Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: WEDNESDAY, May 11, 1994 TAG: 9405110104
SECTION: NATIONAL/INTERNATIONAL PAGE: A-8 EDITION: METRO
SOURCE: By WILLIAM NEIKIRK CHICAGO TRIBUNE
DATELINE: WASHINGTON LENGTH: Long
President Clinton, in the role of social reformer, has found a quicker, quieter way to overhaul America's welfare and health care systems. He is letting the states do the job.
Clinton has granted what observers call an unprecedented number of federal waivers allowing 14 states to experiment with dramatic changes in their welfare systems. Welfare waivers for another 16 states likely will be granted.
In general, states must receive a waiver from federal welfare or Medicaid requirements written in the Social Security Law to try experimental or pilot programs.
A waiver can cover a small area or the entire state. Federal rules require that any waiver be "budget neutral," that is, the state - not the federal government - will have to bear any cost increases caused by the waiver.
Five states have received administration waivers to revise their Medicaid programs, chiefly by cutting costs. Meanwhile, Clinton has encouraged a number of states to press ahead with new health care plans applying to all their residents, for which no waiver is needed.
By turning the states into bustling laboratories for new welfare and health care ideas, some analysts believe Clinton has found a way to achieve through the back door what he is having a difficult time doing through the front door in Congress.
If Congress rejects Clinton's more ambitious national plans for health care and welfare, as now seems likely, the waivers still will keep the reform effort alive in both areas for several more years.
And the waivers, limited in time - usually five years - and scope, can be extended by the president.
"He's a big waiver guy, as a former governor and as someone who worked in welfare reform a long time," said Bruce Reed, White House domestic policy adviser and one of the architects of Clinton's welfare reform bill. "He doesn't believe we have all the answers in Washington. He believes state flexibility is very important."
Illinois, Iowa, Wisconsin, South Dakota and North Dakota are among Midwestern states with welfare reform waivers. Illinois' plan calls for work incentives to encourage recipients to get a job.
Illinois also boasts of having the only waiver request turned down so far: A provision to pay a lower grant to recipients who move into the state was deemed unconstitutional.
Medicaid waivers have been granted in Hawaii, Oregon, Kentucky, Rhode Island and Tennessee.
In general, it appears Clinton is cautious of saying no to his old fraternity of governors when they request waivers to find ways to cut their budgets. The states are experimenting with welfare programs requiring recipients to work or denying benefits to additional children born to mothers on welfare.
One criticism of the rapidly growing waiver programs is that patchwork health and welfare policies would cause uneven treatment of the poor from state to state.
But more seriously, the speedy pace of waivers also is raising concerns among many experts that Clinton is compromising the process of state experimentation. Some analysts think the Clinton waivers introduce so many variables at once that it is virtually impossible to evaluate them properly.
Not only are time, money and effort being wasted, some critics fret, but evaluators possibly could come to the wrong conclusion about any of the experimental ideas and recommend national adoption.
With the welfare program especially, there is suspicion that politics, and not pure science, is driving the testing process.
This concern has piqued some interest in Congress. Its investigative arm, the General Accounting Office, is launching a study to determine whether the waiver process is going awry.
"The administration is now actively soliciting waiver proposals and approving them without a great deal of rigorous review or insisting upon evaluations," a Senate Finance Committee staff member said.
"In many waivers, they are trying to do too many things at once," said Gary Burtless, a Brookings Institution scholar. "You can't tell which reform would have an observable effect."
But Mary Jo Bane, assistant secretary of children and families for the Health and Human Services Department, insisted that the department rigorously evaluates welfare reform waivers. States "see welfare reform as a package, to do lots of things simultaneously," she said.
Clinton has urged the department to be responsive to waiver requests, she said, adding that state-by-state variance brings flexibility.
"I don't think we ever want one big national system," Bane said. "What we want is a set of national principles within which states' individual communities figure out what to do at the local level."
Indeed, White House adviser Reed said the welfare reform plan Clinton will unveil later this month will institutionalize that kind of flexibility. But the reform plan, which calls for a two-year time limit on welfare and training and jobs for recipients, already is in trouble on Capitol Hill.
Will Marshall, president of the Progressive Policy Institute, a think tank of centrist Democrats, said critics of Clinton's speedy approach to use more waivers to restructure welfare and Medicaid are too wedded to the status quo.
"I just think it's nonsense," he said. "Advocates of incremental change say you have to know everything before you can move ahead."
by CNB