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Children's Advocates Seek To Influence Health-Care-Reform Plan

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WASHINGTON--As the Clinton Administration scrambles to fulfill its self-imposed deadline to complete a national health-care-reform plan by the end of next month, a coalition linking health and children's advocates has laid out an agenda for how a transformed health-care system should meet the special needs of children.

A central goal of the advocates, who are expected to play a major role in shaping the Administration's package, is to insure that children and pregnant women are among the first to gain from any expansion of health-care benefits.

In addition, the coalition is pushing to multiply the existing network of school-based or school-linked clinics as sites for preventive care and to provide increased support for development of health and physical-education curricula.

The Health Access Coalition, a 170-member group led by the Children's Defense Fund and the American Academy of Pediatrics, is currently drafting a statement outlining the costs and implementation methods of programs for children. The group plans to deliver the policy paper to the Administration this month, according a spokeswoman for the C.D.F.

Task Force Targeted

The advocates are hoping to have an impact on the work of the President's Health Care Task Force, which is headed by Hillary Rodham Clinton and includes six Cabinet secretaries. The panel was created to come up with a comprehensive proposal to revamp the nation's health-care system, contain skyrocketing health costs, and insure access for all Americans.

Although the task force has made no formal endorsements, Mr. Clinton has said he favors the managed-competition model, under which large purchasing networks would compete to provide medical care.

The efforts by the child-healthgroups are just a part of the already intensive lobbying efforts in Washington to influence the shape of a new system, with its profound implications for the nation's social, economic, and political future.

'One Piece of the Puzzle'

The Administration satisfied one of the child-health group's main concerns with the President's announcement this month of his proposed "comprehensive child-immunization act of 1993.'' If passed by Congress, the $1-billion-a-year plan would provide free vaccines by 1995 to all children by their second birthdays.

While universal immunization has been a goal of child-health advocates for decades, the groups say the proposed program also must be coupled with outreach, education, and infrastructure changes to be effective.

"Immunization is only one piece of the puzzle,'' said Dr. Howard A. Pearson, the president of the American Academy of Pediatrics, who urged that health education be part of any comprehensive reform effort.

Universal access--providing each child regardless of economic status with a means to receive proper care--is another critical element for children, advocates say.

"Access means everybody should have a health-insurance card, including children,'' said Lourdes Rivera, a senior health associate at the C.D.F. Children and pregnant teenagers should be the first beneficiaries, she added.

"We are urging the task force to bring [a plan] in soon and start with children,'' echoed Carol Regan, the C.D.F.'s health director, "because it's a wise investment.''

For every dollar invested in prenatal care, according to the A.A.P., three dollars are saved on subsequent medical costs.

Ms. Regan, Dr. Pearson, and others argue that setting up a medical-tracking system, expanding recreational activities for students, and promoting research on adolescent and child health also need to be part of a comprehensive plan.

Children must have individualized services, the advocates contend. Although young people are the healthiest segment of the U.S. population, they suffer from a variety of health problems, including depression, drug addiction, and sexually transmitted diseases. Moreover, one in five of the nation's children live in poverty.

"One size does not fit all,'' said Dr. John Tutor, the president of the American Academy of Family Physicians, in testimony before a hearing of the task force last month.

School-Based Clinics Debated

Many child-health experts say the best way to deliver services to children and adolescents is through school-based or school-linked clinics centered in the community.

There are currently over 400 school-based clinics in the country, according to the Center for Population Options.

There are differences, however, over the extent of a new school-based program. Since school-health centers have a captive audience and are well situated to coordinate existing resources, some advocates argue that nearly every school could play a role in providing some kind of health-care service.

But other groups suggest that efforts should be focused on school clinics in rural and underserved urban areas where there are limited alternatives.

"The clinics might be the only show in town,'' said Ms. Rivera of the C.D.F. "If those guys disappear it's iffy as to who's providing the services.''

Conservative groups are vehemently opposed to any federal funding of school-based health clinics because, they say, the facilities promote sexual activity.

Schools are not an appropriate setting for health care, clinic opponents argue. "To have a candy store in the midst of a group of students who are theoretically sexually active is medical malpractice at its best,'' said Janet Parshall, a spokeswoman for Concerned Women for America.

Meanwhile, school-based-clinic backers are suggesting that one way to provide funds to the centers quickly would be to relax Medicaid regulations to allow schools to serve as health-care providers to eligible low-income students. Currently, school-health centers do not automatically qualify to receive Medicaid funds.

"If they are going to work on replacing Medicaid, they should recognize the fact that schools have a great interest in having healthy kids in their classrooms,'' said Edward R. Kealy, the director of federal programs for the National School Boards Association. "They should make it easier for schools to make referrals by eliminating the enormous amount of bureaucratic red tape.''

Health Curricula Backed


A curriculum component is also needed, educators urge. "We believe it's a natural thing to enlist schools in a national effort [to provide] preventive health care,'' said Mr. Kealy. "And the best way to emphasize prevention is to have public schools working on new health and physical-education curricula.''

The N.S.B.A., the Association for the Advancement of Health, and the C.D.F. have hailed a bill reintroduced by Sen. Jeff Bingaman, D-N.M., last month that would establish a $500 million grant program for schools to develop a comprehensive K-12 health-education curriculum. The bill would also create an office on school health and a national clearinghouse for school-health materials in the Health and Human Services Department.

'On the Table'

Because of the lengthy absence from the task force of Mrs. Clinton, who spent several weeks early this spring with her hospitalized father shortly before his death, some observers have suggested that the reform plan will not made public until this summer. But Administration officials insist the proposal will be released by the end of next month.

Whenever the plan comes out, advocates are confident the Administration will include a strong child-health program.

The coalition's recommendations are "definitely on the table,'' said Carrie Billy, an aide to Senator Bingaman and a member of the health-care task force.

"School-based clinics are a viable option,'' she said. "We are operating under the assumption that [the Administration] supports the idea of schools as a delivery site.''

Ms. Regan acknowledged that the reform effort is a "very complex and politically divisive issue.'' But the C.D.F.'s close ties to the Administration--both Mrs. Clinton and Secretary of Health and Human Services Donna E. Shalala are former chairwomen of the group's board of directors--suggest that many of the coalition's proposals will be heard.

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