Battle lines emerged last week over two wildly different legislative blueprints that aim to reauthorize and expand the State Childrens Health Insurance Program. Members from both chambers of Congress and the White House itself were embroiled in political one-upmanship just days before an actual bill is expected to emerge.
The three-way scrum set the stage for a lengthy debate over how much funding SCHIP should get and how far lawmakers should go to expand eligibility requirements.
At issue is a House blueprint for a bill that not only funds SCHIP at $50 billion over five years, but also includes a raft of additional healthcare provisions championed by hospital and physician interest groups. All told, the House proposal could cost nearly $100 billion. Meanwhile, a Senate blueprint plays it straight, with a $35 billion expansion of the program, according to multiple sources. Funding for both bills would be spread over five years.
While both bills would rely on a proposed 61-cent increase to the federal tobacco tax for funding, the Houses version would also slash payments to some Medicare Advantage plans. The Senate bill, according to sources, would not. Under congressional paygo rules, only offsetting funds can be used to finance new legislation. The Senate Finance Committee is expected to complete its bill on July 17.
Ron Pollack, executive director and vice president of Families USA, which has actively lobbied members of Congress to bolster funding for the program, praised the bipartisanship of the Senate deal, but said that more money would ultimately be needed. The idea is to cover all children who are currently eligible and are uninsured, he said. Thirty-five billion over five years is not going to do it.
But Pollack also said he is confident that the House and Senate can hammer out a workable compromise. While the differences between the congressional blueprints are significant, he said, theyre not overwhelming.
Adding to the pressure is an increasingly vocal White House, which in recent weeks has chided lawmakers for overstepping what it says is the original intent of SCHIP. In a speech last week in Cleveland, President Bush used some of the strongest language yet to hint at a possible veto if an SCHIP bill would encourage people to transfer from the private sector to government healthcare plans lands on his desk.
The speech prompted Republicans on the Senate Finance Committee to call on President Bush to stop an administration practice of granting and extending waivers that allow states to enroll adults in SCHIP. In letters sent to both Bush and HHS Secretary Mike Leavitt, Sens. Chuck Grassley (R-Iowa), Orrin Hatch
(R-Utah) and Pat Roberts (R-Kan.) said that they were committed to returning the federal-state program to its focus on low-income children, but that HHS-administered waivers have allowed states to enroll more and more adults in SCHIP.
The mess created by the waivers makes it even more difficult to reauthorize SCHIP, said Grassley, the leading Republican on the committee, in a written statement.