WASHINGTON -- The House approved sweeping health care legislation yesterday that would expand government benefits for children, the elderly and doctors while boosting tobacco taxes and cutting Medicare payments to private insurance companies.
The largely party-line 225-204 vote followed hours of debate and parliamentary stalling tactics by Republicans. Cheers rang out in the House chamber when Speaker Nancy Pelosi, a California Democrat, announced that the bill had passed.
The House bill would expand a popular health insurance program mainly for the children of the working poor. It would also improve preventive benefits for Medicare recipients, provide low-income elderly with more help - particularly with prescription costs - and roll back a scheduled 10 percent cut in Medicare fees for doctors.
President Bush has threatened to veto the legislation, and GOP leaders have denounced it as a step toward government-run medicine.
The Senate is expected to finish work this week on a compromise bill dealing only with the children's program. Republican and Democratic senators are trying to line up a veto-proof majority because Bush also opposes that measure.
"If they fail to reach a compromise on covering kids, it would be pathetic," said Drew Altman, president of the Kaiser Family Foundation, an information clearinghouse on health care issues. "If they can't agree on kids, what will they be able to reach a deal on when it comes to health reform? Failure to reauthorize [the children's program] would damage many of the most important state health reform efforts around the country."
Created by a Republican Congress in 1997 and signed into law by President Bill Clinton, the program insures about 6 million children whose parents make too much to qualify for Medicaid but too little to afford private insurance. Still, 8 million to 9 million children remain uninsured, and most qualify for help through government programs.
Washington contributes about $5 billion a year to the children's program, which covers most of the cost. States design their own coverage plans, and most have opted to rely on private managed-care plans to insure children. But with the rising cost of health insurance, current funding levels can't sustain the program. Some states have come up short of funds.
The House bill would add $50 billion to the program over five years, bringing the total to $75 billion and allowing coverage for about 5 million more children.
The Senate bill would add $35 billion over five years and cover about 3 million more children.
Many Republicans say that is too much money. They say spending on the program has increased rapidly because some states have been allowed to cover children in middle-class families and adults.
"We want to reauthorize [the program]. That fact cannot be emphasized enough," said Rep. Jim McCrery, a Louisiana Republican. "But we cannot support this proposal. Democrats want to raise taxes to fund a massive expansion of government-controlled health care."
Maryland House members voted along partisan lines. Democratic Reps. Elijah E. Cummings, Steny H. Hoyer, C.A. Dutch Ruppersberger, John Sarbanes, Chris Van Hollen and Albert R. Wynn voted for the bill. Republican Reps. Roscoe G. Bartlett and Wayne T. Gilchrest voted against it.
Republicans accused Democrats of wanting to expand the program to cover illegal immigrants and of trying to foist a "hidden tax" on private insurance.
Democrats called those charges distortions.
The bill would give states the option of covering children of legal immigrants. It would also allow states to establish methods for verifying citizenship. That would reverse recent federal documentation requirements that critics say are too burdensome and have had the unintended consequence of denying coverage to some citizens.
The bill "does not allow one single dime to be spent on illegal immigrants," said Rep. John D. Dingell, a Michigan Democrat.
A $2-per-person fee would be used to fund research into cost-effective treatments that could save money for individuals, employers and government programs, a Democratic aide said.
That bill and the Senate version would more than double tobacco taxes. The House bill would raise the 39-cent tax on a pack of cigarettes 45 cents, and the Senate measure would raise it 61 cents. But, because the House legislation attempts to do much more than the Senate bill, its sponsors had to come up with additional funding.
To cover more children, improve benefits for the elderly in Medicare and roll back fee reductions for doctors, Democrats want to cut payments to private managed-care plans that participate in Medicare.
Congressional analysts have found that those fees are inflated by about 12 percent per beneficiary when compared with the cost of traditional Medicare treatment.
Doing that, according to the health insurance industry, would force about 3 million seniors - about one-third of those now enrolled - out of Medicare managed-care plans.
Ricardo Alonso-Zaldivar writes for the Los Angeles Times.