President Obama signed legislation Wednesday to expand publicly funded health insurance for children, marking a historic shift in Washington's political landscape and providing the White House its biggest victory since Obama took office.
Less than two years ago, former President George W. Bush blocked similar bills by congressional Democrats, labeling the proposed expansion of the State Children's Health Insurance Program as a step toward government-run healthcare.
But with Democrats now firmly in control of the White House and Congress, the party's leaders easily pushed through a $33-billion bill that is expected to provide government-subsidized insurance to 4 million mostly low-income children.
That would reduce the number of uninsured children in America by about half over the next 4 1/2 years and boost the number covered by the program to 11 million.
The measure -- funded primarily by increasing the federal tax on cigarettes by 61 cents, to $1 a pack -- sailed through the House earlier Wednesday on a largely party-line vote of 290 to 135. The Senate overwhelmingly approved the bill last week.
The swift passage came in marked contrast to the economic recovery package, which is mired in debate on Capitol Hill despite pleas from Obama for congressional action.
The bill was an early benchmark in the Democrats' planned campaign to reshape the nation's healthcare system over the next two years.
"The way I see it, providing coverage to 11 million children . . . is a down payment on my commitment to cover every single American," Obama said before signing the bill in the East Room of the White House.
The new president also drew on language from an earlier era, when Washington more openly embraced the expansion of the government-funded safety net. "We're not a nation that leaves struggling families to fend for themselves," he said.
SCHIP, as the program is called, was created in the late 1990s when President Clinton and a Republican Congress addressed concerns that some families who earned too much to qualify for public assistance through Medicaid could not afford insurance for their children.
The federal poverty line for a family of four was $21,200 in 2008, while family insurance premiums averaged about $12,680, according to the Kaiser Commission on Medicaid and the Uninsured in Washington.
Most of the 7 million children enrolled in SCHIP nationwide come from families with incomes of less than twice the poverty line. However, several states have opened the program to families that make more.
About 30 million of the nation's poorest children receive healthcare through Medicaid.
Democrats made expanding the popular children's healthcare program a top priority when they took control of Congress in 2007 after 12 years of mostly Republican control.
Bush vigorously opposed the move, twice vetoing SCHIP legislation despite substantial GOP support for the bills.
On Wednesday, Republican lawmakers echoed many of the former president's critiques.
"The Democrats continue to push their government-run healthcare agenda -- universal coverage, as they call it," said Rep. Pete Sessions (R-Texas), who helped lead opposition to the bill.
Republicans also chafed at provisions that would allow states to provide insurance to the children of legal immigrants who have been in the country for less than five years and loosen identification requirements for those enrolling. Advocates for immigrant rights hailed the moves.
GOP lawmakers said that would result in illegal immigrants also receiving taxpayer assistance. They also complained that the bill did not do enough to ensure that the most needy children receive coverage.
Republicans called for rules that would prohibit states from offering insurance to middle-income families unless states could ensure that more lower-income children had been enrolled, a requirement that many SCHIP advocates said was unworkable.
But GOP lawmakers could do little to slow the momentum. Groups including the insurance industry, organized labor and the March of Dimes rallied behind the legislation.
But there also were signs of the difficulties that may confront the new president and his Democratic allies in their push to win over Republican support for overhauling the nation's healthcare system.
The SCHIP bill attracted just 40 Republican votes in the House on Wednesday, fewer than similar legislation won in 2007.
Democratic leaders quickly joined Obama in casting the bill as a prelude to their more sweeping healthcare agenda.
"This is the beginning of the change that the American people voted for in the last election and that we will achieve with President Obama," House Speaker Nancy Pelosi (D-San Francisco) said on the House floor.