WASHINGTON — President Obama and his congressional allies took a modest step toward reshaping the nation's healthcare system Thursday as the Senate passed legislation to expand health insurance for children.
But rather than building momentum for the sweeping healthcare reform Obama has promised, the victory on Capitol Hill -- a largely party-line vote, 66 to 32 -- 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 healthcare discussions, including health reform," Sen. Orrin G. Hatch (R-Utah) warned his 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 last year around health reform.
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 probably be a much larger debate, Republicans rebelled at Democratic moves to expand the federal government's role in providing health insurance.
Nine GOP senators backed the children's health bill Thursday; in 2007, 18 backed similar legislation.
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 currently $21,200 for a family of four.
Advocates of overhauling the whole healthcare system had hoped broad support for SCHIP would pave the way for similar consideration of the larger healthcare issues.
But the largely party-line votes on SCHIP and the stimulus raised the prospect that the healthcare overhaul promised by Obama this year may soon become a one-party exercise.
Several senior Democrats seemed unconcerned by that possibility.
"You try to get bipartisan support," said Rep. Henry A. Waxman (D-Beverly Hills), chairman of the powerful House Energy and Commerce Committee. "But if they don't want to be for it, that's their choice. They'll have to answer to their voters."
Other Democrats noted that bipartisan discussions about broader health legislation are continuing.
"This is going to work out well," said Senate Finance Committee Chairman Max Baucus (D-Mont.), one of the leading architects of planned health reform legislation.
Baucus and other Democrats have been meeting with Senate Republicans about health reform for months, as have a host of interest groups, including insurers, doctors, hospitals, business leaders and consumer advocates.
"Healthcare reform will be on a different track," said Ron Pollack, head of Families USA, an influential consumer group that has led efforts to build consensus around the current campaign.
With control of the White House and commanding majorities in the House and Senate, Democrats need only a handful of GOP votes in the Senate to pass their agenda.
But many advocates believe that major healthcare reform will need substantial GOP support to endure, much as Medicare did since it passed more than four decades ago.
In contrast, the Medicare drug benefit, which Republicans pushed through in 2003 on a largely party-line vote, has been fiercely debated since and remains a top target for some Democrats.
"Nobody wants . . . to see reform get repealed," said Karen Ignagni, president of America's Health Insurance Plans, an insurance industry lobbying group that has been intensely involved in the current health reform talks.
In 2007, SCHIP legislation developed by senior Republican and Democratic lawmakers -- and ultimately vetoed by President Bush -- garnered as many as 45 GOP votes in the House and 18 in the Senate.
Going into this year, lawmakers from both parties also backed more federal spending on health information technology, a major part of the economic stimulus package.
But the consensus on these modest first steps collapsed quickly after the new Congress convened this month.