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Lawmakers Offer Clues About the Health of Youth Issues

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Washington

As Congressional panels begin acting on health-care-reform legislation, lawmakers have offered clues about how they may handle some issues of interest to educators.

While Senate deliberations have been conducted largely behind closed doors, the health subcommittee of the House Ways and Means Committee has already reported a bill that the full committee is expected to build on.

In addition, the House Education and Labor Committee's Subcommittee on Labor-Management Relations held markup sessions last week on a version of President Clinton's bill drafted by its chairman, Rep. Pat Williams, D-Mont.

The subcommittee also plans to mark up a version of the "single payer'' approach, under which the government would finance all health care. Aides said the full committee may also report two bills for consideration on the House floor, to assuage supporters of the single-payer proposal and to pave the way for a possible compromise in which such a plan would be an option for states.

Lawmakers attempting to forge the compromises necessary to allow them to pass a bill before the end of the year have been concentrating on the overarching issues of providing universal coverage and financing the reforms.

Youth-health advocates are hoping that children's issues, which have yet to capture the attention of many members, are not sacrificed in the effort to cut costs.

"There is some danger that [these issues] have taken kind of a back seat ... and we're scared we're going to lose them,'' said Pat Cooper, the executive director of the National School Health Education Coalition.

Positive Outlook for Clinics

However, aides and other observers said that one of the education community's priorities, provisions supporting health education and school clinics, appears to have considerable support on Capitol Hill.

An aide to Rep. Major R. Owens, D-N.Y., the chairman of the House Subcommittee on Select Education and Civil Rights, said that panel will not hold a separate markup and will recommend to the full Education and Labor Committee that those sections of the Clinton bill be retained with only minor fine-tuning.

In order to make the Clinton proposal--which would authorize $50 million a year for health-education grants and up to $400 million a year for the development or expansion of school-based clinics--acceptable to some Republicans, aides said they are drafting language specifying that localities would have control over the content of health curricula and services.

Indeed, several aides and advocates described a "learning process'' that may result in bipartisan support for school clinics and health education, topics that traditionally have been controversial.

"There was a big misperception that health clinics have to be condom distribution and abortion counseling,'' Mr. Cooper said.

Since these elements of the Clinton plan are not entitlement programs, and therefore would not mandate federal funding, observers say they are likely to survive at least the House's deliberations.

Senate Prospects Unclear

When the bill hits the Senate floor, however, the school-health provisions could come up against opposition from conservatives.

"Who knows if what will come out on the floor will be something everyone can support?'' said Adele Robinson, the director of legislative affairs for the National Association of State Boards of Education.

An aide to Sen. Edward M. Kennedy, D-Mass., the chairman of the Labor Committee, said that members of the panel plan to discuss the school-health sections of the bill this week, and that the committee will most likely approve some sort of school-clinic and health-education provisions.

Observers also said that senators had been discussing the possibility of giving priority for grants to states and localities that have existing collaboration between schools and health programs.

The Senate panel is aiming to complete work by Memorial Day.

School groups are also watching how the House labor-management subcommittee handles issues that would affect schools as employers.

Under the Clinton plan, employers would be required to pay a portion of employees' health premiums, but private businesses would not be required to spend more than 7.9 percent of their total payroll. For public entities, that cap is not phased in until 2002, a lag time that some fear could be devastating for school districts.

Last week, the subcommittee approved an amendment from Rep. Eliot L. Engel, D-N.Y., and Rep. Matthew G. Martinez, D-Calif., that would phase in a 8.7 percent cap for public employers as early as 1996, and cap their expenses at 7.9 percent of payroll by 2002.

The House Energy and Commerce Commitee, which had yet to begin markups last week, is expected to back a similar proposal.

'Opt Out' Option

The labor-management subcommitee also adopted an amendment from Representatives Engel and Martinez that would allow state and local governments with more than 5,000 employees to "opt out'' of membership in the health alliances that would purchase health care for large, regional groups of people under the Clinton plan.

Choosing to self-insure could save significant amounts of money for some districts, but only private entities would have this option under the Clinton bill. In an informal poll, the National School Boards Association found that one-third of its members currently self-insure.

"The only reason they do that,'' said Laurie Westley, a lobbyist for the N.S.B.A., "is that they're trying to squeeze that dollar.''

Businesses that opted out of alliances under the Clinton plan would pay a payroll tax of 1 percent. Because this would actually generate revenue for the government, observers say this provision is more likely to pass than the cap, which would cost money.

But some observers predicted that opposition from the Administration could doom the measure.

According to Ms. Westley, a top Administration health adviser said early in the deliberations that the plan would not succeed without including public employees--a large, generally healthy group--in the pool of people covered by alliances.

"He said, 'I can give you lots of things you want,''' Ms. Westley said, "'but the opt-out is not one of them.'''

Meanwhile, a bill like the one that emerged from the Ways and Means health subcommitee would make these issues moot, because it would not mandate health alliances or cap the amount that employers would pay.

The health-care legislation, Mr. Cooper observed, is "still kind of in the stirring mode.''

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