House Democrats Likely Will Support SCHIP Compromise Bill

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State Children's Health Insurance Program

Some House Democrats are "unhappy with concessions their leaders areproposing to make" on compromise SCHIP legislation, including onspending and Medicare revisions, but they likely will not oppose thefinal bill, CQ Today reports (Wayne, CQ Today,9/17). The draft compromise bill, announced on Sunday, closelyresembles the Senate version of SCHIP legislation, which would providean additional $35 billion in funding over the next five years and bringtotal spending on the program to $60 billion. The additional fundingwould be paid for by an increase in the tobacco tax, which would besimilar to the 61-cent-per-pack tax proposed in the Senate version.

The compromise legislation likely would waive some of the new enrollment rules,but it probably would not eliminate all of them. The rules, announcedby the Bush administration last month, would require states to enrollat least 95% of children with family incomes below 200% of the federalpoverty level who are eligible for Medicaid or SCHIP before expandingSCHIP eligibility above 250% of the poverty line. In addition, the billwould affirm states' right to decide who qualifies for enrollment inthe program.

The bill does not include revisions to Medicarethat were included in the House version of the bill. Senior Democratsin the House and Senate said that Medicare revisions will be addressedin separate legislation later this year (Kaiser Daily Health Policy Report, 9/17).

Manydetails of the compromise bill still need to be addressed, includingwhether to limit SCHIP eligibility and whether to provide coverage fordocumented immigrants, according to House Ways and Means CommitteeChair Charles Rangel (D-N.Y.). Rangel said that although he is "veryunhappy" with the compromise bill -- largely negotiated by HouseSpeaker Nancy Pelosi (D-Calif.) -- it "would be very difficultrejecting a bill, even though it's not everything I want to see."

House Democratic leaders "expect most of their caucus will feel similarly," according to CQ Today (CQ Today, 9/17). Lawmakers are not likely to convene a formal conference committee, according to CongressDaily.Instead, the House will need to pass different SCHIP legislation thatclosely resembles the Senate version, according to a House aide. If thecompromise SCHIP bill includes deviations from the Senate bill, theSenate also will need to approve new SCHIP legislation before sendingit to President Bush (Bourge/Johnson, CongressDaily, 9/17).

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Administration Response

Office of Management and Budget Director Jim Nussle on Monday in an interview said he will not compromise on Bush's SCHIP spending limit, CongressDailyreports. Nussle said, "The president has made it very clear .... hesets the top-line number, and he's going to hold to it," adding, "Idon't feel as if I need to reinterpret what the president said" (Cohn, CongressDaily,9/18). Bush has proposed a $5 billion increase over five years forSCHIP, which would raise the program's total five-year funding to $30billion. Bush has said he would veto the House and Senate bills (Kaiser Daily Health Policy Report, 9/6).

Nusslesaid that Democrats are "choosing political strategy over kids ... theycan't get their work done, so they're going to send up something thatthey know is veto bait," adding, "Everyone knows that; it's been astelegraphed as just about anything around here" (CongressDaily,9/18). White House spokesperson Tony Fratto said that SCHIP "should befocused on children in poor households," adding, "We should not becreating policy that substitutes a government-run program for privatehealth insurance" (Lee, Washington Post, 9/18).

State Efforts

In related news, New York Gov. Eliot Spitzer (D), California Gov.Arnold Schwarzenegger (R) and 28 other governors on Monday sent aletter to HHS Secretary Mike Leavitt asking the administration to reverse the recent rules that are designed to limit SCHIP enrollment, the AP/Miami Heraldreports. Spitzer and Schwarzenegger wrote, "The requirements amount toa unilateral restriction on state authority to provide health insurancecoverage for children and undermine the foundation of the state-federalpartnership upon which SCHIP was built" (AP/Miami Herald, 9/18). The letter was signed by five Republican governors.

TheSCHIP enrollment rules "have created widespread anxiety at the statelevel, where officials are uncertain about not only their expansionplans but also the future of their existing initiatives," according to The Hill. Lesley Cummings -- the director of Healthy Families, California's SCHIP -- said, "They're basically backtracking with us and with others" (Young, The Hill, 9/18).

Related Coverage

  • Healthcare lobbying: The health care industry spent more than $227 million inthe first half of 2007 for lobbying efforts, a 17% increase over 2006spending levels and the first time the industry has spent more than$200 million, according to a review of semi-annual reports filed withthe Senate Office of Public Records, CQ HealthBeatreports. Of the 10 highest spending interest groups on lobbying in thefirst half of this year, health care organizations -- including the Pharmaceutical Research & Manufacturers of America, American Medical Association, Amgen, American Hospital Association and Pfizer-- accounted for five of these spots, according to the review. Thegroups focused their efforts on legislation to reauthorize and expandSCHIP. In addition, significant funds were spent on raising awarenessof the success of the Medicare prescription drug benefit, according toPhRMA Senior Vice President Ken Johnson (Cadei, CQ HealthBeat, 9/17).
  • Medicare Advantage: The Post on Tuesday profiled Karen Ignagni, president of America's Health Insurance Plans, who "has been fighting a rear-guard action in Congress this year to defeat a cutback" in MA plans. According to the Post,Ignagni "supplemented [a] deluge" of phone calls from seniors tolawmakers with a national advertising campaign, including newspapersads to "praise the overall" SCHIP legislation, while "pointedly"recommending the Senate version of the bill that did not include cutsto MA plans (Birnbaum, Washington Post, 9/18).

Reprinted with permission from kaisernetwork.org. Youcan view the entire Kaiser DailyHealth Policy Report, search the archives, and sign up for email deliveryat kaisernetwork.org/email. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, afree service of The Henry J. Kaiser Family Foundation.

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