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WASHINGTON – Sweeping healthcare legislation working its way through Congress is more than an effort to provide insurance to millions of Americans without coverage. Tucked within is a provision that could provide billions of dollars for walking paths, streetlights, jungle gyms, and even farmers’ markets.

The add-ons – characterized as part of a broad effort to improve the nation’s health “infrastructure’’ – appear in House and Senate versions of the bill.

Critics argue the provision is a thinly disguised effort to insert pork-barrel spending into a bill that has been widely portrayed to the public as dealing with expanding health coverage and cutting medical costs. A leading critic, Senator Mike Enzi, a Wyoming Republican, ridicules the local projects, asking: “How can Democrats justify the wasteful spending in this bill?’’

But advocates, including Senator Edward M. Kennedy of Massachusetts, defend the proposed spending as a necessary way to promote healthier lives and, in the long run, cut medical costs. “These are not public works grants; they are community transformation grants,’’ said Anthony Coley, a spokesman for Kennedy, chairman of the Senate health committee whose healthcare bill includes the projects.

“If improving the lighting in a playground or clearing a walking path or a bike path or restoring a park are determined as needed by a community to create more opportunities for physical activity, we should not prohibit this from happening,’’ Coley said in a statement.

The Senate health panel’s bill does not specify how much would go to the community projects. A Senate staff member said the amount of spending will be left up to the Obama administration. A House version of the bill caps the projects at $1.6 billion per year and includes them in a section designed to save money in the long run by reducing obesity and other health problems.

It is not clear yet how the money would be allocated. The legislation says that grants will be awarded to local and state government agencies that will have to submit detailed proposals. The final decisions will be made by the secretary of Health and Human Services.

The proposal was inserted at the urging of a nonprofit, nonpartisan group called Trust for America’s Health, which produces reports about obesity and other health matters. Part of the group’s proposed language for the community grants was inserted into the Senate bill. It called for “creating the infrastructure to support active living and access to nutritious foods in a safe environment.’’ The group provided examples of grants for bike paths, jungle gyms, and lighting, though the Senate bill doesn’t list those specifics.

Jeffrey Levi, the group’s executive director, said that “it is easy to satirize’’ the projects, but they are needed to improve America’s health.

“We will see a return on this investment if you use this money strategically for proven, evidence-based programs,’’ Levi said in an interview, citing efforts to stop smoking and to promote physical activity. “We will prevent or reverse chronic diseases such as heart disease. . . . It will pay for itself.’’

While many may think the healthcare bill strictly aims to increase coverage, Levi said that is a mistaken impression. “This isn’t just about health insurance,’’ he said. “This bill is about creating a healthier country.’’

The group says that a modest community project can lead directly to improvements in public health. In a recent report, the group cited two examples from Massachusetts that it said were effective: Shape Up Somerville, which helped elementary school children lose weight by promoting physical activity, and the Physical Activity Club in Attleboro, which also helped children lose weight.

The idea of using the healthcare bill as a vehicle for preventing diseases has bipartisan appeal. President Obama has called for “the largest investment ever in preventive care, because that’s one of the best ways to keep our people healthy and our costs under control.’’ Enzi, too, has said that “reducing healthcare costs has to begin with promoting healthier behaviors.’’

But there is disagreement about the best way to do that. Senator Tom Harkin, an Iowa Democrat who is working closely with Kennedy on the healthcare bill, has criticized the current healthcare system for focusing on “sick care’’ and has called for more investment in a variety of measures that would help prevent diseases, including the community grants, restricting junk food in schools, and encouraging children to be more active.

“We spend 75 cents of every healthcare dollar treating people with chronic diseases like diabetes, heart disease, and asthma, and only 4 cents on prevention,’’ Harkin said in a statement. “But the majority of these diseases can be prevented through lifestyle and environmental changes.’’

However, it can be difficult to quantify the benefits of a park or pathway, leading some critics to say such funding is an example how the healthcare legislation has spiraled out of control.

Enzi has said that instead of paying for pathways, it would be more effective to encourage lower insurance premiums for individuals who can prove they have taken steps to improve their health. He said that construction grants belong in other bills.

Enzi, the top Republican on the Senate health committee, has unsuccessfully pushed an amendment that would specifically prohibit the use of funds for sidewalks, streetlights, and other infrastructure projects.

Kennedy spokesman Coley said such proposed amendments are counterproductive, stressing that the projects would be modest and are not intended to replace larger ones that can be funded in other bills. Nonetheless, he said, the projects “may be a very cost-effective and long-lasting intervention.’’

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Cost of propping up Fannie Mae and Freddie Mac pegged as high as $25b, part of housing rescue.

WASHINGTON (AP) — A federal rescue of Fannie Mae and Freddie Mac could cost taxpayers $25 billion, congressional budget experts said Tuesday, as lawmakers put finishing touches on legislation that would tap the troubled mortgage giants’ profits to help save homeowners from foreclosure.

A costly rescue is just a worry, not a fact at this point. Peter R. Orszag, director of the Congressional Budget Office, predicted in a letter to lawmakers that there’s a better than even chance the government will not have to step in to prop up the companies by lending them money or buying stock.

But Congress is expected to vote as early as Wednesday on a housing measure that would give the Treasury Department authority to throw Fannie and Freddie a temporary lifeline.

It’s part of a plan to let hundreds of thousands of strapped homeowners refinance into more affordable, government-backed loans at fixed rates rather than losing their homes. Defying President Bush, the bill would send $4 billion to neighborhoods hit hardest by the housing crisis — something that has prompted the White House to threaten a veto.

Taking advantage of the momentum behind the election-year housing package at a time when economic woes top voters’ concerns, Democratic leaders planned to include a separate measure to increase the statutory limit on the national debt by $800 billion, to $10.6 trillion.

The housing bill also would create a new regulator and tighter controls on Fannie Mae and Freddie Mac, the government-sponsored companies that own or guarantee $5 trillion in U.S. mortgages — almost half the nation’s total.

And it would create a new affordable housing fund, which would be drawn from the firms’ profits and cover any losses from the foreclosure rescue plan.

Treasury Secretary Henry M. Paulson has been pressing to add to the bill temporary power for the government to offer unlimited sums to prop up Fannie Mae and Freddie Mac, a backup plan he says is intended to help calm investors and stabilize financial markets. The firms’ stocks have plummeted on fears about their financial stability in a chaotic housing market where falling home values and rising defaults have contributed to large losses at the companies.

Orszag said it’s most likely that the companies will remain afloat and the government won’t have to put up any money, but there’s a very small possibility that Treasury will have to step in to help cover losses at Fannie and Freddie topping $100 billion. The $25 billion estimate reflects his office’s best guess of how big a federal infusion would be needed.

“This is like two months in Iraq for something that involves, literally, market stability and (calms) global jitters,” said Sen. Christopher J. Dodd, D-Conn., the Banking Committee chairman. Dodd said he hoped the legislation would clear Congress by the end of the week.

With financial markets now assuming the measure will be approved, Orszag suggested the cost of inaction could be steep, too.

“It is arguable that if it were not enacted at this point, that the consequences could be quite severe,” he told reporters.

Paulson said in a New York speech Tuesday that Congress needs to quickly approve the Fannie and Freddie support package to make sure they maintain their critically important role in housing finance. He said their operations were “central to the speed with which we emerge from this housing correction.”

“Because of their size and scope, Fannie and Freddie’s stability is critical to financial market stability,” Paulson told an audience at the New York Public Library. “Investors in our nation and around the world need to know that we understand how important these institutions are to our capital markets broadly and to the U.S. economy.”

Later, at the Capitol, he used a weekly closed-door party lunch to try to sell the plan to Senate Republicans.

Paulson told the group that by showing a clear willingness to back up Fannie and Freddie, Congress actually would help ensure that no federal rescue would be needed.

“If you go in strong, it’s less likely that you’re going to have to use the strength,” Sen. Sam Brownback, R-Kan., said after the session.

However, Senate critics have charged that the open-ended offer of support exposes taxpayers to billions of dollars of losses.

Sen. Jim Bunning, R-Ky., told reporters that Paulson was trying to “ram down” his proposal to shore up Fannie Mae and Freddie Mac. That, said Bunning, “smacks of socialism.”

Rep. Jeb Hensarling, R-Texas, head of the conservative Republican Study Committee, said the companies should be privatized as part of any plan to rescue them.

“If Congress is forced to bail out Fannie and Freddie, I believe that we must take all the necessary steps to protect taxpayers” from a future collapse, he said.

However, many lawmakers in both parties regard a lifeline for the companies as vital to restoring investor confidence and market stability.

“Freddie and Fannie are important mainstays in the American economy, and we need to find solid footing for these enterprises before the economy can recover, right itself and get back on track,” said Sen. Judd Gregg of New Hampshire, the top Budget Committee Republican.

The $25 billion cost estimate “will pale in comparison to our long-term costs if we do not address this problem now, and so I fully support (Paulson’s) authority to provide funding for these institutions if it comes to that,” Gregg said.

Still, the measure faces delaying tactics from foes who oppose tying it to the broader housing package, particularly the $4 billion in neighborhood grants.

Paulson “may want this bailout so bad that he may give in to that,” said Sen. Jim DeMint, R-S.C. But Democrats “will use this as an excuse to pass some bad policy, and whether or not the president holds the line is the question right now.”

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