I was in Washington last week working on a profile of John Cornyn, as Congress was preparing for the vote on the reauthorization and expansion of the Children’s Health Insurance Program, known in D.C. as S-CHIP, “s” standing for “state.” CHIP is designed to cover children from families whose income is too high to qualify for Medicaid but too low to afford private health insurance. President Bush, who has always been a CHIP grinch (as governor, he favored limiting coverage families with incomes up to 180% of poverty; the Legislature opted for 200%) favored a $5 billion expansion.

The Senate Republican leadership supported a $9 billion plan. The Democratic leadership wanted $35 billion, and that’s what they got, with 18 of the 49 Republican senators voting with them. The increased funding would cover four million of the nation’s nine million uninsured kids. Bush has threatened to veto the bill, even though it is funded by a 61-cent increase in the federal tobacco tax.

The CHIP issue split the Republicans for two reasons. One is that more and more Republicans, in Austin and in Washington, are coming around to the view that millions of uninsured children is a social calamity. The other is that more and more Republicans are scared to death of the upcoming elections. The Washington Post reported that every Republican senator facing a serious reelection challenge voted for CHIP.

I think CHIP is a great program, but I have some qualms about the way it works at the federal level. States have been allowed to seek waivers so that they could cover families at up to 400% of poverty, and the Bush administration has granted some of them. The result is that a program designed for children covers, in some states, families with incomes up to $82,000. Some states are using CHIP to cover adults. The reauthorization bill has a ceiling of 300% of poverty, which is high enough that some 2 million children currently covered by private insurance are expected to switch to CHIP.

Republican opponents claim, with considerable justification, that Democrats are using CHIP as a stalking horse for government-run universal health care. With less justification, Republicans say that CHIP amounts to socialized medicine. Dallas congressman Jeb Hensarling says, “This is a government-run socialized wolf masquerading in the sheep skin of children’s health.” How can CHIP be socialized medicine when services are delivered by private docs and coverage is provided by private insurance companies? In fact, the American Health Insurance Plans, the largest lobbying group for the industry, endorsed the bill.

Cornyn voted against the CHIP reauthorization. He posted a long statement on his Web site, arguing that the program should focus on outreach–“focus on enrolling those who are already eligible but not participating”–rather than “expanding government-run insurance programs.” He favored the $9 billion Republican plan that included $700 million in outreach and enrollment grants.

CHIP will certainly be an issue in Cornyn’s campaign for reelection. This is not one of those obscure federal issues that the folks back home know little about. Texans have heard plenty about CHIP since the Republican budget cuts of 2003 reduced enrollment in the program. The program was the central issue in the 2004 congressional race between Democrat Chet Edwards, who had been targeted for defeat in Tom DeLay’s redistricting plan, and Republican Arlene Wohlgemuth, the author of the health care budget cuts. Edwards used the CHIP issue to defeat Wohlgemuth. One TV spot in particular, of a single mom relating her story of how she lost her CHIP coverage, proved devastating:

“I’m Jamie Jones. I’m 28 years old, I live in Teague, Texas, and I have a little girl that’s three, Bailey. Two years ago, in March, my husband was killed in a house fire, and she got put on CHIP, and I knew no matter what happened, she was going to be OK. And then, about six months ago, she was denied. I haven’t changed, I didn’t get a raise at work, she was just denied. You know, there are many people out there that work so hard. I don’t want to be on welfare, I just want good insurance for my child. Yes, I could quit my job tomorrow and she’d be set, but I’m not going to do that, and there’s a lot of people out there that aren’t going to do that, and why that group of us has to get hurt, I don’t know. Look at my little girl, look into her eyes, and tell her why she’s not good enough to be taken care of.”

So why did Cornyn vote against it? I’m sure that many of his concerns that he advanced on his Web site are legitimate, but I don’t think they are the reason he voted against the bill. The answer lies in something he had told me during an interview. Cornyn is a member of the Republican leadership, the vice-chair of the Republican conference. The leadership had its own version of the reauthorization bill. Cornyn had told me, as a general observation rather than as a statement about CHIP, “Sometimes it can be a disadvantage to be in the leadership. You have an obligation to vote with the rest of the leadership.”

Texas’s other senator, Kay Bailey Hutchison, is also one of five senators on the Republican leadership team, ranking fourth, just ahead of Cornyn. Hutchison, however, had voted for the bill. She told me, “Everything I wanted for Texas, I got. I felt honor bound to support the bill.”