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Lobbyists Set Priorities, Part Paths in Health-Care Debate

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Washington

When President Clinton released his health-care-reform plan last fall, education lobbyists unanimously praised its guarantee of universal coverage and emphasis on preventive measures, elements that promise to deliver healthier children to the schoolhouse door.

Eight months later, lobbyists have had time to size up the 1,342-page bill and set their priorities. While the major school groups have argued in tandem on some agenda items, they have different emphases. At some points, particularly on issues related to employers' responsibilities, their interests are likely to collide.

The education community won two collective health-care victories earlier this month, when the plan was debated by the two Congressional committees that handle education issues--Labor and Human Resources in the Senate, and Education and Labor in the House--which are among five Congressional panels with jurisdiction over sections of the legislation.

The benefits package in the bill pending before Education and Labor offers items for children not found in the Clinton package, including coverage of chronic and congenital conditions, which lobbyists said were inadvertently excluded by the original language; expanded mental-health benefits; and coverage for hearing aids.

And the Labor and Human Resources Committee passed a version of the Clinton plan that raised authorized funding for school-based clinics from $1.5 billion to $2.35 billion over six years. (See Education Week, June 1, 1994.)

The outlook for a health-reform bill seems to have alternately brightened and dimmed in recent weeks as lawmakers have contended with issues such as an employer mandate to pay most of the cost of their workers' insurance.

But while education lobbyists are unwilling to guess what would be in a final bill, they say they expect one to pass this year.

"I expect that unless something really nutty happens, there ought to be a bill,'' said Bruce Hunter, a senior associate executive director of the American Association of School Administrators.

Setting Priorities

The school-based-clinics program, meanwhile, offers an example of educators' differing priorities for what such a bill would look like.

The education community is generally supportive of the clinics program, and some groups lobbied enthusiastically for the increased funding level in the Labor and Human Resources Committee's bill.

But Mr. Hunter said that the A.A.S.A. has not emphasized the issue because the question of whether clinics could provide abortion services or referrals clouds its political future.

"How excited should we get about an item that, in this political climate, is never going to be a big item in the federal budget?'' he said.

Meanwhile, education lobbyists have helped fix technical snags that posed threats to teachers. President Clinton's bill and many of its spinoffs, for example, define "full-time workers'' as employees who work at least 120 hours a month. Under such a narrow definition, teachers might be excluded and lose their health benefits.

But lobbyists helped draft language, which was adopted by both education panels, stating that teachers who are considered full-time workers by their schools would be eligible for benefits.

Divisive Mandates

Several pending issues will inevitably pit school groups against each other as they strive to represent the financial interests of their members, of which employer mandates loom largest.

"Employer mandates are where the rubber really meets the road,'' Mr. Hunter said.

The Clinton plan calls for employers to pay roughly 80 percent of the cost of their employees' health el-62lcoverage, and both the American Federation of Teachers and the National Education Association have publicly set 80 percent as the minimum employer contribution in any plan they will accept.

Most school districts provide some form of health coverage today, argued Joel Packer, a senior professional associate at the N.E.A., and the Clinton mandate would continue that in the fairest way possible.

The National School Boards Association, meanwhile, has called for reduced employer contributions, arguing that an 80 percent mandate could crush smaller, poorer districts and lead to cuts in school services.

The A.A.S.A. will chart a compromise course, looking for a financing scheme that would insure that all children have coverage, according to Mr. Hunter.

"We are in a way caught,'' he said. "I guess everybody is. Do we advocate what we think will help the children thrive and develop best, or do we advocate on behalf of the financial health of the institution? You walk a line there.''

Similar lines will be drawn when lawmakers address the issue of coverage for part-time employees, as unions lobby for expanded coverage and the N.S.B.A. watches out for district budgets.

Public and Private

All the groups have mobilized, however, to correct what they see as a disparity in the treatment of public and private employers in the Clinton plan.

Under the President's plan, new entities called "health-care alliances'' would bargain with service providers and buy insurance for employers and individuals within a defined region, with the cost of premiums largely determined by an alliance's overall costs.

But under the Clinton plan, private employers with more than 5,000 workers could "opt out'' and self-insure or set up their own alliances. Public employers would not have this choice.

The N.E.A. originally hoped that everyone would be required to participate in the alliance system, which would spread the risks most el10lfairly, according to Mr. Packer.

But with at least two of the five committees with fingers in the health-care pie likely to approve opt-out provisions, the N.E.A. fears that public employers and employees would be forced to assume a disproportionate share of the risk--and cost--of alliance coverage.

"What we're worried about in the back of our heads,'' explained Mr. Packer, "is that we'll end up with a plan that will say: 'All public employees and unemployed people and Medicaid recipients, you're in the plan. And most private employers, you're out.'''

School boards want the opt-out alternative extended to public employers because many districts self-insure, often through regional or affiliation pools, said Laurie A. Westley, the chief legislative counsel for the N.S.B.A. In eastern Oregon, she said, 80 percent of districts, mostly small employers, have joined an N.S.B.A. insurance pool.

School groups also are fighting to extend to public employers a federal subsidy the Clinton plan el-29lwould apply more generously to private businesses.

Under the Clinton bill, the federal government would pick up an employer's health-coverage costs after they reached 7.9 percent of the payroll. However, while private companies would reap this benefit immediately, the subsidy would be phased in for state and local governments, and would not take full effect until 2002.

Both education committees have made some changes to address this disparity and the proposal to allow only private employers to opt out.

The Education and Labor Committee is considering a bill that would phase in a cap and federal subsidies for schools and other public employers. The cap would start at 8.7 percent of payroll in 1996 and drop to 7.9 percent by 2002.

The bill approved by the Labor and Human Resources Committee would make schools eligible for federal subsidies whenever health-care costs topped more than 12 percent of a worker's wages.

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