House votes to expand health insurance to 4 million more children

WASHINGTON -- Making a down payment on president-elect Barack Obama's promise of universal health coverage, the House voted Wednesday to expand government-sponsored insurance to 4 million more children in working families with income too high to qualify for Medicaid.

Between 300,000 and 600,000 of the new enrollees could be non-citizen children of legal immigrants who have been in the country less than five years, a sticking point for some Senate Republicans who will consider a similar bill.

Obama said he hoped the Senate acts with the "same sense of urgency so that it can be one of the first measures I sign into law when I am president."

"In this moment of crisis, ensuring that every child in America has access to affordable health care is not just good economic policy, but a moral obligation we hold as parents and citizens," he said.

Forty Republicans joined Democrats in passing the bill 289-139. Congress passed similar legislation in 2007 but it was vetoed both times by departing President Bush.

The bill would raise the federal excise tax on cigarettes by 61 cents to $1 a pack to pay for the $32.3 billion cost of expanding the State Children's Health Insurance Program for the next 4 1/2 years. Other tobacco products would experience a comparable tax increase.

About 7 million children now get government-sponsored health care through SCHIP.

The Senate Finance Committee is scheduled to begin writing a similar bill today. Democrats would like to send a House-Senate compromise to Obama for his signature in coming weeks as an early victory signifying the party's control of both the White House and Congress for the first time since 1994.

"This is only the beginning of the change we will achieve with our new president," said House Speaker Nancy Pelosi, D-Calif., who got a congratulatory call from Obama after the vote.

The Congressional Budget Office projected that nearly 83 percent of the 4.1 million uninsured children who would gain coverage are in families with incomes below current eligibility limits. About 700,000 children would gain coverage because their states broadened eligibility.

Most of the children who gain coverage live in families with incomes of less than twice the federal poverty level -- $42,400 for a family of four, analysts said. However, some states have expanded their programs to cover families with more moderate incomes, as much as three times the federal poverty level -- or $63,600 for a family of four.

Republicans pointed to budget office estimates that the bill would shift 2.4 million children currently with private coverage to government-provided care.

"The priority of SCHIP should always be to serve those children most in need of assistance, not subsidize those who already have access to private insurance," said Rep. Darrell Issa, R-Calif.

They also objected to the additional spending.

"The kids will have to pay through the nose for the things we are doing today," said Rep. Dan Burton, R-Ind. "We don't have the money to do all these things."

Democrats dismissed both arguments

"Forty days in Iraq equals over 10 million children in America insured for one year," Pelosi said. "We certainly can afford to do that."

Opponents also said the tobacco tax increase would not be enough to keep pace with the growing costs of health care. As a result, lawmakers down the road will have to cut children from the program or increase taxes. They said the latter option is more likely.

"The Democrats are blowing a giant cloud of smoke into the face of the American taxpayers, and I believe the impending tax increases that must come to cover this program will have us all in a severe coughing fit," said Rep. Dave Camp, R-Mich.

The bill would provide coverage for pregnant legal immigrants in addition their non-citizen children who entered the U.S. in the past five years.

Current law requires a five-year waiting period before legal immigrants become eligible for coverage under Medicaid and SCHIP. Supporters say expanding coverage would mean children could get treatment for acute conditions like asthma and diabetes so they were less likely to need care in an emergency room.

"These are not illegal immigrants. They are children who go to school, go to day care with our children, our grandchildren," said Rep. Gene Green, D-Texas. "Those children ought to have health care."

Passage of the bill follows House votes last week on two labor bills that Democrats also hope to send to the White House this month. One was a response to a U.S. Supreme Court decision that put strict time limits on when a worker may sue an employer for pay discrimination and the other specifies that victims of pay discrimination may get compensatory and punitive damages in court.

The Senate was scheduled to begin debate Thursday on that first labor bill, named for Lilly Ledbetter, a former supervisor at a tire factory in Alabama who was denied compensation because she was not aware for years that she was receiving less pay than male co-workers.