Senate, House Reach Deal on Compromise Kids’ Health Legislation
Senate and House negotiators on Friday announced that they have reached an agreement on compromise legislation that would reauthorize the State Children's Health Insurance Program and expand enrollment from 6.6 million children to about 10 million children, CQ Today reports.
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 (Wayne , CQ Today, 9/21). The compromise legislation does not include revisions to Medicare (Lengell, Washington Times, 9/22).
In addition, the bill would:
- Change the name of the program from SCHIP to the Children's Health Insurance Program;
- Require dental benefits for all children enrolled in the program, as well as "mental health services on par with medical and surgical benefits" covered under SCHIP, according to a summary released by the Senate Finance Committee;
- Reinforce coverage of early periodic screening diagnosis and treatment benefits;
- Allow states to enroll pregnant women in SCHIP or cover them through other approaches;
- Phase out coverage of childless adults after one year. The government would provide temporary Medicaid funding to cover those adults enrolled in SCHIP, and states would be able to ask the government for a waiver to cover the adults through Medicaid;
- Revise CMS enrollment restrictions announced in August, including the provision that mandates states cover the lowest-income children prior to enrolling children in families with annual incomes above 250% of the federal poverty level. The SCHIP bill "gives states time and assistance in developing and implementing best practices" to prevent substitution of private coverage for public assistance, according to the Senate Finance Committee summary;
- Provide enrollment incentives to states that include "additional up-front funding for states planning improvements to their" SCHIP programs; adjustment payments to states that "face a funding shortfall and meet enrollment goals" to ensure that "no child who is eligible for Medicaid or [S]CHIP is denied coverage or placed on a waiting list;" and provide $100 million in grants to states, local governments, schools, community organizations and others to enroll eligible children in the program, according to the summary;
- Expand premium assistance programs; and
- Set overall spending caps on the federal funding to ensure that program costs do not exceed the amounts authorized (Reichard, CQ HealthBeat, 9/21).
Final language is expected on Monday (Stout, New York Times, 9/21).
Sen. Jay Rockefeller (D-W.Va.) on Friday said that the delay in the final language is due to concerns about the wording of the provision that revises the CMS rule. Rockefeller said that the rule could not be rescinded completely because supporters of the bill did not want to "hand [President Bush] a reason to veto" the compromise bill.
While some House Democrats expressed concern over the size of the cigarette tax increase, House leadership said that they expect the bill to be approved (Johnson/Bourge, CongressDaily, 9/21). The House is scheduled to vote on the measure on Tuesday (Chicago Tribune, 9/22). The Senate is expected to vote on the bill by Thursday (Lee, Washington Post, 9/22).
Senate Finance Committee ranking member Chuck Grassley (R-Iowa) said, "This legislation will get [SCHIP] back on track and reclaim precious resources for low-income kids," adding, "It breaks the legislative impasse and should have strong support from both Democrats and Republicans" (Swanson, The Hill, 9/22).
Sen. Orrin Hatch (R-Utah) said on Friday that the negotiated bill is "an honest compromise that improves a program that works for America's low-income children" (New York Times, 9/21).
House Speaker Nancy Pelosi (D-Calif.) said, "We are hopeful that the president will reconsider his veto threat and sign this bill into law on behalf of our nation's children" (Washington Post, 9/22).
Bush in his weekly radio address on Saturday called the compromise legislation "irresponsible," the AP/Washington Post reports. "Democrats in Congress have decided to pass a bill they know will be vetoed," Bush said, adding, "Members of Congress are risking health coverage for poor children purely to make a political point." He continued, "Our goal should be to move children who have no health insurance to private coverage -- not to move children who already have private health insurance to government coverage" (Loven, AP/Washington Post, 9/23).
White House spokesperson Dana Perino on Friday said, "Once the Democrats finish their political posturing, the president looks forward to working with Congress to pass SCHIP reauthorization he can sign" (Washington Post, 9/22).
HHS Secretary Mike Leavitt said that the debate over SCHIP "is a crossroads" and Bush sees the SCHIP deadlock as the "moment" to have a "larger debate" about health care (Wolf, USA Today, 9/23).
Democrats on Saturday responded to Bush's statements, saying that if Bush vetoes the bill, 15 states will run out of funding by the end of September and thousands of children will lose coverage, according to the AP/Post.
Pennsylvania Gov. Ed Rendell (D) said, "The administration has tried to turn this into a partisan issue and has threatened to veto. The health of our children is far too important for partisan politics as usual." Rendell added, "If the administration is serious about solving our health care crisis, it should be expanding, not cutting back, this program, which has made private health insurance affordable for millions of children" (AP/Washington Post, 9/23).
According to CQ Today, House Democrats are attempting to win Republican support through "both cajoling and outright pressure."
The Democratic Congressional Campaign Committee on Sept. 20 issued press releases to the media in the districts of 50 House Republicans asking whether the lawmakers would "stand with ... children, or with President Bush?" However, "[w]hat distresses some supporters is that there does not appear to be any plan for what to do after" Bush vetoes the compromise bill.
Bruce Lesley, president of First Focus, said, "It's sort of like, 'Don't talk to us about that, we're not there yet'" (Wayne , CQ Today, 9/21). Hatch said that Congress would have difficulty overturning a presidential veto and most likely would need to pass a temporary extension of the program, according to the Los Angeles Times (Alonso-Zaldivar, Los Angeles Times, 9/23).
Bush "is headed into a spending battle with Congressional Democrats" after threatening to veto SCHIP because of its "fiscal irresponsibility," the New York Times reports. According to the Times, Bush's shift toward being fiscally conservative "has undeniable political benefits for a president struggling to reassert his authority when his standing even within his own party is under attack." Democrats say that the administration is hypocritical in accusing them of being fiscally irresponsible, the Times reports.
If Bush "was interested in fiscal discipline, he should have started $3 trillion ago," House Democratic Caucus Chair Rahm Emanuel (D-Ill.) said. The White House defends the veto threats, saying that Republicans when in the majority stayed within fiscal limits, while Democrats have not (Gay Stolberg, New York Times, 9/22).
- Richmond Times-Dispatch: "Congressional Democrats claim too many Americans can't afford to buy health insurance in the private market" as a reason for expanding SCHIP coverage, according to a Times-Dispatch editorial. The editorial continues, "Americans certainly have a harder time of it when taxes take more money out of their pockets than food, clothing or shelter. Expanding the current program to cover the upper middle class is a shameless example of trying to buy people's votes with their own money." It concludes that Bush "should carry through on his veto threat, and sink this SCHIP" (Richmond Times-Dispatch, 9/24).
- Seattle Post-Intelligencer: Bush's "bring-'em-on determination to block expansion of American kids' access to health coverage is deeply troubling," according to a Post-Intelligencer editorial. The president's veto threat "is absurd, coming from the same president who earlier wouldn't wait for Senate Republicans to finish work on an excellent expansion compromise before promising a veto," the editorial writes, adding, "Bush is blatantly misrepresenting compassionate expansion as a step toward government takeover of health care" (Seattle Post-Intelligencer, 9/23).
- Wall Street Journal: The administration's SCHIP enrollment standard that limits enrollment of children in families with annual incomes greater than 250% of the federal poverty level "moves the most disadvantaged children to the head of the line, before subsidizing those who need it less" and "checks SCHIP's mission creep," according to a Journal editorial. It concludes, "With his veto pledge, ... Bush is trying to hold SCHIP to something close to its original intent. We hope enough Republicans appreciate the policy stakes to sustain it" (Wall Street Journal, 9/24).
- Jim Wooten, Atlanta Journal-Constitution: "As Democratic leaders have demonstrated repeatedly in grandstanding on Iraq, offering pullout legislation they know has no chance of succeeding, the SCHIP bill that will hit the president's desk in the coming weeks is entirely about politics," and Bush should veto it, Wooten, associate editor of the Journal-Constitution editorial page, writes (Wooten, Atlanta Journal-Constitution, 9/23).
- Judith Graham, Chicago Tribune: "After years of being a third rail of American politics, health care reform is back on the national agenda, raising the issue's political profile," which has turned the debate over SCHIP "into a much larger, more contentious argument," Graham, a health and medicine writer for the Tribune, writes in an opinion piece. Graham writes, "Amid the political jockeying and the inflamed rhetoric, it can be easy to lose sight of the facts -- and the stakes -- of this debate" (Graham, Chicago Tribune, 9/23).
- Newt Gingrich/David Merritt, The Politico: "Fundamental questions over which direction our country takes on health care are at the heart of the discussion over SCHIP," but lawmakers must "not lose sight of what is at stake in their rush to find a quick fix to a long-term problem: the health and well-being of children who are in danger of losing their insurance coverage," Gingrich, former House speaker and founder of the Center for Health Transformation, and Merritt, head of the Insure All Americans project at the center, write in a Politico opinion piece. They write that Congress "can protect kids by passing a clean, temporary 18-month extension of the current program," which would "give members of Congress the time and opportunity to carefully consider the future of SCHIP and how it can play a role in extending health insurance coverage to all Americans" (Gingrich/Merritt, The Politico, 9/21).
- Rep. Jim McCrery (R-La.), Washington Times: Democrats have focused "attention on the authorized cost of [SCHIP] over the next five years, while ignoring the long-term shortfall -- a classic bait and switch," House Ways and Means Committee ranking member McCrery writes in a Times opinion piece. "There is a better way" to reauthorize SCHIP, McCrery writes. A bill by House Energy and Commerce Committee ranking member Joe Barton (R-Texas) would "increase the programs' funding and keep the focus where it belongs, on helping low-income kids, according to McCrery. "The Democrats' bill is a Trojan horse, cynically exploiting our desire to help needy children in a stealthy attempt to create a massively expensive government health system," he concludes (McCrery, Washington Times, 9/24).
WAMU's "The Diane Rehm Show" on Monday is scheduled to include a discussion about the debate over SCHIP. Scheduled guests include Robert Greenstein, founder and executive director of the Center on Budget and Policy Priorities; Jonathan Weisman, a reporter for the Washington Post; Nina Owcharenko, senior policy analyst at the Heritage Foundation's Center for Health Policy Studies; and Grassley ("The Diane Rehm Show," Web site, 9/24). A broadcast schedule and additional details about the segment are available on the program's Web site. Audio of the segment will be available online about one hour after the broadcast.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.