Transcripts For CSPAN3 Hearing Focuses On Childrens Health I

Before i begin, lets call the meeting to order. Before we begin to take just a moment to say that our thoughts and prayers go out to those who have been impacted over the past few days by hurricane irma. Of course, we continue to keep those suffering from the effects of Hurricane Harvey in our thoughts and prayers as well. These have truly been horrific events, and i hope and pray for the safety of everyone involved. I join with my colleagues in the commitment to doing all we can to assist our citizens who are in need at this extremely difficult time. We will see what we can do to help alleviate some of the pain. Now, the hearing were having today will come to order. 20 years ago senator ted kennedy and i came together to create the Childrens Health Insurance Program, or chip, in order to provide Health Corner for Vulnerable Children and family who were too poor to afford private coverage but still didnt qualify for medicaid. 20 years ago we were at something of a crossroads. The year before c. H. I. P. Was signed into law a rep Congress Passed and a democratic president signed a welfare reform bill which ended the entitlement to cash welfare. Welfare reform sought to replace a culture of dependency with an emphasis on work. The emphasis was to move families off assistance and towards selfsu fifficiency. C. H. I. P. Was intended to help families. Senator kennedy and i worked in good faith for months to craft c. H. I. P. While neither of us got everything we wanted, the result was a dedicated funding stream for the program to help low income families get good, reliable Health Insurance. From the outset, it was a program that was bipartisan and continues to enjoy bipartisan support throughout the country, and i might add in congress. While it isnt perfect and while in my view some of the changes to the program have been regrettable, i believe that overall people consider it to be a success. Current lay provides federal c. H. I. P. Funding through the end of fiscal year 2017. According to the Congressional Research service, if congress doesnt act to provide additional federal funding a number of children who would likely be eligible for c. H. I. P. Will go uninsured once federal funding is exhausted. Additionally, an action by congress with regard to c. H. I. P. Would cause another layer of unpredictability and anxiety for states that have to administer the program. Of course, this anxiety will pale in comparison to what families who rely on chip will be faced if congress dont act. As we contemplate the future of the chip program there are thresholds we need to consider. The basic question is does the Committee Want to reauthorize or mealy extend chip. Reauthorization would entail more extensive debate and consideration of potential policy changes for the underlying program. As many of you know, in 2015 congressman fred upton, who was then chairman of the house energy and commerce committee, and i put forward a number of substantive policy recommendations for reforming c. H. I. P. While some policy changes are in order for the program, but we need to give full consideration to c. H. I. P reform prior to the expiration of federal funding at the end of this fiscal year. With these concerns in mind someone suggested instead of reauthorizing the entire program we act to extend c. H. I. P funding. Of course, that option comes with its own set of questions. For example, we will need to determine the appropriate length for the extension and whether to continue with the 23 increase in federal matching for c. H. I. P provided under the Affordable Care act and extended in 2015. I know some of our members have strong feelings about both of these questions. These are not particularly complicated issues but they will require some deliberation among members of the committee. Long story short, we have some difficult questions ahead of us. Whether we opt to reopen c. H. I. P to reforms or simply provide another extension, the committee will need to address significant time and effort to find answers to these questions. Today we will continue our discussion of these matters as we hear from witnesses who will testify to the importance of c. H. I. P and the need for it to continue. I hope members will listen carefully to these witnesses concerned with their states and let me know how they would prefer to proceed with regard to c. H. I. P. I look forward to working on a bipartisan basis with my good Ranking Member senator wyden and all of the members of the Senate Finance committee to move forward on a bipartisanship bill. With that, let me now turn to my good friend senator warner for his opening remarks. Thank you very much, mr. Chairman. I want as we start this extraordinarily important effort, mr. Chairman, to note your history with senator kennedy. The fact is it was that bipartisan partnership that got this program off the ground. It significantly reduced the number of uninsured kids in america. Were very appreciative that you set this in motion, and i and i know all of the members on our side very much look forward to working with you to make sure that we get this reauthorized and done quickly. Thank you, senator. Colleagues, you know, the fact is it would be easy for those who are casual observers of political news to get lost right now in whats going on in washington d. C. Theres an awful lot of washington lingo thats justin comprehensible to people. Theres the continuing resolution, the debt ceiling, csr payment, cost sharing, nbaa that is the defense fact and i think all of us could go on and on with others. Today were talking about the Childrens Health Insurance Program, c. H. I. P. It is the only health bill with a time stamp on it. The program is going to expire in a few weeks, and i think our message needs to be on this committee that we see our jobs as putting kids first. That means we are going to have to swing into action quickly here because this program is a lifeline for 9 million, almost 9 million vulnerable kids. It is a source of profound relief for parents across the country, and i want to talk for a moment about the kind of person who really sees this as the lifeline ive described. I might be talking about a single mom who works multiple jobs, pays the bills and handles all of what life throws at her all by herself. The last thing that single mom needs is a government letter stamped notice of termination, explaining that her sick kids are on their own because c. H. I. P funding has run out. That single mom is already juggling an awful lot, and i think it is fair to say she doesnt neread page 817 of the morning newspaper every day because she has too much going on to be able to do that and try to decode all of this washington lingo to determine if the congress is going to act. That single mom sits in her kitchen, and if all shes got is that scary termination letter were going to see a lot of single moms and families in a huge mess very quickly. Thats the prospect families across the country face in a matter of weeks and it is what they dont deserve. Kids who desperately need care might not get it. States are going to be required to start planning for the worst. That means enrollment freezes, belt tightening and emergency steps to try to preserve care for kids currently in the program. But a vulnerable child not yet enrolled in c. H. I. P might have to, in effect, wait until the Congress Gets its act together. That leaves families with a maximum of stress, anxiety and heartache. At worst, it is a life and death proposition for a great many of some of the most Vulnerable Children in our country. So today the finance committee is going to discuss the leading Health Care Issue congress has to address, has to address this fall. The congress created c. H. I. P with one goal in mind. That was to make sure that no american child falls through the cracks of our Health Care System. In the coming weeks weve got an opportunity, as chairman hatch noted, to put together a strong bipartisan agreement that up holds c. H. I. Ps promise to family and gives those kids security for years to come. Im beginning this discussion in an optimistic kind of way because ive discussed this, as i know many of you have, with chairman hatch and know the history. In the decade since they led the congress to create c. H. I. P, the percentage of kids in america living without Health Coverage has fallen from nearly 14 to less than 5 . Chairman hachl and senator kennedy gave us concrete proof again that you can have senators who can have fierce disagreements on a variety of issues finding Common Ground when it comes to big challenges, and i submit and i heard senator casey and others talk about this it doesnt get any bigger than standing up for vulnerable young children. So it is important for the congress to act soon. Theres no kicking this can down the road with a shortterm bill and it cant wait until december. The states run their programs differently. Some are going to run out of funding earlier than others. In that time no family ought to face the panic of being unable to get the care their sick child needs. As i wrap up, one other point is to note how c. H. I. P and medicaid work hand in hand. For American Kids and families, particularly those families working hard every day to climb into the middle class, c. H. I. P adds a level of security to the health care that single mom and others beyond above and beyond medicaid. C. H. I. P can only work if medicaid works. So weve got hard work to do, colleagues, now to uphold the senates promise to kids and families. We will hear from a Witness Panel that it would be fair to say knows c. H. I. P from a to z, a mom who counts on this program, that ensures c. H. I. P runs smoothly in her state, and an independent expert that knows the Program Inside out. I see this as an opportunity for all senators, both sides of the aisle, to learn about and discuss the Critical Program and set the stage for the work to come. Im confident that in short Order Congress can pass a strong and bipartisan extension of c. H. I. P that will last for many years. This is exactly what the important work of the finance committee is all about. Now, chairman hatch is going to have to be doing some juggling here, so im going to call on audible and would like to welcome each of our three witnesses to our hearing today. Each of your perspectives is important with respect to c. H. I. P. First were going to hear from m ms. Lianna george who will be introduced by senator burke. Welcome, lianna. Lianna is a proud parent of two children. Is that kaleb behind you . Caleb, wave at everybody. Were glad to have you. Liannas daughter is eligible for medicaid because of her disability. Caleb, her son, is insured by the c. H. I. P program. Lianna serves takes beneficiary representative on the medicaid and c. H. I. P payment and access commission. She is also a chairperson of the North Carolina council on Educational Services for Exceptional Children and is the secretary of the consumer Family Advocacy committee for Johnston County Mental Health center, the local Management Entity that connects Johnston County citizens with Mental Health, intellectual health and disabilities and Substance Abuse services. She is not only a mom, but an advocate in every sense of the word at every level we have. We are honored to have you here today. Welcome. Thank you, very much, senator byrd. We are going to hear from dr. Schwartz, executive director of the medicaid and c. H. I. P payment and access commission, commonly known in washington lingo as macpaac. It is the legislative agency that provides policy and Data Analysis and makes recommendations to congress. The secretary of health and Human Services on the state on a wide variety of issues affecting medicaid in the state and c. H. I. P program. Dr. Schwartz previously served as Deputy Editor of the journal of health affairs, and special assistance to the executive director and Senior Analyst to the physician payment review commission, a precursor to the medicare payment advisory commission. She is a health commission. She holds a doctorate in Health Policy from the school of hygiene and public health, Johns Hopkins university. Finally we will hear from ms. Linda navlo who will be introduced by our good friend senator warner. Thank you, senator wyden. I want to echo what you and senator hatch said about the importance of c. H. I. P. I would like to present to my colleagues my good friend linda navlo, she is with the department of medical assistance services. Linda and i go back to the days when bob casey was addressing me as his excellency, the governor. And linda at that point was director of division of maternal and child Health Services. Our c. H. I. P program back in the early 2000s was, frankly, a dreadful disaster. We were literally sending tens of millions of dollars back to the federal government because we didnt appropriately sign up our eligible children. We came in and with lindas great help turned that program around, make it a much easier process to get through the signup process. Turned a multipage application into a single page application process. Linda and i traveled the state at clinics and other gatherings and because of her good work and the work of a lot of folks we went from one of the bottom of the barrels to where we signed up 98 pearls of our eligible children. Kaiser foundation recognized us as one of the most effective c. H. I. P programs in the country. Linda has gone on to serve with dms and she has now come back. She has a great expertise and great heart for the program and will be a valuable witness. Thank you, senator wyden. Thank you, senator warner. Now we have gotten to the best part, and thats our witnesses. Why dont we begin with you, ms. George. We will go down the row. The tradition of the committee is if you could highlight your testimony in five minutes. Well make your prepared remarks a part of the record in full. Please proceed, ms. George. Thank you very much. Good morning. My name is lianna george, and as was indicated im from North Carolina. It is a very small rural county. Thank you for the opportunity to be here today, to meet with you and to share my familys experience with the c. H. I. P program and how it impacts families like mine throughout our great country. I married to a wonderful man named jim who is a marine corps vet, and he did third year of electricians Training Program to become a fully licensed electrician. I have three children, one who lives in a group home and my son caleb behind me. Both are on the autism spectrum. Caleb has adhd as well as a neurological condition. As you guys heard, he has medicaid and is insured by c. H. I. P. Im not here to testify on behalf of macpaac, it wasnt until i was appointed to the commission i realized c. H. I. Ps future was uncertain. As a child with special needs, i have been advocating for children with disabilities like my daughter. I was not aware that c. H. I. P was in danger and that the children of working class families like mine were in jeopardy of losing their Health Insurance. While there is need for the waivers i already said that part. Im sorry. As the commission discussed c. H. I. P program, yet to wonder how losing c. H. I. P impact my family. How would it affect those that pay for my insurance, when you dont have access to services you need, how much would it cost us. With the current Health Insurance plan there would be no increase to our premium because my plan only covers employees or familyonly coverage. Theres no employeespouse only coverage. However, it has a very high deductible which prevents my husband and i from accessing medical care that we need. This assured me that the services caleb needs would be pretty much out of our financial reach to get for him without c. H. I. P. These Services Include Occupational Therapy, which addresses fine meteor challenges that impact his ability to write and basic health care tasks like tying shoes. He receives periodic mris to monitor progression of his neurological condition which allows us to be proactive in treatment. My son takes daily medication which helps him focus in schools which impacts his grades and ability to learn. Over the years the c. H. I. P program has provided all of these services to us for little to no cost. Even in years when weve had cost sharing, c. H. I. P is still a tremendous value for my family. Without c. H. I. P coverage his access to services will be greatly diminished. C. H. I. P also provides families with Financial Security and moms like me with peace of mind. In january my husband was laid off of work. That resulted in an insurance lapse for him and me. We worked hard to ensure he continued his medication that he needed, but were able to feel confident caleb had the services he needed or he would become sick. Im thankful that i never had to call his pediatrician and say, i have to cancel our apointment, we dont have insurance. I never had to watch him lying in bed sick with a fever and not be able to pursue medical intervention for him. C. H. I. P has meant m