The new Republican-led House will lead a movement to ban earmarks in the next Congress. But while projects like Alaska's "Bridge to Nowhere" have given earmarks a bad rap, some earmarks fill a vital need.
Case in point? The $400,000 earmark that funds the Fort Drum Regional Health Planning Organization, which helps connect military service members and their families with private-practice physicians. That's necessary because Fort Drum, in upstate New York, is the only Army base in the country without its own hospital.
And Fort Drum has seen a lot of action this decade: Thousands more soldiers, tons of new construction -- all to support constant rotations in and out of Iraq and Afghanistan.
Denise Young, who runs the Fort Drum Regional Health Planning Organization, says that because there's no hospital, the community health care system had to step up.
"When a soldier gets deployed, he deserves to know that his family here in our community is going to be taken care of," Young says. "They are serving us, and we need to serve them."
Five years ago, an earmark from then-congressman, now-Secretary of the Army John McHugh (R-NY) created Young's organization to become the glue between the military and civilian health care worlds.
This is a novelty for many military families -- a positive one, says Stephanie Burke, whose family moved to Fort Drum last spring. At military hospitals on other bases, she says, her medical records were lost. She says assigned doctors didn't know her children's names or histories. At Fort Drum, she says, it's better.
"My husband, first thing when he in-processed, he called me on his cell phone and he said, 'Wait, you get civilian doctors, you get to go off post, you get to choose who you want to go to.' And so you're very excited about that," Burke says.
The Health Planning Organization is also working on a military-wide problem: a shortage of mental health clinics to deal with PTSD and the effects of multiple deployments on families. It has helped triple the number of mental health providers in the region. But that is still barely keeping up.
Retired soldier Jim Sheets is studying to be a social worker in a program brought here by the Health Planning Organization. He says half the students want to become mental health counselors.
"You're going to have 20 people ... right back in this area providing services," Sheets says.
The Health Planning Organization also has grants to digitize medical records, recruit doctors, and run fiber-optic cable between the region's five hospitals. Director Denise Young says a $400,000 per year earmark has leveraged $100 million in projects.
"The earmark is the catalyst to bring all of these resources to bear in this region to improve the health care system," Young says.
You could argue that all these changes around Fort Drum would have happened without the earmark. Dr. Steven Lyndaker at Lewis County General Hospital disagrees. He says someone needed to bring big institutions like hospitals and the Army together.
"We wouldn't be talking about this, quite honestly, if Denise Young didn't write a grant proposal," he says.
Across the country, rural areas suffer from a shortage of doctors, especially specialists. Rep. Bill Owens, a Democrat, will be the one defending the Fort Drum Regional Health Planning Organization earmark in the next Congress. He says it has helped this region try to buck that trend.
"When you do this," Owens says, "you improve the health care for both the military community and the civilian community."
Young says her organization transcends politics. It takes care of the people who fight for our country. And she says she's "absolutely confident" it will survive the battle over earmarks.