Parties, president try to hammer out SCHIP compromise

As this issue of State Health Watch was finalized, some members of Congress were working behind the scenes to hammer out a compromise that could gain enough Republican votes to overcome a presidential veto. And President Bush signaled a willingness to accept some program expansion.

The president and other critics of a Democrat-sponsored, $35 billion SCHIP spending increase said they could support expanding coverage to families of four making up to 300% of the federal poverty level ($62,000 per year), but wanted to limit states' ability to expand coverage even more.

Observers say about 35 states ignore some income when determining who qualifies for the health coverage. Thus, many states exclude child support payments when calculating income, while others deduct child care expenses.

President Bush initially proposed a $5 billion increase in SCHIP spending over five years, but congressional Democrats countered with a $35 billion boost that he vetoed.

A second bill tried by the House of Representatives would have added some 3.9 million uninsured children to the rolls by 2012. The president promised to veto that bill as well if the Senate didn't make major changes.

Sen. Chuck Grassley (R-IA), ranking member of the Senate Finance Committee, an outspoken GOP supporter of SCHIP expansion, reportedly was working with House Republicans and some Senate Democratic leaders on an amendment to meet the demands of a group of House Republicans who said they might support a changed bill.

In addition, House majority leader Steny Hoyer (D-MD) and Democratic caucus chair Rahm Emanuel (D-IL) met with Republican lawmakers to see if a compromise could be reached. While additional meetings were planned, some Republicans said it appeared there was not enough flexibility from Democrats to resolve questions on proof-of-citizenship guidelines, income limits, and mandatory targets for enrolling children in families with less than 200% of poverty.

After the second House bill was considered, a group of 36 Republicans sent a letter to Speaker Nancy Pelosi (D-CA) outlining six changes they wanted in exchange for their support. Observers said their top requests were that the measure include a mechanism requiring states to ensure that most children in families earning less than twice the poverty level are covered by SCHIP or Medicaid before expanding coverage to higher-income families; that all adults, including parents, be excluded; and that it include stronger safeguards against illegal immigrants enrolling in SCHIP.

Some Democrats, including members of the Congressional Black Caucus, warned their leaders that too much negotiating could erode their support of the bill. Overall, some observers saw the beginnings of a change in the political dynamic in which Democrats have been uncompromising on issues such as SCHIP. They said Democratic leaders may believe the need to show they can govern may trump the fear that too much compromise will anger their political base.