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Health-Care Plan Applauded As a 'Plus' for Children, Schools

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WASHINGTON--When President Clinton unveiled his long-awaited plan for overhauling the nation's health-care system last week, many educators and child-health advocates applauded enthusiastically.

They are pleased because the President's health-care prescription would guarantee health coverage for all Americans and include tangible benefits for schools and children, from grants to bolster school clinics to full coverage for childhood immunizations.

"All in all, it's a big plus for kids, and therefore schools,'' said Michael Casserly, the executive director of the Council of the Great City Schools.

Dr. Howard A. Pearson, the president of the American Academy of Pediatrics, said the plan's emphasis on children is so strong that "the academy could have written it.''

But many questions linger about the scope and logistics of the massive health-care proposal.

A 239-page draft of the plan has been circulating in Washington, but the Administration is expected to clarify many points in a more detailed, final version due on Capitol Hill within two weeks.

"The Administration laid out a good proposal ... and as they say at the race track, we are off and running,'' said Keith B. Geiger, the president of the National Education Association.

Access for All

The plan's emphasis on "universal access'' has immediate appeal to educators concerned about the number of children who arrive at school with untreated health problems.

An estimated 37 million Americans are without health insurance at any given time. According to the Children's Defense Fund, nine million are children.

The Clinton plan would guarantee health coverage to all American citizens that would not disappear even if they became unemployed or changed jobs.

"We like the fact that it seems to cover teachers, who may not know until the last minute whether or not they're going to be employed,'' said Samuel G. Sava, the executive director of the National Association of Elementary School Principals.

The plan's potential financial effect on schools is murky. Many observers predict that school districts' health-care bills would remain relatively stable under Mr. Clinton's reform scheme. Large districts with 5,000 or more employees could form their own health alliances and offer coverage to their employees. But smaller districts, like small businesses, may initially see their health-care costs increase. (See story, page 1.)

"My guess is state legislators will have to find some way to help them recover,'' said Bruce Hunter, a senior associate executive director of the American Association of School Administrators.

The Administration's plan to create standardized forms and "health-security cards'' may help reduce costs for administrators by eliminating paperwork, Mr. Hunter added.

Emphasis on Prevention

The proposal's emphasis on prevention has been welcomed by education representatives and child advocates with particular enthusiasm.

Under the plan, all children would receive all medically necessary vaccines by age 2. Preventive dental and eye care for children under 18 would also be covered. In addition, the plan calls for new federal grants supporting health-education and other initiatives designed to prevent substance abuse and AIDS in adolescents, as well as childhood mental disorders.

"In general, anything that targets preventive health efforts will have enormous payoffs later and is worth endorsing,'' said Mr. Casserly.

"This is certainly a major improvement,'' said Becky Smith, the executive director of the Association for the Advancement of Health Education, adding that health education has typically been viewed as a luxury, rather than a central component of disease-prevention efforts.

Some health-education funding is expected to flow to schools.

"Schools will be an information center for parents to provide them with necessary information,'' said Mr. Sava.

But Dr. Pearson of the A.A.P. criticized the Clinton plan's limitation on routine medical checkups. The proposal would cover seven visits to the doctor during a child's first two years and two more between the ages of 3 and 5, but only seven visits would be covered between the ages of 6 and 19.

"The plan short-changes adolescents,'' said Dr. Pearson, arguing that adolescents should have annual checkups.

School Nursing Prominent

The plan's emphasis on prevention is likely to be a boon to school nurses, as preventive care is at the core of their mission, said Melinda E. Mercer, a lobbyist for the American Nurses Association.

School nurses would probably play an enhanced role under the proposal, as it calls for increases in the number and scope of school-based and school-linked health centers, Ms. Mercer noted.

Under the plan, school clinics would automatically qualify for reimbursement from health plans for services provided to students. (See Education Week, Sept. 22, 1993.)

"Clinics will most likely look different from community to community,'' said Ms. Mercer, adding that schools will be places where "new and exciting things [will be] happening.''

Special Education

While the proposal does not specifically address special education, some advocates speculated that healthcare reform may ultimately affect the way special education is financed. For example, it might shift some of the cost of serving medically fragile children away from schools.

Mr. Hunter of the A.A.S.A. suggested that the reforms could indirectly drive down the cost of serving disabled students by reducing the number of birth defects, since prenatal care is covered.

"It's too early to tell how [health-care reform] would ultimately affect educational institutions,'' said George Ayer, the executive director of the Council for Exceptional Children.

However, he said, because the plan prohibits discriminiation based on pre-existing conditions and offers mental-health benefits for children, it would probably have a positive impact on students with disabilities.

Mental-Health Benefits

But some mental-health advocates charge that the plan's standard package of benefits fails to provide adequate coverage for the treatment of mental illness.

For example, the plan would limit coverage for inpatient mental-health treatment to 30 days per episode, with an annual limit of 60 days.

"Children seldom need hospitalization, but when they do it is extremely serious,'' said Mary P. Crosby, the director of government affairs for the American Academy of Child and Adolescent Psychiatry.

She said the academy will push for unlimited inpatient coverage for children and adolescents.

Indeed, lobbyists representing an unusually broad panorama of interest groups are drawing up their battle plans for the months of legislative scrutiny that lie ahead. While most observers predicted that Congress would eventually enact some kind of health-care-reform package, they suggested that the final product may barely resemble the Clinton plan at all.

For example, Congressional Republicans have already issued a competing proposal that aims to provide universal health coverage within seven years.

The plan would not require employers to foot the bill for employees' health care, but would provide tax breaks to make it easier for businesses and individuals to purchase insurance, and allow small companies to increase their bargaining power by forming collectives. Poor people would receive government vouchers with which to purchase insurance. Insurers would be barred from excluding people who are sick.

Unlike the Administration plan, the Republican alternative would not specify which benefits must be covered; instead, a national commission would establish a minimum-benefit package that could be considerably less comprehensive than the one the President envisions.

Since the education community is generally pleased with the President's proposal, its representatives are gearing up to protect what they view as its child-friendly features.

"Its going to be a long and tough debate because the devil is partly in the details,'' said Martin Blank, a senior executive at the Institute for Education Leadership.

Staff Writer Lynn Schnaiberg also contributed to this story.

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