Dispute Over Children’s Health Care Is Buried in Federal Spending Bill : Religion: Christian Scientists lobbied for parents’ right not to put their children under a physician’s care.

Working quietly through two sympathetic congressmen and outmaneuvering children’s advocates, the Christian Science church is about to gain important ground in Congress in an emotional fight over medical care for youngsters.

The fruit of their effort is a single paragraph buried deep within the year’s biggest spending bill. It would block the Department of Health and Human Services from doing what it’s done for years: Pressuring states either to require parents to provide medical care for their children despite religious objections, or oblige local authorities to supply such treatment.

Christian Scientists, like members of some smaller religions, believe in attending to illness with prayer, not medical treatment. They have been under fire from some doctors, prosecutors and former Christian Scientists after several well-publicized cases in which children of some church members died from diseases that could have been cured with medicine.

“We don’t believe the Constitution allows legislators to single out one class of children and say they don’t have the same rights to medical care other children do,” said Rita Swan of Sioux City, Iowa, who left the Christian Science church after her 16-month-old son died of meningitis. She works against religious exemptions from providing care.

“We’re not fanatics who only care about putting our children into heaven, not caring if they die,” countered Phil Davis, who lobbies for the church in Washington. “We think we’ve done a pretty good job with children.”

Swan says at least 165 children have died since 1975 after medical care was withheld on religious grounds. Davis says the figure is “a handful,” and says many other youngsters have died under doctors’ treatment during the period.

The provision is the latest controversial pronouncement inserted into one of Congress’ 13 annual appropriations bills, which finance federal agencies. Over the years, those measures have been used to halt smoking on airlines, make it harder for poor women to get abortions, and wind down the Vietnam War.

All but four states--Hawaii, Maryland, Massachusetts and South Dakota--let parents withhold medical care for their children for religious reasons. (California law includes a religious exemption, but parents can be prosecuted if their child’s health is endangered by withholding medical care.) The Department of Health and Human Services allows the religious exemption, but requires states to provide medical treatment for ailing children.

HHS considers Alaska, Colorado, Florida, Louisiana and the District of Columbia to lack the needed procedures for providing emergency care--and could cut federal child abuse aid to those states if they fail to comply.

The fight began late last year when Christian Scientist lobbyists out to block HHS decided to focus on the $250-billion appropriations bill financing HHS and the departments of Education, Labor and other agencies for 1995.

With the 1974 federal anti-child abuse law up for renewal next year, a victory would stall HHS’s enforcement efforts for one year and create momentum for a permanent change in the law in the church’s favor.

Church lobbyists in Washington and officials from their Boston headquarters began talking to members of the Appropriations panel. Committee members also began getting visits and telephone calls from Christian Scientists.

Among the people Davis spoke to was Rep. Lamar Smith (R-Tex.), a Christian Scientist who has opposed HHS’s efforts.

“It’s been constricting the ability of thousands of individuals to practice their religion in good faith and good conscience,” he said. “I offered to open some doors.”

Smith helped Davis get an appointment with Rep. John Edward Porter (R-Ill.), the senior Republican on the Appropriations Committee’s subcommittee that wrote the bill.

“I felt there was a serious question of religious rights being encroached upon,” said Porter, who was reared as a Christian Scientist.

Porter approached Rep. Neil Smith (D-Iowa), who chairs the Appropriations subcommittee. Smith agreed to put Porter’s provision into his bill, barring HHS from requiring states to drop their religious exemptions or order medical care for children.

“There was interest in it, and I didn’t see much harm in delaying things for one year and not getting all involved in a religious brawl,” Smith said.

With little debate, Smith’s subcommittee--and then the full Appropriations Committee--approved the spending bill, including the provision.

Suddenly, opponents like Swan, the American Academy of Pediatrics, the National District Attorneys Assn. and even HHS itself realized the only way to defeat the provision would be a fight on the House floor, a battle they felt they would lose.

“Members (of Congress) see religious freedom and they want to go with religious freedom,” said one lobbyist.

The House passed the overall bill in August with no mention of the provision. Instead, opponents turned to the Senate, which was just starting to write its version of the bill, in hopes of getting softer language.

They got it from Sen. Tom Harkin (D-Iowa), the liberal chairman of the Senate Appropriations Committee’s subcommittee that writes the spending bill. Harkin’s provision would prevent HHS from denying child abuse aid to recalcitrant states for a year. The agency would retain its authority to otherwise persuade states to drop their religious exemptions.

The Senate approved the overall bill containing Harkin’s language last month. When House-Senate bargainers meet to write compromise legislation, they are expected to accept the Senate language.

And the fight will be rejoined next year.