Bush administration weighs program effectiveness against cost

Hector Garza's National Council for Community and Education Partnerships leads a national effort to improve college entry rates for poor children under an Education Department program called GEAR UP. A week ago, Garza, the president of the council, had no idea that the White House would propose eliminating the very education program that his nonprofit organization helps to implement.

"We certainly never expected bad news," Garza said upon learning that President Bush's fiscal 2006 budget calls for slashing GEAR UP from a $300 million-plus program this year to zero next year. "I have been monitoring the president's budget for weeks, and we were never on the chopping block."

But the White House contends that the budget ax does not fall randomly. Rather, the administration says that it bases the budget on an analysis of the results that government programs deliver for the taxpayer dollars that they spend. The more than 150 federal programs that are to be eliminated or substantially reduced either are not succeeding, are duplicating other efforts, or are not essential, the White House said. "Every government program was created with good intentions, but not all are matching good intentions with good results," the president said in defending his $2.57 trillion spending blueprint.

The Office of Management and Budget measures the results through the "Program Assessment Rating Tool," a 25-question survey launched three years ago to evaluate each of the 1,200 programs in the federal budget. On a scale ranging from "effective" to "results not demonstrated," OMB has so far rated more than half of the programs, enough to use the system for the first time to help make budget decisions.

Critics, however, question whether PART is a neutral evaluation tool for making budget decisions or a political device designed to provide justifications for eliminating programs that the White House was predisposed to cut.

Program assessments "are completed based on evidence," insisted a White House source involved in the process. "Sure, there is professional judgment on what evidence you consider and how much weight you give it, but we try to disclose all of that. There is nothing in our process that influences ratings by presidential priorities."

The PART quiz asks specific questions -- "Is the program designed so that it is not redundant or duplicative of any other federal, state, local, or private effort?" -- and asks for evidence to support the answers, such as legislation, internal-review documents, or third-party assessments. Questions are grouped in four categories: program design; strategic planning and goals; program management, including financial oversight; and measurable results.

Still, the answers apparently leave some wiggle room for the White House. For example, it judged GEAR UP not to be duplicative because the program targets entire grades of students for assistance and is national in scope. Yet the White House seized on this very element of uniqueness as the reason to eliminate the program. A White House staffer said that GEAR UP was chosen for the guillotine not because it was failing, but because it was "a narrow program" that could be better managed by being merged with other programs into a comprehensive strategy for college access.

OMB Deputy Director for Management Clay Johnson is emphatic that the budget cuts do not imply that the White House is uninterested in pursuing the goals of an eliminated program. The idea, Johnson says, is to focus on outcomes instead of raw budget numbers. "Let's think about the topic writ large," Johnson said to reporters in January, "and let's support what works, and let's get rid of things that don't work or combine them."

By the same token, Bush's budget calls for increasing funding for some programs still facing lingering questions about their effectiveness.

For instance, the president's budget requests $206 million for abstinence-only sex-education activities, an increase of $39 million. This money "will help educate adolescents and parents about the health risks of early sexual activity and provide the tools needed to make healthy choices," said Health and Human Services Secretary Mike Leavitt. But there is a fierce debate about whether these programs do any good. Karen Pearl, interim president of Planned Parenthood Federation of America, said, "As far as I know, there has been no documentation that abstinence works.... What these programs are really about is promoting ideology."

Pearl points to a study done for the Texas Department of State Health Services; it found that high school students were more sexually active after receiving abstinence education. Abstinence-education advocates point to the same study as evidence that the programs work, arguing that the rate of increase in sexual activity among students who have been in abstinence programs is lower than the rate of increase among their peers who have not been in those programs.

"The abstinence programs have been evaluated more than any program I know of," said Leslee Unruh, president of the Abstinence Clearinghouse.

An OMB source says that the government's abstinence programs have never been subjected to a PART analysis. Management of the program was moved last year from HHS's Maternal and Child Health Bureau to the department's Administration for Children and Families, headed by Wade Horn, who also runs Bush's Healthy Marriage Initiative.

In 2004, OMB did review the Adolescent Family Life Program at HHS. The program, which included both demonstration grants to test abstinence curricula and "care grants" to assist pregnant and parenting teens, was graded "results not demonstrated" because it had no long-term performance targets, and no independent evaluations of the program had been conducted. The PART analysis said that while HHS required grantees to evaluate their own programs, third-party reviewers concluded that "in many cases, the evaluation design and implementation has been inadequate."

Barry White, who spent 25 years at OMB and now serves as director for Government Performance Projects for the Council for Excellence in Government, defended PART, saying it alone does not determine federal funding and that it is not a nefarious exercise meant to obscure tough decisions.

"What these guys are doing that's important, first of all, is doing that process systematically, asking similar questions of all the programs they look at, and then, secondly, making those data available so everybody can see it," White said.

"They are not saying that low-scoring programs get cut and high-scoring programs get money," White added. "They can't say that, because part of the decision-making process is the issue of preference and policy. If I'm the president and I dislike spending federal money on a particular program because I don't think it's a high priority, and that program gets a high score, I don't care. And we elect these people. They get to do this."

Besides, he said, Congress can reject those cuts regardless of whether there is analytical material backing up the administration's position.

Wesley Warren, deputy director of advocacy at the Natural Resources Defense Fund who worked at OMB during the Clinton administration, said, "I don't think the PART exercise is about executing the law; I think it's just about giving the White House an opportunity to second-guess what the priorities of the agency should be."

Warren points out that the PART questions do not directly ask whether the program is meeting its statutory obligations, or whether it is fulfilling its legislative intent. Instead, they probe whether the program has a clear purpose that does not overlap with another federal program, and whether it is meeting its annual planning targets.

"It is really sort of a closed, interior, political review process on the part of the White House," Warren said. "And it is not always obvious how they come up with the PART scores. They publish some fact sheets about what the answers to some questions were, but it just becomes subjective on the part of White House staff whether they want to say that was good enough for them or not."

And while programs are not ranked by political preference, the list of graded programs generally gives better marks to presidential priorities than to programs the White House has long opposed.

For instance, the president's budget seeks a $304 million increase for community health centers, a top administration health care priority. The PART analysis scored the program somewhat generously as "effective," the highest grade under the scoring system, despite the fact that it does not have strong financial management practices in place, and that its results are somewhat speculative. The program received credit for making "progress toward meeting its long-term goals," even though it fell short of its goal for the number of clients served in 2001, the last year data were available.

Meanwhile, the White House requested a $287 million cut in the health professions training grants at HHS, a program that is intended to train the health professionals who would be likely to staff the health clinics in rural and minority communities.

The program, which provides money to academic institutions to subsidize students in the health professions to work in underserved areas, has been a target of White House budget cutters since the days of the Clinton administration, said Erica Froyd, senior legislative analyst for the Association of American Medical Colleges. But Congress keeps putting the money back.

This year, OMB has rated the program "ineffective" -- basically a failing grade -- so White House officials "have come up with some justification for when they cut it," Froyd said.

Froyd acknowledges that "there is a huge dearth of data on the outcomes of the programs," in part because the authorizing statute does not provide a tracking component for gathering data on where the scholarship students end up practicing medicine. And the OMB analysis points out that years of legislative amendments have watered down the program's goals, and have created dozens of different grant packages within the same program.

Still, Froyd suspects Congress will frown upon efforts to cut the program, noting that Senate Majority Leader Bill Frist, R-Tenn., has endorsed it in years past.

This is pretty much where Hector Garza finds himself these days -- expecting Congress to save his program from the budget ax.

"Damn it, we are the only college-access program funded by the federal government," Garza said. "There is no doubt in anyone's mind, here or in the Congress, that we are going to save this program."