During its annual meeting, the National Governors Association reaffirmed support for expanding the State Children's Health Insurance Program while declining to endorse a specific funding amount.
"The governors have been very firm that SCHIP is their No. 1 health care priority at the federal level," said Arizona Gov. Janet Napolitano, wrapping up her term as chairwoman of the organization.
The program subsidizes insurance for children and some adults with incomes too high for Medicaid but not high enough to afford private insurance.
The Senate Finance Committee last week approved a five-year, $35 billion expansion, to be paid for with a 61-cents-per-pack increase in the federal cigarette tax.
Supporters said that would allow 6.6 million people to maintain their existing health coverage while adding 3.2 million uninsured children to the program.
House Democrats are expected to seek a $50 billion increase, financed by cutting payments to insurers that administer managed care plans under the Medicare program for seniors.
The American Hospital Association, the American Medical Association and the American Cancer Society support the increase.
But the Bush administration, which has consistently referred to SCHIP as government-run health care, says billions of dollars in insurance costs will be shifted from the private sector to the federal government under the Senate proposal.
President Bush told an audience in Nashville last week that the Senate bill is "the beginning salvo of the encroachment of the federal government on the health care system."
Mr. Bush has threatened a veto, saying the program should grow only by $5 billion.
The SCHIP program will expire Sept. 30 if Congress and the White House can't agree on terms for continuing it.
In letters to Mr. Bush and congressional leaders, the governors urged them to settle the matter without a series of stopgap extensions. They praised the Senate bill's preference for giving state governments flexibility in running the program instead of strict mandates.
"Gridlock, no answer, is the worst answer," New Jersey Gov. Jon Corzine said during a panel discussion at the governors meeting. Continuing the program without adequate federal funding would be "disastrous" for state budgets, he said.
A variety of groups — seniors, doctors, unions, family advocates and pharmaceutical companies — are lobbying for the Senate or a competing House bill, and are working to help create a veto-proof majority.
AARP and the American Medical Association plan to make it uncomfortable for Republican lawmakers to agree with the administration's position. On Friday, the two organizations announced a lobbying campaign that they said will likely exceed $2 million.
They back the House legislation for two reasons: It would expand health insurance to more children and eliminate a 10 percent cut in reimbursement rates for doctors who see Medicare patients. The cut would kick in Jan. 1, unless Congress intervenes.
The House legislation would pay for those changes by increasing tobacco taxes and lowering payments to insurers who administer health plans for Medicare beneficiaries. The two groups say the insurance companies are overpaid.
"This is a substantial effort we're undertaking in order to get this legislation passed," Bill Novelli, the AARP's chief executive officer, said Friday.
Just a day earlier, the Partnership for Quality Care, an organization of labor unions and health providers, unveiled an ad in which children, parents and health care providers explain that an increased tobacco tax will not only help more children become insured, but would also decrease smoking.
The group was the first to use ads that clearly advocate for a way to pay for SCHIP's expansion.
Kate Navarro-McKay, spokeswoman for the partnership, said the ads would run in 13 congressional districts — eight Democratic districts and five Republican districts, over two weeks. The cost: $1.2 million.
The ads were not designed to pressure lawmakers so much as to appeal for bipartisan leadership on the issue. The 13 were chosen because of their potential to be leaders on the issue, she said.
"It's a message of optimism. We're appealing to their angel," Navarro-McKay said.
Health insurers will join the lobbying campaign for SCHIP by running ads that would support the Senate's call for a tobacco tax increase. They will pay for separate ads designed to dissuade viewers from the approach the House plans to pursue, which is to cut payments to insurers that administer managed care plans under Medicare. That particular program is called Medicare Advantage.
"If it's anywhere near the ($50 billion) number that we're hearing it is, it means the end of the Medicare Advantage program," said Karen Ignagni, president and CEO of America's Health Insurance Plans. "That means Congress would be asked to vote on one of the largest Medicare cuts in history."
The television ads coming from Families USA and the trade associations it partnered with won't be partisan. They won't favor one legislative chamber's proposal over the others, but they could have political influence nonetheless.
"We're trying to influence members of Congress to do the right thing and support the expansion of the SCHIP program," said Families USA spokesman Dave Lemmon.
Also taking part in the alliance with Families USA and the drug manufacturers are trade associations representing doctors, hospitals and nursing homes.
The trade association representing drug manufacturers, the Pharmaceutical Research and Manufacturers of America, has been running television ads for several weeks on cable news shows touting SCHIP. The ads ask viewers to tell Congress to support SCHIP but don't talk about the size of an expansion. Officials did not disclose the amount spent on the ads.
Another organization that has put big dollars into lobbying for the program but won't disclose how much is the Children's Defense Fund. The organization has paid for television ads on CNN and on local television in several states. The organization also has placed print ads in the New York Times and in states where presidential debates are occurring, as well as in move theaters.
The Children's Defense Fund has also set up its own Web site for a fictional presidential candidate, a young girl named Susie Flynn. The candidate asks people to sign her petition in support of health care for all children. As of Friday, about 20,000 people had signed it.