Faith-Based Initiative Flops.

From the perspective of the long-term care community, the first significant political death during the Bush administration occurred in March, when Republican members of Congress told the President to go back to the drawing board on his faith-based initiative.

Government relations with the faith community are crucial to the long-term care field because so many long-term care and elderly housing providers are affiliated with religious groups. More than three-quarters of the 5,600 nursing homes, housing groups, home-based care programs and other providers in the American Association of Homes and Services for the Aging (AAHSA) are affiliated with faith organizations. In general, religious groups interested in providing long-term care establish not-for-profit subsidiaries that receive Section 202 housing grants, Medicare and Medicaid payments, and other federal benefits. The subsidiaries are affiliated with faith communities but are independently accountable for their use of government funds.

Similar practices generally are followed when private foundations fund long-term care services provided by the faith community. Perhaps the best-known of these is Faith in Action (FIA), a 20-year-old program sponsored by the Robert Wood Johnson Foundation. FIA mobilizes volunteers from multiple religious congregations in a community to provide supportive home care and day care for the elderly and others.

In spite of these accomplishments of the faith community, George W. Bush came to the White House believing that government spurns the involvement of religious institutions in providing direct services. This perception dates back to 1996, when then-governor Bush established a Faith-Based Task Force to survey the effects of Texas law and regulations on the provision of services by faith based groups. He specifically listened to complaints from a prison program known as InnerChange, which relies on the power of faith rather than "secular counseling" to change inmates' lives. The result was Texas House Bill 2017, which directed the Texas Department of Human Services to encourage the work of faith-based organizations and required state human services agencies to partner with such groups.

Bush was not alone in sponsoring reforms to encourage faith solutions to long-term care and other problems. As governor of New Jersey, Christine Todd Whitman--now Bush's appointee as director of the Environmental Protection Agency--sponsored a faith-based initiative in her state, as did Democratic Governor Gray Davis of California. George W. Bush went on, throughout his campaign, to describe his support for faith-based initiatives as an innovation that distinguished him from the other candidates. He promised that "In every instance when my administration sees a responsibility to help people, we will look first to faith-based institutions, to charities and to community groups that have shown their ability to save and change lives."

Within a week of the inauguration, President Bush signed an executive order creating a White House Office of Faith-Based and Community Initiatives and a second executive order establishing Centers for Faith-Based and Community Initiatives in five federal agencies. Bush again highlighted the faithbased initiative in his first televised speech as President. "We must encourage and support the work of charities and churches and community groups that offer help and love one person at a time.... Government should welcome these groups to apply for funds and not discriminate against them." Shortly afterward, congressmen J.C. Watts (R-OK) and Tony Hall (D-OH) introduced H.R. 7, the Community Solutions Act, to transform the administration's faith-based initiative into law.

Aside from its tax-credit provisions for charitable donations, the administration's faith-based initiative would provide faith organizations that accept federal funds with partial immunity from federal employment discrimination provisions; the House bill would allow a denomination's religious practices to serve as a basis for rejecting job applicants. However, the bill also mandates extensive accounting revisions for churches and religious institutions accepting federal funds to provide services to the elderly and other populations--and therein lies a problem.

John J. DiIulio, Jr., a former journalist who now heads the White House Office of Faith-Based and Community Initiatives, encountered widespread skepticism when he tried to promote the program among religious groups. Although part of the opposition included the expected criticism of Americans United For Separation of Church and State, such religious conservatives as Pat Robertson and Terry Scanlon also raised concerns about federal oversight and other matters. Interestingly, for example, while Scanlon's Capital Research Center warned that providing funds for liberal religious groups would enable them to spend more money on lobbying, Rabbi David Saperstein, director of the Religious Action Center of Reform Judaism, warned that federal support for services provided by fundamentalist Christians would enable these groups to 'free up their money to come after us" and target young Jews for conversion.

President Bush responded to a portion of the criticism in an interview on March 9. "There are some who worry about, once government gets involved, government will force religion on people. And I am mindful of those concerns, our policy will understand that. We'll fashion a policy that...will, I believe, answer these critics."

Nevertheless, some of the unexpected supporters that the faith-based initiative garnered might have hurt the cause as much as its opponents did. National groups of witches and pagans enthusiastically debated over the Internet whether their own social programs should demand federal funds. Their interest reflects the fact that the federal government has been unable to define a "faith-based institution." For example, court cases repeatedly have ruled that Scientologists, a group with a history of rabid opposition to psychiatry, can qualify as a religious organization. It is at least possible that federal agencies would be required by the faith-based initiative to fund long-term care services provided by groups on the fringe of spiritual life.

On March 13, faced with the unexpected negative reactions to the initiative, Senator Rick Santorum (RPA) announced that he would delay serious action on the legislation for at least a year. The delay, according to Santorum, was needed to give policymakers time to rethink the initiative. Since Santorum is the principal Senate sponsor of the Senate companion legislation of H.R. 7, his announcement effectively killed the prospects for passage of the initiative until late 2002. Even if it should eventually win Senate and House approval, the administration already has "watered down" the language of the initiative to include "grass-roots" as well as religion-affiliated organizations.

Thus it appears that the first casualty of the President's agenda might be his proposed solution to a problem--discrimination against faith-based organizations applying for federal funding--that many religion-affiliated long-term care providers deny ever existed.