California Healthline Daily Edition

Summaries of health policy coverage from major news organizations

House Democrats Allow Concessions on Kids’ Health Insurance Bill

Some House Democrats are "unhappy with concessions their leaders are proposing to make" on compromise State Children's Health Insurance Program legislation, including on spending and Medicare revisions, but they likely will not oppose the final bill, CQ Today reports (Wayne, CQ Today, 9/17).

The draft compromise bill, announced on Sunday, closely resembles the Senate version of SCHIP legislation, which would provide an additional $35 billion in funding over the next five years and bring total spending on the program to $60 billion. The additional funding would be paid for by an increase in the tobacco tax, which would be similar 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, announced by the Bush administration last month, would require states to enroll at least 95% of children with family incomes below 200% of the federal poverty level who are eligible for Medicaid or SCHIP before expanding SCHIP eligibility above 250% of the poverty line. In addition, the bill would affirm states' right to decide who qualifies for enrollment in the program.

The bill does not include revisions to Medicare that were included in the House version of the bill. Senior Democrats in the House and Senate said that Medicare revisions will be addressed in separate legislation later this year (California Healthline, 9/17).

Many details of the compromise bill still need to be addressed, including whether to limit SCHIP eligibility and whether to provide coverage for documented immigrants, according to House Ways and Means Committee Chair Charles Rangel (D-N.Y.).

Rangel said that although he is "very unhappy" with the compromise bill -- largely negotiated by House Speaker Nancy Pelosi (D-Calif.) -- it "would be very difficult rejecting 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 that closely resembles the Senate version, according to a House aide. If the compromise SCHIP bill includes deviations from the Senate bill, the Senate also will need to approve new SCHIP legislation before sending it to President Bush (Bourge/Johnson, CongressDaily, 9/17).

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, CongressDaily reports.

Nussle said, "The president has made it very clear .... he sets the top-line number, and he's going to hold to it," adding, "I don'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 for SCHIP, which would raise the program's total five-year funding to $30 billion. Bush has said he would veto the House and Senate bills (California Healthline, 9/6).

Nussle said that Democrats are "choosing political strategy over kids ... they can't get their work done, so they're going to send up something that they know is veto bait," adding, "Everyone knows that; it's been as telegraphed as just about anything around here" (CongressDaily, 9/18).

White House spokesperson Tony Fratto said that SCHIP "should be focused on children in poor households," adding, "We should not be creating policy that substitutes a government-run program for private health 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 a letter to HHS Secretary Mike Leavitt asking the administration to reverse the recent rules that are designed to limit SCHIP enrollment, the AP/Miami Herald reports.

Spitzer and Schwarzenegger wrote, "The requirements amount to a unilateral restriction on state authority to provide health insurance coverage for children and undermine the foundation of the state-federal partnership upon which SCHIP was built" (AP/Miami Herald, 9/18). The letter was signed by five Republican governors.

The SCHIP enrollment rules "have created widespread anxiety at the state level, where officials are uncertain about not only their expansion plans 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).

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