Small Business Tax Relief Act of 2007--Continued
Floor Speech
SMALL BUSINESS TAX RELIEF ACT OF 2007--Continued -- (Senate - August 02, 2007)
BREAK IN TRANSCRIPT
Mr. ENZI. Mr. President, I rise today to speak about the State Children's Health Insurance Program, or what folks on Capitol Hill are calling S-CHIP.
SCHIP was created by a Republican Congress in 1997 to help low income kids get health insurance. The goal of the program is to help kids that don't qualify for Medicaid, but also can't afford to get health insurance on their own, receive the care they need. This program expires on September 30, 2007, and I am here today to speak about how important it is to reauthorize this critical program in a way that protects private health insurance and keeps kids healthy.
I would like to speak for a few minutes about the how the program works today and how the proposals the Senate is discussing will change what currently happens.
Currently States have three options: they can enroll kids in Medicaid, create a new separate program, or devise a combination of both approaches. SCHIP is financed jointly by the Federal Government and the States, and States receive a higher percentage of Federal money for their SCHIP beneficiaries than they do for their Medicaid beneficiaries. This was originally designed to encourage States to create SCHIP programs. States have 3 years to spend their SCHIP allotments. Funds that aren't spent within 3 years are usually redistributed to States that have spent their allotment and need additional money.
When the Republican-led Congress enacted SCHIP in 1997, the program authorized $40 billion for 10 years. I will come back to this point in a bit, but the underlying bill before us today authorizes $60 billion over 5 years--the baseline spending is $25 billion over 5 years and this bill authorizes an additional $35 billion over 5 years. The budget resolution contained a deficit neutral reserve fund to spend $50 billion over 5 years in addition to the $25 billion in the baseline, so a total in the budget resolution is $75 billion over 5 years. This is a lot of money and Congress needs to ensure the money is being used to pay for health insurance for kids that don't currently have health insurance.
The nonpartisan Congressional Budget Office estimates that Senator Baucus' bill will reduce private coverage--that is kids will move from private health insurance to taxpayer-funded public health insurance. This is a highly inefficient policy--especially given how bureaucratic some State programs are structured. This is not an efficient use of the taxpayer's money.
Part of the reason why the crowd out effect is so great under the Finance bill is because the bill allows States to expand coverage to kids up to 400 percent of the Federal poverty level--which by the way translates to an annual income of $82,000 for a family of four. The higher the income expansion, the greater the crowd out effect. This is simple economics.
Now I would be remiss if I didn't mention what a great job my home state of Wyoming is doing in administering SCHIP. Wyoming first implemented its SCHIP program, Kid Care CHIP, in 1999 and in 2003, Wyoming formed a public-private partnership with Blue Cross Blue Shield of Wyoming and Delta Dental of Wyoming to provide the health, vision, and dental benefits to nearly 6,000 kids in Wyoming. These partnerships have made Kid Care CHIP a very successful program in Wyoming. All children enrolled in the program receive a wide range of benefits including inpatient and outpatient hospital services, lab and x-ray services, prescription drugs, mental health and substance abuse services, durable medical equipment, physical therapy, and dental and vision services. Families share in the cost of their children's health care by paying copayments for a portion of the care provided. These copays are capped at $200 a year per family.
Wyoming is also engaged in an outreach campaign targeted at finding and enrolling the additional 6,000 kids that are eligible for Kid Care CHIP but aren't enrolled.
As Congress works to finalize a bill to reauthorize this program, it is essential that we focus on the kids first. Some states SCHIP programs cover parents of kids that are on SCHIP and some States even cover childless adults. Adults without health insurance are a problem in this country, but not a problem this program was originally intended to address. I think there are responsible, market-based things Congress can do to help more American adults get health insurance, but this bill, the State Children's Health Insurance Program, should focus on the C for Children.
Not only does this bill need to focus on kids, we need to focus on low income kids. In July 2005, Wyoming's Kid Care CHIP began covering kids up to 200 percent of the Federal poverty level--those with family incomes below $42,000. The median family income in the United States is about $46,000, so the Wyoming benefit is very generous. Some of my colleagues are advocating for expanding SCHIP to cover kids and adults at 400 percent of the Federal poverty level. That means families making as much as $82,000 a year would have their kid's health insurance paid for by the government. Again, this is an inefficient use of taxpayer dollars. Why should the government provide health care for kids that come from families making $82,000 a year? I'll tell you why my colleagues are advocating for it--they see this as the first step toward government-run health care. They want the U.S. to be more like Canada and Great Britain. They want to take the private sector out of health care. They want to put the government in the exam room and tell you what doctors you can see and when you can see them and what drugs they can prescribe for you. I don't believe in this. Not only do I not believe in this, I think this goes against all the principles upon which this country was founded.
Now I do agree that our health care system is breaking down, and in fact I don't think we have a health care system, I think we have a sick care system. That is why, earlier this month, I introduced ``Ten Steps to Transform Health Care in America,'' a bold and comprehensive solution that addresses our health care crisis by building on market based ideas to expand access to health insurance for all Americans. I would like to take just a little bit of time to discuss each of Ten Steps.
The first of the Ten Steps is eliminating unfair tax treatment of health insurance, expanding choices and coverage and giving all Americans more control over their own health care. The Joint Committee on Taxation estimated that removing this tax bias and a few related health care tax policies will save the Federal Government $3.6 trillion over the next ten years. That is a lot of money that can and should be used to expand choices and access and give individuals more control over their health care. Ten Steps ensures every American can benefit from this savings--whether they get their health care from their employer, from the individual insurance market, or they decide they want to get off Medicaid and switch to private insurance. Everyone should be treated equally.
The second step of Ten Steps would increase affordable options for working families to purchase health insurance through a standard tax deduction. The national, above-the-line standard deduction for health insurance will equal $15,000 for a family and $7,500 for an individual.
The third step of Ten Steps is what makes this a hybrid approach--I couple the standard deduction with a refundable, advanceable, assignable tax-based subsidy. The tax subsidy is equal to $5,000 for a family, $2,500 for an individual. The full subsidy amount is available to individuals at or below 100 percent of the Federal poverty level, FPL, which is $20,650 for a family of four. The subsidy is phased out as an individual's salary increases, with individuals at 200 percent receiving half of the subsidy and individuals at 301 percent receiving the standard deduction instead of the subsidy.
The fourth key step for health care reform is to provide market-based pooling to reduce growing health care costs and increase access for small businesses, unions, other kinds of organizations, and their workers, members, and families. Those of you who know me well recognize how central this would be to any health care reform proposal of mine.
The fifth step blends the individual and group market to extend important HIPAA portability protections to the individual market so that insurance security can better move with you from job to job.
The sixth step emphasizes preventive benefits and helps individuals with chronic diseases better manage their health. America should have health care, not sick care. Prevention. Prevention. Prevention. This step is modeled after a very successful program in Wyoming. In 2005, Wyoming EqualityCare, our Medicaid Program, began providing one-on-one case management for Medicaid participants with a chronic illness, such as diabetes, asthma, depression, and heart disease, to encourage better self-management of these conditions. The program provides educational information on self-management as well as a nurse health coach that follows up with each patient to ensure they have what they need to take care of themselves.
The seventh step gives individuals the choice to convert the value of their Medicaid and SCHIP program benefits into private health insurance, putting them in control of their health care, not the Federal Government. This is very pertinent to the underlying bill we are discussing today. The rationale for this step is simple. If the market can provide better coverage at a lower price, then why not allow Americans to access that care? This gives low-income individuals more options about where they receive their care and what care is available to them. It is time for people to start making decisions about their care--let's get the government out of the doctor's office.
The eighth step in Ten Steps is a bipartisan proposal which the HELP Committee approved last month--the Wired for Health Care Quality Act. This bill will encourage the adoption of cutting-edge-information technologies in health care to improve patient care, reduce medical errors and cut health care costs. Some of the most serious challenges facing healthcare today--medical errors, inconsistent quality, and rising costs--can be addressed through the effective application of available health information technology linking all elements of the health care system.
The ninth step of Ten Steps helps future providers and nurses pay for their education while encouraging them to serve in areas with great need. The ninth step also ensures appropriate development of rural health systems and access to care for residents of rural areas and gives seniors more options to receive care in their homes and communities.
The final step decreases the sky-rocketing costs of health care by restoring reliability in our medical justice system through State-based solutions.
I realize that I have talked for quite a bit about Ten Steps to Transform Health Care in America and that, the underlying legislation is the reauthorization of the State Children's Health Insurance Program. I believe it is important to think bigger than just one program and think about the health care system as a whole. I have spoken a few times on the Senate floor about what I call the 80/20 rule. I always believe that we can agree on 80 percent of the issues and on 80 percent of each issue, and that if we focus on that 80 percent we can do great things for the American people. I believe that if we work together on these proposals we can find that 80 percent. I would like to work with my colleagues on that 80 percent. I want action--real action to provide real coverage for Americans. I support reauthorizing this program in a way that protects private health insurance and keeps kids healthy. I also support looking beyond this single program at reforming the entire health care system.
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