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A.M.A. Devotes Journal To Issue of Access to Care

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To call attention to the growing number of children and adults who lack health insurance, the nation's largest association of physicians has devoted an entire issue of its research journal to an examination of proposals to provide greater access to health care.

On the issue of major health-care reform, "an aura of inevitability is upon us," wrote Dr. George Lundberg in an editorial in the May 15 issue of the Journal of the American Medical Assocation. The special issue contains 13 lengthy articles on ideas for revamping and expanding access to the nation's health-care system.

"It is no longer acceptable morally, ethically, or economically for so many of our people to be medically uninsured or seriously underinsured," wrote Dr. Lundberg, the editor of the journal, which is published by the American Medical Association.

The journal's editors said the special two-volume issue, which took a year to prepare, was prompted by statistics that show a 24 percent increase over the last decade in the total number of uninsured Americans,

Most of the controversy last year centered around the program's fund4ing formula. But those involved in the legislation appear to have reached a consensus that the job-training program, which has long been accused of enrolling mainly the best-prepared job seekers, should begin focusing on needier youths and adults.

Focusing on the Needy

The new focus would require more intensive services, including remediation and basic-skills instruction for dropouts and unskilled adults. In designing such programs last year, lawmakers provided that school officials assist in establishing education offerings, planning entrance assessments, and outlining individual education and job-training plans for jtpa participants.

In addition to the increased education services, the Labor Department proposal also would:

Tighten local accounting and procurement policies in response to findings by the General Accounting Office that the program is "vulnerable to waste, abuse, and mismanagement."

Expand the act's youth effort8from a summer-only program to a year-round activity serving mostly out-of-school youths.

Revise eligibility criteria and funding formulas to complement the program's new focus.

Mandate greater cooperation between federal job-training, employment, welfare-to-work, and vocational- and adult-education programs.

Greater Coordination Sought

Ms. Martin said her agency also would revive its call for a single human-resources investment council in each state, which would replace existing separate advisory councils for the various federal employment and training programs. Such a plan was included in one version of last year's reauthorization of the Carl D. Perkins Vocational Education Act, but died in a conference committee.

The Administration's job-training proposal would further push coordination by directing that coordination funds already included in the various federal programs be focused on improving school-to-work-transition programs and adult-literacy efforts.

Roberts T. Jones, assistant secretary of labor for employment and training, said the coordination effort would also be a key focus of upcoming jtpa debate.

"Given the President's education agenda, we will continue to increase the atmosphere in which a number of the proposals are going this way," he said.

Legislative aides last week said a timetable had not yet been set for the progress of the legislation.

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