WASHINGTON - Democrats and healthcare advocates are expressing increasing confidence that their emphasis on expanding children's health insurance - a measure already vetoed once by President Bush - has succeeded in putting healthcare on the national agenda.
They point to a new round of polls that found wide public support for the child health program.
Proponents say the difference between the Republican and Democratic positions is stark, giving voters a clear choice on what many call the most important domestic issue in next year's presidential election.
Bush, along with every Republican candidate for president, opposes adding $35 billion over five years to the State Children's Health Insurance Program, known as SCHIP, saying it will lead to socialized medicine.
Every Democratic candidate for president supports the expansion to cover an additional 4 million children who currently do not have health insurance, saying it is government's role to provide health coverage for the neediest.
"SCHIP is the first issue beyond Iraq that is the subject of congressional debate that has penetrated the public's awareness," said Democratic pollster Geoffrey D. Garin, president of Peter D. Hart Research Associates. "Everything I'm seeing in terms of public opinion is that voters feel good that Democrats are taking on this fight. It's the president who is perceived as being mule-headed and stubborn."
Several polls have indicated strong support for the $35 billion expansion of SCHIP by increasing the tax on cigarettes by 61 cents a pack.
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But the Democrats' strategy is not without risk. If the current stalemate continues and Congress funds SCHIP at present levels, an estimated 21 states, including Massachusetts, this year will begin to pare children from its healthcare coverage because of rising costs. Some will blame Democrats for not working harder for a compromise, some activists say.
"Some Democrat could conclude it wouldn't be bad to leave it unresolved because they would have a good election issue against some Republicans," said Lew Finfer, director of Massachusetts Communities Action Network, a federation of faith-based groups.
For now, according to Democrats and some House Republicans, the intransigence rests with the White House and its supporters in Congress.
Last week, Senate Democrats huddled with House Republicans in hopes of finding a compromise both could accept after Bush last month vetoed the first SCHIP bill. Democrats had already agreed to several concessions, including limiting eligibility to children in families that made three times the poverty level, as much as $62,000 a year, down from four times the poverty level, or roughly $83,000 a year.
The negotiations were abruptly halted, though, when Senate minority leader Mitch McConnell, a Kentucky Republican, and Senate minority whip Trent Lott, a Mississippi Republican, refused to allow a delay in the Senate vote on the bill. That upset several House Republican negotiators, who had hoped they could find a compromise given more time.
The Senate passed the bill 64 to 30 on Thursday; Bush has said he will veto the second SCHIP bill.
The debate over SCHIP, which has gone on for several months, took many analysts by surprise.
Members of both parties have called the 10-year-old program remarkably successful, reducing the number of uninsured children to 14 percent nationally, down from 23 percent in 1997. And several studies have shown the benefits of extending insurance coverage to children. One study, for instance, found that uninsured children are five times more likely to have dental problems.
But Bush objected to the sheer scale of the expansion, instead backing a $5 billion increase over five years.
"The administration strongly supports reauthorization . . . in a way that puts poor children first," the White House said in a statement last week. The current bill, the White House said, "continues to move children from private health insurance to government programs [and] provides insufficient safeguards to assure that funds will not be spent on ineligible individuals."
Robert Blendon, a professor of health policy and political analysis at Harvard School of Public Health who helped design a recent poll on SCHIP, said the debate has "made this a very good election issue," one that largely favors Democrats.
"Most people didn't know what SCHIP was. It was really noncontroversial," Blendon said. "But what has happened with the Democrats fighting for it, and the president attacking it, is that it's become a poster child for the broader debate on whether government should guarantee coverage for people."
Just 15 percent of those respondents in the Harvard poll said children in families earning $80,000 annually should be eligible for the program, while one-third said those earning $60,000 should be eligible.
The majority of those polled, however, did not think that expanding SCHIP would lead to a government-run healthcare system - one of Bush's key assertions.
David Blumenthal, director of the Institute for Health Policy at Massachusetts General Hospital/Partners Health System, said he believed the debate addressed the more immediate issue of providing insurance for children in poverty as well as a more philosophical debate about government's role in providing health coverage.
"I think the larger argument, of how much the federal government is willing to pay for healthcare, will take place after a next president is elected," Blumenthal said.
But Finfer, the Massachusetts activist, is concerned about a more pressing issue.
"I'm worried that if a compromise isn't reached, millions of kids will not be covered," he said. "The bottom line is that Democrats clearly want to cover more kids, but people on both sides are trying to play politics with this."
John Donnelly can be reached at firstname.lastname@example.org