WASHINGTON — Buried in the fine print of the massive deficit-reduction bill is–of all things–a brand new social program.
The new program will cost $1 billion over the next five years–somewhat less than the Clinton Adminstration had requested, but still a substantial sum in this era of tight budgets.
Supporters, including Health and Human Services Secretary Donna Shalala, insisted that some provisions in the new program actually would save the government money in the long run. Even many of the program’s supporters questioned that assertion, however, although they insisted that the money is worth spending in any case.
The family preservation and support program–along with expanded spending for childhood immunization, tuberculosis prevention, food stamps, “empowerment zones” intended to help inner cities and the earned income tax credit for low-income workers–represents the flip side of the massive budget cutting and tax-raising efforts of the bill. All told, those social programs–aimed in large part at helping families with children–will receive an additional $29 billion from the bill.
“The President’s long-term investments for kids and families have been very well supported by this bill,” said Shalala.
The social-program funds not only were key to keeping some of President Clinton’s policy initiatives alive, they were crucial to winning support for the budget in the heavily Democratic House, where liberal Democrats and members of the Congressional Black Caucus had threatened to vote against the budget bill unless it contained money to back up at least part of Clinton’s promise to “invest” in programs for the poor.
“There are a number of important features in this bill that represented the basis for many liberal and progressive Democrats to feel they could support the overall budget,” said Rep. Henry A. Waxman (D-Los Angeles).
The survival of the family preservation program, which at several points during the long budget negotiations seemed likely to die, would mark the end of a long legislative road. The program would give money to the states for early intervention and support programs for troubled families. It has passed the House three times and was approved by both chambers last year as part of another piece of legislation ultimately vetoed by then-President George Bush.
Supporters of the program argued that, by intervening early, social workers can help troubled families before their situations deteriorate so much that the state has to place children in costly foster care programs.
Skeptics, including Senate Finance Committee Chairman Daniel Patrick Moynihan (D-N.Y.), argued that the ability of social workers to accomplish those goals has never been proven. At one point during budget talks, Moynihan derided the program as “welfare for social workers,” several participants said.
But other legislators argued that, even if the program does not save money by avoiding foster-care placements, it will provide badly needed help for children. “This creates early intervention to keep children from being abused,” said Rep. Robert T. Matsui (D-Sacramento), who was the program’s chief sponsor in the House.
The program “has been pared down a good deal, but at least we got it,” Matsui said.
The birth of this new program is an object lesson in how legislators and Administration officials can use the arcane rules of the budget-cutting process to advance other items on the legislative agenda.
Over the years, Waxman has become a master at that art. This time around, he engineered a new $200-million program to expand the number of tuberculosis patients who can receive federal Medicaid benefits over the next five years. He also played a key role in winning money for the Administration’s proposed child immunization program, which would receive $585 million under the budget bill.
Although immunization has been a high priority for Clinton and First Lady Hillary Rodham Clinton, Waxman and other supporters of the program had to overcome opposition not only from congressional conservatives but from some White House officials who were willing to accept much lower dollar amounts for the program as they sought to hit their deficit-cutting goals, according to Administration and congressional sources.
Under the tuberculosis program, people who are poor but not otherwise eligible for Medicaid–primarily single men without children–and who have active tuberculosis can receive government-supplied out-patient services if the state they live in decides to participate. Public health officials said they hope that the additional money will reduce the rapid spread of the disease by targeting a group of people who often do not receive care.
The immunization program has two major components. The first part will provide $500 million over the next five years to pay for vaccinations for 2.6 million children whose families lack insurance. The money also will cover the 6.5 million children now covered under Medicaid, relieving the states of a financial burden.
The second part of the bill, which has drawn howls of outrage from drug manufacturers, would allow all states to buy vaccines in bulk at the price manufacturers provide to the federal Centers for Disease Control and Prevention–something 11 states now do. The CDC has negotiated steep discounts from the prices that drug companies charge private pediatricians.
