In 2007, the Bush administration said it would strictly adhere to guidelines that limited the scope of the State Children's Health Insurance Program.

A year later, it backed off its threat to penalize states that enrolled middle-class children without first proving they had enrolled nearly all poorer children first.

In a memorandum issued Thursday, Obama completely lifted the restrictions, which many governors and Democratic lawmakers said were nearly impossible to meet.

Obama said in a letter to the Department of Health and Human Services that "tens of thousand of children have been denied health care coverage" because of the directive.

Under the restrictions, at least 95 percent of poor children eligible for Medicaid or SCHIP had to already be in those programs before states could begin using federal funds to cover higher-income children.

Also, states covering higher-income children had to make sure individuals were without health insurance for one year before they were allowed to get government-sponsored coverage.

Obama's memo was issued a day after he signed legislation that will enable about 7 million children to continue coverage through SCHIP and allow another 4 million to sign up.

"The way I see it, providing coverage to 11 million children through SCHIP is a down payment on my commitment to cover every single American," Obama said Wednesday at a White House bill-signing ceremony.

The measure was similar to two bills vetoed by former President George W. Bush. It was pushed through both the House and Senate by Democrats eager to give Obama an early victory on health care.

Most lawmakers and advocacy groups in the health reform debate acknowledge that the next steps toward reform will be harder than expanding SCHIP, given the increasing federal deficit.

More ambitious changes envisioned by Obama will face entrenched interests in the health care community and Republicans who oppose expanding government-funded insurance.

"Republicans are committed to making health care more affordable, more accessible and offer more options to American families," said Rep. Roy Blunt, R-Mo. "Unfortunately, the only options we've seen so far this Congress would push us to a one-size-fits all government-run system."

And not all Democrats are on the same page with Obama. Montana's Democratic Sen. Max Baucus, who chairs the Senate Finance Committee, plans to put together a bill that has the same goal as the president but takes a different approach to achieving universal coverage.

Obama acknowledged the difficulties of reforming health care at Wednesday's bill-signing ceremony.

"It won't be easy; it won't happen all at once," the president said. "But this bill that I'm about to sign, that wasn't easy either."

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The bill is H.R. 2.

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On the Net:

Congress: thomas.loc.gov