes, not likely to maintain operations in 

compliance with this chapter, or 

‘‘(F) has been convicted of a felony violation of any provision of Federal or State 

criminal law relating to tobacco products, 

processed tobacco, cigarette paper, or cigarette tubes, 

the Secretary shall issue an order, stating 

the facts charged, citing such person to show 

cause why his permit should not be suspended or revoked. 

‘‘(2) ACTION FOLLOWING HEARING.—If, after 

hearing, the Secretary finds that such person 

has not shown cause why his permit should 

not be suspended or revoked, such permit 

shall be suspended for such period as the Secretary deems proper or shall be revoked.’’. 

(3) EFFECTIVE DATE.—The amendments 

made by this subsection shall take effect on 

the date of the enactment of this Act. 

(c) APPLICATION OF INTERNAL REVENUE

CODE STATUTE OF LIMITATIONS FOR ALCOHOL

AND TOBACCO EXCISE TAXES.— 

(1) IN GENERAL.—Section 514(a) of the Tariff Act of 1930 (19 U.S.C. 1514(a)) is amended 

by striking ‘‘and section 520 (relating to refunds)’’ and inserting ‘‘section 520 (relating 

to refunds), and section 6501 of the Internal 

Revenue Code of 1986 (but only with respect 

to taxes imposed under chapters 51 and 52 of 

such Code)’’. 

(2) EFFECTIVE DATE.—The amendment 

made by this subsection shall apply to articles imported after the date of the enactment of this Act. 

(d) EXPANSION OF DEFINITION OF ROLLYOUR-OWN TOBACCO.— 

(1) IN GENERAL.—Section 5702(o) of the Internal Revenue Code of 1986 is amended by 

inserting ‘‘or cigars, or for use as wrappers 

thereof’’ before the period at the end. 

(2) EFFECTIVE DATE.—The amendment 

made by this subsection shall apply to articles removed (as defined in section 5702(j) of 

the Internal Revenue Code of 1986) after 

March 31, 2009. 

(e) TIME OF TAX FOR UNLAWFULLY MANUFACTURED TOBACCO PRODUCTS.— 

(1) IN GENERAL.—Section 5703(b)(2) of such 

Code is amended by adding at the end the 

following new subparagraph: 

‘‘(F) SPECIAL RULE FOR UNLAWFULLY MANUFACTURED TOBACCO PRODUCTS.—In the case of 

any tobacco products, cigarette paper, or 

cigarette tubes manufactured in the United 

States at any place other than the premises 

of a manufacturer of tobacco products, cigarette paper, or cigarette tubes that has filed 

the bond and obtained the permit required 

under this chapter, tax shall be due and payable immediately upon manufacture.’’. 

(2) EFFECTIVE DATE.—The amendment 

made by this subsection shall take effect on 

the date of the enactment of this Act. 

(f) DISCLOSURE.— 

(1) IN GENERAL.—Paragraph (1) of section 

6103(o) of such Code is amended by designating the text as subparagraph (A), moving 


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January 14, 2009 CONGRESSIONAL RECORD — HOUSE H245 

such text 2 ems to the right, striking ‘‘Returns’’ and inserting ‘‘(A) IN GENERAL.—Returns’’, and by inserting after subparagraph 

(A) (as so redesignated) the following new 

subparagraph: 

‘‘(B) USE IN CERTAIN PROCEEDINGS.—Returns and return information disclosed to a 

Federal agency under subparagraph (A) may 

be used in an action or proceeding (or in 

preparation for such action or proceeding) 

brought under section 625 of the American 

Jobs Creation Act of 2004 for the collection 

of any unpaid assessment or penalty arising 

under such Act.’’. 

(2) CONFORMING AMENDMENT.—Section 

6103(p)(4) of such Code is amended by striking ‘‘(o)(1)’’ both places it appears and inserting ‘‘(o)(1)(A)’’. 

(3) EFFECTIVE DATE.—The amendments 

made by this subsection shall apply on or 

after the date of the enactment of this Act. 

(g) TRANSITIONAL RULE.—Any person who— 

(1) on April 1 is engaged in business as a 

manufacturer of processed tobacco or as an 

importer of processed tobacco, and 

(2) before the end of the 90-day period beginning on such date, submits an application 

under subchapter B of chapter 52 of such 

Code to engage in such business, may, notwithstanding such subchapter B, continue to 

engage in such business pending final action 

on such application. Pending such final action, all provisions of such chapter 52 shall 

apply to such applicant in the same manner 

and to the same extent as if such applicant 

were a holder of a permit under such chapter 

52 to engage in such business. 

SEC. 703. TREASURY STUDY CONCERNING MAGNITUDE OF TOBACCO SMUGGLING 

IN THE UNITED STATES. 

Not later than one year after the date of 

the enactment of this Act, the Secretary of 

the Treasury shall conduct a study concerning the magnitude of tobacco smuggling 

in the United States and submit to Congress 

recommendations for the most effective 

steps to reduce tobacco smuggling. Such 

study shall also include a review of the loss 

of Federal tax receipts due to illicit tobacco 

trade in the United States and the role of 

imported tobacco products in the illicit tobacco trade in the United States. 

SEC. 704. TIME FOR PAYMENT OF CORPORATE ESTIMATED TAXES. 

The percentage under subparagraph (C) of 

section 401(1) of the Tax Increase Prevention 

and Reconciliation Act of 2005 in effect on 

the date of the enactment of this Act is increased by 1 percentage point. 

The SPEAKER pro tempore. Pursuant to House Resolution 52, the gentleman from New Jersey (Mr. 

PALLONE), the gentleman from Missouri (Mr. BLUNT), the gentleman from 

New York (Mr. RANGEL), and the gentleman from California (Mr. HERGER) 

each will control 15 minutes. 

The Chair recognizes the gentleman 

from New Jersey. 

GENERAL LEAVE

Mr. PALLONE. Madam Speaker, I 

ask unanimous consent that every 

Member have 5 legislative days in 

which to revise and extend their remarks and include extraneous material 

on the legislation now before us. 

The SPEAKER pro tempore. Is there 

objection to the request of the gentleman from New Jersey? 

There was no objection. 

Mr. PALLONE. Madam Speaker, I 

yield myself 1 minute. 

Madam Speaker, we have been working to reauthorize the Children’s 

Health Insurance Program for the past 

2 years. In the last Congress, we passed 

legislation that enjoyed bipartisan support in both the House and Senate as 

well as the support of the American 

people. Unfortunately, it did not enjoy 

the support of the President, who vetoed our bill not once, but twice, and 

went on to proclaim that uninsured 

children can simply go to the emergency room to have their medical 

needs met. 

But this is a new day in Washington. 

Soon we will have a new President who 

has committed himself to reforming 

our Nation’s health care system so 

every American can access affordable 

and quality health care. The bill we are 

considering today makes a down payment on that promise by putting the 

health and well-being of our children 

first. 

Madam Speaker, this bill will make 

critical improvements to CHIP. There 

will be more resources for States to enroll eligible children. There will be better benefits. As a result, there will be 

11 million children who will have access to the quality health coverage 

they need and deserve. 

b 1230 

The SPEAKER pro tempore. The 

time of the gentleman has expired. 

Mr. PALLONE. Madam Speaker, I 

yield myself another 15 seconds. 

After 2 years of trying to get this bill 

enacted, we are now nearing the finish 

line and with not a moment to spare. 

As the Nation moves deeper into a recession and unemployment rates continue to rise, millions of Americans are 

joining the ranks of the uninsured, 

many of whom are children. We can’t 

delay. We must enact this legislation 

now. 

Madam Speaker, I reserve the balance of my time. 

Mr. BLUNT. Madam Speaker, I yield 

myself 2 minutes. 

As I have returned to a more active 

role in the Energy and Commerce Committee, Madam Speaker, in this Congress, I will say I was surprised not to 

have a markup of this bill. 

We don’t have to reauthorize this 

program until April. Certainly I’m for, 

as almost all the Members are for, a reauthorization of the current program 

and even for discussing how we can 

make that program better. But we 

didn’t have a markup. We didn’t see 

the bill, at least I haven’t seen it, until 

today. And I have concerns about this 

bill. Certainly there are several reasons 

to look at this bill and think we could 

have improved it, bring it to the floor. 

Poor kids first, poor children first 

being served was the reason to have 

SCHIP, for children whose families 

couldn’t afford insurance. This bill 

doesn’t require the States to meet any 

kind of threshold standard that would 

ensure that States were doing everything they could to find kids who needed insurance before they begin to spend 

money to find kids who may not have 

the same need. 

Under the bill several thousands of 

American families would be poor 

enough to qualify for SCHIP and have 

the government pay for their health 

care, but they’d be rich enough to still 

be required to pay the alternative minimum tax. The bill changes welfare 

participation laws by eliminating the 

5-year waiting period for legal immigrants to lawfully reside in the country 

before they can participate in this program. The bill significantly weakens 

provisions in current law requiring 

citizenship verification standards before an individual can be enrolled in 

this particular program. The bill will 

ship 2.4 million privately insured children to a government-run program. 

We think we have a better response. 

While there will be debate about how 

this bill is paid for, the biggest problem 

in the paid-for is in the 10th year, the 

final year, we assume that 65 percent of 

the people who are receiving the benefit—— 

The SPEAKER pro tempore. The 

time of the gentleman has expired. 

Mr. BLUNT. Madam Speaker, I yield 

myself 30 more seconds. 

In the final bill, we assume that 65 

percent of the children receiving the 

benefit wouldn’t get the benefit anymore. 

It seems to me this bill needs more 

work, would have benefited from a 

committee hearing. It doesn’t 

prioritize poor kids to ensure that they 

get health care first. 

I look forward to the debate today. 

Madam Speaker, I reserve the balance of my time. 

Mr. RANGEL. Madam Speaker, I 

yield myself such time as I may consume, and that won’t be long. 

This is a great opportunity for Members who have returned to this Congress, but it’s a better opportunity for 

the new Members. 

I won’t be speaking on this bill because so many people want to be associated with this on our side. And I’m 

convinced it’s not a Republican/Democratic issue. It’s an issue of whether 

the families of 11 million kids are 

going to get health care. You cannot 

say in dollars and cents what it’s 

worth. We had overwhelming support 

in the other Congress. Now we don’t 

have the threat of a veto. 

So I hope that you consider the children and not technical things that 

you’re seeking in perfection. 

Madam Speaker, I yield the balance 

of my time over to PETE STARK, who 

for over a year has attempted to perfect this bill to reach the popularity 

and support it’s gained on both sides of 

the aisle. I thank Chairman WAXMAN

for the work that his committee and 

Mr. DINGELL have made to make certain that we all read from the same 

page. And I look forward to this being 

the beginning where one day this Congress can say that no child will be able 

to say they’re not covered by a decent 

health care program. So by unanimous 

consent I do hope that you will allow 

me to turn the balance of my time and 


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H246 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

my thanks to Chairman STARK, who 

brought us to this point once again. 

The SPEAKER pro tempore. Without 

objection, the gentleman from California will control the time. 

There was no objection. 

Mr. BLUNT. Madam Speaker, I yield 

1 minute to a member of the Health 

Subcommittee of the full committee, 

Mr. SHADEGG from Arizona. 

Mr. SHADEGG. Madam Speaker, this 

is a sad day. It’s a sad day because we 

are about to adopt a radically different 

bill than the bills that were before with 

no hearings and no amendments. I 

would suggest democracy deserves better. 

About an hour ago, the Democratic 

majority leader told the tragic story of 

Deamonte Driver, a 12-year-old Maryland boy who died in 2007 from complications resulting from what started 

as a simple toothache. The majority 

leader used Deamonte’s story to argue 

that we need to expand SCHIP. 

Stunningly, however, Deamonte 

Driver’s story is a story of a government health care program that failed. 

This was a child that went into a government health care program. It failed 

him so miserably, he died. 

Several colleagues on the opposite 

side of the aisle argue that Republicans 

don’t care about health care. That’s 

dead wrong. We care about health care 

for America’s poor and America’s children. What we are against and adamantly against is promising Americans 

health care but failing to live up to 

that promise. That is what this bill 

will do. 

The SPEAKER pro tempore. The 

time of the gentleman has expired. 

Mr. BLUNT. Madam Speaker, I yield 

the gentleman an additional 30 seconds. 

Mr. SHADEGG. The Republican alternative is to give every single American family, every single one, the ability to buy a health care plan of their 

choice, not just the rich, not just the 

poor, but even those who don’t respond 

to a government request that they enroll. We want to put them in a position 

to buy the health care they need by 

their choice from the doctor they 

choose. 

That’s not good enough for the other 

side. They want to expand government 

programs that in the tragic story of 

Deamonte Driver resulted in the death 

of a 12-year-old boy from a problem 

that started as a toothache. 

Mr. PALLONE. Madam Speaker, I 

yield 1 minute to the gentleman from 

California, the chairman of the Energy 

and Commerce Committee (Mr. WAXMAN). 

(Mr. WAXMAN asked and was given 

permission to revise and extend his remarks.) 

Mr. WAXMAN. Madam Speaker, I 

want to thank the gentleman from New 

Jersey, a very able chairman of the 

subcommittee of the Energy and Commerce Committee, for his authorship 

and managing this bill today. 

This is an important bill, and I want 

to commend Chairman Emeritus JOHN

DINGELL for all the work he has done 

on this legislation. 

This bill and everything that’s in it 

has already passed the House in the 

last 2 years; so we’re not talking about 

anything new. What we are talking 

about is legislation that President 

Bush vetoed twice even though there 

was a strong bipartisan majority in the 

House and the Senate to try to get this 

legislation into law. The original program was a bipartisan program adopted 

in 1998, and it’s going to be expiring; so 

we need to reauthorize it. 

This bill is a down payment, a down 

payment on health care for all Americans. But at least we will start covering millions of low-income children, 

children who are right above the poverty line. 

I urge support for the legislation. 

Ten years ago, a Democratic President and 

Republican Congress worked together to pass 

a landmark program to provide health care to 

children who had fallen through the cracks of 

our health care system. 

That program—CHIP—expires in less than 

3 months. This bill extends and improves that 

program and makes the largest investment in 

children’s health since the original CHIP law 

was enacted. 

It provides new outreach tools and bonus 

payments to states that find and enroll these 

children. 

The bill provides a new option to cover 

pregnant women in CHIP. It provides states 

the ability to ensure that children don’t have to 

wait 5 years for health care just because they 

are legal immigrants residing in this country. 

This bill is not the end but the beginning of 

a health reform effort that will ensure all children and all Americans will have health care 

coverage. 

I urge my colleagues to support this bill. 

Let’s send to incoming President Obama legislation that will make all the difference in the 

lives of millions of children across this Nation. 

Mr. BLUNT. Madam Speaker, I yield 

1 minute to the gentleman from Texas, 

Dr. Burgess, who is on our committee 

and on the subcommittee. 

Mr. BURGESS. I thank the gentleman for yielding. 

Madam Speaker, the bill before us 

today is going to harm access to highquality hospital care by prohibiting 

physician ownership of hospitals. 

In past Congresses there have been 

attempts to prohibit physician ownership, and they have been struck down 

due in large part by the recognition of 

many Members of Congress across the 

aisle and on this side that these few 

physician-owned hospitals are doing a 

great job. Patients like going there. 

Physicians and nurses like working 

there. And I will just tell you as someone who has worked in a physicianowned facility, there’s nothing like the 

pride of ownership in helping you deliver first class care. 

The bill before us today will put 

rural Americans at risk. Physicianowned hospitals also provide care in 

many rural areas of this country where 

patients have few health care options. 

The attack on physician-owned hospitals will hurt the economy in a number of States. It’s estimated up to $4 

billion is generated in activity in these 

facilities in eight States in the country 

including my own home State of Texas. 

During this time of economic downturn, it is simply irresponsible to shut 

down a strong stream of economic activity in these States while shutting 

down patient access to care. 

Mr. STARK. Madam Speaker, I am 

delighted to yield 1 minute to the distinguished gentleman from Washington, Dr. MCDERMOTT. 

(Mr. MCDERMOTT asked and was 

given permission to revise and extend 

his remarks.) 

Mr. MCDERMOTT. Madam Speaker, I 

rise in strong support for SCHIP reauthorization legislation, and I want to 

thank Speaker PELOSI for her leadership in bringing this bill to the floor as 

the first bill. 

H.R. 2 clearly says that change has 

arrived for our country and our children. Instead of a veto pen that was 

used last year by the outgoing President to deny health care to children, 

our new President will sign this legislation and in so doing to begin a new 

chapter in America’s commitment to 

its children and our future. 

H.R. 2 is a real down payment on our 

efforts to get universal access to affordable health care for all Americans. 

It builds on a successful model that has 

expanded access to millions of children 

nationwide. 

Health care should be a right, not a 

privilege for the rich in America. This 

legislation affirms the commitment of 

the new Congress to serve all the people, not merely those with means who 

can pay any price for health care while 

the Nation pays a steep price for not 

covering its children. H.R. 2 represents 

an additional 4 million children who 

will get health care. 

It’s time to act, now. 

H.R. 2 means an additional 4 million children will have access to health care. It will 

provide access to preventive health care and 

this alone means America will raise healthier 

children who will grow to become healthier 

and more productive adults. 

The American people have spoken. They 

want a more compassionate response to our 

Nation’s problems. Today, we are voting with 

our heads and hearts to do just that. This is 

not about ideology or party. It is about providing health care to children. H.R. 2 represents real change. 

l am proud to represent a State that took 

the lead on expanded access for children. In 

1994, 3 years before the enactment of the 

original SCHIP, Washington State expanded 

access to children up to 200 percent of the 

Federal poverty level. 

This was a huge commitment and clearly 

my State took the lead. As a result we have 

fewer children uninsured. We have a healthier 

population and more integrated primary care. 

It’s a commitment that worked for all of us in 

the State. 

H.R. 2 recognizes Washington State’s efforts and includes language that will allow the 

State to access a more than $30 million to 

maintain this commitment. H.R. 2 rewards 

States like Washington who knew early on 


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January 14, 2009 CONGRESSIONAL RECORD — HOUSE H247 

that providing quality affordable health care to 

children was a sound and humane investment. 

H.R. 2 will also allow Washington State to 

expand our successful program to cover more 

uninsured children in working families. The bill 

provides greater flexibility and will allow the 

State to meet the needs of our low income 

working families. 

I am also grateful that this legislation includes important access for legal immigrant 

children who are currently denied coverage— 

children who are born in the U.S. and are 

legal U.S. citizens. In Washington State we 

have provided coverage for these children. But 

the State is doing this alone without the full 

partnership of the Federal Government. H.R. 2 

corrects this error and will allow Washington 

State to maintain coverage for more than 

3,000 children. 

Madam Speaker, we need to do the right 

thing. Providing universal coverage for children is an objective that we should all support. 

This legislation takes us one step closer to 

meeting this goal. I urge my colleagues to 

support this bill. 

Mr. BLUNT. Madam Speaker, I yield 

1 minute to the gentleman from Texas, 

a member of the Ways and Means Committee (Mr. CULBERSON). 

Mr. CULBERSON. Madam Speaker, 

the most open, allegedly transparent 

Congress in the history of America has 

begun this session by throwing out a 

bill that may cost upwards of $100 billion over 10 years that was written in 

secret. This bill has never had a committee hearing, not allowed amendments. There are no amendments allowed on the floor of the House. 

No one would consider buying a 

house, buying a car without reading 

the contract; yet you’re asking the 

American people to spend borrowed 

money, up to $100 billion of borrowed 

money—every dollar we spend from 

this day forward is borrowed money— 

asking us to spend up to $100 billion 

over 10 years and not knowing what’s 

in the bill. This is a blind ‘‘yes’’ vote 

for all of you. 

We all support health insurance for 

children, but we must remember the 

$62 trillion of unfunded liability that 

our children and grandchildren are facing today. The money we spend today 

is going to be passed on to future generations, and it’s essential that the 

public be given the right to read these 

bills. This bill was not even posted up 

on the Web site publicly until about 24 

hours ago. What are you afraid of? 

Let the sunshine in and let the public 

read your legislation. 

Mr. PALLONE. Madam Speaker, I 

yield 1 minute to the gentleman from 

Michigan, the chairman emeritus of 

the Energy and Commerce Committee 

(Mr. DINGELL). 

(Mr. DINGELL asked and was given 

permission to revise and extend his remarks.) 

Mr. DINGELL. I thank the gentleman for yielding. 

Madam Speaker, I stand in strong 

support of H.R. 2, the Children’s Health 

Insurance Program Reauthorization 

Act of 2009. This bill was passed twice 

last year by overwhelming votes, with 

the support of large numbers of my Republican colleagues. 

Since its inception CHIP has covered 

more than 7 million children who otherwise would not have had health care. 

H.R. 2 would extend coverage to 4 million more children identically situated. 

Since last year when this bill passed, 

more than 1 million children have lost 

their health coverage because parents 

were laid off and lost employer-based 

coverage. My own State is particularly 

hard hit with over 150,000 uninsured 

children. These children are our treasure and we must see to it that they are 

protected, educated, nurtured, and 

properly fed. 

The bill is only a beginning. I look 

forward to working with the new administration towards reforming our 

health care system. We must not stop 

until all Americans qualify for quality, 

affordable health care. 

I urge my colleagues to vote again 

for the CHIP Reauthorization Act of 

2009. This bill will be signed into law, 

and it will help 4 million kids that 

without this bill would have no health 

care. 

Mr. BLUNT. Madam Speaker, I yield 

1 minute to the gentleman from Michigan, a member of the Health Subcommittee, Mr. ROGERS. 

b 1245 

Mr. ROGERS of Michigan. Madam 

Speaker, we have seen pictures of children on the floor, certainly touched 

our hearts. We have heard stories, I 

think from the new gentleman, the new 

Member from Colorado, who talked 

about the 100,000 kids who are eligible 

and not enrolled. 

But what we haven’t heard today, or 

we haven’t seen, are the faces of hundreds of thousands of senior citizens 

who will be told, when this is signed 

into law, you cannot go get your cancer care. You cannot go get your pain 

care at the hospital of your choice that 

your doctor has referred you to. 

We found one hospital in Washington 

where 90,000 Medicare seniors will not 

be able to get the care that they have 

and the relationship that they have 

with their doctors. We can do better. 

We should not pit kids against seniors. We don’t have to do that. And 

what you say to that family in Colorado is, you may be a family of four 

making $21,000, and we haven’t found 

you yet to get connected to the services you deserve, but we think we are 

going to go out and find that family in 

New Jersey making $80,000. Apparently 

that $80,000 family is more important 

than that Colorado $21,000 family. 

Let’s get our priorities right. Let’s 

not pit kids against seniors. 

I would urge a strong ‘‘no’’ vote 

against the bill. 

ANNOUNCEMENT BY THE SPEAKER PRO TEMPORE

The SPEAKER pro tempore. Members are reminded to heed the gavel 

and conclude their remarks within the 

time yielded. 

Mr. STARK. Madam Speaker, I am 

pleased to recognize the distinguished 

gentleman from Georgia (Mr. LEWIS) 

for 1 minute, and Mr. LEWIS understands that the AARP has endorsed 

this bill. 

Mr. LEWIS of Georgia. Madam 

Speaker, I want to thank the chairman 

for yielding. 

Madam Speaker, at long last we will 

do what is right for our Nation’s poorest children. Today we will expand 

SCHIP to 4 million more children. We 

have a mission, an obligation and a 

mandate to provide health insurance 

for all Americans and now we have a 

Congress and a President who will 

meet that obligation for our children. 

It has taken too long. This Nation 

has been wrong to choose war and 

greed over children and health. Children need our help. They have a right 

to health care. 

Today we will do what is right and 

pass this expansion of SCHIP. 

Mr. BLUNT. Madam Speaker, I yield 

1 minute to the newest member of our 

committee, who is going to add a lot on 

health care issues, Dr. GINGREY from 

Georgia. 

Mr. GINGREY of Georgia. Madam 

Speaker, I rise in opposition to H.R. 2, 

not because of the 4 million children 

expansion, as my colleague from Georgia on the other side of the aisle, the 

distinguished Representative JOHN

LEWIS just said. It’s not that; it’s that 

we are expanding beyond the original 

intent of the bill. And the chairman, 

Mr. WAXMAN, said in his remarks, right 

above the poverty line. 

Indeed, 200 percent of the Federal 

poverty level is the intent of the bill, 

and yet there are States, 13 of them, 

who are using a gimmick called ‘‘income disregard’’ to lower the income of 

a family so that they become eligible, 

not only for this program but for Medicaid. That’s wrong. That’s gaming the 

system. 

If you had allowed a modified open 

rule so that we could have brought 

amendments to correct that and other 

things, then I would certainly be very 

comfortable and enthusiastic in supporting this bill and supporting the expansion. But, no, you wouldn’t allow 

that, so I am going to have to regretfully oppose the bill. 

Mr. PALLONE. Madam Speaker, I 

yield 1 minute to the gentlewoman 

from Colorado, the vice chair of our 

committee, Ms. DEGETTE. 

(Ms. DEGETTE asked and was given 

permission to revise and extend her remarks.) 

Ms. DEGETTE. Madam Speaker, 6 

million children in this country who 

are currently eligible for SCHIP and 

Medicaid do not have health insurance. 

These children’s parents work, but 

they cannot afford to ensure that their 

children have well-child care, and they 

have to resort to the emergency room 

for even the most basic services, like 

treatment for an ear infection. This is 

wrong. 

Today’s bill will help these families, 

but with a number of changes that 

vastly improve the legislation. It allows States to give coverage to pregnant women and people who are here 


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H248 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

legally. It preserves simplified outreach and enrollment procedures. 

Madam Speaker, in the face of the 

current economic downturn, it is even 

more vital that we enact this bill. 

Sharp increases in unemployment are 

adding to the ranks of the uninsured, 

while at the same time State budgets 

are shrinking, and the safety net is 

struggling to meet this increased demand. 

Because, Madam Speaker, we need to 

provide this care for our kids because 

in the most civilized country in the 

world, no child should go without 

health care. 

Mr. BLUNT. Madam Speaker, I yield 

1 minute to the gentlelady from Tennessee (Mrs. BLACKBURN). 

Mrs. BLACKBURN. Madam Speaker, 

you know, it is so interesting as we 

have this debate, SCHIP, as it was 

originally put in place, is something 

that we are all for. That program as a 

block grant program worked well. 

But, Madam Speaker, here is a 285- 

page bill that the Democrat majority 

laid on the table yesterday about 1:00. 

In that bill, it allows for expansion of 

coverage to adults. We know that there 

were over 700,000 adults on this program at some point in 2006. We also 

know I had an amendment that would 

have removed, phased out all non-pregnant adults from this program and that 

amendment was not allowed. 

This bill, this bill, will actually 

crowd out a lot of the low-income children who have benefited from being on 

the SCHIP program, and I find that 

very unfortunate that we will reduce 

the amount of health care available to 

the children of the working poor and 

allow the expansion of adults and middle-income children. 

Mr. STARK. Madam Speaker, I am 

pleased to yield 1 minute to the distinguished gentleman from New Jersey 

(Mr. PASCRELL) who understands that 

many of the adults on the program last 

year were pregnant women. 

Mr. PASCRELL. Madam Speaker, 

you can’t have it both ways. You can’t 

be for it and then you are going to vote 

against it. 

I am listening to the many people on 

the other side. Substance is more important than process. You don’t get it. 

You don’t understand it. 

So I am in strong support as a proud 

cosponsor of the Children’s Health Insurance Program which does reauthorize and is fiscally responsible, reasonable. This is long overdue. 

Ensuring health coverage for our Nation’s children is a critical first step in 

any health reform effort. In fact, it’s 

the least we can do. If we can’t have 

universal care automatically right 

now, then we need to at least take care 

of the children of our country. You say 

you agree with it, then you ought to 

vote for it. 

Taking swift and decisive action on 

this legislation has become critically 

important. As unemployment climbs, 

the ranks of the uninsured swell, and 

the roles of our safety-net programs 

grow. I am particularly proud that this 

bill provides flexibility in determining 

eligibility criteria that makes sense 

for individual States. 

Higher income eligibilities, for example, are 

common sense in States like New Jersey 

where a dollar simply doesn’t go as far. 

In New Jersey, we have set out on an ambitious endeavor to cover every child by July of 

this year, including the 267,000 currently uninsured children in our State. 

It is estimated that as many as 130,000 of 

these children are eligible for FamilyCare, 

New Jersey’s CHIP plan, but are not currently 

enrolled. 

Passing the important legislation that is before us will help States like mine to take the 

steps necessary to ensure that every child has 

access to affordable, quality health care. 

The stakes are bigger now than ever, so it 

is time to cast aside political games and pass 

this bill. 

Mr. BLUNT. Madam Speaker, I yield 

1 minute to the gentleman from Nebraska, a member of our committee, 

Mr. TERRY. 

Mr. TERRY. Madam Speaker, under 

this legislation, physician-owned hospitals would be banned in the future. 

This includes the Bellevue Medical 

Center currently under construction in 

my congressional district. 

This first photo is a view of the finished—this is 48 hours old, this photo 

here, showing a nice steel structure 

and a half-completed building. If this 

bill would pass today, construction on 

this facility has to stop because it’s 40 

percent owned by physicians. The other 

partner in here is a hospital. We have 

two facilities like this in my district. 

Now, not only is it appalling that we 

are going to have to shut down construction on it or else not accept Medicare patients, but the fact is the community that this is being built in is a 

town, it’s incorporated within the 

Omaha area, about 50, 60,000 people and 

also has a base, an Air Force base on it. 

There are no other medical facilities in 

this general area. This will be it, and 

we will be shutting this down. 

Madam Speaker, I rise today in opposition 

to this SCHIP bill. 

Under this legislation, physician-owned hospitals would be banned in the future. This includes the Bellevue Medical Center currently 

under construction in my congressional district. Also, the Midwest Neuroscience Center 

and Nebraska Orthopedic Hospital, which are 

both specialty hospitals that would not be allowed to expand under this legislation. The 

Bellevue Medical Center, to be located at 

Highway 370 and 25th Street in Bellevue, will 

have 60 inpatient and observation beds which 

will all be private rooms. Potential future expansion can allow for additional 60 beds. In 

addition to general medical services, the hospital will provide labor and delivery care, emergency care, inpatient and outpatient surgery 

and intensive care. Facilities will feature stateof-the-art diagnostic services and equipment, 

including a cardiac catheterization lab, radiology, lab testing and pharmacy on premises. 

There will be a medical office building adjacent to hospital which will house patient clinics. 

Construction of the Bellevue Medical Center 

is ongoing. It started late in 2007 and is expected to be completed later this year with a 

total cost of $135 million. Sixty percent of this 

hospital will be owned by the Nebraska Medical Center, which is a community hospital, 

and up to 40 percent of this hospital will be 

owned by community physicians and faculty of 

the University of Nebraska College of Medicine. Unfortunately, under Sec. 623, Bellevue 

Medical Center would have had to have their 

Medicare Agreement signed by January 1, 

2009, in order to be compliant. This is very 

unfortunate for a number of reasons, but none 

larger than the community in which this hospital will serve. 

The location in which the hospital is being 

built is an ideal location for a new hospital 

since there is a population of almost 100,000 

people who can take advantage of it. This 

would include the city of Bellevue, Offutt Air 

Force Base and Plattsmouth. In particular, the 

Bellevue Medical Center would have a strong 

focus on serving the healthcare needs of the 

following military related personnel in the 

Bellevue area: 10,000 active duty personnel, 

20,000 dependents of active duty personnel 

and 11,000 military retirees. 

Bellevue’s other medical facility, Ehrling 

Bergquist Clinic, located at Offutt Air Force 

Base, no longer has inpatient services and 

has limited outpatient services. Operations at 

this clinic include same-day surgery, and urgent care. As a result, the Bellevue Medical 

Center is needed to meet the hospital needs 

of the Offutt community. The Bellevue Medical 

Center will also serve as a training area for Air 

Force physicians, including approximately onethird of the Air Forces’s complement of family 

practice physicians. 

This hospital is also needed to serve the 

fast-growing population of Sarpy county, which 

according to the U.S. Census Bureau, is the 

fastest growing county by population in Nebraska and western Iowa. Nebraska Governor 

Dave Heineman and the Bellevue Chamber of 

Commerce support the Bellevue Medical Center. 

Madam Speaker, this is one of the major 

reasons that I cannot support this legislation 

and will be voting against it today. 

Mr. PALLONE. Madam Speaker, I 

yield 1 minute to the gentlewoman 

from California (Ms. ESHOO). 

Ms. ESHOO. Madam Speaker, I thank 

the chairman of our subcommittee, Mr. 

PALLONE, also Mr. DINGELL, Mr. WAXMAN, and everyone that’s been involved 

in shaping this legislation. 

Senator Hubert Humphrey was very 

fond of saying that a society is measured on how it treats those in the autumn of their lives and how it treats 

those in the spring of their lives. 

Today we rise to honor the young in 

our country with legislation that will 

provide for them what is one of the 

great necessities of life, and that is 

health care. We will not have healthy 

adults in our country unless we have 

healthy children. 

Today we put down a magnificent 

down payment to ensure health care 

for 11 million children in our country. 

This is a smartly drafted bill. Why? Because it is responsible, because it is 

paid for. 

Over 90 percent of the providers are 

private sector. So I think today is not 

only a profound moment in the Congress, but a sacred one. I look forward 


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January 14, 2009 CONGRESSIONAL RECORD — HOUSE H249 

to its passage and what it will do to 

strengthen our country and strengthening our country’s children. 

Mr. BLUNT. Madam Speaker, I yield 

1 minute to the gentleman from Indiana (Mr. BUYER). 

Mr. BUYER. I thank the gentleman 

for yielding. 

Madam Speaker, a lot of my colleagues, some of whom were here in 

1997, voted against the Balanced Budget Act of 1997, actually voted against 

the SCHIP program. 

So you are coming here to the floor 

now accusing Republicans saying if you 

are going to go vote against this you 

are voting against children. 

When we passed this on a bipartisan 

basis, please don’t do that. I am not 

going to come here to the floor and 

say, oh, you were against children because you voted against the Balanced 

Budget Act. So let’s be really accurate 

with regard to our language. 

One thing that does concern me right 

now is when you look at the number of 

adults that are on the SCHIP program, 

every time an adult is in that program, 

over 700,000 of them, it costs more 

money. 

So what we should be doing is saying 

in agreement here SCHIP is a good program. Republicans created the SCHIP 

program. When we worked with Bill 

Clinton in doing welfare reform, we 

said we are going to put people to 

work. We are going to take care of 

those children. 

The States then got all overeager and 

excited in a good economy and expanded the eligibility. 

Now, as the economy turns down, 

now we have President-elect Obama—— 

The SPEAKER pro tempore. The 

time of the gentleman has expired. 

Mr. BLUNT. Madam Speaker, I yield 

the gentleman an additional 30 seconds. 

Mr. BUYER. He is now proposing in 

the stimulus plan to say well, gee, let’s 

go to the Federal Government. We 

don’t want to change our program. 

Let’s go to the Federal Government 

and ask for 200 billion-plus to bail out 

those judgments of the past. 

So what, we are going to stimulate 

the past as now we are going to add to 

exacerbate the problem here on the 

House floor? Let’s stop and pause and 

think about what we are doing here, 

folks. Let’s look at this program to actually cover children. You are about to 

say of the 700,000 adults that are on the 

program, by 2013 we could have over 1.4 

million in the program. 

For every adult that is in this program, we are taking away more money 

that actually could cover children. 

Mr. STARK. Madam Speaker, I am 

delighted to yield 1 minute to the distinguished Congresswoman from Florida (Ms. KOSMAS). 

Ms. KOSMAS. Thank you, Mr. Chairman. 

Madam Speaker, I am pleased today 

to rise, my first time on the floor of 

the House, to speak in favor of the 

State Children’s Health Insurance Program Reauthorization Act. 

This bill, for me, is an opportunity 

for working families in my district to 

provide health care to their children. 

Let me say it again, it’s an opportunity for parents to provide health 

care, working families to provide 

health care for their children. In these 

tough economic times, we have more 

and more families which are unemployed or underemployed, and this 

gives them an opportunity to give their 

children the health care that they need 

and deserve. 

With many of them providing health 

care to their children through emergency rooms, as opposed to having this 

access to quality care, we are losing 

both an efficiency factor and an economic factor. 

So I rise again, as I say, to speak in 

favor of this bill. Providing health care 

to children is not just the right thing 

to do, but this is an economic investment that we are making in the future 

of those who will carry us forward into 

the next generation. 

Mr. BLUNT. Madam Speaker, I yield 

1 minute to the gentleman from Indiana (Mr. BURTON). 

Mr. BURTON of Indiana. I don’t want 

to discuss things that have already 

been discussed, but the things that 

concern me are things like this will be 

a magnet for more illegal aliens coming into this country because it’s going 

to provide a mechanism for illegals to 

get coverage under this bill. 

It’s going to cost $44 billion more 

than the baseline. It’s going to involve 

a tax increase. 

You know, one of the things that 

really concerns me about what we are 

doing is we passed a bailout bill for $700 

billion. We are going to pass another 

bill here, a supplemental, it’s going to 

be $1.2 trillion. We spent $14 billion for 

the auto industry. 

This is going to cost $44 billion over 

the baseline. Where do you think all 

this money is coming from? And I wish 

my colleagues would start thinking 

about the kids in the future as well as 

what we are talking about today. Because the inflation problem they are 

going to face is going to be huge. 

You have got to print this money. It 

has got to come from someplace. And 

the kids of kids of today and tomorrow 

are going to have to pay through the 

nose for the things we are doing today. 

We don’t have all the money to do 

these things, and yet we are spending. 

That will lead to hyperinflation down 

the road and severe economic problems. 

b 1300 

Mr. PALLONE. Madam Speaker, I 

yield 1 minute to the gentleman from 

Texas (Mr. GENE GREEN). 

(Mr. GENE GREEN of Texas asked 

and was given permission to revise and 

extend his remarks.) 

Mr. GENE GREEN of Texas. Madam 

Speaker, I thank our Chair of our subcommittee. 

I rise in strong support and as a cosponsor of H.R. 2, the Children’s Health 

Insurance Program Reauthorization 

Act, or CHIPRA. During the 110th Congress, we made two attempts to reauthorize the SCHIP program. Unfortunately, both these bills were vetoed by 

the President. 

With 6 million American children 

currently eligible yet unenrolled, the 

passage of this bill is overdue. CHIPRA 

reauthorizes SCHIP through 2013 and 

extends SCHIP coverage to 7 million 

children already enrolled, but the 

SCHIP program covers 4 million more 

children. Eleven million children will 

be covered under SCHIP when we pass 

this bill. 

The bill includes a provision that I 

am proud is in there, H.R. 465, the Immigrant Children’s Health Improvement Act, which gives the States the 

option to cover children and pregnant 

women of lawfully residing children in 

our country. These are not illegal immigrants. They are children who go to 

school and go to daycare with our children and our grandchildren. Those children ought to have health care to protect our own children. 

CHIPRA also includes language from another bill of mine, H.R. 1238, which provides 

one year of emergency Medicaid coverage for 

children born in the U.S. and their mothers, 

which is crucial in protecting the health and 

wellness of newborns born in this country. 

I do have to express my disappointment that 

the bill did not include the provision that was 

included in the first SCHIP bill we passed 

which would guarantee that children in families 

earning less than 200 percent of the poverty 

level will have 12 months of continuous eligibility under SCHIP. 

The outreach and enrollment package includes an incentive for States to provide this 

eligibility guarantee. 

But for a State like mine, we need to ensure 

that the State of Texas does right by Texas 

children and doesn’t use the flexibility inherent 

in the program to kick them off the rolls on a 

budgetary whim. 

The 175,000 Texas children who were 

kicked off the rolls in 2003 know all too well 

of the State’s willingness to balance the State 

budget on their backs, and I hoped that this 

bill would take away the State’s ability to do 

that in the future. 

However, the need to reauthorize SCHIP 

before the program expires on March 31st is 

more important than political battles. 

I hope my colleagues will join me in supporting this legislation and sending a strong 

message to the President that we must abandon partisan politics and reauthorize SCHIP 

for America’s low-income children. 

Mr. BLUNT. Madam Speaker, I yield 

1 minute to the gentleman from Iowa 

(Mr. LATHAM). 

(Mr. LATHAM asked and was given 

permission to revise and extend his remarks.) 

Mr. LATHAM. Madam Speaker, I 

thank the gentleman. 

Madam Speaker, there is no question 

the State Children’s Health Insurance 

Program needs to be reauthorized to 

provide the funds necessary to maintain current coverage and enroll currently eligible low-income children. 

In the past I have supported bipartisan legislation that represented the 


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H250 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

input of both parties to reauthorize the 

SCHIP program, H.R. 976 and H.R. 3963, 

including legislation that was vetoed 

by President Bush. However, I cannot 

support this partisan legislation before 

us today because Democrats have radically departed from the bipartisan 

agreement that had been reached. 

First, they have removed the provision that would have capped eligibility 

for SCHIP for families making over 300 

percent of the Federal poverty line, or 

roughly $63,000 per family of four, allowing unlimited expansion of the program in the future. Furthermore, there 

are no requirements that a certain 

level of coverage for low-income children be met before expanding eligibility to higher income groups. 

Second, they have rescinded a requirement in current law that noncitizens who are here must legally wait 5 

years to become eligible for the SCHIP 

program. 

The bill also reduces citizenship verification 

requirements for the Medicaid program, potentially allowing illegal aliens to game the system 

to obtain taxpayer-funded welfare benefits. 

At a time when nearly 70 percent of uninsured American children are already eligible 

for Medicaid or SCHIP, our economy is weak 

and the budget deficit is soaring, it makes no 

sense to put non-citizens or wealthier children 

ahead of poor American children from hardworking, tax paying families who desperately 

need access to these programs.’’ 

Mr. STARK. Madam Speaker, I yield 

1 minute to the distinguished gentleman from Maryland (Mr. VAN

HOLLEN). 

Mr. VAN HOLLEN. I thank my colleague. 

Madam Speaker, this is a moment of 

important substance and important 

symbolism. The substance and merits 

of this bill are clear. We are going to 

preserve health coverage for 7 million 

American children and expand it to another 4 million children from working 

families who earn too much to qualify 

for Medicaid, but do not earn enough to 

be able to afford the very high costs of 

private health insurance. 

Taking this bill up right now also 

sends a very important signal that 

change has come to Washington, DC as 

a result of the last election. President 

Bush twice vetoed this legislation on 

children’s health. We will soon have a 

new President, President Barack 

Obama, who as one of his first acts as 

President will sign this legislation, a 

President who understands the hardships American families are struggling 

under at a time when more than 2 million Americans have lost their jobs in 

just 2 months. 

The difference could not be clearer. 

The current President used his mighty 

veto pen to say ‘‘no,’’ to veto and protect the status quo. The new President 

will use that pen to say ‘‘yes,’’ to 

change the status quo and provide 

health care to 4 million new American 

children as we continue to protect 7 

million American children. That is 

change we can believe in. 

Mr. BLUNT. Can I ask how much 

time is remaining on each side? 

The SPEAKER pro tempore. The gentleman from Missouri (Mr. BLUNT) has 

90 seconds remaining; the gentleman 

from California (Mr. HERGER) has 15 

minutes remaining; the gentleman 

from New Jersey (Mr. PALLONE) has 83⁄4

minutes remaining; and the gentleman 

from California (Mr. STARK) has 9 minutes remaining. 

Mr. BLUNT. I reserve the balance of 

my time. 

Mr. HERGER. Madam Speaker, I 

yield myself such time as I may consume. 

Madam Speaker, I rise in support of 

SCHIP and believe its reauthorization 

is critical to millions of children, but I 

am opposed to the bill before us today. 

This legislation does nothing to make 

private health coverage more affordable. By expanding a program that severely underpays doctors in my State 

of California, it may result in higher 

costs for private coverage. And assuming that the increased tobacco tax 

achieves the goal of discouraging 

smoking, it commits an irrational policy of financing a growing program 

through a declining revenue source. 

In addition, this new version would 

effectively shut down physician-owned 

hospitals currently under construction, 

including a $40 million project in my 

district in Yuba City, California, scheduled to open in a couple of months. 

This will be a severe blow to a small 

county that has long had one of the 

highest unemployment rates in California. 

Madam Speaker, in the middle of the 

worst economic downturn in decades, 

this provision would destroy jobs in 

Yuba City and in dozens of other cities 

across America. 

I would urge all of my colleagues to 

ask themselves, do you believe that a 

corporate board halfway across the 

country would do a better job of holding down costs and ensuring high quality care than a team of local doctors, 

and, if so, are you certain enough that 

you are willing to deny your constituents the opportunity to make that 

choice? 

I urge rejection of this misguided 

provision and a ‘‘no’’ vote. 

I reserve the balance of my time. 

Mr. PALLONE. Madam Speaker, I 

yield to the gentlewoman from New 

York (Mrs. MALONEY) for the purpose of 

a unanimous consent request. 

(Mrs. MALONEY asked and was given 

permission to revise and extend her remarks.) 

Mrs. MALONEY. Madam Speaker, I 

rise in strong support of this bill. 

Madam Speaker, if history is any guide, the 

current recession will lead to a substantial increase in the demand for children’s health 

care coverage under SCHIP and Medicaid. 

Rising unemployment and staggering job 

losses have left many families without health 

insurance. The high cost of private coverage 

means more and more Americans are turning 

to state programs for assistance. 

But state budgets are already strained by 

the recession, and many have already enacted budget cuts that would reduce funding 

for these programs. 

My home state of New York has been 

forced to propose such cuts. 

Unprecedented need combined with a shortage of funding is creating a perfect storm—a 

storm that can only be avoided if Congress 

votes to reauthorize the Children’s Health Insurance Program. 

Over the next 41⁄2 years, our bill, H.R. 2, 

would preserve coverage for the more than 7 

million children currently covered by SCHIP, 

and extend coverage to nearly 4 million children who are currently uninsured. 

Passing SCHIP reauthorization would guarantee sufficient funding levels for the Children’s Health Insurance Program to serve future enrollment needs. It would bring much 

needed stability to the program, giving states 

fiscal security to plan for expansions and 

make improvements in advance of broader 

health care reform. 

This legislation will make covering children 

the top priority for SCHIP, while also giving 

states the option to enroll mothers during 

pregnancy. And under the bill all children enrolled in SCHIP will have dental coverage and 

access to mental health services. 

We are in an economic crisis as serious as 

any this nation has ever faced. As families 

struggle to make ends meet, and states are 

forced to make difficult budget cuts, we cannot 

afford to leave millions of children without the 

health insurance they so critically need. 

We have the opportunity now to make good 

on our commitment to helping America’s families in these tough economic times. 

I urge my colleagues to vote ‘‘yes’’ on H.R. 

2. 

Mr. PALLONE. Madam Speaker, I 

yield 1 minute to the gentleman from 

Georgia (Mr. BARROW). 

Mr. BARROW. Madam Speaker, I 

thank the gentleman. 

Madam Speaker, I am proud to be up 

here today to support H.R. 2, the Children’s Health Insurance Program Reauthorization Act of 2009. It has been a 

long time coming. I am glad we are 

considering this bill on the floor so 

early in this Congress, when we spent 

most of the last 2 years trying to enact 

it. I think it says something very positive about the commitment of this new 

Congress and of our new President to 

improving health care for all Americans. 

H.R. 2 will allow us to enroll 4 million more kids in programs like Georgia’s PeachCare who are just as eligible 

as the 7 million kids already enrolled. 

It is not a free lunch. Parents will still 

have to pay what they can afford to 

pay, but the kids will be able to go to 

the doctor, where they get good preventive care at the lowest cost, and 

keep them out of the emergency room, 

where they get the least effective care 

at the greatest possible cost to the taxpayer. That is more health care, better 

outcomes, at less cost. It is not only 

the right thing to do, it is the smart 

thing to do, and that is why I am proud 

to be a cosponsor of this legislation 

and urge all of my colleagues to support it. 

Mr. HERGER. Madam Speaker, I 

yield 2 minutes to the gentleman from 

Texas (Mr. SAM JOHNSON), a member of 

the Health Subcommittee. 


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(Mr. SAM JOHNSON of Texas asked 

and was given permission to revise and 

extend his remarks.) 

Mr. SAM JOHNSON of Texas. Madam 

Speaker, I rise today in strong opposition to a provision in this bill that 

would have drastic consequences for 

hospitals in my district and hospitals 

around the Nation. Everyone in this 

Chamber can agree that health care in 

this country needs transformation. 

America has always been a leader when 

it comes to medical research, training 

the best, the brightest, and providing 

superior care. We need to make sure 

that tradition continues. 

Physicians across the country have 

decided they can provide better health 

care to more people by engaging in the 

process. Some doctors have decided to 

play a role in the care delivered in the 

hospitals in their community, and 

studies show that this has resulted in 

higher quality care and higher patient 

satisfaction. 

Physician-owned hospitals employ 

highly skilled workers. They are an engine in the local economy, and language in this bill will devastate most 

of them. I say most, because a handful 

of hospitals located in special congressional districts will have rights that 

hospitals in my district and the majority of others will not. Why do only a 

handful of Members of Congress receive 

the privilege of a carve-out for their 

hospitals? 

Many facilities have poured millions 

of dollars into constructing hospitals 

that will be forced to shut down because of this bill. Baylor Hospital in 

particular in my district is in the process of adding additional operating 

rooms and hospital beds to serve the 

community needs. This local hospital 

won’t be able to complete the project 

because of this bill. 

I ask my colleagues on both sides of 

the aisle to work with me to see that 

all existing hospitals and those under 

development are treated the same in 

this legislation. No carve-outs, no special privileges. It has to be all fair and 

all the same. Physician-owned hospitals have proven over and over again 

they spur greater choice and offer higher quality care to patients. These hospitals all deserve the right to be able to 

continue to serve their community. 

That is the American way. 

Mr. STARK. Madam Speaker, at this 

time I am pleased to yield 1 minute to 

the distinguished gentlewoman from 

Nevada (Ms. BERKLEY). 

Ms. BERKLEY. I thank the gentleman for yielding. 

I rise in support of this long-overdue 

legislation. Coming from a State with 

one of the highest percentages of uninsured children, it is essential to reauthorize SCHIP to extend the program 

to cover more low-income uninsured 

children. 

In 2007, more than 40,000 youngsters 

benefited from the Nevada Check Up 

program. This bill will enable Nevada 

to continue coverage for these children 

and to reach out to a portion of the 

70,000 children currently eligible who 

remain uninsured. This bill also includes funding to improve outreach to 

eligible populations. Increased funding 

and the focus on outreach and enrollment will help extend coverage to 

thousands of additional Nevada children and an additional 4 million kids 

nationwide. 

I urge my colleagues to support this 

bill. I look forward to having a President in the White House that is anxious to sign it. 

Mr. HERGER. Madam Speaker, I 

yield 2 minutes to the gentleman from 

Wisconsin (Mr. RYAN), a member of the 

Health Subcommittee. 

(Mr. RYAN of Wisconsin asked and 

was given permission to revise and extend his remarks.) 

Mr. RYAN of Wisconsin. Madam 

Speaker, today is the beginning of a 

new Congress. Our new President 

hasn’t even taken the oath of office 

and we are throwing fiscal discipline 

out the door. This whole idea of 

PAYGO is gone. It doesn’t exist. It is a 

charade. 

Let’s take a look at what this bill actually does. This bill proposes to add 

all these new kids on the SCHIP program, and then in the out-years it 

shoves them off a cliff, taking 7 million 

children off of the SCHIP program. 

They do this only to carve and jam this 

bill into compliance with PAYGO. 

I received a letter from the CBO just 

this morning that if this bill was actually carried through, if you didn’t kick 

all of these children off of this program, it would cost $42 billion more. 

This bill has a $42 billion deficit hole in 

it. The spending increase in SCHIP in 

this bill increases on average 23 percent a year. Madam Speaker, Medicare 

is going bankrupt according to the 

trustees, and that increases at 6.5 percent a year. 

We are being deprived of a bipartisan 

opportunity to extend the current 

SCHIP program, which would have an 

enormous vote here if you brought a bipartisan bill to the table. That is not 

what is happening. Budget gimmicks, 

fiscal irresponsibility, a $42 billion deficit, and the creation of a brand new 

entitlement program. And what is 

worse, we are committing our taxpayer 

dollars, which are so precious in this 

difficult economic time, to pay for insurance that people already have. 2.4 

million people who already have private health insurance are going to get 

kicked off of their private health insurance and the taxpayers are going to 

pick up the tab. That is not fiscal responsibility. 

Let’s solve the uninsured problem. 

Let’s come together and fix the health 

care problems in America. Let’s not 

bankrupt the country. Let’s not play 

budget gimmicks. Let’s not throw 

PAYGO out the window. And let’s not 

take away the health insurance that 

people already have and make them 

have government-sponsored health insurance. We should reject this bill. 

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, 

Washington, DC, January 14, 2009. 

Hon. PAUL RYAN, 

Ranking Member, Committee on the Budget, 

House of Representatives, Washington, DC. 

DEAR CONGRESSMAN: As you requested, the 

Congressional Budget Office (CBO) has estimated the budgetary effects of modifying 

H.R. 2, the Children’s Health Insurance Program Reauthorization Act of 2009, to extend 

the program’s authorization through 2019 in 

a manner that would provide sufficient funding to allow states to meet demand for increasing enrollment within the program’s 

parameters. If H.R. 2 were changed to authorize the Children’s Health Insurance Program (CHIP) through 2019 and to provide sufficient funding for such increasing enrollment throughout that period, CBO estimates 

that enacting that alternative version of the 

bill would increase deficits by $41.6 billion 

over the 2009–2019 period. In contrast, CBO 

estimates that the version of H.R. 2 introduced in the House of Representatives on 

January 13, 2009, would result in a net reduction in deficits of $0.4 billion over that 11- 

year period. 

The introduced version of H.R. 2 would authorize CHIP through 2013 and would provide 

significant funding increases over the next 

few years, leading up to a total funding level 

of $17.4 billion in 2013. The program’s funding 

for the second half of fiscal year 2013 would 

be $3 billion. Under baseline rules, that 

amount annualized—$6 billion—would be projected for each subsequent year. The estimated cost of the bill assumes that funding 

level for CHIP for fiscal years 2014 through 

2019. On that basis, CBO estimates that the 

introduced version of H.R. 2 would increase 

federal direct spending by $73.3 billion 

through 2019, including the costs of other 

provisions in the bill. (That spending would 

be offset by increases in federal tax revenues 

totaling $73.6 billion over the same period, 

primarily from increases in the excise taxes 

levied on tobacco products.) 

As an alternative to the introduced version 

of H.R. 2, you requested that CBO assume the 

CHIP rules and structure as currently delineated in H.R. 2 would remain unchanged 

through 2019 and that sufficient funding 

would be made available after 2013 to accommodate projected enrollment growth. The 

projected enrollment growth is based on expected growth in the total population, as 

well as changes in the health insurance market and the economy as a whole. Under those 

assumptions, CBO estimates that average 

monthly enrollment in CHIP would rise from 

about 9 million in 2013 to about 12 million in 

2019. 

Based on the assumptions you specified, 

CBO estimates total changes in direct spending of $115.2 billion, as compared with the 

$73.3 billion increase we estimate for the introduced version of H.R. 2. (Revenue increases would remain unchanged.) Thus, the 

net budget impact of a modified version of 

H.R. 2, as you specified, would be an increase 

in deficits totaling $41.6 billion over the 2009– 

2019 period. 

If you wish further details on this estimate, we will be pleased to provide them. 

The CBO staff contacts are Robert Stewart 

and Sean Dunbar. 

Sincerely, 

ROBERT A. SUNSHINE, 

Acting Director. 

Mr. PALLONE. Madam Speaker, I 

yield 30 seconds to the gentlewoman 

from California (Mrs. CAPPS). 

Mrs. CAPPS. Madam Speaker, I have 

30 seconds to explain why H.R. 2, the 

State Children’s Health Insurance Program, means everything to a school 

nurse. 


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b 1315 

And I’ll just tell you, I can see the 

faces of the children I cared for as best 

as I could who would have benefited so 

dramatically from this program. And 

I’ll tell you what this feels like now, as 

so many moms and dads are losing 

their jobs and need this program even 

more. And my State, California, is cutting even the children who presently 

are served so dramatically. 

And give States the option of covering pregnant women. That is the 

greatest thing we can do for the health 

of a child is to cover the mom. 

Mr. HERGER. Madam Speaker, I 

yield 3 minutes to the ranking member 

of the Ways and Means Committee, the 

gentleman from Michigan (Mr. CAMP). 

Mr. CAMP. Madam Speaker, I believe 

every child in America should have access to quality health care. The Children’s Health Insurance Program has 

done just that for those in families 

without the means to provide or buy 

insurance on their own. 

SCHIP was created as a bipartisan 

program, and it was one I was proud to 

support. The bill before us today, however, not only threatens the core mission of the program, which is providing 

health care to low-income children, but 

creates a new entitlement that will demand higher taxes on all Americans in 

just a few short years. 

Let me first state the obvious problem with this bill. A children’s health 

program should not be used to cover 

adults, noncitizens, potentially illegal 

immigrants and those making $80,000 a 

year. 

There’s another problem with the 

bill, one the majority hopes you ignore. 

This bill blatantly attempts to hide the 

true cost of the bill to the American 

taxpayer. It’s irresponsible and untenable to fund a children’s health program with the revenue stream that’s 

fast drying up. Increasing the cigarette 

tax, regardless of your support for such 

an idea, does not, will not, and cannot 

cover the cost of this program. 

The Democrats are blowing a giant 

cloud of smoke into the face of the 

American taxpayers, and I believe the 

impending tax increases that must 

come to cover this program will have 

us all in a severe coughing fit. 

The Democrats want you to ignore 

the fact that the percentage of Americans who smoke has been dropping for 

decades. But research and logic both 

show that raising the prices of cigarettes will lead to less smoking and 

fewer tax dollars coming into the Federal Treasury. Yet, the only way for 

this funding scheme to work is if the 

majority finds 22.4 million new smokers. I can’t wait to see the look on Senator Daschle’s face when the Speaker 

tells the soon to be Health and Human 

Services Secretary that little tidbit. 

But in all seriousness, with its funding base declining, SCHIP costs will increase exponentially. CBO predicts 

that SCHIP spending will more than 

double under the Democrats proposal. 

The resulting gap between program 

spending and revenue becomes staggering, a gap the Democrats will soon 

ask the American taxpayers to fill. 

In closing, I’d like to add one final 

note. This bill represents a broken 

promise to lower- and middle-income 

Americans. President-elect Obama 

promised that no one making less than 

$250,000 per year would see their taxes 

go up; yet, under this proposal, a working-class family with two adult smokers would face hundreds of dollars in 

additional Federal tobacco taxes each 

year. 

We haven’t made it to Inauguration 

Day, and House leaders are already 

breaking this campaign promise. That 

might be a record, even here in Washington, D.C. 

Let’s keep SCHIP focused on low-income children. Let’s not ask 22.4 million Americans to start smoking, and 

let’s demand a better bipartisan bill. 

I ask my colleagues to vote ‘‘no’’ on 

this bill. 

Mr. STARK. Madam Speaker, I am 

pleased to recognize Mr. SCHAUER from 

Michigan for 1 minute. 

Mr. SCHAUER. Madam Speaker, I 

came to Washington to be a voice for 

those in my State who are hurting. 

H.R. 2 will help children and families 

who are victims of our economic crisis; 

100,000 children in Michigan lack 

health insurance. That is immoral and 

weakens our economy. This bill ensures comprehensive health care coverage for children, and is an investment in prevention and approved overall health status for America. 

With Michigan’s economy in crisis, 

with our Nation’s economy struggling, 

with our families losing health insurance due to this recession and unfair 

trade, now is exactly the right time, 

colleagues, to act, to cover 11 million 

children with the health care coverage 

they deserve and need. 

Mr. HERGER. Madam Speaker, I 

yield 1 minute to the gentleman from 

Louisiana (Mr. BOUSTANY), who is a 

physician. 

Mr. BOUSTANY. Madam Speaker, as 

a physician, we all recognize the importance of high quality health care for 

all children in this country. In addition 

to the declining source of revenue as a 

means to pay for this, which I believe 

is an irresponsible way to legislate on 

health care, there’s a serious other 

problem that needs to be discussed and 

that is, does this bill provide real access to quality health care? 

Too often children on Medicaid and 

SCHIP receive fewer visits from primary care providers than those with 

private coverage. That’s clear. And 

they are much more likely to seek care 

in the emergency room when it’s late. 

They don’t get the necessary 

screenings and vaccinations. 

GAO criticized government-run programs like SCHIP for disregarding patients’ access problems. 

It’s disappointing to me, as a physician, that the majority rushed this 

flawed bill to the floor without permitting any opportunity for improvements. I offered an amendment that 

went to Rules which was not allowed, 

which would have encouraged States to 

measure and report provider access 

problems for SCHIP programs. It would 

also require States to report their 

plans to limit ‘‘crowd out’’ of private 

coverage. 

The SPEAKER pro tempore. The 

time of the gentleman has expired. 

Mr. BOUSTANY. I would like to include the rest of my statement in the 

RECORD. 

In section 402 of their bill, Majority leaders 

failed to address the access problems I 

brought to their attention last year. 

Their vague language does not require 

states to uniformly report primary care visits. 

It does not mention surveying parents on 

whether sick children received needed care 

quickly. 

It also fails to require states to describe their 

plans to avoid displacing children’s private 

coverage. 

We need to help poor children first. 

A plastic government coverage card that 

delays access to needed care is an insult to 

low-income families. 

Congress has a duty to help enrolled children who—despite being covered—still can’t 

find a doctor to treat them when they’re sick. 

Mr. PALLONE. Madam Speaker, I 

would yield 1 minute to the gentleman 

from New York (Mr. ENGEL). 

Mr. ENGEL. Madam Speaker, I rise 

in strong support of the bill. I am so 

proud that under our new administration we’ll finally enact a comprehensive, robust reauthorization of the 

SCHIP program which will provide 

health care to over 11 million low-income children. No more playing politics with our children, no more Presidential vetoes of this bill. We are finally going to do what is right for our 

Nation. 

It simply makes economic sense to 

cover the uninsured. When we fail to 

provide our citizens with primary and 

preventive care, routine health problems compound into emergency conditions. 

New York, my home State, operates 

a separate stand-alone program under 

SCHIP called Child Health Plus. As of 

December 2006, nearly 400,000 children 

were enrolled and receiving comprehensive health care coverage in the 

program. As the third largest SCHIP 

program in the Nation, New York reduced the number of uninsured children in the State by 40 percent. We are 

only one of seven States to do that. 

And New York’s program has increased 

enrollment by over a quarter of a million children since the start of SCHIP. 

SCHIP also contributed to a nearly 30 

percent increase in children enrolled in 

Medicaid. 

This is necessary. It is good. We 

should all support this bill. 

The SPEAKER pro tempore. The gentleman from California (Mr. HERGER) 

has 5 minutes remaining. The gentleman from New Jersey (Mr. PALLONE) 

has 61⁄4 minutes remaining. The gentleman from California (Mr. STARK) 

has 7 minutes remaining. 


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January 14, 2009 CONGRESSIONAL RECORD — HOUSE H253 

Mr. HERGER. Madam Speaker, I 

yield 1 minute to the gentleman from 

Georgia (Mr. LINDER). 

Mr. LINDER. Madam Speaker, when 

SCHIP first passed about a dozen years 

ago, Georgia’s program was called 

Peach Care. It was open to large numbers of people, and millions signed up, 

many of whom came off private health 

insurance to do so. A friend of mine, 

who made $150,000 a year, signed up 

too. She never used it. But you could 

sign up by the Internet. 

Some of that’s been tightened up, but 

this bill opens that back up again. 

You’re eligible by just stating your Social Security Number, no need to prove 

who you are. 

The 5-year waiting period that’s always been in place for legal immigrants who come here sponsored, is 

erased. And we all know that sooner or 

later we’re going to have an amnesty 

for those 20 million illegals, and that 

will dwarf this system. 

I was in dental school in 1936 when 

Lyndon Johnson delivered the great society speech; and he said, using easily 

quantifiable user statistics, we know 

that by 1990, Medicare will cost $9 billion, and Medicaid will cost $1 billion. 

He was wrong. And this will be abused 

also. 

Mr. STARK. Madam Speaker, at this 

time I am delighted to yield 1 minute 

to the distinguished gentleman from 

California (Mr. THOMPSON). 

Mr. THOMPSON of California. 

Madam Speaker, I rise in strong support of this bill because investing in 

children’s health care is one of the 

wisest choices we can make. Children 

have to be healthy to get an education 

and to achieve their full potential as 

adults. When kids see the doctor more 

regularly, they receive the preventive 

services that keep them healthier 

longer, and they are less likely to end 

up in the emergency room, which saves 

everyone money. 

Almost a quarter of a million children in my State of California are uninsured. That’s simply not acceptable. 

In contrast to President Bush’s multiple vetoes of similar bills, today, 

with President-elect Obama’s enthusiastic support, the House will vote to 

provide coverage for 4 million, 4 million additional children. 

Madam Speaker, that truly is change 

we can believe in. 

Mr. HERGER. How much time do we 

have, Madam Speaker? 

The SPEAKER pro tempore. The gentleman from California (Mr. HERGER) 

has 4 minutes remaining; the gentleman from New Jersey has 61⁄4 minutes; the gentleman from California 

(Mr. STARK) has 6 minutes; and the 

gentleman from Missouri has 90 seconds. 

Mr. PALLONE. Madam Speaker, I 

yield 30 seconds to the gentlewoman 

from the Virgin Islands (Mrs. 

CHRISTENSEN). 

Mrs. CHRISTENSEN. Madam Speaker, I am proud today to rise for the 11 

million children who will have health 

coverage when we pass H.R. 2 for the 

first time and it’s finally signed into 

law by the incoming President. 

CHIPRA will make a significant 

down payment on President-elect 

Obama’s and our promise to insure all 

of our children. And it rightfully refuses to leave out children and pregnant woman legally admitted into our 

country. 

It includes dental and mental health 

care, and will help eliminate health 

disparities because many of those covered children will be children of color. 

Healthy children have a better chance 

to also become healthy adults. 

It’s the right thing to do. It should 

not have take this long, and I urge my 

colleagues to pass it for the good of our 

children and the good of our country. 

Mr. HERGER. Madam Speaker, I continue to reserve my time. 

Mr. STARK. Madam Speaker, I am 

delighted to yield 1 minute to the distinguished gentlewoman from Colorado 

(Ms. MARKEY). 

Ms. MARKEY of Colorado. Madam 

Speaker, I rise today in support of H.R. 

2, the reauthorization of SCHIP. 

When our Nation faces tough economic times, we must look beyond the 

grim statistics to see the true cost of 

our struggles. Seven percent of this Nation is unemployed, which leaves too 

many families without health insurance. 170,000 children in Colorado alone 

have no health coverage. That’s more 

than one in eight. 

How we as a Nation approach health 

care for our children speaks not just to 

our economic priorities but to our 

moral priorities. 

Colorado ranks seventh worst nationally in the rate of uninsured children. 

As the mother of three kids who knows 

the worry and heartache that comes 

with caring late into the night for a 

sick child, that is one statistic I hope 

I have a hand in changing. 

I as all of my colleagues on both 

sides of the aisle to pledge their support for our children and vote for this 

bill. 

Mr. STARK. Madam Speaker, at this 

time I am delighted to yield 1 minute 

to the distinguished gentleman from 

Georgia (Mr. SCOTT). 

Mr. SCOTT of Georgia. Madam 

Speaker, I represent Georgia, which 

has 300,000 children who badly need 

coverage in this legislation. Let me 

take a part of my moment here, if I 

may, to respond to what I think are 

some misstatements from the other 

side because this is, indeed, a children’s 

health program, and they’ve mentioned 

about adults being on this program. 

One category of adults, Madam 

Speaker, is pregnant women. Of all 

adults, a pregnant woman with child in 

her womb, they need care. They should 

be and are covered in this. 

As far as the other category, here’s 

what the bill says as far as parents. No 

new waivers to cover parents in the 

CHIP program will be allowed. That’s 

in this bill. 

What about childless adults who 

don’t have? The bill says the current 

law, that prohibition on waivers to 

cover coverage of childless adults is retained. Childless adults are prohibited 

in this law. 

Issue of illegal immigration; only 

legal immigrant children and their 

pregnant immigrant legal immigrant 

women are covered under this bill. 

b 1330 

Mr. PALLONE. Madam Speaker, I 

yield 1 minute to the gentleman from 

Illinois (Mr. FOSTER). 

Mr. FOSTER. Madam Speaker, I rise 

in strong support of H.R. 2, the Children’s Health Insurance Program Reauthorization Act of 2009. 

This historic legislation renews and 

improves SCHIP. It extends coverage 

to 4 million uninsured children who are 

currently eligible for but who are not 

enrolled in SCHIP and in Medicaid. 

As a fiscal conservative, I am also 

proud that even in today’s financial 

storm and even under scoring rules 

that do not fully reflect the long-term 

fiscal benefits of providing adequate 

health care to children that the bill is 

fully paid for. With a modest increase 

in tobacco sales tax providing a bulk of 

the funding, we are able to provide coverage to millions of children and not 

add to the deficit. 

This bill honors our moral commitment to help our youngest children in 

their health while ensuring that this 

legislation does not hinder their future 

by saddling them with huge debts. 

The bill could not come at a better 

time. Our economy continues to worsen, and more and more people are at 

risk of losing their health care. This 

program will help give millions of parents the peace of mind that their children at least will have access to health 

care. 

Mr. HERGER. Madam Speaker, I 

yield 1 minute to the gentlewoman 

from Florida (Ms. GINNY BROWNWAITE). 

Ms. GINNY BROWN-WAITE of Florida. Madam Speaker, first of all, let me 

state that I support health insurance 

for children. As a matter of fact, it was 

my bill on the floor of the Senate 

where we created KidCare. 

Where did the money come from? It 

was from a historic vote that I cast to 

be able to go after the tobacco companies for settlement. That’s where the 

money came from originally for the 

SCHIP program, but the bill we have 

before us today is not a bill that taxpayers can support. 

First of all, there is no prohibition 

against crowd-out. In other words, it 

pushes children off of private insurance 

onto the government program, and it 

does allow States to continue for at 

least 2 years the enrollment of adults. 

It actually does nothing to prohibit illegal aliens from being on the program, 

and that’s something that taxpayers 

are very concerned about. Additionally, Madam Speaker, there is no incentive here, really, to go after and to 

have low-income children covered by 

this bill. 


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H254 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

For those reasons, I oppose it. 

Mr. STARK. Madam Speaker, I reserve the balance of my time. 

Mr. PALLONE. Madam Speaker, I 

would yield 30 seconds to the gentlewoman from New Hampshire (Ms. 

SHEA-PORTER). 

Ms. SHEA-PORTER. Madam Speaker, I support H.R. 2, the Children’s 

Health Insurance Program Reauthorization Act of 2009. 

We have children in New Hampshire 

and in America who need us to fight for 

them. Unemployment is rising. Even 

working families are losing their 

health insurance. Providing more 

money now will give 4 million more 

children health insurance. This is a 

moral issue. We are the only nation in 

the world that does not provide health 

care to all of its children. This is simply unconscionable. 

I am proud to support this legislation 

to help New Hampshire’s children and 

America’s children. 

Mr. HERGER. Madam Speaker, I 

yield 2 minutes to the Republican 

whip, the gentleman from Virginia (Mr. 

CANTOR). 

Mr. CANTOR. Madam Speaker, I rise 

today to underscore that all of us, Republicans and Democrats alike, desire 

to ensure that all children of low-income working families have access to 

high-quality, affordable health care. 

But at this time in our economy when 

deficits threaten to climb to $1.6 trillion, without Republican input or without any debate, the majority has 

rushed a bill to the floor that substantially expands the reach of this program beyond its original intended purpose. All the while, a substantial portion of the existing target population 

has never been reached. 

It is with much disappointment that 

I stand in opposition to this bill today, 

because it could have had significant 

bipartisan support had the majority 

opened the process to our substantive 

ideas. 

Before our ideas and solutions were 

shut out at the Rules Committee, we 

sent President-elect Obama and Speaker PELOSI a letter which outlined four 

central issues that we had hoped would 

be addressed. 

First: We believe that the SCHIP bill 

should follow the original intent of the 

law. That is to cover children in lowincome working families. 

Second: We Republicans believe that 

expanding SCHIP should not shift children away from private health insurance options into government-run programs that are funded exclusively by 

the taxpayers. Instead, we should be 

providing families who are currently 

uninsured with more affordable options 

to better meet their needs, not a onesize-fits-all government solution. 

Third: We Republicans believe that 

the legislation should include meaningful provisions to prevent fraudulent activity by those who seek to illegally 

gain access to this program. 

Finally, Madam Speaker, when Congress reauthorizes the program, we 

must do so responsibly. The budget 

gimmicks included in this bill suggest 

that the majority is not seriously trying to comply with PAYGO. This bill 

will only put the States and the Federal Government into further debt. I 

don’t think there is any question that 

many in this House want to do the 

right thing. Unfortunately, Madam 

Speaker, I feel this bill doesn’t quite 

reach this mark. 

Mr. PALLONE. Madam Speaker, we 

inquire of the time that is remaining. 

The SPEAKER pro tempore. The gentleman from New Jersey has 41⁄4 minutes remaining. The gentleman from 

California (Mr. STARK) has 4 minutes 

remaining. The gentleman from California (Mr. HERGER) has 1 minute remaining. The gentleman from Missouri 

has 90 seconds remaining. 

Mr. PALLONE. Madam Speaker, at 

this time, I would yield 30 seconds to 

the gentleman from New York (Mr. 

MASSA). 

Mr. MASSA. Madam Speaker, I am 

compelled to observe that, while Rome 

burns, my friends and colleagues across 

the aisle argue process. 

We were elected to come here and 

make a difference in the lives of the 

people who we represent. Today, I will 

proudly cast a vote in the affirmative 

for the expanded State Children’s 

Health Insurance Program Reauthorization Act of 2009 to do exactly that. 

We are in a time of financial and economic crisis, and we cannot ignore the 

individuals who have sent us here to 

help them. It is a plain and clear call 

to action. It is wrong to say that you 

support children’s health care and, at 

the same time, vote against it. This is 

not about process. It is about standing 

with America’s children, and I am 

proud to do so today. 

The SPEAKER pro tempore. The 

Chair will recognize in reverse order 

the managers for closing comments. 

That would be Mr. HERGER, followed by 

Mr. STARK, followed by Mr. BLUNT, followed by Mr. PALLONE. 

Mr. PALLONE. Madam Speaker, I 

have some additional speakers, though. 

I yield 30 seconds to the gentleman 

from Virginia (Mr. CONNOLLY). 

Mr. CONNOLLY of Virginia. Madam 

Speaker, this vote is about values. If 

you are an uninsured kid in America 

and you have appendicitis, the chance 

of death is five times that of a kid who 

is insured. This is about values. We are 

the only developed country in the 

world that does not extend full health 

insurance to its children. History has 

shown no nation can truly consider 

itself great without providing for the 

well-being of its most vulnerable. 

I urge my colleagues to support this 

legislation. 

Madam Speaker, I rise in support of the bill. 

It is clear that the Congress sees value in this 

critical investment in our Nation’s children, 

having passed a similar measure not once but 

twice in its last session. Thankfully, we will 

now have a President who shares that same 

compassion and commitment to our low- and 

middle-income working families. 

Given the ongoing economic crisis, the 

number of at-risk children will only continue to 

increase. The number of Americans who are 

now unemployed, and ostensibly now without 

health care, has increased by more than half 

in the past year, from 4.7 percent to 7.2 percent nationally. When you factor in the skyrocketing costs of health care, coupled with 

the economic pinch being placed on people’s 

pocketbooks, today’s American families are 

being bled dry and countless children are 

being left without health care. In that context, 

we are making a critical investment in the 

health of our Nation by adding these 4 million 

children to the 7 million already covered by 

SCHIP. 

The long-term risk of not making this investment now will surely cost us more. Let me cite 

just one example: It is my understanding that 

an uninsured child diagnosed with appendicitis 

is 5 times more likely to die as a result of lack 

of access to medical attention than a child 

who is has been insured. By expanding access to more working families, we begin to lay 

the foundation for the principles by which we 

hope to overhaul our Nation’s health care system. 

As my colleagues may be aware, the United 

States is the only developed nation in the 

world that does not provide health care for all 

of its children. That is unconscionable. As history has proven, no nation can truly consider 

itself great without providing for the well-being 

of its most vulnerable. 

Mr. PALLONE. Madam Speaker, I 

would yield 30 seconds to the gentleman from Iowa (Mr. LOEBSACK). 

Mr. LOEBSACK. Madam Speaker, we 

have voted for similar SCHIP measures 

in the past, but those efforts were 

thwarted time and time again. I believe 

today is a new day. 

Today, we will send a clear message 

to those who need our help the most— 

our children. This Congress and the 

new administration will tell the 38,000 

uninsured children in Iowa and the millions more across the country that we 

care and that we will no longer leave 

them without the health care they 

need. 

I look forward to casting my vote in 

strong support of this legislation. I 

urge my colleagues to do the same. 

Mr. STARK. Madam Speaker, at this 

time, I am delighted to recognize for 1 

minute the distinguished gentleman 

from Illinois (Mr. DAVIS). 

(Mr. DAVIS of Illinois asked and was 

given permission to revise and extend 

his remarks.) 

Mr. DAVIS of Illinois. Madam Speaker, I am pleased to rise in strong support of the Children’s Health Insurance 

Program Reauthorization Act of 2009. 

I am pleased to note that my State, 

the State of Illinois, has made it possible for every child to receive access 

to health care and to see that this action takes place across the country so 

that every child, no matter who he or 

she might be, has an opportunity to 

grow and develop to become the kind of 

person that his or her potential provides. 

It is a great day for the United 

States of America. It is a great day for 

this Congress. It is a great day for all 

of the children in America. 


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Mr. STARK. Madam Speaker, if I 

may, I will yield myself 2 minutes. 

I just want to rise and ask my colleagues to support H.R. 2. It has done a 

lot of things. It expands insurance coverage to another 4 million children. 

You can argue one way or the other 

that they may have insurance someplace else, but this will guarantee that 

those 4 million additional children will 

get the medical care or the insurance 

and, without which, they will not get 

first-class medical care in this country. 

We’ve passed this bill in several different forms in the past, and I want to 

thank the 40 or 50 Members from across 

the aisle who have supported it in the 

past. We’ve made some changes, and 

we’ve acknowledged the legitimacy of 

all legal residents in our Nation by giving States the option to cover them if 

they choose. 

I am glad to report that the bill is 

fully financed. We can argue about 

what happens 4 or 5 years out, but I am 

sure we’ll have more of an argument on 

whether the very rich should enjoy escaping the capital gains tax or whether 

we should do away with the inheritance tax, which will bother many of 

the opponents much more than the 

idea of the tobacco tax or, indeed, the 

prohibition on the unethical kickbacks 

that physicians receive from ownership 

hospitals, most of which are of questionable safety and quality. This legislation expands health coverage to our 

Nation’s children, and it is worthy of 

our support. 

I would like to take just a moment to 

thank the staff members who have 

worked so hard over the past almost 2 

years. From the staff on the Committee on Energy and Commerce: 

Bridgett Taylor, Karen Nelson, Andy 

Schneider, Amy Hall, Purvee Kempf, 

Tim Gronninger, Hasan Sansour, and 

Bobby Clark. 

The SPEAKER pro tempore. The 

time of the gentleman has expired. 

Mr. STARK. Madam Speaker, I yield 

myself an additional 10 seconds. 

From our own staff on the Committee on Ways and Means Health Subcommittee: our staff director—Cybele 

Bjorklund—Jennifer Friedman, Debbie 

Curtis, Karen McAfee, Chiquita 

Brooks-LaSure, and Drew Dawson. 

I urge the passage of H.R. 2. 

I reserve the balance of my time. 

Mr. BLUNT. Inquiring, does the gentleman have any additional speakers 

besides his closing comments? 

Mr. PALLONE. I do not, but I was 

going to ask how much time remains. 

The SPEAKER pro tempore. The gentleman from Missouri has 90 seconds 

remaining. The gentleman from California (Mr. HERGER) has 1 minute remaining. The gentleman from California (Mr. STARK) has 1 minute remaining. The gentleman from New Jersey has 23⁄4 minutes remaining. 

Mr. PALLONE. Madam Speaker, I 

would yield myself a minute and a half. 

I just want to stress how important 

this bill is and also that it is, essentially, the same bill that we passed in 

the last Congress. It was bipartisan. It 

was passed in both houses with a fairly 

large margin. The only thing that 

stood in the way was President Bush’s 

veto. 

Now we do have a new President. We 

know that he has supported the legislation. It is so crucial for the children of 

this country, for the 4 million or so 

now who are eligible but for whom 

there is no funding, who will be covered 

by this legislation. It is fully paid for. 

Particularly now, when we have a recession and when we know that so 

many people are losing their jobs and, 

as a consequence, their health insurance for themselves and for their families, what could be more important 

than making sure that those families’ 

children are covered by this legislation? 

b 1345 

I must say I’m very proud of the fact 

that we are here in the first week, essentially, of this new Congress passing 

this bill. I know the other body is 

about to pass it as well and that we 

will be able to send it to the President 

and have it be one of the first accomplishments of his Presidency and of 

this Congress. 

I know Mr. STARK already thanked 

the various staff members, so I won’t 

thank them again. But I do want to 

pay particular attention to Bridgett 

Taylor because I know that she worked 

on this legislation for 2 years or more 

and was even there when we first 

passed the SCHIP bill 10 years before 

that. And it has always been one of the 

things that she cares so much about. 

But I want to thank all of the staff 

people and all of my colleagues for all 

of the work that they’ve done on this 

legislation. 

Mr. HERGER. Madam Speaker, I reserve the 1 minute I have to close, but 

I would yield to the gentleman from 

Missouri (Mr. BLUNT) for the time that 

he has that he controls. 

Mr. BLUNT. Madam Speaker, I yield 

my minute-and-a-half to the ranking 

member of the Health Subcommittee 

on Energy and Commerce, the gentleman from Georgia (Mr. DEAL). 

Mr. DEAL of Georgia. I appreciate 

the gentleman yielding. 

Madam Speaker, very few bills come 

to the floor of this House with so much 

rhetoric disassociated from facts as we 

have heard in this bill. 

Now, let’s talk about a few of the 

real facts. 

First of all, the program was designed, at its outset, to insure children 

that were above the Medicaid level of 

poverty but below 200 percent of poverty. All of the stories that we have 

heard today—from both sides of the 

aisle, quite frankly—as to examples of 

children who are uninsured, in almost 

every one of those instances are children that should have been insured 

under the current law under either 

SCHIP or Medicaid but are unenrolled. 

One of the amendments that I offered 

that was not allowed was an amendment that said before you can go up 

the poverty scale, you should have a 90- 

percent saturation of those children 

that are below 200 percent of poverty. 

Many States that are well above the 

300 percent of poverty still have not 

covered a quarter of their children that 

are below the 200 percent of poverty 

level. 

So ‘‘poor children first’’ is not in this 

bill. 

Secondly, with regard to the issue of 

illegal immigration. Now, you can say 

that illegal immigrants will not be allowed, but you are removing the requirements of certification of eligibility. And by the way, pregnant 

women, regardless of their immigration status, are considered ‘‘children’’ 

under the SCHIP bill in everybody’s 

version of the law. 

Now, if you’re not acknowledging 

that illegals are going to be enrolled in 

this program by virtue of the change 

you’re making in this bill, then you 

ought to talk to CBO because CBO says 

in the next 10 years that the Federal 

Government will spend $5.1 billion and 

States will spend $3.85 billion on people 

who are illegally in this country. 

Mr. STARK. Madam Speaker, I’m delighted to recognize the Speaker of the 

House, the distinguished gentlelady 

from California (Ms. PELOSI). 

The SPEAKER pro tempore. The gentlewoman from California is recognized 

for 1 minute. 

Ms. PELOSI. Madam Speaker, I 

thank the gentleman from California 

for yielding. 

My colleagues, this is a day of triumph for America’s children. With 

what I expect to be a strong bipartisan 

vote, the House will bring us one step 

closer to providing health care for 11 

million children in America. 

With this action and with the legislation last week to ensure equal pay for 

equal work for women, Congress makes 

clear that we put women and children 

first. It is important that we have this 

legislation up so soon in this new Congress because children are our top priority. We like to be considered a Congress for the children, a Congress for 

the future. 

At a time of economic crisis, nothing 

could be more essential than ensuring 

that children of hardworking families 

receive the quality health care they deserve. Many of these children are from 

families of hardworking Americans 

who have lost their jobs through no 

fault of their own. It’s sad to say that 

America lost 2.6 million jobs last year. 

Over half a million jobs were lost in 

the month of December—500,000 jobs in 

the month of December alone. It was 

actually 526,000 jobs. Each month, until 

we have an economic recovery initiative, we will continue to lose at least 

500,000 jobs per month. 

With such job loss, America sees the 

health care coverage that we all need 

for our children disappear. For every 1 

percent increase in the unemployment 

rate, it is estimated that as many as 1.5 

million Americans will lose their 


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H256 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

health care coverage. A record 47 million Americans, including nearly 9 million children, are without health insurance now. 

Ensuring that children have access to 

affordable health care just makes 

sense. It’s not just about addressing 

their health needs when they are sick. 

It’s about keeping them healthy in advance. It’s about prevention. It’s about 

diet, not diabetes; it’s about prevention, not amputation. It’s about a 

healthier America. 

Contrary to the views of some, an 

emergency room is not good health 

care on a regular basis. An emergency 

room is, as it describes, for emergencies—not for ongoing health care. 

So for those who say that all people in 

our country have access to health care, 

that they can go to an emergency 

room, I don’t know what they could be 

thinking. 

By ensuring health care coverage for 

11 million children, families will have 

regular doctor visits and preventative 

care. We will ensure that children get 

the care they need and the health care 

costs are not inflated due to expensive 

emergency room care. 

That is why more than 80 percent of 

the American people support this legislation. It’s bipartisan. It is fully paid 

for by a 61-cent tax on a pack of cigarettes as the major part of its funding, 

and it represents a new direction because, again, it is good health care for 

America’s children. It is paid for. 

We have fought in the last Congress 

together, Democrats and Republicans, 

in the House and in the Senate to pass 

this legislation—which we did—but it 

was vetoed. At the time, President 

Bush said that we could not afford this 

legislation, that we could not afford to 

insure America’s children. Forty days 

in Iraq equals over 10 million children 

in America insured for 1 year. Forty 

days in Iraq, 1 year insuring over 10 

million children. We certainly can afford to do that. 

We look forward to bringing this legislation to President Obama’s desk as 

one of the first bills that he will sign. 

And when we do, we owe a great deal of 

gratitude to Chairman HENRY WAXMAN

of the Energy and Commerce Committee, Chairman RANGEL of the Ways 

and Means Committee, Chairman 

Emeritus JOHN DINGELL, who’s worked 

on this issue for a very long time and 

engineered it through the last Congress. Thank you, Mr. DINGELL. Congressman PALLONE, the Chair of the 

subcommittee; Congressman STARK, 

the Chair of the appropriate Committee on Ways and Means; the Congressional Hispanic Caucus, which led 

the fight to make sure that legal immigrant children are covered under this 

legislation, and our Congressional 

Black Caucus. All elements of our Congress, a coalition, and on the outside, 

because we could not succeed with just 

our inside maneuvering on legislation 

so important and so pervasive in its 

impact. 

Without the support of more than 300 

organizations, from AARP to the 

YMCA and everything in between, the 

March of Dimes, Easter Seals, almost 

every organization you can name supports this SCHIP; and they support 

providing quality, affordable health 

care to America’s children, and they 

support doing it by the passage of the 

State Children’s Health Insurance Program legislation that we have before us 

today. 

So I thank all of those in the Congress for their leadership in making 

this important day possible for America’s children. It’s important to children because of their health. It’s important because it’s paid for. We do 

something great for children without 

adding to our deficit and delivering 

mountains of debt to future generations. 

So this, all in all, is great for kids. 

Let’s keep our reputation going as a 

Congress for children and give a strong 

bipartisan vote to this important legislation. 

Mr. HERGER. Madam Speaker, I 

yield the remainder of our time to the 

minority leader, the gentleman from 

Ohio (Mr. BOEHNER). 

The SPEAKER pro tempore. The gentleman from Ohio is recognized for 1 

minute. 

Mr. BOEHNER. Madam Speaker, let 

me thank my colleague from California 

for yielding. 

I rise today in opposition to this bill, 

frankly because of my strong support 

for the SCHIP program. 

In 1997, Republicans here in Congress 

worked with our Democrat colleagues 

to create the State Children’s Health 

Insurance Program. I was there, and 

many of you were here as well. And 

throughout that process it was bipartisan, it was fair, and open discussion 

and open debate. And unfortunately 

today, the voices of millions of Americans who want to provide input into 

this proposal have been silenced in the 

process. 

Earlier this week, I wrote to Speaker 

PELOSI and President-elect Obama expressing our willingness to work together on this critical issue. We outlined our principles for this program’s 

reauthorization. The principles are 

nothing new. In fact, they’re the same 

principles that led to the creation of 

SCHIP in 1997. 

And they are this: This program 

ought to cover poor children first. Unfortunately in many States, more than 

two-thirds of those enrolled in the 

SCHIP program are adults. And there 

is nothing in this bill that really does 

ensure that poor children will be 

brought into the program first. 

Secondly, taxpayer funds for this 

program should not be used to fund 

benefits for illegal immigrants. And 

there’s been this big debate about 

whether it does or it doesn’t, but the 

fact is that while the bill says we will 

not cover illegal immigrants in this 

bill, the whole verification process that 

should be in here to ensure that only 

American citizens and legal residents 

are entitled to these benefits, no 

verification to speak of is contained in 

the bill. 

And we also believe that SCHIP 

should not force children with private 

insurance into a State-run health insurance program. Last year in this proposal, there was language that made it 

clear that children with a private 

health insurance program, that they 

should stay in that private program 

and not be pushed into the State-run 

program. Unfortunately, the bill before 

us does not reflect these principles, the 

same ones that have guided this program since its creation. 

I believe that the bill before us would 

undermine the original intent of the 

SCHIP program by expanding the program to adults, illegal immigrants, and 

upper-income families who already 

have access to private health insurance. 

b 1400 

I think taxpayers deserve better, and, 

more importantly, our Nation’s children deserve better. That’s why today 

Republicans will offer a better way. 

I said on the opening day, when I 

gave the gavel to Ms. PELOSI, that Republicans would not just be the party 

of ‘‘no,’’ that we would come to this 

floor with better solutions. And the 

better solution that we will offer here 

soon is a program that would reauthorize SCHIP for 7 years, not the 41⁄2 years 

that we see in the majority’s bill; it 

will reflect our principles, and make it 

clear that poor children should be covered first; and it will fully fund the 

SCHIP program without raising taxes 

on American families across our country. 

Madam Speaker, Federal funds targeted for low-income children should 

benefit low-income children, period. 

Only one measure on the floor today 

will serve those children’s interests, 

and that’s what the motion to recommit will contain. So I would urge my 

colleagues to vote ‘‘yes’’ on the motion 

to recommit and ‘‘no’’ on the underlying bill. 

Mr. MARKEY of Massachusetts. Madam 

Speaker, I rise today in strong support of the 

Children’s Health Insurance Program Reauthorization Act of 2009. 

I am proud to be an original cosponsor of 

this important legislation to expand the highly 

successful State Children’s Health Insurance 

Program (SCHIP). This bill will allow the program to provide health insurance to an additional 4 million low-income children on top of 

the nearly 7 million who already benefit from 

the program. 

In my home State, SCHIP enrollment is part 

of the reason why Massachusetts has the lowest rate of uninsured children in the country. 

More than 180,000 Massachusetts children receive health coverage through SCHIP, and 

this reauthorization will allow the state to cover 

even more children who currently do not have 

health insurance. 

It is unfortunate that the previous two attempts to reauthorize SCHIP were vetoed by 

President Bush, who chose to side with big 

corporations over children. With the current 

economic crisis causing significant job losses, 


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January 14, 2009 CONGRESSIONAL RECORD — HOUSE H257 

millions of Americans also are losing their 

health coverage, making today’s vote even 

more urgent. 

While President Bush twice dashed the 

hopes of millions of low-income families in 

need of health care for their children, the incoming Obama administration recognizes the 

value of ensuring that all low-income children 

get the health care they need. 

I urge my colleagues to stand with the hard 

working families who want to provide their children with the health care they need. Vote yes 

on this critical legislation. 

Mrs. BACHMANN. Madam Speaker, today I 

rise in opposition to H.R. 2, the Children’s 

Health Insurance Reauthorization Act of 2009. 

While I support the State Children’s Health Insurance Program, SCHIP, and its continued 

reauthorization, the proposal before the House 

today reauthorizes this program in an irresponsible manner, at a time when the American people need responsible government 

more than ever. 

As you know, I recently joined many of my 

Republican colleagues in a letter to you, 

Madam Speaker, and to President-elect 

Obama asking that any reauthorization of 

SCHIP contain commonsense provisions to 

ensure that the program’s mission is fulfilled. 

For instance, SCHIP is meant to ensure that 

children without means can gain access to 

health care. The program is designed to cover 

them first, before extending coverage to children whose families may be able to afford 

coverage. Unfortunately, the bill with which we 

have been presented includes no requirement 

that states focus the funds in this bill on lowincome children. There is a likelihood that the 

failure to include such a provision will lead to 

funds being diverted from the children who 

need them most, particularly in the states that 

have expanded their SCHIP programs most 

dramatically. 

Another concern that I have is the impact of 

this legislation on the private insurance market 

and the families who depend upon it. In scoring this legislation, the Congressional Budget 

Office (CBO) estimated that 2.4 million people 

will drop their existing private insurance, opting instead for the public program. This 

‘‘crowding out’’ will constrict the health insurance pool and further increase the cost of private insurance for millions more. Given the 

ranks of Americans who already cannot afford 

health insurance, this is the last thing the 

American people need. 

There are other concerns that I have with 

this bill and with the way it is being pushed 

through with so little debate and no opportunity for amendment. While the House leadership has again promised that it will work in a 

bipartisan fashion, bringing both sides of the 

aisle together to build consensus legislation, 

this promise has turned out to be nothing 

more than empty to the American public. I 

urge my colleagues to join me in opposing this 

legislation. 

Mr. POMEROY. Madam Speaker, I rise 

today in strong support of H.R. 2, the Children’s Health Insurance Program Reauthorization Act of 2009. 

We were all deeply disappointed that President Bush vetoed bipartisan legislation that 

would have reauthorized the popular State 

Children’s Health Insurance Program, SCHIP, 

not once, but twice during the 110th Congress. However, under a new Congress and a 

new incoming President, I am pleased that we 

can finally move forward with bringing health 

care to 11 million needy low-income children. 

In my own State of North Dakota, there are 

roughly 14,000 children who lack health care 

coverage. Under this legislation, the nearly 

3,600 children who are already covered under 

the Healthy Steps program will continue to obtain the care they need and there is the potential to cover many more given the $100 million 

in outreach and enrollment grants as well as 

the $3.2 billion in performance grants to states 

to help enroll needy children who are eligible 

but currently enrolled in SCHIP. 

Our Nation’s current economic crisis illustrates just how urgent the need is to reauthorize SCHIP. With 2 million jobs lost in 2008, 

more and more needy children are finding 

themselves without health care coverage this 

year. That is why I urge my colleagues to join 

me in standing up for 11 million children and 

pass this important bipartisan piece of legislation. 

Ms. EDDIE-BERNICE JOHNSON of Texas. 

Madam Speaker, I rise in support of H.R. 2, 

the Children’s Health Insurance Program Reauthorization Act of 2009. 

Texas ranks last in the Nation in terms of 

taking care of its children. A report released in 

2009 by the organization called, ‘‘Texans Care 

for Children’’ contains dismal statistics. 

For example: 

Texas continues to rank 50th out of 50 

among the States in health coverage for children. 

Infant mortality rates have steadily climbed 

in Texas this decade, while remaining unchanged in the Nation as a whole. 

Texas still ranks near the bottom in child 

hunger, child poverty, and child deaths from 

abuse or neglect. 

The State of Texas continues to be ineffective at resolving the problem of uninsured children in our State. 

I am sympathetic to States’ needs to avoid 

revenue shortfalls regarding SCHIP, and so I 

support Congress allocating the funds needed 

to cover children in need. 

Today’s legislation is similar to a bill passed 

by Congress in 2007 and vetoed by the President. 

It would provide health care coverage to 11 

million children in this country who currently 

have none. 

I support a generous expansion of this program. 

Children with health insurance are more 

likely to be up to date on immunizations and 

to receive treatment for sore throats, ear 

aches and other illnesses. 

Good health means fewer sick days and 

better school performance—and less burden 

on our emergency rooms. 

As a nurse, I can not over-emphasize how 

important it is for young people to have a 

medical home. 

Having a family physician can prevent so 

many minor illnesses from developing into serious, expensive illnesses. 

Health care coverage of children just makes 

good sense. 

I urge my colleagues to avoid delay in passing this bill, as it is critical for the health of so 

many children. 

Mr. MORAN of Virginia. Madam Speaker, I 

rise today in strong support of H.R. 2, the 

Children’s Health Insurance Program Reauthorization Act of 2009. Truly, we face a health 

care crisis in this country—in the richest country on Earth; 47 million Americans do not have 

health insurance, including 9 million children. 

The need is even greater in these sad economic times. With rising unemployment, more 

families are losing their health insurance. This 

bill will go a long way to provide health care 

for uninsured children and fulfilling our moral 

obligation to them. 

In my home State of Virginia, the CHIP program currently provides coverage to 144,163 

low-income children each year. The CHIP Reauthorization Act will help us cover an additional 75,000 children. It will ensure that these 

children have access to high quality health 

care, including the preventative services that 

children need to be healthy and successful in 

school and later in life. This bill will provide 

dental and mental health benefits on par with 

medical and surgical services—truly ensuring 

that the whole child’s health is provided for. 

The CHIP Reauthorization Act does this 

without increasing the deficit, primarily by increasing the Federal excise tax on cigarettes. 

In my view as Chairman of the Congressional 

Prevention Caucus, an increase in the Federal 

tobacco tax is sound public health policy. It 

provides a reliable revenue source to offset 

the costs of expanding coverage to low-income children and it will reduce health care 

costs in this country by reducing the prevalence of chronic disease. 

In the past, there has been misleading and 

false information regarding the bill’s treatment 

of illegal aliens. Critics of the legislation seem 

to ignore existing Federal law and provisions 

in the CHIP Reauthorization Act that prevent 

federal funds from being spent to provide benefits for illegal immigrants. What H.R. 2 does 

do is offer an opportunity for States to waive 

a five year waiting period on legal non citizens. Current law requires a five-year waiting 

period before legal immigrants are eligible for 

CHIP. Allowing State flexibility in this regard is 

sound public health policy that would enable 

thousands of American children access to vital 

health services to help them live better, 

healthier, and more productive lives. The bill 

does not mandate the change, but leaves it to 

the states to make their own decisions. 

Reauthorizing SCHIP is sound public health 

policy—research shows that children who 

have access to health insurance are substantially more likely to access key preventative 

services, miss fewer days of school due to illness, get better grades, and grow to become 

healthy and productive adults. Moreover, the 

financial benefits of covering children vastly 

outweigh the costs—one need only compare 

the cost of a visit to a primary care provider 

to the cost of a night spent in the emergency 

room. Ultimately, covering all our children is a 

moral imperative—it is the only possible humane, responsible course of action. I urge a 

yes vote on H.R. 2. 

Mr. CARSON of Indiana. Madam Speaker, I 

rise today on behalf of the thousands of uninsured children in Indianapolis, Indiana. 

In this recession, many of my constituents 

can no longer afford the skyrocketing cost of 

health care. Without checkups or medication 

for their children, they sit powerless. 

So, I implore those who oppose this bill to 

think of the uninsured children in their congressional districts. Should they be made to 

suffer from rising health care costs and an unstable job market? And should your constituents suffer because their children hang between Medicaid and private insurance? The 


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H258 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

answer to both of these questions should be 

an unwavering no. 

There are few opportunities in this body 

where the right decision is so obvious. Support our children by voting yes on SCHIP. 

Mr. SMITH of Texas. Madam Speaker, I oppose this bill for many reasons. In my role as 

the ranking member of the Judiciary Committee I want to point out a few immigration 

provisions that undermine personal responsibility and burden American taxpayers. 

In the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Congress, with the overwhelming support of the 

American people, required that legal immigrants wait 5 years after coming to the United 

States before receiving welfare benefits. 

It’s only fair that American taxpayers not 

foot the medical bills of foreign nationals who 

arrive with a sponsor’s pledge not to become 

a ‘‘public charge.’’ 

H.R. 2, changes current law and allows immigrants to get medical benefits at the expense of U.S. taxpayers. 

Immigrants, both legal and illegal, already 

have a federally mandated right to emergency 

medical care. That mandate has helped bankrupt hospitals all over the United States. 

Federal law requires that the American 

sponsor of new immigrants sign an affidavit of 

support stating that they will be responsible for 

any public costs incurred by the immigrant. 

Unfortunately, those affidavits have never 

been enforced and immigrant sponsors know 

they will not be held accountable if the immigrants receive welfare and become public 

charges. 

The 5-year waiting period for immigrants to 

receive government benefits is the last line of 

defense for the U.S. taxpayer. It should not be 

repealed or altered in any way 

Prior to laws enacted in 1996, the cost of 

welfare for immigrants had jumped to $8 billion a year. The number of noncitizens on 

Supplemental Security Income increased more 

than 600 percent between 1982 and 1995. 

Both of those numbers will be much higher if 

H.R. 2 is enacted. 

At a time when government spending is out 

of control, and when States, cities and American citizens are struggling to make ends 

meet, the last thing we need is to change 

good policy and further burden U.S. taxpayers. 

This legislation should be opposed. 

Mr. KLEIN of Florida. Madam Speaker, I 

rise in strong support of the Children’s Health 

Insurance Program Reauthorization Act of 

2009. This critical legislation will take care of 

unfinished business from the 110th Congress 

by providing health insurance coverage to 11 

million children along with enacting needed reforms to the CHIP program. 

I applaud Speaker PELOSI for bringing this 

bill to the floor so quickly and President-Elect 

Obama for calling on Congres to have this 

legislation ready when he takes office. To be 

frank, this bill can’t come fast enough for the 

millions of children without basic healthcare 

coverage and for the low-income families 

struggling to make ends meet. 

Never in my life has our country been in 

such a precarious state. Our once soaring 

economy is teetering, with unemployment at 

7.2 percent, and the traditional pillars of our 

economy are struggling to stay in business. 

Now more than ever, the government must fill 

its role by helping the most vulnerable in our 

society meet their basic needs like healthcare. 

Madam Speaker, we’re not asking my colleagues to take a leap of faith on some untested program. Created a decade ago, the State 

Children’s Health Insurance Program is a 

product of true bipartisanship. A Republican 

Congress passed it, and a Democratic President signed it into law. And it is not an entitlement program; it is an empowerment program 

that encourages enrollment into private health 

insurance programs and a sliding scale for 

premiums based on a working family’s ability 

to pay. 

In my home State of Florida, CHIP is administered through the Healthy Kids Program. 

During my tenure in the Florida State Senate, 

I helped oversee its implementation while 

serving on various committees. While we ran 

into some roadblocks with enrollment, I can 

say that people from both parties as well as 

the business community felt it was an innovative way to provide health care coverage to 

hundreds of thousands of low income children 

in Florida. 

Madam Speaker, passing CHIP legislation 

today is our first test of leadership in the 111th 

Congress. If we fail—if we fail our children— 

then we must ask ourselves what leadership 

means in a time of crisis and whether we deserve the trust of the American people. 

Mrs. CHRISTENSEN. Madam Speaker, I 

rise today for 11 million reasons—the 7 million 

children whose insurance will continue and the 

more than 4 million other children who will be 

insured for the first time—many of whom are 

children of color—with the passage of H.R. 2. 

I must commend Chairmen PALLONE, WAXMAN and DINGELL—whose steadfast efforts to 

expand health coverage to millions of American Children and whose unwillingness to accept mediocrity is why we are here today. 

If we are all having de ̃ja ̃vu, it is because we 

have done this twice before. And we are here 

today not just because of the charm on the 

third try, but because this year we will have a 

new president who will finally sign it into law. 

H.R. 2 will not only make a significant down 

payment on President elect Obama’s and our 

promise to insure all of our country’s children, 

it rightfully refuses to leave out children and 

pregnant women who have been legally admitted into our country. Doing this is not only the 

right thing to do it is the least we can do to 

insure the health of all of our children. 

This bill also includes important expansions 

to the program for screening and prevention 

as well as dental and mental health care, addressing child health in a more holistic way 

Because more than half of all uninsured 

children are racial and ethnic minorities, this 

bill will help to eliminate health disparities in 

this most vulnerable group and improve the 

outlook for their health later in adulthood. 

Today we have the opportunity to reach 

across the political aisle to do the right thing— 

to make the health and health care needs of 

our nation’s children the priority they must 

be—to make sure that every child has the opportunity to reach their fullest potential, so that 

our Nation can too. 

I urge all of my colleagues to vote for H.R. 

2—to vote for America’s children. It is nothing 

less than a vote for the future of our country. 

Mr. CUELLAR. Madam Speaker, I rise today 

in strong support of the Children’s Health Insurance Program. 

Growing up as the son of migrant parents, 

I was among the millions of American children 

who had no health insurance. When someone 

in our family got sick, seeing a doctor simply 

wasn’t an option. 

I got lucky. Even without health insurance, I 

grew up into a healthy adult. But I could just 

as easily have ended up going untreated for a 

chronic disease or serious injury, and a lifetime of opportunities would have evaporated. 

It is unacceptable that 1.4 million Texas kids 

continue to bear that risk today. 

When I served in the Texas State House, I 

had the honor of launching the first CHIP program in Texas at Farias Elementary School in 

Laredo. The program later expanded statewide, and today, it has helped millions of 

Texas families—families like the one I grew up 

with—afford to see a doctor. 

In these difficult economic times, as millions 

of Texas families struggle with job losses and 

pay cuts, CHIP is more important than ever. 

For families living on the financial edge, CHIP 

is a critical source of care, support, and peace 

of mind. 

Mr. HONDA. Madam Speaker, I rise today 

in support of H.R. 2, the State Children’s 

Health Insurance Program Reauthorization Act 

of 2009. Over the last 2 years, it has become 

necessary to fund the Children’s Health Insurance Program in some States through supplemental appropriations as program wait-lists 

grew and children waited for care. Now, with 

the country in the midst of the severest financial crisis in decades, parents are more concerned than ever about the health and wellbeing of their children. The bill before us today 

represents an investment in our Nation’s safety net; by preserving and expanding the program to provide coverage for 11 million children over the next 41⁄2 years, the bill alleviates 

some of the stress placed on men and women 

faced with unemployment. 

My home county of Santa Clara was the 

first in the Nation to ensure that every child 

with parents at or below 300 percent of the 

federal poverty level has real access to regular health care as a result of being insured. 

The county’s Children’s Health Initiative raises 

its own money to add to State and Federal 

funding in order to keep all the children of my 

district healthy—last year, the program enrolled over 144,000 children and serves as a 

model for 17 other California counties. 

This innovation is threatened by the county’s $220 million projected budget deficit for 

fiscal year 2009; and we in Santa Clara County face the possibility of deep cuts in our 

healthcare system totaling nearly $100 million. 

The budget woes of the State of California 

limit the assistance it can provide, and so 

without this reauthorization of SCHIP, the financial burden on the county would be significantly heavier. I’m proud to vote today for legislation that will provide our program and our 

county’s children with much needed stability 

for the next 41⁄2 years. 

As the chairman of the Congressional Asian 

Pacific American Caucus, it is particularly 

gratifying to see the inclusion of a provision in 

this bill that will allow States to waive the 5- 

year waiting period for Medicaid and SCHIP 

imposed on pregnant women and children 

who are legally present in the United States. 

It is morally unconscionable that pregnant 

women and innocent children have been 

made victims of a raucous and frequently misleading immigration debate. Hundreds of thousands of people from Asian countries immigrated legally to the United States in 2007 and 

2008; at the very least the children in those 


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families deserve to have health insurance and 

access to care. CAPAC has consistently 

joined with the Congressional Black Caucus 

and Congressional Hispanic Caucus in advocating for protection of this vulnerable population and I thank Speaker PELOSI and our 

other House leadership for redressing this injustice. 

The passage of this bill protects the health 

of millions of American children. It is the first 

step in a long journey toward repairing our 

healthcare system and providing universal 

coverage, care, and access to the people of 

our Nation, and I look forward to working with 

my colleagues to complete that journey. I urge 

the Senate to act in as swift and responsible 

manner as we do today and pass this bill. 

Mr. BARTON of Texas. Madam Speaker, as 

we debate this new SCHIP bill, I think it is important to figure out what we know about the 

bill and the undemocratic methods that produced it. 

First, we know that few, if any, Members of 

Congress actually have read the bill. Despite 

the promises made by Majority Leader HOYER

on Friday that we would get at least 48 hours 

to review the bill, the new, 285 page SCHIP 

bill only turned up yesterday at 11:20. The 48 

hours that Majority Leader HOYER promised 

somehow shrank to less than 24 hours. The 

Rules Committee met without an official score 

from the Congressional Budget Office. I will 

stipulate that Members may not always read 

the legislation they vote on, but most of us at 

least read the summaries and analyses that 

our staff members prepare. And every one of 

us has a right to the time required to know 

what these bills contain. 

That’s what the regular legislative process is 

all about—listening, thinking, proposing, thinking some more, amending and debating. Implicit in normal process is the notion that all 

useful ideas may not reside exclusively in the 

minds of the Speaker’s assistants. 

And all this careful listening and critical 

thinking by House Members is supposed to 

happen before we vote. Democrats seem to 

think that’s got it backwards. They want to 

vote first and think later. It’s all about bills written in private, delivered at night, and 

ramrodded through here with the blink of an 

eye. Now, I recognize that a strong majority 

can do things that way, and Republicans 

aren’t without sin. But when secrecy and arrogance are combined with perfect efficiency, 

the country always seems to pay a heavy 

price. 

On this bill especially, I’ve been treated better by used car salesmen. They didn’t want 

me looking too closely at their products, but 

they didn’t dump a wreck on my front lawn 

after sundown and tell me I had to buy it or 

else. The Democrats don’t want anyone to inspect their product, either, and maybe that’s 

because it has the qualities of a used Edsel. 

There has been no process, much less any 

fair process. Evidently changes have been 

made to the bill from 2 years ago, but what 

are they? There have still been no committee 

markups on any SCHIP legislation and no legislative hearings. And I can’t find evidence that 

a single one of the numerous suggested improvements to past SCHIP bills has been incorporated into this one. The majority is interested in what it wants and nothing else. 

We also know, Madam Speaker, that today 

is largely a political exercise. The Senate is 

actually going to have a real markup in the 

Senate Finance Committee. I’ll say that again 

to make sure my friends on the other side of 

the aisle heard what I said: The Senate is actually going to put their SCHIP bill through the 

full committee process, including considering 

ideas from people not on the Democrat leadership staff. 

It’s possible to legislate the right way, and 

it’s pitiful that the people’s House is reduced 

to taking lessons in democracy from our 

friends in the Senate. 

Over here, the tricks don’t stop with tactics. 

Every Member of this body understands that 

they will be vilified if they don’t fall in line and 

support this bill. If you don’t vote for the 

Democrats’ SCHIP bill, your constituents will 

be told that you hate kids. Your people will be 

told that the only way to ensure that kids get 

health care is by supporting the bill produced 

by the Democrat leadership without a whisper 

of a complaint. They want the people to believe that there are no other ideas and no 

other options. 

Well, Madam Speaker, I want to make clear 

to the American people that my Republican 

colleagues and I do want to reauthorize the 

SCHIP program. We have repeatedly reached 

out to the Democrats and have asked for a 

chance to sit down with them and work on a 

compromise that can become law. Last year, 

we heard many impassioned speeches about 

how important it was to override the President’s veto of the Democrats’ bills, but after 

these votes those same people were literally 

applauding when the veto was not overridden. 

That’s right, Madam Speaker, there were 

Democrats applauding on the floor of the 

House when the bill they supported was rejected. That’s more than partisan politics, that 

is cynicism and deception at their ugliest. 

Madam Speaker, when the Democrats stop 

making this about political advantage at the 

expense of low-income children, and decide to 

actually produce a serious, passable SCHIP 

program, I am still ready to work with them. 

As it stands now, I urge all Members to reject this cynical ploy and vote ‘‘no’’ on this 

deeply flawed and highly partisan bill. 

Mr. KUCINICH. Madam Speaker, I rise in 

strong support of H.R. 2, which will provide 

health care for 4 million previously uninsured 

children. In Ohio, it will make the difference for 

up to 50,000 kids. 

Ohio has had to suspend its efforts to expand eligibility to children because of tight 

State budgets. At the same time, the number 

of eligible children is growing rapidly as more 

parents lose their jobs or simply watch the 

premiums of private health insurance companies skyrocket beyond their means. This bill is 

needed more than ever. 

The bill also includes mental health parity as 

well as dental coverage. Dental coverage is a 

topic I explored in the Domestic Policy Subcommittee of the Oversight and Government 

Reform Committee in a 7-month investigation 

into the death of 12-year-old Deamonte Driver. 

He died of a brain infection caused by tooth 

decay. 

Finally, the bill allows states the option to 

cover children born outside the U.S. but now 

here legally. This provision will not only give 

these children the health care they deserve 

but will also save States money by allowing 

them to move routine care from the emergency room to the doctors office where it belongs. I fought for this provision in a previous 

version of this bill when it was excluded. I am 

glad to see that it has been retained this time 

and look forward to its passage. 

Every child has a right to health care. This 

bill is a step in the right direction. 

I urge my colleagues to pass the SCHIP reauthorization. 

Mrs. CAPPS. Madam Speaker, I rise in 

strong support of this legislation to strengthen 

SCHIP and in strong support of America’s children. 

As a former school nurse, I consider it a 

crime that there are children in America who 

cannot access all of the healthcare services 

they need. 

And today we have an opportunity to fix this 

injustice. 

The excellent bill we have before us will ensure that millions of children in working families can get the proper preventive and primary 

care they need to ensure a healthy childhood. 

I am also pleased to see that this bill preserves State options to cover pregnant 

women. 

After all, the health of a mother is the greatest contributor to a child’s health. 

The current economic climate only adds to 

the urgency of this legislation. 

States are experiencing budget shortfalls 

which threaten the status of children already 

enrolled in SCHIP. 

And as parents lose their jobs; their health 

coverage is lost, too. 

So I hope every one of my colleagues will 

join me in voting ‘‘yes’’ on this bill today and 

secure a better future for the health of our 

children and grandchildren. 

Ms. HIRONO. Madam Speaker, I rise today 

in strong support of H.R. 2, the Children’s 

Health Insurance Program (CHIP) Reauthorization Act of 2009. 

I believe our Nation must show true compassion for the most vulnerable among us, 

and CHIP is a program that helps millions of 

low-income American children to receive 

health care so they can grow up in good 

health. 

Since its creation in 1997, CHIP has been 

successful in providing vital health care coverage for children in families who cannot afford private insurance yet earn too much to 

qualify for Medicaid. There are now 6.6 million 

children enrolled in the program, which includes 20,000 keiki (children) from my home 

State of Hawaii. 

Regrettably twice in 110th Congress, President George W. Bush vetoed bipartisan bills 

that would have reauthorized and improved 

CHIP in order to provide secure health coverage for millions of uninsured children in 

working families. These vetoes were made despite the fact that the bills had passed in both 

the House and Senate with strong bipartisan 

majorities. As a result of these vetoes, Congress was only able to provide a short-term 

extension of CHIP, through March of 2009, but 

was not able to enact program improvements 

to help States reach additional uninsured children. 

The bill before us today is based on the two 

previously vetoed bipartisan bills. It also offers 

the 111th Congress the opportunity to right the 

wrongs of the out-going administration. President-elect Obama has previously expressed 

strong support for CHIP because it provides a 

much-needed down-payment on children’s 

health. By extending health coverage to millions more children, this legislation is an important first step in stemming the rising tide of 

the uninsured. 


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H260 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

I urge my colleagues to join me and vote in 

support of this bill and of the health and wellbeing of children most in need of our help. 

Ms. TSONGAS. Madam Speaker, today, I 

rise in support of legislation we will be considering today to expand the Children’s Health Insurance Program. 

This bill provides coverage to children 

whose families cannot afford private insurance, and would expand access to health insurance for millions of children nationally— 

over 200,000 living in Massachusetts. 

I first voted to override the President Bush’s 

veto of similar legislation on the day I was 

sworn into office. It was my first vote and one 

of which I am enormously proud. Tens of 

thousands of people from my District, and millions more across the country, both Republicans and Democrats, have made their support for this program resoundingly clear. 

This program is also important to my State 

of Massachusetts, where the program was first 

developed, because it is a critical component 

of the groundbreaking universal Massachusetts Health Care Plan. 

Today, I stand with a strong bipartisan majority ready to give our Nation’s children a 

chance at a healthy childhood and I urge my 

colleagues to do the same. 

Mr. SIRES. Madam Speaker, I rise today to 

speak about the State Children’s Health Insurance Program or SCHIP. This is a successful, 

popular, bipartisan program that currently provides private health care coverage for more 

than 6 million children who would otherwise go 

without care. I am very proud to stand here 

today and say I will vote for a bill that provides 

health care to children in need, and that President-elect Obama said he would sign into law. 

Our action could not come at a better time. 

With rising unemployment, many families can 

no longer afford their health insurance. This 

bill brings them needed relief. Now parents 

can find comfort knowing their children will 

have access to health care while they look for 

a new job. This is particularly important in my 

home State of New Jersey. FamilyCare in 

New Jersey serves 122,000 children every 

year, a small percentage of which come from 

families with incomes up to 350 percent of the 

poverty line. It is expensive to live in my State, 

and even these families need help getting by. 

I am happy that this bill maintains the State’s 

right to serve these families. 

Today we get to make a real impact on the 

lives of many struggling families. I am proud to 

support H.R. 2, the SCHIP Reauthorization 

Act of 2009. 

Mr. BARTON of Texas. Madam Speaker, I 

rise today to discuss an unrelated issue that 

has been neatly tucked into this bill. The issue 

is timely access to quality hospital care in our 

Nation’s communities. 

The Majority says we don’t need any regular 

legislative process with this bill because everyone knows what’s in it. Well, my staff received 

this 285-page bill at 11:20 a.m. yesterday. 

Even with full knowledge of what went into 

previous versions of this legislation, it isn’t reasonable to expect that people will be able to 

gain a good understanding of the new bill with 

that sort of time constraint. I would also note 

that since the last time the House voted on an 

SCHIP bill, we’ve added more than 60 new 

Members. 

This is politics as usual, and it should give 

every new Member great pause before voting 

for this bill, or any bill. I don’t believe that any 

of our new Members comes from a background where they were expected to approve 

a major policy on the basis of the idea that, 

well, it’s been here before, so we don’t need 

to read it or understand it. In fact, didn’t most 

of us run against that sort of deceptive politics 

in Washington? 

I want to point out to the new Members that 

your vote today could also cause hospitals in 

your district to close. Hospitals that are under 

construction now and intended to serve your 

constituents soon may never see a patient. 

And why will that happen? Because a few 

Members of your conference with clout believe 

physicians in your communities shouldn’t own 

hospitals. They say that the people who care 

for and about their communities, who have a 

personal stake in the care that is delivered, 

those people should not be trusted. 

We have had no hearings on the issue of 

physician ownership of hospitals in the last 

two Congresses. The Health Subcommittee 

did have one hearing last year to discuss 

health disparities and we heard from a physician from Louisiana. His story illustrates what 

can happen when physicians are able to help 

their communities. After Katrina, hospitals 

were closing and residents couldn’t get care. 

The doctors in these communities made a difference by coming together to make sure people could continue to receive health care. Why 

on earth would we want to eliminate people’s 

ability to serve their community? 

Why are the opponents of physician-owned 

hospitals so antagonistic? I’m not sure, because these hospitals provide higher quality 

care at lower costs than other hospitals. They 

have higher patient satisfaction rates and don’t 

experience workforce shortages like other hospitals do. 

I offered an amendment along with Congressman JOHNSON and Dr. BURGESS to strike 

the section that was written to eliminate physician-owned hospitals. Unfortunately, the Rules 

Committee rejected that idea. Congressman 

BOREN and Congresswoman JACKSON-LEE

proposed a very fair amendment that would 

have delayed the implementation of Section 

623 to July 1, 2010, so hospitals that are currently under construction could finish being 

completed and serve patients. That amendment also was rejected. 

Last week, the House changed the rules on 

motions to recommit stating we could continue 

to have the committee and amendment process to voice our concerns. Madam Speaker, 

this has had neither, and it is a shame because the provision of quality hospital care is 

too important to be eliminated due to some 

philosophical bent of a couple of your senior 

Members. 

New Members, this is an early to important 

test: do you vote your district or do you vote 

your leadership? Do you vote your hospitals or 

do you vote for a policy that was concocted in 

private in Washington. 

Madam Speaker, in 1997, the Republican 

Congress enacted the State Children’s Health 

Insurance Program to help children’s families 

near poverty. But now, true to their big government agenda, the Democrat Congress 

wants to send the President-elect a massive 

increase in the SCHIP Program that will usher 

in a new era of socialized medicine in America. 

This bill will take a program designed to 

help children near the poverty level and expand it to include families with incomes of up 

to $84,000 a year. 

And Democrats will pay for this middle class 

entitlement with a 61 cent—$1 per pack tax increase on cigarettes. 

Let’s provide health insurance for children of 

the poor, but let’s reject a liberal Democratic 

Congress attempt to create middle class entitlements on the backs of American smokers. 

Since Congress has already reauthorized 

and fully funded SCHIP through March 31, 

2009, we should work in a bipartisan manner 

to thoughtfully develop a longer-term reauthorization of the State Children’s Health Insurance Program. 

While I have been pleased to support 

SCHIP in the past, and continue to support its 

original intention to cover needy children who 

do not qualify for Medicaid, the bill being considered today hardly resembles the bipartisan 

compromise reached in 1997. 

My Republican colleagues and I are eager 

to work with Democrats—as we did more than 

10 years ago—to ensure that needy children 

receive health care coverage. As the program 

expands, health care for needy children is 

jeopardized. Republicans will work tirelessly to 

see that every currently eligible child is covered first and that taxes are not raised on the 

poorest among us. 

The Democrats’ SCHIP bill spends billions 

of dollars to substitute private health insurance 

coverage with government-run healthcare coverage. The Democrats’ SCHIP bill taxes the 

poor to benefit the middle class. The bill uses 

the funding gained from taxing the poor to pay 

for expanding SCHIP eligibility to higher-income families. The Democrats’ SCHIP bill focuses on enrolling higher-income kids instead 

of low-income, uninsured kids. The Democrats’ SCHIP bill enables illegal aliens to 

fraudulently enroll in Medicaid and SCHIP. 

Short of finding at least 22.4 million new 

smokers (the number required to adequately 

fund SCHIP) Democrats will be forced to either kick millions of children off of health insurance or raise taxes on all of us by tens of billions of dollars. 

It is irresponsible to fund a children’s health 

program, particularly one targeted at vulnerable children, with a declining revenue stream. 

The revenue to fund this expansion will 

soon disappear, causing all of us to pay more 

in taxes. 

The percentage of Americans who smoke 

has been dropping for decades. And research 

and logic both show that raising the prices of 

cigarettes will lead to less smoking, and therefore less revenue. 

The Democrat expansion of SCHIP takes 

money from taxpayers in States like Indiana to 

pay for middle class children in wealthier 

States. 

I oppose this legislation and urge my colleagues to do the same. 

Mr. LARSON of Connecticut. Madam 

Speaker, I rise today in support of the reauthorization of SCHIP, an important piece of 

legislation that has become even more necessary now than it was when we started working on it 2 years ago. I commend my colleagues, Congressman PALLONE, Congressman WAXMAN, the dean of the House, Congressman JOHN DINGELL, Congressman RANGEL, Congressman STARK, and many others 

for their tireless efforts on this bill. 

Madam Speaker, by passing this bill today 

we will provide health care for 11 million children. This is not just a bipartisan achievement, 

it is the right thing to do. 


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January 14, 2009 CONGRESSIONAL RECORD — HOUSE H261 

With the economic downturn and some of 

the worst unemployment numbers we’ve seen 

in decades, rising health insurance costs are 

making it increasingly difficult for families to afford health care for their children. States faced 

with the constitutional responsibility of balancing their budgets have been cutting programs that provide children with access to 

health care. Some states have already cut 

thousands of children from their CHIP programs and more States are considering drastic action. By reauthorizing SCHIP, we will enable States to prevent the loss in health coverage for many of these children and allow 

more uninsured families to participate in the 

program. In Connecticut alone this legislation 

will mean thousands of our 43,000 uninsured 

children will now be covered. 

One story that has been brought to my attention is the story of the Farr family in Manchester, CT. Joseph and Danielle Farr are in 

their early thirties. They are hardworking citizens who have a young child soon to turn 1. 

They have a household income that is just 

$15 above Medicaid. But they qualify for 

SCHIP, which they call a ‘‘godsend’’ for their 

family. 

The Farrs just learned that Joe is likely to 

be laid off from his job in March—a story familiar to many Americans. But, thanks to 

SCHIP, their son will continue to get the 

health care he needs. By reauthorizing SCHIP 

we will make sure that families like the Farrs 

will continue to have health care for their child 

even if they do fall victim to the economic 

downturn. 

This bill will increase outreach efforts targeted at children currently eligible but not enrolled in the program and also give pregnant 

women access to health care through SCHIP. 

While we still have many more miles to travel 

on the road to fulfilling the promise of health 

care reform, this, Madam Speaker, is a downpayment on that effort. I am proud to support 

this legislation and urge my colleagues to 

stand with us, to stand with our children, and 

pass this bill. 

Ms. LEE of California. Madam Speaker, I 

rise in strong support of H.R. 2, the State Children’s Health Insurance Program (SCHIP) Reauthorization bill. 

I want to thank Chairman WAXMAN and 

Chairman PALLONE and all the staff for their 

work in ensuring that this bill moves forward 

as one of our highest priorities in the 111th 

Congress. 

Today we will take the long overdue step to 

expand health insurance coverage to over 11 

million children throughout the country. 

As our Nation remains mired in the depths 

of the worst economic crisis since the Great 

Depression, the action we take now could not 

be more important or more necessary. 

The fact is that the economic policies of the 

outgoing administration have left our Nation in 

worse shape than we were 8 years ago. 

Today, more people are living in poverty, 

more people are living without health insurance, and more people are unemployed than 

they were 8 years ago. 

As always, it is the most vulnerable, the 

children, who suffer the greatest during tough 

economic times like these. 

Passage of the SCHIP legislation today will 

at least help to make life a little easier for 4 

million more children who will receive health 

coverage under this expanded program. 

Although I strongly support this legislation, I 

believe it can still be improved, most immediately by removing the citizenship verification 

requirements that remain in this bill. 

Ultimately we must move our Nation towards a universal health care system to cover 

all children and all Americans. Nonetheless 

this bill is an important step forward. 

Madam Speaker, the Nation’s children have 

waited far too long for this moment. I urge my 

colleagues to pass this bill. 

Ms. JACKSON-LEE of Texas. Madam 

Speaker, I rise today in strong support for the 

‘‘Children’s Health Insurance Program Reauthorization Act of 2009.’’ We stand today, closer to helping 4 million children without health 

insurance. No longer will these children be 

forced to live with fear of getting sick. 

Today is a great day. Today we can bring 

4 million children into the fold. Today we can 

tell those 4 million children that are begging 

for help that Yes We Can! 

NATIONALLY AND IN TEXAS

There are an estimated 8.9 million uninsured children in America. Overall, about 11.3 

percent of children in the United States are 

uninsured, but the percentage of uninsured 

children in each State varies widely. Based on 

a 3-year average, there were an estimated 

20.9 percent of uninsured children (under 19 

years of age) in the Texas, representing 

1,454,000 of the State’s children. 

According to the Institute of Medicine, uninsured people are less likely to use preventive 

services and receive regular care. They are 

also more likely to delay care, resulting in 

poorer health and outcomes. Texas has the 

highest uninsured rates of all 50 States and 

the District of Columbia (2005–2007). Almost 

one-quarter, 24.4 percent, of Texans are uninsured compared to 15.3 percent of the general 

U.S. population. 

Data show that virtually all the net reduction 

in SCHIP enrollment has been among children 

in families with incomes below 150 percent 

FPL. The number of below-poverty children 

has dropped by more than 68 percent, and the 

number of children between 101–150 percent 

FPL has dropped by more than one-third since 

September 2003. I want to share with you just 

some of the scary health statistics that are affecting children: 

74 percent of uninsured children eligible for 

SCHIP or Medicaid but not enrolled. 

11 percent of uninsured children in families 

not eligible for Medicaid or SCHIP with incomes below. 

15 percent of uninsured children in families 

with incomes over 300 percent of the Federal 

poverty level who are ineligible for Medicaid 

and SCHIP. 

90 percent of uninsured children that come 

from families where at least one parent works. 

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

3.4 million uninsured children who are white, 

non-Hispanic. 

1.6 million uninsured children who are African American. 

3.3 million uninsured children who are Hispanic. 

670,000 uninsured children of other racial 

and ethnic backgrounds. 

In the great State of Texas, there is a young 

man named Jason who had SCHIP health insurance for years, and the coverage was life 

saving. 

When he was in a car accident over a year 

ago, SCHIP covered his treatment and all the 

medical bills. His family needs SCHIP because they cannot afford private health coverage. The parents work hard, but the father’s 

employment in pest control is seasonal and 

provides only about $35,000 annually. Jason’s 

mother is wheelchair-bound with multiple sclerosis and has significant health care expenses. 

When Jason lost SCHIP a year ago, his 

mother suspected they had been denied because of the 2003 Ford truck the family purchased so that she could transport her wheelchair. Prior to last year, she had never had 

problems renewing coverage, and the family’s 

income had not change. But the income 

guidelines had changed. 

New SCHIP guidelines that took effect in 

December 2005 do not count children over 18 

years of age as family members. Although 

their full-time student daughter lives at home, 

she is not counted as part of the family, and, 

as a result, they are about $50 a month above 

the income limit for a family of three. So now 

the entire family is uninsured. This lack of coverage means that when Jason gets sick or 

hurt, they have to delay paying other bills to 

pay for medical care. 

Lack of coverage also has affected Jason’s 

performance in school. He has been sick quite 

a bit in the past few years with allergies and 

has missed many days of school because his 

eyes become swollen and he is unable to 

breathe. School officials had reprimanded the 

mother about his absences but now realize 

that Jason has some serious health issues. Finally we will be able to help people like Jason 

and assuage his mothers concerns. We are 

able to insure those who need it most. 

PHYSICIAN-OWNED HOSPITALS

Sadly, there is one portion of this bill I did 

have some trouble with, the restrictions on 

physician-owned hospitals. Yesterday, my 

dear friend from Oklahoma, Congressman 

BOREN, and I were able to voice a very real 

concern that we had with the prohibition on 

physician-owned hospitals. 

As the bill was originally written there was a 

provision in the bill that would have drastically 

affected the quality of care available to Houston residents and people in urban communities across the entire country. 

JACKSON-LEE AMENDMENT

Yesterday, I put forth an amendment that 

would have exempted General Acute Care 

Full Service Physician-Owned Hospitals from 

section 1877 of the Social Security Act, as 

added by section 623 in SCHIP. There is no 

direct evidence that demonstrates that overutilization of services and improper self-referrals are in any more excess at General Acute 

Care Full Service Physician-Owned Hospitals. 

My amendment would have exempted responsible and efficient physician-owned hospitals to develop, purchase, sell, and/or transfer their interests. 

BOREN/JACKSON-LEE AMENDMENT

My amendment with Congressman BOREN

would have provided an extension for the January 1, 2009 grandfather clause for physicianowned hospitals to allow physician-owned 

hospitals currently under construction to be 

completed. 

At least 85 hospitals across the Nation have 

been affected. Boren/Jackson-Lee does not 

differentiate between General Acute Care, Full 

Service, and Specialty Hospitals. 

The exceptions that exist to grandfather in 

certain physician owned hospitals are inadequate and will affect more than 85 hospitals 


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that are currently in development and under 

construction. It will also restrict sales and 

transfers of many responsible physicianowned hospitals. 

In my district of Houston, TX the population 

has grown close to 4.5 million people, and 

there are only approximately 16,000 beds 

available in the city. Eliminating physician 

ownership in general acute care hospitals 

would only contribute to this ever growing 

problem. 

While many specialty hospitals are accused 

of turning away uninsured and Medicaid patients and practicing only profitable healthcare, 

responsible physician-owned hospitals do just 

the opposite. 

Physician-owned hospitals like St. Joseph 

Medical Center in my district provide essential 

emergency, maternity, and psychiatric care for 

their patients. They delivered over 6,000 babies in 2008, of which 3,700 were insured by 

Medicaid. Currently they provide $14M in uninsured care in the Houston market. A Houston 

institution for 120 years, St. Joseph Medical 

Center is also a major provider of psychiatric 

beds as it currently operates 102 of the 800 licensed beds in Houston. 

While Members of the Texas delegation 

have continued to support general acute-care 

hospitals and their future development; we still 

believe that general acute-care hospitals still 

need to be able to: 

Maintain a minimum number of physicians 

available at all times to provide service; 

Provide a significant amount of charity care; 

Treat at least 1/6 of its outpatient visits for 

emergency medical conditions on an urgent 

basis without requiring a previously scheduled 

appointment; 

Maintain at least ten full time interns or residents-in-training in a teaching program; 

Advertise or present themselves to the public as a place which provides emergency care; 

Serve as a disproportionate share provider, 

serving a low income community with a disproportionate share of low income patients; 

and 

Have at least 90 hospital beds available to 

patients. 

This issue is of the utmost importance to me 

because I, like others in the Democratic Caucus, have hospitals and hospital systems such 

as University Hospital Systems of Houston in 

my district that would have been greatly affected by this provision. 

ST. JOSEPH MEDICAL CENTER

In 2006, St. Joseph Medical Center, downtown Houston’s first and only teaching hospital, was on the verge of closing its doors. 

When I learned that they were going to shut 

down this hospital and turn it into high-end 

condominiums, I personally worked with the 

hospital board, community leaders, and local 

government to ensure this did not take place. 

Eventually, after I was assured that it would 

be responsibly managed and its doors would 

remain open, I was able to help a hospital corporation, in partnership with physicians, which 

has purchased the hospital and has made it 

the premier hospital in the region to keep 

open St. Joseph’s doors including its qualified 

emergency room responsive to a heavily populated downtown Houston. 

This formerly troubled medical center is now 

in the process of reopening Houston Heights 

Hospital, the fourth oldest acute care hospital 

in Houston. Without language that specifically 

addresses this distinction, this project too will 

come to an end. 

Sadly, it remains unclear if CHIP provides 

for physician-owned hospitals to still be considered grandfathered if have a sale or transfer at the same ownership rate or at a different 

physician-ownership rate. 

Between December 2007 and December 

2008, the U.S. economy shed about 2.6 million jobs, while Texas made significant gains. 

Texas’ nonfarm employment registered a stable 2.1 percent growth rate over the year, 

even as the Nation’s job losses reached their 

worst level since 2003. CBO forecasts the following: 

A marked contraction in the U.S. economy 

in calendar year 2009, with real (inflation adjusted) gross domestic product (GDP) falling 

by 2.2 percent; 

A slow recovery in 2010, with real GDP 

growing by only 1.5 percent; 

An unemployment rate that will exceed 9 

percent early in 2010. 

The U.S. Bureau of Labor Statistics announced on November 21, 2009, that October’s unemployment rate was 6.5 percent, a 

jump of 0.4 percent, which was double what 

most economists expected and its highest 

level in 14 years. The economy has now lost 

1.2 million jobs since the beginning of the 

year, with nearly half of those losses occurring 

in the last 3 months alone, pointing to acceleration in the pace of erosion in labor markets. 

It is more important than ever in this economy 

that children’s health care is not sacrificed. 

Madam Speaker, my faith is renewed in the 

process that is so often maligned in the 

media. Thoughtful and deliberate actions were 

taken to improve this legislation that would not 

only help the children of my district and many 

others across the nation, but also it was able 

to address concerns that many of us, myself 

included have on these specialty hospitals. 

I look forward to a day when every child is 

covered and can play on football fields and 

jungle gyms without their parents fearing a 

bankrupting injury to their child. This legislation is piece of mind to 4 million families, and 

I will joyfully cast my vote for passage of this 

important legislation. 

Mr. LEVIN. Madam Speaker, some of the 

issues we debate in Congress are complicated. This one is quite simple. Americans 

want the children of this country covered by 

health insurance. 

The State Children’s Health Insurance Program currently covers about 7 million children, 

including 114,000 kids in my home State of 

Michigan. However, there are still about 9 million children in our country who are uninsured. 

This is unconscionable. No mother should 

have to worry about whether she can pay for 

the health care her child needs. No father 

should have to take his son to the emergency 

room because he does not have insurance to 

visit a primary care doctor. No society should 

allow a child to go without the security health 

insurance provides. 

Congress passed two SCHIP bills last session. Both pieces of legislation were bipartisan, and both cleared the House and Senate 

with large majorities. Unfortunately, President 

Bush vetoed these bills. 

As economic conditions have worsened 

over the course of the last year and more and 

more children have lost health insurance, this 

bill has become even more vital to ensuring 

that children do not fall through the cracks of 

our current health care system. The legislation 

under consideration today would extend coverage to another 4 million low-income children. 

It is an important step toward the goal of ensuring that all Americans, especially children, 

have the quality and affordable health care 

they need. 

President-elect Obama strongly supports 

this SCHIP legislation. I can think of no better 

beginning to the next 4 years than to send the 

new President this critical investment in children’s health. I urge my colleagues to vote for 

passage of H.R. 2, the Children’s Health Insurance Program Reauthorization Act of 2009. 

Mr. POSEY. Mr. Speaker, I rise to express 

both my support for the State Children’s 

Health Insurance Program, SCHIP, and my 

reservations about the particular SCHIP bill, 

H.R. 2, that is before us today. I would also 

add that I am pleased to support an alternative version that will be offered as a substitute today. This alternative focuses SCHIP 

on low income children and addresses the 

problems with the underlying bill. 

Our nation faces very serious financial challenges. The Congressional Budget Office, 

CBO, projects that this year’s Federal budget 

deficit will be nearly $1.2 trillion dollars. In 

other words one out of every three dollars that 

the Federal Government will spend this year 

will be borrowed from future generations. 

Given that our children and grandchildren will 

have to pay back everything that this generation borrows, we must give the greatest scrutiny to each and every dollar that is spent. 

I am committed to working to assist lowerincome children who lack insurance. SCHIP 

was established as a bipartisan program to insure children in families too poor to pay for insurance but not poor enough to qualify for 

Medicaid. If that was what the bill before us 

did, I would be voting for it. Unfortunately, 

H.R. 2 goes well beyond focusing specifically 

on these children. 

H.R. 2 expands SCHIP to extend taxpayer 

subsidies to the children of those living in, for 

example, New Jersey and making more than 

$80,000 per year, 400 percent of the poverty 

level. 

The CBO estimates that 2.4 million of the 

new enrollees in SCHIP will be children who 

simply dropped private coverage to enroll in 

SCHIP. Given our massive Federal deficit, 

does it make sense to borrow money from our 

children and grandchildren in order to enroll in 

SCHIP children who currently have other private insurance? 

H.R. 2 continues to allow states to enroll 

single adults in SCHIP. Over 600,000 are enrolled in the SCHIP program and three states 

have more adults enrolled in SCHIP than children. This is particularly troubling given that in 

many states with large numbers of adults enrolled in SCHIP, many qualified children remain uninsured. This is a misappropriation of 

limited resources and children should not have 

to sit on the sidelines while able-bodied adults 

take their benefits. 

H.R. 2 also repeals safeguards that were 

put in place to ensure that illegal immigrants 

were not enrolled in taxpayer subsidized 

SCHIP. Removing these safeguards will actually encourage illegal immigration by offering 

taxpayer funded benefits to people who bypass our laws and enter the U.S. illegally. In 

a sense, it gives foreign nationals an incentive 

to break our immigration laws. 

Finally, in an admission by the sponsors of 

H.R. 2 that the bill is unaffordable, the bill assumes that millions of children will be dropped 


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January 14, 2009 CONGRESSIONAL RECORD — HOUSE H263 

from the SCHIP program in 2013 in order to 

meet the technical requirements of Federal 

budget rules. Does anyone really believe that 

the Congress would kick millions of people out 

of SCHIP in 2013? It’s time for this Congress 

to be honest with the American people and 

this bill does not meet that test. By employing 

this budget gimmick, the sponsors of H.R. 2 

are admitting that the bill is unaffordable. 

I am fully supportive of legislation that would 

focus on ensuring that lower income children 

are able to enroll in SCHIP. This bill falls far 

short of that goal. 

In conclusion let me say that we have until 

March 31 to reauthorize SCHIP. Congress 

should use that time wisely to further examine 

the effectiveness of this program to date and 

address these shortcomings. I am disappointed that this 286-page bill is being 

rushed to the House floor under a closed 

process that denies Members of the House 

the opportunity to have an up or down vote on 

amendments that would address these concerns. I believe that America’s children deserve better. 

Mr. ABERCROMBIE. Madam Speaker, I rise 

today to address an issue raised by my colleagues regarding Hawaii’s Keiki Care program as a reason not to expand SCHIP. It 

was suggested earlier today that the Keiki 

(meaning ‘‘child’’) Care program was cancelled 

due to perceived crowd-out, a situation where 

parents drop their children’s private insurance 

in order to enroll into a free government program. 

I have supported the State Legislature’s efforts to expand health care coverage for children and followed the implementation of Keiki 

Care closely. The statements made about a 

crowd-out problem leading to the program’s 

demise were baseless. The Keiki Care program had no problems with crowd-out. First of 

all, it was intentionally designed to prevent 

such behavior in requiring that children who 

wish to enroll must be uninsured continuously 

for 6 months. Secondly, if parents were indeed 

hoping to drop their insurance and wait 6 

months to enroll, then Keiki Care would have 

seen a spike in enrollment. Blue Cross Blue 

Shield Hawaii, the health insurance provider 

for Keiki Care, did not see any spikes in enrollment and have no evidence to believe 

crowd-out occurred. 

Furthermore, there was little incentive for 

parents to switch to the Keiki Care program 

from any private health plan. The health insurance plan offered under Keiki Care was basic 

preventative care. This means that parents 

would have had to pay for expanded care 

costs out of pocket. In looking closer at the 

Keiki Care program, it is evident that a parent 

with a full coverage plan for their child would 

have no incentive to drop a private insurance 

for this basic, prevention-centered plan. 

The State Administration has given various 

explanations regarding the decision to end 

Keiki Care, including a growing budget deficit. 

However, the facts about the program are 

clear. There was never a problem regarding 

crowd-out and if continued, the program would 

have helped to cover more of Hawaii’s uninsured children. Therefore, Madam Speaker, it 

is my hope that by clarifying the details regarding Keiki Care, it will no longer be used 

as a rationale that has no basis in fact against 

SCHIP or other efforts to expand health insurance to children and the uninsured. 

Mr. BACA. Madam Speaker, I rise today in 

strong support of H.R. 2, to extend and improve the Children’s Health Insurance Program. 

Families in my district in San Bernardino, 

California, are struggling to make ends meet 

and bring food to the table. 

Congress must answer to these and other 

families across America. 

SCHIP is a vital component of our country’s 

health system, allowing for individual states to 

take care of our most vulnerable, America’s 

children. 

A facility in my district, the Community Hospital of San Bernardino is about to rip apart at 

the seams. 

Without SCHIP, they will either have to turn 

away or eat the cost of 4,000 families enrolled 

in Healthy Families, California’s version of 

SCHIP. 

If SCHIP is not reauthorized, these alarming 

figures will jump even higher, further jeopardizing their ability to provide care for our community. 

This problem is even worse when you consider the impact of the recession, and the 

growing number of unemployed and without 

health insurance. 

I urge my colleagues to help these families, 

do the responsible thing and vote for SCHIP. 

Mr. DINGELL. Madam Speaker, I stand in 

strong support of H.R. 2, the Children’s Health 

Insurance Program, CHIP, Reauthorization Act 

of 2009. 

In 1997, a Republican Congress and Democratic President passed a landmark program 

to reach children who had fallen through the 

cracks of our healthcare system. These kids 

weren’t poor enough to qualify for Medicaid, 

and their parents—most of whom worked— 

couldn’t afford health insurance. The CHIP 

program has proven to be a major success— 

covering more than 7 million children who otherwise would not have health coverage. 

Last year, my colleagues and I tried, on two 

occasions, to reauthorize this program and expand it to provide care for many more kids in 

need of its services. Unfortunately, President 

Bush stood in our way—not once, but twice. I 

am confident President-elect Obama has his 

priorities straight and will do what President 

Bush refused to do—provide much needed 

health care for our nation’s children. 

The current economic crisis increases the 

importance of the CHIP program. More than 1 

million children have lost their health coverage 

because their parents were laid off and lost 

their employer-based coverage over the past 

year. 

This is especially true in Michigan, which 

has over 150,000 children uninsured. While 

Michigan has one of the lowest rates of uninsured children in the country, I fear that the 

number of uninsured will worsen as Michigan’s 

unemployment rate continues to increase. Recent reports suggest that Michigan’s unemployment rate will reach 11.3 percent by the 

end of the year. 

H.R. 2 is critical in this regard because it not 

only will continue to provide coverage for the 

7 million kids already participating in the CHIP 

program, but will extend health care to 4 million more. 

H.R. 2 is for every child out there who 

needs a vaccination, a cavity filled, chemotherapy, insulin, antidepressants and more life 

sustaining health care. 

This bill is a great first step as we begin our 

work to reform the nation’s health care system 

and provide health coverage for 47 million uninsured Americans. I look forward to working 

with my colleagues, Senator Daschle, and 

President-elect Obama to continue the work. 

We will not stop until all Americans have access to quality, affordable healthcare. 

I encourage all of my colleagues to vote for 

the children in your district, and for all of 

America’s children. Vote for H.R. 2, the Children’s Health Insurance Program, CHIP, Reauthorization Act of 2009. 

Mr. LANGEVIN. Madam Speaker, I rise 

today in strong support of H.R. 2, the Children’s Health Insurance Program Reauthorization Act. This legislation represents a crucial 

and long overdue investment in the health and 

wellbeing of our nation’s most valuable assets—our children. 

Since 1997, the State Children’s Health Insurance Program (SCHIP) has successfully 

provided health coverage to millions of low income children across the country who would 

not otherwise be able to access these services. I have been especially proud of the Rite 

Care program in my home state of Rhode Island, which covered approximately 24,000 

children last year under both the SCHIP and 

Medicaid programs. However, too many children and their families remain without access 

to proper health services. We must reaffirm 

our commitment at the federal level to ensure 

states have the means to address the health 

care needs of our constituents, particularly in 

the midst of an economic crisis that has resulted in dramatic increases in unemployment 

levels. 

H.R. 2 will ensure health coverage for a 

total of 11 million American children by reauthorizing SCHIP for four and a half years and 

extending coverage to an additional 4 million 

uninsured children who are currently eligible 

for, but not enrolled in, SCHIP and Medicaid. 

Two-thirds of uninsured children are eligible 

for coverage through SCHIP and Medicaid, 

but better outreach and adequate funding are 

needed to identify and enroll them. This bill 

provides $100 million in grants for new outreach activities to states, local governments, 

schools, community-based organizations and 

other safety-net providers. It also improves 

SCHIP by ensuring dental coverage for children, mental health services on par with medical and surgical benefits, as well as improved 

access to private coverage options through 

premium assistance subsidies. 

Finally, H.R. 2 reauthorizes and improves 

SCHIP without adding to our ballooning federal deficit. Since the cost of the bill is completely offset, it will allow us to make a muchneeded investment in the health of our children without requiring them to pay for it in the 

future. 

As many of my colleagues know, universal 

access to health care has been a top priority 

of mine throughout my tenure in Congress. I 

can think of no better place to start than by 

guaranteeing that children across the country 

receive the health care services they both require and deserve. I, therefore, urge all of my 

colleagues to support passage of this measure. 

Mr. PALLONE. Madam Speaker, I 

yield back the balance of my time. 

The SPEAKER pro tempore. All time 

for debate has expired. 

Pursuant to House Resolution 52, the 

bill is considered read and the previous 

question is ordered. 

The question is on the engrossment 

and third reading of the bill. 


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H264 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

The bill was ordered to be engrossed 

and read a third time, and was read the 

third time. 

MOTION TO RECOMMIT

Mr. DEAL of Georgia. Madam Speaker, I have a motion at the desk. 

The SPEAKER pro tempore. Is the 

gentleman opposed to the bill? 

Mr. DEAL of Georgia. I am in its current form. 

Mr. WAXMAN. Madam Speaker, I reserve a point of order. 

The SPEAKER pro tempore. A point 

of order is reserved. 

The Clerk will report the motion to 

recommit. 

The Clerk read as follows: 

Mr. Deal of Georgia moves to recommit the 

bill, H.R. 2, to the Committee on Energy and 

Commerce with instructions to report the 

same back to the House forthwith with the 

following amendment: 

Strike all after the enacting clause and insert the following: 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘SCHIP Full 

Funding Extension Act of 2009’’. 

SEC. 2. EXTENDING SCHIP FUNDING THROUGH 

FISCAL YEAR 2015. 

(a) THROUGH FISCAL YEAR 2015.— 

(1) IN GENERAL.—Section 2104 of the Social 

Security Act (42 U.S.C. 1397dd), as amended 

by section 201 of the Medicare, Medicaid, and 

SCHIP Extension Act of 2007 (Public Law 

110–173), is amended— 

(A) in subsection (a)(11), by striking ‘‘and 

2009’’ and inserting ‘‘, 2009, 2010, 2011, 2012, 

2013, 2014, and 2015’’; and 

(B) in subsection (c)(4)(B), by striking 

‘‘through 2009’’ and inserting ‘‘through 2015’’. 

(2) AVAILABILITY OF EXTENDED FUNDING.— 

Funds made available from any allotment 

made from funds appropriated under subsection (a)(11) or (c)(4)(B) of section 2104 of 

the Social Security Act (42 U.S.C. 1397dd) for 

fiscal year 2009, 2010, 2011, 2012, 2013, 2014, or 

2015 shall not be available for child health 

assistance for items and services furnished 

after September 30, 2015. 

(b) EXTENSION OF TREATMENT OF QUALIFYING STATES.— 

(1) IN GENERAL.—Section 2105(g)(1)(A) of 

the Social Security Act (42 U.S.C. 

1397ee(g)(1)(A)), as amended by section 201(b) 

of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110–173), is 

amended by striking ‘‘or 2009’’ and inserting 

‘‘2009, 2010, 2011, 2012, 2013, 2014, or 2015’’. 

(2) CONFORMING AMENDMENT.—Section 

201(b) of such Public Law is amended by 

striking paragraph (2). 

(c) ADDITIONAL ALLOTMENTS TO MAINTAIN

SCHIP PROGRAMS THROUGH FISCAL YEAR

2015.—Section 2104 of the Social Security Act 

(42 U.S.C. 1397dd) is amended by striking subsection (l) and inserting the following new 

subsections: 

‘‘(l) ADDITIONAL ALLOTMENTS TO MAINTAIN

SCHIP PROGRAMS FOR FISCAL YEAR 2009.— 

‘‘(1) APPROPRIATION; ALLOTMENT AUTHORITY.—For the purpose of providing additional 

allotments described in subparagraphs (A) 

and (B) of paragraph (3), there is appropriated, out of any money in the Treasury 

not otherwise appropriated, such sums as 

may be necessary, not to exceed $3,000,000,000 

for fiscal year 2009. 

‘‘(2) SHORTFALL STATES DESCRIBED.—For 

purposes of paragraph (3), a shortfall State 

described in this paragraph is a State with a 

State child health plan approved under this 

title for which the Secretary estimates, on 

the basis of the most recent data available to 

the Secretary, that the Federal share 

amount of the projected expenditures under 

such plan for such State for fiscal year 2009 

will exceed the sum of— 

‘‘(A) the amount of the State’s allotments 

for each of fiscal years 2007 and 2008 that will 

not be expended by the end of fiscal year 

2008; 

‘‘(B) the amount, if any, that is to be redistributed to the State during fiscal year 2009 

in accordance with subsection (i); and 

‘‘(C) the amount of the State’s allotment 

for fiscal year 2009. 

‘‘(3) ALLOTMENTS.—In addition to the allotments provided under subsections (b) and (c), 

subject to paragraph (4), of the amount 

available for the additional allotments under 

paragraph (1) for fiscal year 2009, the Secretary shall allot— 

‘‘(A) to each shortfall State described in 

paragraph (2) not described in subparagraph 

(B), such amount as the Secretary determines will eliminate the estimated shortfall 

described in such paragraph for the State; 

and 

‘‘(B) to each commonwealth or territory 

described in subsection (c)(3), an amount 

equal to the percentage specified in subsection (c)(2) for the commonwealth or territory multiplied by 1.05 percent of the sum of 

the amounts determined for each shortfall 

State under subparagraph (A). 

‘‘(4) PRORATION RULE.—If the amounts 

available for additional allotments under 

paragraph (1) are less than the total of the 

amounts determined under subparagraphs 

(A) and (B) of paragraph (3), the amounts 

computed under such subparagraphs shall be 

reduced proportionally. 

‘‘(5) RETROSPECTIVE ADJUSTMENT.—The 

Secretary may adjust the estimates and determinations made to carry out this subsection as necessary on the basis of the 

amounts reported by States not later than 

November 30, 2008, on CMS Form 64 or CMS 

Form 21, as the case may be, and as approved 

by the Secretary. 

‘‘(6) ONE-YEAR AVAILABILITY; NO REDISTRIBUTION OF UNEXPENDED ADDITIONAL ALLOTMENTS.—Notwithstanding subsections (e) and 

(f), amounts allotted to a State pursuant to 

this subsection for fiscal year 2009, subject to 

paragraph (5), shall only remain available for 

expenditure by the State through September 

30, 2009. Any amounts of such allotments 

that remain unexpended as of such date shall 

not be subject to redistribution under subsection (f). 

‘‘(m) ADDITIONAL ALLOTMENTS TO MAINTAIN

SCHIP PROGRAMS FOR FISCAL YEAR 2010.— 

‘‘(1) APPROPRIATION; ALLOTMENT AUTHORITY.—For the purpose of providing additional 

allotments described in subparagraphs (A) 

and (B) of paragraph (3), there is appropriated, out of any money in the Treasury 

not otherwise appropriated, such sums as 

may be necessary, not to exceed $4,000,000,000 

for fiscal year 2010. 

‘‘(2) SHORTFALL STATES DESCRIBED.—For 

purposes of paragraph (3), a shortfall State 

described in this paragraph is a State with a 

State child health plan approved under this 

title for which the Secretary estimates, on 

the basis of the most recent data available to 

the Secretary, that the Federal share 

amount of the projected expenditures under 

such plan for such State for fiscal year 2010 

will exceed the sum of— 

‘‘(A) the amount of the State’s allotments 

for each of fiscal years 2008 and 2009 that will 

not be expended by the end of fiscal year 

2009; 

‘‘(B) the amount, if any, that is to be redistributed to the State during fiscal year 2010 

in accordance with subsection (f); and 

‘‘(C) the amount of the State’s allotment 

for fiscal year 2010. 

‘‘(3) ALLOTMENTS.—In addition to the allotments provided under subsections (b) and (c), 

subject to paragraph (4), of the amount 

available for the additional allotments under 

paragraph (1) for fiscal year 2010, the Secretary shall allot— 

‘‘(A) to each shortfall State described in 

paragraph (2) not described in subparagraph 

(B) such amount as the Secretary determines 

will eliminate the estimated shortfall described in such paragraph for the State; and 

‘‘(B) to each commonwealth or territory 

described in subsection (c)(3), an amount 

equal to the percentage specified in subsection (c)(2) for the commonwealth or territory multiplied by 1.05 percent of the sum of 

the amounts determined for each shortfall 

State under subparagraph (A). 

‘‘(4) PRORATION RULE.—If the amounts 

available for additional allotments under 

paragraph (1) are less than the total of the 

amounts determined under subparagraphs 

(A) and (B) of paragraph (3), the amounts 

computed under such subparagraphs shall be 

reduced proportionally. 

‘‘(5) RETROSPECTIVE ADJUSTMENT.—The 

Secretary may adjust the estimates and determinations made to carry out this subsection as necessary on the basis of the 

amounts reported by States not later than 

November 30, 2010, on CMS Form 64 or CMS 

Form 21, as the case may be, and as approved 

by the Secretary. 

‘‘(6) AVAILABILITY; NO REDISTRIBUTION OF

UNEXPENDED ADDITIONAL ALLOTMENTS.—Notwithstanding subsections (e) and (f), 

amounts allotted to a State pursuant to this 

subsection for fiscal year 2010, subject to 

paragraph (5), shall only remain available for 

expenditure by the State through September 

30, 2010. Any amounts of such allotments 

that remain unexpended as of such date shall 

not be subject to redistribution under subsection (f). 

‘‘(n) APPLICATION TO FISCAL YEARS 2011, 

2012, 2013, 2014, OR 2015.— 

‘‘(1) IN GENERAL.—Subject to paragraph (2), 

subsection (m) shall apply to each of fiscal 

years 2011, 2012, 2013, 2014, or 2015 in the same 

manner such subsection applies to fiscal year 

2010. 

‘‘(2) APPLICATION.—In applying subsection 

(m) under paragraph (1) with respect to— 

‘‘(A) fiscal year 2011— 

‘‘(i) each reference to a year or date in 

such subsection shall be deemed a reference 

to the following year or to one year after 

such date, respectively; and 

‘‘(ii) the reference to ‘$4,000,000,000’ in paragraph (1) of such subsection shall be deemed 

a reference to ‘$5,000,000,000’; 

‘‘(B) fiscal year 2012— 

‘‘(i) each reference to a year or date in 

such subsection shall be deemed a reference 

to the second following year or to two years 

after such date, respectively; and 

‘‘(ii) the reference to ‘$4,000,000,000’ in paragraph (1) of such subsection shall be deemed 

a reference to ‘$6,000,000,000’; 

‘‘(C) fiscal year 2013— 

‘‘(i) each reference to a year or date in 

such subsection shall be deemed a reference 

to the third following year or to three years 

after such date, respectively; and 

‘‘(ii) the reference to ‘$4,000,000,000’ in paragraph (1) of such subsection shall be deemed 

a reference to ‘$6,000,000,000’; 

‘‘(D) fiscal year 2014— 

‘‘(i) each reference to a year or date in 

such subsection shall be deemed a reference 

to the fourth following year or to four years 

after such date, respectively; and 

‘‘(ii) the reference to ‘$4,000,000,000’ in paragraph (1) of such subsection shall be deemed 

a reference to ‘$7,000,000,000’; and 

‘‘(E) fiscal year 2015— 

‘‘(i) each reference to a year or date in 

such subsection shall be deemed a reference 

to the fifth following year or to five years 

after such date, respectively; and 


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January 14, 2009 CONGRESSIONAL RECORD — HOUSE H265 

‘‘(ii) the reference to ‘$4,000,000,000’ in paragraph (1) of such subsection shall be deemed 

a reference to ‘$7,000,000,000’.’’. 

SEC. 3. OPTION FOR QUALIFYING STATES TO RECEIVE THE ENHANCED PORTION OF 

THE SCHIP MATCHING RATE FOR 

MEDICAID COVERAGE OF CERTAIN 

CHILDREN. 

Section 2105(g) of the Social Security Act 

(42 U.S.C. 1397ee(g)) is amended— 

(1) in paragraph (1)(A), by inserting ‘‘subject to paragraph (4),’’ after ‘‘Notwithstanding any other provision of law,’’; and 

(2) by adding at the end the following new 

paragraph: 

‘‘(4) OPTION FOR CERTAIN ALLOTMENTS.— 

‘‘(A) PAYMENT OF ENHANCED PORTION OF

MATCHING RATE FOR CERTAIN EXPENDITURES.— 

In the case of expenditures described in subparagraph (B), a qualifying State (as defined 

in paragraph (2)) may elect to be paid from 

the State’s allotment made under section 

2104 for any fiscal year (beginning with fiscal 

year 2009) (insofar as the allotment is available to the State under subsection (e) of such 

section) an amount each quarter equal to the 

additional amount that would have been paid 

to the State under title XIX with respect to 

such expenditures if the enhanced FMAP (as 

determined under subsection (b)) had been 

substituted for the Federal medical assistance percentage (as defined in section 

1905(b)). 

‘‘(B) EXPENDITURES DESCRIBED.—For purposes of subparagraph (A), the expenditures 

described in this subparagraph are expenditures made after the date of the enactment 

of this paragraph and during the period in 

which funds are available to the qualifying 

State for use under subparagraph (A), for the 

provision of medical assistance to individuals residing in the State who are eligible for 

medical assistance under the State plan 

under title XIX or under a waiver of such 

plan and who have not attained age 19, and 

whose family income equals or exceeds 133 

percent of the poverty line but does not exceed the Medicaid applicable income level.’’. 

SEC. 4. REQUIRING OUTREACH AND COVERAGE 

BEFORE EXPANSION OF ELIGIBILITY. 

(a) STATE PLAN REQUIRED TO SPECIFY HOW

IT WILL ACHIEVE HEALTH BENEFITS COVERAGE

FOR 90 PERCENT OF LOW-INCOME CHILDREN.— 

(1) IN GENERAL.—Section 2102(a) of the Social Security Act (42 U.S.C. 1397bb(a)) is 

amended— 

(A) in paragraph (6), by striking ‘‘and’’ at 

the end; 

(B) in paragraph (7), by striking the period 

at the end and inserting ‘‘; and’’; and 

(C) by adding at the end the following new 

paragraph: 

‘‘(8) how the State for each fiscal year (beginning with fiscal year 2010) will achieve, 

through eligibility and benefits provided for 

under the plan and otherwise, a rate of 

health benefits coverage (whether private or 

public) for low-income children in the State 

that is at least 90 percent.’’. 

(2) EFFECTIVE DATE.—The amendments 

made by paragraph (1) shall apply to State 

child health plans for fiscal years beginning 

with fiscal year 2010. 

(b) LIMITATION ON PROGRAM EXPANSIONS

UNTIL LOWEST INCOME ELIGIBLE INDIVIDUALS

ENROLLED.—Section 2105(c) (42 U.S.C. 

1397dd(c)) is amended by adding at the end 

the following new paragraph: 

‘‘(8) LIMITATION ON INCREASED COVERAGE OF

HIGHER INCOME CHILDREN.—For child health 

assistance furnished in a fiscal year beginning with fiscal year 2010: 

‘‘(A) SPECIAL RULES FOR PAYMENT FOR CHILDREN WITH FAMILY INCOME ABOVE 200 PERCENT

OF POVERTY LINE.—In the case of child health 

assistance for a targeted low-income child in 

a family the income of which exceeds 200 percent (but does not exceed 300 percent) of the 

poverty line applicable to a family of the 

size involved no payment shall be made 

under this section for such assistance unless 

the State demonstrates to the satisfaction of 

the Secretary (in accordance with any methodology established by the Secretary) that 

the State has met the 90 percent retrospective coverage test specified in subparagraph 

(B) for the previous fiscal year. 

‘‘(B) 90 PERCENT COVERAGE TEST.—The 90 

percent retrospective coverage test specified 

in this subparagraph is, for a State for a fiscal year, that on average for any 3-consecutive month period during the fiscal year, at 

least 90 percent of low-income children residing in the State have health benefits coverage (whether private or public). 

‘‘(C) GRANDFATHER.—Subparagraphs (A) 

and (B) shall not apply to the provision of 

child health assistance— 

‘‘(i) to a targeted low-income child who is 

enrolled for child health assistance under 

this title as of September 30, 2009; 

‘‘(ii) to a pregnant woman who is enrolled 

for assistance under this title as of September 30, 2009, through the completion of 

the post-partum period following completion 

of her pregnancy; and 

‘‘(iii) for items and services furnished before October 1, 2009, to an individual who is 

not a targeted low-income child and who is 

enrolled for assistance under this title as of 

September 30, 2009. 

‘‘(D) PROMULGATION OF METHODOLOGY.—Not 

later than July 1, 2009, the Secretary shall 

issue regulations that establish a methodology by which States meet the requirements of subparagraph (A). 

‘‘(E) DETERMINATION OF INCOME BASED ON

GROSS FAMILY INCOME WITHOUT DISREGARDS OR

EXCLUSIONS.— 

‘‘(i) IN GENERAL.—For purposes of this 

paragraph, the family income shall be determined under subparagraph (A) (and under 

subparagraph (B) for purposes of determining 

who is a low-income child, as defined in section 2110(c)(4)) based on gross family income. 

‘‘(ii) GROSS FAMILY INCOME DEFINED.— 

‘‘(I) IN GENERAL.—Subject to subclause (II), 

in this subparagraph, the term ‘gross family 

income’ means, with respect to an individual, gross income (as defined by the Secretary in regulations) for the members of the 

individual’s family. For purposes of the previous sentence, in defining ‘gross income’ the 

Secretary shall, to the maximum extent 

practicable, include income from whatever 

source, other than amounts deducted under 

section 62(a)(1) of the Internal Revenue Code 

of 1986. 

‘‘(II) INCOME DISREGARDS AUTHORIZED.—A 

State may provide, through a State plan 

amendment and with the approval of the 

Secretary, for the disregard from gross family income of one or more amounts so long as 

the total amount of such disregards for a 

family does not exceed $250 per month, or 

$3,000 per year.’’. 

SEC. 5. SCHIP GROSS INCOME ELIGIBILITY CEILING. 

(a) APPLICATION OF SCHIP ELIGIBILITY

CEILING.— 

(1) IN GENERAL.—Section 2110 of the Social 

Security Act (42 U.S.C. 1397jj) is amended— 

(A) in subsection (b)(1)— 

(i) by striking ‘‘and’’ at the end of subparagraph (B); 

(ii) by striking the period at the end of 

subparagraph (C) and inserting ‘‘; and’’; and 

(iii) by adding at the end the following new 

subparagraph: 

‘‘(D) whose gross family income (as defined 

in subsection (c)(9)) does not exceed 300 percent of the poverty line.’’; and 

(B) in subsection (c), by adding at the end 

the following new paragraph: 

‘‘(9) GROSS FAMILY INCOME.— 

‘‘(A) IN GENERAL.—Subject to subparagraph 

(B), the term ‘gross family income’ means, 

with respect to an individual, gross income 

(as defined by the Secretary in regulations) 

for the members of the individual’s family. 

For purposes of the previous sentence, in defining ‘gross income’ the Secretary shall, to 

the maximum extent practicable, include income from whatever source, other than 

amounts deducted under section 62(a)(1) of 

the Internal Revenue Code of 1986. 

‘‘(B) INCOME DISREGARDS AUTHORIZED.—A 

State may provide, through a State plan 

amendment and with the approval of the 

Secretary, for the disregard from gross family income of one or more amounts so long as 

the total amount of such disregards for a 

family does not exceed $250 per month, or 

$3,000 per year.’’. 

(2) DENIAL OF FEDERAL MATCHING PAYMENTS

FOR STATE SCHIP EXPENDITURES FOR INDIVIDUALS WITH GROSS FAMILY INCOME ABOVE 300

PERCENT OF THE POVERTY LINE.—Section 

2105(c) of the Social Security Act (42 U.S.C. 

1397ee(c)), as amended by section 4(b), is 

amended by adding at the end the following 

new paragraph: 

‘‘(9) DENIAL OF PAYMENTS FOR EXPENDITURES FOR CHILD HEALTH ASSISTANCE FOR INDIVIDUALS WHOSE GROSS FAMILY INCOME EXCEEDS 300 PERCENT OF THE POVERTY LINE.—No 

payment may be made under this section, for 

any expenditures for providing child health 

assistance or health benefits coverage under 

a State child health plan under this title, including under a waiver under section 1115, 

with respect to an individual whose gross 

family income (as defined in section 

2110(c)(9)) exceeds 300 percent of the poverty 

line.’’. 

(b) EFFECTIVE DATE; TRANSITION.— 

(1) IN GENERAL.—Subject to paragraph (2), 

the amendments made by this section shall 

apply to payments made for items and services furnished on or after the first day of the 

first calendar quarter beginning more than 

90 days after the date of the enactment of 

this Act. 

(2) TRANSITION.—The amendments made 

by— 

(A) subsection (a)(1) shall not apply to an 

individual who was receiving, or was determined eligible to receive, child health assistance or health benefits coverage under a 

State child health plan under title XXI of 

the Social Security Act, including under a 

waiver under section 1115 of such Act, as of 

the day before the date of the enactment of 

this Act, until such date as the individual is 

determined ineligible using income standards or methodologies in place as of the day 

before the date of the enactment of this Act; 

and 

(B) subsection (a)(2) shall not apply to payment for items and services furnished to an 

individual described in clause (i); 

SEC. 6. TIME FOR PAYMENT OF CORPORATE ESTIMATED TAXES. 

(a) 5-YEAR PERIOD.—The percentage under 

subparagraph (C) of section 401(1) of the Tax 

Increase Prevention and Reconciliation Act 

of 2005 in effect on the date of the enactment 

of this Act is increased by 19 percentage 

points. 

(b) 10-YEAR PERIOD.—Notwithstanding section 6655 of the Internal Revenue Code of 

1986— 

(1) the amount of any required installment 

of corporate estimated tax which is otherwise due in July, August, or September of 

2018 shall be 130 percent of such amount, and 

(2) the amount of the next required installment after the installment referred to in 

paragraph (1) shall be appropriately reduced 

to reflect the amount of the increase by reason of paragraph (1). 


smartinez on PROD1PC64 with HOUSE
H266 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

Mr. WAXMAN (during the reading). 

Madam Speaker, I ask unanimous consent that the motion to recommit be 

considered read, and I also withdraw 

my point of order. 

The SPEAKER pro tempore. Is there 

objection to the request of the gentleman from California? 

There was no objection. 

The SPEAKER pro tempore. Reservation of the point of order is withdrawn. 

The gentleman from Georgia is recognized for 5 minutes in support of his 

motion. 

Mr. DEAL of Georgia. Madam Speaker, the Republican motion to recommit 

replaces what I consider to be a deeply 

flawed bill that has been offered and 

also has improvements to the SCHIP 

proposal that we are considering. 

Unlike H.R. 2, the Republican motion 

to recommit fully funds SCHIP program for the next 7 years, not 41⁄2 years 

as the underlying bill would do, and 

thereby ensures that needy families 

and those with low incomes will be covered and eligible under SCHIP through 

fiscal year 2015. According to the Congressional Budget Office, the motion to 

recommit will not cause a single 

SCHIP enrolled child to lose his or her 

health care coverage. 

Unlike the bill that is under consideration, H.R. 2, the motion to recommit puts poor children first by holding 

States accountable for not finding and 

enrolling their low-income, uninsured 

children. Each year, States would be 

required to report to the Secretary of 

HHS how they intend to ensure that at 

least 90 percent of their children with 

family incomes under $40,000 per year 

have quality health care coverage in 

either a public or private health care 

plan. States would also be required to 

demonstrate that they have met this 90 

percent coverage target before they are 

able to shift their enrollment activities 

to higher income families. 

Unlike H.R. 2, the motion to recommit maintains the requirement in current law that States verify the identity 

and citizenship status of Medicaid and 

SCHIP applicants and prevents illegal 

aliens and other unqualified individuals from fraudulently gaining access 

to these taxpayer-funded programs. 

Unlike H.R. 2, the Republican motion 

to recommit preserves limited SCHIP 

dollars for low-income, uninsured children by preventing States from abusing 

the income-disregard loophole that is 

in the current law and would be continued under the underlying bill. 

Unlike H.R. 2, the Republican motion 

to recommit Federal funds will be reserved for families with incomes under 

300 percent of the Federal poverty 

level, which is currently $63,600 for a 

family of four. 

This motion to recommit is compliant with the majority’s PAYGO rules 

by asking corporations with assets in 

excess of $1 billion to shift some estimated tax payments due in fiscal year 

2009 to fiscal year 2018. 

The majority has repeatedly used 

this short-term shifting of funding to 

meet the 5-year PAYGO requirements, 

and we’re using it today to comply 

with the majority’s PAYGO requirements without raising taxes. 

Fully paid for without increasing 

taxes on the American people is what 

this motion to recommit would provide. And unlike the underlying bill, 

H.R. 2, the Republican recommit motion will actually allow President-elect 

Obama to keep his promise to the 

American people of not increasing 

their taxes. 

We believe that these fundamental 

changes from the underlying bill not 

only improve it, but extend the life of 

it for a full 7-year period and is altogether appropriate, and does not include increasing taxes on the American 

people. 

We believe in the SCHIP program. We 

think that it should be properly applied in States and applied primarily to 

those who are low-income, poor families first rather than going up the economic scale of eligibility. 

For these reasons, I would urge this 

body to adopt the motion to recommit 

and to pass a bill for a 7-year period 

that fully funds and assures States and 

families that their children will be covered. 

Madam Speaker, I yield back the balance of my time. 

Mr. PALLONE. Madam Speaker, I 

rise in opposition to the motion to recommit. 

The SPEAKER pro tempore. The gentleman from New Jersey is recognized 

for 5 minutes. 

Mr. PALLONE. Madam Speaker, it 

wasn’t enough that President Bush vetoed two children’s health bills that 

would have made great advances in 

children’s health. Now my Republican 

colleagues are trying to undermine the 

coverage gains that would be made in 

this bill. 

This proposal being put forward by 

my Republican colleagues isn’t a way 

to put poor kids first. It’s a way to stop 

States from moving forward to help additional uninsured children. 

The CHIP bill already puts poor kids 

first by targeting enrollment bonuses 

only to the poorest kids, those in Medicaid. Eight in ten newly insured children under CHIP have incomes below 

current eligibility levels. The Republican proposal is simply a way to stop 

States from moving forward. 

Unfortunately, the reality of today is 

that these moderate income families 

who would be excluded under this motion are struggling to make ends meet, 

too. Health costs have been rising 

much faster than income over the past 

decade. A family at 300 percent of poverty, for example, earning $52,800 a 

year—these so-called rich folks, according to Republicans—now spend an 

average of 19 percent of their income 

on premiums for employer-sponsored 

coverage if they even have access to it. 

Ten years ago, that same family was 

only spending 11 percent of income on 

premiums for their employer plan. 

The CHIP bill moves us forward. It’s 

the largest investment in children’s 

health since the original CHIP law was 

passed in ’97. And this Congress will do 

more for children, and it’s an excellent 

step forward. 

Now I want to mention that research 

shows that no means tested program 

reaches 90 percent of the individuals or 

families eligible for it. Moreover, there 

is not reliable State-by-State data to 

even measure participation rates accurately among the States. 

While the Bush administration initially attempted to establish measures 

like Mr. DEAL is talking about, leading 

independent academic and research institutions discredited the Bush administration’s target rate, such as CBO and 

the Urban Institute, and the Bush administration has moved away from its 

initial administrative directive of enforcing such limits on States the way 

this motion would do. 

So again, the point is we need to 

move forward. This is simply a rouse 

essentially to gut the bill for those 

moderate-income families that would 

benefit for it. 

I would urge my colleagues to oppose 

this motion to recommit. Let’s move 

the bill as originally proposed. It will 

do great things for America’s children. 

Madam Speaker, I yield back the balance of my time. 

The SPEAKER pro tempore. Without 

objection, the previous question is ordered on the motion to recommit. 

There was no objection. 

The SPEAKER pro tempore. The 

question is on the motion to recommit. 

The question was taken; and the 

Speaker pro tempore announced that 

the noes appeared to have it. 

Mr. DEAL of Georgia. Madam Speaker, I object to the vote on the ground 

that a quorum is not present and make 

the point of order that a quorum is not 

present. 

The SPEAKER pro tempore. Evidently a quorum is not present. 

The Sergeant at Arms will notify absent Members. 

Pursuant to clause 9 of rule XX, the 

Chair will reduce to 5 minutes the minimum time for any electronic vote on 

the question of passage. 

The vote was taken by electronic device, and there were—yeas 179, nays 

247, not voting 7, as follows: 

[Roll No. 15] 

YEAS—179 

Aderholt 

Akin 

Alexander 

Austria 

Bachmann 

Bachus 

Barrett (SC) 

Bartlett 

Barton (TX) 

Biggert 

Bilbray 

Bilirakis 

Bishop (UT) 

Blackburn 

Blunt 

Boehner 

Bonner 

Bono Mack 

Boozman 

Boustany 

Brady (TX) 

Bright 

Broun (GA) 

Brown (SC) 

Brown-Waite, 

Ginny 

Burgess 

Burton (IN) 

Buyer 

Calvert 

Camp 

Campbell 

Cantor 

Cao 

Capito 

Carter 

Cassidy 

Castle 

Chaffetz 

Coble 

Coffman (CO) 

Cole 

Conaway 

Crenshaw 

Culberson 

Davis (KY) 

Deal (GA) 

Dent 

Diaz-Balart, L. 

Diaz-Balart, M. 

Dreier 

Duncan 

Ehlers 

Emerson 

Fallin 

Flake 

Fleming 

Forbes 

Fortenberry 

Foxx 

Franks (AZ) 

Frelinghuysen 

Gallegly 


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January 14, 2009 CONGRESSIONAL RECORD — HOUSE H267 

Garrett (NJ) 

Gerlach 

Gingrey (GA) 

Gohmert 

Goodlatte 

Granger 

Graves 

Guthrie 

Hall (TX) 

Harper 

Hastings (WA) 

Heller 

Hensarling 

Herger 

Hoekstra 

Hunter 

Inglis 

Issa 

Jenkins 

Johnson (IL) 

Johnson, Sam 

Jones 

Jordan (OH) 

King (IA) 

King (NY) 

Kingston 

Kirk 

Kline (MN) 

Lamborn 

Lance 

Latham 

LaTourette 

Latta 

Lee (NY) 

Lewis (CA) 

Linder 

Lucas 

Luetkemeyer 

Lummis 

Lungren, Daniel 

E. 

Mack 

Manzullo 

Marchant 

Marshall 

McCarthy (CA) 

McCaul 

McClintock 

McCotter 

McHenry 

McHugh 

McIntyre 

McKeon 

McMorris 

Rodgers 

Mica 

Miller (FL) 

Miller (MI) 

Miller, Gary 

Minnick 

Moran (KS) 

Murphy, Tim 

Myrick 

Neugebauer 

Nunes 

Olson 

Paul 

Paulsen 

Pence 

Petri 

Pitts 

Platts 

Poe (TX) 

Posey 

Price (GA) 

Putnam 

Radanovich 

Rehberg 

Reichert 

Roe (TN) 

Rogers (AL) 

Rogers (KY) 

Rogers (MI) 

Rohrabacher 

Rooney 

Ros-Lehtinen 

Roskam 

Royce 

Ryan (WI) 

Scalise 

Schmidt 

Schock 

Sensenbrenner 

Sessions 

Shadegg 

Shimkus 

Shuster 

Simpson 

Smith (NE) 

Smith (TX) 

Souder 

Stearns 

Taylor 

Terry 

Thompson (PA) 

Thornberry 

Tiahrt 

Tiberi 

Turner 

Upton 

Walden 

Wamp 

Westmoreland 

Whitfield 

Wilson (SC) 

Wittman 

Wolf 

Young (AK) 

Young (FL) 

NAYS—247 

Abercrombie 

Ackerman 

Adler (NJ) 

Altmire 

Andrews 

Arcuri 

Baca 

Baird 

Baldwin 

Barrow 

Bean 

Becerra 

Berkley 

Berman 

Berry 

Bishop (GA) 

Bishop (NY) 

Blumenauer 

Boccieri 

Boren 

Boswell 

Boyd 

Brady (PA) 

Braley (IA) 

Brown, Corrine 

Buchanan 

Butterfield 

Capps 

Capuano 

Cardoza 

Carnahan 

Carney 

Carson (IN) 

Castor (FL) 

Chandler 

Childers 

Clarke 

Clay 

Cleaver 

Clyburn 

Cohen 

Connolly (VA) 

Cooper 

Costa 

Costello 

Courtney 

Crowley 

Cuellar 

Cummings 

Dahlkemper 

Davis (AL) 

Davis (CA) 

Davis (IL) 

Davis (TN) 

DeFazio 

DeGette 

Delahunt 

DeLauro 

Dicks 

Dingell 

Doggett 

Donnelly (IN) 

Doyle 

Driehaus 

Edwards (MD) 

Edwards (TX) 

Ellison 

Ellsworth 

Engel 

Eshoo 

Etheridge 

Farr 

Fattah 

Filner 

Foster 

Frank (MA) 

Fudge 

Giffords 

Gillibrand 

Gonzalez 

Gordon (TN) 

Grayson 

Green, Al 

Green, Gene 

Griffith 

Grijalva 

Gutierrez 

Hall (NY) 

Halvorson 

Hare 

Harman 

Hastings (FL) 

Heinrich 

Higgins 

Hill 

Himes 

Hinchey 

Hinojosa 

Hirono 

Hodes 

Holden 

Holt 

Honda 

Hoyer 

Inslee 

Israel 

Jackson (IL) 

Jackson-Lee 

(TX) 

Johnson (GA) 

Johnson, E. B. 

Kagen 

Kanjorski 

Kaptur 

Kennedy 

Kildee 

Kilpatrick (MI) 

Kilroy 

Kind 

Kirkpatrick (AZ) 

Kissell 

Klein (FL) 

Kosmas 

Kratovil 

Kucinich 

Langevin 

Larsen (WA) 

Larson (CT) 

Lee (CA) 

Levin 

Lewis (GA) 

Lipinski 

LoBiondo 

Loebsack 

Lofgren, Zoe 

Lowey 

Luja ́n 

Lynch 

Maffei 

Maloney 

Markey (CO) 

Markey (MA) 

Massa 

Matheson 

Matsui 

McCarthy (NY) 

McCollum 

McDermott 

McGovern 

McMahon 

McNerney 

Meek (FL) 

Meeks (NY) 

Melancon 

Michaud 

Miller (NC) 

Miller, George 

Mitchell 

Mollohan 

Moore (KS) 

Moore (WI) 

Moran (VA) 

Murphy (CT) 

Murphy, Patrick 

Murtha 

Nadler (NY) 

Napolitano 

Neal (MA) 

Nye 

Oberstar 

Obey 

Olver 

Ortiz 

Pallone 

Pascrell 

Pastor (AZ) 

Payne 

Perlmutter 

Perriello 

Peters 

Peterson 

Pingree (ME) 

Polis (CO) 

Pomeroy 

Price (NC) 

Rahall 

Rangel 

Reyes 

Richardson 

Rodriguez 

Ross 

Rothman (NJ) 

Roybal-Allard 

Ruppersberger 

Rush 

Ryan (OH) 

Salazar 

Sa ́nchez, Linda 

T. 

Sanchez, Loretta 

Sarbanes 

Schakowsky 

Schauer 

Schiff 

Schrader 

Schwartz 

Scott (GA) 

Scott (VA) 

Serrano 

Sestak 

Shea-Porter 

Shuler 

Sires 

Skelton 

Slaughter 

Smith (NJ) 

Smith (WA) 

Space 

Speier 

Spratt 

Stark 

Stupak 

Sutton 

Tanner 

Tauscher 

Teague 

Thompson (CA) 

Thompson (MS) 

Tierney 

Titus 

Tonko 

Towns 

Tsongas 

Van Hollen 

Vela ́ zquez 

Visclosky 

Walz 

Wasserman 

Schultz 

Waters 

Watson 

Watt 

Waxman 

Weiner 

Welch 

Wexler 

Wilson (OH) 

Woolsey 

Wu 

Yarmuth 

NOT VOTING—7 

Boucher 

Conyers 

Herseth Sandlin 

Sherman 

Snyder 

Solis (CA) 

Sullivan 

b 1435 

Mr. HALL of New York, Ms. FUDGE, 

Ms. LORETTA SANCHEZ of California, 

Messrs. CARNEY, SIRES, FARR, Ms. 

SPEIER, and Mr. RAHALL changed 

their vote from ‘‘yea’’ to ‘‘nay.’’ 

Messrs. ROSKAM, NUNES, CANTOR, 

LATOURETTE, ROGERS of Kentucky, 

and GERLACH changed their vote from 

‘‘nay’’ to ‘‘yea.’’ 

So the motion to recommit was rejected. 

The result of the vote was announced 

as above recorded. 

The SPEAKER pro tempore. The 

question is on the passage of the bill. 

The question was taken; and the 

Speaker pro tempore announced that 

the ayes appeared to have it. 

RECORDED VOTE

Mr. CARDOZA. Madam Speaker, I demand a recorded vote. 

A recorded vote was ordered. 

The SPEAKER pro tempore. This is a 

5-minute vote. 

The vote was taken by electronic device, and there were—ayes 289, noes 139, 

not voting 6, as follows: 

[Roll No. 16] 

AYES—289 

Abercrombie 

Ackerman 

Adler (NJ) 

Altmire 

Andrews 

Arcuri 

Austria 

Baca 

Baird 

Baldwin 

Barrow 

Bean 

Becerra 

Berkley 

Berman 

Berry 

Bishop (GA) 

Bishop (NY) 

Blumenauer 

Boccieri 

Bono Mack 

Boren 

Boswell 

Boyd 

Brady (PA) 

Braley (IA) 

Brown, Corrine 

Buchanan 

Butterfield 

Cao 

Capito 

Capps 

Capuano 

Cardoza 

Carnahan 

Carney 

Carson (IN) 

Castle 

Castor (FL) 

Chandler 

Childers 

Clarke 

Clay 

Cleaver 

Clyburn 

Cohen 

Connolly (VA) 

Conyers 

Cooper 

Costa 

Costello 

Courtney 

Crowley 

Cuellar 

Cummings 

Dahlkemper 

Davis (AL) 

Davis (CA) 

Davis (IL) 

Davis (TN) 

DeFazio 

DeGette 

Delahunt 

DeLauro 

Dent 

Diaz-Balart, L. 

Diaz-Balart, M. 

Dicks 

Dingell 

Doggett 

Donnelly (IN) 

Doyle 

Driehaus 

Edwards (MD) 

Edwards (TX) 

Ehlers 

Ellison 

Ellsworth 

Emerson 

Engel 

Eshoo 

Etheridge 

Farr 

Fattah 

Filner 

Foster 

Frank (MA) 

Frelinghuysen 

Fudge 

Gerlach 

Giffords 

Gillibrand 

Gonzalez 

Gordon (TN) 

Grayson 

Green, Al 

Green, Gene 

Griffith 

Grijalva 

Gutierrez 

Hall (NY) 

Halvorson 

Hare 

Harman 

Hastings (FL) 

Heinrich 

Herseth Sandlin 

Higgins 

Hill 

Himes 

Hinchey 

Hinojosa 

Hirono 

Hodes 

Holden 

Holt 

Honda 

Hoyer 

Inslee 

Israel 

Jackson (IL) 

Jackson-Lee 

(TX) 

Johnson (GA) 

Johnson, E. B. 

Kagen 

Kanjorski 

Kaptur 

Kennedy 

Kildee 

Kilpatrick (MI) 

Kilroy 

Kind 

King (NY) 

Kirk 

Kirkpatrick (AZ) 

Kissell 

Klein (FL) 

Kosmas 

Kratovil 

Kucinich 

Lance 

Langevin 

Larsen (WA) 

Larson (CT) 

LaTourette 

Lee (CA) 

Lee (NY) 

Levin 

Lewis (GA) 

Lipinski 

LoBiondo 

Loebsack 

Lofgren, Zoe 

Lowey 

Luja ́n 

Lynch 

Maffei 

Maloney 

Markey (CO) 

Markey (MA) 

Massa 

Matheson 

Matsui 

McCarthy (NY) 

McCollum 

McCotter 

McDermott 

McGovern 

McHugh 

McIntyre 

McMahon 

McNerney 

Meek (FL) 

Melancon 

Michaud 

Miller (MI) 

Miller (NC) 

Miller, George 

Minnick 

Mitchell 

Mollohan 

Moore (KS) 

Moore (WI) 

Moran (KS) 

Moran (VA) 

Murphy (CT) 

Murphy, Patrick 

Murphy, Tim 

Murtha 

Nadler (NY) 

Napolitano 

Neal (MA) 

Nye 

Oberstar 

Obey 

Olver 

Ortiz 

Pallone 

Pascrell 

Pastor (AZ) 

Paulsen 

Payne 

Pelosi 

Perlmutter 

Perriello 

Peters 

Peterson 

Petri 

Pingree (ME) 

Platts 

Polis (CO) 

Pomeroy 

Price (NC) 

Rahall 

Rangel 

Rehberg 

Reichert 

Reyes 

Richardson 

Rodriguez 

Rogers (AL) 

Ros-Lehtinen 

Ross 

Rothman (NJ) 

Roybal-Allard 

Ruppersberger 

Rush 

Ryan (OH) 

Salazar 

Sa ́nchez, Linda 

T. 

Sanchez, Loretta 

Sarbanes 

Schakowsky 

Schauer 

Schiff 

Schrader 

Schwartz 

Scott (GA) 

Scott (VA) 

Serrano 

Sestak 

Shea-Porter 

Shuler 

Simpson 

Sires 

Skelton 

Slaughter 

Smith (NJ) 

Smith (WA) 

Space 

Speier 

Spratt 

Stark 

Stupak 

Sutton 

Tanner 

Tauscher 

Taylor 

Teague 

Thompson (CA) 

Thompson (MS) 

Thompson (PA) 

Tiberi 

Tierney 

Titus 

Tonko 

Towns 

Tsongas 

Turner 

Upton 

Van Hollen 

Vela ́ zquez 

Visclosky 

Walz 

Wasserman 

Schultz 

Waters 

Watson 

Watt 

Waxman 

Weiner 

Welch 

Wexler 

Wilson (OH) 

Wolf 

Woolsey 

Wu 

Yarmuth 

Young (AK) 

Young (FL) 

NOES—139 

Aderholt 

Akin 

Alexander 

Bachmann 

Bachus 

Barrett (SC) 

Bartlett 

Barton (TX) 

Biggert 

Bilbray 

Bilirakis 

Bishop (UT) 

Blackburn 

Blunt 

Boehner 

Bonner 

Boozman 

Boustany 

Brady (TX) 

Bright 

Broun (GA) 

Brown (SC) 

Brown-Waite, 

Ginny 

Burgess 

Burton (IN) 

Buyer 

Calvert 

Camp 

Campbell 

Cantor 

Carter 

Cassidy 

Chaffetz 

Coble 

Coffman (CO) 

Cole 

Conaway 

Crenshaw 

Culberson 

Davis (KY) 

Deal (GA) 

Dreier 

Duncan 

Fallin 

Flake 

Fleming 

Forbes 

Fortenberry 

Foxx 

Franks (AZ) 

Gallegly 

Garrett (NJ) 

Gingrey (GA) 

Gohmert 

Goodlatte 

Granger 

Graves 

Guthrie 

Hall (TX) 

Harper 

Hastings (WA) 

Heller 

Hensarling 

Herger 

Hoekstra 

Hunter 

Inglis 

Issa 

Jenkins 

Johnson (IL) 

Johnson, Sam 

Jones 

Jordan (OH) 

King (IA) 


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H268 CONGRESSIONAL RECORD — HOUSE January 14, 2009 

Kingston 

Kline (MN) 

Lamborn 

Latham 

Latta 

Lewis (CA) 

Linder 

Lucas 

Luetkemeyer 

Lummis 

Lungren, Daniel 

E. 

Mack 

Manzullo 

Marchant 

Marshall 

McCarthy (CA) 

McCaul 

McClintock 

McHenry 

McKeon 

McMorris 

Rodgers 

Mica 

Miller (FL) 

Miller, Gary 

Myrick 

Neugebauer 

Nunes 

Olson 

Paul 

Pence 

Pitts 

Poe (TX) 

Posey 

Price (GA) 

Putnam 

Radanovich 

Roe (TN) 

Rogers (KY) 

Rogers (MI) 

Rohrabacher 

Rooney 

Roskam 

Royce 

Ryan (WI) 

Scalise 

Schmidt 

Schock 

Sensenbrenner 

Sessions 

Shadegg 

Shimkus 

Shuster 

Smith (NE) 

Smith (TX) 

Souder 

Stearns 

Terry 

Thornberry 

Tiahrt 

Walden 

Wamp 

Westmoreland 

Whitfield 

Wilson (SC) 

Wittman 

NOT VOTING—6 

Boucher 

Meeks (NY) 

Sherman 

Snyder 

Solis (CA) 

Sullivan 

ANNOUNCEMENT BY THE SPEAKER PRO TEMPORE

The SPEAKER pro tempore (during 

the vote). There are 2 minutes remaining on this vote. 

b 1445 

So the bill was passed. 

The result of the vote was announced 

as above recorded. 

A motion to reconsider was laid on 

the table. 

Stated for: 

Mr. MEEKS of New York. Madam Speaker, 

on Rollcall No. 16, I was avoidably delayed 

and just missed the vote. Had I been present, 

I would have voted ‘‘aye.’’ 

f 

b 1445 

ANNOUNCEMENT BY THE SPEAKER 

PRO TEMPORE 

The SPEAKER pro tempore (Mr. 

HOLDEN). Pursuant to clause 8 of rule 

XX, the Chair will postpone further 

proceedings today on a motion to suspend the rules on which a recorded vote 

or the yeas and nays are ordered, or on 

which the vote is objected to under 

clause 6 of rule XX. 

Any record vote on the postponed 

question will be taken later. 

f 

REQUIRING COMMITTEES TO INVESTIGATE REPORTS OF WASTE, 

FRAUD, ABUSE, OR MISMANAGEMENT 

Mr. CARDOZA. Mr. Speaker, I move 

to suspend the rules and agree to the 

resolution (H. Res. 40) amending the 

Rules of the House of Representatives 

to require each standing committee to 

hold periodic hearings on the topic of 

waste, fraud, abuse, or mismanagement 

in Government programs which that 

committee may authorize, and for 

other purposes, as amended. 

The Clerk read the title of the resolution. 

The text of the resolution is as follows: 

H. RES. 40 

Resolved, That clause 2 of rule XI of the 

Rules of the House of Representatives is 

amended by adding at the end the following 

new paragraphs: 

‘‘(n)(1) Each standing committee, or a subcommittee thereof, shall hold at least one 

hearing during each 120-day period following 

the establishment of the committee on the 

topic of waste, fraud, abuse, or mismanagement in Government programs which that 

committee may authorize. 

‘‘(2) A hearing described in subparagraph 

(1) shall include a focus on the most egregious instances of waste, fraud, abuse, or 

mismanagement as documented by any report the committee has received from a Federal Office of the Inspector General or the 

Comptroller General of the United States. 

‘‘(o) Each committee, or a subcommittee 

thereof, shall hold at least one hearing in 

any session in which the committee has received disclaimers of agency financial statements from auditors of any Federal agency 

that the committee may authorize to hear 

testimony on such disclaimers from representatives of any such agency. 

‘‘(p) Each standing committee, or a subcommittee thereof, shall hold at least one 

hearing on issues raised by reports issued by 

the Comptroller General of the United States 

indicating that Federal programs or operations that the committee may authorize are 

at high risk for waste, fraud, and mismanagement, known as the ‘high-risk list’ or 

the ‘high-risk series’.’’. 

SEC. 2. Clause 1(d)(3) of rule XI of the Rules 

of the House of Representatives is amended 

by adding at the end the following new sentence: ‘‘That section shall also delineate any 

hearings held pursuant to clauses 2(n), (o), or 

(p) of this rule.’’. 

The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 

California (Mr. CARDOZA) and the gentleman from California (Mr. DREIER) 

each will control 20 minutes. 

The Chair recognizes the gentleman 

from California (Mr. CARDOZA). 

GENERAL LEAVE

Mr. CARDOZA. Mr. Speaker, I ask 

unanimous consent that all Members 

have 5 legislative days within which to 

revise and extend their remarks and to 

include extraneous material on House 

Resolution 40. 

The SPEAKER pro tempore. Is there 

objection to the request of the gentleman from California? 

There was no objection. 

Mr. CARDOZA. Mr. Speaker, I yield 

myself such time as I may consume. 

Mr. Speaker, make no mistake about 

it, these are tough times for our country. The United States is facing an economic disaster unlike anything we 

have seen since the Great Depression. 

In the coming weeks, there will surely be differences of opinion as to how 

to best address the ailments of our Nation. But one thing is certain: Now, 

more than ever, it is time to ensure 

that government spends the taxpayers’ 

money wisely. 

For the first 6 years of the Bush administration, there was virtually no 

oversight by the Republican-led Congress. This led to rampant fraud and 

abuse, and billions of dollars of taxpayer dollars that were squandered by 

the administration, particularly regarding Iraq reconstruction and the response to Katrina. 

Beginning in January of 2007, the 

Democratic Congress turned a new 

page and took numerous steps to begin 

changing the way we do business by restoring accountability and oversight. 

House Resolution 40, introduced by my 

very good friend and fellow Blue Dog 

colleague, the gentleman from Tennessee (Mr. TANNER), and myself, simply adds another layer to the rigorous 

oversight measures that we have already established. 

This resolution amends the House 

rules to require each standing committee to hold at least three hearings 

per year on waste, fraud and abuse 

under each respective committee’s jurisdiction. It requires a hearing in the 

event that an agency’s auditor issues a 

disclaimer that the agency’s financial 

statements are not in order. It also requires a hearing if an agency under 

that respective committee’s jurisdiction has a program deemed by the GAO 

to be at high risk for waste, fraud and 

abuse. 

Mr. Speaker, at the request of my 

friends on the other side of the aisle, 

there are two other stipulations. First, 

that the resolution shall be considered 

in light of existing House rules governing the conduct of committee hearings, including hearings held in executive session and the treatment of executive session materials; and, second, to 

require that committee activities reports identify the hearings held under 

the resolution. 

Friends, plain and simple, it is now 

time to audit America’s books. This 

resolution will add another level of accountability by shining light on the 

most egregious cases of government 

waste. 

I would add, Mr. Speaker, that I am 

very encouraged by President-elect 

Obama’s statements regarding his intent to pore through the budget lineby-line to eliminate wasteful spending. 

However, while I take the Presidentelect at his word, this resolution demonstrates that this Democratic Congress will not turn a blind eye to government waste simply because there is 

now a Democratic administration. Free 

passes are over, and we must build 

upon increased oversight and accountability efforts. 

We have an opportunity to reinvent 

government and adhere to the fiscal accountability measures that Blue Dogs 

have long advocated. This will require 

tough decisions. But given these challenging economic times, cutting out 

waste, fraud and abuse must be among 

our top priorities in this Congress. All 

this requires is some bureaucratic soulsearching. 

I ask my colleagues on both sides of 

the aisle to join the Blue Dogs in this 

quest. 

Mr. Speaker, I reserve the balance of 

my time. 

Mr. DREIER. Mr. Speaker, I yield 

myself such time as I may consume, 

and I very gladly rise in strong support 

of this resolution, and, more importantly, in the bipartisan spirit in which 

it has been shaped. 

The basic idea behind this resolution, 

as my friend has said, is to ensure that 

committees are fulfilling their oversight duties and fully addressing the 


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