President Bush last Thursday urged Congress to send him a bill providing for a short-term extension of the current State Children’s Health Insurance Plan as it became more evident that House and Senate negotiators would be unable to reach agreement on legislation reauthorizing and expanding the program.

Rep. Nancy Pelosi, D-Calif., had earlier told Democratic members of her caucus to expect a Sept. 25 vote on legislation expected to mirror the Senate version of the bill.

However, the inability of House negotiators to agree to the smaller Senate package and their insistence on provisions to improve the Medicare program and cut back on the Medicare Advantage program offered by private insurers have caused the talks to reach an impasse, according to congressional staffers.

“Members of Congress are putting poor children at risk so they can score political points in Washington,” Bush said as he opened a news conference.

“More than a million children could lose health coverage” if the program is allowed to expire, the president said.

The program expires at the end of the current fiscal year, and Bush has proposed adding an additional $1 billion a year for 5 years to the current program, which has spent $25 billion over 5 years.

The Senate bill increases the SCHIP program by $35 billion over 5 years. The far more expansive House bill would have increased funding by $50 billion over 5 years, and made major changes in the Medicare and Medicaid programs.

The cuts in the Medicare Advantage program under the House bill would be used to partly fund the larger increase in the SCHIP program. The House bill also calls for an increase of the federal cigarette tax by 45 cents per pack. The Senate bill increases the tobacco tax by 61 cents, but does not touch the Medicare Advantage program.

The language House negotiators are insisting on includes a provision cutting funding to the Medicare Advantage program over 4 years, to the level paid for Medicare fee-for-service, and imposing greater oversight over marketing and operations of Medicare Advantage plans.

Meanwhile, New Jersey newspapers reported that New Jersey Gov. Jon Corzine said on Sept. 19 that the state would seek legal action against the Bush administration in a challenge to new rules designed to limit SCHIP enrollment to the lowest-income people.

The threat was contained in a letter to President Bush and Secretary Mike Leavitt, the newspapers said.

The newspapers said Corzine wrote that although a letter from the Bush administration outlining the rules “purports to clarify existing requirements, the simple fact is that it sets forth entirely new and unreasonable conditions.”

At the same time, Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee who helped draft the Senate bill, accused the Bush administration of altering an independent report commissioned by the Centers for Medicare and Medicaid Services to justify its position on the SCHIP issue.

Baucus “applauded” the “new evidence” that SCHIP is fulfilling its mission to help low-income, uninsured American children. But he accused CMS of “apparent manipulation” of part of the new report on CHIP.

“While the original final draft of the report said the substitution of private health coverage with CHIP coverage, or ‘crowd-out,’ was ‘not an issue,’ the final report with CMS-requested edits eliminates that phrase and instead emphasizes the fact that some ‘crowd-out’ does occur,” Baucus said.

The charge that many or most children in CHIP could have available private coverage has been a major argument of the administration and opponents of the Children’s Health Insurance Program.

“This report shows that CHIP has worked overwhelmingly well to get low-income, uninsured American kids the doctor’s visits and medicines that they need,” Baucus said. “It’s proof that plans to reach more low-income children through CHIP are the right way to go,” he added.

“But CMS can’t just rewrite some facts to suit its fancy,” he said. “Mathematical researchers apparently determined months ago that crowd-out has been so minor and so well-managed that it really isn’t an issue in the administration of CHIP,” Baucus explained.

“But it seems like CMS didn’t want the full success of the Children’s Health Insurance Program known–not to the Congress rewriting the CHIP law, and not to the American public,” he added.