Leading Senate Republican Faults Bush on Kids’ Health Bill

Sen. Chuck Grassley (R-Iowa) on Monday said that President Bush is threatening to veto the State Children's Health Insurance Program compromise bill in order to force revisions to the tax code that would provide deductions to individuals who purchase private insurance, the Washington Post reports.

Grassley said -- and White House aides agreed -- that Bush's opposition to SCHIP does not result from the cost of the bill but rather from larger health policy issues, according to the Post (Weisman/Lee, Washington Post, 9/25). '

The compromise bill, which resembles the Senate version of SCHIP legislation, 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 a 61-cent-per-pack increase in the tobacco tax, as proposed in the Senate version. The compromise legislation does not include revisions to Medicare. The House could vote on the measure as early as Tuesday, with the Senate expected to vote on the measure later this week (California Healthline, 9/24).

Grassley said that Bush's desire to pass the tax revisions is commendable but that the revisions can no longer feasibly be linked to SCHIP. Grassley, speaking of a conversation with Bush on Thursday, said that Bush "has a goal that I share, that we need to take care of the uninsured through private health insurance," but "you can't put that on this bill." Grassley said he was surprised to hear Bush discuss larger health care issues during the conversation because Grassley had discussed linking an SCHIP extension with larger health care reform in the spring with HHS Secretary Mike Leavitt, White House National Economic Council Director Al Hubbard and Hubbard's deputy, Keith Hennessey.

Grassley endorsed the approach and encouraged the administration to garner Democratic support. However, when the White House made no effort to do so, Grassley in April decided that the SCHIP reauthorization would proceed without larger reforms (Washington Post, 9/25).

Grassley on Monday said he has not considered negotiating with Bush. Grassley said, "I'm concentrating on getting this passed, and hopefully the president wakes up and realizes it does everything he said he wanted to do" (Johnson/Bourge, CongressDaily, 9/25). Grassley said that if he were a Democrat, he would send a reauthorization bill to the president every three months, along with campaign advertisements to Republicans that accuse them of abandoning children.

Under this plan, pressure would grow for Bush to either sign the bill or for Republicans to override his veto (Washington Post, 9/25). Democratic Caucus Chair Rahm Emanuel (D-Ill.) in a statement said, "For this president who helped rack up $3 trillion in new debt, it is not about the spending, it is about priorities, and the president has made his clear" (Russell Chaddock, Christian Science Monitor, 9/25).

Administration officials said they were "concerned that the White House was being hurt by televised news reports that portrayed the fight as a struggle between ... Bush and poor children, rather than a philosophical debate over the role of government in health care," the New York Times reports (Pear/Hulse, New York Times, 9/25). White House spokesperson Tony Fratto said that the SCHIP bill is "bad policy," adding, "Why should we go along with bad policy if we've got something better?" Fratto continued, "It is a bigger issue. There's no question it is," adding, "It's not a question of fiscal prudence. It's a question of appropriate policy" (Washington Post, 9/25).

Meanwhile, both Democrats and Republicans "appear to be having problems corralling votes to support their position," according to CongressDaily.

A senior Democratic aide said, "It's kind of heavy lifting going into this right now," adding, "There is a bit of unrest." Democrats have encountered resistance to the compromise bill from some centrist Blue Dogs, a group of Democrats that supports fiscal responsibility, and the Congressional Black Caucus -- "many in rural tobacco-growing districts" -- who are upset about the tax increase, CongressDaily reports.

CBC members have complained that the bill does not provide coverage to enough needy children. Meanwhile, the Congressional Hispanic Caucus members are unhappy that the bill does not extend coverage to documented immigrants. According to CongressDaily, "Democratic defections are expected, but enough Caucus members are expected to capitulate to ensure approval."

Republicans hope to unify opposition to the bill by "pointing to what they say is flawed logic in using a tobacco tax increase to fund SCHIP," CongressDaily reports (CongressDaily, 9/25).

Reps. Joe Barton (R-Texas) and Nathan Deal (R-Ga.) in a letter to colleagues said that under the bill, "the poorest Americans will be burdened with even higher federal taxes so that wealthier families and businesses can shift the cost of their health care coverage to the American taxpayers." Republicans also say that the legislation improperly appropriates funds, assuming a lower spending level for the program after 2012, which means that Congress will need to allot additional revenue to fund the program after that date or cut enrollment, according to the AP/San Jose Mercury News.

In addition, Republican leaders have assured House Republicans concerned about voting against a children's health bill that they will get another opportunity to vote for SCHIP legislation. "Everybody gets another chance. At the end of the day, you're going to get to vote for SCHIP," a Republican aide said (CongressDaily, 9/25).

Republican officials said the White House has suggested that Bush "will eventually agree to increase the program by more than $5 billion" over five years, the funding level Bush supports, "in hopes of softening the blow to lawmakers who support his veto," the AP/Arizona Daily Star reports.

House Minority Leader John Boehner (R-Ohio) in a statement on Monday said that Republicans support a modest SCHIP expansion, "but they have warned a huge expansion of massive government-run health care would lead to a system of 'Hillarycare' that puts government rather than doctors and patients first" (AP/Arizona Daily Star, 9/25).

In related news, Reps. Ray LaHood (R-Ill.) and Heather Wilson (R-N.M.) on Monday sent a letter to House Republicans asking them to support the compromise bill.

According to the letter, "A bipartisan group of Senate and House members have crafted this agreement. While not perfect, this agreement retains the core principles of SCHIP when it was enacted and provides states with new tools to enroll more eligible low-income children" (CongressDaily, 9/25). The letter continues, "Federal assistance is reduced if states expand coverage to middle-income children" (AP/Arizona Daily Star, 9/25).

LaHood also has worked with Emanuel to enlist moderate Republicans to support the compromise bill and is hoping to gain 30 Republican votes to approve it. However, many Republicans "are unlikely to show their cards until the end of the vote," according to CongressDaily (CongressDaily, 9/25).

NPR's "All Things Considered" on Monday included a commentary by NPR senior news analyst Daniel Schorr about the debate over SCHIP (Schorr, "All Things Considered," NPR, 9/24). Audio of the segment is available online. NPR's "Morning Edition" on Tuesday also reported on SCHIP. The segment includes comments from Bush; Mary Grealy, president of the Healthcare Leadership Council; Sister Carol Keehan, president of the Catholic Health Association of America; and Grassley (Rovner, "Morning Edition," NPR, 9/25). Audio and a partial transcript of the segment are available online.