Asked to choose between better health insurance for children and older people or protecting the tobacco industry, US Rep. Mike McIntyre chose tobacco...

Asked to choose between better health insurance for children and older people or protecting the tobacco industry, U.S. Rep. Mike McIntyre chose tobacco.

The congressman from Southeastern North Carolina joined only nine other House Democrats in opposing expansion of a program that provides health insurance for children of the working poor - families whose incomes are too high to qualify for Medicaid, but too low to pay for insurance.

The bill also would help older people by raising (by one-half of one percent) federal payments to doctors who care for Medicare patients. Under existing law, those payments would be cut 10 percent in January - bad for doctors, worse for patients. Cuts that deep would prompt some doctors, possibly many, to reduce the number of Medicare patients they treat. And it can already be tricky for people 65 and older to find doctors.

To help pay for these health improvements for children and retirees, the House voted to reduce what the government pays HMOs that enroll people eligible for Medicare. The Congressional Budget Office found that the government pays these commercial insurance plans about 12 percent more than for the same services under Medicare.

But the other way the House wants to pay for improving health coverage for children and older people is to raise the federal cigarette tax by 45 cents. That would be a noticeable hit, but highly unlikely to wipe out North Carolina's tobacco industry.

The Senate passed a more modest bipartisan expansion of the insurance program, but with a bigger cigarette tax: 61 cents. North Carolina's Richard Burr and Elizabeth Dole voted against it, and President Bush is threatening to veto it.

The opponents have their reasons, of course. Perhaps they'll explain them to millions of poor children and their families.

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