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Congress set to add 4 million people to insurance program despite Bush veto threat
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    WASHINGTON — Congress is rushing to add 4 million people to a popular children’s health insurance program, knowing President Bush will likely win a veto fight and hand Democrats a campaign issue for next year’s elections.
    The Senate moved Thursday toward a final vote on a bill passed earlier by the House to expand the State Children’s Health Insurance Program, or SCHIP. The bill calls for increasing spending from about $5 billion annually to about $12 billion annually for the next five years.
    The vote was not expected to differ much from the one passed two months ago, when the Senate approved virtually the same bill 68-31. That’s enough to override a veto. But supporters in the House are about two dozen votes shy of an override.
    Scores of Republican lawmakers have lined up with Democrats to expand the program to reach about 4 million of the estimated 9 million children in the country without any health insurance.
    GOP leaders, however, chose to cast the legislation as an effort to score political points and another step toward universal health care paid for by the government.
    ‘‘Democrats are counting down the hours so they can tee up the election ads saying Republicans don’t like kids,’’ said Senate Minority Leader Mitch McConnell, R-Ky. ‘‘Meanwhile, they’re using SCHIP as a Trojan Horse to sneak government-run health care into the states.’’
    New York Sen. Hillary Rodham Clinton, the front-runner for the Democratic presidential nomination next year, said a veto will show the president ‘‘will be putting ideology, not children, first.’’
    Sen. Max Baucus, D-Mont., a principal author of the bill, implored Bush to change his mind.
    ‘‘He can bring health coverage to 3.8 million low-income uninsured children who have no insurance today,’’ Baucus said. ‘‘Or he can cut it with his hatchet, cutting coverage for at least a million children who would otherwise get the doctor’s visits and medicines they need.’’
    The president has recommended a $5 billion increase for SCHIP, bringing total spending to $30 billion over the next five years. Baucus said that’s not enough money to continue coverage for all of the more than 6 million children and 670,000 adults getting federally subsidized care under the program.
    The program is a federal-state partnership that subsidizes health coverage for low-income families. On average, the federal government picks up about 70 percent of the costs. States can also require participants to pay some costs.
    The president and most GOP lawmakers say the spending increase is too large and would expand the program beyond its original intent — helping families with incomes too great to qualify for Medicaid but not enough to afford private insurance.
    Sen. John Cornyn, R-Texas, said a spending increase of 140 percent would come at a time when many of his constituents believe the federal government has lost its way when it comes to spending.
    Sen. Tom Coburn, R-Okla., said the bill would lead to more government control of health care.
    ‘‘If you think health care is expensive now, wait until it’s free,’’ Coburn said.
    Other GOP senators disagreed. Sen. Bob Corker, R-Tenn., said that waivers granted by the administration to several states has already expanded the program to adults and middle-income children.
    ‘‘The fact of the matter is, what will move this country toward socialized medicine is not this SCHIP bill,’’ Corker said.
    The children’s program subsidizes health coverage for children in families who earn too much to qualify for Medicaid but not enough to afford private insurance. Some states also use the program to provide medical care to the parents of those children.
    Bush and several lawmakers who oppose the bill say the legislation could potentially let the state of New York amend its program to cover children up to four times the federal poverty level, or nearly $83,000 for a family of four.
    Several senators disagreed with that assessment. They said the bill doesn’t change eligibility levels for the program. Health and Human Services Secretary Mike Leavitt still will have final word when it comes to eligibility limits in the states, they said.
    ‘‘The authority to approve what states do with the CHIP program rests with him and no one else,’’ said Sen. Charles Grassley, R-Iowa.
    The additional spending would be paid for through a 61-cent increase in the federal excise tax on tobacco. Sen. Gordon Smith, R-Ore., said the tax could end up lowering future health care costs.
    ‘‘Discourage smoking and you connect the habit with all the public health care costs that it imposes,’’ he said.
    But Sen. Jim Bunning, R-Ky., said the tax increase could lead to a drop in revenue to states that also rely on tobacco taxes.
    Opponents also say they worry that expanding the program too much would lead to many families dropping private coverage. The Congressional Budget Office has projected that about 2 million children who otherwise would have private insurance would join SCHIP.
    The program, enacted a decade ago, is due to expire Saturday. Anticipating a veto, Congress will continue it at its current level until mid-November as part of another bill keeping federal agencies in operating funds beyond Sept. 30.
    The bill is entitled the amendment to the Senate amendment to HR 976.

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