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The US president, George Bush, opened his press conference last week by announcing that he would veto bills that would renew and expand the US state children's health insurance programme (SCHIP). The programme was passed earlier this year by the House of Representatives and the Senate, with wide support from Democrats and Republicans. The federal programme, which has been going for 10 years, was to expire on 30 September.
The House and the Senate passed different bills. As usual, they reached a compromise bill last weekend, on which they were expected to vote on Tuesday and Thursday.
A presidential veto can be over-ridden by a two thirds vote in both House and Senate, but it is not clear whether there are enough votes in the House to over-ride the veto.
Several health policy experts told the BMJ that Bush's veto and confrontation with Congress were part of a negotiating strategy in which Congress would come back with changed regulations, and Mr Bush might agree to a modified programme.
The American Public Health Association urged Mr Bush to sign the bill and said “the reasons the president gives for his intended veto are unfounded.” Many newspaper editorials supported expansion of the programme.
In Congress, the children's health insurance bill has bipartisan support. The senator Chuck Grassley, an Iowa Republican who supports expanding the programme, said that he had pleaded with Mr Bush to accept a compromise but was disappointed.
The argument over children's health insurance is a forerunner of the debate about providing health insurance for all Americans, a key issue in the coming presidential election.
Mr Bush said that the House and Senate bills were “irresponsible” and were a political ploy by Congress to put health coverage for poor children at risk. The proposed expansion “would move millions of American children who now have private health insurance into government-run health care,” he said, calling the expansion “an incremental step toward the goal of government run health care for every American.” He said, “We should work to make basic private health insurance affordable and accessible for all Americans.”
The children's health insurance programme has been in effect for 10 years and is considered a success in providing health care for children in poor and some middle income families. The programme offers health insurance to children in families who earn too much to qualify for Medicaid, which provides care for poor people, and who cannot afford or do not have health insurance. The federal government pays about 70% of the cost and states pay the rest.
At least eight million US children don't have health insurance, down from about 11 million before the programme was introduced.
Bush proposed a $5bn (£2.5bn; €3.5bn) expansion of the programme for five years. The House and Senate passed bills calling for up to $35bn over five years and for making more families eligible, including families of four with incomes up to $83000. The tax on cigarettes would be raised to $1 a pack from 39 cents to pay for increasing coverage of children.
Several states asked for approval of plans to expand their programmes, but the administration said that each state must provide assurance that it had enrolled at least 95% of children in the targeted low income population. That was difficult to do, several states said. New York state is suing the federal government, saying that it already covered 88% of children in families with incomes below 200% of the poverty level and wanted to provide insurance to 70000 more children in families earning up to 400% of the poverty level.