Vote Nearing in Battle Over Kids' Health Care

Hall doles out another $500 a month for Kevin's medicine and pays $95 every two weeks for him to visit an infusion clinic, costs that SCHIP used to cover. Altogether she figures she pays more than $12,000 a year in insurance and medical bills, more than a quarter of her annual gross income of about $44,000.

"That's our marching band money; that's our drill team money; that's our we-can't-take-a-vacation this year money," said Hall, who also pays a mortgage on a three-bedroom home. "I'd like to see anybody else do a balancing act with that type of an income. . . . I just don't feel I should be penalized. I'm working every day; I'm doing what I'm supposed to do."

According to the Urban Institute, a Washington think tank, about 70 percent of the children who would gain or retain coverage under Congress's bill are from families whose incomes are at, or below, twice the poverty level. The program already grants states considerable leeway to cover kids above that level, and those that do generally require higher-income families to pay modest premiums. The legislation preserves that flexibility and would allow states to cover children from households making as much as three times the poverty level fairly easily. That means limits of $51,510 for a family of three or $61,950 for a family of four -- above the amounts Bush favors.

Advocates say many such families need help. Of the nation's 9.4 million uninsured children younger than 19, 1.4 million are in households with incomes between twice and three times the poverty level, according to an analysis of census data by researcher Genevieve Kenney of the Urban Institute.

The bill's backers point out that, according to the Congressional Budget Office, Bush's proposed funding is too little even to maintain coverage for children already in the program. They accuse the president of withholding needed money for uninsured children at home even as his administration is spending hundreds of billions on the war in Iraq.

"It just kind of amazes me how we can always reach out to help other countries and help other people," Hall said. "But what about us here, you know, people who need a helping hand just to be able to maintain the levels that we're living at right now?"

In Salisbury, Md., Nikki Nelson has watched her son, Alexander, who will turn 2 in December, suffer a string of illnesses, including salmonella poisoning that required hospitalization, croup, serious ear and eye infections and a tear-duct problem that could only be conquered with surgery.

"He's had so much happening," said Nelson, a customer service representative for a global positioning system tracking company.

As she and her husband, Seth, both 26, struggled to keep Alexander healthy, the family's annual income peaked at about $41,000 and at times dipped to $35,000. After paying $570 a month for their mortgage, $400 a month for child care, plus the cost of food, car insurance and other bills, there wasn't much money left for health insurance, Nikki Nelson said.

She pays $32 a month for health coverage for herself through her job. Putting Alex on the policy would increase the monthly premium to $250. That's far more than the $57 a month the family pays for Alex to be in the state program, which covered all of his medical bills, including the surgery.

"If we didn't have this program, honestly, my husband and I would probably be working two jobs apiece to pay for the health care," Nelson said. "We haven't been on a vacation in, like, four years. We can't afford to do the extras. We don't eat in restaurants; we don't do McDonald's; we don't do any of that stuff. . . . We're really going to be in a jam if we lose coverage for my son."

In their current situation, that's not likely. The Nelsons, like many families on the edge, are often at the mercy of the economy. Last month, Seth Nelson lost his job as a salesman at a company that sells building supplies, a victim of the slumping real estate market. The family's annual income plunged to $19,500, barely above the poverty level of $17,170 and well within Maryland's eligibility limits.

For now, the only one going without health insurance is Seth Nelson.