From the Los Angeles Times
Senate passes children's health insurance bill
The largely party-line vote foreshadows a bigger
partisan struggle for overhauling the nation's healthcare system.
By Noam
N. Levey
January 30, 2009
Reporting from Washington — President
Obama and his congressional allies took a modest step toward reshaping the
nation's healthcare system Thursday as the Senate passed legislation to expand
health insurance for children.
But rather than building momentum for the
sweeping healthcare reform Obama has promised, the victory on Capitol Hill -- a
largely party-line vote, 66 to 32 -- marked a rocky start for what many hope
will be the biggest reform campaign in a generation.
"To start out the
year on this note does not bode well for future healthcare discussions,
including health reform," Sen. Orrin G. Hatch (R-Utah) warned his colleagues as
the Senate debated the children's health insurance bill, which would enlarge the
current program for helping children of the so-called working poor.
Like
Wednesday's battle over the economic stimulus package, expansion of the State
Children's Health Insurance Program became engulfed in a partisan struggle.
The stimulus debate also showcased several skirmishes among interest
groups, despite the consensus that seemed to be developing among many last year
around health reform.
Business and consumer groups scuffled over
federally subsidized health insurance for jobless Americans in the stimulus
package. Insurers faced off with privacy advocates over access to patients'
electronic health records, which the stimulus bill would promote.
And
foreshadowing what will probably be a much larger debate, Republicans rebelled
at Democratic moves to expand the federal government's role in providing health
insurance.
Nine GOP senators backed the children's health bill Thursday;
in 2007, 18 backed similar legislation.
The current bill -- which
parallels one approved in the House two weeks ago -- would cover an additional 4
million children at an estimated cost of nearly $33 billion over the next 4½
years.
SCHIP, as the program is called, helps states provide health
insurance for families that earn too much to qualify for Medicaid, the federal
medical insurance program for the poor, but not enough to buy private
insurance.
In the past, the program has enjoyed extensive bipartisan
support, though Democrats and Republicans have differed over how much families
could earn before their children became ineligible.
State rules vary, but
some cover children in families with incomes more than twice the federal poverty
line, which is currently $21,200 for a family of four.
Advocates of
overhauling the whole healthcare system had hoped broad support for SCHIP would
pave the way for similar consideration of the larger healthcare
issues.
But the largely party-line votes on SCHIP and the stimulus raised
the prospect that the healthcare overhaul promised by Obama this year may soon
become a one-party exercise.
Several senior Democrats seemed unconcerned
by that possibility.
"You try to get bipartisan support," said Rep. Henry
A. Waxman (D-Beverly Hills), chairman of the powerful House Energy and Commerce
Committee. "But if they don't want to be for it, that's their choice. They'll
have to answer to their voters."
Other Democrats noted that bipartisan
discussions about broader health legislation are continuing.
"This is
going to work out well," said Senate Finance Committee Chairman Max Baucus
(D-Mont.), one of the leading architects of planned health reform
legislation.
Baucus and other Democrats have been meeting with Senate
Republicans about health reform for months, as have a host of interest groups,
including insurers, doctors, hospitals, business leaders and consumer
advocates.
"Healthcare reform will be on a different track," said Ron
Pollack, head of Families USA, an influential consumer group that has led
efforts to build consensus around the current campaign.
With control of
the White House and commanding majorities in the House and Senate, Democrats
need only a handful of GOP votes in the Senate to pass their agenda.
But
many advocates believe that major healthcare reform will need substantial GOP
support to endure, much as Medicare did since it passed more than four decades
ago.
In contrast, the Medicare drug benefit, which Republicans pushed
through in 2003 on a largely party-line vote, has been fiercely debated since
and remains a top target for some Democrats.
"Nobody wants . . . to see
reform get repealed," said Karen Ignagni, president of America's Health
Insurance Plans, an insurance industry lobbying group that has been intensely
involved in the current health reform talks.
In 2007, SCHIP legislation
developed by senior Republican and Democratic lawmakers -- and ultimately vetoed
by President Bush -- garnered as many as 45 GOP votes in the House and 18 in the
Senate.
Going into this year, lawmakers from both parties also backed
more federal spending on health information technology, a major part of the
economic stimulus package.
But the consensus on these modest first steps
collapsed quickly after the new Congress convened this month.
Democrats
infuriated Republicans by inserting a provision in the SCHIP bill to expand
health insurance for children of legal immigrants.
An earlier bipartisan
compromise had limited that aid to children who had been in the country for more
than five years.
Democrats also rebuffed Republican efforts to place
limits on how far states could go in providing insurance to children from
families with incomes above the federal poverty line.
Sen. Charles E.
Grassley of Iowa, the ranking Republican on the Finance Committee who had worked
with Democrats to craft the SCHIP legislation two years ago, was particularly
angry.
"For a guy like me that shed so much blood and took such a
hammering from my own party, it's a real disappointment . . . that my side of
the aisle is being so ignored," the veteran lawmaker told reporters.
But
the GOP resistance is unlikely to derail health reform efforts, given the
determination of the Obama administration and its Democratic allies on Capitol
Hill, said Chip Kahn, a former Republican staffer who heads the Federation of
American Hospitals.
"At the end of the day," he said, "it may be that
healthcare reform will be passed with only a small number of
Republicans."
noam.levey@latimes.com