Lawmakers Nearing Agreement on SCHIP Reauthorization, Expansion Legislation That Would Increase Funding by $35B Over Five Years

House and Senate negotiators on Sunday said they have reached a tentative agreement on a framework for compromise SCHIP legislation that would expand enrollment to an additional four million uninsured children, the New York Times reports. The draft compromise bill closely resembles the Senate version of SCHIP legislation, according to the Times (Pear, New York Times, 9/17).

A measure approved by the Senate (S 1893) would reauthorize SCHIP and increase the federal cigarette tax by 61 cents per pack to boost funding for the program by $35 billion over five years. The House version (HR 3162) would reduce payments to Medicare Advantage plans and increase the federal cigarette tax by 45 cents per pack to increase funding for SCHIP by about $50 billion over five years. The bill also would make a number of revisions to Medicare (Kaiser Daily Health Policy Report, 9/13).

Under the proposed compromise, SCHIP would receive an additional $35 billion in funding over the next five years, bringing total spending on the program to $60 billion. The additional funding would be paid for by an increase in the tobacco tax, which would be "generally similar" to the 61-cent-per-pack tax proposed in the Senate version of the legislation, according to the Times.

The compromise legislation "is likely to roll back some" of the new enrollment rules, but it "would probably not eliminate all of them," the Times reports. The rules, announced by the Bush administration last month, would require states to enroll at least 95% of children with family incomes below 200% of the poverty level who are eligible for Medicaid or SCHIP before expanding SCHIP eligible above 250% of the poverty line. In addition, the bill would affirm states' right to decide who qualifies for enrollment in the program.

The bill does not include revisions to Medicare that were included in the House version of the bill because the provisions are "vehemently opposed by Republicans," according to the Times. Senior Democrats in the House and Senate said that Medicare revisions will be addressed in separate legislation later this year. According to the Times, while some details "have yet to be decided," aides "predicted that Congress would approve the compromise before the" program expires on Sept. 30 (New York Times, 9/17).

Bush, Republican Response
President Bush has threatened to veto the measure, according to the Washington Post (Washington Post, 9/15). White House spokesperson Tony Fratto said, "We have issued veto threats against both the House and Senate bills. So the House moving toward the Senate position is not sufficient." Fratto added, "The House and the Senate still appear to be far away from legislation that we would find acceptable."

While the bill "is likely to pick up some Republican votes in the House," it will "probably not" be enough to override Bush's veto, according to the Times (New York Times, 9/17). Brian Walton, spokesperson for the Republican National Committee, said, "Democrats have decided to use SCHIP as yet another vehicle to try to increase government control of health care and slip tens of millions of dollars of extra spending in the budget" (AP/Boston Herald, 9/15).

Comments
A Senate aide said, "There are still details being worked out, but there has been a realization in the House that the final bill needs to be closer to our bill," adding, "There is a new spirit of 'We've got to get this done,' -- $35 billion is the number everybody is zeroing in on" (Los Angeles Times, 9/15).

Sen. John Rockefeller (D-W.Va.) said, "I'm increasingly optimistic that we're going to have a deal. The House and Senate are working day and night to put together a framework that both Democrats and Republicans can support." Rockefeller said that while neither the Senate nor the House will be completely satisfied, "we are very close to a compromise that will protect the health and future of millions of children."

Rep. Rahm Emanuel (D-Ill.) said, "If the president signs the bill we present to him, it's a major accomplishment," adding, "If he vetoes the bill, it's a political victory for us. Public opinion polls show strong support for expanding kids' health coverage" (New York Times, 9/17).

Sen. John Kerry (D-Mass.) called Bush's veto threat and possible program expiration "unconscionable," adding that if the program expires, "children will die and some will end up with permanent disabilities" (AP/Boston Herald, 9/15).

Ron Pollack, executive director of Families USA, said Democrats "don't want to be in a situation where any delay (in renewing the program) was occasioned by Congress," adding, "They want to get this done and let the onus be on the president for vetoing it" (Alonso-Zaldivar, Los Angeles Times, 9/15).

Broadcast Coverage
American Public Media's "Marketplace Morning Report" on Monday reported on SCHIP. The segment includes comments from John Sweeney, president of the AFL-CIO; Maria Ghazal, director of public policy for the Business Roundtable; Janet Trautwein, executive vice president and CEO of the National Association of Health Underwriters; and Dennis Smith, director of the Center for Medicaid and State Operations (Dimsdale, "Marketplace Morning Report," American Public Media, 9/17). Audio and a transcript of the segment are available online.