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Public Statements

Children's Health Insurance Program Reauthorization Act Of 2009 - Continued

Floor Speech

Location: Washington, DC


Mr. COBURN. Mr. President, I wonder if anybody has ever asked the question--it has certainly never been answered--if you are a family and you qualify at the new 300 percent and you are buying your own insurance and you are covering your two kids, what happens when you transfer your kids to SCHIP, the Children's Health Insurance Program? What happens to your premium? I can tell you what happens to the premium. Do you know what happens to the premium? It goes down zero because health insurance is sold as an individual or a family product. So by taking two children, if I am earning 300 percent of poverty, and taking them off and transferring--now I am paying for it--and transferring that to the State Children's Health Insurance Program, the taxpayers of this country now will pay for that premium about $2,200 a piece when you can buy it in the private market for $1,100 a piece, but the parents will get no decrease in their insurance premium. That is why the crowdout provision is so negative for the American taxpayer and the generations that follow us.

My friend, the Senator from Ohio, mentioned that everybody wants to cover the 200 percent and below. The fact is, we have done a terrible job of covering the 200 percent and below. There are 5.4 million children out there today who do not have health insurance, whose parents do not have health insurance, who are eligible for Medicaid and SCHIP today, and they are not signed up. What are we doing? We are expanding a program that has only gotten about 51 percent of the kids who are eligible right now signed into the program. We are also being dishonest about what it costs. It is actually going to cost $42 billion more than what we say it is going to cost. Nobody will deny that. So why would we not want to have something that will limit the amount of crowdout because as we take money for kids who are now insured and put it to them through a Government program, it means these same 5.4 million kids are still not going to get covered.

We have not improved the program by increasing the eligibility. What we have done is we have just moved the income scale up to $60,000, some $62,450 a year, and we say: We will now cover your kids, and even if you have them covered now, you will not get any break from your insurance. But the same 5.4 million kids who are in poverty or at 200 percent of poverty still are not covered.

What are we doing? Why wouldn't we want to fix it to where all the kids who are out there today who do not have insurance, who are 200 percent and below the poverty level, why aren't we making sure they are covered? Why are we not doing that? Why are we not saying: States, you can go to the 300 percent if you want but only after you have covered the kids whom the program was designed for in the first place.

There is an amendment by Senator Hatch in that regard.

Why would we spend all this extra money?

By the way, we just met with the President. Other than the short-term financial struggles we are in, one of the big concerns with him is the fact that we have an unending entitlement disaster before us and we are getting ready to make it worse. Why would we not address that? Why would we say we are going to help kids but not really help kids? Why would we say we want to help the poorest children and the families who need it the most but still ignore them?

There is an answer to it. There is an answer to it, in that we want to move whichever way we can to eventually have a single-payer system in this country. We gutted the Premium Assistance Program. The Senator from Pennsylvania listed all the great things about the Premium Assistance Program. He listed all the different programs in Pennsylvania. Those are gutted under this bill. You can have one, but by the time you get it, nobody will want to have it.

We have taken what people have and said maybe we could spend $500 per kid per year to keep them in a health insurance program that the parents might have at work, but instead we are taking them all out and putting them in a Government program that costs twice as much as it does to buy them the same insurance in the open market.

Crowdout is a real phenomenon, but the most important thing is it helps the people who need it the least the most. And it helps the least those people who need it the most. That is what we are doing in this bill. We are not helping the lowest. We are only moving it up the chain and we are saying if you make $62,000 a year in this country, your children can be covered by the Government.

Why would you not want to do that? We do not have any other Government program that people do not voluntarily take if we put it out there. That is in the face of the fact that this year--hear my words very clearly--this year the true Federal budget deficit will be $1.6 trillion. The Government will spend $24,000 per family more than it takes in. Hear those words--$24,000 more per family it will spend than it takes in.

What is the future to be for this child at the 300 percent above poverty level? Their parents make $62,000 and we are going to give them this gift of health insurance today. But you will not be able to afford a college education. You certainly will never afford a home. It is doubtful you will ever be able to afford a car that is reliable. You will be in a debtor nation. Those are the consequences of our actions in the name of wanting to expand a program that today is highly ineffective in addressing the needs of the real poor children in this country.

Why would we do that, and just say: Don't worry, you have a pricetag to pay if you ever hope to get out of college or have the ability to get out of college? By the way, we are going to up your taxes if you get out there and get it up here on the front end.

This body is abandoning the very principles this country was built on. This country was built on a heritage of sacrifice, sacrifice by the common man for the common good to create a great, bright shining future for the generations that follow. This bill doesn't fit with that heritage. This bill, as a matter of fact, undermines that heritage. In the name of helping children, we are hurting those children's children. We are stealing opportunity from those children's children.

As I said earlier this morning, I want every child in this country insured. If we took the money that was out there today in Medicaid and SCHIP and the State contribution to it, we could insure every child in this country. We could create an insurance policy for every child in this country that gives them total screening exams, could give them prevention care, could give them acute care, and could give them hospital care. Yet when we run it through the Government, it costs twice as much because of the inefficiencies that are inherent in the system.

Later on I am going to offer a limitation based on improper payments. The American public may not know this. Certainly Members of Congress know. We do not know how much money is wasted in Medicaid because Medicaid has refused to report it. By law they are mandated to report it. They have refused to report it. We now have the information on 17 States on improper payments. The average is 10.5 percent on the 17 States we have looked at. Of that, 90 percent of those are overpayments. In New York City alone their own inspector general said at a minimum $15 billion a year is wasted in fraud, abuse, and deceit on the Medicaid Program. Where have we addressed any of that in this? Where have we put the safeguards to make sure this doesn't happen here? We have not done that.

We are not fixing the problems that are in front of us. What we are doing is creating more problems in the name of expanding a children's insurance program and limiting the future of the things that have been very successful with it, such as premium assistance, and taking that away.

There is going to be crowdout and the crowdout is going to benefit the most wealthy of the upper middle income because in some States, by the time you count exclusions, you can earn $120,000 a year and have your kids on SCHIP. We are going to help them. But not the kids of the parents working at $7 an hour, both of them, making $28,000 or $30,000 a year, of which half of them are not on either Medicaid or SCHIP. Why would we do that? Do we truly care about children's health? Are we really about trying to solve it?

Where are the ideas of combining where the biggest health care disparities are in our country? We know where those are. Why not design a program to go and attach and direct health care dollars to the large health care disparities? We know it pays big returns in terms of childhood obesity, in terms of precluding the onset of smoking, in terms of prevention and vaccinations, in terms of well-child care? Why would we not look at where the problems are and try to direct dollars to where the problems are? Instead, we are going to allocate across this country, to those who can now afford it, we are now going to start paying for it.

Even if we wanted to do that, why would we do it at twice the cost of what you could buy in a private market? Mr. President, $1,156 is the average market cost to insure a child in this country. Why would we spend $2,200 to get the same thing? So we can say we did something?

If, in fact, you could take $1,156 or $1,200 for every child out there--we have more than enough money with what we are spending today to accomplish that--we could buy them all an insurance policy.

I am not sure this bill is about children. I am not sure it is about children's health care. I have some doubts when we are not frugal. If it is about children's health care now, it is certainly not about those children's long-term financial security, when we are not even going to be honest with how much this bill costs. We have pulled a trick so we do not have a pay-go rule, and the trick keeps us from offsetting $42 billion in expenses associated with this bill. Everybody knows that. Nobody will say that is not right. Nobody wants to talk about that. That is what is wrong.

That is why people do not have confidence in the Congress. It is because we have this sleight-of-hand. We want to do something good but we don't want to tell you what it costs and we don't want to get rid of programs that don't work in order to be able to do something good. We are going to hide it under the blanket. So we are hiding $42 billion under the blanket. We are playing the inside baseball game, not being honest with the American people about what it costs; not being honest with the American people that it is a lot cheaper to give premium assistance than it is to give a program directly to a child; not being honest about the fact that this costs twice as much as what you could buy a health insurance policy for, for every child in this country.

We are not being honest at all, so our integrity is in question. Would we do the right thing in the long term for these kids that we say we care about their health care? I do not have the confidence we will. I have the confidence that this train is going to roll, we are going to do it just the way we have done it. There are still going to be 5.4 million kids out there 10 years from now, when we look at eligibility. It will be the same 5.4 million under the 200
percent of poverty level that we did not reach, that we didn't get out and actually make a difference. And then we are going to pay a larger cost as they mature as adults because what we could have prevented will not have been prevented, what we could have taught will not be taught, and the health care costs associated with that will be tremendous.

Mr. President, 5.4 million children are presently eligible for either SCHIP or Medicaid and we have done nothing to make sure those kids get a program that is readily available to them today. We have done nothing. We put $100 million in for outreach and said we will feel good about it because maybe that will reach some of them. We will still have millions of children who are eligible for these programs who will not get it.

We are going about approaching it the wrong way. We ought to be saying let's have a bill that insures every American child. Let's do that. Every American child, universal access with an insurance policy for every American child, why won't we do that? That is what we should be doing. Let's do it for every child. Then the insurance rates on adults will modulate and then husband and wife will not be paying a falsely elevated price once their kids get pulled off of their insurance policy and go into a Government program. Why not buy them all something, from then until the time they are 21, that covers them, that gives them the prevention care, that gives them the counseling, that gives them the immunizations? We know what it costs and we know what we can do it for. Why not do that?

Instead, we have created this complex, convoluted system that can be gamed. The estimate on Medicaid fraud--listen to this--the estimate on Medicaid fraud is $60 billion a year. That is enough to pay for where we cheated on this program if we would get rid of 10 percent of it a year over the next 10 years, if we got rid of 10 percent of the fraud. There is nothing in here on fraud. There is nothing in here to make the States accountable for the money we send out there.

We have done a poor job. We claim we want to help children, we claim we want children to have health insurance, yet we mortgage those very children's futures by not being honest about how we are going about doing it, about how we are going to pay for it and what the ultimate results will be.

I yield the floor.


Mr. COBURN. Mr. President, I thank my colleague for his comments. There is an easy way to solve this; it is called auto enrollment. You just write a bill. Anybody in any region under 200 percent who has a claim of deduction for children is automatically enrolled in SCHIP or Medicaid. It is not hard. We do not want to do that. Why are we not doing that? Because we do not want to help all of these 5.4 million children. We do not want to do that.

We have all of these incentives that have not worked in the past. We have done all of these things. All you have to do is auto enrollment. We can write a law. We can pass it. We can say: The IRS can look at every family who has children under 200 percent who files a tax return or files for the earned income tax credit, and their children are automatically enrolled. They automatically get a notice that says: Here is your insurance. Here is your State card. You have coverage.

It is not hard. We can do that. But we have not done it.

I yield the floor.


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