WASHINGTON - Making a down payment on President-elect Barack Obama's promise of universal health coverage, the House voted overwhelmingly yesterday to expand government-sponsored insurance to four million more children in working families with income too high to qualify for Medicaid.
Obama said he hoped the Senate acts with the "same sense of urgency so that it can be one of the first measures I sign into law when I am president."
Forty Republicans joined Democrats in passing the bill, 289-139. All Philadelphia-area representatives voted for the measure, except Rep. Joseph R. Pitts, (R., Pa.), who voted against. Congress passed similar legislation in 2007, but it was vetoed both times by President Bush.
The bill would raise the federal excise tax on cigarettes by 61 cents to $1 a pack to pay for the $32.3 billion cost of expanding the State Children's Health Insurance Program for the next 41/2 years. Other tobacco products would experience a comparable tax increase.
About seven million children now get government-sponsored health care through SCHIP.
The Congressional Budget Office projected that nearly 83 percent of the 4.1 million uninsured children who would gain coverage were in families with incomes below current eligibility limits. About 700,000 children would gain coverage because their states broadened eligibility.
Most of the children who will become insured live in families with incomes of less than twice the federal poverty level - $42,400 for a family of four, analysts said. But some states have expanded their programs to cover families with more moderate incomes, as much as $63,600 for a family of four.
Republicans pointed to budget office estimates that the bill would shift 2.4 million children currently with private coverage to government-provided care.
"The priority of SCHIP should always be to serve those children most in need of assistance, not subsidize those who already have access to private insurance," said Rep. Darrell Issa (R., Calif.).
Opponents also said the tobacco-tax increase would not be enough to keep pace with health care's growing costs.
Democrats dismissed the arguments. "Forty days in Iraq equals over 10 million children in America insured for one year," said House Speaker Nancy Pelosi (D., Calif.). "We certainly can afford to do that."
From 300,000 to 600,000 of the new enrollees could be noncitizen children of legal immigrants who have been in the country less than five years, a sticking point for some Senate Republicans.
The House bill would provide coverage for pregnant legal immigrants in addition their noncitizen children who entered the United States in the last five years.
Current law requires a five-year waiting period before legal immigrants become eligible for coverage under Medicaid and SCHIP. Supporters say expanding coverage would mean children could get treatment for acute conditions such as asthma and diabetes so they were less likely to need care in an emergency room.
The Senate Finance Committee is scheduled to begin writing a similar bill today.