WASHINGTON -- With the chances looking slim that Congress will be able to override President Bush's veto of the State Children's Health Insurance Program expansion this week, leaders on Capitol Hill and at the White House are bracing for a potentially bruising round of negotiations to keep current recipients covered.
The popular program for moderate-income families expires in mid-November, and both sides face pressure to reach a deal that maintains funding. But they remain far apart on the costs of a program that Democrats and some Republicans want to expand by millions of children and tens of billions of dollars.
"What we did all agree on is that 10 million children would be covered," Pelosi told reporters last week. "With that as the starting point, we'd be happy to have any conversations, in my view, to insure the 10 million children."
Bush, who proposed a $5 billion expansion, has signaled a willingness to add more money to the program, but nowhere near the amount approved by Congress. White House spokesman Tony Fratto said any compromise would have to involve "a more rational children's health care program -- one that focuses more on poorer children."
At issue is the expansion of a program that now covers more than 6 million children and 670,000 adults from families not poor enough to qualify for Medicaid. Bush has vetoed legislation that would have expanded the number of children covered to 10 million and moved some of the adults to Medicaid.
The Senate approved the expansion by a veto-proof margin, but the House vote fell short of the two-thirds needed to override. Democrats and their allies have sunk millions of dollars into radio, television and print advertisements during the past two weeks to pressure at least 15 House Republicans to change their nays to yeas for the override attempt scheduled for Thursday.
But of the dozen targeted Republican lawmakers who responded to a query last week by The Sun, all said they planned to vote against the expansion again this week. Rep. Eric Cantor, the Virginia Republican who serves as his party's chief deputy whip in the House, said last week that he expected no further defections beyond the 45 party members who already voted for the expansion.
Senate Majority Leader Harry Reid has called repeatedly on Rep. Roscoe G. Bartlett, the only member of the Maryland delegation to vote against the insurance program's expansion, to switch sides. A spokesman for Bartlett said last week that the Western Maryland Republican has no such plans.
Democrats are not giving up.
"We're just keeping the pressure on," said Montgomery County Rep. Chris Van Hollen, chairman of the Democratic Party's House campaign operation. "We believe that as members hear from their constituents, the pressure will build for them to vote to support children's health."
Some Republican opponents of the expansion accuse Democrats of jeopardizing the program by waiting two weeks before attempting to override Bush's veto. Democrats say they needed the time to try to build support; Republicans say they have been playing politics with the issue.
"I would have much rather spent the time working to come up with a bill which is financially sound and guarantees poor American children are the first in line to receive benefits," said Rep. Tom Feeney, a Florida Republican. "By the time we vote ... we will have wasted two important weeks and have less than a month to come up with a plan."
"We believe voters will hold members accountable at the ballot box if they choose President Bush over children's health," van Hollen said.
Bush has described the expansion as a step toward government-funded national health care, and Republican leaders have seized on the debate to talk about again branding the GOP as the party of fiscal responsibility.
But some question whether children's insurance program--popular among most Republican voters as well as Democrats and independents -- is the right issue on which to take that stand. Eighteen Republicans voted for the expansion in the Senate; 45 did in the House.
"This is an issue that divides the two parties, but also splits the Republican Party in two," said Paul Herrnson, director of the Center for American Politics and Citizenship at the University of Maryland, College Park. "Americans are fiscally conservative, but pragmatically, they like to support programs that are important. This is a program that many Americans view as important."
Launched with bipartisan support during the Clinton administration, the program gives money to states in the form of block grants, which give state officials flexibility to assess local needs and determine who may benefit. In Maryland, a family of four earning up to three times the poverty limit, or $61,950, can get coverage.
Liberals and moderates in Congress see the program as an integral step toward universal health coverage. But conservatives say it has expanded beyond its original mission and express concern that government-sponsored health coverage could replace private insurance.
The White House also opposes an increase in the federal cigarette tax to pay for expanded coverage. Critics, meanwhile, say Bush's proposal to increase spending by $1 billion a year for five years would result in hundreds of thousands of children losing their coverage.
In a radio address after he vetoed the bill this month, Bush suggested a starting point for negotiations.
"If putting poor children first takes a little more than the 20 percent increase I have proposed in my budget for SCHIP, I am willing to work with leaders in Congress to find the additional money," he said. "Ultimately, our nation's goal should be to move children who have no health insurance to private coverage -- not to move children who already have private health insurance to government coverage."
Reid has called Bush's invitation to negotiate "an insult."
"You cannot wring another ounce of compromise out of this," the Nevada Democrat told reporters after the veto.
Pelosi has appeared more willing than Reid to talk with the White House about the insurance program. But the California Democrat expressed skepticism yesterday about negotiations.
"A compromise to the president means, in all due respect to him, ...'Do it my way,' " she said on ABC's This Week with George Stephanopoulos. "One thing's for sure," she said. "We won't rest until those 10 million children have health care."
On the same program, Senate Minority Leader Mitch McConnell, who has opposed the expansion legislation, predicted the sides would reach a deal.
"We're not going to leave children -- uninsured children -- uncovered," the Kentucky Republican said. "I don't know any members of Congress, Republican or Democrat, who are not in favor of [providing] insurance for low-income children. The issue is, how do you do it?"