Senate debates child health legislation

WASHINGTON_Democratic lawmakers inched closer Thursday to giving President Barack Obama an early health care victory as they considered extending government-sponsored health insurance coverage to about 4 million uninsured children.

The Senate was expected to pass the legislation late Thursday after Democrats spent much of the day fending off Republican amendments. The House plans to take up the same measure next week.

The bill calls for an additional $32 billion over the next 4 1/2 years for the State Children's Health Insurance Program. Even with the added spending, an estimated 5 million children still will be without health insurance. During his election campaign, Obama called for requiring all children to have health coverage.

The bill pays for expanding SCHIP by increasing the federal excise tax on cigarettes from 39 cents to $1 a pack. Opponents argued that the tax would hit the poor the hardest.

Republicans opposed letting states use federal dollars to cover children of newly arrived legal immigrants, saying that the immigrants' sponsors had pledged that those coming to the United States would not be dependent on government assistance. Republican opponents also sought stricter income limits for participating families so that some states would focus more on covering children of the working poor.

Current law requires a five-year waiting period before legal immigrants become eligible for coverage under Medicaid and SCHIP. Democrats said that removing the ban would help children before small health problems became big ones.

"It is likely many of these children are already U.S. citizens and many will become U.S citizens, and their being unhealthy doesn't make sense for that family, and it certainly does not make sense for our nation." said Sen. Richard Durbin, D-Ill.

Support for expanding SCHIP has had strong, bipartisan support. In 2007, former President George W. Bush twice vetoed bills to expand the program. The Senate voted to override Bush, but the House fell about 15 votes short of an override.

Scores of interest groups have lined up in support of more money for SCHIP, including trade groups representing insurers, hospitals, doctors, unions and the pharmaceutical industry.

Some Republican senators complained that Democrats had worked closely with many of them on SCHIP in the past but had ignored them this year when crafting the bill.

"I think we could have had 95 votes," said Sen. Orrin Hatch, R-Utah. "That would have sent a tremendous, tremendous message that hasn't been sent around here for a long time.

More than 7 million children were enrolled in SCHIP at some point in 2008. The program was created more than a decade ago as a way to provide health care to children in families with incomes too high to quality for Medicaid but too low to afford private coverage.

The House already has approved a bill to expand SCHIP. It's comparable to the Senate bill, except it included a provision opposed by physicians and supported by the influential American Hospital Association. That provision would have prevented new physician-owned hospitals from opening, but it's not part of the Senate bill.

Republicans said they are fearful that Democrats are using SCHIP to increase the government's role in providing health care. They said about 2.4 million children who otherwise would have access to private insurance will also join SCHIP in coming years.

Democrats responded to those concerns by requiring any state covering families earning more than three times the federal poverty level, or $63,600 for a family of four, to be reimbursed at Medicaid levels rather than the higher SCHIP level.

But the bill allowed an exception for New Jersey and New York. Lawmakers said a family of four in New York could potentially qualify for SCHIP even if the family's income came to about $85,000.

"These are certainly not low-income families," said Sen. Jim Bunning, R-Ky., who unsuccessfully tried to remove the exemption for the two states.