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Education Reporter

     Public Schools As Nurse And Nanny

Speech by Pennsylvania Rep. Sam Rohrer,
Eagle Forum Leadership Conference, Sept. 27, 1997

Expansion of the "Nanny State" continues at breakneck speed. It seems our national love affair with Marxism and fascism is turning into a life-long commitment, with you and me and every freedom-loving American being stiff armed and turned into the partner cast off.

Between the "medicalization of the schools" through the expanded use of Medicaid, and the subversion of the world's finest system of health care through managed care and other government-induced health care reform, we are witnessing the total restructuring of society.

Medicaid has moved mainstream into our schools. It is paying salaries, funding multiple programs that boldly intrude into the sanctity of the home, and is the cause of escalating federal and state budgets. Even more objectionable, the Medicaid component is but one spoke in the wheel of the larger societal restructuring movement that clearly orchestrates a number of large federal entitlement programs to produce what the Clinton administration calls a "safety net." In reality, if left unrestrained, it will become Marc Tucker's "seamless web" through which no one will fall and ultimately no one will escape.

An encounter with our Pennsylvania Departments of Education and Welfare revealed a covert attempt to push our public schools into registering as "partial hospitalization providers" under Medicaid.

The inability to obtain full disclosure from these departments prompted me to introduce House Resolution 37. By a wide margin, the Pennsylvania House of Representatives passed this resolution and created a select subcommittee. This subcommittee was chartered to investigate the issue of Medicaid in the schools, how it got there, its fiscal impact, as well as the issues of parental consent violations, pupil privacy invasions, data collection and security. As chairman, I pursued these objectives carefully. The subcommittee completed and circulated its final report, known as the H.R. 37 Report, at the end of November, 1996. It is probably the most documented and researched report to come out of a legislative committee in Pennsylvania, detailing these issues and making specific findings and recommendations. The findings revealed but the tip of an iceberg.

While many serious problems were identified, there is one that is most serious because it breeds many others. It is that dramatic public policy shifts are simultaneously occurring in the areas of education, workforce development and health care. Almost all are through executive branch initiatives and bureaucratic maneuvering. These shifts all have one thing in common -- the realignment of control. Control is being wrested away from individuals, parents, local school boards and health care providers, and ultimately, from employers.

Without dispute, these shifts, if left unaltered, will produce an economy planned not by parents and individuals, but by government fiat.

Up to now, these monumental changes were for the most part bypassing Congress and the elected state legislatures because of a great urgency to make key structural changes before the year 2000. Congress and the legislatures are generally viewed as impediments that must be avoided. As such, the necessary constitutional principle of checks and balances is violated and the scrutiny afforded by public and legislative debate is pre-empted. The necessary safeguards and protections are not established and the citizens of this nation, our children, our parents and ultimately our entire population are victimized by the intruding arm of government. The picture coming into focus is quite ugly.

It is the apocalyptic black horse of government-run health care on which the enemy of freedom has most stridently and recently ridden. Reacting to public exposure from reports like HR 37, there has been a grand and brazen attempt to legislatively sanction what has already occurred through executive order.

Together, Marc Tucker and Hillary Clinton are spinning their seamless web around Hillary's village and all of us. Their clearly stated goal is a "cradle to grave" net into which infants will be swept from the womb, toddlers immunized and medicated, adolescents coddled and remediated, workers trained and molded, and, when no longer productive to the state, released to flounder.

At the 1989 National Governor's Conference, which was chaired by then-Governor Bill Clinton, an initiative called America 2000 was officially adopted by the governors. Implementation began simultaneously at both the state and federal levels. While this movement was dubbed the "educational restructuring movement," it became the umbrella under which other restructuring efforts in health care and the labor force could occur without a great deal of suspicion. And because the strategically chosen object of this restructuring was and is children, it defies criticism by all except protective parents and a few courageous others.

The six goals of what is now Goals 2000 became the banner under which individual state initiatives were started or consolidated. For instance, the first goal states: "By the year 2000, all children will start school ready to learn." In Pennsylvania, our former governor placed medical assistance and other health-related areas under this goal. OBE was advanced as Pennsylvania's unique approach to learning; however, in reality, it conformed totally to the national goals.

According to the 1992 SCANS report, produced pursuant to the adoption of America 2000 by the National Governor's Conference, this federal plan became the "blueprint for change." The SCANS spelled out the details of how labor policy, education, and health care would be combined in the classroom. In this setting children, considered as "human capital" by proponents of this approach, became objects for tinkering and experimentation by social planners.

It was apparent that these wholesale structural changes could not be accomplished without a massive infusion of new dollars, which were simply not available at the state level. But never fear. Funding is as available as increasing the national debt. Two ready-made programs existed but had too many restrictions for broad-based use. The programs were Title I funding and Medicaid. However, the restrictions did not pose formidable obstacles. In October of 1994, President Clinton signed into law the "Improving America's Schools Act." In addition to reauthorizing over $7 billion for F.Y. 1995, this legislation rewrote the Elementary and Secondary Education Act. Among other things, this change allows Title I funds to be expended on all students who are labeled "educationally deprived," not just "economically deprived."

As for Medicaid, similar changes have occurred. Originally a government-sponsored health insurance program for the poor, poverty guidelines have been dropped entirely for ages 0-21. Through the exploitation of a loophole in the Omnibus Budget Reconciliation Act of 1989 (OBRA 89), terms have been redefined. Disability now includes reading and math deficiencies for such things as "breaking up with one's boyfriend or girlfriend." Other terms have been expanded like "at risk," which now means "at risk of becoming at risk.'' This assures that every child can become "identified," and, once identified under Goals 2000 or Title I as "at risk," can be remediated under Medicaid mental health "wrap around services."

In order to provide these mental health remedial services, schools must agree to provide mental health services, which can be done through the "partial hospitalization provider status." This is what allows the schools to provide all health-related services through the vehicle of school-based clinics.

The EPSDT (Early Periodic Screening, Detection, and Treatment) program is cited as the federal mandate to provide diagnosis and treatment under the "Rehabilitation" option available to the states. Medicaid then becomes the funding source for all areas of identified "health and mental health remediation and rehabilitation." Not only will EPSDT/Medicaid pay for true medical services, it will pay for a long list of subjective mental health diagnoses. It is this "identification" process, fueled by new Title I requirements, EPSDT allowances, and School-to-Work requirements, that necessitates the "profiling" of every child. Once a child is identified, the school either bills Medicaid directly or, as is most common, utilizes a data billing company. Schools can either hire their own counselors, therapists, and nurses or, more commonly, allow outside agencies to provide services to "identified" children, either within the school or wherever the child may be. For instance, mobile therapists can bill $42/hour for the time they spend riding the bus home with Johnny if Johnny is "stressed" by a bully on the bus. Since there is no classification for "normal" according to the DSM-IV manual, every child can be found in need of remediation all paid for by Medicaid.

Additional structural changes had to be made in order to allow states to begin providing these expanded health-related services on a statewide basis. No problem; simply have the state executive branch and Department of Welfare apply to the Health Care Finance Administration and waivers will be granted. Once granted, these waivers allow for all types of things to occur. But isn't the very purpose of waivers to allow that which is not permitted by law? Even the Government Accounting Office (GAO) testified before the Congressional Committee on the Budget on April 4, 1995 that "allowing the waiver process to be used to expand coverage to hundreds of thousands of additional individuals without the consultation and concurrence of the Congress appears inappropriate. The result of these waivers could lead to a heavier financial burden on the federal government." And a substantially greater fiscal burden will fall on the states as well.

Not only can expanded services be provided as indicated by the GAO, but health care reform is being accomplished through the use of school-based clinics and managed care within the Medicaid population. Orchestrated as it is in Pennsylvania and many states, the Clinton health care reform agenda is being accomplished through the back door without federal or state legislation.

It's not that the Health Security Act did not pass in 1993, it just failed to pass Congress. As children were the object in the 1989 adoption of America 2000, so are they in the implementation of health care through the back door. In a document obtained from the released White House files from the Health Care Task Force meetings, school-based clinics were identified as the vehicle for change. Because schools represent the place where most students are housed, they represent a "captive audience" and, as such, are prime targets for social policy change. The school-based clinic concept conveniently enables screenings to take place under the cloak of "health."

The Pennsylvania back-door health reform plan was called "KidsFirst." According to the same documents, full implementation of government-controlled health care would start with forced managed care of the expanding Medicaid population and would target children through the use of school-based clinics. Full implementation would then work its way through the general population by age groups, and is intended to be completed by the year 2000. In Pennsylvania, we are well on our way to meeting this target.

You may justifiably be wondering who or what is the engine driving all this. The answer is private foundations and private foundation money. The largest and most influential foundation avowedly committed to Clinton-style comprehensive health care is the Robert Wood Johnson (RWJ) Foundation in New Jersey. Extremely successful in influencing bureaucratically imposed public policy by providing grant money to state governments for health-related pilot programs, this foundation is responsible for the health care reform component of the larger equation. It has been and remains the glue, the muscle, and the brains behind this restructuring.

The December 16, 1996 edition of Forbes magazine entitled "Trojan Horse Money" speaks eloquently to this matter. By regularly circumventing the elected legislatures, the balance of power is tilted against the elected representatives of the people. If left unbridled, this abuse of the process will cause the demise of representative government.

Since the completion of the HR 37 Report, the march towards government-run health care on the backs of children continues unabated. In Pennsylvania, the pilot was the Children's Health Insurance Program (CHIP), created in 1991 and funded by a tax on cigarette sales. CHIP was created at the request of our former Governor at the behest of RWJ. This creation was critical to RWJ's strategy because they needed a structural change to "legitimately" direct public dollars into the private health care sector. Social liberals know that the real value of pilot programs is to get the camel's nose under the tent. Well, the camel is now in the tent, and RWJ is using Pennsylvania as a success story of how to use children, purchase public policy, and magnify people's fears to initiate social change.

Building on the Pennsylvania model, the RWJ Foundation targeted Governors, wooing them with promises of grant money and soliciting the commitment of the executive branch to pursue vital legislation. The strategy used is in essence always the same. Approach the Governor. Offer a grant, promise money, etc., write the bill, buy the votes, implement a legislative full court press, and, of course, resist public hearings to avoid debate because the "urgency of the situation does not allow such delays." These efforts have garnered full support from Governors, and have crystallized in the form of public/private nonprofit corporations, sometimes called the Healthy Kids Corp. (Florida) or KidCare in many other states. Interestingly, it doesn't seem to matter from which party the Governor hails: in Missouri, a Democrat, in Texas, a Republican. According to legislators in these states, a common method for implementation of this health insurance is the use of school-based clinics either overtly or covertly. So now, state after state has legislatively institutionalized the structure to funnel public dollars into a private-sector-run industry.

Not surprisingly, in most states these new corporations are not answerable to the legislature. The directors are appointed and controlled by the Governor.

The manner in which state and federal initiatives coordinate should make everyone stand in amazement. To my knowledge, this level of involvement is unprecedented and it is frightening.

The latest federal component in the puzzle is officially designated as SCHIP, which stands for State Children's Health Insurance Program. Recently passed as a part of the federal budget agreement, this new program is referred to as a "state entitlement." I've heard some Republicans who voted for it say that "we'll have to be careful so as to not allow this program to become an entitlement." Well, it already is, and says so in the legislation.

SCHIP was created under a new Title XXI of the Social Security Act and appropriates billions for children's health care. It guarantees funding in the amount of $24 billion over five years, and $48 billion over ten years, but this amount could increase before that time.

It amazes me how budget compromises work. President Clinton asks for $10 billion, the Senate recommends $16 billion, the House $20 billion, and the conference committee compromises at $24 billion!

In order to justify their vote, some Republicans claim victory on this issue because the states were given a great deal of latitude in spending this money on children's health. Consistent with RWJ strategy, however, the latitude is pure smoke. It doesn't exist, because the bill does not properly place oversight with the state legislatures. Oversight rests squarely with the Governors, who have already demonstrated that they are under the influence (of RWJ). The bill says the states can use these new health care dollars to either augment and expand the very broad Medicaid program, as in Pennsylvania, or create a new structure.

But let's look at what the bill really requires. Key mandates include:

  1. Medicaid Expansion: To access funds, states must phase in Medicaid coverage for children under poverty level by 1998 to age 17 and by 2000 to age 19. This is a very broad group, and will significantly raise the cost of Medicaid for both states and the federal government. It accomplishes the health care destroyers' agenda through state waivers that circumvent the legislatures.

  2. Mandated Benefits: These must equal or surpass the best preferred plan available within the state, including vision and dental. The three legislated benchmarks are
    1. Blue Cross/Blue Shield's preferred provider plan;
    2. the state employee plan; and
    3. coverage offered by the state's largest HMO.

  3. Eligibility:
    1. no exclusion for pre-existing conditions; and
    2. children must reside in families with incomes below 200% of federal poverty level, or $31,200 for a family of four.

  4. Expansion of Coverage: States may use funds to purchase family coverage for target children. So, the truth is, this is not just a children's health insurance. Are any of us surprised?

  5. Mandated Program Growth and Annual Reporting: States are required to identify specific strategic objectives aimed at increasing enrollment. States must:
    1. prove progress made in reducing the number of uncovered low-income children;
    2. prove success in increasing the number of children with health coverage;
    3. document the effectiveness of the program; and
    4. prove the effectiveness of coordination with other public and private programs. It is here that I see a giant skunk in the wood pile. This program establishes the basis for employers to begin offering plans to employees without children's coverage. Employees will be encouraged to transfer their children's health care coverage to the taxpayer-paid plans.

  6. Mandated Data Collection and Federal Government Access to Data: States are required to:
    1. file plans with the Federal Government assuring that the state will collect data, maintain records, and provide required reports to the Secretary; and
    2. provide the Federal Government with access to all records. This provision creates privacy concerns by requiring data collection and reporting. Since there is no prohibition against collecting data on individuals, you can be certain it will be specific.

  7. Mandated Advertising: A full 1% or $240,000,000 is mandated for use in marketing and advertising. But since outreach and administration is capped at 10%, a full $2.4 billion could be skimmed off the top for new bureaucrats or to dispense juicy contracts to favored clients.

The overall problem with this legislation is that it is the Clinton Health Care Plan. It is not warmed-over Clinton-Care, this is the 1993 plan before our eyes, right on track.

Aside from the destruction this program will bring to quality health care, the cost of this gigantic boondoggle will break the bank. The White House estimates 10 million uninsured children and Clinton originally requested $10 billion over five years. The Children's Defense Fund, however, states that the $24 billion now appropriated will serve only five million children at a cost of $960/year/child, or $80 per month. Therefore, up the budget! The OMB says that the $24 billion will only serve 1.7 million children. That figures out to approximately $2,824/year/child or $235/month! Where does the OMB figure the extra dollars will be siphoned off?

The commonly cited statistics used to "prove" the uninsured children "crisis" are bogus. Rather than this being a benevolent government program for children, it could more accurately be described as a government-sanctioned child abuse program! How else can you describe a government program that, by stealth, strategically targets the family, and "uses" children to accomplish a clearly self-serving political and economic agenda?

The ultimate goal is for federal control of education, labor and health care. Both the shadowy process by which the changes have been made and the official "blueprint" speak clearly to the veracity of the claim that their goal is a "total managed economy." For the sake of these United States, for the freedom we have enjoyed, and for the children who will replace us, we must put a stop to Federal Government intrusion into education, health care and the workforce. For the sake of our children, our professions, our freedom, let's not give up but stand up, speak out and hold fast!

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