Republicans and the White House say Democrats are pursuing a "giant leap" toward socialized health care by trying to draw middle-class families into a federally funded health insurance program for low-income children.
They say proposals being pushed in the House and Senate this week undermine the marketplace by offering coverage to children already insured privately and try to do so by cutting benefits to the elderly.
"Democrats are once again moving us toward 'Hillary Care' — a massive, complex system wholly run by government bureaucrats," said House Minority Leader John A. Boehner of Ohio.
The federal Office of Management and Budget said the Senate version would expand the State Children's Health Insurance Program (SCHIP) to families earning as much as $83,000 annually.
Both versions face a veto threat from the White House, which has proposed a $5 billion expansion to the program versus the Democrats' call for as much as a $50 billion increase.
Democrats say the program's expansion is needed to ensure the world's wealthiest nation properly protects its children.
"The richest country on the face of the earth should not have children who cannot access health care because they don't have insurance and they can't afford the cost," said House Majority Leader Steny H. Hoyer of Maryland.
"That is neither a moral posture for our country to be in, nor is it — from a fiscal, economic well-being, competitive position — a situation that we ought to be in."
Few, if any, Capitol Hill lawmakers dispute the need to reauthorize the 10-year-old SCHIP, but how much it should grow, who should be eligible and how to fund it will dominate the debate.
"No child in our nation should ever go without health care," said Rep. Rahm Emanuel of Illinois, the Democratic Caucus chairman. "Now, this Congress has the chance to make a down payment on this goal. But one man is standing in the way: President Bush."
House Democrats have proposed a $50 billion spending increase for the program over five years, for a total of about $75 billion. The plan would add an estimated 5 million children to the 6 million already enrolled in the program, which expires Sept. 30.
The Senate version would spend an additional $35 billion over five years and would cover 3 million children not currently enrolled.
Republicans said the Democrats' measures would extend coverage to families with incomes as high as 400 percent above of the federal poverty level — even if the majority of children in those families already have private coverage.
Republicans add that the Democrats' plans would give SCHIP eligibility to 600,000 to 2.1 million children now on private insurance plans.
"At a time when Republicans in Congress are working furiously to find new ways to rein in entitlement spending and put our nation's economy back on firm financial footing, Democrats see SCHIP as a means of expanding entitlement spending to levels no economy can sustain," said House Minority Whip Roy Blunt of Missouri.
"It's a strategy that's become the centerpiece of their domestic agenda, and it's one that, if ever passed into law, would bankrupt our economy."
SCHIP, which is a joint federal-state partnership, subsidizes the cost of insuring children living in families that earn too much to qualify for Medicaid but not enough to afford private insurance. The federal government pays for about 70 percent of the program, and the states pay the rest.
States are allowed to set eligibility guidelines, with some opting to expand coverage to as much as four times above the poverty level, or about $70,000 for a family of four. Some states also have extended coverage to some adults.
This "certainly is not low-income — this is middle-income coverage," said Senate Minority Whip Trent Lott, Mississippi Republican. "That has really started causing problems of higher and higher level of income for the children and adults being included. That was never the intent."
Republican leaders say they want to limit the program to children whose families truly cannot afford health insurance.
A Senate Republican alternative would reduce the cost of health insurance for small employers by 12 percent — or $1,000 per employee. The measure would cover more than 1 million uninsured Americans in working families, said Senate Minority Leader Mitch McConnell of Kentucky, who co-sponsored the measure.
"This redefines SCHIP to help the children it was designed to help — that is, low-income children," Mr. McConnell said.
Democrats reject the minority's charges that additional children their proposals would serve aren't worthy of federally funded health care.
"We're going to have a healthier nation because we're going to invest in children and make sure that they're going to get a healthy start for their future," said Sen. Edward M. Kennedy, Massachusetts Democrat. "We're going to be a stronger nation because we are a healthy nation."
To pay for the plan, House Democrats propose a 45-cents-per-pack cigarette tax increase, which they say would raise about $27 billion.
They also proposed cuts to the Medicare Advantage program, a program that works to provide health care services for rural seniors and minority communities across the nation. The cuts would save billions of dollars more, Democrats say.
Republicans counter that the House Democrats' plan unnecessarily pits children against seniors.
The Senate version proposed no cuts to Medicare Advantage, but it calls for a 61-cents-per-pack cigarette tax increase, which is strongly opposed by many Republicans.
The proposal also is angering Republicans who say it makes it easier for illegal aliens to get government-funded health care. It eliminates a requirement that legal aliens must be in the country five years before getting benefits and also makes it optional for states to check whether a recipient is in the country legally.
"Again, the Democrats have proven their loyalty to illegal aliens over American citizens," said Rep. Tom Tancredo, Colorado Republican.