John Chafee

Mr. CHAFEE

Mr. CHAFEE. I move to lay that motion on the table. The motion to lay on the table was agreed to. Amendment No. 2979

Mr. CHAFEE. Mr. President, there is a lot of talk about who is in the wagon these days. If we have no room in the wagon for 12-year-old poor children, pregnant women, the blind, and disabled, we have become an unworthy society.

Mr. CHAFEE. Mr. President, we have 30 seconds now?

Mr. CHAFEE. Mr. President, I am interested in this amendment. Are you just skipping it once or what?

Mr. CHAFEE

Mr. CHAFEE. Mr. President, I move to reconsider the vote by which the amendment was agreed to.

Mr. CHAFEE. Mr. President, if I could have just a portion of that.

Mr. CHAFEE. Mr. President, I am offering this amendment on behalf of Senator Conrad and myself. What it does, it guarantees Medicaid eligibility for low-income individuals with disabilities. Under the language reported by the Senate Finance Committee, States are required to provide coverage to persons with disabilities. However, and here is the hitch--the States are given complete latitude in establishing the definition of who is disabled. It could be only those who are quadriplegics who are blind are considered disabled. I mean, they can have any definition the States wish. What our amendment does is it sets a minimum standard by requiring States to provide coverage to children and adults with disabilities who receive benefits under the Supplemental Security Income Program [SSI]. But here are the important words, the SSI Program, as amended by the welfare reform bill which we passed here a month or so ago, we passed here by a vote of 87 to 12. So this is a very restricted group. This is not the SSI group that we worry about that included substance abusers, for example. That is not in this category. Only the neediest individuals qualify for SSI. They all have incomes below the poverty level and indeed currently they have to--they cannot be above 75 percent of the poverty level and qualify. Now, this is a pretty low- income group. Why is this amendment important? Without this requirement, States will have the ability to exclude from coverage a group of individuals who depend on this Medicaid coverage as their only source of health insurance coverage. There is no place else they can go. You say get private insurance. Well, they first cannot afford it. And second, they all have preexisting conditions, and so therefore would not be qualified. Mr. President, there is no mandated benefit package in this proposal. These are the facts. We do not mandate a benefit package. We leave that up to the States. All we are saying is, you have to cover this group. And how do you describe this group? You describe them by the SSI description as we had it in the welfare program. So, indeed, with no mandated benefit package, the States could say, ``For this group there will be one aspirin a year.'' That could be done. But at least you have to cover everybody in the group with whatever the benefit package is. Mr. President, I think it is very important to remember that we are giving the States, over the next 7 years, $800 billion--$800 billion, Mr. President. And they are going to receive their allocations based on the fact of those whom they covered in 1995, and in the group that they covered in which they got their money are these disabled. So, Mr. President, these are a very, very low-income group in our society. They are being cared for very frequently by their parents and others, kept in the community. And without this safety net they would have to in many cases be institutionalized at a far higher cost. I hope my colleagues will join me in preserving this critical safety net. I yield time to Senator Conrad.

Mr. CHAFEE. Mr. President, I would ask that further reading of the amendment be dispensed with.

Mr. CHAFEE. I am sending the amendment to the desk, an unprinted amendment, and ask for its immediate consideration.

Mr. CHAFEE. If the Chair could tell me at the end of 3 minutes, I would appreciate it.

Mr. CHAFEE. Mr. President, I ask that the Chair would be good enough to tell when I have used 3 minutes. As I understand it, we have 5 minutes on our side.

Mr. CHAFEE. Mr. President, I do not want to look at this in terms of whether we are voting for America or not. People would not want to stand up here and suggest they were not voting for America. I suspect they believe the amendments are for America. What I am saying, Mr. President, is that we are doing something retroactively. And it was our belief that 5 years was the fair way. Now, I suppose you could do it in 1 year. But that does not make it any fairer. So, Mr. President, that was the basis on which we did the 5 years in the Finance Committee. Mr. DOMENICI addressed the Chair. How much time do I have remaining?

Mr. CHAFEE. Yes.

Mr. CHAFEE. Mr. President, this provision that is referred to as a loophole was entirely legal over the years that it was enforced, and in the Finance Committee, after considerable negotiation in what we are doing in retroactively repealing something, if you would, the belief was that doing it over 5 years was a fair method of proceeding. And the belief was that to do it in 4 years--a very abbreviated time--was just not fair. So, Mr. President, this is an intricate, complicated system, and a complicated piece of legislation. But we felt in the Finance Committee that indeed there was considerable pressure to give a longer time to phase it out. But we arrived at 5 years thinking that was a fair way of doing it, and the 4 years just does pose a severe problem and difficulty upon those who chose to use this type of company-owned life insurance policies. So, Mr. President, that was the rationale for going to the 5 years.

Mr. CHAFEE. Mr. President, it is such an outstanding amendment. I do not think there is any opposition.

Mr. CHAFEE. Mr. President, the Senator from Texas says this is a new entitlement. Let us look at what the present law is. The present law mandates that, in every State of the Nation, the State must provide Medicaid coverage for every child 5 and under up to 133 percent of poverty, and for those over the age of 5, it is up to age 12 and lower, to 100 percent of poverty; and that increases it by a year each year so that by 2002, every child up to the age of 18 will be mandated coverage. So this is no new entitlement. Second, the Senator from Texas says, ``What arrogance for us to say to these States they must cover children up through the age of 12, 100 percent of poverty and below. What right have we to levy such a mandate on the States?'' What he fails to mention is that we are sending the States $800 billion over the next 7 years--not million, but billion, with a ``b.'' When you send out money like that to the States, it seems to me you are entitled to ask for something. What do we ask for? We say they must cover poor children, 100 percent of poverty, up through the age of 12. Do we say what kinds of coverage, what the health care package is? No. It could be the most modest package. Indeed, one aspirin a year could be the health care package. So to say this is arrogance, when we demand that the States cover this little group, come on now. I thought this was being offered with a sense of humor, but I see the Senator is serious about this. So, Mr. President, I hope this amendment is resoundingly defeated because we have to stand for something around this place. When we send out $800 billion, we are entitled to ask for something on behalf of the States' poor.

Mr. CHAFEE. Mr. President, I commend the Senator from Arkansas for his efforts in connection with the nursing home standards and, indeed, he and I have worked together in the Finance Committee. I voted with him in connection with his amendment, which was defeated 10 to 10. Since then, in conjunction with Senator Cohen and others on this side, we have prevailed upon what you might call the managers of the bill to put in a very good Federal nursing home standard provision. As regards nursing homes, there are two provisions in here that I think are superior to the provision that Senator Pryor has, although I am not intimately familiar with everything that he has. One, in the provision that we have, we remove the costly and duplicative requirement that standards perform so-called preadmission screening and annual resident review, which is known by the acronym of PASARR, and that would not be included and it is my understanding that this is a rather good provision. Second, we have a proposal that if the States have tighter inspection requirements than the Federal, then the States can apply to the Secretary of HHS for a waiver and have those tighter provisions included as the inspection requirements or the standard requirements for the nursing homes within that State. You might say, ``Well, how do they go about enforcing it?'' We have a provision that it can be enforced by HCFA. So we think that this has a lot of provisions in it that have merit. I urge those on the other side to take a look at this provision that is in the so-called managers amendment.

Mr. CHAFEE. Quickly, because it is on my time.

Mr. CHAFEE. I think the suggestion was to put the vote off until the morning and to give you a chance to look at this particular provision.

Mr. CHAFEE. Do I still have control of the time? I would have been delighted to have yielded that time.

Mr. CHAFEE. Was there another question, or does that satisfy everyone?

Mr. CHAFEE. Mr. President, I ask Senator Cohen if he wants to say anything?

Mr. CHAFEE. Mr. President, I am pleased to be joined in this amendment by Senators Conrad and Frist. The reconciliation bill says States must cover the disabled but does not define who is disabled. This amendment adopts the same definition of ``disabled'' as we used in the welfare bill which we passed----

Mr. CHAFEE. Do I start my 30 seconds over?

Mr. CHAFEE. Well, I will start. This amendment adopts the same definition of ``disabled'' as we used in the welfare bill which we passed 87-12. It does not include substance abuses. That is a mistake in the little chit that was circulated here. These individuals are at 75 percent of the poverty level or less. They cannot get health insurance. This safety net is essential to them if they are going to stay in the community.