Additionally, the Prevention Council is a priority for Senator Harkin. This requires a change of culture, however, and that can be scary for people.

Whitener added that a wealth of knowledge about what is actually happening in communities and how programs are having an impact on people is being obtained by the agencies. Because Congress is a very action-oriented place, she said, it is useful to have that knowledge so that a problem can be fixed when it is presented. For example, an effort to coordinate transportation among Medicaid facilities, schools, and clinics would keep four different vans from going to the same neighborhood to pick up neighbors and separately take them to various places simply because they receive funding through separate funding streams. Therefore, it is helpful when outside groups or experts can present a problem and suggest solutions on which Congress can act.

Bernardette Arellano added that allowing federal agencies some flexibility allows for creativity, but it also means that Congress must give up some control. Under a friendly administration, much can be done to work in the interest of low-income people. She also said that use of the report language that accompanies a spending bill can be a very powerful strategy to encourage a federal agency to act. For example, report language suggested the creation of an interagency task force on viral hepatitis. Even though direct funding may not be provided, when Congress expresses support for something via report language, an agency director will closely look at that language and parcel out funding for the project. Report language can therefore be a powerful tool.

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