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Children's Health Insurance Program Reauthorization Act Of 2009

Floor Speech

Location: Washington, DC


Mr. COBURN. Madam President, the bill we are considering is designed to help low-income kids have coverage and have care. What do we know about the kids who are in those programs and the care they have? Here is one of the things we know: They don't have access to 60 percent of the doctors in this country because the reimbursement rates are so low they won't be seen. That is the first thing. No. 2 is they don't have access to the best drugs because a lot of Medicaid programs and SCHIP won't pay for the best drugs for those children.

I got to thinking about this bill and what it does and what it is intended to do. What is in agreement in the Senate is that we want all of the kids covered. We want every child in this country to be able to have access to quality care with no limitation of their choice of who their doctor is going to be--the one the child and the parent feel the most comfortable with--because we know if that is the case, they are going to be most compliant. So we want them to have the greatest care, and we want every one of them to be able to have access to care.

This bill brings up Government payments under SCHIP to 300 percent of the poverty level--60,000 bucks, essentially. Anybody making, essentially, over that wouldn't be benefited by this bill but everybody under it. It adds $70 billion worth of taxes to the American people to be able to do that. As it does it, it takes 2 million kids who are presently covered by insurance off insurance and gets 2 million out of the 8.9 million or 9.8 million kids who aren't covered today with anything. So we are going to spend $70 billion to get 4 million kids, a little less than 4 million kids covered, of which we are going to absorb the costs that are already being paid by businesses for those kids right now.

By the way, I ask unanimous consent to add Senators MCCONNELL, ENZI, CORNYN, DEMINT, JOHANNS, KYL, ALEXANDER, GRAHAM, BURR, CHAMBLISS, THUNE, and BARRASSO as cosponsors of the amendment.

The PRESIDING OFFICER. Without objection, it is so ordered.

Mr. COBURN. So maybe it is instructive for us to look at what we are doing right now and say: What could we do with that money? Right now, we have 31 million kids in America who don't have private coverage. In other words, we have 31 million out of the 78 million kids who don't get to choose where they want to go, don't get to have the best drugs, don't get the referral to the best centers, don't get the referral to the best doctors because they are on a Government-run program. So 8.9 million kids aren't even covered by any program right now, and not all of those 8.9 million kids are in families who are at 300 percent of the poverty level or less. This is based on 2005 numbers, and we know it is greater now, but these numbers for the number of children are accurate right now. We are spending $67 billion to do that.

What does that mean? That means we are spending $2,160 each to cover 22 million kids. Well, if you divided the 31 million kids who are out there into this number, you would get $2,160 available for every child at 300 percent of the poverty level who is not covered right now by their parents, and that includes Medicaid and SCHIP. So you have $2,160 to work with.

Now, the average price in the individual market in this country is less than $1,200 a year. Some will say: Well, that coverage is not as good. Well, let's make it $1,700, which is $300 more than what our kids cost. Let's make it $1,700, or let's make it $1,800, or let's make it $2,160. What could we buy for $2,160 for every kid at 300 percent of the poverty level or less who is not on the program? What we could buy for all of them is a top-grade policy outside of Government-run programs that would give insurance to 100 percent of the children who don't have insurance and give them 100 percent access to every quality doctor in this country on a competitive basis and give them access to the drugs the Members of Congress' kids have access to and the same doctors to whom the Members of Congress have access.

The important point is, we have a government-run program and the administrative costs and the inefficiencies of it cost more than private insurance, than if we would just go out and buy every one of these guys an FEHPB--Federal Employees Health Benefits Plan--a top-drawer plan. Why would we run it through the Government? Why would we take away choice? Why would we take away access by running it through a government-run program and one that is highly inefficient?

There is another thing we should know. The rate of fraud in private insurance products is about 3 percent. The rate of fraud in Medicaid is 10.4 percent, and in SCHIP it is 14 percent. So because the Government is running the program and we can't run it well and we don't run it well, we are losing about 11 percent or 11 cents out of every dollar that we are trying to get to kids because we can't run efficient or effective programs.

So wouldn't it be smarter, rather than to have all of this gobbledygook government, to make sure that every kid in this country whose parents don't make $60,000, who isn't covered with insurance today, has access to a top-drawer health insurance policy that gives them 100 percent access, gives them 100 percent quality, and gives them 100 percent access to the drugs and the physicians they want? Who is going to argue with that?

As a matter of fact, several of my colleagues are cosponsors of the Healthy Americans Act, and that is exactly what it does. It is going to be very interesting to see if they are cosponsors of this bill but yet don't vote for this for kids. And that is a bipartisan bill. So if it is good enough for all of America and if it is good enough for the Members of Congress and their kids and if it is good enough for Federal employees, why can't we give that to the children of this country who don't have health insurance? Why can't we do that? We can't do it because it doesn't fit into the partisan rancor of Washington.

This is a commonsense proposal that doesn't cost a penny more than what we spent in 2005. And we cover all of the kids, not just 4 million more; we cover 8.9 million more with the same amount of money. All the children have access.

It is not a child's fault if their parents can't afford or don't have a job that gives them access to 100 percent of physicians or access to the best medicines or access to equal care. It is not the child's fault. So if we are going to spend this much of the American taxpayers' money, why don't we get value for it? Why don't we decide we want value for this money?

So if you take all the kids out there--31 million--on what we spent in 2005, you can spend $2,160 on every one of them--every one of them--and get them a top-drawer health insurance policy. Top drawer. Top of the line. That is almost double what the charge is for an individual policy now. So we could spend almost twice as much to get that same coverage. Why would we not do that? What is going to keep us from helping all the kids?

I will tell my colleagues the other aspect of it. We are also not going to raise taxes $71 billion if we do this plan. Let me say that again. President Obama said your taxes won't be raised. This bill raises $71 billion--granted, from tobacco products, which I don't have any objection to--but let's save the $71 billion on tobacco products for something else when we can efficiently buy our kids health care and buy them a health insurance policy.

Another key point: As somebody who has cared for Medicaid kids and Medicaid moms, when you have the ``Medicaid'' stamp on your forehead, it is not equivalent care. When we give all these children access to a private insurance policy of their own, it is no longer a Medicaid program, it is their insurance policy. Providers will never know how they got that policy. They will never know if it was an employment-based policy, an individually bought policy, or a policy that comes through SCHIP and Medicaid.

What we do is we take the demeaning qualities and characteristics of having to be dependent through a government program, and we throw that out. So the bias goes out, the discrimination goes out, and the self-esteem goes up.

What will happen if this passes? The first thing that will happen is we will save $70 billion. The second thing that will happen is not 4 million kids--actually, it is a net 2 million kids will get coverage--8.9 million kids will get coverage, and we will do it with the same amount of money we spent in 2005. Every child will be covered. There will be a real choice of who is going to be your provider. Right now you get hustled into whoever will take care of you in these programs. Some are great and some are not. Confidence will be restored. There will be increased quality of outcome and increased access to specialists who now today cannot afford to see a Medicaid or SCHIP patient because their overhead is so great.

Finally, $70 billion--I know we are talking about $1 trillion in the stimulus package--doesn't seem like much, but $70 billion is a lot of money. If you look at it, it is about $2,000 per man, woman, and child over the next 5 years that we will save in this country.

If the goal of SCHIP and all the speeches we have heard all week long is to care for kids, to make sure kids have access, to make sure they have care, if that is the goal, then anybody who is not going to vote for this amendment is not secure in saying they want to cover all the kids. This one will.

This substitute allows the Secretary to develop autoenrollment. There is $100 million in this amendment so we can have outreach, trying to get kids coverage. This takes away the negative consequences of applying for Medicaid or applying for SCHIP when your parents cannot afford to get you coverage.

The other thing it does is there is a compensation in terms of making sure we help people who have insurance keep their insurance by compensating to keep them on their employer's insurance, which costs a whole lot less. It costs maybe $200 or $300 a year. But the most important thing it does is it provides liberty and freedom and equal access for every child in this country.

They are going to say this will not work. But notice there is not going to be a point of order filed against this amendment because this amendment does not cost any money. It saves money. It does not cost a penny. It will not cost us and will cover so many more children.

My question to my colleagues, as we wrap up the SCHIP bill, is: Do you want to do it right? Do you want to do it better? Do you want to cover all the kids. Or do you want to play the games of Washington and political gamesmanship and partisanship and say: Yes, I care about the kids, but I couldn't do the right thing, the easy thing, the commonsense thing, the things that are associated with order, priority, and common sense that says: Gosh, we can buy and get better coverage for less money; why wouldn't we do that?

We are going to hear all the reasons. We may not hear any because most of the amendments I offered nobody will debate them. They know they have the votes to defeat them so they will not debate. They will not come out and say why this would not be a good idea.

The American taxpayers ought to think: Here is a great opportunity for us to save a ton of money and do something very good socially: cover innocent children with quality health care that they do not have access to today, with no increase in cost--with no increase in cost. Yet we are going to see a vote where they are going to say no. Then we are going to know if you care about kids and whether you care about access for kids.

I will end my debate at this time and yield to my colleague from North Carolina, Senator Burr.

I ask unanimous consent to add Senator Vitter as a cosponsor.


Mr. COBURN. Mr. President, first, this does not get rid of the system, and it certainly does not privatize it. What it does is it guarantees every child in this country, all 3l million--which is something this bill does not do--all 3l million who don't have an insurance policy today will be insured with a plan equal to what we have for our children.

What it doesn't get rid of is access. They only have access to 40 percent of the physicians now. It gives them access to 100 percent of all the physicians. We are defending a system that, first, is only going to enroll 4 million new kids, is still going to leave 5 million not covered and 2 million of the 4 million they enroll are from those who already have private insurance, and we are going to say we will stick with a system to take care of the ones we have now and we are not going to give real access, and with the not real access comes no choice of a physician because we limited the number of physicians who can participate because of the economics of it.

I will tell you what it does get rid of. It gets rid of $70 billion of taxpayers' money that we are not going to use to cover every one of these kids. Based on the 2005 numbers, we can buy a premium health insurance policy for all 31 million kids--the 8.9 million who do not have any coverage now and the 22 million who are covered in either SCHIP or Medicaid today. We save all the administrative expense. We autoenroll them so we don't have to worry about picking up only 4 million with an additional $70 billion in taxes.

To say this is privatization is a total mischaracterization of it. What it does is it guarantees that all children will not have a Medicaid stamp or SCHIP stamp on their forehead that says: Yes, we are giving you coverage but you can't see all the physicians, you can't get referrals to the best because you have a government-run program.

Not only do we increase access and quality, we save tremendous amounts of money, and it will still be a government-run program because it will be administered by the Secretary in a way that guarantees these kids are autoenrolled. They will have premium health insurance coverage and we still save money, even after that. We are spending $2,160 per kid now based on 2005 numbers, and we will cover every one of these kids and not spend more money than that.

To characterize this as getting rid of coverage is wrong. What it does is greatly create and increase access for children in this country to have the same access that our children have. It saves money and markedly improves quality for those children. Every American child ought to have access, and what we do is take the money we are spending now and spend it more wisely, and create a system where they all have coverage.

I yield the floor.


Mr. COBURN. Mr. President, this amendment really is the amendment that is going to take care of our children. It is going to take the Medicaid stamp and SCHIP stamp off their foreheads. It is going to create access to the finest doctors, not just 40 percent of the doctors as we see in Medicaid and SCHIP. It is going to give the same care to all the children--those at the 300 percent poverty level and under--that we give to our own kids. It does all that not spending the $70 billion in increased taxes that is in this bill and auto-enrolling children so that we don't just pick up 4 million kids, we pick up all 8.9 million kids who are not insured.

To my colleagues who sponsored the Wyden bill, the Healthy Americans
bill, that is exactly what is in that bill, except we are going to do it for children without increasing costs but increasing the quality, increasing the care, and increasing the outcomes. We are going to truly make children on the same level we are in terms of their access. They are going to get to choose their doctor rather than have their doctor chosen for them. They are going to get a referral to the best rather than to one who will just take them. They are going to get the same thing we get, and they deserve it, and we are not going to spend a penny more than we are spending today.

We don't do away with SCHIP, we don't privatize SCHIP; what we do is say we really care about kids and we are going to give them the same thing we have. At the same time, we are going to save the American taxpayers $70 billion.

I yield my time.


Mr. COBURN. Mr. President, what this amendment does is it says you have 14 percent improper payment rate in SCHIP, we have 10.6 percent improper payment in Medicaid. The average improper payment rate across the rest of the Federal Government on every agency--this amendment says that before New York can go to 400 percent, they have to bring their improper payment rates in line with the rest of the Federal Government. The improper payment rate in New York--New York alone--accounts for 50 percent of the fraud in Medicaid. Fifty percent of that is in New York State alone.

So what this amendment would do is it would delay the improper payment reporting requirements and limit earmark program expansion until the Medicaid and SCHIP improper payment rates match the Federal average of improper payment rates. It is meant to help us get back on track. We just started getting improper payment rates on Medicaid, and they are out of control. We should not be delaying the onset of that, and we should put teeth into it so that where it is bad, we don't expand it and make it worse.

With that, I reserve the remainder of my time.


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