The Senate measure now must 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 back door 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.

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Contributing: Suzanne Struglinski, Deseret Morning News