President Obama signed legislation Wednesday to expand a popular health care plan for millions of uninsured children, capping a two-year effort by Democrats that had been blocked repeatedly by Capitol Hill Republicans and President Bush.
"We're not a nation that leaves struggling families to fend for themselves, especially when they've done everything right," Mr. Obama said during an afternoon 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 Health Insurance Program, or SCHIP, passed the House earlier in the day by a 290-135 vote. Forty Republicans supported the measure, and 133 rejected it. Only two Democrats voted no: Reps. Bobby Bright of Alabama and Jim Marshall of Georgia.
The Senate approved the measure last week by a vote of 66-32.
The expansion serves as a high-profile down payment on Mr. Obama's campaign promise 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 children's hour that signifies that we are a Congress for those children," Mrs. Pelosi said.
The measure is expected during the next 4 1/2 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 funded by a 62-cent federal tax on each pack of cigarettes.
The Democrat-controlled Congress twice in 2007 passed measures to expand SCHIP by $35 billion over five years, to $60 billion.
Mr. Bush vetoed both bills. Citing his objections, he said the bills were too costly, would cover some adults and children in middle-class families, and would increase 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," Rep. Joe L. Barton, Texas Republican, said in a letter this week to Rep. Louise M. Slaughter, New York Democrat and House Rules Committee chairman.
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.
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 didn't 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."
Wednesday's White House signing gave Mr. Obama a welcome respite 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 health and human services secretary nominee, and Nancy Killefer removed herself from the nomination to be chief performance officer.