Health-Care Feud Intensifies

By: Wall Street Journal

Defining What Is ‘Poor’
October 18, 2007

WASHINGTON — Antagonists in the debate over government health coverage for poor children are staking out increasingly incompatible positions, firing a debate that is set to play a big role in the 2008 election season.

Democrats in Congress, along with some Republicans, have been pushing to expand the State Children’s Health Insurance Program to encompass nearly four million more children, most of whom are eligible but not enrolled. President Bush has vetoed the bill, and a veto-override attempt in the House today was expected to fail.

Supporters plan to bring the bill back again and say they are considering only minor changes to address criticisms raised by opponents. Their hope is that changes to certain elements — such as states’ ability to offer programs to people at higher income levels — might produce enough support to beat Mr. Bush’s veto in the House or pressure him to sign a bill. In the Senate, support for the bill is already sufficient to override a veto.

Some leading Republican lawmakers, by contrast, are gathering support for a new alternative after largely playing an opposition role: tax credits to help lower-income people buy private-sector health coverage.

Most Republicans view the Democrats’ plan as an expensive, unwanted increase in the government’s role in providing health-care coverage. Administration officials have said the current bill would allow states to cover children and parents at income levels that are too high. Mr. Bush, speaking at a news conference yesterday, repeated that his administration is willing to negotiate with lawmakers, but administration aides made it clear they don’t want to expand the program beyond its current limits.

The emerging Republican alternative, which has been shaped in part by the White House but has little traction in Congress, seems intended to give the party’s candidates much-needed cover for the 2008 election campaign, where polls already suggest health care will be a crucial domestic issue. Schip is intended to help cover working-class children whose households earn too much to qualify for Medicaid but who typically have trouble getting private-sector insurance at work.

“You can’t fight something with nothing,” said Gail Wilensky, a former top health-care aide to the first President Bush in the early 1990s. “They [Republicans] need to get serious” about offering an alternative, Ms. Wilensky added.

Today, Sen. Mel Martinez of Florida, the chairman of the Republican Party and a close ally of President Bush, is expected to embrace the tax-credit idea in a Schip bill put together with White House input. The measure would add $11.5 billion in new funds to the program, compared with $35 billion over five years in the current bill, and would include a $1,400 tax credit per child for families making too much to qualify. Republicans are working on a package of proposals to offset its costs.

Supporters of the original legislation say their best chance lies in enticing House Republicans. One major flashpoint has been a request from New York to cover children in families up to 400% the poverty level, or about $83,000 for a family of four, which was rejected by the Bush administration but that some Republicans fear would be approved in the future. One possible change to the bill under consideration would limit states’ ability to cover kids above 300% the poverty level.

Other changes that might spur Republican support include tightening language preventing illegal immigrants from gaining coverage and beefing up a provision that lets states contribute CHIP money toward the cost of certain private employer-sponsored insurance. The bill doesn’t permit illegal immigrants to be covered in CHIP, but many critics say the requirements for documenting citizenship are too loose.

Democratic leaders aren’t inclined to bend on funding or the number of children covered, especially because they have significant Republican support in the Senate. “How in the world do they think we got where we are?” said Senate Majority Leader Harry Reid (D., Nev.) on Tuesday. “We have compromised and compromised and compromised.”

It is unclear how many more Republicans will ultimately break with Mr. Bush. About 20 are under heavy pressure to override the veto. Liberal political advocacy group has promised to run more ads targeting Republicans who vote the other way. The ads feature a young recipient named Bethany holding a sign that says “Don’t veto me.”

Some conservatives say they won’t budge, and that the fight with Democrats will help them reclaim the Republican “brand” of fiscal conservatism. Republicans have also endeavored to turn the program into an ideological battle contrasting their private-market approach with the Democrats’ reliance on government.

“Some of us would like to elongate the debate,” said Rep. Tom Feeney, a Florida Republican who is backing a House version of the Martinez bill. He said people in his district “are thanking me for sticking to the principles of fiscal responsibility and for fighting benefits for illegal immigrants. …We would like to be debating this until March or November of next year.”

Write to Sarah Lueck at and John D. McKinnon at

* Content From the Wall Street Journal supplied by Elva Ramirez:
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