Washington
As Congress nears what one lawmaker called “high noon’’ for health-care reform, a key Senate committee last week unanimously approved the first federal program designed specifically to support school-based health clinics.
On a 17-to-0 tally, the Senate Labor and Human Resources Committee voted to authorize $2.35 billion over six years in grants for the program, as the committee worked to draft its version of the Clinton Administration’s health-care bill.
President Clinton’s original legislation called for $1.53 billion in federal grants for school clinics, but the committee added another $820 million.
Local community partnerships made up of health-care providers, school districts, and community-based organizations serving at-risk children would be eligible for grants of up to $200,000.
The more than 500 schools that currently house clinics generally patch together funding from a variety of sources, with significant help from private foundations. The federal contribution is about $17 million, according to rough estimates made by state and federal officials. (See Education Week, Oct. 13, 1993.)
Four other Congressional committees will work on the health-care bill, but the unanimous vote by the Senate committee bodes well for the fate of the school-clinics program. Both Democrats and Republicans voiced support for school clinics in committee debate.
Such clinics “have become the family doctor for many families in America,’' said Sen. Paul Wellstone, D-Minn.
How Prescriptive?
“I feel more strongly about this than almost any other program that we’ve talked about,’' said Sen. Nancy L. Kassebaum of Kansas, the panel’s ranking Republican.
The funding level and the federal role in designing clinic services proposed in the version of the health-care bill introduced by Sen. Edward M. Kennedy, D-Mass., the committee chairman, proved to be the two main sticking points. His bill would have authorized $3.15 billion in grants, more than double what the President proposed.
It also would have required clinics to offer a wide range of services, including controversial “age-approriate programs’’ targeting high school dropouts, teen pregnancy, substance abusers, and violence.
Senator Kassebaum called the bill “enormously prescriptive’’ and said, “We cannot design these clinics from Washington.’'
She proposed that local school boards and parents be allowed to determine clinic services, and she called for cutting the funding ceiling by half.
Senator Kennedy defended his plan, arguing that “based on the number of children and schools involved, it’s a rather modest approach.’'
As for the required services, he said: “We’re not trying to prescribe how to do any of these.’' Rather, he said, the bill outlined areas of preventive care that clinics “should pay attention to.’'
But Republican attacks on the plan’s cost and red tape struck a chord with some Democrats.
Sen. Barbara Mikulski, D-Md., said that allowing clinics to be designed at the local level might put to rest their “bad rap’’ as “federally funded programs that give out condoms.’'
Local Control
Mr. Kennedy and Ms. Kassebaum eventually agreed to split the difference in funding between their two proposals, as Senator Mikulski suggested.
Their compromise amendment also left the determination of specific clinic services to each health provider, with input from the local community partnership and final approval by the local school board.
At the suggestion of Sen. Dan Coats, R-Ind., the amendment also included a requirement that clinics follow state laws regarding parental notification when medical services are provided to a minor.
During debate on other sections of the bill, the committee jousted over the benefits package that would be guaranteed every American under Senator Kennedy’s bill. The legislation would expand coverage for women and children beyond what the President’s bill proposed, adding such items as annual physicals for 13- to 19-year-olds.
Republicans attacked the cost of these benefits. But in a bipartisan move, the committee approved by a 17-to-0 vote an amendment introduced by Sen. Jeff Bingaman, D-N.M., to establish an independent commission to review the benefits selected by Congress and recommend modifications if the package proves too costly.
The Labor and Human Resources Committee is the first full committee to cast votes on a health-care bill. In a briefing for reporters before a meeting with Congressional leaders and President Clinton, Senator Kennedy said the time for action had come.
The President knows “as we do that this is really the high noon of the debate on health care,’' he said.
Teachers’ Benefits
School groups gave Senator Kennedy’s bill a mixed review, generally hailing the school-clinics program and the increased benefits for children while taking exception to other provisions.
Lobbyists for both teachers and administrators expressed concern that under both the Kennedy and Clinton bills, teachers might not qualify for the benefits given full-time workers. Under the so-called employer mandate in both bills, employers would pick up 80 percent of the health-coverage costs for full-time workers.
Full-time workers are defined as employees who log at least 120 hours a month on the job. Some education groups have expressed concern that this formula would ignore teachers’ work outside the classroom and designate many teachers as part-time workers.
Sen. Claiborne Pell, D-R.I., will propose an amendment to make clear that teachers qualify for benefits, according to a Senate aide.
Groups representing school officials also took issue with what they perceive as an inequity in the employer mandate as it would apply to the private and public sectors.
Both the Kennedy and Clinton bills would cap employers’ health-coverage costs at 7.9 percent of payroll expenditures. But the cap would be phased in for government entities and would not take full effect until 2002.
“We would like school districts and other units of government to be treated the same as the private sector,’' said Bruce Hunter, an associate executive director of the American Association of School Administrators.
