Includes: Welfare Reform; Immigration; Child Welfare; Affirmative Action; Adoption; Minimum Wage; Medicaid/Medicare; Defense of Marriage Act; Mental Health Parity; Employment Non-Discrimination Act; HCFA Conditions of Participation; Funding For Violence Against; Women; Managed Care Standards Act (VAWA) Programs; Health Insurance Portability; Ryan White CARE Act Reauthorization; Federal Budget; Vocational Rehabilitation Act Services; FY 1997 Labor/HHS/Education Appropriations; Public Health Service; Health Professions; Individuals with Disabilities Education Act (IDEA); Training;
WELFARE REFORM:
On August 22, 1996, after vetoing two previous versions, President Clinton signed the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 into law (Public Law 104-193). NASW supported realistic welfare reform, but strongly opposed the approach taken by the new law, which repeals the 61 year old Aid to Families with Dependent Children (AFDC) entitlement. The AFDC entitlement, which guaranteed minimal cash assistance to all families who met income and asset eligibility requirements, is replaced by a fixed-sum Temporary Assistance to Needy Families (TANF) block grant, under which even eligible families may be denied assistance.
The new law also
[For more details of the new law, please refer to the Government Relations Update, Personal Responsibility and Work Opportunity Act of 1996 (H.R. 3734), Public Law 104-193: Summary of Provisions, August 27, 1996.]
CHILD WELFARE: One bright spot in the Personal Responsibility and Work Opportunity Reconciliation Act is the absence of a child welfare/child protection block grant. NASW, working with social work educators and researchers (ANSWER coalition) and others, was successful in eliminating the child welfare block grant from the final bill. All federal child welfare programs will remain intact, including Title IV-B and IV-E training programs. The new law permits states to make Title IV-E foster care maintenance payments to for-profit as well as nonprofit child care institutions; requires states to consider giving preference to an adult relative over a non-related caregiver when determining a foster care placement; extends the enhanced federal funding rate for Statewide Automated Child Welfare Information Systems (SACWIS); and calls for a multi-year, national study of children who have been abused and neglected or are at risk of abuse or neglect.
Child Abuse Prevention and Treatment Act. On October 3, 1996, President Clinton signed the Child Abuse Prevention and Treatment Act (CAPTA) Amendments of 1996 into law (P.L. 104-235). Advocates were successful in preserving a number of essential protections for children, maintaining a federal role in funding research, training, technical assistance, data collection and information dissemination and modifying provisions on the termination of parental rights and the redefinition of "child abuse and neglect." In addition to providing state grants for improving child protective services (CPS), community-based efforts to prevent child maltreatment and children's justice programs, the new law requires states to establish citizen review panels, composed of volunteers broadly representative of the community. Panels, which must include members with expertise in child abuse and neglect prevention and treatment, are to examine CPS policies and procedures and specific cases, where appropriate, and report annually to the public.
ADOPTION: Portions of the Adoption Promotion and Stability Act were included in the bill increasing the minimum wage (Small Business Job Protection Act), which President Clinton signed into law (P.L. 104-188) on August 20, 1996. The provisions provide a nonrefundable $5,000 per child tax credit for expenses incurred by adoptive families and a $6,000 tax credit for families adopting children with special needs. Also included are provisions amending the Multiethnic Placement Act, which do not preclude states from considering race and ethnicity in selecting a foster or adoptive home, but prohibit states from delaying or denying placement of a child solely on the basis of race, color, or national origin. The penalty for noncompliance is a reduction in Title IV-E funding. In letters to the relevant committees, NASW supported the expeditious movement of children into safe, stable, nurturing homes, but maintained that to be successful, cultural heritage must be one of several significant factors considered. The association promoted the need for vigorous recruitment of families that mirror the child welfare caseload and support and training for families who are candidates for transracial placements.
Indian Child Welfare Act Amendments. The original version of the adoption bill contained provisions amending the Indian Child Welfare Act (ICWA), which NASW criticized as undermining Indian tribal sovereignty and jeopardizing the well-being of Indian children. The ICWA provisions later were placed in a separate bill (S. 1962/H.R. 3828) and revised. The new bill retained tribal court jurisdiction over American Indian children and set strict deadlines throughout the adoption process to ensure participation by all parties involved. The Senate passed the bill on September 26, but the House failed to take final action prior to adjournment.
MEDICAID/MEDICARE: The best news for the Medicaid and Medicare programs in the 104th Congress is that the programs were not altered. Advocates successfully blocked the House and Senate leadership's attempts to drastically cut funding and to end the entitlement of basic health care services to poor women, children, the disabled, and the elderly through a Medicaid block grant to the states. For the most part, Medicaid entitlement will also continue for current AFDC-eligible families, even if they no longer receive assistance through a state's new welfare program. Advocates also stalled the leadership's attempts to dramatically alter Medicare and increase privatization of the program. Retention of the Medicaid and Medicare programs represent a significant victory in the 104th Congress. NASW advocates maintaining the current structural integrity of the Medicaid and Medicare programs with adequate funding support.
MENTAL HEALTH PARITY: On September 26, President Clinton signed into law H.R. 3666, FY 1997 Appropriations for the Departments of Veterans Affairs and Housing and Urban Development. The new P.L. 104-204 contains a scaled-back version of the mental health parity provision that was originally added to the Senate's Kassebaum-Kennedy bill and dropped in conference. Effective on January 1, 1998, the parity provision requires all health plans, including plans covered by the Employee Retirement Income Security Act (ERISA), that provide a mental health benefit to establish equal annual payment limits and lifetime caps for coverage of mental and physical illnesses. (Businesses employing fewer than 50 employees are exempt from the parity requirement.)
The provision does not cover substance abuse or chemical dependency benefits, nor does the requirement apply to Medicare or Medicaid programs. Businesses are not required to offer a mental health benefit, and insurers may continue to differentiate between mental and physical illnesses with respect to co-payments, deductibles, and benefit design. NASW lobbied on behalf of the parity provision and views its enactment as a significant win and a first step toward ending the discriminatory insurance treatment in coverage of mental health services.
[For more details of the new law, please refer to the Government Relations Update, The Health Insurance Portability and Accountability Act, Public Law 104-191 and Mental Health Parity, Title VII, VA-HUD Appropriations Bill, Public Law 104-204, October 4, 1996.]
HCFA CONDITIONS OF PARTICIPATION: NASW continues to monitor publication of new conditions of participation governing the Medicare program. As of this date, the proposed rules have not been published by the Health Care Financing Administration (HCFA). Earlier this year NASW met with HCFA Administrator Bruce Vladeck and HHS Secretary Donna Shalala regarding efforts within HCFA to downgrade the definitions and qualifications for social workers providing services through Medicare's Home Health, Hospice, and End Stage Renal Disease Program. HHS officials assured NASW that the current definitions of and qualifications for social worker would be continued through the new conditions of participation. However, comments would be solicited regarding whether the definitions of social worker should be changed in the future.
MANAGED CARE STANDARDS: The 104th Congress was not willing to address managed care standards in any comprehensive fashion. Consequently, H.R. 2400, the Family Health Care Fairness Act of 1995, which was endorsed by NASW, was not scheduled for any legislative action. However, a few managed care standards received attention in a piecemeal fashion as Congress neared adjournment. Like the mental health parity provision, a measure to require health plans to provide minimum 48-hour hospital stays for mothers and newborns was attached to the VA-HUD appropriations bill and will go into effect January 1, 1998. A bipartisan measure in the House to prohibit health plans from requiring providers to sign "gag clauses" on treatment options and referrals made headway in the House and Senate but did not become law. Similarly, an unsuccessful attempt was made during Congress' final days to attach a health rider to the Interior appropriations bill that would require plans to accept a "prudent layperson" definition for coverage of emergency care. NASW supports the development of comprehensive federal standards for managed care, consistent with the 1993 NASW publication, The Social Work Perspective on Managed Care for Mental Health and Substance Abuse Treatment.
HEALTH INSURANCE PORTABILITY: The Health Insurance Portability and Accountability Act of 1996, commonly referred to as the Kassebaum-Kennedy health insurance bill, was signed into law on August 21. The new P.L. 104-191 is complex and contains a variety of provisions that are intended to help people obtain and keep private health insurance coverage. Most of the law's provisions become effective July 1, l997.
The law offers portability in health insurance coverage for employees who are covered through employer-sponsored plans and for previously covered individuals who can afford to pay health insurance premiums out of pocket. Eligible individuals must be offered coverage, regardless of health status, and critically needed limits are imposed on waiting periods for pre-existing conditions. Other positive provisions in the law include an increase in the tax deductibility of the cost of premiums for the self-employed, new tax deductions for long-term care expenses, and for individuals suffering from chronic and terminal illnesses, receipt of tax-free accelerated death benefits. Negative features of the law include its failure to address affordability or to provide assistance to those who are uninsured, a demonstration program allowing creation of 750,000 tax-deductible medical savings accounts and permission to insurers to sell duplicative policies. NASW actively lobbied on behalf of the positive provisions in the bill, including the more comprehensive mental health parity provision that was added to the Senate bill, and opposed medical savings accounts and other anti-consumer provisions.
[For more details of the new law, please refer to the Government Relations Update, The Health Insurance Portability and Accountability Act, Public Law 104-191 and Mental Health Parity, Title VII, VA-HUD Appropriations Bill, Public Law 104-204, October 4, 1996.]
FEDERAL BUDGET: The House and Senate on June 13, cleared a budget resolution (H.Con.Res.178) that set forth congressional spending and taxing priorities for the next six years and called for further congressional actions to balance the federal budget by fiscal year 2002. The resolution projected a fiscal 1997 federal budget of $1.6 trillion, with a deficit of $153.4 billion as much as $37 billion more than the Congressional Budget Office's estimate of the deficit for fiscal 1996. The budget plan was designed to balance the federal budget by cutting discretionary spending and reducing projected spending on entitlement programs such as Medicare and Medicaid, while cutting a variety of taxes. NASW lobbied against the FY 1996 resolution on the basis that the cuts were disproportionately targeted on vulnerable populations.
As an internal congressional document, the annual budget resolution does not have the force of law and does not require the president's signature. However, it develops congressional action on appropriations bills and a deficit-reducing reconciliation measures.
FY 1997 LABOR/HHS/EDUCATION APPROPRIATIONS: In the final hours of the fiscal year, President Clinton signed into law (P.L. 104-208) the omnibus appropriations bill, H.R. 3610, which provides full fiscal year (FY) 1997 funding for eleven federal departments and numerous agencies, including the Departments of Labor, Health and Human Services (HHS), and Education. Because Congress was anxious to resolve the appropriations stalemate and adjourn as quickly as possible, the Republican leadership agreed to add $6.5 billion in additional discretionary funding that the president had sought for such priorities as education, job training, and environmental initiatives.
The omnibus spending agreement provides $71.1 billion to the Departments of Labor, HHS, and Education for discretionary programs, $400 million more than the House appropriations bill and $7.8 billion more than the FY 1996 appropriations. The increased funding resulted in more funding for many programs of interest to social workers. NASW actively lobbied to preserve and increase funding for social work-related research and training programs in HHS, with a particular focus on Child Welfare Training, Title IV-B; training programs in the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA), and the creation of a new child abuse and neglect research initiative in the National Institutes of Health (NIH). NASW joined with other organizations and coalitions in lobbying to increase funding for federal mental health, substance abuse, AIDS-related, health professions training, education, and Violence Against Women Act programs.
The big winner for social work training is the provision of $4 million for the Title IV-B Child Welfare Training Program, $2 million more than in FY 1996. Intense lobbying by NASW, the active support of the Action Network for Social Work Education and Research (ANSWER), and the leadership of Rep. Nita Lowey (D-NY) reversed the decision by the House Labor/HHS/Education Appropriations Subcommittee to eliminate the Child Welfare Training Program. (On the Senate side, Senators Arlen Specter (R-PA) and Mark Hatfield (R-OR) were strong supporters of the Child Welfare Training Program.) SAMHSA received a significant increase in funding for their mental health and substance abuse demonstration program, referred to as the Knowledge Development and Application (KDA) program. The Department of Education received an additional $3.1 billion over FY 1996, which enabled continued funding for the Goals 2000 initiative at $491 million, increased funding for Head Start to raise it to $3.98 billion, and increased funding of $790.5 million over FY 1996 for the Individuals with Disabilities Education Act (IDEA) for a total of $4 billion. The Safe and Drug-Free Schools program also received a sizable increase, from $465.9 million in FY 1996 to $555.9 million in FY 1997.
Final FY 1997 and FY 1996 funding for selected HHS discretionary programs are as follows:
PROGRAM FY 1996 FY 1997
(in (in
millions) millions)
Child Welfare Services Program $ 277.4 $ 291.9
Family Preservation and Family Support Services 225.0 240.0
Child Welfare Training (Title IV-B) 2.0 4.0
Child Care and Development Block Grants 934.7 956.1
Child Abuse Prevention and Treatment Act (CAPTA) 21.0 21.0
Child Protective Services State Grant Program
CAPTA Community-Based Family Resource Centers 23.0 32.8
Social Services Block Grant Program (Title XX) 2,381.0 2,500.0
Aging Grants to States: Supportive Services and 300.5 300.5
Centers
Head Start 3,570.1 3,981.0
Ryan White AIDS Program 757.4 996.2
Family Planning 192.5 198.4
Maternal and Child Health Block Grant 678.2 681.0
Health Professions Training 258.5 292.9
AIDS Education and Training Centers 12.0 16.2
Mental Health Block Grant (Performance 275.4 275.4
Partnerships)
Mental Health Knowledge Development and 38.0 58.0
Application (KDA)
Grants to States for the Homeless (PATH) 20.0 20.0
Substance Abuse Treatment KDA 89.7 156.0
Substance Abuse Treatment Block Grant (Performance 1,234.1 1,310.1
Partnerships)
Substance Abuse Prevention KDA 89.7 168.8
Violence Against Women Programs and Violent Crime 53.0 123.0
Reduction
Report Language. NASW was very successful in incorporating report language beneficial to social workers in the House and Senate Appropriations Committee reports that accompanied the House-passed Labor/HHS/Education Appropriations bill and the Senate Appropriations Committee bill (the full Senate never voted on their version of the Labor/HHS/Education Appropriations bill). The omnibus bill did include by reference the House and Senate Committee Labor/HHS/Education report language. NASW collaborated with the Institute for the Advancement of Social Work Research (IASWR) on the research-related report language. Although report language does not have the force of statutory language, it is important in identifying areas of interest to Members of Congress and thus influences the activities of the operating agencies. Both the House and Senate Labor/HHS/Education Appropriations Committee reports (S. Rpt. 104-368 and H. Rpt. 104-659) included NASW-recommended language that
In addition, the Senate Appropriations Committee Report included other NASW-recommended language related to social work research and training pertaining to NIH, the Agency for Health Care Policy and Research, the National Health Service Corps, and the Centers for Disease Control and Prevention.
[For more details on the new law, please refer to the Government Relations Update, Update on Fiscal Year 1997 Appropriations, October 8, 1996.]
INDIVIDUALS WITH DISABILITIES EDUCATION ACT (IDEA): IDEA provides federal funding to schools for programs to support and improve early intervention and special education for infants, toddlers, children and youth with disabilities. Congress worked throughout 1995 to reauthorize the program but in the end could not come to agreement in key areas. NASW has submitted written recommendations with the National Association of School Psychologists to the House Committee on Economic and Educational Opportunities commenting on their draft bill. NASW's recommended promoting the use of related services personnel including social workers, in the appropriate sections of the act. NASW addressed two other major concerns with the draft legislation. Current law allows for alternative education opportunities when a student with a disability is involved in a serious disciplinary infraction. Proposed legislation bill would have eliminated alternative opportunities for students with disabilities, thus, imposing a higher risk of their dropping out of school. The effort for same disciplinary treatment for all students was led by Senator Slade Gorton (R-WA). NASW oppose changing the current law. NASW also opposed the proposed expansion of the use of paraprofessionals in related services personnel duties.
IMMIGRATION: On September 30, 1996, President Clinton signed into law an omnibus spending bill for fiscal year 1997 (P.L. 104-208), which included a compromise agreement on the immigration bills passed by the House (H.R. 2202) and Senate (S. 1664). Provisions in the bills that NASW vigorously opposed were dropped from the final legislation. These provisions included denying public education to the children of illegal immigrants, limiting immigrants access to treatment under Medicaid for HIV infections, deporting legal immigrants who claim more than twelve months of public assistance in a seven year period and cutting off benefits to legal immigrants. Proposed income requirements for sponsors of legal immigrants also were scaled back. Instead of having to earn twice the poverty rate, sponsors will only have to make 25 percent more. A primary sponsor of the House bill, Rep. Lamar Smith (R-TX), introduced a bill in late September that would have reinstated all the dropped provisions and has vowed, if re-elected, to reintroduce it at the outset of the 105th Congress.
AFFIRMATIVE ACTION: On March 8, the House Judiciary Panel approved the Equal Opportunity Act of 1995 (H.R. 2128), which prohibits federal officials from considering race and gender when hiring employees or contractors or when implementing any other federal program or activity. The Senate version, the Equal Opportunity Act of 1995 (S.1085), was not extensively debated, and the legislation died with the end of Congress. Outside of California, efforts to force affirmative action issues onto the ballot have failed and numerous state legislative proposals to curtail or eliminate affirmative action were unsuccessful. The issue lost momentum due, in part, to an election year reluctance to alienate minority and female voters and opposition by some of the nation's most prominent moderate Republicans to elimination of affirmative action programs. NASW will continue to strongly oppose any efforts to eliminate the regression of discriminatory practices.
MINIMUM WAGE: On August 20, 1996, President Clinton signed the Small Business Job Protection Act (H.R. 3448) into law (P.L. 104-188). The new law increases the minimum wage by 90 cents over the next year. Wages increased from $4.25 to $4.75 on October 1 and will rise to $5.15 on September 1, 1997. NASW successfully lobbied for passage of the legislation, which is estimated to benefit approximately 10 million workers.
DEFENSE OF MARRIAGE ACT: On September 21, 1996, President Clinton signed the Defense of Marriage Act (H.R. 3396) into law (P.L. 104-199). NASW opposed the new law, which bars receipt of federal benefits for partners in same-sex marriages and permits states to ignore gay marriages sanctioned in other states.
EMPLOYMENT NON-DISCRIMINATION ACT: On September 10, 1996, the Senate narrowly defeated the Employment Non-Discrimination Act (S.2056), which would have barred employment discrimination based on sexual orientation. The 50 senators voting "no" included 45 Republicans and five Democrats. The 49 who voted "yes" included 41 Democrats and eight Republicans. NASW, in coalition with the Human Rights Campaign, urged passage of the measure.
FUNDING FOR VIOLENCE AGAINST WOMEN ACT (VAWA) PROGRAMS: The omnibus spending bill (P.L. 104-208) included substantially more funding for VAWA programs. HHS received an increase of $70 million for FY 1997 for a total of $123 million. This includes $72.8 million for battered women's shelters, $6 million for community-based programs, and $35 million for rape prevention and education programs. The Department of Justice (DOJ) received $197.5 million for FY 1997 for VAWA programs, including $145 million for state STOP (Services, Training, Officers, Prosecutors) Grants, an increase of $15 million over FY 1996. Those interested in receiving state VAWA funding who do not know which state agency to contact should call the DOJ at 202-307-6026. For overall assistance on resources, research, funding, and technical assistance related to domestic violence, contact the Domestic Violence Resource Network at 1-800-537-2238.
RYAN WHITE CARE ACT REAUTHORIZATION: On May 20, the President signed S. 641, the Ryan White CARE Reauthorization Act of 1995 into law. P.L. 104-146 reauthorizes, through the year 2000, the Ryan White CARE Act, which provides federal funds to HIV-endemic areas to plan and coordinate services for people with HIV. Members of the National Organizations Responding to AIDS Coalition, including NASW, lobbied to remove a House provision to mandate HIV testing of pregnant women and newborns and a Senate provision that would have prohibited AIDS services agencies from providing gay men with information and counseling to prevent the spread of AIDS.
VOCATIONAL REHABILITATION ACT SERVICES: Final regulations have not yet been issued by the Department of Education to implement changes to the Vocational Rehabilitation Program made through the Vocational Rehabilitation Act Amendments of 1992 and Technical Corrections Amendments in 1993. (As a result of NASW's advocacy, one change made to the program was an amendment allowing states to utilize the services of any licensed provider for diagnosis and treatment services in their state programs. Prior to this legislative change, many state programs interpreted the law to restrict their use of mental health care providers to psychiatrists and psychologists.) In February 1996, NASW submitted comments on the proposed regulations that supported the statutory revision and encouraged increased use of clinical social workers in state vocational rehabilitation programs.
PUBLIC HEALTH SERVICE HEALTH PROFESSIONS TRAINING: The 104th Congress failed to reauthorize Titles VII and VIII of the Public Health Service (PHS) Act, which provide federal funding for health professions and nurse training. The programs are intended to improve the supply and distribution of health professionals and the representation of minorities and disadvantaged individuals. In the final days of the session, the Senate passed the reauthorizing legislation, S. 555, Health Professions Education Consolidation and Reauthorization Act of 1995. However, the House failed to act. The legislation would have consolidated 45 different health professions training programs authorized under the PHS Act into three broad areas--health professions education programs, financial assistance programs, and nursing education. Schools of social work now eligible for some of the current programs under Title VII would have had more funding options under the new legislation. Currently, schools of social work receive some Title VII funding under the Health Careers Opportunity Program and the Rural Health Interdisciplinary Training Program. Training for social workers is also provided through Title VII-funded Geriatric Education Centers, Area Health Education Centers, and AIDS Education Centers. NASW had successfully lobbied to ensure eligibility of graduate programs in mental health practice, including schools of social work, in many of the Title VII consolidated programs and to require collection of workforce data on clinical social work along with other health professions. As with many federal programs that fail to be reauthorized, the programs will continue. In fact, Title VII programs received a substantial increase in their fiscal year 1997 appropriation.