NEW YORK -- When she talks about health care reform on the campaign trail, Democrat Hillary Rodham Clinton points to a multibillion-dollar health insurance program for children as one of her signature accomplishments.
The program, enacted in 1997, has provided $24 billion over 10 years to states to cover more than 6 million children whose families earn too much to be eligible for Medicaid but cannot afford private health insurance.
While it has enjoyed broad support on Capitol Hill, President Bush this week vetoed legislation that would have vastly expanded the program's reach.
Clinton claims significant credit for helping launch the effort _ formally the state Children's Health Care Insurance Program _ as first lady during her husband's second term. Her new television ads prominently mention it as evidence of her long-term commitment to health care and children.
"She changed the lives of 6 million kids when she championed the bill that gave them health insurance," says one ad. "Hillary stood up for universal health care when almost no one else would, and kept standing until 6 million kids had coverage," says another.
Is she justified in claiming so much credit?
After the first lady's effort to enact universal health insurance went down to calamitous defeat in late 1994, she and other White House officials began looking for smaller changes that could win bipartisan support. Republicans had taken control of both the House and Senate that year.
A similar effort was taking place on Capitol Hill, with Sen. Edward Kennedy playing a lead role. One area he and the Clintons explored involved expanding health insurance coverage to children who had none.
On Dec. 9, 1996, senior White House health adviser Chris Jennings sent a memo to the first lady outlining several options _ and recommending ways for her to increase her visibility on the issue.
With his wife's backing, President Clinton announced a plan to expand health coverage to as many as 5 million children in his 1997 State of the Union address.
Kennedy, meanwhile, introduced legislation based on a Massachusetts model with Utah Sen. Orrin Hatch as the lead Republican co-sponsor. The bill called for $20 billion in grants to states, paid for in part by raising the federal tax on cigarettes.
Gene Sperling, a Hillary Clinton campaign adviser who served as one of President Clinton's lead budget negotiators in 1997, said efforts to include children's health coverage were constrained by a balanced budget agreement between the White House and Republican congressional leaders.
But he said Hillary Clinton pushed hard and even favored boosting the price tag to $24 billion, instead of the $16 billion that had been floated as a compromise.
"Her office was across from mine, and I knew what her priorities were," Sperling said. "I remember her having a lot of influence _ you're getting this done because you know the first lady wants it."
The effort nearly went off the rails when Senate Majority Leader Trent Lott, a Republican, said it violated the balanced budget agreement. President Clinton, eager to preserve the agreement, actually phoned lawmakers to kill the legislation when it came to the Senate floor.
Hillary Clinton defended her husband's action at the time. "He had to safeguard the overall budget proposal," she told one audience. But she insisted he would find other ways to provide health coverage for kids.
The effort was revived, with Kennedy, Hatch and a coalition of advocacy groups ranging from the Children's Defense Fund to the Girl Scouts lobbying hard. Kennedy made a special appeal to the first lady, who added her pressure anew.
"The children's health program wouldn't be in existence today if we didn't have Hillary pushing for it from the other end of Pennsylvania Avenue," Kennedy told The Associated Press.
President Clinton signed the bill in August 1997.
While Kennedy is widely viewed as the driving force behind the program, by all accounts the former first lady's pressure was crucial.
"She wasn't a legislator, she didn't write the law, and she wasn't the president, so she didn't make the decisions," says Nick Littlefield, then a senior health adviser to Kennedy. "But we relied on her, worked with her and she was pivotal in encouraging the White House to do it."
Associated Press Writer Andrew DeMillo in Little Rock, Ark., contributed to this report.
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