GOP Leaders Fight Expansion of Children's Health Insurance

By Robert Pear

The New York Times

Wednesday 25 July 2007

Washington - Republican leaders of the House and Senate on Tuesday attacked proposals that call for a major expansion of the Children's Health Insurance Program, to be financed with higher tobacco taxes.

"Republicans will fight these proposals," said the House Republican leader, Representative John A. Boehner of Ohio.

In an unexpected turn of events, the top two Republicans in the Senate, Mitch McConnell of Kentucky and Trent Lott of Mississippi, said they opposed a bipartisan bill that the Senate Finance Committee approved last week and would offer an alternative on the Senate floor.

House Democrats announced their proposals on Tuesday night and estimated that they would provide coverage for five million children who are now uninsured. The Senate bill is expected to cover 3.2 million children.

Top House Republicans objected to the House Democrats' plan to finance their proposals, with increases in tobacco taxes and cuts in subsidies for private health plans serving older Americans on Medicare. Republicans say public coverage would in some cases replace private insurance.

"Dragging people out of private health insurance to put them into a government-run program is 'Hillary care' come back," Mr. Boehner said, referring to the Clinton administration plan for universal coverage.

House and Senate members are working on separate bills to expand coverage for children. Democratic leaders said they hoped that both chambers would approve the bills next week, before Congress begins a monthlong summer recess.

The House bill, developed entirely by Democrats, would increase spending on children's coverage by $50 billion over five years, providing a total of $75 billion.

The bill approved by the Senate Finance Committee, 17 to 4, calls for an increase of $35 billion, for a total of $60 billion.

In a letter to colleagues, Mr. McConnell and Mr. Lott said that the measure "imposes an open-ended financial burden on American taxpayers and takes a significant step toward a government-run health care system."

Six Republicans voted for the bill. Mr. McConnell said other Republican senators were concerned about "the size of the plan that came out of the Finance Committee and what that may portend for the future in terms of an entire government takeover of American health care and, in essence, a single-payer system down the road."

Representative Diana DeGette, Democrat of Colorado, a leading proponent of the House bill, said: "For the longest time, I was mystified why Republicans would oppose expansion of the Children's Health Insurance Program to kids who are eligible but not enrolled. Now I realize. They are trying to deny us a political victory. They want to be able to say that Democrats can't get anything done.

"Unfortunately," Ms. DeGette said, "Republicans are pursuing this strategy on the backs of poor children."

The Senate bill focuses on coverage for children. The House bill also calls for major changes in Medicare. It would, for example, halt a 10 percent cut in payments to doctors, scheduled for January, and would reduce payments for private insurance known as Medicare Advantage plans. Medicare typically pays the private plans more than it would cost to care for the same people in traditional Medicare. Many private plans offer additional benefits.

America's Health Insurance Plans, a trade group, announced a national television advertising campaign. The ads will urge older people to contact their members of Congress and speak out against the proposed cuts in payments to private insurers.

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To Fund Children's Health Plan, House Would Pay Insurers Less

The Associated Press

Wednesday 25 July 2007

To fund the $50 billion program expansion, Democrats would cut insurers' payments and raise cigarette taxes. Bush threatens veto.

Washington - House Democrats would rely less on tobacco taxes than the Senate would and more on cuts to Medicare insurers to pay for a proposed $50-billion expansion of a children's health insurance program.

The proposal, introduced late Tuesday, also would eliminate a 10% cut due next year in the reimbursement rate for doctors who treat Medicare patients. Instead, the legislation would give doctors a 0.5% increase in their reimbursement rates each of the next two years when they treat Medicare patients.

Democrats would pay for the expansion of the State Children's Health Insurance Program, or SCHIP, through a 45-cent increase in the federal excise tax on a pack of cigarettes. They would also lower payments to many insurance plans participating in the Medicare Advantage program over four years.

The Senate proposes spending $35 billion more for SCHIP, and would pay for it by increasing the tax on a pack of cigarettes by 61 cents. That would push overall spending for SCHIP over the next five years to $60 billion.

President Bush has indicated he would veto the Senate bill. The White House has recommended a $5-billion increase in the program.

"If he wants to veto healthcare for kids, historians will deal with that," said Rep. Pete Stark (D-Fremont).

The 10-year-old program subsidizes the cost of insuring children in families that earn too much to qualify for Medicaid but not enough to afford private insurance.

More than 6 million people, including about 600,000 adults, get health insurance coverage each year through SCHIP. The federal government pays for about 70% of the program, and the states pay the rest.

The House bill is more than 900 pages long and deals with much more than SCHIP. It would eliminate cost-sharing for preventive services in Medicare, such as cancer screenings. It reduces the co-payment on mental-health outpatient services from 50% to 20%.

The bill would also freeze reimbursement rates for some Medicare providers next year; namely, home health agencies, nursing homes and long-term-care hospitals. Such hospitals typically care for patients with complex needs who stay in the hospital more than 25 days.

It even takes on the new Medicare drug benefit. Now, Medicare recipients must have less than about $11,700 in assets to qualify for extra help in paying for their medicine. The House bill would increase that threshold to $17,000.

It also allows beneficiaries to change drug plans if the list of drugs covered changes during the course of the year. It would also allow coverage of benzodiazepines, a category of drugs often used in the treatment of anxiety disorders and insomnia.

The overall cost of the bill is about $90 billion over five years.

Republican leaders made it clear that they believed the proposed expansion of SCHIP was too large.

"It will continue to increase taxpayer-funded coverage for adults and middle-class children and move the United States toward a system of completely government-controlled healthcare," said Rep. Jim McCrery of Louisiana, ranking Republican on the House Ways and Means Committee.

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