WASHINGTON — Republicans appear to have overplayed their hand when blocking the expansion of a children’s health care program last year. As a result, they face the likelihood that Democrats in the coming weeks will pass a bill that they dislike even more.
And now, with more Democrats in Congress and President Barack Obama in the White House, Republican lawmakers no longer have the tools — the numbers to block legislation or the threat of a presidential veto — to do anything about it.
The Senate began debate Monday on a bill that would increase spending on the State Children’s Health Insurance Program (SCHIP) by $31.5 billion over the next four and a half years.
Congress approved a similar bill in late 2007 that former President George W. Bush vetoed. The House fell about 15 votes shy of the two-thirds majority needed to override the veto. But the current legislation contains some important changes.
It is friendlier to states that want to cover children in families with incomes exceeding three times the federal poverty level — $63,600 for a family of four.
Also, the bill calls for covering children of legal immigrants now barred from government-sponsored insurance until they have been in the country at least five years.
The two provisions have angered Senate Republicans, including some who disagreed with Bush and worked closely with Democrats on expanding the program in 2007. Democrats have countered that 90 percent of the bill is based on legislation that previously had broad bipartisan support in the both the Senate and House.
“It’s the 10 percent that represents barbed wire and a heck of a burr underneath our saddles,” said Sen. Pat Roberts, a Kansas Republican.
SCHIP was designed to provide health coverage to families with incomes too high to qualify for Medicaid, the health insurance program for the poor, but not enough to afford private insurance. Federal money for the program expires March 31.
When Congress sought to renew the program in late 2007, Bush said it needed to be refocused on the working poor. So he vetoed the first bill that lawmakers sent him. Lawmakers went back to work and agreed to limit federal dollars to health coverage for families earning less than three times the federal poverty level.
But Bush vetoed that bill, too.
That income limit is gone in the legislation now moving through Congress. States can use SCHIP to cover children of any income level. When they do move higher than three times the poverty level, states will get the payment rates they normally get through Medicaid instead of the rate they get for SCHIP, which is higher.
“I don’t believe it’s good public policy for a family with an income of $83,000 to be able to get onto SCHIP,” said Sen. Charles Grassley, an Iowa Republican, citing a potential example where states could get federal money.
Democrats question whether states will expand coverage to more middle-class families during the current tough economic conditions. Even if some do, they don’t see a problem.
“It would be irresponsible for the federal government to cap funding to the states when working families need more public assistance, not less,” said Sen. Jay Rockefeller, a West Virginia Democrat.
Republicans are expected to push for an amendment that would keep children of newer legal immigrants out of SCHIP or Medicaid. By allowing for such coverage, they claim Democrats have turned what could have been a simple renewal of SCHIP into a debate about immigration.
“Why would anyone want to bring one of the most divisive and contentious and passionate issues of the last decade into this debate?” Roberts said during a Senate Finance Committee hearing.
Senate Majority Leader Harry Reid said that investing in children’s health coverage brings savings down the road because those kids are more likely to become productive adults.
“Some people want to make this a debate about immigration. This isn’t a debate about immigration,” Reid said. “It’s a debate about taking care of our children, children who are here legally.”
The money to pay for expanding the program would come from a 61-cents per pack increase in the tax on cigarettes, as well as tax increases on other tobacco products.
The Congressional Budget Office projects that the extra spending would allow 4 million uninsured children to gain coverage through Medicaid and SCHIP through 2013. Another 2.3 million will join the program after previously getting private insurance.