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The State Children's Health Insurance Program, known as SCHIP, is a popular one. And last week a Senate committee overwhelmingly approved a bipartisan bill to continue it. But on Capitol Hill two House committees yesterday began work on their version of a bill to renew and expand SCHIP.
And as NPR's Julie Rovner reports, in the House the parties are far more polarized.
JULIE ROVNER: Both Republicans and Democrats on both the Energy and Commerce and Ways and Means Committees said they want to renew the SCHIP program, which otherwise is set to expire at the end of September. But that was about all they agreed on at simultaneous meetings that stretched late into the night.
Republicans like former House Speaker Dennis Hastert of Illinois said the bill written by House Democrats expands the children's health program so much that it will substitute government for private coverage.
Representative DENNIS HASTERT (Republican, Illinois): Now, we're sending messages to families across the country - drop your children from your private insurance plan, the American taxpayer will foot the bill.
ROVNER: Democrats like California's Henry Waxman, however, said the Republican substitute proposal doesn't go nearly far enough.
Representative HENRY WAXMAN (Democrats, California): With the amount of money they are proposing, they won't even be able to keep pace with current enrollees. I have to drop kids out of the program, let alone cover more of the children that need it.
ROVNER: But differences over how much to expand the children's insurance program are only the start of the dispute, although the expansion alone is enough to have drawn a veto threat from the Bush administration. What angered Republicans even more is how the bill proposes to pay for the additional $50 billion that would go the SCHIP program over the next five years. In particular they object to cuts in spending for private HMOs and other health plans that serve Medicare patients.
Arizona Republican John Shadegg said that made no sense.
Representative JOHN SHADEGG (Republican, Arizona): So we're going to take money away from our seniors to give it to the children in families where those families already earn $82,600 a year.
ROVNER: Well, not exactly. That $82,000 represents four times the poverty level for a family of four. Only a few families who earn that much could qualify. And the money being taken from the private Medicare plans is what budget analysts agree are overpayments. The cuts would simply pay the plans what the average Medicare patient costs. But the dispute to underscore what has become an unfortunate fact that seems to hold no matter which party controls Congress, says Patrick Morrisey, a health care lawyer and lobbyist and former congressional staffer.
Mr. PATRICK MORRISEY (Lawyer and Lobbyist): Unfortunately, nothing is simple in health care these days.
ROVNER: Part of the difficulty is how the Democrats are trying to pay for their health care expansion, using not only the controversial Medicare changes but an even more controversial 45 cents per pack increase in the cigarette tax. But Morrisey says that over the past several years Congress has also created its own problem in health care by making Medicare payment policies that last for just a few years at a time.
Mr. MORRISEY: So you have this amazing amount of pressure all funneling in into one or two health care bills a year, which means that any one bill, even if it's something which should be non-controversial, ends up becoming bigger and bigger and bigger because you literally have dozens and dozens or hundreds of groups lining up saying we would like more money because our payment policy expires at the end of the year.
ROVNER: This year the big money problem is a 10 percent cut in Medicare payments to doctors starting next January. The House bill cancels that cut. But it comes at a cost - a big one. Eliminating the cut for just two years adds more than $100 billion to Medicare spending over the next decade. That's considerably more than the entire expansion of the children's health insurance program.
And lawmakers had to find the money by trimming payments for other health care providers who aren't very happy about it. Still, House Democratic leaders hope to have the bill on the floor next week, their last before the month-long summer break. That's when the Senate bill is also expected up for a vote.
Julie Rovner, NPR News, Washington.
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