Casey Urges Health Care Reform and a Focus on Children

WASHINGTON, DC-As the United States Senate continues to debate health care reform, U.S. Senator Bob Casey took to the Senate floor to highlight the help it would provide to the American people and to emphasize the importance of protecting children in health care legislation.  

“I still believe, even with the progress we have made on children, we have much to do,” said Senator Casey.  “For example, we have to do everything possible to increase outreach and facilitate enrollment for low-income families and children. We should not have a program such as Children's Health Insurance, or Medicaid, and then make it hard for families to enroll. So I led the effort in our HELP Committee this summer, even before we voted on a bill, to make sure that enrollment is made easier.”

Senator Casey also stressed the need to include consumer protections in health care reform such as encouraging preventative care and eliminating preexisting conditions as a barrier to medical coverage.

Full text of Senator Casey’s speech is below.

Statement of U.S. Senator Bob Casey
10/29/2009
Mr. President, I rise tonight to speak about health care and all the issues we have been debating under the broad umbrella of health care reform. Obviously, I will not get to all of them tonight, but I am going to spend a few minutes talking about two general areas. One is a list of changes that I believe will take place when our work is completed in the Senate and after what I hope will be President Obama signing a bill on health care reform in a matter of weeks. That will change what I believe has been an unfair burden carried by the American people, at the expense of the American people but brought on by the power, sometimes the awesome power, of insurance companies. I will talk about that, but also I want to speak mostly about changes that need to be made in our health care system for children.

There are a couple of points on basic reform measures that I believe will be part of what we complete in the next couple of weeks. First, a basic list of consumer protections that we talked about for many years but we have never made illegal will prevent insurance companies from continuing what is often blatant discrimination. One of the things we have to do this year is end discrimination for preexisting conditions. If what I believe is the prevailing point of view in this body is successful, insurance companies will be prohibited from refusing you coverage because of your medical history. Out-of-pocket costs will be limited, as well as deductibles or co-pays.

Free preventive care: Why should we say on the one hand we encourage prevention, as we have for years, but now we are going to get serious about prevention in our health care system and make it part of every insurance policy and demand that we all engage in steps that will be preventive in nature and we also will say, for example, for a woman a mammogram is important but why, in the face of all of that, do we say to women in America, as is the current policy, that women have to pay exorbitant costs for mammograms? Frankly, I believe they should have to pay nothing for something as essential to prevention. So preventive care should be free or at a very low cost.

If you are seriously ill, an insurance company should be prohibited from dropping your coverage. We should make that practice illegal.

We should make gender discrimination illegal as it relates to insurance companies. I find it hard to believe that in 2009 we have to legislate to prevent insurance companies from discriminating against women, but we have to because that in fact happens today. Insurance companies will not be able to charge you more because you happen to be a woman, as happens today.

Eliminating annual lifetime caps on coverage has to be part of the final health care legislation.
Extending coverage for young adults is critically important.

Guaranteed issue renewal: Insurance companies, I believe, should be required to renew any policy as long as the policyholders pay their premium in full and insurance companies will not be allowed to refuse to renew a policy because someone gets sick. If you get sick you should not lose your coverage, and if you get sick you should not have to bankrupt your family to pay for the health care you deserve.

Finally on this list, and it is not an exhaustive list but I think it is an important list to review: protecting small businesses. Small businesses should receive tax credits so they can give their employees comprehensive and affordable health care and include a limit on out-of-pocket costs.

These are some of the basic consumer protections I believe we should enact as part of this health care legislation.
I also believe if you want to focus on a particularly vulnerable group of Americans, a group of Americans we have made some progress with in terms of their coverage, though we have not done nearly enough yet, I speak of children. We have made tremendous progress with the Children's Health Insurance Program, for example, and also the children in America covered by Medicaid, so children have the opportunity to receive very good care in almost every instance.

But there are still some problems. Even in a State such as Pennsylvania, where you have, by last count, in a survey done in Pennsylvania last year for the Insurance Department, it showed that just 5 percent of Pennsylvanians up to the age of 18 were uninsured. That 5 percent is too high. We want to get that to zero, of course, but it is a lot lower than it would have been without the Children's Health Insurance Program or without other strategies.

Unfortunately in our State, and I think it is true of most States, when you look at the age category 19 to 64, in that category the uninsured rate is more than double the uninsured rate for children. Instead of being 5 percent uninsured for children age 19 to 64, it is 12 percent. In Pennsylvania what that means is, if you are between the ages of 19 and 64, you are one of more than 870,000 Pennsylvanians who are uninsured. We cannot build an economy or improve our economy in Pennsylvania if we have that many people uninsured for a long period of time.

I still believe, even with the progress we have made on children, we have much to do. For example, we have to do everything possible to increase outreach and facilitate enrollment for low-income families and children. We should not have a program such as Children's Health Insurance, or Medicaid, and then make it hard for families to enroll. So I led the effort in our HELP Committee this summer, even before we voted on a bill, to make sure that enrollment is made easier. I worked very closely with Senator Dodd, who long has been a champion for children and a strong advocate for children's health insurance.

We should also focus on the benefit packages related to pediatrics, pediatricians. We had an amendment this summer in the HELP Committee that Senator Merkley and I cosponsored, ensuring that a pediatric representative would be part of any advisory commission to the Secretary of Health and Human Services regarding what should be in a benefit package. It is very important to have a pediatric representative at the table.

Another thing that is critical is to have a requirement that pediatric preventive care be included in the list of mandatory preventive services that insurance plans offer with a minimum of cost-sharing requirements for families.
No. 4 on this list, in terms of what happens to children in pediatric settings: In our committee bill we talked about medical homes--not a physical place, but a way to provide treatment, that is the idea for every American to have a primary care physician and then a network of specialists around them they have access to. That is certainly the ideal and the intent of a large part of the HELP Committee bill. Also it is important to remember that children are not just smaller adults or smaller versions of an adult; they have particular and special needs in terms of their treatment. So for children, their primary care doctor is a pediatrician and therefore pediatricians must be among those practitioners who are at the center of the care or the center of the medical home that surrounds a child.

Also ensuring critical health care for children involving their oral health care: We ensured in the HELP Committee this summer the establishment of an oral health care education prevention campaign at the CDC focusing on preventive measures. We also increased funding for training for pediatric dentists in the bill we passed this summer out of the committee. It is critically important that children have access to that kind of health care in the early years of their life. We had a tragic, horrific example of what could go wrong when a child died here in the Washington region a couple of years ago--I believe actually the State of Maryland--when that child did not have access to a dentist and had horrific problems which led to that child's death. As a result of changes we make in our health care system, we must ensure that does not happen.

Strengthening the pediatric workforce: Along with both Senator Brown and Senator Dodd, this summer in our HELP Committee bill we added a loan repayment program for pediatric specialists and providers for mental health services for children. We can't say that we care about children and not build in these particular protections for them in our health care system. Part of that is a workforce issue. We heard a lot in this debate about the shortage of primary care physicians. The intent of our bill in the HELP Committee was to make sure we would have a building up, an increase, in the number of primary care physicians. Again, for a child, his or her primary care physician is a pediatrician and it is critically important that pediatric specialists be available to children when they have special needs and special challenges that need to be treated by a specialist.

I know I am over my time. I will conclude. One last point about the CHIP program: The Children's Health Insurance Program as we know is now a stand-alone program. There were some efforts this past summer and into the fall to have that program folded into any exchange that would be created as a result of the health care legislation. I thought that was a mistake. I made that very clear to others and to the Finance Committee as we were debating it. Thank goodness, Senator Rockefeller worked so hard and led the fight to keep the Children's Health Insurance Program as a stand-alone program. We should not fix what “ain't broken,” as the expression goes, and the Children's' Health Insurance Program works well for millions of children today. Within the next couple of years, that program will cover 4 million children who will be given access to the kind of care we would hope every child has.

I think all these changes I have talked about, and more, come under the headline of “No Child Worse Off.” That should be, and will continue, I believe, to be one of the goals of health care reform. At the end of this process no child in America, especially poor children and children with special needs, will be worse off.

We have a long way to go, lots more work to do. But if we are guided by that principle we will make sure our children have the kind of health care that we all hope for and they have a right to expect.
 
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