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Senate Proceeding 01-27-09 on Jan 27th, 2009 :: 1:03:25 to 1:34:30
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Richard Burr

1:03:21 to 1:03:42( Edit History Discussion )

Richard Burr: you've got coverage. it's not hard. we can do that. but we've not

Richard Burr

1:03:43 to 1:04:05( Edit History Discussion )

Richard Burr: i yield the floor. the presiding officer: the senator mr. burr: mr. president, i want to pick up where i was before lunch, and i'm glad to see my good friend from ohio here. we were having conversations

Richard Burr

1:04:06 to 1:04:27( Edit History Discussion )

Richard Burr: before lunch on clearly, an important piece of legislation, as dr. coburnnd i said before lunch. i think that every member of the united states member of the congress and probably everybody in country believes that it's important to cover children.

Richard Burr

1:04:28 to 1:04:50( Edit History Discussion )

Richard Burr: that prevention and wellness aspects of having that we have a healthier community, that we've taken those who, by the way, are historically more healthy -- younger folks -- and we've given them the assurances of checkups

Richard Burr

1:04:51 to 1:05:11( Edit History Discussion )

Richard Burr: and the ability doctor so that we minimize anything happening to in 1996-1997, the senator from ohio and i were both on the energy and commerce committee. we were involved in crafting the original i rember it today as well as i

Richard Burr

1:05:12 to 1:05:32( Edit History Discussion )

Richard Burr: did then. it was targeted at a specific group of our country's those over 100% of poverty that families made too much for medicaid but those with not enough income between their parents to be able to afford

Richard Burr

1:05:33 to 1:05:54( Edit History Discussion )

Richard Burr: health care at the time, and my gracious, health care has done nothing but get more expensive since 1997. we appropriated and authorized 0 million for a ten-year program to target -- i can't remember what the target was for the num 100% of porty for a family of

Richard Burr

1:05:55 to 1:06:16( Edit History Discussion )

Richard Burr: four they'd have an income of 2,000. 2,000, they medicaid, regardless of what state they're in. and health care is provided. dr. coburn pointed out, i think rather clearly, for medicaid and

Richard Burr

1:06:17 to 1:06:37( Edit History Discussion )

Richard Burr: for schip eliminated about 40% of the health professionals who choose not to participate in it. why? it's because the reimbursements are so pitiful in those two programs, regardless of the state, that to opt out of providing that

Richard Burr

1:06:38 to 1:07:01( Edit History Discussion )

Richard Burr: care and focus just on the medicare and private market, or just on the private market. so just the creation of medicare and schip means that eliminated some choice for these people who this is option. it is their safety net. now, if i had my

Richard Burr

1:07:02 to 1:07:22( Edit History Discussion )

Richard Burr: rather be here debating -- no now if i had my drudgeerings i would rather be here -- now, if i had my drudge,i'd rather be here debating health care reform. we will have a big disagreement on how we get there. but we can get there. and were

Richard Burr

1:07:23 to 1:07:45( Edit History Discussion )

Richard Burr: talking about the expansion of one program that hits a small group startinged to put them in a one-size-fits-all program that only 40% of the health care professionals even participate in. now, having said all this, we're up for reauthorization. we're now road. and we're talking about how do

Richard Burr

1:07:46 to 1:08:06( Edit History Discussion )

Richard Burr: you change this bill to apply what we learned? can we what it can we cover mor people? if so, how? which states have done well? which can we learn which have done poorly? which should we work wit legislation to try to

Richard Burr

1:08:07 to 1:08:27( Edit History Discussion )

Richard Burr: wealth, we find in this legislion that over the 10 years we grew from poverty to 300% of i don't have any disagreement with that with the rising health care costs. 300% of poverty for a family of four is 6,000 a year.

Richard Burr

1:08:28 to 1:08:48( Edit History Discussion )

Richard Burr: so currently, not reauthorization -- if a child lives ia household who has an income of 6,000 and above 2,000, they are egible for schip today. so what's our experience so

Richard Burr

1:08:49 to 1:09:09( Edit History Discussion )

Richard Burr: as we get ready for this reauthorization, we got 7.4 million children enrolled in schip in 2008. but the average monthly enrollment for 2008 was 5.5 million. meaning that we've had almost 2 million drop out. that he moved to a different --

Richard Burr

1:09:10 to 1:09:31( Edit History Discussion )

Richard Burr: they've moved to a different state, the income of their family changed -- they're to longer eligible. so 5.5 million covered children today seems to be sort of a fixed point. well, how many are eligible today i think my colleagues would be

Richard Burr

1:09:32 to 1:09:52( Edit History Discussion )

Richard Burr: amazed to find out the a 5.4 billion -- 5.4 million. excuse me. we're covering 35.5 million but we're not -- we're covering 5.5 million but we're not covering 5.4 million that are eligible under today's guidelines. so in typical washington response what do we do to that?

Richard Burr

1:09:53 to 1:10:16( Edit History Discussion )

Richard Burr: we come up with an authorization thatxspann already we have in pla a waiver where new jersey can currently go up to 350% of poverty. what's that? 7,175. and now in the reauthorization we're going to grandfather

Richard Burr

1:10:17 to 1:10:37( Edit History Discussion )

Richard Burr: 350% and we're going to suggest that we'll go up do 400% for new york. that's 8,200. where's that 1.4 million that were eligible before -- how does that eligible before get enrolled?

Richard Burr

1:10:38 to 1:11:02( Edit History Discussion )

Richard Burr: they're not. this is what dr. coburn was talking b how about the kids that nobody is going out to enroll through autoenrollment? it's easy. but attempting to do. this bill is attempting to increase the eligibility, to get a bigger slice eligible for gov so that at some point the number of folks that are on government

Richard Burr

1:11:03 to 1:11:23( Edit History Discussion )

Richard Burr: programs -- medicaid, medicare, schip, v.a., and the list goes on -- is well over 50% of america and cast. we go to a the government runs it. the government we get. the government tells us where we go and the american taxpayer pays for everybody. now, here's a decision of the

Richard Burr

1:11:24 to 1:11:44( Edit History Discussion )

Richard Burr: united statesate has got. the house has already voted this bill out. we got the decis going to stand up for this 5.4 million. these are the tough ones. these are the ones that didn't walk into the door and rai their hand when their parents were told they're eligible a said

Richard Burr

1:11:45 to 1:12:05( Edit History Discussion )

Richard Burr: i would like health care, i would like a medical home. they are eight 5.4 mlion children that are out there that no state is reaching o they're just letting them fall by the wayside. and rather than focus million, we're focused on how we increase eligibility, how we

Richard Burr

1:12:06 to 1:12:29( Edit History Discussion )

Richard Burr: change the income parameters. let me just point out, new jersey -- which is grandfathered to 47th in the country at enrolling children that are 200%

Richard Burr

1:12:30 to 1:12:53( Edit History Discussion )

Richard Burr: -- that are poverty. a state that we have allowed to be grandfathered at 3w50% of poverty ranks 47th out of 50 in the united states in enrolling kids between 200% of poverty. as a matter of fact, 28% of

Richard Burr

1:12:54 to 1:13:15( Edit History Discussion )

Richard Burr: their children are that 100%-to t-00% of poverty. yet once again we're going to grandfather them and allow this incredible expansion to continue. so where is their focus? let's go after the easy ones. let's go after the ones in families that are easier to find where they'll enroll. why does that happe

Richard Burr

1:13:16 to 1:13:36( Edit History Discussion )

Richard Burr: let me point tout my colleagues, medicaid pays a range depending upon which state you're from and that range is from 50% to 75.9% with a ceiling of so, as the state makes a medicaid payment of , depending upo you're, from the federal

Richard Burr

1:13:37 to 1:13:58( Edit History Discussion )

Richard Burr: government reimburses anywhere from 50 cents to 83 c but if you're enrolled in schip, the range goes from 65 cents to 85 cents. you're a state on the bottom, why would you -- why

Richard Burr

1:13:59 to 1:14:20( Edit History Discussion )

Richard Burr: lie before expanded nur a going to have an increase in the federal pay of what you pay it's 15 cents of every dollar. you're crazy if for not lobbying for this. because you're going to the cost over the entire

Richard Burr

1:14:21 to 1:14:43( Edit History Discussion )

Richard Burr: taxpayer base. it makes a lot of sense if your focus is not on children and how they get covered and how they get health care. if you get a bigger piece of the federal pie. if you're only focused on how you get a bigger share of space at the trough, then this makes a tremendous amount of sense.

Richard Burr

1:14:44 to 1:15:04( Edit History Discussion )

Richard Burr: but from a developing health care policy, it makes absolutely no sense whatsoever. now, i don't take it for just looking at one section of the bill. dr. coburn pointed out and i

Richard Burr

1:15:05 to 1:15:28( Edit History Discussion )

Richard Burr: pointed out earlier that just the f suspect. in fiscal year 2012, which is the last of five years, we allocate 4.98 billion to fund

Richard Burr

1:15:29 to 1:15:50( Edit History Discussion )

Richard Burr: this almost 5 billion. yet, in 2013, the bill reduces the allocation to .7 billion. how do you hav program for children with all these people enrolled suckin up 5 billion a year, and all of a sudden the next

Richard Burr

1:15:51 to 1:16:12( Edit History Discussion )

Richard Burr: year it drops off and it drops to .7 billion? and the answer is: you don't. and we all know it. and the reality is you've got to go to the next five-year period to find the answer. and the answer is starting in year six, out five-year budget, we do a

Richard Burr

1:16:13 to 1:16:34( Edit History Discussion )

Richard Burr: onetime payment of 1.7 billio 1.7 billion on top of what it costs us to run the program for 2013. so what's that mean? quite frankly, it means that the accounting methods used in washinon a methods that any family in america could use because their creditors would walk in the door

Richard Burr

1:16:35 to 1:16:55( Edit History Discussion )

Richard Burr: and they would shut them down. yet, we get up here every day, and we claim we like people at home. and in fact, we know twhe comes to budgets, family that can get away with what we get away, especially when it's this obvious. one year it costss 5 billion. the next year it costs us .7 billion. there are only two ways you

Richard Burr

1:16:56 to 1:17:16( Edit History Discussion )

Richard Burr: accomplish it. you either reduce drastically or you magically come up with the money, and you stick it in and say didn't understand that was going to happen. we understood it w going to happen. to get around the pay-go can actually just take this money right to the deficit and

Richard Burr

1:17:17 to 1:17:37( Edit History Discussion )

Richard Burr: the debt of the in other words, we're going to provide our children health care with one hand and we're going to rob their future financially with our other hand all at the sa time. miraculous that we would even attempt to do this. at least we could ask for honesty and transparency in how

Richard Burr

1:17:38 to 1:17:59( Edit History Discussion )

Richard Burr: we're funding this program. now, mr. president, it's important that we sort of recap what is schip? who might not have been in congress very long, certainly weren't here in 1996 and when we passed it, people across the country might be saying, i

Richard Burr

1:18:00 to 1:18:20( Edit History Discussion )

Richard Burr: never heard of this program. well, again, we saw the need in 1996 to create an insurance product for children's health, for those people who financially didn't qualify for families didn't make enough to

Richard Burr

1:18:21 to 1:18:45( Edit History Discussion )

Richard Burr: purchase insurance on the open market. and schip was created with the vision of trying to take kids from 100% of poverty to 200% of poverty and to make them eligible for a program where 100% of them would care. as i said, nationally the

Richard Burr

1:18:46 to 1:19:07( Edit History Discussion )

Richard Burr: parameters grew from 100% to 300%, and we still haven't met the mission of covering all the kids. because with 5.5 million people covered today, average m number, we still have 5.4 over here who are eligible and don't have insurance.

Richard Burr

1:19:08 to 1:19:29( Edit History Discussion )

Richard Burr: clearly, we've got a tremendous amount of work to do just to get thechip program to fulfill its original mission. now, let me the bill that we've got before us. the c.b.o. estimates the bill will increase outlays by

Richard Burr

1:19:30 to 1:19:50( Edit History Discussion )

Richard Burr: billion above the baseline over five years and 5 billion over 10. the cost is tobacco tax. i'm from north carolina. i can go up and wail about how this is unfair. it's not the first time the congress has done it. it is the most regressive tax we have known.

Richard Burr

1:19:51 to 1:20:12( Edit History Discussion )

Richard Burr: in essence, we're taking a who financially are challenged and, according to every analysis i've looked at, the person who's going to be most taxed tobacco increase are those people in the lower socioeconomic levels.

Richard Burr

1:20:13 to 1:20:35( Edit History Discussion )

Richard Burr: so, in essence, we're not spreading we're asking the parents of these children to pay for the expansion and eligibility because we're going to tax them for every cigarette that they buy and consume. and we're going they quit. and when they quit, i'm not sure how wre going to fund program except probably do it

Richard Burr

1:20:36 to 1:20:58( Edit History Discussion )

Richard Burr: the same way that we're doing in the year 2013. we will come up with the money in some way, in some fashion. now, i think it's we realize

Richard Burr

1:20:59 to 1:21:20( Edit History Discussion )

Richard Burr: something that we call a medicaid medicaid starts here. schip goe medicaid wraps on the top. it's hard to believe that we could have something designed that's s complicated for the states that medicaid here to some, schip applies here

Richard Burr

1:21:21 to 1:21:41( Edit History Discussion )

Richard Burr: to others, and medicaid applies on top of that to an even larger group. if it seems confusing, it is. has to it? why don't we fix it? yet, as i continue to go through senator baucus' bill, what i

Richard Burr

1:21:42 to 1:22:04( Edit History Discussion )

Richard Burr: find is that we're making it more complicated. we're designing it in a fashion that aggressively goes after an increase in enrollment, but not from the 5.4 million that currently today are unenrolled in the program but are certainly eligible.

Richard Burr

1:22:05 to 1:22:25( Edit History Discussion )

Richard Burr: as a matter of fact, in senator baucus' bill, it spends 4 billion over fiv it targets 5.7 million new children. i might add, 2 million of those

Richard Burr

1:22:26 to 1:22:47( Edit History Discussion )

Richard Burr: children today covered under their parents' insurance. so we've actually got a net pickup of 3.7 million kids who were uninsured. and that's 4 billion. there's an alternative plan. it's called the mcconnell substitute.

Richard Burr

1:22:48 to 1:23:11( Edit History Discussion )

Richard Burr: it's called "kids first." it uses 9.3 billion over years to enlist, enroll 3.1 million kids who are uninsured today. so, what do we get with the 4 billion investment that we're no billion investment?

Richard Burr

1:23:12 to 1:23:32( Edit History Discussion )

Richard Burr: the 600,000 uninsured kids who enrolled. and when you do the simple math on that, you find out you're paying ,000 per now, i don't expect everybody to associate with this, but last year i had a son who was a senior in high school -- in college. excuse me.

Richard Burr

1:23:33 to 1:23:53( Edit History Discussion )

Richard Burr: and because we have the funky government rules that say no matter where you are in your education process, when you become 22, you're no longer eligible to be under government insurance for your tpaefplt it doesn't apply -- for your family. it applies to every federal employee. i was forced as a parent to go out and go process of i've got to get m

Richard Burr

1:23:54 to 1:24:15( Edit History Discussion )

Richard Burr: son insurance. he's 22 years old. he's healthy as a bull. there's no reason that i should suspect he's going to get sick, but what if something happens to him? so i immediately did what every good federal employee would do. i called the correct office up here and said this has to be something you've run into. have you got some type of gap insurance that i can turn to and

Richard Burr

1:24:16 to 1:24:37( Edit History Discussion )

Richard Burr: i can purchase for that 22-year-old healthy son? they said, certainly, we've negotiated with the same company, the same plan that he was under, and you can go -- he can go on that tomorrow. they sd ,400 a year, for a

Richard Burr

1:24:38 to 1:24:58( Edit History Discussion )

Richard Burr: 22-year-old, senior in college. well, i did probably what every parent would do. i called the college and said, here's the situation." they said absolutely. we've negotiated, as a matter of fact, with the same company, with the same plan he was under as a child of a federal employee.

Richard Burr

1:24:59 to 1:25:19( Edit History Discussion )

Richard Burr: i said, what's the premium? they said ,500 a year. now, the first lesson there, i learned when i became a member of congress. i became a member of i chose the same insurance plan that i was under in winston-salem, north carolina, working for a company of 50 employees; the same exact plan,

Richard Burr

1:25:20 to 1:25:40( Edit History Discussion )

Richard Burr: paying the same 25% and the only difference was that my health insurance cost went up 00. why? because a company of 50 employees negotiated a better government on behalf of 2 million employees. but, you years. i had forgotten that. i learned it firsthand with my

Richard Burr

1:25:41 to 1:26:03( Edit History Discussion )

Richard Burr: son, when all of a sudden i realized he got a plan for ,500 that the university of north carolina, chapel hill negotiated, and the federal government negotiated the sam plan; it no wonder parents are confused. no wonder most americans are confused. what a screwed-up market this is.

Richard Burr

1:26:04 to 1:26:29( Edit History Discussion )

Richard Burr: how unbelievably implicated tor -- complicated for an individual to go out and access insurance. at what point do you actually know that you' well, let me just try to bring for that 22-year-old, chapel hill, his health care

Richard Burr

1:26:30 to 1:26:54( Edit History Discussion )

Richard Burr: plan was 5,0 -- was ,500 a year. for all these kids we're addressing in schip we're spending ,000 a year to insure them. somebody under 18 in america today is about yet, under this plan, we're going to spend -- we're going to

Richard Burr

1:26:55 to 1:27:15( Edit History Discussion )

Richard Burr: invest ,000 per child -- per that 600,000 children, to make sure that they' not but considering my experience with the federal government, i can understand why some people here think that makes absolute perfect sense. now, let's assume for a minute that somebody's going to say my

Richard Burr

1:27:16 to 1:27:38( Edit History Discussion )

Richard Burr: numbers are wrong. and i'm sure they will before this debate is over. let's assume for just a minute that we're trying to figure out of the enrollees -- and i'm not taking insurance and we shifted them over -- what are we paying for them?

Richard Burr

1:27:39 to 1:27:59( Edit History Discussion )

Richard Burr: we're paying about ,200. they're still paying 00 more a ar to insure every child 18 and under than i paid in premiums to cover my 22-year-old, healthy-as-a-bull senior in

Richard Burr

1:28:00 to 1:28:20( Edit History Discussion )

Richard Burr: so, at least we're overpaying by 00. at most, we're overpaying by almost ,500. somewhere in that range, i would hope that the american people would say, hey, let's stop for a second. let's call time-out. let's go back and get congress to relook at this progr because this really doesn't make

Richard Burr

1:28:21 to 1:28:41( Edit History Discussion )

Richard Burr: a lot of sense to us. i'm not getting in to any of the aspects that have already been addressed which deal with the loopholes that were created. i actually sat on the heard somebody say that this a bipartisan bill. well, if you count one republican vote and forward it

Richard Burr

1:28:42 to 1:29:02( Edit History Discussion )

Richard Burr: out of then, you're right, it's bipartisan. but i'm not president obama's interpretation of what bipartisanship is. he came to the hill. he had lunch because he's trying to get more republicans to support a stimulus doesn't want to just win it and he doesn't want to win it by one vote. he wants the american people to understand that there's

Richard Burr

1:29:03 to 1:29:11( Edit History Discussion )

Richard Burr: confidence up here in the legislation that's passed. well, he probly should have

Richard Burr

1:29:44 to 1:30:04( Edit History Discussion )

Richard Burr: talked about this bill. this let me end with this. what i want members t their soul and ask, is it really the federal government's responsibility and more importantly the family included in a plan that's

Richard Burr

1:30:05 to 1:30:25( Edit History Discussion )

Richard Burr: designed and was originally designed to take care of between 100% and 200% of poverty? do we feel bad that today 5.4 million children who are eligible poverty aren't enrolled in the program.

Richard Burr

1:30:26 to 1:30:46( Edit History Discussion )

Richard Burr: this is not the first time that i've had a test like this. my own president last year proposed that we increase spending for in afric to 0 billion. and to many tom coburn and i supported the president.

Richard Burr

1:30:47 to 1:31:11( Edit History Discussion )

Richard Burr: and then all of a sudden they made a change in the program. the program always said that 50% of the money had to go to treatment of h.i.v. and aids patients. meaning they actually had to deliver medicine to them. well, when all of a sudden the companies that got these federal grants to carry these programs out in africa looked at the program, they said, my gosh, for

Richard Burr

1:31:12 to 1:31:34( Edit History Discussion )

Richard Burr: committing .5 million all the way up -- .5 billion up to 2 billion in delivering medicines to people who have h.i.v. and aids, that's going to be really tough. i mean we're going to have to it is going to be dangerous for us in some cases to get the drugs out. what did the white house do?

Richard Burr

1:31:35 to 1:31:55( Edit History Discussion )

Richard Burr: they dropped the requirement in total. they didn't req dime of the 0 billion go to the delivery of drugs to h.i.v. and aids patients. sohat did we do? we held the bill up. i think people as much flak as we wanted to. we were taking the flak from our

Richard Burr

1:31:56 to 1:32:16( Edit History Discussion )

Richard Burr: own president because we bill that was structured poorly. it actually didn't accomplish what we set out to originally. at the end of the d they put back in requirement of 50% and today for multiple countries that this applies to,

Richard Burr

1:32:17 to 1:32:38( Edit History Discussion )

Richard Burr: today we've got a commitment to 2.5 billion is going to go to actually treat individuals that hav our original program. we just expanded it. now, we weren't going to get there just by difficult therefore we don't think we should do that.

Richard Burr

1:32:39 to 1:32:59( Edit History Discussion )

Richard Burr: and this 5.4 million kids that are eligible but not enrolled if we say, you know what, this is hard. and since it's hard, why don't you change the program so that the eligibility is wider so we can get some of the kids that are out here in different income

Richard Burr

1:33:00 to 1:33:20( Edit History Discussion )

Richard Burr: enroll than for us to go and find the 5.4 million that are so hard. well, i want to say to my colleagues like i said to my president, no, thas not what we we put this program together to make sure the most at risk in this country had health coverage

Richard Burr

1:33:21 to 1:33:41( Edit History Discussion )

Richard Burr: so they had a to suggest that we're now going to change the parametersf this and allow a larger income pool to come in because reach out and find these 5.4 million people, it's not going to happen. it may happen, but it should be

Richard Burr

1:33:42 to 1:34:02( Edit History Discussion )

Richard Burr: as difficult at happening as it possibly can. i look forward to the debate that we're going to have. it's my hope an opportunity to actually look at honest budget numbers that share with the american people exactly what this costs. that we can look at the elig

Richard Burr

1:34:03 to 1:34:24( Edit History Discussion )

Richard Burr: with predictability understand who is going to opportunity to be enrolled and hopefully at the end of the day when a bill passes, vote for it or not that we can all look at it and say, you know, there's a real chance that 100% of the kids, 100% to 200% of poverty have a real opportunity to this program.

Richard Burr

1:34:25 to 1:34:30( Edit History Discussion )

Richard Burr: i fear without changes to this legislation, that won't happen. we will not have fulfilled what we set out to do.

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