House Ways and Means Committee
On July 26, the House Ways and Means Committee approved, 24-17, the Children’s Health and Medicare Protect (CHAMP) Act (H.R. 3162), after adopting, by voice vote, a substitute amendment by Chair Charlie Rangel (D-NY) and Rep. Pete Stark (D-CA). The Senate Finance Committee approved its version of the bill on July 19 (see The Source, 7/20/07).
In his opening statement, Rep. Rangel said, “There is no question in my mind that everyone on this committee as well as the Congress and the country has the burning desire to expand health care for American children. We do this, not just because it is the right and moral thing to do, but because in the long run, it makes for a stronger America, stronger communities, and helps prevent expensive, debilitating, chronic diseases. Expanding access to health care for children not only saves money in the long run, but it puts this country on a path to be more competitive internationally. By starting with our very young, our very fragile, we give them an opportunity to have better health, which means a better education and a better job and ultimately more productivity. Looking at the bill before us today, I realize that just talking about a tax can be politically difficult. I have a history of opposition to excise taxes, but in light of the heavy financial weight smokers place on Medicare expenditures and the overwhelming proof linking the increase in cost of tobacco products with a decrease in youngsters buying cigarettes, I am very pleased to have worked with my colleagues on the bill we are reviewing today.”
Speaking in opposition to the bill, Ranking Member Jim McCrery (R-LA) said to the chair, “At the beginning of the year, before the Ways and Means Committee had even organized, the speaker announced that the House would consider two bills in our jurisdiction without a committee hearing or a committee mark-up. I sent you a letter expressing my frustration with this decision. While I was appreciative of your efforts and understanding of the circumstances under which you were operating, it is now obvious that this has unfortunately become a consistent pattern for this committee.” Rep. McCrery cited a number of instances where tariff and revenue provision were passed by the House or House Committees without input from the Ways and Means Committee and noted his concern, saying, “You may ask why I would note all of this…it is…because we have a bill in front of us that raises the tobacco excise tax. Have we had a hearing on this topic? Who is going to pay the burden of this tax? How will it affect the black market sale of cigarettes? How steady is the revenue source? We don’t know, because we haven’t had the opportunity to ask those questions.”
SCHIP was created by the Balanced Budget Act of 1997 (P.L. 105-33) and provides health insurance to low-income children who are ineligible for Medicaid but unable to obtain private health insurance coverage. SCHIP’s current authorization expires on September 30, 2007.
The draft measure would authorize FY2008 allotments to states based on their spending estimates submitted to the secretary of Health and Human Services (HHS) in 2007, plus national health care inflation and state population growth rates. States’ allotments will grow based on these two factors through FY2012.
The bill would prohibit coverage for non-pregnant, childless adults after January 1, 2008, unless the state could certify to the secretary of HHS that there is no waiting list for low-income children to receive services and the state has an outreach plan in place to target all children with family incomes at or below 200 percent of the federal poverty line.
Coverage for children would be expanded to include dental benefits. Mental health parity also would be required; that is, mental health services for children and other eligible populations would be covered to the same extent as medical services. States would have the option to provide coverage to legal immigrant children and children and young adults up to age 24.
The measure would require HHS to develop a Children’s Access, Payment and Equality (CAPE) Commission. The CAPE commission would be charged with developing child-centered quality performance measures, monitoring children’s access to care and services, and evaluating the adequacy of provider payments under SCHIP and Medicaid. The commission also would be required to examine the impact of Medicaid and SCHIP policies on reducing health disparities, including geographic disparities and disparities among minority populations.
States would be allowed to provide optional coverage to pregnant women with incomes of at least 185 percent of the federal poverty level. Pregnancy-related assistance available under SCHIP would include all medical assistance available to a pregnant woman under Medicaid and would provide coverage during a 60-day postpartum period. The bill would presume that any child born to an eligible woman is eligible for SCHIP or Medicaid and would provide health care coverage until the child’s first birthday; thereafter, the woman would have to apply for Medicaid or SCHIP for the child. States would have the option to cover legal immigrant women.
States would be allowed to offer family planning services without a waiver from the Centers for Medicare and Medicaid, including “medical diagnosis or treatment services,” to women whose income does not exceed the eligibility level established by a state for pregnant women.
The bill would reduce the co-payment for outpatient mental health services provided under Medicare from 50 to 20 percent of the total cost beginning in 2008 and continuing to 2014.
Beginning on January 1, 2008, the bill would allow the secretary of HHS to add new benefits for Medicare beneficiaries for preventative services, including cardiovascular screening tests, screening mammography, screening pap and pelvic exams, and bone mass measurements.
The increase in SCHIP spending would be offset by increasing the federal tax on cigarettes by 45 cents to one dollar per pack. The increase would take effect on December 31, 2007. The other offsets would include changes to the Medicare Physician Fee Schedule, equalizing payments between Medicare Advantage and Medicare fee-for-service plans, discontinuing enrollment in Medicare Advantage plans beginning in FY2009, and reducing or freezing payment rates for inpatient hospital services, skilled nursing facilities, oxygen rental, and home health services.
The measure also would extend the Transitional Medical Assistance (TMA) program through FY2009. The TMA program recently was extended through September 30, 2007 (see The Source, 7/16/07). However, the CHAMP Act would not extend Title V abstinence-only education programs.
During debate on the measure, the committee rejected, 16-23, an amendment by Rep. Ron Lewis (R-KY) to strip the provision increasing the federal tax on tobacco products.
House Energy and Commerce Committee
On July 26, the House Energy and Commerce Committee began debating the CHAMP Act, after rejecting, 23-39, a motion by Ranking Member Joe Barton (R-TX) to postpone consideration of the bill until August 1. The House Energy and Commerce has held a series of hearings on SCHIP (see The Source, 2/16/07, The Source, 3/2/07, and The Source, 3/30/2007). The Senate Finance Committee approved its version of the bill on July 19 (see The Source, 7/20/07).
In his opening statement, Chair John Dingell (D-MI) said, “The CHAMP Act reauthorizes and improves the existing Children’s Health Insurance Program. This program, created with bipartisan support by this committee in 1997, has cut the low-income uninsured rate by one-third. Some states have been able to insure as many as 60 percent of their children who previously had no health insurance. ” He concluded, “I am well aware that President Bush has pledged to veto counterpart legislation passed by a Senate Committee that is much more modest in its ambitions. I further note that some of my Republican colleagues have professed a belated desire for a more lengthy process to produce a bipartisan consensus. I wish that such an outcome were possible, but given the president’s pledge to veto a solidly bipartisan legislative product in the Senate, we have little choice but to move forward in this manner, and I regret that they have apparently chosen to side with the president’s outrageous threat. Let me be clear: if we fail to pass this bill, six million children will lose their health care coverage as of October.”
Ranking Member Joe Barton (R-TX) said, “When the Republican Congress conceived and passed SCHIP in 1997, the program was designed for low-income children in families who made too much money to be on Medicaid, but were still below 200 percent of the federal poverty level, which equates to an income of $43,000 for a family of four…Regrettably, that is not the path this committee takes today. The Democratic bill before us is the kind of government-run health care intended to win votes, but will only end up doing what government-run universal health care systems do best putting patients in lines, rationing care, [and] spreading misery.” He continued, “The haphazard manner in which we are considering the legislation today trivializes the importance of these issues…When you try to rush a bill through the committee and quickly onto the floor, the American people often rightly wonder what it is you are hiding from them…I support reauthorizing the SCHIP program, and we must do so before September 30th. However, the Democratic majority is using the reauthorization of SCHIP to destroy the private health insurance market and dump Americans into government-run, rationed care, and everybody here knows it. I urge all my colleagues to vote against this bill, and I hope in the near future we can sit down and draft a reasonable SCHIP policy with the majority.”
