The Senate overwhelmingly approved legislation yesterday to provide health insurance to 11 million low-income children, a bill that would for the first time spend federal money to cover children and pregnant women who are legal immigrants.

The State Children's Health Insurance Program, which is aimed at families earning too much money to qualify for Medicaid but not enough to afford private insurance, currently covers close to 7 million youngsters at a cost of $25 billion.

Lawmakers voted 66 to 32, largely along party lines, to renew the joint state-federal program and spend an additional $32.8 billion to expand coverage to 4 million more children. The expansion would be paid for by raising the cigarette tax from 39 cents a pack to $1.

The House approved similar legislation on Jan. 14, and President Obama is expected to sign a final version as early as next week.

During the presidential campaign, Obama pledged to provide coverage to every American child. Experts estimate that once the program is fully implemented about 5 million youngsters will remain uninsured.

In a statement released this morning, Obama praised the Senate's action as the "worsening economy causes families to lose their jobs and health insurance." He added, "Providing health care to more than ten million children through the Children's Health Insurance Program will serve as a down payment on my commitment to ensure that every American has access to quality, affordable health care."

Democratic lawmakers, noting that President George W. Bush twice vetoed similar legislation, praised the vote as evidence of the changing Washington landscape.

"Low-income, uninsured kids all across America have been waiting for Congress to fulfill the promise of the Children's Health Insurance Program for them," said Senate Finance Committee Chairman Max Baucus (Mont.). The program "works to get low-income, uninsured kids the doctor's visits and medicines they need to stay healthy, and approval of this bill opens the door of the doctor's office to millions of children who live without proper health care today."

But the political victory may come at a price. The rancorous debate -- on a program that once basked in bipartisan popularity -- raised doubts about whether the two parties can unite to pass broader health reform later this year, several moderate Republicans said.

"This is a very unfortunate beginning," said Sen. Charles E. Grassley (Iowa). The top Republican on the Senate Finance Committee, a stalwart supporter of the program, said he was "disgusted" by the way Democratic leaders handled the debate. "It does not bode well for cooperative work in the coming months," he said. But Grassley emphasized that he did not blame Baucus for the change in substance and style.

As the vote came just one day after the House passed an $819 billion economic stimulus package without a single Republican vote, some longtime lawmakers questioned the president's ability to forge a new era of cooperation in the capital.

"If they wanted a nice signing ceremony that showed bipartisanship and carried through on the president's language, this would have been a good vehicle to do it on," said Sen. Judd Gregg (R-N.H.).

Since its creation in 1997 under a Republican-led Senate, the children's health program has received broad bipartisan support.

"Few government programs in our time have enjoyed such great success, as acknowledged by members of both parties and all bipartisan health-care experts," said Senate Majority Leader Harry M. Reid (D-Nev.).

Governors, business executives and consumer advocates lobbied for the expansion, arguing that more and more families have sought the assistance in this weakened economy.

"During this economic turmoil, it is critical that we maintain and strengthen this important lifeline to our nation's children and that we help financially strapped states respond to the growing need for affordable health-care coverage," said Cindy Mann, executive director of Georgetown University's Center for Children and Families.

In 2007, prominent Republicans such as Grassley and Sen. Orrin G. Hatch (Utah) bucked Bush to support renewal of the program.

"We carried a lot of water and took a lot of flak" for that stand, Hatch said. To push through a different version now is "not only unfair," he said, "but a slap in the face to those of us who worked so strongly with our friends on the other side."

The bill approved last night closely resembles the versions many Republicans supported in the past, countered Democrats.

GOP lawmakers objected to the new provision allowing states to enroll certain legal immigrants. Until now, many immigrants' families have been forced to wait five years for coverage.

"The bottom line is: This is a debate about children's health coverage," said Sen. Richard J. Durbin (D-Ill.). "This is not a debate about immigration."

In more than two days of debate -- in unusually personal and emotional language -- Republicans expressed a sense of betrayal that Democrats had dropped the 2007 compromise.

"We could have had 95 votes," Hatch said. "That would have sent a tremendous, tremendous message that hasn't been sent around here for a long time."

Both sides had hoped, and even predicted, that early bipartisan action on children's coverage would demonstrate that Washington's elected officials can cooperate on critical issues such as health care.

"This is on something for which there is so much agreement and something that almost no one argues about," said Helen Darling, president of the National Business Group on Health, which represents 300 large employers. "For the tough things like real national health-care reform, it unfortunately portends a really rocky road."

Compared to the daunting task of overhauling the entire U.S. health system, the debate on the children's health program should have been easy, said Sen. Olympia J. Snowe (R-Maine).

"You would have thought this issue would have been clear sailing on both sides," she said.

Karen Ignagni, president of America's Health Insurance Plans, agreed that "we're not seeing bipartisanship" but said she is optimistic that the public's overwhelming desire for improvement in the health system will force the two parties to the bargaining table. "People are talking about how to do it as opposed to whether to do it," she said.

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