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Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the gentlewoman for this emphasis on a very important issue. To even begin to think of the great need of children with respect to health care and not respond to their need seems to be a travesty and a tragedy.
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I could not help but listen to the dialogue that the gentlewoman had with our colleague, the gentleman from Texas (Mr. LAMPSON). It seems certainly that there has been a problem with the leadership from the executive of the State of Texas and particularly the Texas Department of Health . Although there may be other issues that they have excelled on, this is one that has seen a great vacuum in leadership.
I remember following the work of the State legislature, and many of the legislators from the urban centers had to work very hard to ensure that the funding for the CHIPs program included children beyond the age of 12. The initial effort by the Texas Department of Health and the governor's office was to only provide these CHIP monies for children up to 12, and many of them with the encouragement of many of us in Congress and the questioning of many of us in Congress, asked the question: Do you mean a child does not get sick after age 13?
It seems to me an outrage. I want to applaud those legislators who took the leadership and demanded that they address the question of the needs of good health care, like Sylvester Turner and Rodney Ellis and Garnett Coleman and I am sure that I am leaving out many others around the State, who were actively involved in pressing the point that we needed to have this kind of funding for children beyond the age of children.
Mr. Speaker, it has already been said that Texas is at the bottom of retaining low-income kids on Medicaid since welfare reform in 1996. It also has been noted that Texas has the highest rate of uninsured in the country, and Texas has the second highest rate of uninsured children in the Nation. But what also needs to be noted is that right now in the State of Texas, some 500,000 children qualify for CHIP, and that means, that symbol that the gentlewoman has, the picture of that baby that says, do our children have to really fight, or should our children have to really fight to get good health care. With 500,000 children already qualifying for CHIP, it seems that we are behind the times in moving forward to ensure that this program works. It is well known that Texas has been slow compared to other States in implementing CHIP.
This is not to say that we do not have some very committed health professionals in our own local communities who have been begging for the CHIP program to be implemented. Children enrolled in Texas CHIP can get a comprehensive benefits package which include eye exams and glasses, prescription drugs and limited dental checkups and therapy, all of the items that provide for a healthy child.
Just last week in my district, Senator PAUL WELLSTONE and myself held hearings on mental health . I know we do not have mental health parity , but to hear the parents of children come forward and cry out for needed services in mental health for diagnostic services, for counseling services, knowing full well that we need to keep working toward parity , that is also health care that parents need.
So we can see that the CHIPS program is long overdue in our community. To avoid a logistical nightmare for both the State and parents, Texas should act as quickly as possible to implement changes in children's Medicare eligibility. To reinforce what has been said, we need to eliminate the access test for children's Medicaid. Texas now makes parents of Medicaid-eligible children document not just income, but also the value of savings, IRAs, automobiles, and valuables. There is a lot better way to do it, and we can utilize the Federal law that is used by the Federal Government in 40 States, plus the District of Columbia.
It is important to drop the requirement for face-to-face applications, recertification interviews, because we realize that parents are very busy. We should allow mail-in applications. This is not required by Federal law. Thirty-eight States, plus the District of Columbia, allow mail-ins. So it is important that as we deal with the elimination of assets which are not required by the Federal Government, nor required by 40 States, we can then make more easier, if you will, the ability for these parents to apply and become eligible for CHIP.
The main point that I think we are trying to impress upon our State and the focus of this Special Order that I think is so very important is our children are voiceless. Their parents are fighting for them, but they are the ones who every time a ballot is cast, a child cannot vote, yet they are in need of the good health care that this CHIPS program would allow.
Mr. Speaker, I would hope that the State of Texas would see the value of responding to the needs of our children and quickly eliminate the complicated process that keeps this CHIPS program from being implemented. I think it is important that we get leadership from the State, and I think it is most important that the Texas Department of Health establish a focus that says in a certain period of time, we will ensure that the CHIPS program is working throughout the entire State, and that that needs to be done now.
Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, reclaiming my time, statistics tell us that more and more children are being absent from school because of asthma, and yet, it has been determined that we have one of the worst environments in the Nation, so bad that Oklahoma is complaining that we are polluting parts of Oklahoma. If we have this available and not making any effort to cover the children while we are also providing an environment that is conducive to making them even more unhealthy, what does this tell us? Is there any compassion in Texas?
Ms. JACKSON-LEE of Texas. Mr. Speaker, if the gentlewoman will yield, it seems like we are lacking a great deal of compassion, and the gentlewoman has hit the nail on the head. Healthy children make healthy adults. Children are apt to get all manner of childhood diseases and ailments. Asthma is one of the most devastating childhood diseases that lead into adult asthma. We do have a problem in our respective communities with air quality. We are fighting that problem well now. In fact, as the gentlewoman well knows, she was one of the supporters, and I continue to support, the Mickey Leland Toxic Center that is located in the Texas Medical Center that deals with air quality standards and does the research on respiratory diseases. We find that many children have them.
I believe that there is no compassion in this State if we cannot get the CHIPS program implemented to provide for the children of this State when the program has been passed by this Congress under the Balanced Budget Act since 1997. This is now the year 2000. Why does not the State of Texas, 43rd, if you will, in the care of mental health and some very low number, I know, in the care of health period having the highest number of uninsured cannot provide the CHIPS program for their children. I think that we need to show a great deal more compassion on behalf of Texas children and the Nation's children and ensure that these children do have insurance to make them healthy children and then healthy adults.
Mr. Speaker, I am happy to rise in support of our nation's increased investment in childcare in the form of insurance coverage. A serious oversight has occurred when studies and statistics show a large portion of children that are not covered by medical insurance.
Nationally, over 11 million of our nation's children--one in seven of those children living in the United States are uninsured. Two-thirds of these children live in families with income below 200 percent of the poverty level ($33,400 for a family of four in 1999).
Many escape through the cracks simply because they do not fit the description policy makers have in regards to poverty. Low-income uninsured children typically live in two-parent, working households and have little contact with the welfare system.
In the same instance, families who are below standard income have the misfortune of being undereducated regarding the health benefits they and their children have access to through their entitled aide. Forty-one percent of parents of these eligible uninsured children postponed seeking medical care for their offspring because they could not afford it.
A much-needed solution for adolescents who need insurance comes in the form of Medicaid and the new State Children's Health Insurance Program (CHIP). These two key organizations are publicly funded health insurance programs that offer coverage for low-income adolescents.
These programs enacted by Congress more than thirty years apart, both augment and complement each other. While each has distinctly different characteristics, together they offer a powerful opportunity to reduce the percentage of uninsured adolescents in the
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I must ask that as my colleagues deliberate this week on the real and necessary benefits of the defense appropriations to our nation's security, that they also consider the benefit to domestic security, which is created by their support of health care for all of our nation's youth.
Medicaid provides health insurance coverage for more than 40 million individuals--most are women, children, and adolescents--at an annual cost of about $154 billion in combined federal and state funds.
Eligibility for Medicaid is determined by each state according to its specific guidelines. However, the federal government specifies the mandatory eligibility categories and the optional eligibility categories.
Medicaid is significantly affected by several of the mandatory and optional eligibility categories.
The State Children's Health Insurance Program made available approximately $48 billion in federal funds over ten years to help states expand health insurance coverage to low-income children and youth.
Federal law permits states to use CHIP funds to expand coverage in three ways: through Medicaid expansions; state-designed, non-Medicaid programs; or a combination of these two approaches.
SCHIP, is funded with federal block grant dollars and state matching dollars, as a health insurance program for children in families who make too much money for Medicaid, but who cannot afford other private insurance options.
SCHIP has extended coverage to an additional 2 million children who do not qualify for Medicaid. Yet millions of children are believed to be eligible for these programs, but remain uninsured.
Uninsured youth will benefit from Medicaid and CHIP only if the states in which they live chose to extend eligibility and if states then work to enroll them. This requires more than working with funding for these programs. It entails communicating to the community that needs the service that something is available.
SCHIP benefits depend heavily on program design and state discretion. States currently cover children whose family incomes range generally from below the Federal poverty level (FPL) to as high as 300 percent of poverty.
Even when adolescents are enrolled in insurance programs that provide comprehensive benefits, a number of other factors influenced whether adolescents actually receive the services they need. These include affordability, confidentiality, and availability of providers with expertise and experience in caring for adolescents.
In Texas the rate of uninsured is higher than any other state in the country. In particular Texas has the second highest rate of uninsured children in the nation. In an attempt to combat this high rating the state of Texas has combined the options available to states in order to expand health insurance coverage. This combination includes expansion of Medicaid and state-designed, non-Medicaid programs.
Texas covers children whose family incomes range from below the FPL to 200 percent of poverty. The Federal government allows coverage to children as high as 300 percent.
TEXAS--STATISTICS
Texas has the highest rate of uninsured in the country.
Texas has the second highest rate of uninsured children in the nation.
There are 1.4 million uninsured children in Texas--600,000 are eligible for, but not in Medicaid; nearly 500,000 qualify for CHIP.
Texas attempt to combats the number of uninsured children by combining the options available to states in order to expand health insurance coverage. Texas' combination includes the expansion of Medicaid and state-designed, non-Medicaid programs.
At present time, there is a need for eligibility reforms and aggressive outreach for low-income health programs in Texas.
Texas is at the bottom of retaining low-income kids on Medicaid since welfare reform in 1996.
193,400 Texas children fell off the Medicaid rolls during the past three years, a 14.2 percent decline.
Medicaid data collected finds an increase in the number of people enrolled in Medicaid in June 1999 compared to June 1998, but the magnitude of this success rate is dampened due to the decline of Medicaid in nine states--one of them was Texas.
The status quo in Texas is that children (up to age 19) in families with incomes at or under 100 percent of the federal poverty income level (FPL, $14,140 for a family of 3) can qualify for Medicaid.
Drop the requirement for face-to-face application/re-certification interviews for children's Medicaid. (Allow mail-in applications.) This is not required by federal law, and 38 states plus the District of Columbia allow mail-in application for children. Three states also allow community-based enrollment outside the welfare office.
Adopt and publicize for children's Medicaid the same simple, flexible documentation and verification options used for Texas CHIP. To make a joint mail-in application feasible, children's Medicaid and CHIP must accept the same documents for income and other required verifications. Children's Medicaid documentation should be identical statewide, to make a true joint CHIP-Medicaid mail-in application possible. Federal law allows states to reduce income documentation for children's Medicaid in any way, or even to eliminate it in favor of using third-party verification. Seven states require no income documentation for children's Medicaid.
To avoid a logistical nightmare for both the state and parents, Texas should as quickly as possible implement changes in children's Medicaid eligibility. Without these critical changes, enrollment will be difficult and complex for the many applicant families that are referred to Medicaid--many of whom will have one child eligible for CHIP, and another eligible for Medicaid. States already implementing CHIP report that large proportions of applicants end up in Medicaid. The changes needed are as follows:
Eliminate the assets test for children's Medicaid. Texas now makes parents of Medicaid-eligible children document not just income, but also the value of savings, IRAs, automobiles, and valuables, etc. The test is not required by federal law, and 40 states plus the District of Columbia have already dropped in for children.
Recent federal law changes allow states to cover parents in families with children up to any income limit the state chooses.
Texas has been given the choice to adopt less restrictive methods for counting income and assets for family Medicaid; for example, states can increase earned income disregards, and alter or eliminate asset tests.
Texas has been slow compared to other states in implementing CHIP.
Children enrolled in Texas CHIP will get a comprehensive benefits package--includes eye exams and glasses, prescription drugs, and limited dental check-ups, and therapy.
CHIP does not serve as an alternative to Medicaid for those families, who based on their income, are eligible for Medicaid.
Adopt 12-month continuous eligibility for children's Medicaid. Children enrolled in Texas CHIP stay enrolled for 12 months, regardless of any changes in income during that period. In Texas Medicaid, parents must report any income change within 10 days, and Medicaid is cut off the next month if the new family income is too high for Medicaid. Twelve-month eligibility for Children's Medicaid is a state option Congress created when it passed CHIP. This was done in an effort to allow for identical policies in Medicaid and CHIP, and promote continuity of health care. Fifteen states have adopted continuous eligibility for Children's Medicaid, and Ohio will begin the policy July 2000.
Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I thank the gentlewoman very much.
I yield to the gentleman from Texas (Mr. BENTSEN).
Mr. BENTSEN. Mr. Speaker, I thank the gentlewoman for yielding.
Let me first start out by commending the gentlewoman for having this Special Order to talk about the CHIPs program and the need for greater access to health care for children in this country. As the gentlewoman knows, back in 1997, we were part of an effort to start the CHIPs program, this was a Federal effort. I was pleased to be a member of the House Committee on the Budget when the 1997 Balanced Budget Act, the reconciliation bill, was crafted and ultimately passed and signed by the President. I think there is a certain amount of credit that is due the President as well for his steadfast support for this program.
It is correct that unfortunately, our State, and as a proud Texan I have to say it is unfortunate that our State was a little late in getting a CHIPs program up and running. The legislature, which meets biennially, did not get a chance to take this up or did not choose to take this up until 1999.
I think it is a little ironic when some of us were saying that the legislature should move on this, that the governor perhaps should call a special session to address this very popular bipartisan program, that with fear that Texas might ultimately lose some funds, we now see that the other body has decided to borrow from some of the funds that Congress set aside back in 1997 from the tobacco tax for this. We do know that Congresses have a way sometimes of borrowing and failing to repay those funds. So I am a little nervous that Texas might lose out as a result of that.
Mr. Speaker, I watched with great interest when our legislature had the debate over whether to cover at 150 percent or 200 percent of the poverty level.
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