Legislation expanding a federal children’s health insurance program was headed for likely House passage at press time Wednesday evening, giving the Democratic leadership a win on one of its top priorities as Congress heads toward the August recess.

An intensely partisan debate was fought over the bill, which would add 5 million children to the rolls of the State Children’s Health Insurance Program (SCHIP), increase tobacco taxes and scale back Medicare subsidies to private health insurance companies. The expected House passage brought to a close weeks of vote wrangling, with each party hoping to draw off votes from the other side.           

But a Democratic victory on the bill may be short-lived. President Bush is staunchly opposed to the bill and has promised to veto it. Moreover, the House bill is substantially larger than the Senate counterpart, also being debated this week, which sets up a difficult conference committee process.

The SCHIP-Medicare legislation is the largest healthcare bill to pass the House since the Medicare prescription drug benefit was created in 2003. The political stakes are high, as both parties position themselves for the debate on broad healthcare reform going into the 2008 elections.

Democrats characterized the bill as an opportunity to extend healthcare coverage to vulnerable, poor children. Republicans countered that the measure amounts to a massive increase in federal spending and a step toward socialized medicine. They also warned it would gut Medicare Advantage, a program through which private health plans provide Medicare benefits.           

The House bill would add more than $50 billion to SCHIP over five years and spend more than $20 billion to replace a looming 10 percent cut in Medicare fees for doctors with a small increase for two years. To offset these costs, the measure would raise the per-pack cigarette tax by 45 cents, carve about $50 billion from Medicare Advantage, and freeze or cut Medicare payments to nursing homes and other medical providers.

Democrats were making changes to the measure as late as Tuesday evening to keep it in line with pay-go budget rules and lock in votes from reluctant members.

But Republicans unleashed an arsenal of procedural weapons to slow progress on the bill. Ways and Means and Energy and Commerce committee Republicans forced readings of the entire bills during mark-ups last week.

The GOP stepped up its procedural protests on Tuesday night, using an open rule on the Agricultural Appropriations bill to give speeches about SCHIP, despite the loud accusations from their Democratic colleagues that they were obstructing the process.
Republicans continued their protest into Wednesday.

Rep. John Shadegg (R-Ariz.) said Wednesday afternoon that the lack of input in the Energy and Commerce Committee’s health subcommittee on the bill caused it to be a flawed product.

“There was no hearing in the subcommittee, there was no legislative hearing in the full committee, there was no mark-up in the subcommittee,” he said. “There was never a single word of testimony.”

While the conservative Republican Study Committee held out firmly against the bill, Democratic leaders quietly reached across the aisle to their centrist Republican colleagues to ensure they had the votes they need to pass the massive initiative.

“Democratic leadership has been reaching out to us, mostly in ones and twos,” said one centrist GOP lawmaker, who added that the bill’s Medicare provision has caused some Democratic members to squirm.            

Whipping members of the opposition party became necessary as Democrats realized that some members of their own party were solidly opposed to the bill.

On Wednesday, Rep. Rahm Emanuel (D-Ill.) delivered tailored press releases to media in the home districts of 26 Republican lawmakers, calling upon Republicans to “stand up for America’s uninsured children and help ensure kids across the country can see a doctor and get the medicine they need.” The statements were modified to include the names of the lawmakers targeted, their states, and the number of children in their states enrolled in SCHIP.

Emanuel’s effort to peel off Republican votes mirrors a strategy employed this week by the Republican leadership, which highlighted the tobacco tax, spending and Medicare. That tactic specifically targets Democrats from Southern states, Blue Dogs and lawmakers worried about cuts to the Medicare Advantage program, respectively.             

Republicans also circulated an April letter from the Blue Dog Democrats stating their unequivocal opposition to any increase in tobacco taxes. Writing to thank Budget Committee Chairman John Spratt (D-S.C.) for leaving tobacco taxes out of the budget resolution, Rep. John Tanner (D-Tenn.) and 14 colleagues wrote, “Federal tobacco excise taxes should be viewed no differently than other tax increases that have been suggested and rejected.”