WASHINGTON -- The Republican-led Congress might be about to balance the budget and cut taxes, but the era of big government doesn't seem quite over yet.
Included in the budget legislation entering the final stages of negotiation with President Clinton is a major new spending program that would provide health care for up to 6 million uninsured children of the working poor.
Sharp disputes remain over the structure of the program and over whether the cigarette tax should be raised to help pay for it. But Congress and the White House have long agreed that at least $16 billion worth of new federal help for uninsured poor children is on the way.
"There was a key moment a few months back when someone in the House Republican leadership got up and said: 'Yes, we're in favor of children's health, too,' when I knew something was going to pass this year," said Rep. Benjamin L. Cardin, a Baltimore Democrat.
Not all Republicans are delighted by the prospect. Some argue that the so-called Kidcare program risks becoming another expensive federal "entitlement" that Americans come to feel they are owed, regardless of the cost.
Under plans agreed to by Republican leaders and the White House, money would be channeled through the states to pay for health insurance for children who are not poor enough to qualify for Medicaid but whose parents lack private or employer-subsidized family insurance. The goal is to reach at least half the 10 million uninsured children in this country -- including about 170,000 in Maryland.
"We agreed to it because the president insisted upon it," said Rep. John A. Boehner of Ohio, the fourth-ranking Republican in the House. "If there's one thing we've learned, it's that there are ,, two ends to Pennsylvania Avenue, and we are not going to get our way on everything."
Even so, this expansion of federal responsibilities -- at a time when the majority party has pledged to curb the growth of federal spending -- strikes some conservatives as a sell-out.
"It's another false promise that the government will be incapable of delivering: free health care for children," said Darcy Olsen, an analyst with the Cato Institute, a conservative think tank.
"But once the question became, "Are you for or against health insurance for children?,' who could be against that? They just crumbled," Olsen said of the Republicans.
A proposal with a history
Like most ideas that take hold in Washington, this one has been percolating for a long time.
President George Bush talked about expanding health care for children nearly a decade ago.
President Clinton embraced the idea after the collapse in 1994 of his far more expansive proposal to provide government-backed health care to everyone in the nation.
Congressional Republicans were forced to deal with the issue this year, primarily because of the determined lobbying of Sens. Orrin G. Hatch, a Utah Republican, and Edward M. Kennedy, a Massachusetts Democrat.
The improbable pairing of one of the Senate's most respected conservatives with a leading symbol of Democratic liberalism stifled the charge of "socialized medicine" that typically dog Kennedy's efforts.
Hatch was willing not only to create a new federal health insurance program but also to raise taxes -- by 43 cents a pack on cigarettes -- to pay for it.
What's more, polls taken at the time Hatch and Kennedy were staging splashy floor fights over the issue last spring showed that most of the country agreed with them.
Even self-described conservatives who were polled by the Wall Street Journal in May said, by a 2-to-1 margin, that they favored a steep increase in the cigarette tax to provide health care for children
"I think the Republican leaders knew that Senator Hatch and Senator Kennedy were just going to keep coming back and coming back until they got this done," said Stan Dorn, a health policy analyst for the Children's Defense Fund, which favors the proposal.
In last May's budget deal with Clinton, Republican congressional leaders agreed to provide $16 billion in grants to the states to provide health care for uninsured children.
They thought that was the end of it.
Senate moves ahead
But the Senate, prodded by Hatch and Kennedy, took the proposal further. Senators voted overwhelmingly to boost the program to $24 billion -- including $8 billion that would come from a 20-cents-per-pack rise in the cigarette tax.
The Senate also inserted a requirement that affected children in all states must be covered by a minimum package of benefits, including prescription drugs and vision, hearing and mental health care.
As negotiating with the White House began in earnest this week, Republicans adopted the less expensive, more flexible House proposal, while Clinton advocated a plan similar to the one the Senate passed.
Congressional leaders left open the question of whether to raise the cigarette tax.
State officials are most eager for money that would allow them the greatest flexibility -- and not cost them too much in matching funds.
Impact in Maryland
In Maryland, Gov. Parris N. Glendening tried in vain this year to win General Assembly approval of a $5.6 million program that would provide health coverage for uninsured children up to age 3, along with prenatal care for pregnant women.
Under the proposed $16 billion federal program, Maryland would receive about $300 million over five years, or $60 million a year, which it would have to match with about $30 million.
"That's quite a stretch," said Dr. Martin P. Wasserman, the Maryland health secretary, noting that it would be difficult for Maryland to come up with the $30 million in matching funds.
"But as a pediatrician," he added, "I have to say that any expansion of health care for children has got to be a good thing. More than a good thing -- it's great."
Pub Date: 7/26/97