Senator Eliot Shapleigh - El Paso, Texas

AUSTIN – The House voted Tuesday to add 100,000 low-income youngsters to the rolls of the Children's Health Insurance Program, a big potential step toward rolling back cuts that have divided lawmakers for years and caused political headaches for Republican leaders.

The bill would end some of the eligibility and enrollment restrictions that helped shrink the number of recipients by about 182,000 since 2003.

It advanced by a lopsided vote of 126-16 after a day of contentious debate over budget priorities and how much responsibility to place on the working poor. After a final procedural vote in the House today, it advances to the Senate, where GOP leaders oppose a provision allowing families to renew coverage every year instead of every six months.

Rep. Sylvester Turner, a Houston Democrat and the measure's lead author, asked for a big show of bipartisan support to try to sway the Senate. He noted the bill has five Republican authors and co-authors, including Rep. Kirk England of Grand Prairie.

"It is not intended to be a partisan weapon," Mr. Turner said. "But it is intended to be a bill that is in the best interest of Texas kids ... who need insurance now."

One in five Texas children lacks health insurance, the highest percentage of any state. CHIP, created by a GOP Congress and a Democratic president a decade ago, was designed to help families that make too much to qualify for Medicaid but too little to afford private health insurance.

Cuts imposed when the Legislature grappled with a huge budget deficit four years ago have galled physicians and hospital executives. They complain that Texas has surrendered $913 million in possible federal funding over the years by cutting a comparatively small amount of state funding that the federal government would have matched. Scores of providers rallied at the Capitol in support of the bill Tuesday.

Win for House Dems

Despite sponsors' efforts to play down political impact, the vote was a rare victory for House Democrats, who have fought for years to add funding back to CHIP.

Many Republicans said they worried that loosening rules would encourage families not to buy employer-provided coverage for their children. Some grumbled privately that loosening asset limits would let some parents drive expensive cars while accepting government help.

Rep. Charlie Howard, R-Sugar Land, expressed concern about a provision allowing families to deduct from income their child-care expenses.

For a family of four with two very young children, the change would raise the program's income ceiling to $46,100, from $41,300.

Asked Rep. Linda Harper-Brown, R-Irving: "Do we want the taxpayer to provide health insurance for people who make up to $50,000?"

Rep. Dan Gattis, R-Georgetown, countered that the state should allow the deduction because it encourages people to work. He was among 38 Republicans – including most of those in the Dallas-Fort Worth delegation – who joined Democrats in crushing Mr. Howard's attempt to disallow child-care deductions. That vote was 105-36.

Renewal issue

On the key test, whether to let families renew annually instead of every six months, the coalitions shifted.

While conservatives such as Ms. Harper-Brown and Rep. Jodie Laubenberg, R-Parker, sided with Democrats and supported annual renewals, Mr. Gattis led the opposition.

He offered an amendment to keep the six-month requirement, in effect since 2003. Mr. Gattis argued that it helps tightly screen families whose incomes swing wildly and that it keeps people off the program who don't deserve it.

Mr. Gattis, a key writer of the House's social services budget, said that's especially important because in Texas, families of the very poor and enfeebled sometimes wait as long as eight years for Medicaid's in-home and respite care services.

He said it would also be unfair that people enrolled in Medicaid, the nation's main health care program for the poor, would have to renew their coverage every six months, while CHIP families' coverage would last a year.

Rep. Dawnna Dukes, D-Austin, said that comparisons are difficult and that annual renewals in CHIP make sense. She said families who qualify for Medicaid can have their previous three months' medical bills paid for, though CHIP doesn't have any "look back" reimbursements. It is more like most private health plans, which are renewed annually, she said.

Rep. Helen Giddings, D-Dallas, said medical professionals favor annual renewal because it increases the likelihood a child will receive preventive care – and avoid going to the emergency room for treatment, which is a more expensive cost often borne by local taxpayers.

Rep. Rafael Anchia, D-Dallas, said it was unfair to hassle working poor families, when the state only requires first-time sex offenders to re-register every 12 months.

"Where is the justice in that?" Mr. Anchia said.

Reps. Carl Isett, R-Lubbock, and Wayne Christian, R-Center, said making families submit financial information every six months was not an onerous request.

Noting that Democrats have complained that thousands of CHIP families lost coverage last year because of problems with a private contractor, Mr. Gattis agreed to a proposal by Rep. Frank Corte, R-San Antonio.

It would allow families to renew for a year, which would give the state time to improve operations at four privately run call centers for social program signups.

After that, families would have to renew every six months.

While Lt. Gov. David Dewhurst and key GOP senators also favor six-month renewals, the House killed Mr. Gattis' proposal in a 91-49 vote. Twenty-four Republicans voted with Democrats to return to annual renewals, which were allowed from the program's start in 2000 to the 2003 session.

Proposed changes

Mr. Turner, Ms. Giddings and other supporters of the bill rebuffed more than 15 other attempts to change the bill, either to further loosen CHIP's rules or return to tighter ones.

"If we take these amendments from the right and the left, we will end up losing the bill," Ms. Giddings said.

Instead, she argued, the measure "goes down the middle. It doesn't risk the health insurance for 100,000 children."

On the overwhelming vote to pass the bill, all 16 "no" votes came from Republicans, including four from the Dallas area: Ms. Harper-Brown, Ms. Laubenberg, Rep. Tan Parker of Flower Mound and Rep. Ken Paxton of McKinney.