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Health-Care Debate Raises Legislative Turf Questions

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The battle over the Clinton Administration's proposed "health security act'' has already begun, not with mighty rhetoric about universal coverage and cost containment, but with a behind-the-scenes tussle over which committees will handle the legislation.

This turf fight can have real consequences, however, as the leaders of the victorious panels will win the opportunity to shape the health-care-reform bills that are ultimately considered by the full House and Senate. And the committees vying for control tend to have distinctly different concerns.

In the Senate, both the Finance Committee and the Labor and Human Resources Committee have claimed jurisdiction over health-care reform, and the Senate leadership has yet to make a decision.

Education and child-health advocates would generally prefer to see the legislation handled by the Labor and Human Resources panel, which is chaired by Sen. Edward M. Kennedy, D-Mass., and is considered far more liberal than the tax-writing committee.

"The Kennedy committee has a track record of being concerned with children's-health issues,'' said Julia Lear of Making the Grade, the Robert Wood Johnson Foundation's school-clinic project.

"I don't know how adolescent and school-age children will fare in competition with'' other concerns before the Finance Committee, she said.

"Senate Finance will definitely be more difficult than the Labor Committee,'' said Joel Packer, a senior professional associate at the National Education Association.

The Senate leadership could give the committees joint jurisdiction or divide the bill between them.

Divisions of Work

On the House side, the leadership has given the Energy and Commerce Committee and the Ways and Means Committee joint jurisdiction over the entire bill. The Education and Labor Committee also has jurisdiction over most of the bill, including all the provisions of most interest to educators and child advocates, such as school clinics, health education, children's health, and disability issues. (See Education Week, Sept. 29, 1993.)

Seven other committees have joint jurisdiction over small sections of the legislation. For example, the Armed Services Committee will work on provisions related to the military.

As with the Senate Finance Committee, the tax-writing Ways and Means Committee is viewed as more conservative--and less receptive to children's advocates--than the staunchly liberal Education and Labor panel.

"Ed. and Labor would probably not be willing to put a lot of restrictions'' on school clinics, Mr. Packer said.

Although Energy and Commerce's Subcommittee on Health and the Environment has been a leader on Medicaid and child-health issues, the full committee includes several Southern Democrats who are supporting rival health-care-reform bills.

If several committees have jurisdiction over separate sections of a complex bill, the parts are usually combined before the entire product is considered on the floor. But when several panels have joint jurisdiction, the process is less predictable.

Usually, the leadership in each chamber will attempt to create a compromise version for floor consideration.

In the House, a failure to reach agreement can lead to a battle in the Rules Committee, which has the authority to dictate the terms of floor debate--a scenario aides said they are hoping to avoid.

"It's impossible to say for sure right now,'' an aide to the House Energy and Commerce Committee said. "This is such an enormous piece of legislation.''

In the Senate, the leadership ultimately decides what legislation will be brought to the floor. But the chamber's looser rules, which allow for nearly unlimited amendments, make it a less crucial decision than it is in the House.

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