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Clinton Health Plan Calls for Expanding School Clinics' Role

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WASHINGTON--The health-care-reform package that President Clinton presents to Congress this week will recommend an expanded network of school clinics to serve as delivery sites for a range of services to young people, a draft copy of the proposal indicates.

As part of its call for a comprehensive overhaul of the nation's medical and insurance systems, the Administration will propose a new program aimed at bringing about a major increase in the number of school clinics and sweeping changes in whom they serve, how they operate, and what they offer.

"The numbers [of school clinics] are just going to fly'' if the Administration plan is adopted, said Debra Hauser, the director of the center on school-linked health care of the Center for Population Options.

Currently, there are over 500 school clinics operating in the United States, mostly in high schools, according to the C.P.O., a family-planning research group.

Though the draft plan circulating in the nation's capital last week supplies few specifics on the school-clinic proposal, the document makes clear that clinic services under the new program would include physical and mental health, disease prevention, and family-planning services.

Current clinic services vary widely from school to school, ranging from immunizations and physical examinations for athletes to condom distribution.

Essential-Service Providers

The plan calls for an Adolescent and School-Aged Youth Initiative to "support school-based or school-linked sites consistent with the goals of health reform and Goals 2000,'' the Administration's education-reform legislation currently moving through Congress.

Under the health-care reform, school clinics would operate as "essential-service providers.'' The new designation would confer special status on health clinics, both in the community and on school grounds.

Under the new system, health plans--regional groups of doctors and hospitals that would compete to provide health-care services--would be required to contract with school clinics and reimburse them for services. School clinics would be integrated into such alliances within five years, according to the plan.

"Clinics for the most part are not part of any medical network,'' said Lourdes Rivera, a senior health associate at the Children's Defense Fund. "This would establish automatic links for schools,'' she explained.

Under this arrangement, health plans would be required to pay clinics the same rate they pay other providers for the same services.

Clinics could also form their own health plans with other regional providers, the draft plan says.

That would be a significant change for school clinics, which have traditionally had difficulty getting reimbursed from Medicaid for serving poor students.

As with hospitals and doctors, school clinics would also be required to be licensed, monitored, and inspected.

State Grant Program

To promote the expansion of school clinics and other community-health programs so that they can operate effectively in the new health alliances, the plan proposes a state grant program to insure access to health care for low-income and hard-to-reach populations.

The grants would fund such outreach programs as transportation and child care, as well as efforts to integrate health, community, and social services.

Currently, state and local governments provide about 45 percent of school clinics' budgets, according to a C.P.O. survey. The federal government provides 16 percent, and 39 percent comes from foundation and other sources.

"In the past, school districts that wanted to implement clinics have had to scramble for funding,'' said Christine Morris, the manager of the comprehensive-school-health project for the National School Boards Association.

"As long as it stays locally controlled, [the funding] is going to be a welcome relief to local districts,'' Ms. Morris said.

The plan also calls for federal funding to develop comprehensive health-education programs for adolescents and adults, which the Education and Health and Human Services departments would administer.

Observers predicted that the money would largely be focused on sex-education and AIDS-prevention programs in schools.

Dozens of Questions

Since the language in the draft plan is vague and no specific funding amounts are attached, experts on school-health issues have dozens of questions about what the Administration's plan would mean for clinics.

A more detailed version of the health plan is expected to be delivered to Congress in the next few weeks.

In addition, an analyst for a prominent conservative group expressed concern that school clinics would be required to offer contraceptive services--an issue that has long been a source of controversy in schools.

"They are trying to usurp parental authority [by teaching] permissive attitudes about sexuality,'' said Scott E. Daniels, the director of the ethics-and-health-policy project for the Family Research Council.

The plan stipulates that clinics that received federal grants would have flexibility, however, in what services they offered and how they were delivered.

Although the shape the plan will take as it moves through Congress remains to be seen, advocates of federal children's-health programs said they already see a change for the better.

"The Administration has a commitment to putting the services where kids are,'' said Ms. Rivera of the C.D.F. "They are actually putting some dollars behind it.''

"It's a brave new world for everybody,'' said William W. Hamilton, the chief lobbyist for Planned Parenthood of America.

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