Votes may be hazardous to parties’ health

Times Staff Writer

Sweeping healthcare legislation that would affect benefits for millions of children and seniors -- as well as the bank accounts of doctors and insurance companies -- comes up for floor votes this week in Congress, in a debate fraught with political risk for both parties.

Starting today in the Senate, with the House expected to follow later in the week, lawmakers will consider separate proposals to renew a popular federal-state program that provides health insurance for about 6 million children, mainly from low-income working families.

A bipartisan effort in the Senate has led to a compromise that would expand coverage of the State Children’s Health Insurance Program to about 3 million more children. But in the House, top Democrats are pushing a far more ambitious bill that would also make major changes to Medicare, a program for people who are 65 or older or who are disabled.


“It is going to be a high-profile battle,” said Robert Greenstein, executive director of the Center on Budget and Policy Priorities, a liberal group that advocates for the poor. “Particularly when you consider the House bill, this is the biggest piece of health legislation since the 2003 bill that created the Medicare drug benefit.”

Republicans are calling the Democrats’ action a step toward socialized medicine, and the Bush administration has vowed to veto both bills. The outcome will influence the course of the presidential election debate over how to cover about 45 million uninsured people in the U.S.; about 9 million of those are children.

The children’s program, known in California as Healthy Families, must be reauthorized by Sept. 30 or it will expire.

The House legislation would cover about 2 million more children than the Senate bill. It would also improve preventive care for Medicare recipients; provide more financial help to low-income seniors in the Medicare prescription plan; and reverse a 10% cut, scheduled for next year, in Medicare fees to doctors.

Both bills call for stiff increases in tobacco taxes to pay for expanded coverage for children. But because the House version seeks to help more children, seniors and doctors, it comes with a price tag tens of billions of dollars higher than the Senate’s.

To pay for the added benefits, House Democrats want to cut payments to private insurers in Medicare’s managed-care program. Nonpartisan congressional analysts say those payments are 12% too high when compared with the cost of covering seniors in the traditional Medicare program.

But most Republicans -- even those willing to confront the administration over expanding coverage for children -- are strong supporters of the Medicare managed-care program.

“What [the House] is going to do has no chance of being done in the Senate,” said Sen. Gordon H. Smith of Oregon, one of the Republicans backing the Senate plan. “President Bush is off the hook if the House is serious about cutting” Medicare managed care to pay for children.

The children’s program badly needs a new infusion of funds, and a healthcare policy standoff in Washington could jeopardize coverage for millions of families across the country. The National Governors Assn. is quietly encouraging approval of something close to the Senate plan.

“If Congress fails to agree on a common bill, the Democratic leadership will get blamed, and the story will be ‘Democrats can’t get things done,’ ” said Robert Blendon, professor of health policy and political analysis at the Harvard School of Public Health. “If it fails because of a presidential veto, then the Democrats can run saying, ‘The president stopped the expansion of coverage for children.’ Almost every poll shows the public strongly supports the principle of covering more children.”

The brewing clash has brought out some of Washington’s most influential lobbying groups. Backing the House bill are the American Medical Assn., seniors’ lobby AARP and many grass-roots liberal groups.

America’s Health Insurance Plans, a trade group, is trying to derail the House bill, citing estimates that 3 million out of more than 8 million seniors in Medicare managed-care plans would be dropped if the cuts go through. (They would return to traditional Medicare.)

And tobacco companies and anti-tax conservatives are trying to sink both bills.

Supporters of the House bill say they’re ready for a fight.

“This is a package that helps kids, helps seniors and helps doctors, and is opposed by the tobacco and insurance industries,” said John Rother, group executive officer of policy and strategy for AARP. “Which side do you think the public is going to line up with?”

Greenstein, of the antipoverty group, said Congress would probably have to roll back the 10% cut in Medicare doctors’ fees later this year. Lawmakers may find it advantageous to try to work out both issues at the same time, he suggested.

“There’s probably better than a 50-50 chance that the Senate will insist on taking out” the Medicare provisions, Greenstein said. “But if they can work out some Medicare changes, acceptable to the Senate, to finance a fix for the doctors, the overall bill may become stronger.”

Many conservative Republicans say they believe the votes this week will be a fork in the road for lawmakers.

Democrats brushed off Bush’s proposals this year for tax deductions to help the uninsured buy private coverage, saying the proposals would also have entailed major -- and controversial -- changes for people with employer-sponsored coverage. Now, Republicans say the Democrats’ move to expand and reinforce federal healthcare programs shows a bias toward a big-government solution.

“It’s a down payment on socialized medicine,” said Rep. Paul D. Ryan (R-Wis.), who is on the budget committee. He seeks to slow or block the legislation. “My constituents don’t want me to enact this. It’s an enormous tax on their children and grandchildren.”