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Obama Signs Expansion of Children's Health Program

By Drew Armstrong, CQ Staff

FEBRUARY 4, 2009 -- President Obama on Wednesday signed into law a major expansion of health insurance for children, delivering on a Democratic campaign promise and finishing what Democrats tried and failed to do in the last Congress.

Obama signed the legislation (HR 2) just hours after the House had cleared it, underscoring the difference in the political landscape wrought by the 2008 elections.

President Bush twice vetoed similar bills in the 110th Congress.

The House passed the measure by 290-135. No amendments were allowed under the rule that brought the bill to the floor.

Obama said that with enactment of the bill reauthorizing and expanding the State Children's Health Insurance Program (SCHIP), "we fulfill one of the highest responsibilities we have: to ensure the health and well-being of our nation's children.

"It is a responsibility that has only grown more urgent as our economic crisis has deepened, health care costs have exploded, and millions of working families are unable to afford health insurance," the president said.

The House first passed the legislation Jan. 14 by 289-139. The Senate amended it and passed it Jan. 29 by 66-32.

House Majority Leader Steny H. Hoyer, D-Md., described the expansion of the State Children's Health Insurance Program, or SCHIP, as a first step toward making sure all Americans have health insurance coverage.

He compared the problem of America's estimated 46 million uninsured—a figure climbing rapidly in the economic recession—to a leaking ship. "We can't patch every hole today, but if I could choose one leak to stop, it would be the hold where we keep our poor children," Hoyer said.

The bill would provide $32.8 billion extra over the next four and a half years for the program, an amount estimated to allow coverage of an additional 4.1 million children. The program covered about 7 million in 2008.

SCHIP, a joint federal-state program, was created in 1997 under a Democratic president and Republican Congress to provide health insurance to children in families that are low-income, but not poor enough to qualify for the larger Medicaid program. It was initially funded at $40 billion, to be spent over 10 years, and has been credited with reducing the number of children in the nation without health insurance.

"This is the same bill, by and large, that we passed in the House by an overwhelming bipartisan majority two weeks ago," said House Energy and Commerce Committee Chairman Henry A. Waxman, D-Calif.

There were a few differences between the original House bill and the final version, as amended by the Senate.

The Senate added a state option to provide dental insurance, boosting to 62 cents per pack the cigarette tax increase that will fund the SCHIP expansion. That will more than double the current excise tax to a total of $1.01 per pack. The original House version called for a 61-cent tax increase.

Republican Objections

This year's bill would allow legal immigrant children who have been in the United States for less than five years to enroll, a change from legislation passed and vetoed by President George W. Bush in 2007. That change, along with higher family income eligibility limits and less strict identity checks for enrollment, caused Republicans in both chambers to speak out against the bill.

Rep. Joe Barton of Texas, ranking Republican on the Energy and Commerce Committee, said the program should be targeted to children in families with incomes at or less than 200 percent of the poverty level. He also said stricter rules were needed to keep illegal immigrants out of the program.

"None of those things are met in this bill," Barton said.

The immigrant issue has become a major bone of contention. Democrats loosened identity check and enrollment requirements in order to get more kids into the program.

"You have to show your ID before you cash a check at the grocery store," argued Rep. Michael C. Burgess, R-Texas. "Why should we not require someone to show identification before they sign up for this benefit?"
Sens. Charles E. Grassley, R-Iowa, and Orrin G. Hatch, R-Utah, both voted against the bill in the Senate last week, and Burgess pointedly reminded Democrats of that change of heart. The two GOP senators were key supporters of the SCHIP bill in 2007.

"What does it say about a bipartisan bill when the two principal Republican sponsors in the other body withdrew their support for this bill as it came through the Senate?" asked Burgess.

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