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Health Bill Includes Funds for Health Education, School Clinics

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WASHINGTON--After weeks of preliminary hearings and several postponements, President Clinton and First Lady Hillary Rodham Clinton last week finally delivered their proposed "health security act'' to Capitol Hill.

While much of what the proposed legislation maps out had been revealed through leaks to the media, a few key changes from the early drafts may have important implications for schools.

For example, the legislation offers a much more specific description of school-based education programs that would be mandated under its public-health sections.

The plan proposes spending $50 million per year on grants to state education agencies and school districts for school-based health education, which would cover such topics as environmental health, family life, nutrition, disease prevention, safety, how to use health services, and substance abuse, including information on tobacco and alcohol use.

Grantees under the program would be expected to promote "personal responsibility for a healthy lifestyle and provide the knowledge and skills necessary to adopt a healthy lifestyle, including teaching the legal, social, and health consequences of behaviors that pose health risks.''

The legislation would also authorize Congress to appropriate $100 million in fiscal 1996 for grants to support the development or expansion of school-based health clinics, a funding ceiling that would increase to $400 million by 1999.

The clinics would be run by local partnerships that must include a health-care provider, one or more public schools, and one or more community organizations that serve at-risk youths.

The bill would give preference for grant awards to communities with high levels of poverty, shortages of health professionals, and indicators of high health risks for children and adolescents.

New Concerns Raised

Although representatives of the education community have expressed much enthusiasm for the plan's extension of benefits to children, certain elements prompted concern last week.

In the early drafts of the Clinton proposal, a provision that would cap employer health-care spending at 7.9 percent of payroll made no distinction between private and public employers. In recent weeks, however, Administration officials have made it clear that they only intended the caps to apply to private employers.

The legislation submitted to Congress would phase in the spending cap for private employers by 1998 and for public employers by 2002.

A spokesman for the National Education Association said the union would push for a uniform implementation date, arguing that it is inequitable to mandate benefits for private school teachers that are denied to those in public schools.

The National School Boards Association, meanwhile, voiced concern over some of the plan's financial implications.

Michael A. Resnick, the N.S.B.A.'s associate executive director, said that some school personnel negotiate benefits in such a way that their districts pay less than the 80 percent of employee premiums that would be required under the Clinton legislation.

When the cost of funding a larger percentage of those premiums is added to the cost of newly required premiums for part-time employees, he said, districts may have to make some hefty cuts in their budgets, especially if they are not initially covered by a payment cap.

"We're hoping that educational programs won't be made secondary to insurance costs,'' Mr. Resnick said.

Congressional committees have already begun holding hearings on the Clinton plan, but lawmakers are not expected to enact health-care legislation before next year.

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