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Children's Health Program Back

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By WILLIAM MARCH

wmarch@tampatrib.com

Published: January 27, 2009

Updated: 01/27/2009 12:22 am

TAMPA - A children's health care bill that set congressional Democrats against President George W. Bush's administration in 2008 now appears headed for passage with Florida's two senators splitting their votes.

Democratic Sen. Bill Nelson expects to vote for the State Children's Health Insurance Program bill. Republican Sen. Mel Martinez, according to a spokesman, has not firmly decided but voted against the bill in 2008.

"There's no excuse for American children not getting health care," Nelson said.

The bill uses tobacco taxes, including an extra 61 cents a pack on cigarettes, to expand a program providing health insurance for children of the working poor. It is one of the most divisive issues Congress has considered recently.

The Democratic majority passed it in 2008 but couldn't muster the votes to override Bush's veto.

President Barack Obama says he will sign the bill.

The House passed it Jan. 14, and it is expected to come up for a Senate vote this week.

Republicans say the bill has real problems; Democrats, including Rep. Kathy Castor of Tampa, say those problems are "red herrings."

Some Republicans worry that if they vote against it, they could be tarred in political campaigns as opposing health care for poor children.

Three Florida GOP House members who voted against the bill in 2008 voted for it this year: Reps. Ileana Ros-Lehtinen and brothers Mario and Lincoln Diaz-Balart, all from the Miami area.

All three experienced strong re-election challenges in 2008. Spokesmen did not return calls for comment on why they switched.

Castor has a particular interest in the bill: The program grew from an idea instituted in Florida by former Education Commissioner Betty Castor, her mother, and the late Gov. Lawton Chiles, who sold the idea to then-President Bill Clinton.

Among the GOP arguments against the bill are:

•It doesn't require strict documentation to prevent children of illegal immigrants from receiving benefits, and it allows states to cover children of recent legal immigrants.

•Increasing tobacco taxes will put the burden of paying for the program on lower-income people, who are more likely to smoke.

•It raises income eligibility levels too high, allowing states to cover families up to three times the $22,050 federal poverty level for a family of four.

That, Republicans charge, would cut business for insurance companies because those families can buy insurance, and it would leave less money for the truly needy.

"This bill will transform SCHIP from a health insurance program for disadvantaged children to a taxpayer-funded entitlement for adults and children from more affluent families ... imperiling care for the very children for which it was created," said Rep. Gus Bilirakis, R-Palm Harbor.

Not all Florida Republicans agreed. Along with Ros-Lehtinen and the Diaz-Balarts, Reps. Bill Young of Indian Shores, Vern Buchanan of Longboat Key and Alan Grayson of Orlando voted for the bill along with the Democrats.

In addition to the cigarette tax, the 2008 bill imposed huge increases on cigar taxes - a major concern in Tampa - but those increases have been lessened in the new bill.

The goal of the program is to provide benefits for children in working families who make too much money to qualify for Medicaid but not enough to have insurance.

People under the federal poverty level are eligible for Medicaid.

Castor said the House bill provides benefits up to twice that level, or $44,100 - usually not enough to buy private insurance or, in some cases, even employer-offered family coverage, she said.

States can increase that limit only by obtaining a federal waiver, she said. States with a high cost of living might want to, but Florida has not.

Castor said the bill allows states to set citizenship requirements, including whether legal immigrants are eligible for the program. Florida has strict rules, she said.

She said tobacco taxes are a natural to pay for the program because of the health effects of tobacco.

The program, she said, "has been a wonderful success" and ought to be expanded.

"It's not government health care," she said. "They're going to private clinics and hospitals and seeing private doctors."

Reporter William March can be reached at (813) 259-7761.

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