House To Vote On Revised SCHIP Insurance Bill

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State Children's Health Insurance Program

The House on Thursday will vote on a modified bill to reauthorize and expand SCHIP, the New York Times reports. The revised legislation -- which is similar to the bill vetoedby President Bush earlier this month -- still would expand SCHIP tocover 10 million children and increase spending on the program to $35billion over five years, funded with a 61-cent-per-pack increase in thefederal cigarette tax (Pear, New York Times, 10/25).

Thebill would limit coverage to children in families with annual incomesbelow 300% of the federal poverty level, and performance bonuses wouldbe offered to states that enroll greater numbers of children inMedicaid. The bill also would offer performance bonuses to states thatprovide subsidies to employed parents to offset the cost of enrollingtheir children in a private health insurance plan, a provision that isintended to "answer criticism" that the vetoed bill would haveencouraged families to switch from private coverage to SCHIP, accordingto the Washington Post (Weisman, Washington Post,10/25). In addition, the bill would phase out SCHIP coverage ofchildless adults within one year and require states to apply morerigorous documentation standards to prevent undocumented immigrantsfrom enrolling in the program (Babington, AP/Houston Chronicle, 10/25).

HouseSpeaker Nancy Pelosi (D-Calif.) said, "The bill addresses all of theconcerns that were expressed by our colleagues and by the president,"adding, "We hope the Republicans will take yes for an answer" (New York Times,10/25). Pelosi credited Sens. Orrin Hatch (R-Utah) and Chuck Grassley(R-Iowa) for the modified bill. The two senators met with the staffs of38 Republican members to discuss their concerns (Pugh, McClatchy/St. Paul Pioneer Press, 10/24). Rep. Fred Upton (R-Mich.) said that the changes improve the bill and would allow some Republicans to vote in favor (New York Times, 10/25).

Quick Vote Scheduled

House leaders rejected Republicans' request to postpone the vote untilnext week, saying that a quick vote is necessary to ensure thatsufficient time is available to pass a continuing resolution if Bushvetoes the modified bill (Johnson/Bourge, CongressDaily,10/25). Democratic leaders believe that "enough Republicans are readyfor the issue to go away that they will vote for the new proposal,"according to the Post (Washington Post, 10/25).

However,some Republicans "indicated they have no intention of voting for a billthey had not seen until the eve of the vote, and they dismissed thechanges as cosmetic," CongressDaily reports (CongressDaily,10/25). Republican leaders urged House members not to support themeasure, saying that "the changes are too minor to justify abandoningBush on a high-profile issue," according to the AP/Houston Chronicle (AP/Houston Chronicle, 10/25). A number of "wavering" Republicans at a meeting on Tuesday night with HHSSecretary Mike Leavitt agreed to support Bush, but "others quietlyvoiced concerns that the SCHIP showdown is taking a toll on theirpolitical prospects," according to the Post (Washington Post, 10/25).

Future Veto

Democrats said that Thursday's vote is important but is "not thecrucial test, because both parties agree the bill will easily receive asimple majority," the AP/Chronicle reports. The challengewill be winning enough votes to override a potential presidential veto.The Senate is expected to pass the modified bill with a veto-proofmajority (AP/Houston Chronicle, 10/25).

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HouseRepublican Chief Deputy Whip Eric Cantor (R-Va.) said Republicanleaders are confident that enough members would vote to sustain Bush'sveto, adding, "What is going to be presented is a meager attempt" at acompromise (Young, et al., The Hill,10/25). If the modified bill fails, Democrats will pass a continuingresolution that will "probably" last until fall 2008, allowingDemocrats to revisit the issue just before the election, according toRep. Diana DeGette (D-Colo.) (Wayne, CQ Today, 10/25).

White House Compromises

In an effort to find a "compromise on an issue causing heartburn formany Republicans," Leavitt said Bush is willing to allow states toenroll children in families with annual incomes up to 300% of thepoverty level, up from the administration's previous support for alimit of 200%, the Wall Street Journal reports (Lueck, Wall Street Journal,10/25). In order to achieve this level, according to Leavitt, Bushsupports adding an additional $20 billion in spending over five years-- halfway between his initial request of $5 billion and theCongress-passed level of $35 billion (New York Times, 10/25).

However, Leavitt's "olive branch" also included several conditions, according to the Journal.Leavitt said any SCHIP bill would need to ensure that states meet a"rigorous" standard of first covering children in families with annualincomes below 200% of the poverty level. The administration has saidstates need to enroll 95% of children in families at this income level (Wall Street Journal, 10/25).

Leavittalso said that Bush still opposes funding the expansion with anincrease in the cigarette tax, noting that Bush has proposed changes toMedicaid and Medicare that would save $92 billion over five years,which could be used in part to increase SCHIP funding (New York Times,10/25). However, Democrats "have been unable to find any other way topay for the expansion that is palatable to both their caucus and SenateRepublicans, whose support is crucial," according to CQ Today (CQ Today, 10/25).

Funding Dispute

Despite the moves toward a compromise on enrollment levels, a "gulfremains" between the administration and the bill's supporters overcost, according to the Post (Washington Post,10/25). Leavitt said, "We're not going to put $15 billion that'sunneeded into the program so that they can expand to higher and higherincome levels later" (CongressDaily, 10/25). Funding theprogram at $35 billion would prompt more affluent families to droptheir private coverage to enroll in SCHIP, according to Leavitt (McClatchy/St. Paul Pioneer Press,10/24). Leavitt said, "We're prepared to meet on policy. But if we findcommon ground on policy, we have to see changes as well in the budgetnumber" (Washington Post, 10/25).

Leavitt saidthat Democrats have yet to engage the administration in the debate overSCHIP. He added that if they vote on the bill without doing so, itwould be "clear that they are not interested in compromise, thatthey're not interested in a negotiation, that they're simply interestedin being able to expand (government) health insurance to higher andhigher incomes, that they're interested in moving people off of privateinsurance to government insurance, that they're interested in seeingadults on SCHIP, and so forth" (The Hill, 10/25).

Editorial

Bush "waited until he had vetoed [the] relatively inexpensive" SCHIPbill "before asking for tens of billions of dollars more for hismisadventure in Iraq," according to a New York Timeseditorial. The editorial continues, "The cynicism of that maneuver isonly slightly less shameful than the president's distorted priorities,"adding, "Despite a pretense of fiscal prudence, Mr. Bush keeps throwingmoney at his war, regardless of the cost in blood, treasure orchildren's health care" (New York Times, 10/25).

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 HealthPolicy Report is published for kaisernetwork.org, a free service of The HenryJ. Kaiser Family Foundation.

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