Big Government Left In The Dust By Small County Tillamook’s Teen Pregnancy Fight Cited In Debate Over ‘Devolution’

At a time when Americans are attempting to redefine government so it can work more effectively for their communities, Tillamook County, Ore., has a lesson for the rest of us.

Tillamook (pop. 23,767), a dairy farming center on the Pacific coast, bills itself as the “Land of Cheese, Trees and Ocean Breeze.” But a few years ago, it also had the second-highest teen pregnancy rate in Oregon, after metropolitan Portland.

Local officials, educators, pastors and parents were troubled. Yet it was such a controversial issue, they couldn’t get consensus on what to do. So each group tackled the problem in its own way:

The health department made sure any teenager who asked for an appointment got one within 48 hours. It gave out free condoms.

The churches taught the value of abstinence.

The YMCA set up more sports and confidence-building programs for girls.

The school system revamped its sex education curriculum.

As a result, the teen pregnancy rate began to fall sharply, from 24 per 1,000 in 1990 to 7 per 1,000 in 1994 - the lowest in the state. Last year, it crept back up some, but now people are confident they know how to respond.

“What happened is, everybody took ownership of the problem and it kind of reached a crescendo,” said Sue Cameron, the health department administrator. It didn’t take a federal program; it took local responsibility.

In Washington, D.C., and in state capitals around the country, lawmakers and public officials are paying attention to the kind of roll-up-your-sleeves spirit that worked for Tillamook County. (Health and Human Services Secretary Donna Shalala has even commissioned a study on Tillamook.)

Bureaucrats and politicians want to figure out how to spark this kind of problem-solving energy, how to feed it - or just get out of its way.

The reason for their interest is simple: Though the era of big government may be over, America hasn’t yet figured out what should replace it.

A great debate is under way about whether the feds, the states or private philanthropy should take the lead on society’s most basic problems.

The outcome will be felt by all. It will touch the elderly in nursing homes, newborns in need of immunizations, workers seeking training for new skills, and teen mothers on welfare learning how to handle their first job interview.

Even the air we breathe and the water we drink - both subject to environmental laws and regulations - figure in this tug-of-war.

Advocates of scaling back federal power say states and local governments are closer to the problems and can invent more workable solutions; critics say state control leads to a hodgepodge of results. And when it comes to helping the poor, liberals fear that states will turn their backs.

It’s all part of the age-old argument over American federalism - the proper balance of powers and responsibilities between Washington, state governments and the people.

For most of the 20th century, Democrats and Republicans have collaborated on increasing federal power. But when Republicans took over the House of Representatives last year, they drew a line.

Congress passed the so-called “unfunded mandates” bill, which forbids federal lawmakers from imposing new obligations on state and local governments without paying for them or specifically voting to pass on the costs. President Clinton signed it into law.

Republicans now propose to go further, by turning social programs over to the states wholesale in “block grants” that are essentially big pots of federal money with relatively few strings attached.

The Clinton administration has resisted, while at the same time granting states a record number of exceptions to federal rules. Called “waivers,” these exceptions are letting states redesign welfare and Medicaid, the health program for the poor.

Welfare caseloads are down around the country as states require recipients to get jobs. A sound economy may have more to do with a 9 percent drop in welfare rolls since 1993, but governors and the White House have not been shy about claiming credit.

While welfare reform has the higher public profile, Medicaid is where the real money is. The federal-state health-care program for the poor and the elderly in nursing homes accounts for 40 percent of the $225 billion a year the federal government sends the states.

Medicaid cost increases have leveled off as states require poor families to join health maintenance organizations. But most program spending goes for the elderly, and states have yet to figure out how to squeeze significant savings out of nursing homes.

Devolution and diffusion

It’s probably too much for the average citizen to keep track of dozens of state initiatives around the country.

But there are a couple of terms that everybody should learn in order to follow the public policy debate in the second half of the 1990s: “devolution” and “diffusion.”

Devolution means to give back. It’s what Republican governors want the feds to do with welfare and Medicaid - give control back to the states.

Diffusion is a newer term, coined by conservatives who are interested in going beyond a mere transfer of power between levels of government. They want private charities, religious congregations and even families to take the lead.

“There are a lot of state bureaucrats who are just as inept and probably just as out of touch as federal bureaucrats,” said Cherie Harder, a policy expert with Empower America, a conservative advocacy group.

“There is a reservoir of volunteerism and wanting to help our neighbors that is untapped and can be used, but is now overwhelmed by the federal effort,” said Sen. Dan Coats, R-Ind.

The bottom line

Behind the altruistic rhetoric, there is also a hard-nosed fiscal reality.

Republicans say they are committed to balancing the federal budget by 2002. When it comes to cuts, Social Security, defense and interest on the federal debt are off the table. That’s about half the budget right there.

Grants to states - from Medicaid, to mass transit subsidies, to the school lunch program - represent about 30 percent of the remaining budget.

“In order to cut enough funding out of the federal budget, very large cuts have to be made in grants to state and local government,” said Iris Lav, a budget analyst with the Center on Budget and Policy Priorities, a liberal advocacy group.

The federal government now pays about 70 percent of the cost of safety-net programs. Federal funding for many programs is open-ended. If a state’s economy takes a nosedive and more people legally qualify for welfare benefits, the federal spigot opens wider.

Block grants would work very differently. The amount of federal aid would be capped. State dollars would not be matched, removing the incentive for states to spend more.

Block grants make it easier to balance the federal budget by making costs more predictable. But they may not protect the poor as well.

“What happens the next time a recession comes down?” Clinton asked the nation’s governors in a speech during last year’s budget wars. “How will you deal with the interplay in your own legislature if you just get a block grant for welfare … and the people representing the teachers show up, and the people representing the universities show up, and the people representing the cities and towns who have lost money show up?

“My experience is that the poor children’s lobby is a poor match for most of those forces,” he added. Liberals fear that states would actually compete to cut benefits for the poor, to avoid attracting low-income people from other states.

Republicans say that’s a scare tactic. They point out that state governments are much more sophisticated than in the 1960s, when many federal social programs were launched.

“States are committed to these programs, and committed to running them well,” said Vern Smith, Medicaid director for Michigan’s Republican Gov. John Engler. “State officials have to be accountable to the same voters that federal officials are accountable to.”

Devolution: What does it mean?

MEMO: This sidebar appeared with the story: WHERE THEY STAND A brief look at the views and records of President Clinton and Bob Dole on returning power from Washington to the states: CLINTON Says states should have more authority, but wants to retain national standards and accountability for major social programs. Has granted states a record number of exemptions from federal rules to allow them to redesign welfare and health programs for the poor. Signed legislation to limit federal “mandates” that require states to spend their own money for federal objectives. DOLE Says state governments are closer to the people and should take the leading role in addressing society’s problems. Promises that in a Dole administration the federal government would still provide significant funding for welfare and Medicaid, but states would set the rules on the kind of benefits offered and who gets them. Was a chief backer of bill to limit federal mandates. - Knight-Ridder