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Substantial Funding for Clinics Expected in Health Plan

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PITTSBURGH--The health-care-reform legislation that President Clinton is expected to deliver to Congress next week will likely propose that the federal government spend between $100 million and $400 million on grants to school-based clinics in the initiative's first year and "substantially more'' each year thereafter, a key architect of the clinic plan said last week.

Dr. Robert St. Peter, the coordinator of programs for children and schools at the U.S. Health and Human Services Department, told school-clinic directors meeting here that the clinic-funding proposal had just survived a top-level meeting between officials of the department and the Office of Management and Budget.

"O.M.B. has been hacking away at this, and the clinic program has survived,'' said Dr. St. Peter, a pediatrician who helped develop the school-based-clinic section of the Clinton Administration's health-care plan. "The Administration wants very much to keep this as part of the initiative.''

The Surgeon General, Dr. Joycelyn Elders, confirmed this commitment last week in a speech to the American School Health Association, where she said the Administration will ask for "at least $100 million for the first fiscal year'' of the health initiative, which would be 1995.

The school-clinic plan will likely call for a state program through which clinics could apply for $150,000 planning and implementation grants, Dr. St. Peter told the clinic directors, who were attending a conference sponsored by the Center for Population Options.

This new funding process would be a blessing to school-clinic administrators, advocates of these facilities say.

"Right now they have to go through an incredibly arduous, piecemeal process to get funding,'' said Pamela Haughton-Denniston, the director of public affairs for the C.P.O.

"It is a nightmare,'' she said.

There is no federal program specifically for school clinics, but clinic directors currently solicit funds from a variety of federal sources, including Medicaid, maternal- and child-health block grants, the drug-free-schools program, and Title X of the Public Health Service Act.

The actual amount of federal dollars that flow from these programs to the country's 574 school-based clinics is difficult to determine, but federal and state officials estimate that they received approximately $17 million from federal sources last year.

A Watershed Event

The school-clinic proposal is part of the health-care-reform plan's broader Public Health Service Initiative. The Administration is expected to request $5 billion over the next five years to fund public-health efforts, ranging from training primary-care physicians to funding National Institutes of Health research on adolescents.

The reform legislation will also propose grants to develop comprehensive K-12 health-education programs, according to Dr. St. Peter.

School-clinic experts agree that enactment of the President's program would represent a watershed event for school-based health services.

"It would be an incredible boost to the field,'' said Claire D. Brindis, an associate professor of adolescent medicine at the University of California at San Francisco and an adviser to the Administration on adolescent health.

"And beyond the financial commitment is a policy change,'' she said. "There is a partnership emerging between the Education Department and H.H.S.''

Officials of the two departments were still discussing fine points of the plan last week and were looking for ways to use existing funds to support new school-health initiatives.

"Money is tight, and there is a real desire to get the biggest bang for your buck,'' said Elaine Holland, the U.S. Education Department's liaison to H.H.S. on health-care reform.

Ms. Holland said "there are health-education monies in different departments'' that might be used to finance these programs.

Minimum Services

Officials of the two departments are also expected to decide this week what minimum services school clinics would have to provide in order to be reimbursed for services under the new health-care system envisioned by the Clinton plan.

School-health experts expect that medical procedures now covered by Medicaid--such as physicals, prescriptions, and treatment of sexually transmitted diseases--would be included. Services such as language interpreters and counseling services may also be added to the package.

Ms. Brindis said family-planning services, which are expected to stir up considerable controversy in Congress, will probably be included as discretionary services that school-based clinics can "opt out'' of.

"It's important for communities to make that decision,'' she said.

In testifying last week before the Senate Labor and Human Resources Committee, U.S. Secretary of Health and Human Services Donna E. Shalala said: "It is the position of this Administration that parents [and communities] should determine the content of what is offered in school-based clinics.''

But Kristin Langlykke, a project director at the National Center for Education in Maternal and Child Health, said that setting a minimum requirement for clinics may spur them to provide only those services, and "you may cut off the care that groups may need,'' forcing them to seek health care elsewhere.

Some Congressional advocates of school-based clinics are concerned that funding may be lost in the larger debate on health care--or be delayed as the ambitious plan works its way through Congress.

Aides said some lawmakers--notably Sen. Edward M. Kennedy, D-Mass.--are considering introducing a school-clinic initiative as a separate piece of legislation later this month.

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