With his long-promised veto Wednesday of a bill to expand health insurance for children, President Bush has ignited an ideological battle that could well rage on into next year’s presidential campaign.
At bottom, the issue is whether government should take the lead in extending healthcare benefits to uninsured children -- mostly in low-income families but some in middle-class ones -- or whether the task should be left primarily to the private sector.
The State Children’s Health Insurance Program, managed by states within federal guidelines, also has become entangled in Bush’s late-inning effort to help the GOP recapture its image of fiscal restraint after six years of budget deficits and increased federal spending.
Both Democrats and Republicans seem convinced that they will gain more from confrontation than from compromise. Democrats will try to override Bush’s veto in two weeks with a vote requiring a two-thirds majority. The effort is likely to fall short, even though the bill had significant Republican support.
If the veto stands, Democrats said, they will repass the measure without significant changes and send it back to the White House. That would force the GOP to go on record again as opposing expansion of a program that currently serves about 6 million children, including about 800,000 in California. An estimated 9 million children remain uninsured nationwide, and the number has been rising as employers cut back coverage.
Bush on Wednesday cast the issue in terms of those who want to help the poor and those who want to increase the size and cost of government.
“The policies of the government ought to be to help poor children and to focus on poor children, and the policies of the government ought to be to help people find private insurance, not federal coverage,” he told a crowd of business leaders in Lancaster, Pa. “And that’s where the philosophical divide comes in.”
On the Democratic side, the line of attack was laid down by Rep. Jim Cooper of Tennessee. “This has got to be up there with motherhood and apple pie. This is Tiny Tim. And who is against Tiny Tim? The only person in all of literature was Ebenezer Scrooge,” he said, referring to the crippled boy and hardhearted man in Charles Dickens’ “A Christmas Carol.”
Cooper, a fiscal conservative who voted against a more expansive version of the bill this summer, said Bush “is playing into Democratic hands. Either the program will get passed and he’ll look like Ebenezer Scrooge, or we won’t override the veto and he still looks like Ebenezer Scrooge.”
The political bind for Republicans -- particularly those in swing districts -- is reflected in polls that show broad public support for covering uninsured children. Sen. Orrin G. Hatch (R-Utah) called it “the morally right thing to do.”
The issue also carries risks for Democrats. Having scaled back their ambitions during negotiations with leading GOP senators, they have pledged to make no further compromises. And they could get blamed for politicizing a well-established program that has been seen as a bipartisan success story.
The program, known in California as Healthy Families, was created to help children of the working poor -- low-income families who earned too much to get free coverage under Medicaid but could not afford private insurance.
The current law, which remains in effect while the struggle over a long-term extension goes on, covers children in families earning up to about $40,000 a year, roughly twice the federal poverty level.
But some states have won permission to extend eligibility to families with higher incomes. The bill approved by Congress would permit states to expand eligibility to about three times the poverty level, or just more than $60,000 a year.
The congressional bill would spend $60 billion over five years to expand the program to cover 9 million to 10 million children, and pay for it with higher tobacco taxes. Bush has offered $30 billion, a 20% increase over current levels but not enough maintain the existing enrollment, budget analysts say.
“There clearly is a rationale to argue that families with incomes of $64,000 should not get government-paid insurance. But that said, it will take some superb communications to persuade voters that the White House really is on the side of children’s health,” said Whit Ayres, a GOP pollster.
Gov. Arnold Schwarzenegger, who is pursuing coverage for all Californians, issued a statement saying he was “deeply disappointed” by the veto. But Bush got support from Republican presidential candidate John McCain. In an interview with CNN, the Arizona senator said it was the “right call by the president.”
A House vote on whether to override Bush’s veto is scheduled for Oct. 18, giving supporters two weeks to persuade vacillating Republicans. Whereas the bill passed the Senate by a veto-proof majority, the 265-159 House vote failed to reach the two-thirds margin -- 290 if every House member votes.
House GOP leaders say they are confident they will sustain the veto, though some acknowledge it will be a difficult vote.
“Politically, on the face of it, it’s a very risky vote for Republicans,” said Rep. Jim McCrery (R-La.), a leader on healthcare issues. “But from a policy standpoint, we’re very confident.”
Backers of the plan would need to peel off at least 17 Republicans to have a shot at overriding the veto. Democrats say they will keep sending the bill back to the White House until Republicans are forced to back down.
“At the end of the day, people will tire of that,” said Rep. Mary Bono (R-Palm Springs), a supporter of the legislation. “People will call it for what it is -- political gamesmanship.”
Bono said she would vote to override Bush’s veto. But, reflecting the charged nature of the debate in the House, she said no Democrats tried to enlist her help, although in the past she has reached across the partisan aisle on social issues.
With groups ranging from the liberal MoveOn.org to Catholic Charities USA calling for passage of the bill -- not to mention the medical establishment and the insurance industry -- supporters believe they have a reasonable chance. They point to lawmakers who have had a change of heart.
Last week, Rep. Dan Boren, a conservative Democrat from Oklahoma, voted against the compromise legislation. But after spending the weekend in his district, which includes rural communities with many low- income residents, Boren announced that he would vote to override Bush’s veto.
In an interview, Boren said his concerns about covering middle-class families were allayed because states will get to set their own income guidelines under the legislation.
He still has qualms about the tobacco tax.
“I visited with different groups, ranging from the [American] Cancer Society to others, but I can’t point to one person who swayed me,” Boren said.
“At the end of the day, these kids in my district need the help. These are kids who are uninsured and need the money.”
(BEGIN TEXT OF INFOBOX)
Youth health plan
President Bush vetoed legislation to expand the State Children’s Health Insurance Program, which mainly serves children of the working poor. The House is to vote Oct. 18 on whether to override the veto. Here are some highlights of the bill:
* Spends $60 billion over five years to expand the program.
* Boosts tobacco taxes, raising levy on cigarettes by 61 cents to $1 a pack.
* Covers as many as 10 million children, compared with 6 million now.
* Expands dental and mental health benefits.
* Provides incentives for states to enroll low-income children.
* Allows states to offer benefits to middle-class uninsured children.
* Discourages states from enrolling children in families that earn more than $60,000 a year.
* Allows states to subsidize employer-sponsored coverage.
* Allows states to cover low-income pregnant women.
* Phases out existing coverage for adults in some states.
* Leaves in place a ban on benefits for legal immigrants here less than five years.
Source: Los Angeles Times reporting.