By Shailagh Murray and Ceci Connolly
Washington Post Staff Writers
Wednesday, January 14, 2009
The House is poised to give Barack Obama a quick legislative victory by approving a bill to expand a health insurance program for children, making a down payment on the president-elect's promise to provide coverage to every child in the country.
The bill, scheduled for a vote today, would expand the State Children's Health Insurance Program, a popular initiative created during the Clinton administration that helps children living at or near the poverty line who fall outside the Medicaid system.
The House bill carries an estimated cost of $33 billion over 4 1/2 years and would extend coverage to an additional 4.1 million children, on top of the 7 million who are currently enrolled. It would be paid for primarily through a 61-cent-per-pack increase in the federal cigarette tax.
In 2007, President Bush twice vetoed similar legislation, objecting to its broader reach and its reliance on the tobacco tax hike. Bush's unwavering position was cheered by conservatives but caused political problems in 2008 for Republican candidates in more moderate states and districts.
Obama vowed as a candidate that one of his first acts in the White House would be to sign the long-stalled bill. It will not be ready on Inauguration Day, but congressional leaders hope to complete work well before the program's March 31 expiration date.
The one remaining sticking point concerns the fate of recently arrived legal immigrant children and pregnant women. They are currently required to wait five years before applying for coverage. The House bill would give states the option of allowing legal immigrants into the program. The Senate version, released Monday afternoon by Finance Committee Chairman Max Baucus (D-Mont.), would maintain the status quo, although Baucus said he looks forward to an opportunity to support addition of the immigrant provision as the bill moves forward.
Some supporters of the expansion, while urging quick action, said it nevertheless falls short of Obama's campaign pledge to guarantee health care for every American child.
"This is certainly not the promise to cover every child that the president-elect ran on," said Susan Gates, general counsel at the Children's Defense Fund, who said the legislation would still leave as many as 5 million children with no insurance and millions more with intermittent or partial coverage.
Rep. Diana DeGette (D-Colo.), a proponent of the House bill, conceded the gap but said it would shrink significantly. "This is going to get money to states so they can insure the children of the working poor who are losing their jobs," DeGette said. "The great majority of American people believe we should give kids health insurance."
GOP opposition does not appear to have softened. A Jan. 12 letter to Obama and House Speaker Nancy Pelosi (D-Calif.), signed by 122 House Republicans, spelled out four areas of concerns with the House bill: its failure to address serious Medicaid shortcomings; the immigrant provision; the potential threat to private health coverage; and unspecified "budget gimmicks" that would fund the expansion.
Advocates for the bill, while cheering its revival, fear that an early victory could take pressure off Obama and congressional Democrats to go further. "I am concerned there will be a sense we're done with this and move on to the next issue," said Irwin Redlener, a Columbia University professor and president of the Children's Health Fund.
When Bush vetoed similar bills in 2007, he called the legislation a move toward "government-run health care." Like many conservative Republicans, Bush has promoted private-sector-based incentives to expand coverage. John Goodman, president of the conservative National Center for Policy Analysis, said one option would be to give parents a refundable $1,000 tax credit for each child they could prove was insured.
The Senate Finance Committee will debate a similar bill tomorrow, estimated to cost $31.5 billion over 4 1/2 years, that does not include the state option on legal immigrants. It does add a state option for pregnant women. Senate floor action could come next week.
Sen. Olympia Snowe (R-Maine), a longtime supporter and a member of the Finance Committee, said the panel will seek to move the bill quickly, although it also has a primary role in crafting another urgent measure, the economic stimulus package. "Hopefully we can work it through," Snowe said of the lingering disputes.
The expansion comes at a critical time for states, which are seeing a spike in applications for government assistance and a decline in tax revenue as a result of the economic downturn. As of November, at least 43 states were facing budget deficits totaling about $140 billion, according to a report by the liberal advocacy group Families USA.