RACINE - U.S. Rep. Paul Ryan voted with many of his fellow Republicans Wednesday against a bill that would broaden a federal health insurance program for poor children by increasing a federal tobacco tax and decreasing funding for managed-care companies in Medicare.

The measure, which was passed by the House of Representatives by vote of 225-204, would make about five million more children eligible for the State Children's Health Insurance Program and increase spending for the program by $50 billion.

The increased spending would be offset by a cut in federal payments to private insurance companies that cover seniors under Medicare and a 45-cent-per-pack cigarette tax increase.

Ryan, R-Wis., said Thursday the measure expands government-run health care while cutting medicare benefits.

"This bill uses a children's health insurance program as an excuse to push people from private health insurance to government health coverage, while taking away coverage choices from seniors," Ryan said. "It essentially creates a costly new entitlement program at a time when our existing major entitlements are going broke."

The Senate moved slowly Thursday toward passage of legislation to add 3 million lower-income children to a popular health insurance program, in bipartisan defiance of President Bush's threatened veto.

Senate passage gives Democrats, who were aiming for a a veto-proof vote with their proposal that is less ambitious than the House, a chance to draw a stark distinction between their priorities and Bush's on a potent issue that resonates with voters.

Republicans are "going to face a choice with children's health: Are they going to turn their backs on three and a half million children in this country (who) don't have health care?" said Sen. Charles E. Schumer, D-N.Y., the chairman of his party's campaign committee.

Bush has proposed spending $5 billion to extend the program. He says the Senate's $35 billion expansion would balloon the decade-old program beyond its original mission of covering poor children, and inappropriately would move it toward government-run health care.

The State Children's Health Insurance Program expires Sept. 30.

Once passed, the Senate bill will have to be reconciled with the House-passed $50 billion expansion, which was paid for partly by cutting government payments to Medicare health maintenance organizations.

Both bills include hefty tax increases on tobacco products to pay for the spending increase.

The health program is designed to subsidize the cost of insurance for children whose families earn too much to participate in Medicaid, but not enough to afford private health insurance.

Through federal waivers, the program has expanded in many states to include middle-income children and adults. That has led Republicans to argue that it has become a backdoor way to extend government-provided health care to an increasing number of people.

National polls show overwhelming majorities of voters support expanding the children's health program and are more likely to support candidates who back it.