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Alternate Strategies Seek Universal Child Coverage

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With the prospects for wholesale health-care reform looking dim this year, lawmakers are circulating alternative plans that would usher in incremental changes in the health-care system.

And many education advocates--while reluctant to publicly abandon their support for a large-scale plan promising universal coverage--are revising their strategies to fight for proposals that put children first.

"Our position is if you can't do everybody, let's do kids," said Bruce Hunter, a senior associate executive director of the American Association of School Administrators. "And any proposal that won't cover all kids won't meet our test."

Many health experts say that coverage for children would be less costly than a plan that covers all Americans, because young people are ill less often than adults and preventing illness is less expensive than treating it.

And for Congressional leaders, covering children is looking more and more like a good way to take a small step toward reform, said one Senate aide working on health-care legislation.

"At the end of the day, when the lights are turned off, kids ought to be covered," he said.

Is Health Reform Dead?

The Senate began debate on health-care reform Aug. 9, focusing on a package introduced by the majority leader, Sen. George J. Mitchell, D-Me., that somewhat resembled President Clinton's sweeping proposal.

But the leadership was unable to rally sufficient support for the proposal, and the Senate turned to anti-crime legislation before adjourning for its summer recess.

Some education advocates who have fought the health-care battle in the past year are unwilling to acknowledge that wholesale reform is doomed.

"We believe it's premature to abandon the quest for comprehensive health care," said Michael Edwards, the manager of Congressional relations for the National Education Association. "The last few months of Congress is where 90 percent of the legislation gets passed."

But with less than a month before Congress is scheduled to adjourn in this election year--and partisan rancor lingering from the contentious crime debate--many observers are dubious that comprehensive reform can win enough support to clear both the House and Senate.

"There's just not enough time to get everyone together on anything but incremental reform," said a Senate aide close to the process. "The clock is ticking."

Many lawmakers still want to pass a health-care bill, although it is uncertain how Mr. Clinton--and House members, who have yet to debate the issue--would respond to a stripped-down plan.

Child-Centered Reform

Aides and observers say that all the plans under serious discussion by senators and their aides include subsidies for uninsured children.

Sen. Tom Harkin, D-Iowa, is expected to introduce a proposal this week that one aide described as "universal coverage for children."

The plan would provide a federal subsidy for children from families with income up to 250 percent above the official federal poverty level, according to an aide working on the proposal. It would cover most poor, uninsured children who fail to qualify for Medicaid--an estimated eight million to 10 million children, according to the Health and Human Services Department.

Details were unavailable last week, but the plan would achieve its objective by including uninsured children in the existing health-insurance system for federal employees, which offers a generous package of benefits including immunizations, preventive health screenings, and prenatal care.

But the leading proposal is a still-evolving plan drafted by a "mainstream" coalition of 20 senators, headed by Sen. John H. Chafee, R-R.I., as an alternative to the Mitchell plan.

Indeed, Senator Mitchell recognized this in agreeing to use the plan as the basis for further discussion.

Senator Chafee is expected to introduce a compromise package within the next two weeks under which families of four with incomes up to 200 percent above the poverty line would be eligible for partial subsidies.

This plan would also mandate reforms in the health-insurance industry.

Even the minimalist bill introduced by the Senate minority leader, Sen. Bob Dole, R-Kan., would subsidize insurance premiums for the nation's poorest children.

While some education lobbyists are hopeful that a compromise plan might include coverage for children, they are also wary of how Congress might accomplish that.

For example, some child-health advocates worry that the federal government might create a new program for uninsured children that is phased in slowly, but still reduce Medicaid funding in the first year--effectively increasing the financial burden on poor families in the short term.

Reduced Medicaid funding could also hurt school districts that now receive reimbursement for some special-education services under that program. However, a plan that provided insurance for poor children could also shift some of those special-education costs from districts to insurance companies.

Some observers also wonder whether a plan that focuses on reforming insurance practices would be affordable. For example, a measure that would require insurers to cover people with pre-existing conditions without insuring that healthy people also remain in the insurance pool could drive up costs.

Lobbyists also note that none of the alternative plans under discussion contains all of the provisions education and child-health advocates had applauded in the Clinton and Mitchell plans, such as funding for school and community health clinics and a comprehensive benefits package.

Items such as school-based health clinics are unlikely to make the final cut in a compromise plan, observers say, because clinics are seen as a part of a massive health network that would be beyond the scope of such a compromise.

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