More requests to cut programs enacted, but some remain a tough sell

Defying conventional wisdom, Congress last year eliminated or sharply reduced dozens of programs that did not pass muster with the White House, ranging from a $5 million literacy program for prison inmates to nearly $500 million for earmarked spending on community health centers.

In fact, lawmakers went along with nearly 85 percent of the program terminations Bush requested within HHS, far and away the biggest success rate of any Cabinet-level department.

That makes it all the more remarkable that a little-known 20-year-old program aimed at helping emergency rooms tend to small children escaped the cuts -- and in fact would have received a small increase had it not been for an end-of-session 1 percent cut across the board in all discretionary spending.

The Emergency Medical Services for Children program was founded in 1985 with a $2 million line item offered by Senate Defense Appropriations Subcommittee ranking member Daniel Inouye, D-Hawaii. It was funded at $20 million in the fiscal 2006 Labor-HHS spending bill, which saw cuts in most programs within its purview. The program was funded at the same level in fiscal 2005.

Inouye had become concerned that children admitted to emergency rooms were being treated like "little adults," according to his office.

The program now operates in every state, the District of Columbia and five U.S. territories, according to the American Academy of Pediatrics, providing grants to improve emergency medical services and to medical schools to develop improved procedures to treat children.

In fiscal 2006, lawmakers approved 41 percent of Bush's requests to trim or terminate 154 programs to save $15.8 billion. Congress agreed to cut 89 of those programs to achieve a savings of $6.5 billion. According to OMB, that is up sharply from the year before, when Congress acted on only seven of 65 proposed terminations, for a savings of $366 million.

As Bush unveils his fiscal 2007 budget Monday, with more than 140 program cuts and terminations, there is reason to expect similar wins and losses for the administration as the White House and congressional Republicans again seek to cut non-security discretionary spending below the previous year.

The brunt of last year's proposed terminations fell on the Education Department, but Congress only acted on 16 percent of that $4.3 billion recommendation. By contrast, the second-largest chunk of almost $1 billion fell on HHS, where lawmakers approved about 85 percent of the requests.

Steven Krug, head of pediatric emergency medicine at Children's Memorial Hospital in Chicago, said advocates of the Emergency Medical Services for Children program were even better positioned to fight the cut this year, since last year was the first time Bush proposed to terminate it and they were caught off guard.

"People are already talking about this, anticipating that it's going to happen again. We're better prepared than we were last year," Krug said in an interview last week. "We were maybe a little asleep at the wheel."

OMB uses a process known as the "Program Assessment Rating Tool" to evaluate federal programs; its fiscal 2006 request zeroed out the program because, according to budget documents, it had an "inability to demonstrate results."

OMB went on to say in its budget submission that "despite 20 years of funding, the program has not demonstrated a connection to improvements in health outcomes of children and adolescents receiving emergency medical services. The program also failed to set long-term health outcome goals that would provide evaluators with measures with which to measure the program's effectiveness in the future."

Krug and the American Academy of Pediatrics, which spearheaded the Washington lobbying effort, dismiss such language as bureaucratic legalese. "It was set up as a demonstration project, not an outcomes project," Krug said. "It was never set up as a results project to evaluate outcomes."

What started as four small demonstration projects grew into a nationwide enterprise. In a short time, Inouye found key allies such as Sen. Orrin Hatch, R-Utah, and House Defense Appropriations Subcommittee Chairman C.W. (Bill) Young, R-Fla.

"It's sort of evolved over the years since we started this -- as an earmark, by the way," said Young, who became interested in the issue through his involvement with All Children's Hospital in his St. Petersburg, Fla., district.

Advocates argue many emergency rooms are not equipped to handle the needs of children.

"We found that many hospitals had emergency rooms that were good emergency rooms, but they didn't have any particular special care for young children," Young said.

Added Krug, "Kids don't really get heart attacks."