Health care bill gives GOP a pain

The Baltimore Sun

WASHINGTON -- As they tell the story in Texas, when George W. Bush was governor, he fought hard to put austere limits on a new federal-state plan to provide health insurance for children of low-wage workers in the state. Outmaneuvered by Democrats, he corralled the program's chief sponsor on the statehouse floor and conceded defeat, saying, "You crammed it down our throats."

Now, almost 10 years later, President Bush is threatening to veto federal legislation that would renew the same partnership - the State Children's Health Insurance Program - and expand it to cover more of the nation's nearly 9 million uninsured children.

If he follows through on that threat, Bush could face a first in his presidency: a veto override.

The insurance bill is considered Washington's most important legislation this year on health coverage.

And Bush's fellow Republicans are worried that Democrats might do more than back the president into a corner - they could use his opposition to tar GOP incumbents in next year's elections. If the House and Senate approve a bill and Bush vetoes it, some Republicans say, there is a good chance that many in his own party would join with Democrats in overriding him.

"Many [Republicans] are very nervous," said Sen. Gordon H. Smith, an Oregon Republican and a supporter of a compromise formula that Bush opposes. "On the one hand, you've got the veto threat. On the other hand is the political importance of expanding health care for children. This is public policy broadly supported by the American people."

Added Republican Sen. Orrin G. Hatch of Utah, one of the authors of the original program: "I personally believe there is a reasonable chance he'll be overridden, but I don't want to make any predictions."

A 17-4 vote in the Senate Finance Committee last week to approve the compromise approach showed how unpopular Bush's position is in his own party. Unfazed by the veto threat, a majority of the panel's Republicans joined Democrats in voting to expand the program by $35 billion over five years, far more than the $5 billion in additional spending Bush has proposed.

"The president might be better off if Congress does deadlock over this," said G. William Hoagland, a former senior GOP budget aide in the Senate. "If they hand the president a bill, the risk of an override of his veto would be very high.

"A lot of states and a lot of Republicans are invested in this," added Hoagland, now a policy adviser to health insurer Cigna. "I think this is a dangerous one for him."

At issue is a $5 billion-a-year program that covers about 6 million children whose parents make too much to qualify for Medicaid, which helps the poor, but too little to afford private insurance. The program offers states federal matching funds and flexibility to design their own programs.

The program was originally aimed at families making up to twice the federal poverty level, today about $40,000 for a family of four. But over the years, some states have taken advantage of the flexibility to cover children in families earning somewhat higher incomes, while others have even extended coverage to some adults. Such changes have to be approved by Washington, and the Bush administration signed off on the majority of them.

But now the administration is saying that has gone too far. Bush's advisers say the president strongly supports renewal of the program but wants it to return to its original intent of helping children - not adults - and confining itself to those near the poverty line.

The House has yet to begin work on its version. House Democrats are taking a more expansive approach, adding money for children's coverage and making changes in Medicare as well. The program's Republican supporters in the Senate say that would be unacceptable.

But a leading Democrat in the House said he wants a bill that can pass Congress, not merely make a statement. "We want to actually get something done," said Rep. Frank Pallone Jr. of New Jersey, chairman of a subcommittee that will be writing the legislation.

Ricardo Alonso-Zaldivar writes for the Los Angeles Times.

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