WASHINGTON, Aug. 1 — Over angry Republican objections, the House on Wednesday passed a sweeping expansion of the Children’s Health Insurance Program, financed with increases in tobacco taxes and cuts in subsidies to private Medicare insurance plans for older Americans.
The bill embodies the Democrats’ vision for health care, taking a step toward the goal of universal coverage while reversing what they see as Republican efforts to “privatize Medicare.”
By a vote of 225 to 204, the bill passed, with support from 220 Democrats and 5 Republicans. Ten Democrats joined 194 Republicans in voting against it. The bill would provide coverage for more than four million uninsured children in low-income families, prevent cuts in doctors’ Medicare payments scheduled for Jan. 1 and raise the federal cigarette tax 45 cents a pack, to 84 cents.
It would also increase assistance to low-income Medicare recipients and eliminate co-payments for most preventive care provided to Medicare recipients.
Passing the bill was a major achievement for the new Democratic House leaders. When Nancy Pelosi took the gavel as speaker in January, she was surrounded by the children of House members, and she called the House to order in the name of “all America’s children.”
President Bush has threatened to veto the House bill, developed entirely by Democrats, and a more modest bipartisan measure, expected to win Senate approval this week. Lawmakers see an urgent need for action because the Children’s Health Insurance Program, which covers 6.6 million youngsters, is scheduled to expire on Sept. 30.
Representative Jim McDermott, Democrat of Washington, said, “Today’s debate comes down to this: Do you favor big tobacco or children?”
Republicans tried to block consideration of the House bill and complained that it was being rammed through the House without any opportunity for amendment.
“This is a very partisan bill, done in a very partisan way,” said the House Republican leader, John A. Boehner of Ohio. “It expands government-run health care beyond anything any of us could have imagined in the last 10 years.”
Representative Rahm Emanuel of Illinois, chairman of the House Democratic Caucus, said: “Members of Congress and our children get health care paid for by taxpayers. The children of our constituents deserve the same.”
When it was created in 1997, the children’s program focused on families with incomes less than twice the poverty level. But many states have obtained federal waivers to cover children with somewhat higher family incomes, because those families cannot afford private insurance.
The federal government is spending $5 billion a year on the program. At that rate, it would spend $25 billion in the next five years.
The Senate bill would provide an additional $35 billion over five years, for a total of $60 billion. The House bill would provide $50 billion, for a $75 billion total.
Republicans fear, and Democrats hope, the bill will set a precedent for efforts to cover more of the 45 million Americans lacking health insurance.
Representative Pete Sessions, Republican of Texas, said the bill embodied the Democrats’ “vision for the future: socialized medicine and Washington-run health care.”
“The bill uses children as pawns in a cynical attempt to make millions of Americans completely reliant on government for their health care needs,” Mr. Sessions said.
Representative Lloyd Doggett, Democrat of Texas, said, “The Republicans’ silly claims of socialized medicine are belied by the bill’s endorsement by the American Medical Association.”
Another Democrat, Representative Albert R. Wynn of Maryland, said, “If America is the greatest country in the world, then all of our children should have health insurance.”
Under current law, Medicare payments to doctors would be cut 10 percent in January. Under the bill, payments would go up 0.5 percent.
More than eight million of the 43 million Medicare beneficiaries are in plans offered by companies like Humana and United Health. Since December 2005, enrollment in private plans has shot up 40 percent.
On average, the Congressional Budget Office says, Medicare pays the private plans 12 percent more than it would cost to cover the same people under the traditional Medicare program. The House bill would eliminate the differential, saving $50 billion over the next five years and $157 billion from 2008 to 2017.
Karen M. Ignagni, president of America’s Health Insurance Plans, the chief insurers’ lobby, said the cuts would be “devastating to millions of seniors,” including many on fixed incomes, who rely on private plans. The Congressional Budget Office has estimated that enrollment in such plans would decline 30 percent, to 5.5 million.
Republicans said it was wrong to cut Medicare to finance coverage for children. “This is kids’ care against Medicare,” said Representative Kevin Brady of Texas. “It pits children against their grandparents.”
The Bush administration and many Republicans in Congress have encouraged the development of private plans, saying they can coordinate care and control costs better than the government-run Medicare. Democrats say the “overpayments” are unjustified and threaten the solvency of the Medicare trust fund.
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