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Long Stalled by GOP, Expansion of Children's Health Insurance Program Is Approved in House

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By Shailagh Murray and Ceci Connolly
Washington Post Staff Writers
Thursday, January 15, 2009

The House easily approved an expansion of government health coverage for low-income children yesterday, a top priority for President-elect Barack Obama and the first in a series of stalled measures expected to move quickly through the Democratic Congress as President Bush leaves office.

Obama hailed the 289 to 139 vote and nudged the Senate to act with the "same sense of urgency so that it can be one of the first measures I sign into law when I am president."

The president-elect vowed as a candidate to provide health coverage to every child, and the expansion of the State Children's Health Insurance Program, known as SCHIP, is a major step toward that goal. "In this moment of crisis, ensuring that every child in America has access to affordable health care is not just good economic policy, but a moral obligation we hold as parents and citizens," Obama said.

The House legislation would cost nearly $33 billion over 4 1/2 years and would be funded in part by a cigarette tax increase of 61 cents to $1 per pack. Bush vetoed two similar bills in 2007, objecting to the tax increase and the expansion of government health care. The Senate Finance Committee will take up a similar measure today, with floor action expected to begin next week.

On Friday, the House passed two bills aimed at closing the pay gap between men and women. Both measures are opposed by Bush and supported by Obama, and both have been long stuck in the Senate because of formidable Republican opposition. With their new, much larger margin of at least 58 votes, Senate Democratic leaders hope to approve the measures in the coming weeks.

Other GOP-blocked initiatives that could move quickly would lift restrictions on federal stem cell research, a step Obama could take administratively after his inauguration, and would grant full congressional voting rights to the District of Columbia's delegate.

The House bill would provide health insurance to an additional 4.1 million children and parents, including legal immigrant children and pregnant women, who currently must wait five years before becoming eligible for the program. A total of 11 million individuals could now receive coverage.

House Speaker Nancy Pelosi (D-Calif.), a champion of the equal-pay and children's health measures, called the bills a signal of the House's commitment to taking care of "women and children first," saying Democratic leaders are especially eager to rush the health bill into law.

"At a time of economic crisis, nothing could be more essential than ensuring that children of hard-working families receive the quality health care that they deserve," Pelosi said.

In a policy statement, House Republicans outlined their objections, chiefly that the measure would place a new burden on states already struggling to meet soaring Medicaid costs and would permit states to enroll children from households with incomes of up to $80,000.

"Increasing the amount of federal tax dollars flowing to states that consciously choose to provide benefits to children of these higher-income families before enrolling already eligible poor and low income children is the wrong policy and sends the wrong signal," the statement said.

Republicans also object to the tobacco tax as an unstable revenue source. Opponents of the bill asserted that the steady decline of smokers in recent years would have to be reversed in order to meet funding estimates for the children's health program over the coming decade. But the American Cancer Society estimates that the proposed tax increase would prevent more than 900,000 smoking-related deaths and discourage nearly 1.9 million children from taking up smoking.

GOP critics also believe that Democrats are underestimating participation in the program, and thus its price tag, especially as more people lose private health insurance because of the economic downturn and become eligible for government support. "Couple that with a drop in revenue from decreased smoking and the gap between program spending and revenue becomes staggering," the policy statement said.

A major Republican flashpoint is the House's move to include immigrant children and pregnant women in the program. Sen. Charles E. Grassley (Iowa), the ranking Republican on the Finance Committee, said their addition would violate a 100-year-old law that requires the sponsors of new immigrants to pledge that the individuals will not become a financial burden to taxpayers.

"I feel very strongly that if you sign a contract with the government that brings people over here and you promise that they're not going to cost the taxpayers anything, you ought to keep your word to the taxpayers," Grassley said.

The Senate version of the bill does not give states the option of covering immigrants, but Finance Committee Chairman Max Baucus (D-Mont.) has said he supports adding the provision, and many Senate Democrats concur.


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