Governor Signs Bill Promoting School-Based Health Centers

One of the few health-related bills Gov. Arnold Schwarzenegger (R) signed at the end of the legislative year paves the way for California to establish a system of school-based health centers. There’s no money to do it yet, but the mechanism to spend the money and build a framework is in place.

“That’s a huge step,” said Serena Clayton, executive director of the California School Health Centers Association, co-sponsor of the bill.

“What we want is for the state to see school health centers as an integral part of the overall health system. Early intervention is so important in health issues, and schools are such a good place — maybe the best place — to connect with kids that this just makes good sense,” Clayton said.

The School Health Centers Expansion Act, SB 564 by Sen. Mark Ridley-Thomas (D-Los Angeles), is companion legislation to another bill passed and signed two years ago. That bill established a school health center support program to collect data and provide technical assistance to support new and existing school health centers. 

SB 564, co-sponsored by the California Primary Care Association and the Latino Coalition for a Healthy California, creates a state grant program for school health centers.

Advocates Wary of Veto

Although the bill passed both houses with relatively comfortable margins, advocates were worried that the governor would veto it.

While Schwarzenegger ultimately signed the bill, he did set a veto record this year, rejecting 415 of the 1,187 bills that reached his desk.

That’s nearly 35%, considerably more than the previous record of nearly 25% set by his predecessor, Gray Davis.

All told, the Republican governor ended the year by vetoing more than a dozen bills dealing with health care, including efforts to:

• Create a single-payer health system;
• Curb the insurance industry practice of rescinding policies;
• Limit insurance profit margins and administration costs;
• Address balance billing;
• Reform the high-risk pool of state insured patients;
• Address the impact of “boutique hospitals”;
• Create a publicly owned and operated health insurer; and
• Limit high-interest loans for dental work.

When he signed SB 564, Schwarzenegger offered comments with his signature, including these:

“California’s public schools are at the center of our communities, and school-based health centers are an efficient and effective way to provide critical health services.

“I support laying the groundwork for these health centers, but recognize that expansion will require a significant investment that California cannot afford today. While implementation is contingent upon a future appropriation that will have to be considered in the context of the overall budget, I am signing this bill to establish the statutory framework to guide expansion once resources are available.”

Two Bills Pending in Washington

The national organization promoting school-based health care applauded the governor’s signature on Ridley-Thomas’ bill but wondered what took so long.

“It’s great that things are under way there now, but it’s strange and a shame that California hasn’t maximized the potential for school health care earlier, especially with such a large migrant population,” said Divya Mohan, spokesperson for the National Assembly on School-Based Health Care based in Washington, D.C.

Mohan and Clayton agreed that California has not been a leader in the drive to provide health care through public schools. They mentioned Florida, Louisiana, Michigan, New Mexico and New York as leaders.

Advocates say school health centers can help diagnose and deal with many health problems facing youth — mental health disorders, asthma, obesity and others.

“So many children just don’t have access to care elsewhere. There are eight million uninsured kids in this country,” Mohan said.

The National Assembly sponsored two companion pieces of legislation aimed at creating a national system of clinics based in public schools:

• School-Based Health Clinic Act of 2007 (HR 4230), by U.S. Rep. Darlene Hooley (D-Ore.); and
• School-Based Health Clinic Establishment Act of 2007 (S 600), by Oregon Sen. Gordon Smith (R).

California Catching Up

California has about 150 school-based health centers now, a relatively small proportion of the state’s 10,000 schools.

“It is a very small percentage, but in some ways it’s impressive that we have even that many given there is no state support,” Clayton said.  Each school-based center is formed and funded by a patchwork of unique, community-driven organizations.

The goal of the new legislation is to create 500 school-based health centers through a state-supported grant system.

“In 2006, we were trying to get our foot in the door,” Clayton said. “The first bill established the state office — it didn’t create funding. We started working with the governor’s office that year and began working toward this bill, which still does not actually appropriate any money.”

“That’s our next challenge,” Clayton said. She said she does have some ideas about how to generate funding but “can’t really talk about it.”

Clayton estimates it will require $50 million to $80 million a year to sustain 500 school-based clinics.

Even without money attached, the bill’s passage marks a milestone, Clayton said.

“One of our main goals is to get the state to recognize that school health centers are a valuable component of the overall health system. School-based centers can do so much to complement community providers in so many ways — early intervention, screenings, education, all kinds of programs,” she said.

“We’re not looking for this to be a stand-alone program. We want to be an integral part of both the health and education systems of this state,” Clayton said.

Clayton answered the last question with another question:

Any idea when clinics might start popping up around the state?

“Any idea when the economy’s going to recover?”

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