President Threatens to Veto Child Healthcare Program

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The U.S. Senate recently voted in support of the State Children's Health Insurance Program (S-CHIP). The legislation renews an effort to provide health insurance to children of America's working poor. But President Bush is threatening to veto the plan. NPR Health Policy correspondent, Julie Rovner, offers an update on the issue and explains the President's opposition.


I'm Michel Martin, and this is TELL ME MORE from NPR News.

Later in the program, what's a gabacho? Gustavo Arellano wants to tell you. Plus, beauty pageants for babies and embracing abstinence. We'll tell you one teenager's story.

But first, Congress this week gets back to work on a bill to renew a health insurance program for children of the so-called working poor. That means their parents earn too much to qualify for Medicaid, but not enough to afford private coverage. Just about everybody says they support extending the State Children's Health Insurance Program known as S-CHIP, but President Bush says he will veto a compromise bill approved by a Senate committee last week. And in the House, the measure is being threatened by so many different political factions, you literally need a scorecard to keep up.

NPR's health policy correspondent Julie Rovner joins us from our studios in Washington to talk about all this. Julie, thanks for coming in.

JULIE ROVNER: My pleasure.

MARTIN: Julie, this program covers six million low and moderate-income kids. There's bipartisan support. So who's against it?

ROVNER: Well, nobody's against it. This is really the classic case, textbook example of why nothing in health care is easy when you get to Congress. Everybody says they want to renew the program. The key is how to pay for it. The Democrats, as you know, have reinstituted what we call PAYGO, which means anything you do, you have to pay for. Now, if they were just to renew the program at its current levels, that probably wouldn't be enough to cover all of the current children who are now enrolled.

President said he - in his budgeting he wanted to $5 billion over five years to the $5 billion a year. That wouldn't be enough to cover everybody now. The Democrats, in their budget, said they wanted to add $50 billion over those five years. But when it came down to finding a way to pay for it, they couldn't do it on a bipartisan basis. So - and they've added $35 billion in the Senate. President says that's too much. He'd veto it.

MARTIN: Okay. Wait, let me separate those two things so I can keep up. Take the Senate bill first. The Senate bill passed out of committee last week. And this was considered kind of a carefully crafted measure, you know, which is what the Senate is supposed to do. What was in that bill and what was the president's reaction to it?

ROVNER: Well, the Senate had a real procedural problem, which is that there were a couple of senators who said that they were going to filibuster it. So that meant, immediately, the Senate needed 60 votes to prevent that filibuster. So Senator Max Baucus, head of Finance Committee, immediately knew that he was going to have to find a bipartisan bill, because he doesn't have 60 Democrats. So he's going to have to get some Republicans.

So right away, he knew that he was going to have to find a way to pay for it that was going to get 60 votes. He settled on a 61 cents per pack cigarette tax, and he discovered he could get 60 votes for that. Unfortunately, that only raised $35 billion. So that's where he ended up.

The president says not only is that too much for him, he doesn't like cigarette tax, but, in fact, the president now says he doesn't just want to expand the Children's Health Insurance Program. He wants to do this tax change for the health code. He wants to get bigger than the Children's Health Insurance Program. He wants to look at the whole health insurance. Suddenly, six years into his presidency, he wants to debate health reform.

MARTIN: Oh, that's interesting.

ROVNER: So he says he wants to veto the whole thing. He wants to go in a whole different direction.

MARTIN: Do the senators believe him?

ROVNER: Good question. Some of the senators are in a tight position because they'd like to debate health reforms, and Democrats would like debate health reform. But they say this program's going to expire on September 30th. They don't have time to mess with this. They want to get this program expanded and not leave these six and a half million children uncovered, and then go on and debate health reform.

MARTIN: So they aren't under some time pressure here. What's going on in the House side?

ROVNER: Well, in House, we have what, really, the senators expected to deal with, which is, they want to pay for this bill by taking this Medicare Advantage Program. This is a program that covers seniors. It was done in the 2003 Medicare Drug Bill that, it turns out, they're paying too much for. There's a lot of over expenditure in this program. The Congressional Budget Office says they're paying $50 billion over five years - more than they need to. So that's a quick way to get extra money to pay for what they need for the Children's Health Insurance Program. But the president doesn't want to do that, and a lot of Republicans don't want to do that because the health insurance industry is a big contributor to the Republican Party.

MARTIN: Wow. So it's complicated.

ROVNER: Right. So they're going to drag Medicare into this dread. And now, they're making it even more complicated is that there's a lot of Democrats that don't want to do that, too.

MARTIN: So you got one set of problems on the Senate side, another set of problems on the House side - or issues, let's say. Realistically, do you think that - or do they think that they can work this out by September 30th, when the program will expire, if they do nothing?

ROVNER: It's going to be very, very, very tricky. If they don't they'd have to extend it on a short-term. That's going to have problems of its owns because there won't be enough money for some of the states.

MARTIN: Wow. Thanks, Julie. Keep us posted, will you?

ROVNER: I will.

MARTIN: Julie Rovner is the health policy correspondent for National Public Radio. Julie, thanks so much for coming in.

ROVNER: You're welcome.

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