House, Senate Budget Negotiators Approve Total of $99B for Expanded Uninsured Coverage; Could Be ‘Biggest Boost’ Since Medicare

House and Senate leaders on May 3 hammered out a compromise budget resolution that includes a provision allocating an additional $28 billion over three years toward providing health coverage for the nation's uninsured population, the Los Angeles Times reports. This funding would be added to the $71 billion President Bush has proposed for tax credits aimed to help low-income families purchase health insurance over 10 years. However, the $28 billion health care spending provision carries no specific spending requirements; Congress would have to pass separate legislation stipulating how and where to spend the funding. If the budget is approved in both chambers of Congress, the combined $99 billion health care package would represent "the biggest boost in the government's effort to help the uninsured since Medicare was created in 1965," the Los Angeles Times reports. (Rosenblatt/Hook, Los Angeles Times, 5/4). The provision allocating $28 billion was originally drafted by Oregon Sens. Gordon Smith (R) and Ron Wyden (D) and had been attached to the Senate version of the budget resolution. The Smith-Wyden proposal called for Congress to allocate $28 billion over three years toward a plan that would broaden health coverage through a combination of Medicaid and CHIP program expansions and tax deductions for employers who help their low-income workers pay for private insurance. During final negotiations on May 3, Sen. Phil Gramm (R-Texas) "tried to insist" that the funding be spread out over 10 years, but Smith said this "would have hollowed out our effort." During negotiations, Smith and Gramm agreed to keep the funding limited to three years, but included a clause that would also allow the money to be used for "a measure providing for tax deductions for the purchase of health insurance for, among others, moderate income individuals not receiving insurance from their employers" (Rovner, CongressDaily, 5/3). The House, which had not included a similar provision in its budget plan, "accepted" the Senate proposal during negotiations yesterday. During final budget negotiations lawmakers also agreed to scale back the increase in discretionary spending from 5% to the 4% the White House had "originally sought."

Will the Compromise Hold?
Many lawmakers have expressed "strong support" for the additional spending on health coverage, revealing that a "sense of cooperation among unlikely political allies is helping move the issue of the uninsured to a higher prominence than at any time since" discussions over former President Bill Clinton's health reform plan in 1994, the Los Angeles Times reports. Smith said of the negotiations, "In a time of surpluses and tax cuts, the U.S. Congress can find a bit extra to help those who work hard, play by the rules, but simply cannot afford health insurance for themselves and their families." Ron Pollack, executive director of Families USA, said, "It's a remarkable situation, with the possibility of spending the largest amount of money in more than three decades." However, the provision is "sure to be opposed" by some GOP lawmakers who "want to keep government spending in check," the Los Angeles Times reports. Meanwhile, some Democrats "can be expected to question whether Bush's tax credit plan would go far enough" in helping to shrink the ranks of the uninsured (Los Angeles Times, 5/4). Smith and Wyden agreed that there will likely be debate between those who wish to expand public health insurance programs and those who would like to promote coverage through tax credits and the private sector. "What this does is telegraph the battle lines for the fight ahead," Smith said. Wyden added, "What we've learned in the last 24 hours is that this is going to be a very vigorous, tough debate" (CongressDaily, 5/4). The Bush administration "has not signaled objections" to the additional health spending, but in general, budget provisions are "nonbinding and are likely to change before the year is out," the Los Angeles Times reports. House leaders planned to pass the budget measure early this morning, but had to postponed the vote because of a clerical error. A Senate vote is set for Tuesday (Los Angeles Times, 5/4).