Children’s Health Debate Unfolds in Both Chambers
The Senate, meanwhile, continued to work its way through amendments to its legislation (S 1893) to expand the State Children’s Health Insurance Program (SCHIP) by $35 billion over five years. The Senate is debating its bill as a substitute to a House-passed tax measure (HR 976).
Just minutes after the House debate began on that chamber’s $50 billion expansion of SCHIP (HR 3162), and even before many of them had spoken in opposition to it, Republicans offered a motion to adjourn, forcing a roll call vote.
Republicans have voiced both procedural and substantive objections to the SCHIP expansion, but the stalling tactics were merely postponing what appeared be inevitable House passage.
The Bush administration has promised a veto, and House Republicans have said they would vote to sustain it.
The House bill was brought to the floor by Democrats under a closed rule that gave Republicans no chance to offer amendments. But the rule does not prevent parliamentary delaying tactics, such as motions to adjourn and demanding a roll call vote for approval of the journal.
Before bringing the bill to the floor, Democrats made several changes to the bill to comply with pay-as-you-go budget rules, along with other last-minute tweaks, at an early morning Rules Committee markup.
To save $20.4 billion over 10 years, bonus payments to states for enrolling more children in the program would be eliminated after five years.
Another $35.7 billion over 10 years would come from cuts in Medicare’s physician payments in the out years, cuts unlikely ever to take effect. The bill actually would increase physician payments over the next two years.
The bill would scrap the current Medicare payment formula, which uses a single formula to determine national payment rates. Replacing it would be a system that breaks payment calculations into six different medical areas, including preventive care, imaging procedures, and major medical procedures. Payment levels for each category would be tied to gross domestic product, with a preference given to preventive care and primary care.
Other savings would come from small changes to the program, including new age limits. The change would save $3.6 billion. Senate Amendments
The Senate, meanwhile, defeated a pair of Republican amendments to the SCHIP measure, which relies heavily on a 61-cents-per-pack increase in the federal cigarette tax, to $1 per pack, to offset its costs.
An amendment by John Ensign of Nevada that would have dedicated the bill’s tobacco tax revenue to research at the National Institutes of Health, instead of an expansion of SCHIP, failed by 26-58.
An amendment by Judd Gregg of New Hampshire that would have ended coverage of adults under SCHIP immediately, except for pregnant women, was defeated, 42-53. Under the Gregg amendment, states would have been allowed to continue covering adults, but would have been reimbursed at Medicaid rates, which are lower than SCHIP’s.
The Finance Committee-approved bill would end coverage of childless adults after two years, but would allow coverage of parents indefinitely, if states meet a series of increasingly rigorous conditions.
Senate leaders continue to discuss an agreement on limiting debate on remaining amendments in an effort to avoid another cloture vote, but if no deal is reached, Majority Leader Harry Reid, D-Nev., was likely to file cloture on the underlying bill before the end of the day.
