WASHINGTON — A bipartisan bill to expand a popular children's health program won a crucial battle in Congress on Tuesday, but supporters may have lost the larger war.
In one of the biggest congressional health care votes since 2003, the House of Representatives voted 265 to 159 to reauthorize and expand the State Children's Health Insurance Program by $35 billion over five years.
But the victory tally fell short of the tally needed to override a promised veto of the measure by President Bush.
Forty-five Republicans joined Democrats in supporting the bill that provides health coverage for 3.8 million uninsured children and has the support of most health industry organizations as well as most of the nation's governors, religious leaders and patient advocacy groups.
But expanding government programs to cover more uninsured Americans has proven ideologically intolerable to President Bush and to many House Republicans, whose opposition left the legislation well short of a veto-proof, two-thirds majority despite an all-out push by hundreds of lobbyists.
A vote on the measure is expected Thursday in the Senate where a two-thirds majority is likely. The bill will then go to President Bush who is expected to veto it. In the interim, Democrats will temporarily fund the program, possibly through mid-November, until a long-term funding agreement can be reached, according to a senior Democratic aide.
In a floor speech, Rep. Pete Sessions, R-Texas, summed up the GOP opposition, saying the bill uses "children as pawns in (Democrats') cynical attempt to make millions of Americans completely reliant on the government for their health care."
The White House reiterated Tuesday President's Bush's plan to veto the measure, which he has said is also too costly and would cause parents to drop their children's coverage for cheaper SCHIP coverage.
Before the vote on Tuesday, House Speaker Nancy Pelosi and other bill supporters seemed to accept the fact that they would miss their goal of a two-thirds majority.
Undaunted, Pelosi said supporters will continue to push for the measure, hoping their political pressure will bring more Republican support and force the President to sign the legislation in the future.
"We're looking to make a difference. We're not looking for a fight, but we're definitely prepared to fight for America's children," Pelosi said, adding that President Bush would regret his decision to veto the bill. "This legislation will haunt him again and again and again. It will not go away because the children will not go away...We're in this for the long haul," she promised.
Senator Baraka Obama said Tuesday that Bush's veto threat was an unacceptable reminder "that we must change the way Washington works and finally put the people's interest ahead of the special interests. In the richest nation on Earth we must no longer stand by while 9 million children live without health care."
The SCHIP program was established in 1997 to help cover children whose families earned up to twice the federal poverty level. In 2007, that's the equivalent of $41,300 for a family of four. Over its first 10 years, the SCHIP program and Medicaid, the state-federal health program for the poor, have cut the number of low-income children without health insurance by about a third. The program currently covers 6.6 million children. But some 9 million youngsters are still without health coverage.
The legislation would add 5.8 million new children to the program by 2012. Of these, 3.8 million would be uninsured and meet eligibility guidelines.
President Bush has criticized the proposal for allowing children from more affluent families to get coverage under SCHIP. But research by the Urban Institute and the Kaiser Commission on Medicaid and the Uninsured shows that roughly half of the 710,000 newly uninsured youngsters in 2006 hailed from working poor families with incomes between twice and four times the federal poverty level.
"The president is dead wrong about SCHIP," Democratic presidential candidate John Edwards said Thursday in an online health care forum sponsored by the Kaiser Family Foundation
The Institute of Medicine estimates that a lack of health insurance accounts for 18,000 unnecessary deaths a year and that taxpayers foot 65 percent of health care costs for the uninsured through subsidies to hospitals and clinics. Uninsured children are also four times more likely than insured youngsters to appear in emergency rooms with avoidable illness, said Rich Umbdenstock, president of the American Hospital Association.
Bush's veto threat has put him at odds with leaders in his own party and could prove to be a potent political weapon for Democrats hoping to increase their majority in Congress.
Republican pollsters Fabrizio McLaughlin & Associates found that by a 2-1 margin, (62 percent to 31 percent) GOP voters favor reauthorizing and strengthening SCHIP. The poll was a national sample of 1,000 Republican voters taken on behalf of First Focus, a bipartisan advocacy group for children and families.
The poll also found that GOP voters, by a 4-to-3 margin, are less likely to re-elect members of Congress who oppose the legislation.
In another First Focus poll of 800 "very likely" voters, GOP pollster Frank Luntz found that by nearly a 4-1 margin (66 percent to 17 percent) respondents were less likely to re-elect senators or congressional representatives who oppose legislation to cut the number of uninsured children.
Previously, the House and the Senate adopted different funding proposals, but the final compromise legislation closely mirrors the original Senate bill. Like the Senate proposal, it boosts SCHIP funding by $35 billion to $60 billion over five years. The money wouldn't come from general tax revenues, but instead from steep tax increases on tobacco products, including a 61-cent increase on a pack of cigarettes.
President Bush wants to expand the program by $1 billion a year, bringing total spending to $30 billion over the five years. That's about 36 percent of what the Congressional Budget Office says is needed to preserve current program levels.
President Bush, who called on Congress last week to pass a temporary funding resolution, must sign it by Sept. 30, or states would lose all federal funding for the program.
If that happens, 13 states would have no federal SCHIP money as of Oct. 1. Those states are Alaska, Georgia, Illinois, Iowa, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Nebraska, New Jersey, Rhode Island, and Wisconsin.
Four other states, California, Missouri, North Carolina and North Dakota, will likely exhaust their federal funding by the end of October. And 36 states are expected to run out at some point in 2008.