WASHINGTON - President Barack Obama and his congressional allies took a modest step toward reshaping the nation's health care system yesterday as the Senate passed legislation to expand health insurance for children.
But rather than building momentum for the sweeping health care reform that Obama has promised, the victory on Capitol Hill - a largely party-line 66-32 vote - marked a rocky start for what many hope will be the biggest reform campaign in a generation.
"To start out the year on this note does not bode well for future health care discussions, including health reform," Sen. Orrin G. Hatch, a Utah Republican, warned colleagues as the Senate debated the children's health insurance bill, which would enlarge the current program for helping children of the so-called working poor.
Like Wednesday's battle over the economic stimulus package, expansion of the State Children's Health Insurance Program became engulfed in a partisan struggle.
The stimulus debate also showcased several skirmishes among interest groups, despite the consensus that seemed to be developing among many around health reform last year.
Business and consumer groups scuffled over federally subsidized health insurance for jobless Americans in the stimulus package. Insurers faced off with privacy advocates over access to patients' electronic health records, which the stimulus bill would promote.
And foreshadowing what will likely be a much larger debate, Republicans rebelled at Democratic moves to expand the federal government's role in providing health insurance.
Just nine GOP senators backed the children's health insurance bill yesterday, nine fewer than backed similar legislation in 2007.
The current bill - which parallels one approved in the House two weeks ago - would cover an additional 4 million children at an estimated cost of nearly $33 billion over the next 4 1/2 years.
SCHIP, as the program is called, helps states provide health insurance for families that earn too much to qualify for Medicaid, the federal medical insurance program for the poor, but not enough to buy private insurance.
In the past, the program has enjoyed extensive bipartisan support, though Democrats and Republicans have differed over how much families could earn before their children became ineligible.
State rules vary, but some cover children in families with incomes more than twice the federal poverty line, which is $21,200 for a family of four.
