Congress Poised for Ideologically Charged Battle over Health Care

WASHINGTON — Congress this week is poised to fight a major battle in the ideological war over the future of American health care.

The Democrats who control both houses of Congress have focused on the State Children's Health Insurance Program as a vehicle for providing health coverage to at least 6 million of the roughly 9 million uninsured children in America.

President Bush and conservative think tanks have warned that Democrats' real goal is to expand the federal role in health care to pave the way for a government-provided health care system. Bush has threatened to veto legislation that would dramatically expand the children's health program.

Unless Congress and the president can resolve their differences by Sept. 30, the 10-year-old federal-state program will expire.

Nationwide, the program covers 6.6 million low-income children, but the Congressional Budget Office estimates that another 6 million of the roughly 9 million uninsured children in the United States would qualify for coverage.

It now costs the federal government $5 billion a year, with varying matching amounts contributed by the states. Bush has proposed that over the next five years the amount be increased by $5 billion, from a total of $25 billion to $30 billion.

The House is considering an increase of $50 billion over the next five years, and the Senate is considering an increase of $35 billion. Democratic leaders in both chambers are planning for a vote on their proposals this week before Congress breaks for a five-week recess.

Whatever expansion is adopted will affect states differently. Some states, such as Georgia, have been running out of federal money to support their version of the program. Others, like Florida, have not spent all their federal money. Since 1998, Florida has given up about $140 million in federal money that has been reallocated to other states, said Tara Klimek, spokeswoman for Alex Sink, Florida's chief financial officer.

To pay for the House bill's increase, Democrats have proposed reducing payments to privately managed Medicare Advantage plans to make them equal to payments health care providers receive under the traditional Medicare fee-for-service program. In addition, the House bill would hike cigarette taxes by 45 cents a pack.

The Senate bill relies solely on tobacco taxes, boosting cigarette taxes 61 cents a pack, to $1, and also raising taxes on cigars and other tobacco products.

Bush has not directly addressed the House bill, but in threatening to veto the less ambitious Senate bill, he called it "the beginning salvo of the encroachment of the federal government on the health care system."

The president also suggested the bill, which would allow states to cover children in families with income up to three times the federal poverty level, would "open up an avenue for people to switch from private insurance to the government."

Florida Sens. Bill Nelson, a Democrat, and Mel Martinez, a Republican, represent the two ideological sides of the debate over expanding the federal children's health program.

Nelson said the philosophical issue of whether the government has a role in health care was resolved in the mid-1960s with the creation of the Medicaid and Medicare programs.

"The government has a role for low-income children of helping them with their health," Nelson said, adding that "ultimately it will save us money because, in the long run, if you could do preventive care now, it's going to cost us a lot less in the future."

But Martinez argued that: "We should use government as a last resort, we shouldn't resort to government as the first option. It's too costly. A $1,500 policy will insure a child in Florida for a year. The same cost to government is over $2,500. Government just doesn't do it as well as the private sector.

"I don't think there's any question that it's the first step towards socialized medicine," Martinez said. "This is the first step towards a government-run health care system in America for all Americans."

While Democrats are united behind efforts to expand SCHIP, not all Republicans agree with Bush's limited proposal.

Sen. Charles Grassley of Iowa, the ranking Republican on the Senate Finance Committee, and Sen. Orrin Hatch, R-Utah, were among the leading supporters of the Senate's plan to expand the program.

Efforts to expand the program also have won support from a broad spectrum of interest groups that often disagree over health care policy, including the American Medical Association, AARP, Families USA, and America's Health Insurance Plans, the managed-care industry's trade group.

But while many of those groups earlier this year saw the expansion of SCHIP as a way to reduce the total number of uninsured Americans, roughly 47 million. But with the exception of coverage for pregnant women, the bills in both houses would phase out coverage of adults.