WASHINGTON, Aug. 2 — The Senate defied President Bush on Thursday and passed a bipartisan bill that would provide health insurance for millions of children in low-income families.
The vote was 68 to 31. The majority was more than enough to overcome the veto repeatedly threatened by Mr. Bush. The White House said the bill “goes too far in federalizing health care.”
But Senator Max Baucus, Democrat of Montana and chief sponsor of the bill, said, “Millions of American children have hope for a healthier future tonight.”
The bill would increase spending on the popular Children’s Health Insurance Program by $35 billion over the next five years.
“Covering these children is worth every cent,” said Senator Orrin G. Hatch, Republican of Utah, who helped create the program 10 years ago.
The House passed a much larger bill on Wednesday, presenting negotiators with a formidable challenge in trying to work out differences between the two measures.
Still, the strong commitment to the issue by Democratic leaders virtually guarantees that they can work out a compromise before Sept. 30, when the program is set to expire. But that compromise is likely to be unacceptable to Mr. Bush.
If Mr. Bush vetoes the bill, the future of the program would quickly become an issue in 2008 campaigns for Congress and the White House, in the context of a broader debate about universal coverage for health care.
The House bill, which passed on a vote of 225 to 204, would increase spending by $50 billion over the next five years. The Senate rejected a proposal by Senator John Kerry, Democrat of Massachusetts, to match that increase — and to cover the extra cost by raising taxes on people with incomes exceeding $1 million a year.
Both bills would raise tobacco taxes. The federal excise tax on cigarettes would rise to $1 a pack under the Senate bill and to 84 cents a pack under the House measure, from 39 cents a pack.
The House bill would sharply reduce federal subsidies paid to insurance companies offering private health plans to Medicare beneficiaries. Many Democrats say these plans, which serve nearly one-fifth of the 43 million Medicare beneficiaries, are overpaid. The Senate bill does not deal with Medicare.
Michael O. Leavitt, the secretary of health and human services, said Congress was jeopardizing health care for millions of needy children by passing bills that “the president will have no choice but to veto.”
Senator Charles E. Grassley of Iowa, a Republican who helped write the Senate bill, said he intended to try to persuade Mr. Bush to sign the legislation that emerges from Congress. But Mr. Grassley said that he would fight the proposed cuts in Medicare payments to private plans.
“It’s a question of equity for rural America,” Mr. Grassley said. “Before 2003, rural Medicare beneficiaries rarely had private Medicare plans to choose from. They did not have the same choices people have in urban America. These plans can be a good choice for people with a chronic illness, for lower-income people and for those who want extra benefits.”
Insurers say the private plans would disappear from many parts of the country if Medicare payments were cut as proposed by House Democrats.
But AARP, the lobby for older Americans, has endorsed the House bill. It says the “excess payments” to private plans cause higher premiums for all beneficiaries, including those in traditional Medicare.
In the final Senate vote, 18 Republicans and 2 independents joined 48 Democrats in supporting the legislation. All the no votes were cast by Republicans.
Senator Debbie Stabenow, Democrat of Michigan, set forth the case this way: “As lawmakers, we have a moral obligation to provide health care coverage for the millions of uninsured children. Health care should be a right, not a privilege, and covering every child is an important step toward this goal.”
But the Senate Republican whip, Trent Lott of Mississippi, said: “If you want to go to government-run, socialistic medicine, this is it, this is the way it’s going to happen. Even my colleagues on the Republican side of the aisle are buying this deal.”
Senator Baucus insisted that “this is not a huge massive expansion. This has nothing to do with national health insurance.”
Under the bill, states can use federal money to pay health care providers or to help families buy private insurance.
Senator Kent Conrad, Democrat of North Dakota, said, “To suggest that this is somehow socialized medicine is one of the most far-fetched arguments I have seen on the Senate floor. This care is provided by private physicians, using private insurance companies.”
Both bills would offer bonus payments to states as an incentive to find and enroll low-income children.
The Congressional Budget Office says the Senate bill would cover 3.2 million uninsured children, including 2.7 million who are currently eligible but not enrolled. The House bill, it said, would cover 4.2 million children, including 3.8 million already eligible for benefits. In addition, both bills would provide money to prevent 800,000 children now on the program from losing coverage.
The current allocations of federal money, totaling $5 billion a year, are not enough for states to maintain their current programs.
Senators of both parties said the bill would help Mr. Bush fulfill a promise he made at the Republican National Convention in New York City on Sept. 2, 2004.
“America’s children must have a healthy start in life,” Mr. Bush said then. “In a new term, we will lead an aggressive effort to enroll millions of poor children who are eligible but not signed up for the government’s health insurance programs. We will not allow a lack of attention, or information, to stand between these children and the health care they need.”