WASHINGTON -- With his long-promised veto yesterday of a bill to expand health insurance for children, President Bush has ignited an ideological battle that could rage on into next year's presidential campaign.
At bottom, the issue is whether government should take the lead in extending health care benefits to uninsured children - mostly in low-income, but some in middle-class families - or whether the problem should be left primarily to the private sector.
The State Children's Health Insurance Program, known as SCHIP, is managed by states within federal guidelines. It has become entangled in Bush's late-innings effort to help the GOP recapture its image as the party of fiscal restraint after six years of budget deficits and increased federal spending.
Democrats and Republicans are seemingly convinced they will gain more from confrontation than compromise. Democrats will try to override Bush's veto in two weeks. The effort is likely to fall short, even though the bill had significant Republican support.
If the veto stands, Democrats said, they will pass the measure again without significant changes and send it back to the White House, forcing the GOP to go on record again as opposing expansion of a program that serves about 6 million children, including more than 100,000 in Maryland. An estimated 9 million children remain uninsured nationwide, and the number has been rising as employers cut back coverage.
Bush cast the issue yesterday in terms of those who want to help the poor and those who want to increase the size and cost of government.
"The policies of the government ought to be to help poor children and to focus on poor children, and the policies of the government ought to be to help people find private insurance, not federal coverage," he told an audience of business leaders in Lancaster, Pa. "And that's where the philosophical divide comes in."
'This is Tiny Tim'
On the Democratic side, the line of attack was laid down by Rep. Jim Cooper of Tennessee. "This has got to be up there with motherhood and apple pie. This is Tiny Tim. And who is against Tiny Tim? The only person in all of literature was Ebenezer Scrooge," he said, referring to Charles Dickens' classic story of a crippled boy and a hard-hearted man who regains his sense of compassion at Christmastime.
Cooper, a fiscal conservative who voted against a more expansive version of the bill this summer, said Bush "is playing into Democratic hands. Either the program will get passed, and he'll look like Ebenezer Scrooge, or we won't override the veto and he still looks like Ebenezer Scrooge."
The political bind for Republicans - particularly those in swing districts - is reflected in polls that show broad public support for covering uninsured children. Utah Republican Sen. Orrin G. Hatch called it "the morally right thing to do."
The issue, however, also carries risks for Democrats. They have vowed to make no further compromises, having scaled back their ambitions during negotiations with leading GOP senators. And they could get blamed for politicizing a well-established program that has been seen as a bipartisan success story.
The State Children's Health Insurance Program was created to help children of the working poor - low-income families who earned too much to get free coverage under Medicaid but could not afford private insurance.
Under the current law, which remains in effect while the struggle over a long-term extension goes on, children in families earning up to about $40,000 a year - roughly twice the federal poverty level - can be covered.
But some states have won permission to extend eligibility to families with incomes substantially above the official poverty line. The bill approved by Congress would permit states to expand eligibility to about three times the poverty level, or slightly more than $60,000 a year.
The congressional bill would spend $60 billion over five years to expand the program to cover 9 million to 10 million children and pay for it with a sharp increase in tobacco taxes. Bush has offered $30 billion - a 20 percent increase over current levels - but not enough to maintain current enrollment levels, budget analysts say.
Let's not make a deal
On Capitol Hill, Democrats and their Republican allies seemed in no mood to make deals.
A House vote on whether to override the veto - only the fourth of Bush's nearly seven-year presidency - is scheduled for Oct. 18, giving backers two weeks to try to pick up support. While the bill passed the Senate by a veto-proof majority, the 265-159 House vote was short of the required two-thirds margin.
Democrats think that they will be able to convert some of the president's Republican supporters in the House. House GOP leaders say they are confident they will sustain the president's veto, although some acknowledge it will be a difficult vote.
"Politically, on the face of it, it's a very risky vote for Republicans," said Rep. Jim McCrery of Louisiana, a leader on health care issues. "But from a policy standpoint, we're very confident."
Backers of the program would need to peel off at least 17 Republicans to have a chance to override the veto.
Except for Republican Rep. Roscoe G. Bartlett, Maryland's congressional delegation voted for the bill last week. Yesterday, both of the state's U.S. senators and several House members were critical of the Bush veto.
"The president's incomprehensible veto of this bipartisan, fiscally responsible legislation ... demonstrates a stunning lack of compassion for some of the most vulnerable members of our society," said House Majority Leader Steny H. Hoyer of Southern Maryland.
"President Bush has turned his back on America's children in need," said Sen. Barbara A. Mikulski, a Democrat. "This program is critical to ensure our children have access to the health care they need and deserve."
Gov. Martin O'Malley said he hoped that Bartlett would join the rest of the Maryland delegation in voting to override the veto.
But Bartlett didn't sound like he would be changing his position.
"Only Democratic congressional leaders could demand that a family earning $82,000 a year should qualify for their expanded SCHIP program that Republicans created to help children of the working poor," Bartlett said, "and simultaneously call that same family rich and force them to pay the Alternative Minimum Tax.
"It just goes to show that what Democrats really want is to have the government control how to spend the money that American taxpayers earn," he said.
SCHIP was created in the late 1990s by a Republican Congress and a Democratic administration trying to salvage some progress after the collapse of President Bill Clinton's health reform plan.
The program technically expired Sept. 30, but Congress and Bush have agreed on an extension through mid-November.
Ricardo Alonso-Zaldivar writes for the Los Angeles Times. The New York Times contributed to this article.