Health care debate: The 'Iraq' of the domestic front

Bush called the press conference to call on Congress to send him a "clean'' health care bill, vowing to veto any "federalization'' of health care. White House Photo by Eric Draper.

by Mark Silva

President Bush's promise Thursday to veto a major expansion of government-paid health care for millions of children reflects the political stakes in a newly potent health care debate that is beginning to shake up Congress and resonate through the 2008 presidential campaign.

Just days after Sen. Rodham Clinton (D-N.Y.) made a splash with her own health plan, Bush abruptly called a press conference to strike back against Democrats' assertions that he is indifferent to children's health needs. A Democratic plan for greatly expanding the pool of children eligible for government-financed health insurance, the president warned, would move the country toward nationalized health care.

"I believe this is a step toward federalization of health care," Bush told reporters in the White House press room. "Their proposal is beyond the scope of the program, and that's why I'm going to veto the bill."

The increasingly vocal fight over health care, in Washington and on the campaign trail, reflects the public's growing anxiety over the cost and availability of medical coverage. More than a decade after President Bill Clinton's health reforms died amid concerns they would limit patients' choices, some analysts believe the public is now willing to consider significant changes to the system.

See the rest of the story in today's Tribune:

Still, Democrats remain wary of recommending an overly dramatic overhaul of a familiar system, while Republicans are being careful not to appear indifferent to the problems of the ill. It is against that backdrop that Bush on Thursday criticized some Democratic plans for letting many more families into the State Children's Health Insurance Program, or S-CHIP.

Bush, who has called for a more modest increase in S-CHIP, accused Democrats of holding the program hostage to "score political points." The program will expire Sept. 30 if it is not renewed.

"Instead of working with the administration to enact this funding increase for children's health, Democrats in Congress have decided to pass a bill that they know will be vetoed," Bush said.

But Democrats on Capitol Hill hope the promise of new care for young Americans will outweigh the president's promised veto. They believe it will pressure Republicans in Congress who could be faced with the prospect of denying coverage for millions of lower- and middle-income children in an election year.

House and Senate leaders have reached a compromise that would increase S-CHIP funding by $35 billion over five years, which Rep. Rahm Emanuel (D-Ill.) said would raise the number of insured children from 6 million to 9 million. Bush backs an increase of $5 billion, but Emanuel insisted the politics favor the Democrats.

"Health care on the domestic side is what Iraq is on the foreign policy side. It is a top issue," Emanuel said. "When you veto it, you own it."

The president "is going to veto 10 million kids' health care, and the problem is, Republicans are abandoning him," Emanuel added.

A number of Republicans in Congress are supporting the Democratic plan.

S-CHIP is aimed at children living in households with incomes too high to qualify for Medicaid but still unable to afford private insurance. The government pays 75 percent of the cost and states pay the rest. The program targets families that earn as much as twice the federal poverty level—$41,300 for a family of four this year. It has cut the number of uninsured lower-income children by one-third.

House Democrats initially had hoped to raise the income threshold for families qualifying for coverage to four times the federal poverty level, an annual income of nearly $83,000 a year for a family of four. That is the figure Bush cited in his press conference.

But Senate Democrats wanted to expand the program by less, and leaders of both houses reached a deal that would set the income limit at three times the poverty level—about $62,000 a year—at an added cost to the federal government of $35 billion over five years.

The Senate's plan would finance this with a boost in the federal cigarette tax of 61 cents per package. The House had envisioned a smaller cigarette tax increase, in addition to offsetting the new costs with savings in the Medicare program. Bush has vowed to veto congressional tax increases.

The president contends that Congress wants to transform a program devoted to health care for needy children to one that benefits middle-class families—encouraging them, in some cases, to drop the private insurance they already have and enroll in a government plan.

"Republicans believe we should renew S-CHIP to cover all low-income children who have no health insurance, not adults who already have health insurance," said House Republican Leader John Boehner (R-Ohio). "Time is running out for the S-CHIP program, and yet the majority seems intent on putting politics before the needs of low-income children."

Emanuel, noting that many Republicans have voted for the S-CHIP expansion in both the Senate and House, suggested that the Senate can override a presidential veto but allowed that a House override is less certain.

Sen. Chuck Grassley, an Iowa Republican and key supporter of the S-CHIP expansion, told the Des Moines Register that he personally pleaded with Bush before his news conference to accept a compromise. "I'm disappointed," Grassley said.

If, as Emanuel said, health care is the Iraq of the domestic policy debate, Senate Majority Leader Harry Reid (D-Nev.) is hoping to enlist a lot more Republican support than he has mustered on the war front.

"Democrats and Republicans came together to create the Children's Health Insurance Program 10 years ago, and we are coming together again to reauthorize and improve it before it expires in 10 days" said Reid. "But President Bush—who ran on the promise to enroll millions of more children in CHIP—is going back on his word and irresponsibly threatening to deny kids in working families the care they need."