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Spec.-Ed. Advocates Hail Panels' Health-Care Votes

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Congress has protected the interests of special-needs children in committee-level work on health-care-reform legislation, according to special-education advocates.

But advocates' relief at the outcome of these battles is tempered with fear that they may ultimately lose the war, as lawmakers appear to be retreating from basic tenets of President Clinton's plan that promised better care for students with disabilities.

The disability-rights and special-education communities have scored a number of successes in the four committees that have passed health-care bills, which have altered provisions in the President's original bill that threatened to make getting affordable coverage tougher, not easier, for children with special needs. (See Education Week, Nov. 24, 1993).

Members of Congress were slow to understand the implications of these provisions, but quick to right perceived wrongs, lobbyists said.

"There has been a real learning curve on the part of Congress,'' said Suzanne M. Hansen, a policy analyst at the National Association of Children's Hospitals and Related Institutions.

One key change approved by the House Education and Labor Committee would open the door for health plans to pay for medical services that the Individuals With Disabilities Education Act now requires schools to provide.

At its markup last month, the committee approved an amendment that aims to coordinate the benefits to be offered through health-care plans under the reform legislation with the benefits mandated by the I.D.E.A. program, which requires schools to provide medical services needed to allow students to receive an education.

Financial Relief for Schools

Under the amendment, if medical services required by the I.D.E.A. were covered by an insurance plan, the health plan would pick up the cost, even if the school provided the services.

Dr. Donald A. Kates, the director of financing projects for the Child Development Center at Georgetown University, called the addition "pretty positive language.''

"The managed-care groups will yell and scream if somebody else can spend their money, but it gives schools a strong negotiating stance,'' he said.

Three committees also modified the language of the original Clinton bill to include children with congenital or developmental disabilities among those who would be covered for such outpatient rehabilitation services as physical, occupational, and speech therapy.

In the Clinton plan, such services would have been covered only for those suffering "illness or injury.''

Advocates are also breathing easier now that the three committees with jurisdiction over a Medicaid program they say is critical to special-needs children have retained or expanded it.

The Early and Periodic Screening, Diagnostic, and Treatment program currently provides more than 40 preventive and rehabilitative medical services to children in families with incomes no greater than 185 percent of the national poverty line. Schools are among the providers offering E.P.S.D.T services.

The E.P.S.D.T law mandates screening for eligible children and treatment for children found to have a medical problem. The original Clinton bill, however, would fold Medicaid into a new health-care system and replace E.P.S.D.T with a program whose scope is unclear. Advocates said it would cover seven million fewer children than the current E.P.S.D.T. program.

Not a Done Deal

A health-care bill passed by the Senate Finance Committee would preserve the current E.P.S.D.T services and mandates, while both the House Ways and Means Committee and the House Education and Labor Committee passed expanded versions that would cover children in families with incomes as much as twice the poverty level.

"The beauty of this is that everybody is recognizing the need for this program,'' said Gregg H. Haifley, a senior health associate with the Children's Defense Fund, an advocacy group based here.

Lobbyists cautioned that none of the gains is secure. The leadership in the House and Senate will cobble together two bills that will go to each chamber's floor for votes, and they can drop provisions from any of the four bills that emerged from committees.

And advocates said they are more concerned that their gains could be eclipsed if lawmakers settle on a compromise plan that erodes such basic principles as universal coverage.

The original Clinton bill called for financing universal coverage through an "employer mandate'' where businesses would be required to pick up roughly 80 percent of their employees' health-insurance costs. But this mandate is controversial; opposition to it led to passage of a bill in the Senate Finance Committee that does not guarantee universal coverage.

If such a bill becomes law, advocates said, people with high medical costs--such as the disabled and the chronically ill--could be left either uninsured or underinsured.

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