Republicans complained that Democrats pushed the bill through the House without seeking their input. Democrats responded that the House had already passed similar legislation twice.

"We are not taking up anything new. We are talking about legislation that President Bush vetoed twice," said California Democrat Henry Waxman, the new chairman of the Energy and Commerce Committee.

In the end, 40 Republicans joined 249 Democrats to approve the bill.

About $1.2 billion of the money would come from savings in Medicare, the program for the elderly and disabled. Democrats say the measure tightens Medicare rules designed to bar physicians from referring patients to facilities which the provider owns.

About 7 million children get coverage through SCHIP, which is financed jointly by the federal government and states and costs about $5 billion a year.

Insurance companies that contract with the states provide the coverage, aimed at children whose parents earn too much to qualify for the Medicaid insurance plan for the poor and too little to pay for health insurance on their own.

Employer-provided family insurance cost an average $12,680 this year, a 5 percent increase from 2007, according to a study released in September by the Henry J. Kaiser Family Foundation in Menlo Park, California.

Workers paid more than one-fourth of the price, with their premiums averaging $3,354. The cost of at-work insurance has more than doubled since 1999, outstripping a 34 percent increase in wages, Kaiser said.

The legislation lifts the restriction on states enrolling pregnant legal immigrants or their children before they have resided in the U.S. for five years.