President signs children’s health bill

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President Obama Wednesday afternoon signed into law legislation to expand a popular health-care plan for millions of uninsured children, capping a two-year effort by Democrats that repeatedly had been blocked by Capitol Hill Republicans and former President George W. Bush.

“We’re not a nation that leaves struggling families to fend for themselves, especially when they’ve done everything right,” said Mr. Obama during a signing ceremony at the White House. “No child in America should be receiving his or her primary care in the emergency room in the middle of the night.”

The measure authorizing the $32.8 billion expansion of the State Children’s Heath Insurance Program, or SCHIP, passed the House earlier in the day by a 290-135 vote. Forty Republicans supported the measure, with 133 rejecting it. Only two Democrats voted no: Reps. Bobby Bright of Alabama and Jim Marshall of Georgia.

The Senate approved the measure last week, 66-32.

The expansion serves as a high-profile down payment on a campaign promise by the president of universal health care.

“It is just one component of a much broader effort to finally bring our health care system into the 21st century,” Mr. Obama said. “I am confident that, if we work together, if we come together, we can finally achieve what generations of Americans have fought for and fulfill the promise of health care in our time.”

House Speaker Nancy Pelosi, California Democrat, called the bill “very important legislation” that is “a giant step forward for our children.”

“Right now, we are observing a childrens’ hour that signifies that we are a Congress for those children,” Mrs. Pelosi said.

The measure is expected during the next four-and-a-half years to add at least 4 million children to the more than 7 million currently enrolled in the program — a federal-state initiative for families that don’t qualify for health care through Medicaid but can’t afford private insurance.

The 12-year-old program, set to expire at the end of March without congressional action, will be paid for with a 62-cent federal tax on a pack of cigarettes.

The Democrat-controlled Congress twice in 2007 passed measures to expand SCHIP by $35 billion over five years, to $60 billion. Former President George W. Bush vetoed both bills, objecting because he said they were too costly, would cover some adults and children in middle-class families and would be paid for, in part, with an increase in the federal cigarette tax.

The most significant changes from 2007 versions will allow states to end the five-year waiting period for low-income, uninsured children who are legal residents, and loosens identity checks for enrollment — provisions opposed by many Republicans.

“Given the growing prevalence of identity theft, having welfare officials require less identification than what a checkout clerk at a grocery store normally demands seems likely to encourage fraud and throw the program into disrepute,” said Rep. Joe Barton, Texas Republican, in a letter this week to House Rules Committee Chairwoman Louise M. Slaughter, New York Democrat.

House Minority Whip Eric Cantor, Virginia Republican, said his party was “extremely concerned” that the measure will expand coverage to some adults at the expense of children.

“If you asked me for the most efficient use of a single healthcare dollar, I would put it toward covering more children,” the Maryland Democrat said.

But House Majority Leader Steny H. Hoyer, Maryland Democrat, said that the money authorized in the legislation will be well-spent.

“If you asked me for the most efficient use of a single healthcare dollar, I would put it toward covering more children,” the Maryland Democrat said.

Congress’ decision to expand SCHIP also was applauded by many health-care, social-welfare and union groups.

“This vote underscores the importance of having the grass-roots voice heard in the halls of Congress, said Gabe Gonzalez, director of the Campaign for Community Values, an advocacy group for low-income Americans. “This didnt just happen. It was a monumental effort by thousands of community leaders making calls, writing letters and e-mails, and dropping in on their representatives.”

Karen Ignagni, president and chief executive of Americas Health Insurance Plans, the nation’s largest health insurance lobbying group, said expanding SCHIP is a big first step toward ensuring that all Americans have affordable, quality health care.

“This vital legislation provides health security for millions of children in working families and builds momentum for comprehensive health-care reform,” she said.

Wednesday’s White House bill signing gives Mr. Obama a welcomed reprieve from a difficult week in which two of his appointees embarrassingly withdrew from consideration because of tax problems.

On Tuesday, former Sen. Tom Daschle dropped out as the Health and Human Services secretary nominee, and Nancy Killefer removed herself from the nomination to be chief performance officer.

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