House To Vote On Revised SCHIP Bill; HHS Secretary Leavitt Says Bush Administration Would Accept Measure That Increases SCHIP Funding By $20B

Main Category: Medicare / Medicaid / SCHIP
Article Date: 26 Oct 2007 - 5:00 PDT

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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 vetoed by President Bush earlier this month -- still would expand SCHIP to cover 10 million children and increase spending on the program to $35 billion over five years, funded with a 61-cent-per-pack increase in the federal cigarette tax (Pear, New York Times, 10/25).

The bill would limit coverage to children in families with annual incomes below 300% of the federal poverty level, and performance bonuses would be offered to states that enroll greater numbers of children in Medicaid. The bill also would offer performance bonuses to states that provide subsidies to employed parents to offset the cost of enrolling their children in a private health insurance plan, a provision that is intended to "answer criticism" that the vetoed bill would have encouraged families to switch from private coverage to SCHIP, according to the Washington Post (Weisman, Washington Post, 10/25). In addition, the bill would phase out SCHIP coverage of childless adults within one year and require states to apply more rigorous documentation standards to prevent undocumented immigrants from enrolling in the program (Babington, AP/Houston Chronicle, 10/25).

House Speaker Nancy Pelosi (D-Calif.) said, "The bill addresses all of the concerns 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 of 38 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 until next week, saying that a quick vote is necessary to ensure that sufficient time is available to pass a continuing resolution if Bush vetoes the modified bill (Johnson/Bourge, CongressDaily, 10/25). Democratic leaders believe that "enough Republicans are ready for 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 bill they had not seen until the eve of the vote, and they dismissed the changes as cosmetic," CongressDaily reports (CongressDaily, 10/25). Republican leaders urged House members not to support the measure, saying that "the changes are too minor to justify abandoning Bush 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 HHS Secretary Mike Leavitt agreed to support Bush, but "others quietly voiced concerns that the SCHIP showdown is taking a toll on their political prospects," according to the Post (Washington Post, 10/25).

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

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

White House Compromises
In an effort to find a "compromise on an issue causing heartburn for many Republicans," Leavitt said Bush is willing to allow states to enroll children in families with annual incomes up to 300% of the poverty level, up from the administration's previous support for a limit of 200%, the Wall Street Journal reports (Lueck, Wall Street Journal, 10/25). In order to achieve this level, according to Leavitt, Bush supports adding an additional $20 billion in spending over five years -- halfway between his initial request of $5 billion and the Congress-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 annual incomes below 200% of the poverty level. The administration has said states need to enroll 95% of children in families at this income level (Wall Street Journal, 10/25).

Leavitt also said that Bush still opposes funding the expansion with an increase in the cigarette tax, noting that Bush has proposed changes to Medicaid 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 to pay for the expansion that is palatable to both their caucus and Senate Republicans, whose support is crucial," according to CQ Today (CQ Today, 10/25).

Funding Dispute
Despite the moves toward a compromise on enrollment levels, a "gulf remains" between the administration and the bill's supporters over cost, according to the Post (Washington Post, 10/25). Leavitt said, "We're not going to put $15 billion that's unneeded into the program so that they can expand to higher and higher income levels later" (CongressDaily, 10/25). Funding the program at $35 billion would prompt more affluent families to drop their 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 find common ground on policy, we have to see changes as well in the budget number" (Washington Post, 10/25).

Leavitt said that Democrats have yet to engage the administration in the debate over SCHIP. He added that if they vote on the bill without doing so, it would be "clear that they are not interested in compromise, that they're not interested in a negotiation, that they're simply interested in being able to expand (government) health insurance to higher and higher incomes, that they're interested in moving people off of private insurance to government insurance, that they're interested in seeing adults on SCHIP, and so forth" (The Hill, 10/25).

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

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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