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The US House of Representatives failed by just 13 votes to override President Bush's veto of a plan to renew and expand the state children's health insurance plan.
The plan covers about 6.6 million children in families who earn too much to qualify for help from the Medicaid programme for poor people yet cannot afford to buy health insurance, as well as some pregnant women and some adults in disadvantaged families.
Both the House and the Senate had passed a bill increasing spending for the programme by $35bn (£17bn; €25bn) over the next five years to a total of $60bn (BMJ 2007;335:637, 685 doi: 10.1136/bmj.39349.400069.DB doi: 10.1136/bmj.39356.376470.DB). The proposed expansion would have added another four million children to coverage.
The president defended the veto, saying that the bill would prompt families to drop private health insurance and that it was a step towards government run, socialised medicine. It was better to create tax incentives to encourage families to buy health insurance, he said.
The veto has been widely criticised in media reports. An opinion article in the New England Journal of Medicine (doi: 10.1056/NEJMp0706881) by its correspondent John Iglehart reported that the Republican senator Chuck Grassley, of Iowa, reminded President Bush that he had promised to enrol more children in the plan.
The article says, “A few months ago, reauthorization of [the Plan] seemed like a routine matter. Then Bush decided to single it out as a target of the administration's new found fiscal discipline. The program was created in 1997 to provide coverage to ‘targeted low-income children' who are uninsured and not eligible for Medicaid—typically, families with incomes up to about US$41,300 for a family of four in 2007. As the cost of private insurance has increased and the number of employers offering it has decreased, the ranks of the uninsured have grown . . . including 710,000 children.”
The article concludes that no matter how the saga ends, “it will not lay to rest the larger issue of what level of public support uninsured people deserve as our employer-based insurance system continues to erode.”
Jennifer Howse, president of the March of Dimes Foundation, an independent group founded 70 years ago to fight polio, said that the organisation supported the programme's renewal. In a rebuttal to the president's weekly radio address, she said, “We do not consider children's health a partisan issue . . . We believe it is critical to provide health coverage to 10 million children. According to the Institutes of Medicine, health insurance is the single most important factor in determining whether or not a child receives needed healthcare. Every child needs preventive care. It helps them become healthy, productive adults.”
The Washington Post reports that the Democrats will present a new version of the bill with only minor changes (www.washingtonpost.com, 19 Oct, “Democrats push ahead on SCHIP”).