One provision of the House Republican bill would require older Americans with income of more than $500,000 a year to pay higher Medicare premiums.
“Folks that earn a half-million dollars a year and are over 65, they can pay a little bit more for Medicare,” said Representative Fred Upton, Republican of Michigan. “And you know what? If they don’t want to pay, they don’t have to enroll. That’s a choice they will have.”
The House bill would also make it easier for states to eliminate Medicaid coverage for some low-income people who hit the jackpot in lotteries. Under current Medicaid rules, income received as a lump sum, such as lottery winnings, is counted as income only in the month when it is received.
This forces taxpayers to bear the cost of providing health care benefits for people who no longer need assistance, Republicans said.
But Democrats said it was outrageous for Republicans to demand such offsets for CHIP while pushing huge tax cuts that could add hundreds of billions of dollars to federal budget deficits.
The Republican CHIP proposals “will likely mean more delay and possibly no action in Congress until the end of the year as part of an omnibus appropriations bill,” said Representative Frank Pallone Jr. of New Jersey, the senior Democrat on the Energy and Commerce Committee.
Time is running short.
Minnesota received an emergency infusion of $3.6 million of federal cash on Monday, and Utah has filed an amendment to its CHIP plan that would allow the state to restrict eligibility or benefits if it runs out of cash. Minnesota and two other states are expected to exhaust their CHIP funds by the end of December, and 27 additional states expect to run out of money by March.
“People are scared, and they have every right to be,” said Representative Joseph P. Kennedy III, Democrat of Massachusetts.
Instead of providing money for CHIP, Mr. Kennedy said, “Republicans have focused solely for months on taking health care from millions of Americans” by trying to repeal the Affordable Care Act.
Representative Ryan A. Costello, Republican of Pennsylvania, said he had heard from constituents fearing that children would lose coverage. But in fact, he said, “every child who was eligible for this program as of a week ago is still in that program today.”
The Senate bill does not specify how the government would pay for extending the children’s health program. Republicans and Democrats are working together and expect to agree on financing before the bill goes to the Senate floor.
High-income Medicare beneficiaries already pay premiums of more than $400 a month. Representative Greg Walden, Republican of Oregon and the chairman of the Energy and Commerce Committee, said the House bill would increase premiums by perhaps $135 a month for people with annual incomes over $500,000.
Representative Jan Schakowsky, Democrat of Illinois, said the proposal was “a first step in eroding a social insurance program, Medicare, that has for many years been in the cross-hairs of the Republican Party.” It would, she said, be much better to save money for Medicare by attacking the “price gouging” of some pharmaceutical companies.
Senator Patrick J. Toomey, Republican of Pennsylvania, was the only senator who criticized the Senate bill, saying it provided more money than states could reasonably be expected to use — “a number that’s wildly in excess of what anyone thinks could plausibly happen.” Some of the money, he said, will be available as “a slush fund” for activities unrelated to health care for children.
“It is completely dishonest budgeting,” Mr. Toomey said. “It is unaccountable. It is meant to circumvent any caps” on spending.
But senators of both parties said that Congress could not wait.
“If you don’t get this addressed in a timely way, you put children at risk,” Mr. Wyden said. “These enrollment freezes and belt tightening and other emergency measures that states have talked to us about — they are not abstractions. They represent very real problems for kids and parents and families that are walking on an economic tightrope.”
An earlier version of the photo caption accompanying this article misstated a title for Representative Fred Upton, Republican of Michigan. Mr. Upton is no longer the chairman of the House Energy and Commerce Committee.