WASHINGTON - In what could be a major political setback for President Bush, the Senate voted late Thursday to increase funding by $35 billion for a popular health insurance program for low-income children.
The bipartisan measure was passed 68-31, with enough support from Republicans to override a promised veto by Bush.
The Children's Health Insurance Reauthorization Act provides a five-year $35 billion budget increase for the State Children's Health Insurance Program, which covers children whose families earn too much to qualify for Medicaid, but not enough to afford private health insurance.
By a vote of 225-204 on Wednesday, the House of Representatives passed a Democratic bill that would increase program funding by nearly $50 billion over five years.
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Bush has promised to veto the legislation, saying it would be too expensive and would constitute a first step toward government-funded universal health coverage, which many Democrats support. The president and many GOP leaders prefer tax incentives to help more Americans buy their own private coverage.
The president's veto threat appeared solid after the House vote failed to garner a veto-proof majority. But early Thursday evening, Senate bill co-sponsors Max Baucus, D-Mont., and Charles Grassley, R-Iowa, could hardly contain their excitement as support for their bill continued to grow among Republicans, many of whom expressed initial concern about the cost of the measure.
With more than 20 Republican senators up for re-election next year, it appears that the prospect of voting down a popular health care bill for children and facing a month of criticism from Democrats in their districts proved too daunting a challenge. Congress is scheduled to break for August recess today.
Senate and House negotiators will have a tough time merging the Senate bill with the House bill, which contains a number of Democratic-backed changes to the Medicare program, including payment cuts to private HMOs that provide Medicare coverage.
Baucus said he would try to build a broad bipartisan support base and put children before politics during conference negotiations. "It's going to be difficult, but we're talking about kids. That's the dynamic that pulls us together," Baucus said.
If the president does veto the final bill, Congress might be forced to reauthorize the program without enacting comprehensive funding legislation. That's because the program is set to expire Sept. 30.
If it isn't reauthorized by then, states would be left with no federal funds to help cover the program's 6.6 million youngsters. Most observers say there's little chance of that happening, however.
Baucus said he hopes the resounding Senate victory will prompt Bush to reconsider his veto threat.
"For the life of me, I can't understand why the president would want to veto this legislation," Baucus said. "I'm very hopeful that with a very large vote, the president will think, 'Gee maybe it's not wise to veto this legislation.' "
Grassley said the bipartisan bill was successful because it "brought people of extremes to the center. And that's where things get done in the United States Senate."
Grassley said he hopes "to be able to talk to the president and just show how common sense dictates not vetoing this."
Of the estimated 9 million uninsured youngsters in the United States, between 5 million and 6 million are eligible for SCHIP coverage. The Senate proposal would provide coverage to 3.2 million of them. The Congressional Budget Office estimates that 800,000 children will lose SCHIP coverage within five years without additional funding.
Bush wants to increase program funding by $1 billion a year or $5 billion over five years. But Democrats say that's not enough to stem the growing numbers of uninsured kids.
Critics claim that the children's health bills would expand the program's eligibility well beyond the low-income youngsters it was created to help. They say that will cause families that could afford private health insurance to opt instead for government-subsidized coverage.
The SCHIP program was established in 1997 to help cover children whose families earned up to twice the federal poverty level - that's $41,300 for a family of four in 2007. The Senate bill would allow states to expand coverage without penalties to families earning up to three times the federal poverty thresholds - $61,950 for a family of four.
"Many believe this is going too far," said Sen. Kay Bailey Hutchison, R-Texas.
Baucus said the higher income limits are needed because living expenses and insurance costs vary from state to state. He added that 91 percent of the children in the program are from families with incomes below twice the poverty level.
The Senate bill would be financed by several sharp tobacco tax increases, including a 61-cent-per-pack hike on cigarettes.
In debate, Sen. John Kerry, D-Mass., countered Republican claims that an expanded SCHIP program is "government-run, socialized medicine." He said most youngsters in the program get coverage through private insurance companies contracted by states. "Far from 'socialized medicine,' it represents the kind of common sense public-private partnership that ought to be a model for greater health care reform."
Kerry questioned Republican concerns about the bill's cost. He said if the alternative minimum tax is waived, as expected, tax breaks for people earning more than $1 million a year will cost $43 billion in lost revenue next year.
"Think about that. We are saying we can't afford to cover children to the tune of an additional $15 billion over five years, but we can give $43 billion in tax cuts next year? That's obscene."
On Thursday, Sen. Ben Cardin, D-Md., used the death of 12-year-old Deamonte Driver of Maryland to highlight the need for more coverage. Driver was uninsured, and his parents couldn't afford to have his abscessed tooth removed. Social workers were unable to find a dentist who would treat Driver without insurance, and his infection spread to his brain. Driver underwent a $250,000 emergency operation before he died, Cardin said. The dental procedure that would have saved his life cost roughly $100.
The Senate bill would provide $200 million in grants to help states provide better dental coverage.
"We've got to do better," Cardin said. "Dental disease is the most common childhood illness in the United States today. One out five children between the ages of 2 and 4 will have some form of decaying teeth, and by the time they reach 15, three out of five will have tooth decay."