WASHINGTON – President Barack Obama and his congressional allies took a modest step toward reshaping the nation’s health care system Thursday as the Senate passed legislation to expand health insurance for children.
But rather than building momentum for the sweeping reform Obama has promised, the victory on Capitol Hill – a largely party-line 66-32 vote – marked a rocky start for what many hope will be the biggest reform campaign in a generation.
“To start out the year on this note does not bode well for future health care discussions, including health reform,” Sen. Orrin Hatch, R-Utah, said as the Senate debated the children’s health insurance bill, which would enlarge the current program for helping children of the working poor.
Like Wednesday’s battle over the economic stimulus package, expansion of the State Children’s Health Insurance Program became engulfed in a partisan struggle. The stimulus debate also showcased several skirmishes among interest groups, despite the consensus that seemed to be developing around health reform.
Business and consumer groups scuffled over federally subsidized health insurance for jobless Americans in the stimulus package. Insurers faced off with privacy advocates over access to patients’ electronic health records, which the stimulus bill would promote.
And foreshadowing what probably will be a much larger debate, Republicans rebelled at Democratic moves to expand the federal government’s role in providing health insurance.
Just nine GOP senators backed the children’s health bill Thursday, nine fewer than backed similar legislation in 2007.
The current bill – which parallels one approved in the House two weeks ago – would cover an additional 4 million children at an estimated cost of nearly $33 billion over the next 4 1/2 years.
SCHIP, as the program is called, helps states provide health insurance for families that earn too much to qualify for Medicaid, the federal medical insurance program for the poor, but not enough to buy private insurance.
In the past, the program has enjoyed extensive bipartisan support, although Democrats and Republicans have differed over how much families could earn before their children became ineligible.
Advocates of overhauling the entire health care system had hoped broad support for SCHIP would pave the way for similar consideration of the larger issues. But the largely party-line votes on SCHIP and the stimulus raised the prospect that the health care overhaul promised by Obama this year soon might become a one-party exercise.
“You try to get bipartisan support,” said Rep. Henry Waxman, D-Calif., chairman of the House Energy and Commerce Committee. “But if they don’t want to be for it, that’s their choice. They’ll have to answer to their voters.”
Other Democrats noted that bipartisan discussions about broader health legislation are continuing.
With control of the White House and commanding majorities in the House and Senate, Democrats need only a few GOP votes in the Senate to push through their agenda. But many advocates believe that major health care reform will need substantial GOP support to endure, much as Medicare has since it passed four decades ago with substantial bipartisan support.
“Nobody wants … to see reform get repealed,” said Karen Ignagni, president of America’s Health Insurance Plans, an insurance industry lobbying group.
The GOP resistance is unlikely to derail health reform efforts, given the determination of the Obama administration and its Democratic allies on Capitol Hill, said Chip Kahn, a former Republican staffer who heads the Federation of American Hospitals.
“At the end of the day,” he said, “it may be that health-care reform will be passed with only a small number of Republicans.”