Who cares about children, health care, the poor, the struggling moms, the left out? Why, Bill Clinton, of course. Everybody knows that.
But who lets his OMB director, Jack Lew, slash funds requested by Health and Human Services Secretary Donna Shalala for the community health centers that serve 11 million poor and uninsured Americans, the people whose pain Clinton feels the most? That is also Bill Clinton.
The community health center program was created in the wake of the urban riots of the '60s. It was sponsored by Robert Kennedy, then a senator from New York, and his younger brother, Edward. Today, only Sens. Edward Kennedy (D-Mass.) and Jay Rockefeller (D) of West Virginia, where community health centers are a huge item, seem to care about them.
In 1997, Shalala requested $100 million in appropriations. The White House budget office cut it to $8 million. In 1998, Shalala asked for $100 million, and got $15 million. In 1999, she lost out again to the slashers. They gave her $20 million.
You may be surprised to hear that for three years in a row, the poorest of the poor were bailed out by the other party. The Republicans, who in other areas of the health care debate are hammered for their obtuseness, their obliviousness, their indifference to the have-nots, their unfailing instinct for finding reasons to support their contributors rather than their constituents, came to their rescue. Speaker Dennis Hastert (R-Ill.) is a fan of health centers. So is Rep. John Edward Porter (R-Ill.). They felt obligated to help people who, without health centers located in their neighborhoods, would never see a doctor. Then-Speaker Newt Gingrich was an ally. In the Senate, so was Trent Lott (R-Miss.) and, more predictably, Arlen Specter (R-Pa.) and John Chafee (R-R.I.).
This year, Donna Shalala got the message: She requested only $20 million for 2000. The community health centers, which take care of four out of every 10 poor children in America, are up against it these days. Of the 650 in operation, 45 percent are in severe financial trouble; 7 percent have declared bankruptcy.
The number of uninsured Americans has greatly increased due to a number of factors. Many erstwhile welfare recipients lost medical benefits along with their welfare payments and now are among the centers' clientele. HMOs have squeezed hospitals and doctors on costs to the point where fewer can take on charity cases. When Hillary Clinton was campaigning for her comprehensive health care reforms, the number of uninsured was 38 million. Now it is estimated at 43 million.
Community health centers, by law, cannot turn anyone away for lack of funds. Fees are based on an ability to pay. If a patient has 50 cents, that's what he pays. The centers provide ongoing services--preventive care, prenatal care, immunization. They do deliveries. They give employment to the locals. Their boards are composed 50 percent of patients.
Rep. Danny Davis (D-Ill.) is an impassioned advocate. He "grew up" in community health centers, working in the Martin Luther King Jr. Center in his Chicago neighborhood, before moving on to the Mile Square Center, also in Chicago. He was later president of the National Association of Community Health Centers. He says, "I don't think that I would be doing what I'm doing today if it weren't for the centers and the opportunity for work and training they gave."
Philip Johnston, a Boston health consultant who was once an HHS official and director of human services for Massachusetts, came through town this week to lobby for the centers. He calls the administration's failure to fight for them "a mystery and a scandal." When he asked at OMB, he was told that "the Republicans in Congress will take care of you."
Says the president of the National Association of Community Health Centers, Thomas Van Coverden: "I don't understand it. They provide health care where it is most needed, and the price is right."
OMB's Dan Mendelson, associate director for health and personnel, says the budget office slashes must be understood "in context."
"We have a holistic approach to public health. The system is under a strain, and we are being innovative. We have given increases to the Centers for Disease Control, which also serves minorities and the poor. We have to operate under the budget caps. We did nothing to prevent the Republicans from bringing the restoration of the funds to fruition. The cuts do not represent our assessment of [the community health center program] as a very important aspect of our health care."
Washington has not offered any more striking role reversal lately.