Soon after President Bush delivered on his promise to veto the bipartisan reauthorization of the State Children's Health Insurance Program (SCHIP) on Oct. 3, professional medical societies and children's advocates said they would join with Democrats in the U.S. House who have vowed to round up the votes needed to override the veto.

“We're going to do a full-court press to get that vote,” Dr. James King, president of the American Academy of Family Physicians, said in an interview.

If the status quo were preserved, as proposed by the White House, at least 1 million children nationwide would lose coverage, said Dr. King, who is in private practice in Selmer, Tenn.

“There should be pressure on everybody who doesn't do the right thing for children,” said Dr. Jay Berkelhamer, president of the American Academy of Pediatrics, in an interview.

Dr. Berkelhamer said he did not understand how the president could veto a bill that had such strong bipartisan agreement. The package was not an expansion, but it did ensure that at a minimum, children currently in the program would continue to receive benefits, he said.

Families USA Executive Director Ron Pollack said that even if the House is not successful in overriding the veto, the SCHIP legislation will eventually be approved, and with most of the package intact. “I think there will be increasing pressure on the White House to offer concessions to get this adopted,” said Mr. Pollack in an interview, noting that every round of votes against SCHIP will prove increasingly embarrassing to Republican lawmakers.

Advocates have some time to make their case—SCHIP, which expired Sept. 30, is able to tap funds appropriated as part of a continuing resolution that was approved by Congress to keep the government running until Nov. 16.

The SCHIP program currently covers an estimated 6 million children; the package that was passed by the House and Senate (H.R. 976) and vetoed by the president would have added &dollar;35 billion in funding to the program, increasing the enrollment by as many as 4 million children. The new funding was to come from an increase in the excise tax on tobacco.

The package introduced several new elements, including dental benefits and mental health parity. States would have been given the ability to seek a waiver to extend coverage to low-income pregnant women. And the Department of Health and Human Services was directed to develop of a core set of measures to track quality in the Medicaid and SCHIP programs.

The president signaled his intention to veto for at least a month, saying that the initial package passed by the House would be a step toward government-run health care and that it also would give coverage to higher-income children. Those children might drop private coverage to join SCHIP, said Mr. Bush.

The final package acknowledged that the program might be overreaching and directed the Government Accountability Office to study and share best practices in states that have successfully prevented children from higher-income families from dropping private coverage. That may have been the only point of convergence for the White House and Congress.

President Bush's veto was met with resounding criticism, even from Republican members of Congress.

The Democrats were more vehement. Sen. Edward Kennedy (D-Mass.) said, “Today we learned that the same president who is willing to throw away half a trillion dollars in Iraq is unwilling to spend a small fraction of that amount to bring health care to American children.”

In a statement, Dr. Edward L. Langston, board chair of the American Medical Association, called the veto disappointing. “The number of uninsured kids has increased by nearly 1 million over the past year, and action must be taken to reverse this trend.”

In the meantime, a handful of states are challenging a controversial change in SCHIP issued in August that limits their ability to extend coverage to children in families with incomes more than 250% of the federal poverty level. The stated goal of the administrative change, issued by the Centers for Medicare and Medicaid Services, is to ensure that these families are not opting for SCHIP instead of private insurance.

On Oct. 2, New York sued, alleging that the changes were issued without an opportunity for public comment, as is required by law. The suit seeks to block CMS for using the rules when evaluating states' plans to raise income eligibility limits.

CMS did just that in September when it rejected New York's proposal to cover children in families of four with incomes of up to &dollar;82,600.

The New York suit was joined by Arizona, California, Illinois, Maryland, New Hampshire, and Washington. New Jersey has filed a separate suit.

Child Advocates Vow to Override SCHIP Veto